| dc.description.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. | en_US |
