Abstract:

Community-led total sanitation (CLTS) is a widely used method to tackle health issues related to open defecation within the community. Research indicates successful CLTS in arid and semi-arid areas, but lacks understanding of its implementation, engagement of Community-Based Health Workers, and their expertise. The study aimed to assess the influence of Community-Based Health Workers on the implementation of a Community-Led Total Sanitation approach in Turkana County, Kenya.The survey utilized a community-based cross-sectional design, with 200 community-based health workers and 430 households recruited using multi-stage sampling as participants, and 21 key informants selected purposively. Excel and STATA version 17 were utilized for data management, analysis, and presentation of quantitative results, while NVivo was utilized for qualitative analysis. Quantitative data was analyzed using descriptive and inferential statistics, while qualitative data was analyzed using thematic methods.  The study revealed a positive trend in sanitation infrastructure, with 69.93% of households owning latrines. Facing challenges using latrines demonstrated a highly significant association with both latrine ownership (p < 0.001) and open defecation (p < 0.001), indicating that household members encountering difficulties with latrine usage are less likely to own one and more likely to practice open defecation. CBHWs playing a role (p < 0.001) are all significantly associated with both latrine ownership and reduced open defecation, underlining the influential role of CBHWs in promoting improved sanitation practices and infrastructure within households in Turkana County, Kenya. The study revealed that Community-Based Health Workers significantly enhance households' sanitation infrastructure and support decreases in open defecation practices.

References:

[1].   Kar, K., 2003, Subsidy or self-respect? Participatory total community sanitation in Bangladesh. IDS Working Paper, 184. Available at: https://doi.org/10.19088/IDS.2003.184.

[2].   Kar, K., & Chambers, R., 2008, Handbook on Community-Led Total Sanitation. Plan International.

[3].   Chambers, R., 2009, Going to scale with Community-Led Total Sanitation: Reflections on experience, issues, and ways forward. IDS Practice Papers, 2009(1), 01-50. Available at: https://doi.org/10.19088/IDS.2009.1.

[4].   Water and Sanitation Program [WSP], 2011, Creating demand for sanitation: A summary of lessons learned using the Community-Led Total Sanitation approach. World Bank.

[5].   Kar, K., 2012, CLTS: Reflections on scaling up. Institute of Development Studies. Available at: https://doi.org/10.19088/IDS.2012.1.

[6].   UNICEF, 2020, Progress on household drinking water, sanitation and hygiene 2000-2017. United Nations Children's Fund.

[7].   Venkataramanan, V., Crocker, J., Karon, A., & Bartram, J., 2018, Community-led total sanitation: A mixed-methods systematic review of evidence and its quality. Environmental Health Perspectives, 126(2). Available at: https://doi.org/10.1289/EHP1965.

[8].   Kar, K., 2011, CLTS: From pre-testing to post-implementation. Plan International.

[9].   Ministry of Health, Kenya, 2015, Open Defecation Free Rural Kenya Campaign. Government of Kenya.

[10].  Water and Sanitation Program [WSP], 2015, Kenya’s experience in scaling up Community-Led Total Sanitation. World Bank.

[11].  Water and Sanitation Program [WSP], 2016, Sanitation marketing lessons from Kenya. World Bank.

[12].  Ministry of Health, Kenya, 2016, Sanitation and hygiene policy. Government of Kenya.

[13].  Bartram, J., & Cairncross, S., 2010, Hygiene, sanitation, and water: Forgotten foundations of health. PLoS Medicine, 7(11), e1000367. Available at: https://doi.org/10.1371/journal.pmed.1000367.

[14].  UNICEF, 2016, Water, sanitation and hygiene (WASH). United Nations Children's Fund.

[15].  World Health Organization [WHO], 2019, Water, sanitation and hygiene: A roadmap for 2019-2023. WHO.

[16].  Kenya National Bureau of Statistics [KNBS], 2019a, 2019 Kenya population and housing census Volume II: Distribution of population by administrative units. Kenya National Bureau of Statistics. Available at: https://www.knbs.or.ke/download/2019-kenya-population-and-housing-census-volume-ii-distribution-of-population-by-administrative-units/.

[17].  Ministry of Health, Kenya, 2021, Health and sanitation approach in Turkana County. Government of Kenya.

[18].  Kenya National Bureau of Statistics [KNBS], 2019b, The 2019 Kenya population and housing census: Population by county and sub-county. Kenya National Bureau of Statistics. Available at: https://www.knbs.or.ke/2019-kenya-population-and-housing-census-results/.

[19].  Water and Sanitation Program [WSP], 2017, Latrine construction and sanitation behavior change: Evidence from Kenya. World Bank.

[20].  Ministry of Health, Kenya, 2021, Health and sanitation approach in Turkana County. Government of Kenya.

[21].  Chambers, R., 2012, CLTS: Reflections on scaling up. Institute of Development Studies. Available at: https://doi.org/10.19088/IDS.2012.1

[22].  Ministry of Health, Kenya, 2022, Challenges in CLTS implementation in Turkana County. Government of Kenya.

[23].  WSP, 2020, Challenges and opportunities in CLTS implementation. Water and Sanitation Program, World Bank.

[24].  Venkataramanan, V., Crocker, J., Karon, A., & Bartram, J., 2018, Community-led total sanitation: A mixed-methods systematic review of evidence and its quality. Environmental Health Perspectives, 126(2). https://doi.org/10.1289/EHP1965.

[25].  Mosler, H. J., Mosch, S., & Harter, M., 2018, Is Community-Led Total Sanitation connected to the rebuilding of latrines? Quantitative evidence from Mozambique. PLoS ONE, 13(5), e0197483. https://doi.org/10.1371/journal.pone.0197483.

[26].  KNBS, 2019a, 2019 Kenya Population and Housing Census Volume II: Distribution of Population by Administrative Units. Kenya National Bureau of Statistics. https://www.knbs.or.ke/download/2019-kenya-population-and-housing-census-volume-ii-distribution-of-population-by-administrative-units/.

[27].  KNBS, 2019b, The 2019 Kenya Population and Housing Census: Population by County and Sub-County. Kenya National Bureau of Statistics. https://www.knbs.or.ke/2019-kenya-population-and-housing-census-results/.

[28]. Ministry of Health, Kenya, 2021, Health and Sanitation Approach in Turkana County. https://www.health.go.ke/district-health-information-systemdhis2/.