School of Community Health Sciences, University of Nevada, Reno, NV 89557, USA.
Gangarosa Department of Environmental Health, Rollins School of Public Health, Emory University, Atlanta, GA 30322, USA.
Int J Environ Res Public Health. 2020 Mar 10;17(5):1808. doi: 10.3390/ijerph17051808.
Few rural sanitation programs have documented large increases in sanitation coverage or have assessed if interventions equitably increase sanitation coverage for vulnerable groups. We characterize the impact of the Sustainable Sanitation and Hygiene for All (SSH4A) approach on key program WASH (water, sanitation, and hygiene) indicators, and also assess if these increases in WASH coverage are equitably reaching vulnerable groups. The SSH4A approach was administered in 12 program areas in 11 countries, including Bhutan, Ethiopia, Ghana, Indonesia, Kenya, Mozambique, Nepal, South Sudan, Tanzania, Uganda, and Zambia. Repeated cross-sectional household surveys were administered over four rounds at annual follow-up rounds from 2014 to 2018. Surveys were conducted in an average of 21,411 households at each round of data collection. Overall, sanitation coverage increased by 53 percentage points between baseline and the final round of data collection (95% CI: 52%, 54%). We estimate that 4.8 million people gained access to basic sanitation in these areas during the project period. Most countries also demonstrated movement up the sanitation ladder, in addition to increases in handwashing stations and safe disposal of child feces. When assessing equity-if sanitation coverage levels were similar comparing vulnerable and non-vulnerable groups-we observed that increases in coverage over time were generally comparable between vulnerable groups and non-vulnerable groups. However, the increase in sanitation coverage was slightly higher for higher wealth households compared to lower wealth households. Results from this study revealed a successful model of rural sanitation service delivery. However, further work should be done to explore the specific mechanisms that led to success of the intervention.
很少有农村卫生项目记录到卫生覆盖范围的大幅增加，也没有评估干预措施是否公平地增加了弱势群体的卫生覆盖范围。我们描述了可持续卫生和人人享有环境卫生设施（SSH4A）方法对关键项目 WASH（水、环境卫生和个人卫生）指标的影响，还评估了这些 WASH 覆盖范围的增加是否公平地惠及弱势群体。SSH4A 方法在 11 个国家的 12 个项目地区实施，包括不丹、埃塞俄比亚、加纳、印度尼西亚、肯尼亚、莫桑比克、尼泊尔、南苏丹、坦桑尼亚、乌干达和赞比亚。从 2014 年到 2018 年，每年进行一次后续调查，共进行了四轮重复的横断面家庭调查。在每一轮数据收集时，调查平均在 21411 个家庭中进行。总体而言，卫生覆盖范围在基线和最后一轮数据收集之间增加了 53 个百分点（95%置信区间：52%，54%）。我们估计，在项目期间，这些地区有 480 万人获得了基本卫生设施。除了增加洗手站和安全处理儿童粪便外，大多数国家还展示了卫生设施使用情况的改善。在评估公平性时（如果比较弱势群体和非弱势群体的卫生覆盖水平），我们发现，随着时间的推移，覆盖范围的增加在弱势群体和非弱势群体之间基本相当。然而，与低收入家庭相比，高收入家庭的卫生覆盖范围增加略高。本研究结果揭示了农村卫生服务提供的成功模式。然而，应进一步努力探索导致干预成功的具体机制。
