The session on extra-household settings focused on sanitation and hygiene issues beyond the household,   Ryan Cronk from the Water Institute stated the main areas of interest beyond the household are:  high use areas, high risk areas, and special events.   Settings which lend themselves to this definition are schools, markets, health facilities, refugee camps, settings with internally displaced people, prisons, and mass gatherings.  Various monitoring systems are already available which include information on extra household settings.  These are: national sector information, nationally representative facility surveys, nationally representative household surveys, regional and global data and aggregation reports, and other emerging reports.  However, despite the large amount of information available in these surveys, it appears that WASH is not a focus area for many of them.  It would thus make sense to link with these already available monitoring systems to include WASH indicators for extra household settings.

Archana Patkar from the WSSCC followed the UNC presentation with a presentation on the importance of promoting sanitation and hygiene in extra household settings.  She argues that institutional settings are a great entry point for social justice as it is much more difficult to promote and enforce behaviour changes at the household level.   Extra household settings provide a unique opportunity to scale up regulations and standards for sanitation and hygiene, and to promote equity and the Human Rights to WASH; in short, it's a natural canvas to implement post-2015 aspirations for the WASH sector.   She provided a great example in India where, at a large religious meeting, every roti was stamped with "Wash hands before you eat"; one can imagine the number of people reached with this message. This shows the potential to disseminate messages and facilitate behavior change through extra household settings as an entry point.  In the long term, extra household settings provide opportunities to recognize the realities of behaviour change and practice, have duty bearers with clearly defined and measurable targets for sanitation and hygiene, create institutionalized standards that will enhance and educate demands, and provide an overall impetus for changing social norms.  Improving standards in extra household settings in particular can ensure that people get used to and start demanding better facilities.   In all, focusing on extra household settings may provide greater opportunities for sustained behaviour change in the future.

After this presentation, participants pointed out that in as much as we should focus on extra household settings, this should not discount the focus on promoting changes at the community level.  Communities are still a viable entry point especially for those who may not be seen or may not have access to institutions such as schools (e.g. people with disabilities who may not be able to attend school).   In order to ensure equitable access, WASH initiatives must focus on both institutions and communities.

Another presentation was on a study currently being conducted by Lenka Benova from the London School of Hygiene and Tropical Medicine.   She's conducting research with the SHARE consortium to investigate the links between WASH in health centres and maternal health.  Her presentation was on the current findings in Tanzania.  Gathering all the information available, it appears that about 30.5% of births in total were in a WASH safe environment.  Births in health centres had better WASH conditions than those at home, but no data was available on how the water and sanitation facilities were used or the hygiene behaviours practiced during the births (it was simply the availability of WASH facilities).  Although more work needs to be done to narrow in on the specific effects of WASH on maternal health,  these initial findings provide a good foundation for advocating for more research and potentially, for more focus on WASH in health facilities.

Although the session did not end with tangible actions for moving forward on WASH M&E in extra household settings, it provided a good discussion space on the importance of addressing WASH beyond the household.  There were also some suggestions for moving forward with this agenda, including linking people through the Community of Practice on Sanitation and Hygiene Group on Linkedin, and perhaps at a side session at the upcoming WEDC conference.  This appears to be a relatively new topic area and understandably, monitoring efforts are less developed, but there is much interest in moving this issue forward.   

You might also like to read Andrés Hueso González's blog on the final day of the symposium.

Jolly Ann Maulit jollyannmaulit@gmail.com