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Factors influencing the non Factors influencing the non -sustainability of the -sustainability of the
Improved Water Supply Improved Water Supply and Sanitation Program in and Sanitation Program in
Rural Area of Poor Rural Area of Poor Provinces in Lao PDRProvinces in Lao PDR
By By Environmental Health DivisionEnvironmental Health Division
Department of Hygiene and PreventionDepartment of Hygiene and PreventionMinistry of HealthMinistry of Health
ContentsContents
ObjectivesObjectives MethodMethod Results:Results:
Water and sanitation informationWater and sanitation information Relationship between some key Relationship between some key
factors and non-sustainability of factors and non-sustainability of water supply systems and water supply systems and community management for water community management for water and sanitationand sanitation
ConclusionsConclusions RecommendationsRecommendations
General objectivesGeneral objectives
To know the factors influencing To know the factors influencing the non-sustainability of the the non-sustainability of the improved rural water supply and improved rural water supply and sanitation programs in 4 provincessanitation programs in 4 provinces
MethodologyMethodology
Study design: Cross sectional study Study design: Cross sectional study Target areas: 4 provinces, 4 districts Target areas: 4 provinces, 4 districts
and 32 village:and 32 village: Phongsaly Province: Nyot Ou district, Phongsaly Province: Nyot Ou district, Oudomxay Province: Namor district, Oudomxay Province: Namor district, Xekong Province: Kaleum district, Xekong Province: Kaleum district, Attapeu Province: Phouvong district,Attapeu Province: Phouvong district,
Method of sampling and Method of sampling and instrumentsinstruments
District 8 Villages
Good system with good managementGood system with poor managementBreakdown with poor management
Households
Water supply systems
Latrines
Random sampling Systematic sampling
Village CommitteeFor WSS
General hygieneinspection
Questionnaire
Community surveyFor WSS
Sanitary inspection
Latrine hygiene inspection
Pretested and improved
ResultsResults
Types of organizations to manage water supply systems
Village heads38%
Mass organizations9%
Village Committee for Water and Sanitation
53%
40.6
59.456.3
43.7
0
10
20
30
40
50
60
Percentage
Village Committee forWSS officially assigned
Village Committee forWSS selected by villagers
Village Committees officially assigned and selected by villagers
Yes
No
Number of women in the Village Committee fr Water and Sanitation
Zero53%
1 person28%
2 persons19%
59.4
40.6
25
75
25
75
0
10
20
30
40
50
60
70
80
Percentage
Village Committee for WSS sharedresponsibilities
Village Committee participated inthe training course on water ad
sanitation management
Village Committee participated inthe training course on health
education
Village Committee for Water and Sanitation shared responsibilities, participated in the training course on water and sanitation and health education
Yes
No
65.6
34.438.1
61.9
0
10
20
30
40
50
60
70
Percenatge
Village health volunteers have beenassigned for operation and
maintenance
Village health volunteers participatedin the training course on operation
and maintenance
Village health volunteers have been assigned and participated in the training course on operation and maintenance
Yes
No
Number of women in the village health volunteers for WSS
Zero person81%
One person19%
Village water rules
Yes50%
No50%
100
0
60.5
32.9
6.6
0.8
49.8 49.4
16.9
83.1
0
10
20
30
40
50
60
70
80
90
100
Percentage
Yes No Zero < 30 000kips
> 30 000kips
Zero 1-2persons
> 2persons
Nomaterials
Sand,gravels,woods
and foodsContribution
Household contributions to the construction of water supply systems in 4 provinces
Materials
Labors
Money
Contribution
Water supply systems were breakdow last year in 4 provinces
Yes 58%
No42%
Types of water supply systems breakdown in 4 provinces
Small breakdown63%
Big breakdown31%
Small and big breakdown
6%
35.2
13.5
10.8 10.89.8
4.4 4.6
10.9
0
5
10
15
20
25
30
35
40
Percentage
Poor management Water pipe broken Accidents Children played Obstruction ofintake
Water not good Much used andw ater tap broken
Others
Main causes of water supply systems breakdown in 4 provinces
Number of water supply systems breakdown per year in 4 provinces
< 2 times/year60%
2-4 times/year25%
4-13 times/year15%
Number of days small repairs completed
One day46%
2-4 days36%
4-60 days18%
Having spare parts in 4 provinces
Yes24%
No76%
Money contributed to the repairs of water supply systems breakdown in the last 12 months
Zero60%
500-1000 kips19%
> 1000 kips21%
They got water from other sources when water supply systems were breakdown
Rivers79%
Old dugwells17%
Others4%
21.5
78.5
73.1
26.9
47.8
52.2
41
59
0
10
20
30
40
50
60
70
80
Percentage
Financialvillage
Recording inthe book
Reporting theexpendituresand balances
Showing thebills of all
expenditures
Village financial management in 4 provinces
Yes
No
22.5
77.5
64
36
55.4
44.6
0
10
20
30
40
50
60
70
80
Percentage
Private sector participated with the project Government staffs monitored water projectsafter its completion
International agencies including NGO's monitored water projects after its completion
Participation and monitoring of Governement staffs, International agencies and private sector on water projects after its completion in 4 provinces
Yes
No
31.3
68.7
0
10
20
30
40
50
60
70
Percentage
< 100 Equal 100
Coverage
Water coverage in 4 districts
< 20 litersBetw een 20-50 liters
Betw een 50-100liters > 100 liters
Phongsaly/Yot Ou
Oudomxay/Namor
Xekong/Kaleum
Attapeu/Phouvong
62.5
12.512.5
12.5
37.5
12.5
37.5
12.5
25
50
12.5 12.5
37.5
12.5
2525
0
10
20
30
40
50
60
70
Percentage
Water quantity
Province/District
Water quantity supplied by Province/District
Phongsaly/Yot Ou
Oudomxay/Namor
Xekong/Kaleum
Attapeu/Phouvong
25 25
50
25
12.5
62.5
12.5 12.5
75
15.612.5
71.9
0
10
20
30
40
50
60
70
80
Percentage
Phongsaly/Yot Ou Oudomxay/Namor Xekong/Kaleum Attapeu/Phouvong
Province/District
Continuity of water supply by province
< 50
Between 50-80
> 80
14.5
74.2
11.3
0
10
20
30
40
50
60
70
80
Percentage
Poor Moderate Good
Sanitary status
Sanitary inspection of Gravity Fed System in 3 Provinces
100
0 0
20
65
25
0
15 14.3
0
10
20
30
40
50
60
70
80
90
100
Percentage
Oudomxay: Namor District Attapeu: Phouvong District TotalProvince/District
Sanitary inspection of boreholes in 2 provinces
Poor
Moderate
Good
88.9
11.1
34.8
65.2
38.5
61.5
46.9
53.1
51.9
48.1
0
10
20
30
40
50
60
70
80
90
Percentage
Phongsaly: Yot OuDistrict
Oudomxay: NamorDistrict
Xekong: Kaleum District Attapeu: phouvong Total
Provinces/Districts
General household hygiene by province/district
Poor
Good
55.6
44.4
72.5
27.5
64.3
35.7
63.6
36.4
0
10
20
30
40
50
60
70
80
Percentage
Phongsaly: Yot OU Oudomxay: Namor Attapeu: Phouvong TotalProvinces/Districts
Latrine hygiene by province
Poor
Good
47.6
52.4
45
46
47
48
49
50
51
52
53
Percentage
Poor High
Status
Gender status in 4 Provinces
43.3
56.7
0
10
20
30
40
50
60
Percentage
Poor Good
Status
Community management for water and sanitation in 4 provinces
26.3
73.7
0
10
20
30
40
50
60
70
80
Percentage
Yes No
After having water supply systems family members got diarrhea
9.6
90.4
0102030405060708090
100
Percentage
Yes No
Children with 0-15 year olds got diarrhea in the past two weeks
94.9
5.1
0102030405060708090
100
Percentage
Yes No
Poor families used water as equal as wealth families
23.8
76.2
0
10
20
30
40
50
60
70
80
Percentage
Yes No
Families had latrines in 4 provinces
99.2
0.8
0
10
20
30
40
50
60
70
80
90
100
Percenatge
Open field Dig a hole
Area where family members defecated when they had no a latrine
Relationship between some key Relationship between some key factors and non-sustainability of factors and non-sustainability of improved water supply systems, improved water supply systems, and community management for and community management for
water and sanitationwater and sanitation
Relationship between some key factors Relationship between some key factors and non-sustainability of improved and non-sustainability of improved water supply systems (Breakdown)water supply systems (Breakdown)
FactorsFactors Chi-square Chi-square d.fd.f p-value p-value Poverty Poverty 20.004 20.004 1 0.000 1 0.000 Community satisf 23.74Community satisf 23.74 1 0.000 1 0.000 DRADRA 4.419 4.419 1 0.036 1 0.036 Informed choices 2.282Informed choices 2.282 1 0.131 1 0.131 Financial villageFinancial village 13.699 13.699 1 0.000 1 0.000 Monitoring of Village 2.286Monitoring of Village 2.286 1 1 0.131 0.131
org for Water and Sanitationorg for Water and Sanitation Private sectorPrivate sector 1.027 1.027 1 0.311 1 0.311 Monitoring of Gov staffs 18.114Monitoring of Gov staffs 18.114 1 0.000 1 0.000 Monitoring of Inter ag 31.965 1Monitoring of Inter ag 31.965 1 0.000 0.000
Relationship between some key factors Relationship between some key factors and non-sustainability of improved and non-sustainability of improved water supply systems (Breakdown)water supply systems (Breakdown)
FactorsFactors Chi-square Chi-square d.f p-value d.f p-value Sanitary Inspection of 50.450Sanitary Inspection of 50.450 1 1
0.0000.000water supply systemswater supply systems
Reducing labors and 9.248Reducing labors and 9.248 1 1 0.010 0.010timings of women and childrentimings of women and children
Diarrhea diseasesDiarrhea diseases3.5313.531 1 0.060 1 0.060 Gender participationGender participation 9.8099.809 1 0.002 1 0.002 Village health volunteers1.464Village health volunteers1.464 1 1
0.2260.226 Village committee taken 4.735 Village committee taken 4.735 2 2 0.094 0.094
Care WSCare WS Age of villagersAge of villagers 2.6492.649 2 0.266 2 0.266 Main OccupationsMain Occupations3.2963.296 3 0.348 3 0.348 Ethnic groupsEthnic groups 184.912 184.912 15 15
0.0000.000
Relationship between some key factors Relationship between some key factors and non-sustainability of improved and non-sustainability of improved water supply systems (Breakdown)water supply systems (Breakdown)
FactorsFactors Chi-square Chi-square d.f p-valued.f p-value Level of educationLevel of education 15.603 15.603 6 6 0.016 0.016 SexSex 0.160 0.160 1 1 0.689 0.689 Washing clothesWashing clothes 1.938 1.938 2 2 0.380 0.380 Convenience of using 39.235Convenience of using 39.235 2 2 0.000 0.000
waterwater Satisfaction with job of 6.917Satisfaction with job of 6.917 2 2 0.031 0.031 Village organization for water andVillage organization for water and
sanitationsanitation Training on Community 2.263 Training on Community 2.263 1 1 0.133 0.133
management for water and sanitationmanagement for water and sanitation Far from the city town 1.974 Far from the city town 1.974 2 2 0.373 0.373 Population sizePopulation size 2.376 2.376 2 2 0.305 0.305 Access roadAccess road 19.467 19.467 1 1 0.000 0.000
Relationship between some key factors Relationship between some key factors and community management for water and community management for water
and sanitationand sanitation
FactorsFactors Chi-square Chi-square d.f p-value d.f p-value Age of peopleAge of people 1.288 1.288 2 2 0.525 0.525 Main occupationsMain occupations 17.946 17.946 3 3 0.000 0.000 Ethnic groups 129.357Ethnic groups 129.357 1515 0.000 0.000 Level of education 10.937Level of education 10.937 6 6 0.090 0.090 Private sectorsPrivate sectors 14.523 14.523 1 1 0.000 0.000 Monitoring of Gov 70.742Monitoring of Gov 70.742 1 1 0.000 0.000 Monitoring of Inter 59.729Monitoring of Inter 59.729 1 1 0.000 0.000
agencyagency Sanitary inspection 51.573Sanitary inspection 51.573 1 1 0.000 0.000
water supply system water supply system
Relationship between some key factors Relationship between some key factors and community management for water and community management for water
and sanitationand sanitationFactorsFactors Chi-square d.f p-value Chi-square d.f p-value Community satisfactionCommunity satisfaction 19.431 1 0.000 19.431 1 0.000 Health educationHealth education 71.608 71.608 1 1
0.0000.000 Reducing labors and 5.080Reducing labors and 5.080 2 2
0.079 timings of women and children0.079 timings of women and children Convenience of using water 14.373Convenience of using water 14.373 2 2
0.0010.001 Diarrhea casesDiarrhea cases 7.507 7.507 1 1
0.0060.006 Women participation in 19.632Women participation in 19.632 1 1
0.0000.000water managementwater management
Family latrinesFamily latrines 3.712 3.712 1 0.054 1 0.054 Access road Access road 0.468 0.468 1 1
0.4940.494
ConclusionsConclusions
Even though national water supply and Even though national water supply and sanitation coverage in 2003 were 60.0% and sanitation coverage in 2003 were 60.0% and 43.0% respectively, it does not mean that 43.0% respectively, it does not mean that all villagers with the existing of improved all villagers with the existing of improved water supply systems used enough and safe water supply systems used enough and safe water. water.
From this case study, many villages with From this case study, many villages with improved water supply had problems with:improved water supply had problems with: water quantitywater quantity water qualitywater quality water coveragewater coverage continuity of water suppliedcontinuity of water supplied Cost for O&M Cost for O&M
ConclusionsConclusions
58.6% of villagers indicated that water 58.6% of villagers indicated that water was sufficient throughout the year. was sufficient throughout the year.
They were still needed safe water from They were still needed safe water from other sources like rivers for other other sources like rivers for other purposes purposes
The general hygiene of each household The general hygiene of each household and latrine hygiene were poorand latrine hygiene were poor
Some villagers got diarrheaSome villagers got diarrhea
ConclusionsConclusions
58.4% water supply systems breakdown 58.4% water supply systems breakdown especially small breakdown 63.2%especially small breakdown 63.2%
The main causes of breakdowns were The main causes of breakdowns were poor management of community. poor management of community.
The community management status for The community management status for water and sanitation was poor with water and sanitation was poor with 43.3%. 43.3%.
They had water quality problems during They had water quality problems during raining seasons especially gravity fed raining seasons especially gravity fed systems. systems.
The monitoring of Government staffs and The monitoring of Government staffs and International agencies were poor. International agencies were poor.
RecommendationsRecommendations
Apply rural water supply and sanitation Apply rural water supply and sanitation strategy into local area strategy into local area
Regulation on drinking water quality Regulation on drinking water quality standard management should be standard management should be applied and enforced applied and enforced
Develop clear guidelines on community Develop clear guidelines on community management for water and sanitation management for water and sanitation including water quality surveillanceincluding water quality surveillance
At the district level, develop integrated At the district level, develop integrated planning and monitoring such as local planning and monitoring such as local authorities, NGOs, and private sector authorities, NGOs, and private sector actors. actors.
RecommendationsRecommendations
At community level:At community level: Develop management mechanisms Develop management mechanisms
Encourage community to be the Encourage community to be the
ownership in water and sanitation ownership in water and sanitation managementmanagement
Promote women to be more Promote women to be more participated in water and participated in water and sanitation managementsanitation management
RecommendationsRecommendations
For poor families, appropriate policy For poor families, appropriate policy on contribution in water construction, on contribution in water construction, establishment of financial village, establishment of financial village, operation and maintenance etc.. operation and maintenance etc.. should be developedshould be developed
Encourage people to use widely Encourage people to use widely family latrines-family latrines-
Promote household water treatment Promote household water treatment and safe storage and safe storage
RecommendationsRecommendations
Appropriate technical issues should be Appropriate technical issues should be discussed and fit to the local situations discussed and fit to the local situations
Strengthen Government monitoring Strengthen Government monitoring systems including International systems including International AgenciesAgencies
Promote widely and deeply hygiene Promote widely and deeply hygiene educations to villagerseducations to villagers
Research or case study on why some Research or case study on why some families did not use latrines and families did not use latrines and appropriate technology for improving appropriate technology for improving water quality should be carried out water quality should be carried out
