Promoting sanitation and nutrient recovery through urine separation: the role of health and hygiene education in the acceptance, utilisation, and maintenance of Urine Diversion Toilets (UDDT) in rural communities of KwaZulu-Natal (KZN).

Abstract

Introduction This study was part of the VUNA project which aimed to develop an affordable solution system that produces a valuable fertilizer, reduces pollution of water resources and promotes health. South Africa is one of the countries that is affected by water scarcity due to climate change, dwindling rain, rapid urbanization and the increasing population size. Due to the latter South Africa is looking at new affordable sanitation systems to not only save water but that will promote health like the UDDT. The eThekwini Municipality (EM) introduced the UDDT in it rural areas because it offers the latter and also allow for nutrient recovery from urine to be used as a fertiliser. The UDDT is a new technology and for the facility to be sustainable, social acceptance is vital, properly use and maintenance. A cross sectional study was undertaken, using mixed methods to explore the acceptance, use and maintenance of the UDDT. Key findings indicated that there was a low level of acceptance amongst users due to the poor communication and education, poor design of the toilet and aspirations to own a flush toilet. There is an urgent need for EM to address the misconceptions and the communication gaps through health and hygiene education so to improve the level of acceptance, use and maintenance of the toilet. Aim The study aimed to explore the acceptance, use and maintenance of the Urine Diversion Dry toilet (UDDT) and to use the findings to develop health and hygiene education. Methods Mixed methods were used: both quantitative and qualitative research approaches were used in this study in order to assess the condition of the UDDT and understand the target population’s perceptions, attitudes and behaviour in relation to the UDDT in eThekwini KwaZulu-Natal. Initially a brief questionnaire was administered to assess the condition of the UDDT in 40 households in the three target areas, in total 120 households were visited. This was followed by twelve focus group discussions which were made of one family of the households visited. 25 in-depth interviews were conducted with community members were actively involved in the roll-out of the UDDT’s i.e. the ward councillor, the previous health and hygiene educators and ward committee members with community members. The data from the qualitative research were analysed through content analysis as emphasised by the theoretical framework that words create meaning. Results The results clearly indicated that although education was provided at the time of UDDT installation, the majority of respondents did not have comprehensive information in terms of how to operate and maintain the UDDT. The study also found that the majority of community 2 members had not accepted the UDDT as a permanent household asset. Eighty percent of UDDTs were in a bad condition. The study also found that in all areas very few households were not using the UDDT. Furthermore, the facilitators on the health and hygiene education programme reported that they had not been trained properly for this task. The findings also showed that community members were not aware of the water scarcity in the country and how this related to the introduction of the UDDT. There was also a high level of migration both out of and into the UDDT homestead areas. Conclusion The lack of proper training of the facilitators, inadequate sharing of information within the household and the migration of the original householders resulted in a lack of information within the household and community at large about the use and maintenance of the UDDT. This information gap largely contributed to community members’ poor maintenance of their UDDT. This created negative attitudes towards the UDDTs since users felt that the toilet could not be kept in proper adequate sanitary conditions. It is crucial that communities are included as part of the sanitation provision process and are constantly informed and updated, in order to facilitate community adoption and ownership of the sanitation solutions being offered to them. Recommendations The information about the UDDT needs to be constantly and consistently shared with the households and community at large. The facilitators need to be properly trained on sanitation, health and hygiene, so that they can relay the information competently and effectively. New strategies need to be developed where communities participate in their own development. This process will allow communities to take ownership of their sanitation solutions and develop positive attitudes towards Urine Diversion Dry toilet (UDDT).