Evaluation of Social-Economic Returns on Investment Among Households Beneficiaries of National Total Sanitation Programme in Busia County, Kenya

Abstract

Poor sanitation remains a public health problem. About 21 million Kenyans use unsanitary or shared latrines while 5.6 million have no latrine at all and defecate in the open. Busia County was among the counties with the lowest (42%) sanitation coverage compared to National level of 49%, with more than half of the population defecating in the open. Diarrheal and cholera were among the top three diseases causing morbidity and mortality in the County, with cholera outbreaks frequently being reported. Stimulating collective action to stop open defecation is now relying on behavioural triggers related to status, pride, shame and disgust, rather than relying solely on health-related arguments, to motivate action and lead to greater ownership and sustainability. In December 2012, Kenya government and UNICEF jointly implemented a pilot National Total Sanitation Programme (NTSP) in Busia County to tame poor sanitation. The NTSP was to achieve total sanitation among Busia County households through sanitation behavior change. To assure sustainability of sanitation behavior change, there was need to identify the specific attributable value of NTSP to beneficiaries. This study aimed at evaluating the social-economic returns on investment (SROI) among household beneficiaries of National Total Sanitation Programme (NTSP) in Busia County. The specific objectives were to: evaluate the level of sanitation before implementation ofNTSP, evaluate the outcome ofNTSP, determine the social- economic value ofNTSP and finally, document the lessons learnt after implementation ofNTSP in Busia County. To achieve these objectives, baseline survey was carried out in October 2012 for 30 days to establish level of sanitation in Busia County before implementation of NTSP in December 2012-march 2015. Evaluation of NTSP outcome was carried out from September-December 2015 in which only villages certified by NTSP as having achieved total or 100% sanitation were included in the study. Quasi-experimental study design was used to collect data before (Baseline) and after (Outcome) NTSP implementation without control group. Multi stage-random sampling was used to sample locations, sub locations, villages and respondents from villages that NTSP had been implemented and certified to have achieved total sanitation in Busia County. The target population included NTSP beneficiaries (28,130 households), NTSP implementers (30 public health officers, 15 Community Health Extension Workers, 30 Community Health Workers and UNICEF (1 Main sponsor). A total of 459 respondents participated in the study both at baseline survey and outcome evaluation with data collected using questionnaires and observation checklists. Multi-variate analysis, Chi-square test, Pearsons correlation, frequencies and percentages, were employed to analyze data from baseline survey and outcome evaluation data for NTSP while SROI methodology was used to establish Social-economic value added to residents of Busia County by NTSP. From the study findings, latrine coverage and usage of latrines by children increased by 43.7 % (X2=15.24; df=l ; P:::;O.OOOand) 32.2% (X2=89.97; df=l; P:::;O.OOO)while latrine sharing with neighbours and open defecation reduced by 37.5 % (X2=118.17; df=l; P:::;O.OOO)and 47.9 % (X2=192.05; df=l; P:::;O.OOOres) pectively. There was also a significant improvement in hand washing in critical times with soap after latrine usage [329 (81.0%) after NTSP implementation from 186 (45.6%) baseline; X2=110.02; df=lp:::;O.OOO]Ho . useholds were almost six times (OR=5.99 p=O.OOOI)likely to wash hands after latrine usage. Compared to baseline, [178 (43.6%)], most households, [274 (67.5%)] had installed hand washing basin/leaky taps within 3 metres radius around the latrine (X~114.34; df=2 P:::;O.OOOHous ). eholds were twice (OR=2.41P=0.0001) likely to have a hand washing basin or leaky tap after NTSP intervention. Social economic value added to Busia County residents was KES 1: 10.5 meaning that for every KES 1 invested created a social-economic value of KES 10.5 to Busia residents. These results suggest that NTSP should be rolled out country wide with a view of improving level of 'sanitation and hygiene. The NTSP implementors need to enhance followed-up to sustain sanitation behavior change.