Assessing Strategies to Promote Equity in Rural Sanitation among Vulnerable Populations: A Qualitative Case Study of Northern Zambia Open Access

Uwah, Eberechukwu (Spring 2021)

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Background: Achieving equitable access to sanitation services and facilities requires prioritizing the sanitation needs of vulnerable groups. However, despite all the progress made to meet target 6.2 of the sustainable development goals (SDGs)—universal sanitation for all—sanitation disparities between urban and rural areas and non-vulnerable and vulnerable populations are still evident. There are still knowledge gaps regarding the practical adaptation of strategies that equitably improve sanitation coverage and use in low- and middle-income countries. Considering that progress on achieving SDG 6 is considerably slow, scientific documentation of evidence to support implementing equitable rural sanitation interventions that enable transformative solutions is required.

Objectives: This study explores vulnerable groups in northern Zambia and describes the Sustainable Sanitation and Hygiene for All (SSH4A) rural sanitation strategies that promote equitable access and use of improved sanitation facilities among vulnerable groups.

Methods: We collected qualitative data through fifteen key informant interviews with representatives from the community to the national level; and ten focus-group discussions with community members in seven villages. We adopted a thematic approach to examine rural sanitation strategies that equitably promoted sanitation coverage and use among vulnerable groups. Informal discussions were also conducted with previous SSH4A project staff.

Results: We identified five groups of vulnerable individuals— female-headed households, widows, persons with disabilities, the elderly, and orphans—in the study region. Fourteen sanitation strategies were identified to have promoted sanitation access and use equitably through (1) mobilization of community members to provide support to vulnerable groups through the pooling of resources, labor, and non-monetary support (2) strengthening local supply capacity by training masons on innovative, inclusive, affordable and context-appropriate toilet designs and (3) using behavior change communication that specifically target each of the identified vulnerable group.

Conclusions: The identified strategies are by no means prescriptive but serve to highlight mechanisms through which common rural sanitation approaches were adapted to specific contexts. Our findings suggest that the combination of targeted strategies in implementing behavior change communication, community engagement, and supply chain approaches supports equitable improvement in access and use of sanitation facilities among vulnerable groups.

Table of Contents

Introduction 1

Methods 4

    Data collection 5

    Data management 8

    Data analysis 8

    Ethical considerations 10

Results 12

    Vulnerable groups 14

    Behavior change communication 15

    Supply chain 17

    Social mobilization and community engagement 20

    Financial support: Subsidies and social cash transfer 24

Discussion 25

    Strength and limitations 27

Conclusion 28

References 29

Appendix A: Key informant interview guides 33

List of Tables and Figures

Table 1. Contextual details of the wards involved in the study 5

Table 2. Summary of key informant interview participants 7

Table 3. Demographics of focus group discussion participants 7

Table 4. Summary of codebook used for analysis 10

Table 5. Summary of equitable strategies identified from the data 12

Figure 1. Data analysis process and definitions of key terms for qualitative research 11

Figure 2a. Molds for fabricating elevated latrine seats 18

Figure 2b. Elevated latrine seat 18

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