Developing Coastal Communities through Integrated WASH Interventions Knowledge, Attitude and Practice (KAP) Survey on Water, Sanitation and Hygiene District Badin and Thatta, Sindh September 2013 Social Sector Services National Rural Support Programme Islamabad, Pakistan Copyright © National Rural Support Programme - September 2013 All rights reserved, but development organisations which are working in the rural areas specially non-profit organisations working for capacity building can use this material for the benefit of poor rural communities. It is requested that please acknowledge the effort made by NRSP. No parts of this publication may be reproduced, stored in a retrieval system or transmitted in any form or by any means electronic, mechanical, photocopying, recording for the commercial or profit making purpose or otherwise without the written permission of the National Rural Support Programme. Authored by: Shahid Hanif Malik (Programme Officer - SSS) Supervised by: Arafat Majeed (Programme Manager - SSS), Ghulam Mustafa Jamro (Regional General Manager, Badin), Muhammad Yousaf Khoso (Project Manager, Badin) Technical Facilitation by: Sharafat Hussain (Data Analyst, MER), Humaira Haroon (Badin), Irfan Khatti (Badin) Design & Layout: Mansoor Abid Table of Contents Executive Summary 1 Background 2 Project Introduction 2 Survey Methodology 3 Sampling Plan 3 Staff Orientation and Pretesting of Questionnaire 4 Field Work & Data Collection 4 Household Questionnaires 4 Focus Group Discussions 4 Data Quality Control Mechanism 4 Data Cleaning and entry 4 Findings and Results 5 Socio-demographic Profiles of Respondents 5 Household population 6 Household Occupation 6 Monthly Expenses 7 Housing Structure and Ownership 8 Sanitation 9 Availability of Latrine Facilities 9 Open Defecation Practices 9 Types and Status of Functional latrines 10 Cleanliness status of available latrines 10 Handling Children Excreta 11 Hand Washing Facilities, Material nearby/ in the HH Toilet 11 Accessibly of latrine to older and Person with Disability (PWD) 12 Reasons for not Building Latrines 13 Satisfaction from Current defecating Practices 13 Reasons for not being satisfied 13 Drinking water 15 Main Source of water 15 Distance from water source 15 Drinking Water Storage & Transportation 16 Quality of Drinking Water 16 Knowledge about Water Scarcity 17 Knowledge to cope with diarrhea 18 Personal Hygiene 19 Hand washing Before Eating 19 Hand washing Practices of Household Population 19 Hand washing after defecation 20 Frequency of personal Hygiene 20 Participation in Hygiene awareness 21 Solid Waste Management 22 Livestock Possession 22 Household Waste Disposal 22 Waste Water Drainage 22 Knowledge about Hazards of improper waste disposal 23 Perception about Waste as a Problem 23 School WASH 24 Availability of Sanitation Facilities 24 Sanitation Facilities in Schools 24 Defecating Practices in Schools 24 Personal Hygiene in schools 24 Health/ WASH Awareness activities 24 Waste Disposal 24 Conclusions and Recommendations 25 Conclusions 25 Recommendations 25 List of Annexures Annexure 1: Questionnaire 27 Annexure 2: List of Household interviewed 34 Acronyms BLS Baseline Survey CBOs Community Based Organizations CLTS Community Led Total Sanitation COs Community Organizations CSOs Civil Society Organizations DCCIWI Developing Coastal Communities through Integrated WASH Interventions FGDs Focus Group Discussions HH Households IEC Information, Education and Communication JMP Joint Monitoring Programme KAP Knowledge, Attitude & Practice Km Kilometer LHVs Lady Health Visitors LHWs Lady Health Workers LSOs Local Support Organizations MCH Mother & Child Health MCQs Multiple Choice Questions NRSP National Rural Support Programme ODF Open Defecation Free PATS Pakistan Approach toward Total Sanitation PWDs Person with Disabilities SCCDP Sindh Coastal Community Development Programme TB Tuberculosis UCs Union Councils VOs Village Organizations WASH Water, Sanitation and Hygiene WATSAN Water and Sanitation WBDs Water Borne Diseases WHO World Health Organization WSS Water Supply Scheme Knowledge, Attitude and Practices Survey on Water, Sanitation and Hygiene (WASH) in District Thatta & Badin Executive Summary access to improved sanitation facilities, remaining households were using unimproved sanitation NRSP received funding from WaterAid to implement facilities. “Developing Coastal Communities through Integrated WASH Interventions” (DCCIWI) project in Coastal areas Proper hand washing at the most critical times was of Thatta and Badin districts of Sindh. DCCIWI project very poor. About 84 percent of the households were is targeting 14,000 households of 8 Union Councils of washing hands during the key times only with water district Badin and Thatta respectively. Areas selected and 15 percent of the respondents were washing for project interventions are disaster prone and hands with soap and water. people of these areas are the consistent affectees of natural calamities. Non-availability of the safe Up to 83 percent households interviewed had an drinking water coupled with bad sanitation and poor access to safe drinking water from safe water hygiene posed a high risk of water borne diseases sources i.e. from hand pumps and filtration plants, like diarrhea, cholera and malaria, aggravating while, 17 percent of the target population was using the already compromised status of families and drinking water from unsafe water sources. potentially resulting to increased morbidity and mortality. 95 percent of the total household interviewed said that they throw the household wastes to the bush/ NRSP conducted the baseline survey to ascertain garden or leave them in the compound; No proper the knowledge, attitude and practices of the target solid waste management system found in surveyed population on water supply, sanitation and hygiene areas. before takeoff stage of project interventions. The KAP survey will be used to highlight the root causes of poor adoption of hygiene practices, Water quality at households and socio-cultural practices in the selected villages and will provide a baseline for evaluation of program effectiveness. The survey was conducted in September 2013. Total 1,400 households comprising 57 percent men and 43 percent women were interviewed through structured questions whereas FGDs on the subject of WASH were organized with representatives of networks of community organizations (LSOs and VOs). In order to gather comprehensive information of KAP in project areas, respondents having multidimensional demographic characteristics were interviewed. Key results of KAP survey show that; 92 percent households were practicing open defecation and only 3 percent households had an Developing Coastal Communities through Integrated WASH Interventions 1 Knowledge, Attitude and Practices Survey on Water, Sanitation and Hygiene (WASH) in District Thatta & Badin Background intrusion and an increase in salinity and water- logging. Diarrhea is the main disease associated with unsafe water and poor sanitation and is responsible for the Project Introduction deaths of 1.8 million people every year, 90% of which are children under five years age1 . It is estimated The coastal districts of Thatta and Badin have that 1.6 million deaths per year are attributed to experienced six major natural disasters including unsafe water supply and poor sanitation. This figure cyclones, droughts, floods and flash floods during the includes 88% of the deaths due to diarrheal diseases last decade. According to the baseline survey of Sindh world-wide which is considered to be the attributable Coastal Community Development Project (SCCDP) fraction of diarrhea due to unsafe water supply and conducted in March, 2012, the worst affected areas poor sanitation2. in terms of degraded natural resources and rampant poverty are the 8 coastal sub-districts/talukas Pakistan is one of those countries cursed with this including Badin and Shaheed Fazil Rahu in district deadliest problem. Being a resource scarce country Badin whereas Jati, Shah Bandar, Mirpur Sakro, greater proportion of Pakistan’s health budget Ghora Bari, Kharo Chan and Keti Bandar in district is spent on cure of such diseases that can be Thatta. circumvented easily by taking preventive measures by programming and prioritizing areas. It is evident Multiplier effects of mentioned disasters worsened from research studies across the globe that the major water, sanitation and hygiene in these areas of contributing and complementing factor in meager Sindh, so to minimize this worst situation of water health of people is poor sanitation and hygiene sanitation and hygiene, NRSP, with the financial conditions. This is the area that is least emphasized support of WaterAid initiated “Developing Coastal in many economies, particularly in least developed or Communities through Integrated WASH Interventions developing countries. According WHO survey, in 2010 (DCCIWI) in coastal zone of the area. DCCWI is 11 around 884 million people around the world still lack months duration project started from 1st May 2013 access to improved water supply and around 2.6 billion to 31st March 2014. Project will develop communities people have lack of access to improved sanitation. through integrated Wash interventions in eight union councils of two districts of coastal belt i.e. Thatta and In Pakistan, diarrhea is the leading cause of death Badin. for children under five years of age Approximately 16,103 children under the age of five in Pakistan died The purpose of this project