Wells, toilets, water towers, and pipelines. Even the well-designed elements of Rotary water, sanitation, and hygiene (WASH) projects can fail if people don’t use them. There are many reasons people might hesitate to use a communal toilet. It’s important to understand the reasons before you build the toilet. Learn about behavior change and its role in WASH programs, how it’s connected with culture and community values, and how to incorporate it into your WASH projects and measure the outcomes. Moderator: F. Ronald Denham, Water and Sanitation Rotarian Action Group Chair Emeritus, Rotary Club of Toronto Eglinton, Ontario, Canada

1. Changing Hygiene Habits
in Rural Bolivia
Shifting from Open Defecation to
Proper Use and Maintenance of Dry
Composting Latrines

2. Bolivian Reality
Poorest country in South America
45% of 10 million people living in poverty (3x
greater in rural areas)
Access to clean water (88%) and sanitation
(54% urban, 27% rural)
Nutrition: 1 in 4 children has stunted growth
(malnourished), rural children twice as likely to
be malnourished
Life expectancy: 67 yrs. (vs. 75 yrs. for Latin
America and the Carib., 2013)
Source: http://data.worldbank.org/country/bolivia

3. What is Etta Projects?
Public health NGO founded in 2003
in Montero, Sta. Cruz, Bolivia.
Office in USA (WA)
Program Areas:
Community health promoters
Ecological Dry Composting
Latrines
Organic gardening, composting,
recycling and trash separation in
the home, school, and
community
Solar powered water systems in
remote communities, training of
water committees.
EP Health Promoters practicing first aid skills

4. The Problem
Many rural Bolivian
communities have no
access to sewage systems.
Families dig a hole for a
“pit latrine” and build
make-shift walls (plastic,
bamboo, scrap metal) for
privacy.
Open defecation in the
fields or yard, around
their homes.
Pit latrine in rural Bolivia.

5. The Problem
Rainy season: 6 months of rain
and flooding causes pit latrines
to fill with water, bringing feces
to the surface, spreading fecal
matter throughout community.
Contamination: typhoid, E.
Coli, cholera, dysentery…
Globally: 1.4 million children
die each year from diseases
caused by contact with fecal
matter. That’s more than
AIDS, malaria, and
tuberculosis combined.
Hiking to remote communities to deliver
workshops on hygiene and sanitation in Bolivia

6. Desired Outcomes
Stop open defecation
Halt transmission of fecal-oral
diseases
Change hygiene habits (hand-
washing after toilet, before
food prep and eating, after
diaper changing )
Improve overall health for
families

7. Secondary and Long Term
Outcomes
Improved nutrition (for improved
health and disease prevention) via
family organic vegetable and
fertilizer production.
Trained sanitation promoters for
Education and M&E
Families and school children:
increased awareness of water borne
disease transmission, practice, habit
change
Community leadership, advocacy,
and project development for
continued growth
EP staff leading community workshop on
DCL use and maintenance

8. The Solution: Ecological Dry
Composting Latrines
How does it work?
• Separation of urine and feces
• Urine and feces used for fertilizer
• After each use, deposit dry material
and toilet paper into chamber (to
dry out the feces)
• Stir the chamber 1x/week.
• Clean the toilet 2x/week.
• Family fills the chamber (6 mos. –
1 yr.)
• Allow 6 mos. to decompose
• Harvest and fertilize!

9. Benefits of DCL
2 sealed chambers= no
contamination of water,
soil, air.
Uses no water
After 6 months, harvest the
fertilizer for the
garden/fruit trees
Families no longer face:
rain, insects, flies,
mosquitoes, snakes, wild
animals, and roaches when
using the toilet.
Community Sanitation Promoter fills water bottle
with bleach mixture for cleaning urine pipe.

10. Recipe for a Successful DCL
Program
Community engagement in every
step:
Request for project
Community needs assessment
Community meeting to discuss
the project
Meeting with the municipal gov’t
to request the project, formal
contract
Community workshops: local
coordination, attendance,
announcements, place, snacks,
chairs, clean up.
Community members monitor
and evaluate, solve problems

11. Local Health and Sanitation
Promoters
Training of local sanitation promoters on use and
maintenance of the latrines, proper hygiene and
sanitation practices, disease prevention, trash
separation (recycling and composting techniques), and
use of the dry latrine compost on organic gardens.

12. Community Needs
Assessment
Gather information on: family
composition, current health status,
defecation practices, hygiene practices,
access to basic services, and skill set
(assets-based community development
approach).
Train local health promoters/leaders
to conduct the interviews (already
gained trust of community)
Gauge interest in community via
asking questions. “Do you know what
a dry latrine is? Would you use one?
Are you interested in the project?”
Women from El Abra del Astillero participate in
Community Monthly Water Meeting (2014)

13. Generating Interest and Demand
•Define specific requirements for participation (economic contribution
of each family, workshop attendance, and labor for construction).
•Create a beneficiary list: Ask interested families to sign up and sign an
agreement for required participation in three areas.
Community Health
Promoters and EP
Program Director armed
with tools for the pilot
latrine project.

14. Requirements for Participation
All family members must attend
all workshops.
Implement a sanitation project
in the home BEFORE approval
for construction.
Carry construction materials to
the house.
Help build the latrine.
Pay their portion of the latrine
(US$75-$200, based on distance
and local gov’t % support)

15. Information: Accessible,
Interesting, Engaging!
Poverty, little formal education, work all day
in the fields (sugar cane, rice, yucca)
Economically conservative and resistant to
change
Requires: interactive, dynamic, participatory
approach to the program. Learn names. Greet
people. Ask about their families.
Plan workshops at night and on weekends to
accommodate workday
Healthy snacks for those who arrive on time

16. Tactics
Use fear, disgust, and shame as
motivating forces for habit
change.
Make sure the habit change is
as easy as possible (access to
water and soap for hand
washing) . May require
installation of a water faucet
near the DCL. Include this in
the program plan and budget.
Local sanitation and health promoters practice hand-
washing with students

17. Shame Factor
Create large canvas map of the community, including each of the
family’s homes.
Sanitation promoters score each family during their weekly home
visits, including: presence of trash in the yard, farm animals roaming
freely, flies in the latrine, wash stand for hand washing (with soap
and water), clean toilet bowl, supply of dry material for covering up
feces, etc.
Each house is color coded according to sanitation quality: Red: poor
condition, sanitation problems. Yellow: needs improvement but not
terrible. Green: Good sanitation conditions.
Map displayed at weekly workshops, for families to see clearly how
they and their neighbors have scored. The top scoring families
receive incentives (soap, toilet brushes, plastic buckets).

18. Use of Humanure
Harvesting the humanure: Disgust
and fear factor. How to overcome?
Organize community workshop to
harvest a DCL together. Empty the
soil and put on the garden. Ask
the family to show results to the
community at harvest time.
Take soil sample to lab and show
results (bacteria).
Urine is a great fertilizer! Ratio: 1:5 urine
to water. Deters ants and other insects,
contains Nitrogen, Phosphorus, and
Potassium. How to overcome fear? Use
urine on one half of garden and
compare. Note difference in growth rate.

19. Elisabeth, a
community health
promoter, has 11
children. She
harvested the
fertilizer for her
fruit trees.

20. Participation in the Construction
Requirement: Families must pick up their building materials
and help build the latrine. 1 member (male or female), 4 days.
Learn: how each part functions, how to repair.

21. Celebrate!
Community inauguration of
DCL’s
Graduation of Sanitation
Promoters
Invite local authorities, mayor,
Wat./san. dept. officials, Rotary
Club members
Ribbon cutting
Speeches
Prizes for “best latrine”

22. Use M&E results
EP: 4th year DCL project.
Use M&E results to improve the construction model.
NGO should implement model! Build a DCL at the office,
use it, understand it, clean it. Harvest it and use the
fertilizer. Make improvements. Show it off to visitors.
Develop a manual for sanitation promoters training, for the
community workshops, and school workshops. Make it
available to all (literacy levels, pictures), to understand and
copy.

23. Follow-Up
Three year process
Continued M&E
Incentives: proper use and maintenance
Contests: prettiest, most improved,
cleanest latrine, etc.
Support for sanitation promoters (dry
goods baskets, sanitation tools, use and
maintenance posters for each latrine).

24. Concrete vs. Conceptual
Ex: “How many times have your
children suffered diarrhea
this past month?”
How much time, money (on
transportation, medical visits,
and medicine), anxiety did
she suffer each time a child
became ill?
Explain: A DCL and hand-
washing practice prevent
diarrhea, save time, worry,
and money.
Health, hygiene and sanitation: focus on
concrete, current situations (vs. better
quality of health in the future).

25. Personal Contact:
EP staff and sanitation
promoters must increase their
presence in the communities, by
making home visits frequently,
chatting with families,
developing the relationship.
This is essential for the long
term success of the project.

26. Thank You!
Obrigada
Gracias
Xie xie
Danke
Merci
Grazie
Arigato
Takk
Salamat Po
Asante
Kop Koon Ka’
Dona Pascuala, El Abra del Astillero, Solar
Water Project beneficiary, EP 2014.