Clean water and sanitation: How design can influence behavioral changes

Editor's note: The following piece by Jeannette Laramee first appeared on the Stantec website.

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Designs for clean water and sanitation infrastructure in developing areas should encourage use to achieve the goal of creating healthy communities

The new global challenge of COVID-19 compounds the already intractable risks of poor access to clean water and sanitation. The challenge will continue to be even greater for the billions of people globally still lacking access to safe water and sanitation, which is responsible for an estimated 829,000 deaths annually. In early childhood years, poor access to water, sanitation, and hygiene (collectively known as WaSH) also leads to “stunting”—which affects children physically and mentally—resulting in major impacts to social development.

The United Nations’ Sustainability Development Goal (SDG) No. 6 aims to achieve universal access to water and sanitation by 2030. While the world has made progress toward this goal, significant efforts over the next decade will be needed to meet the target date. Simply building infrastructure won’t be enough. A key challenge will be how to sustain access. A major hurdle? How to effectively change behaviors to promote use of facilities and how to ensure the maintenance of infrastructure over its lifespan. Splash’s Project WISE—WASH in Schools for Everyone—seeks to overcome that challenge.

Splash is a US-based nonprofit that designs child-focused WaSH solutions with governments in some of the world’s largest and low-resource cites. Splash has partnered with the Ethiopian government on Project WISE. Ethiopia needs significant progress to meet the SDG target. For example, in 2017 only 38% of Ethiopia had access to safe water and only 20% had access to basic sanitation. With the help of other funders over the next 5 years, the Splash partnership aims to reach every public school in Addis Ababa. By improving water, sanitation, hygiene, and menstrual health solutions, more than 500,000 children will ultimately benefit. 

To help Splash develop prototypes for school sanitation, we brought together an international, multidisciplinary team of architects and engineers for a holistic design process. A major goal was to create a positive and safe sanitation environment—especially for girls—at school. We wanted to create a latrine design that was functional, cost-effective, and flexible—but also create an environment to encourage use by students and upkeep by school management.

The team conducted site visits and interviews at schools in Addis Ababa to understand the shortcomings of current school sanitation and identify where improvements could be made. Our investigations revealed several challenges, including:

• Minimal openings and narrow hallways created dark toilet stalls, which discouraged use. Children opted to go outside
• Unreliable and insufficient water supply limited handwashing and cleaning
• Insufficient access to the underground waste tanks made it difficult to empty them

We also reviewed existing sanitation standards, including designs developed by the Government of Ethiopia, to determine how we could incorporate useful elements into our plans. 

To create a plan that encouraged children to use the latrine and handwashing facilities, we used Splash’s behavior-change and menstrual-health research. This informed key design elements and rooted our design in the overall experience we wanted them to have. Handwashing with soap is one of the most effective ways to prevent diarrhea and lung disease but is difficult to practice in areas with low resources. Moreover, not having access to ample resources for menstrual hygiene management results in a sense of shame and anxiety that contributes to absences and poor performance at school for girls.

For example, as a “behavioral nudge,” the facility entrances are oriented in a way that encourage users to pass handwashing stations as they exit. All toilet stalls will have an automatic shut-off tap to conserve water and allow for washing. We also included plenty of space in the stalls for waste bins and a shelf. These small, yet useful, design elements provide girls with the privacy needed to manage their menstrual health and could make the difference between a girl staying at the top of her class, falling behind, or dropping out due to missed days at school.

Emphasis on the user experience and building aesthetics was a central part of our architecture team’s strategy. The entrance was clearly visible and accessible to promote use, while also ensuring privacy. A light and open superstructure was selected to ensure airflow and maximize natural light. To ensure the facility’s flexibility to a school’s needs, the structure was designed to work on a standard module for easy adjustment. An additional two toilet stalls can be added to each column bay.

Our engineering team emphasized access to underground tanks for easy emptying and maintenance. Calculating an adequate tank volume for containment and land area for waste infiltration was vital. To combat water supply challenges, we included an elevated water tank. Our structural engineers designed various foundation options for the different soil types in Addis Ababa, which can range from hard rock to expansive clay soils. The foundation options will minimize material use and costs—at up to 400 schools.

Working with Metaferia Consulting Engineers, an engineering and architectural firm in Addis Ababa, helped our team understand the availability of local materials, weather conditions, and considerations for material selection, as well as best practices in Ethiopia. For example, Metaferia’s insights led to the selection of a cost-effective and durable local timber for the roof. We also needed to know local builders’ skills and adjust our designs. Metaferia helped our team understand soil conditions, building codes, and local constraints. This partnership was critical in understanding the cultural suitability of the latrine designs, such as the height of the doors from the ground to provide privacy for squat-type toilets and the best placement of boys urinals to allow for privacy while providing enough ventilation.

National and local governments and international donors make major investments annually toward the SDG’s universal access to water and sanitation target. The World Bank estimates that current spending needs to triple to $114 billion annually to meet the target.

While building functional infrastructure is important, we must also strive to create designs that will sustain long-term development outcomes. Considering multiple perspectives and cultural contexts, as well as the user’s experience, is a critical first step.