CAWP Statement on PPM-Handwashing Report

Tuesday 15th May 2007

Tuesday 15 May 2007



A recently completed Research Report entitled, The Problem of Handwashing and Paying for Water, conducted for the Municipal Services Project has found that prepaid water meters impact negatively on people’s handwashing behaviours, raising the risk of water-borne disease and lowering people’s hygiene conditions in lower-income communities.

The research involved 107 households in Soweto and found that: “In general, hygiene behaviours were worse in households that were being supplied by the prepaid method ... Importantly, there was a significant difference in the proportion of household carers with deemed versus prepaid water who never washed their hands with flowing tap water (43% with deemed consumption versus 77% with prepaid meters; p<0.05)”. Evidence was found, “that those who were being asked to prepay for their water were practising poorer hygiene behaviours than their neighbours who were still on deemed consumption”. Further, the Report states that this finding, “was bolstered by the qualitative data in which respondents were acutely aware of the cost of water, especially in the context of the deep poverty that they are already suffering”. It’s final conclusion is instructive: “In a country where poverty is rife, where there is soaring unemployment, where there is a massive housing backlog, and where hunger is a daily reality, it is unrealistic to expect poor people to purchase, in advance, a basic good such as water”.

These crucial findings lend clear empirical and analytical support to the ongoing legal challenge by the Coalition (a collection of community organisations and progressive NGOs struggling against the negative effects of current water policies on the poor) and involving Phiri (Soweto) residents - initially filed in the Johannesburg High Court in July 2006 against Johannesburg Water (Pty) Ltd, the City of Johannesburg and the Minister of Water Affairs & Forestry - which, amongst other things, seeks to have Johannesburg Water’s unilateral decision to install prepayment meters declared unconstitutional and unlawful and an order for those so affected to have the option of a credit-metered supply installed at the cost of the City of Johannesburg.

The Report was conducted earlier this year by three leading South African health experts: Dr. David Sanders (Professor and Director, School of Public Health, University of the Western Cape); Dr. Mickey Chopra (Senior Lecturer, School of Public Health, University of the Western Cape); and, Farhaad Haffajee (Fellow of the Optometric Association of South Africa.

Dr. Sanders is available for press interviews on the Report. He can be contacted directly on 082 202 3316.

Below is a brief summary of the main findings of the Report

“Water-related diseases, in particular diarrhoea, are widely recognised as a major threat to public health, especially in the developing world. It is estimated that globally 19% of all infectious diseases are related to water, sanitation and hygiene risk factors. Nearly two million children die annually from diarrhoeal diseases, making them one of the top three killers of children in the world today. Epidemiological investigations have shown that even in the absence of toilets, diarrhoeal morbidity can be reduced with the adoption of improved hygiene behaviours.

In 2001 the South African government became a partner in the Water, Sanitation and Hygiene for All (WASH) campaign, which was, in brief, designed to bring attention to and attract resources towards addressing the situation of millions of people without access to adequate water supply and sanitation in the world.

In Johannesburg, a privately managed parastatal company - Johannesburg Water - has been contracted to deliver water and associated services in the city. As part of their water service delivery and improvement of services, the company has opted for various methods of delivery, some of which include the use of prepaid water meters and yard taps. A large pilot project of water service delivery through prepaid water meters has been embarked upon in Soweto.

The research question asked in this study was: Do households respond differently to hygiene and handwashing interventions such as WASH depending on the water systems and payment systems that they have? More specifically, is there a difference in handwashing behaviours between caregivers living in households with in-house prepaid water meters as compared to caregivers living in similar households with deemed consumption accounts for water (i.e. credit billing that is paid at the end of each month)? If so, why?

Hygiene education materials (specifically related to the transfer of pathogens and diarrhoea), which were developed, tested and used with great success by a group in Cape Town called the Khayelitsha Water and Sanitation Programme, were used to educate the selected sample households in Soweto with respect to hygiene practice, particularly those aspects related to pathogen transfer. Each household in the Soweto case study was visited; the caregiver and all other interested members in the household were then given the intervention. Afterwards, questions were answered and appointments were made with the household to visit them for the observation (data collection) task.

Data were collected via observation of the carers at the selected households. The observations were carried out by trained researchers using a general questionnaire and a structured questionnaire/checklist. Of the 107 households surveyed, 51 had prepaid meters and 56 were operating on deemed water consumption. All of the deemed consumption households had water available on the day of the observation, while in the prepaid households water was available in 48 (95%) of households. Water availability was considered an essential variable in determining water use with respect to handwashing and hygiene.

This study illustrates that the WASH campaign has definitely not had any impact in the community under study. In fact, the campaign seems to have been completely ineffective in that hands were not even being washed at all, let alone being washed at ‘the right times’. ‘The WASH campaign - with its numerous pamphlets, newspaper articles and radio clips - has focused upon spreading these hygiene messages through the media. However, no attention has been paid to the cost-benefit analysis that individuals and households undertake in deciding whether to take up new behaviours. In particular the regular washing of hands requires an investment in time and in the use of water and soap.”

FOR HARD OR PDF COPIES OF THE REPORT, CONTACT: Dale McKinley on 072 429 4086 or [email protected]


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