Piloting a monitoring & evaluation tool for water supply ...

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Secretariat of the Pacific Community (SPC)

Piloting a monitoring & evaluation tool for water supply, sanitation and hygiene

(WASH) in Funafuti, Tuvalu2011

November, 2013

SOPAC SURVEY REPORT (PR183)Rodney Lui & Kathryn Bright

Water and Sanitation Programme & Independent Consultant

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This report may also be referred to as SPC SOPAC Division Published Report 183

Applied Geoscience and Technology Division (SOPAC) Private Mail Bag

GPO Suva Fiji Islands

Telephone: (679) 338 1377 Fax: (679) 337 0040

E-mail: [email protected] Web site: http://www.sopac.org

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Piloting a monitoring & evaluation tool for water supply sanitation and hygiene (WASH) in Funafuti, Tuvalu, 2011

SOPAC SURVEY REPORT (PR183)

November 2013

Rodney Lui & Kathryn Bright

Water and Sanitation Programme & Independent Consultant

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DISCLAIMER

While care has been taken in the collection, analysis, and compilation of the data, it is supplied on the condition that the Applied Geoscience and Technology Division (SOPAC) of the Secretariat of Pacific Community

shall not be liable for any loss or injury whatsoever arising from the use of the data.

Applied Geoscience and Technology Division (SOPAC) Private Mail Bag

GPO Suva Fiji Islands

Telephone: (679) 338 1377 Fax: (679) 337 0040

E-mail: [email protected] Web site: http://www.sopac.org

http://www.sopac.org/

1 – SPC SOPAC Division Published Report 183

INTRODUCTION In 2010, the United Nations general assembly declared Water and Sanitation a human right. This global declaration indicates the growing global consensus on development issues such as water supply, sanitation and hygiene (WASH). Increasing people’s access to sanitation and drinking water brings large benefits to the development of individual countries through the improvements in health outcomes and the economy. (WHO, 2010). Water and sanitation are cross cutting and strong development issues addressed nationally and regionally in the Pacific. This is strongly pronounced in various regional agreements. ‘People’s health and well-being are influenced by water supply, sanitation and hygiene (WASH). Interventions to improve these have long been an important aspect of the development agenda. Such interventions are normally based on community’s needs and local conditions. (Wetlands International, 2010) ‘Water and sanitation improvements in association with hygiene behaviour change, can have significant effects on population and health by reducing a variety of disease conditions such as diarrhoea, intestinal helminths, guinea worm and skin diseases.’ (Patricia Billig, 1999) Sanitation coverage for the Pacific region in 2006 was 48% compared to the global coverage at 62% (World Health Organization, 2008) the island nation of Tuvalu through the Global Annual Assessment of Sanitation and Drinking Water (GLAAS) indicates for the same year 88% had access to improved sanitation facilities and 84% coverage for improved drinking water sources of the urban population (WHO, 2010) although this data indicates good coverage, rising urban populations and limited space on islands such as Funafuti in Tuvalu have dire implications on public health. Monitoring and evaluation (M&E) tools for WASH interventions are an important aspect of community based heath interventions in the water and sanitation. Design and selection of appropriately measurable monitoring and evaluation tools for use with WASH interventions is essential to measure impact. The aim of this study was to develop and trial an M&E tool suitable for use in the Pacific. This framework would look at assessing the health outcomes of WASH interventions using a number of tools and indicators. PILOTING THE MONITORING AND EVALUATION TOOL FOR WASH Tuvalu is a small Pacific Island nation characterized by atoll like conditions with scarce land and water resources. Tuvalu has been supported through various water and sanitation initiatives and is currently part of a larger GEF Pacific project to Tuvalu. As a low lying atoll island and scarce groundwater resources, Tuvalu is dependent on rainwater harvesting for its drinking water. The dry weather conditions on the island and contaminated groundwater supply has made communities dependent on rainwater harvesting as its primary source of drinking water. The main island of Funafuti in Tuvalu is made up of seven villages. The research compiled in this paper is focused on piloting a household survey tool in two villages on the main island of Funafuti and they are Fakaifou and Teone. The research was conducted by a team of volunteers from the period of July to October, 2010 with guidance from the Ministry of Health, Tuvalu.


Figure 1: Map of the islands of Tuvalu.

OBJECTIVES

The primary objectives of this research were to:

I. Pilot the use of a survey tool (household survey questionnaire). II. Discuss basic conclusions/key in some the baseline findings from July to October, 2010.

RATIONALE

The SPC division under the Water & Sanitation Programme commissioned a report on "Indicators and Tools for Monitoring and Evaluating WASH Interventions" (SOPAC, 2009). This report identified four key indicators that could be used to evaluate WASH interventions. The discussed indicators are:

I. Improved water supply and sanitation. II. Improved water quality.

III. Improved hygiene practices. IV. Behaviour change & health outcomes.

METHODOLOGY The research was conducted in two phases:

• Phase 1: development of the M&E framework (Kathryn Bright, 2009). Summarised findings combined with a literature search of all the available tools and methods used in the field.


Table 1: Review of WASH tools and indicators.

Tools/Methods Indicators Water and Sanitation

access

Water Quality

Behavior Change

Health Outcomes

1. Diarrhoeal survey 2. Hospital/health center surveillance 3. Semi-structure interviews 4. Sanitary surveys 5. H2S testing 6. Laboratory testing 7. PATIS 8. Joint monitoring programme 9. Baseline data 10. Pocket voting 11. Structured observations 12. Focus groups 13. Rapid appraisal of perceptions (RAP)

Table 1 highlights the four key indicators in WASH and the available tools and resources:

1. Access to water and sanitation. 2. Water quality. 3. Behavior change. 4. Health outcomes.

These WASH indicators were then evaluated against current field techniques. The report describes the tools; description/purpose, practical application(s), limitations, challenges, cost and time associated with the use of each tool or method. Based on the findings in this report, a survey tool was drafted for field testing at the household level. The tool was a combination of various components for collecting information on WASH data. The survey tool includes: a diarrhoea survey; H2S testing; structured interviews and observations; and sanitary surveys combined with a skin sore tool.

• Phase 2 ─ pilot testing the tool in Tuvalu. The pilot selected Tuvalu and Funafuti Island as the location on the basis of criteria such as: 80-90% drinking water sourced from rainwater harvesting, ongoing synergies through other water projects in sanitation and hygiene. (GEF Pacific IWRM Demonstration Project-Eco Sanitation1).

The tool was developed in response to a recognised need to understand the local impacts at a household level of WASH interventions/activities in the Pacific. The Pacific WASH Coalition2 sought interest in developing the tool further for use in quantifying WASH intervention at the household level.

1 Global Environment Facility Pacific Integrated Water Resource Management project on Eco sanitation in dry atoll environments. 2 Pacific WASH Coalition is a partner platform of various agencies formed in 2007 which supports/collaborates, coordinated regional initiatives for

WASH.


WASH M&E tools & indicators report completed 2009

•Tuvalu scoped & tool pretested

Teams selected, trained and pilot survey conducted

•Local communities selected and surveys initiated

3 rounds of surveys are planned and

completed July‐Oct 2010

•Information collected & processed for further action and development

Figure 2: Development of M&E tool pilot inception Nov 2009 ─ Dec 2010. OBJECTIVE 1: PILOT OF SURVEY TOOL In the preparation for the use of the tool, a mission to the island of Funafuti was completed to make an initial assessment, generate awareness and also reach consensus on the need for and the context for conducting the research work. The ministry of health through the public health agreed to take the lead in collaboration with key WASH stakeholders such as: Local Government (Kaupule); Bureau of Statistics (BoS); GEF Pacific IWRM Demonstration Project; PACC project; Tuvalu Association of NGOs (TANGO); Tuvalu Red Cross Society (TRCS); Public Works Department (PWD); and the Ministry of Health and Public Health (MoH/PH). The tool which is a survey questionnaire was designed and field-tested, (November, 2009) in 7 households to field test the tool. The tool was pre-tested in a sample village of approximately 44 households. The final surveys were completed in three rounds of surveys in two selected communities with a combined total of 202 households. The survey tool consists of 7 sections outlined below:

1) Household information: respondent information, occupation of homeowner, number of people, number of rooms for sleeping etc.

2) Water sources/household water treatment & storage practices: catchment type, water treatment systems, and storage.

3) Available sanitation facilities and distance to tap: stands & hygiene practices (proxy indicators).

4) Rainwater tank risk assessment (sanitary surveys) and water quality tests. 5) Skin infections (health). 6) Diarrhoeal prevalence (health). 7) Household feedback/awareness.

Survey Scheduling & Team Preparation (July ─ October, 2010) The designed survey tool was piloted (Nov 2009) and trialled (May 2010) with appropriate training and sufficient up-skilling of local teams and preparation of material/supplies for the survey. Sufficient training and capacity building was provided to the local survey team and also MoH staff on the use of the survey tool. A SOPAC/WHO initiated Water Quality Training Package was also delivered to the survey teams. Pre-testing3 identified a strong need for appropriately trained surveyors to conduct the survey, the selection of surveyors is important. Clear and practical training is a crucial step in this study, understanding sustainable and practical options for local teams to continue survey rounds must also be clearly provided for to adequately support the survey rounds.

3 Pretesting involved testing the survey in seven households selected randomly to identify possible improvements and practical lessons in the

delivery of the survey tool.


Baseline Surveys A baseline survey was conducted initially to establish the context and background for the communities involved. Survey rounds are staggered in 2-3 month intervals with an intervention4 conducted at the end of each round. Due to the timing and other factors, planned community interventions were not conducted. Table 2: Survey tool and indicators.

Section/Indicator Water & Sanitation access

Water quality

Behaviour Change

Health outcomes

Section 1: Homeowner information Section 2: Water Sources x x Section 3: Sanitation x x Section 4: Rainwater tanks risk assessment + H2S WQ tests

x x x

Section 5: Skin infections xSection 6: Health (diarrhoeal prevalence)

x x

Section 7: general feedback/community awareness

x

NB Diarrhoeal calendar + translated sanitary survey/ results sheet H2S

x x x x

Table 1, sections 1 & 7 describes general homeowner information and the context of the survey, while sections 2 & 3 are based on observed conditions.

November 2009: scoping mission completed and partners identified, buy in established, lead agency identified and communities identified for pilot, pretesting completed.

May 2010: Training mission and up skilling training provided to teams, with a pilot village tested

July 2010: Round 1 (Baseline) completed in the 2 pilot communities

Sept 2010: Round 2 survey completed in 2 pilot communities, follow up on round 1 information

October 2010: Round 3 survey completed in the 2 pilot communities with follow up information collected on round 2

Figure 2: Timeline of monitoring and evaluation tool implementation and pilot.

4 Interventions are understood to be community focused actions conducted with specific objectives along WASH themes

for e.g. A community awareness session on hygiene practices at the household level and health.


OBJECTIVE 2: The second objective of the planned study was to trial the tool and generate baseline data with at least one data set for some comparative analysis in the two pilot communities. Community Selection Funafuti is comprised of seven key communal settlements. Site selection for the project was based on the following criteria:

• 95% homes used rainwater tanks for drinking water. • Each community had approximately 180-200 HH. • Communities identified water-borne illnesses and skin disease as key issues.

The household surveys and some information on them were as follows: Table 4: Survey rounds May ─ October, 2010. Milestone Date Details

Training and pilot tool in demo village

May 20 participants trained and the tool was practically field trialled in Te Kavatoetoe village with approximately 51 HH

Round 1: Baseline survey

July 19-23 The baseline survey is completed with: Teone: 64 HH5 Fakaifou: 138 HH

Round 2: Survey round 2

September 6-10

The baseline survey is completed in Teone: 60 HH Fakaifou: 129 HH

Round 3: Survey round 3

October 25-29

The baseline survey is completed in Teone: 54 HH Fakaifou: 111 HH

Survey Baseline (July 2010) The survey tool collects a range of information which can be used to interpret the relevant indicators for:

I. Water & sanitation access. II. Water quality.

III. Behaviour change. IV. Health outcomes.

Water and Sanitation Access/Water Quality The following presents some selected baseline findings from the two pilot communities, Teone (n=64) and Fakaifou (n=138) on water and sanitation access. The tool collects household level data on water sources, household water treatment and storage practices, sanitation types and proxy indicators for hygiene practices such as hand washing.

5 HH‐Households


Drinking water sources The two communities indicate the use of rainwater tanks as the primary source for drinking and cooking.

6.7% 6.7%

60%

20%

3.3%0%

3.3%

10.1%4.7%

41.1%

27.1%

14.7%

1.6% 0.7%0

10

20

30

40

50

60

70

Catchment Above (CA)

Catchment Below (CB)

Rainwater Tank (RWT)

Rainwater Tank (RWT), (CA)

(RWT, CB) (CA,CB) others

Percen

tage

of h

ouseho

lds

Drinking water sources by type

Drinking water sources baseline data 2010

Teone R1 (n=64) Fakaifou R1 (n=129)

Figure 3: Drinking water sources by type in Fakaifou & Teone communities. Information from the baseline (Figure 4) indicate surveyed households are reliant on rainwater tanks and underground tank storage, therefore it is crucial that a clear understanding of these systems is captured in planning for WASH at the community and household level. Household water treatment and safe storage (HWTS) and water quality The tool also collects data at household level of water treatment and storage options. Source water is described as water direct from source without any form of treatment. Figure 5 indicates some reduction in the level of H2S producing bacteria present due to treatment by boiling for Teone with little to no effect for water supplies in Fakaifou. There are a number of reasons for this and some of which are from boiling time (time taken to bring water to rolling boil), handling and storage practices, and so forth to name a few. The tool also collects information on the various storage methods available at the household level.


25

38.6

13.5

4.3

57.754.9

3.80

0

10

20

30

40

50

60

70

TeoneR1 (n=104) FakaifouR1 (n=184)

Percen

tage

hou

seho

lds (%)

Pilot communities

H2S results compared for boiled drinking water & source water (July 10)

(+ve) boiled drinking water

(‐ve) boiled drinking water

(+ve) source water

(‐ve) source water

Figure 4: Baseline results boiled drinking water and raw (untreated) source water for 2 pilot communities.

3425

5

93

39

60

20

40

60

80

100

Low 1‐5 Medium‐High 6‐8 High 9‐13

Percen

tage

(%)

Sanitary survey scores

Sanitary survey scores, baseline july 2010

TeoneR1 (n=64) Fakaifou(n=138)

Figure 5: Sanitary score risk assessment scores by village, baseline data. Hydrogen sulphide (H2S) tests are a (presence/absence) indicator for hydrogen sulphide producing bacteria. The H2S tool is used strongly with the sanitary survey as a means of verification and the need to action identified risks in the sanitary survey. The H2S tool is effective in prompting people to change their attitudes towards the operation and maintenance of rainwater harvesting systems because of the dramatic colour change from yellow to black in the presence of H2S producing bacteria. The sanitary survey risk assessment for the rainwater tank along with the H2S tests indicate the probable risk associated with a rainwater catchment system and the possible presence/absence of H2S bacteria in water supplies could pose some threat to the quality of water. The results of the baseline indicate that household water treatment and storage as possible intervention actions for household’s testing positive for H2S bacteria. The tool also collects information on various indicators such as proper storage of drinking water, hygienic practices in cross contamination from dirty surfaces etc. The field work indicate the homeowners' interests and concerns over rainwater systems and sanitary surveys and were interested in keeping a copy of their sanitary survey forms.


Figure 6: Options for storage of drinking water in households.

57.8

1.6

29.7

9.4

1.6

68.1

0

25.4

2.9

3.6

0 20 40 60 80 100

Container & lid (CL)

Container no lid

Pot with lid

Tap

Other

Percentage of households

Storage op

tions in

hou

seho

lds

Household storage options July 2010

Fakaifou (n=138)

Teone (n=64)

Figure 7: Water treatment practices; boiling.

78.1

10.9

10.9

87.7

3.6

8.7

0 20 40 60 80 100

Boiled water (B)

Not boiled (NB)

Sugared water (S)

Percentage of households

Treatm

ent b

y bo

iling

Household treatment by boiling July 2010

Fakaifou (n=138)

Teone (n=64)


Sanitation Figure 9 is a breakdown of the representation of available sanitation systems in both communities. The strong reliance of water systems such as flush and water seal systems pose significant threats to diminished water resources. It was noted during discussions with homeowners that most people use the beach and open sea to defecate in during dry periods.

Figure 8: Pit toilet with makeshift cover beside rainwater tank, Teone community.

14.1

4.7

23.4

7.8

50

0

0

1.4

1.4

73.2

0.7

21.7

0.7

0.7

0 20 40 60 80 100

Beach (B)

Compost toilet (CT)

Flush(F)

Open Sea (OS)

Water Seal(WS)

F,WS

Pit

Percentage of households (%)

Sanitatio

n system

s available

Sanitation systems baseline July 2010

Fakaifou (n=138)

Teone (n=64)

Figure 9: Sanitation systems data for 2 pilot communities. Data from Round 1 (Figure 4 & 10) for sanitation indicate heavy reliance in both communities on flush toilet style systems, although selected to be an appropriate sanitation option; flush systems are water demanding which places stress during drier periods in Tuvalu. The use of the beach and open defecation is important to note as this practice is common during the drier months when

ater is scarce. w


Health outcomes ─ skin sores/diarrhoeal disease The 2 main health outcomes that were considered in this study were: diarrhoeal incidences and skin sores. It was noted that when considering health outcomes it is advisable to understand the timescales these surveys are framed where health such as skin sores cannot show immediate improvements within the survey time frame. The data available from health services such as the medical centre is not included as this is often underestimated since most children and often adult cases are not reported. (Patricia Billig, 1999) This study does not compare information collected in hospitals on the burden of disease for diarrhoeal disease. Under diarrhoeal incidences, field observation indicates that most respondents do not follow the clinical definition of diarrhoea, instead register diarrhoea as more than 4 or more incidences of loose motion. The use of a health calendar for tracking the prevalence of diarrhoea in households was introduced in Round 1 and later discontinued due to lack of interest and poor recording in households. Skin sore data was gathered by survey observations with children present in households, prior to surveys, some health training was provided to survey teams on basic skin sore types and a picture tool used by survey teams to help identify and classify the degree of skin sores in under 15 year olds. WASH and climate variability The survey recognises the opportunity to link rainfall and climate with diarrhoeal prevalence. Respondents from households have anecdotally identified that during drier period’s people using the lagoon for sanitation/bathing have experienced increased rates of skin infections. Linkage between the prevalence of diarrhoea has been seen in wetter seasons as opposed to the drier season, (Patricia Billig, 1999). The Pacific Adaptation to Climate Change project for Tuvalu has expressed interest in attempting to show this relationship and is currently working in a separate pilot community with some of these ideas in mind. Lessons learned and future challenges The pilot of the tool has generated significant lessons and possible opportunities for further learning. The pilot was initiated to trial and field test the effectiveness for the tool to collect WASH information at the household level. The tool was field tested with a local Pacific Island community and some pre-conditions identified as essential to the use and trial of the tool. Table 1. Lessons learned.

Stakeholder group

Lessons gained

Survey teams • Survey teams are selected from community workers who are both fluent in english and the local language. Team members are also available to work on follow-up surveys in developing working relationships with communities and households.

• Team members have some understanding of the relationships between water and health and are able to facilitate the proper use of the survey tool.

• Local administrators and authorities are endorsed and are aware of the activities in the communities.

Communities/ households

• Have agreed in principle to participate and actively assist in providing information to survey teams by the active use of health calendars and also the sanitary survey sheets (homeowner copy).

• Are sufficiently aware of the survey dates/time and well prepared to have an adult or key person available for the interview.

• Community representatives such as traditional leaders must be included at all phases of the project.


MoH (implementing team)

• Environmental health lab is of a reasonable standard to handle production and disposal of H2S paper strips and samples. Laboratory staffs are adequately trained and laboratories are adequately stocked with necessary supplies and reagents to run a testing program.

• Records can be stored in a centralised location and converted to electronic format for data analysis. Appropriate training in data entry and PC use would be an advantage for correct data entry.

Next steps & practical lessons With a practical baseline of what the tool is capable of at a local Pacific Island level, some key next steps and lessons learned are:

• Practical implementation must include strong participation and ownership of the local communities and authorities involved in the provision of safe drinking water, community leaders, homeowners, relevant public health officials, and local community action groups (NGOs) and youth where possible. This is achieved through strong participatory planning and implementation and strong feedback to all stakeholders at all levels during all phases of the project from planning to inception,; implementation; monitoring and evaluation; and finally to post project follow-up.

• The use of health outcomes looking at diarrhoeal and skin sore incidences along with behavioural change indicators can be difficult to prove given the short timeframes. This section of the tool should be carefully considered when selecting WASH indicators to monitor.

• Household participation in the study is essential to success, and at community level, a reasonable incentive and interest in the positive outcomes and benefits of the study need to be clearly communicated to all stakeholders from planning to inception and implementation.

• Clear demonstrations of health outcomes based on monitoring for WASH should involve strong community support and feedback with respect to cultural norms and practices in the Pacific.


CONCLUSION The timeframe for this study was completed in approximately 13 months from scoping to final survey rounds; the survey tool was tested in 3 survey rounds and identified key areas and indicators for WASH with reference to health outcomes, diarrhoeal incidences and skin sores. It is concluded that for the tool to be successful, community participation and ownership are central to the quality of information collected. Information sharing and collaboration with other stakeholders such as MoH and Bureau of Statistics are important aspects which were taken into consideration in the planning and implementation of this work. Behavioural change indicators are difficult to define and measure in the context of the time taken to undertake this work, therefore simplistic household change such as comparing sanitary survey scores and homeowner actions were used to gauge change in attitude at the household level. Successful implementation and use of the survey tool is possible through strong community support and framing the tool within the local culture and context. Society and culture are also identified as important aspects in the collection of clear and relevant data for WASH indicators on health. Successful country implementation is ideally possible with the support of key WASH actors at the country level, integrating the tool with other regional projects such as PACC is a measure of the level of importance of WASH in countries such as Tuvalu. The existing workloads and capacity of existing staff in the public sector must be considered when undertaking investigation in the area of WASH at country level when working across various partners. The unique nature of water resources on the island of Tuvalu has influenced the level of participation and support in the area of WASH as water remains heavily reliant on rainwater harvesting and extended drier periods tend to be more intense and frequent.


REFERENCES Patricia Billig, D. B. (1999). Water and Sanitation Indicators Measurement Guide. Washington DC: United States Agency for International Development (USAID).

SOPAC. (2009). Indicators and Tools for Monitoring and Evaluating WASH Interventions. South Pacific Applied Geosciences Commission.

Wetlands International. (2010). Wetlands and Water, Sanitation and Hygiene (WASH) Understanding the linkages. Ede Netherlands: Wetland International.

WHO. (2010). GLAAS 2010 UN Water Global Annual Assessment of Sanitation and Drinking Water. Geneva Switzerland: World Health Organization.

WHO. (2010). UN WATER Global Annual Assessment of Sanitation and Drinking Water. Italy: World Health Organization.

World Health Organization, W. P. (2008). Sanitation, hygiene and drinking water in the Pacific island countries; Converting commitment into action. Manila, Philippines: WHO WPRO .


ANNEX 1

Date: Interviewer:

Homeowner ID:

HOUSEHOLD WATER SUPPLY, SANITATION, AND HYGIENE, HEALTH SURVEY ROUND 1 SURVEY FUNAFUTI ATOLL TUVALU

All questions contained in this questionnaire are strictly confidential.

1. Name (Last, First, M.I.): M F

2. Ethnicity of people living in the household:

Tuvaluan Samoan Nauruan Tongan Kiribati Indo-fijian Fijian Other (please specify) ________________________________

3. Occupation of head of household:

Farmer Fisher Govt. employee Private sector employee Unemployed Other (specify) ___________________

4. Number of rooms used for sleeping (also include Fale Umu):

SECTION B: WATER SOURCES (INTERVIEWER OBSERVATION)

1. Where does your drinking water come from? (Tick all that apply)

Plastic rainwater tank concrete above ground rainwater tank concrete below ground rainwater tank well other sources (please specify):

2. Is your drinking water boiled? Always (If yes continue to Q3.) Sometimes (If yes continue to Q3.) Never (Go to Q4.)

3. How long do you boil your drinking water for? Bring to boil Boil for 2 minutes Boil for over 5 minutes

4. What other filtration systems does your house have Ceramic filters Bio disc others:

5. How do you store your drinking water? (observation)

Plastic containers with lid plastic container without lid Steel pot (with lid) Steel pot (without lid)

Direct from tap

other sources (please specify):

Date: Interviewer:

Homeowner ID:

SECTION C: SANITATION (INTERVIEWER TO OBSERVE)

1. What is the most common type of toilet used by household members?

Flush Water seal Compost Pit Bush/Beach Other (specify)

___________________

Distance from flush the septic tank to vai sameni tank: ________m Distance from the septic tank to rainwater tank: ___________m Distance from compost toilet to rainwater tank: ___________m Distance from the pit to rainwater tank: ___________m Notes (in case of no vai sameni tank):

2. What is the distance from the toilet to the nearest tap? (est-dist m): 3. Is there soap available at the tap nearest to the toilet? (now) Yes No

SECTION D: RAINWATER TANKS RISK ASSESSMENT

1. Is there any visible contamination of the roof catchment area (plants, dirt, or excreta) Yes No 2. Are there overhanging trees or branches? Yes No

3. Are the guttering channels that collect water dirty? Yes No

4. Is the tank inlet screen absent? Yes No

5. Is there any point of entry to the tank that is not properly covered? (Like manhole) Yes No

6. Is there any defect (cracks or damage) in the wall of tank? Yes No

7. Is the tap (outlet) leaking or faulty? Yes No

8. Is the concrete floor under the tap dirty? Yes No

9. Is the water collection area poorly drained? Yes No 10. Is there any source of pollution in the area surrounding the tank or water collection area?

( e.g. Like roaming animals, animal faeces) Yes No

11. Is a bucket or any other container in use and left in a place where it may get contaminated? Yes No

12. Is the inside of the tank dirty? Yes No

13. Is the first flush device absent? Yes No Total score of risks: ( /13) H2S collection point sample

Sample 1: Tank drinking water Sample 2: Point of use (Household drinking water)

Drinking water boiled stored in container

H2S collection point sample results Sample 1: Tank drinking water (check one)

Action required: ____ No Action: _____



Drinking water not boiled stored in container Direct from tap other sources (Specify)

Sample 2: Point of use (Household drinking water) Action required: ____ No Action: _____

Date: Interviewer:

Homeowner ID:

All questions contained in this questionnaire are strictly confidential

Number of people living in household

<15yrs >15yrs Male Female

SECTION E: SKIN INFECTIONS

Number of children <15yrs present in house: Number of children <15yrs present in house with skin sores:

Names Schools

Age Gender Discrete sores/lesions

with pus or crusts present? (Y/N)

# sores (<5, 5-20, 20+)

Scabies present?

(Y/N)

Seek medical help (Y/N)


SECTION F: HEALTH Has anyone had diarrhea (running stomach) in the last 14 days? Yes NoWas the diarrhea 3 or more times in a day? If yes, complete the table below.

Initials

Age

Gen

der

Record each household member, who has had diarrhea in the past 2 weeks1

See

k m

edic

al

help

(Y/N

)

D1

D2

D3

D4

D5

D6

D7

D8

D9

D10

D11

D12

D13

D14

CHECKLIST: Interviewer 1. Have you informed the household of the next visit? Yes No

2. Have you given the homeowner a filled copy of the sanitary survey? Yes No

3. Have you collected and labeled correctly the water samples? Yes No

4. Have you given the homeowner a copy of the calendar? Yes No

1 If blood is present in the stool, indicate with a capital ‘B’

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