I’m Paul O’Sullivan, a hygiene promoter currently working in Haiti, where the British Red Cross is working in two large camps in Port-au-Prince; La Piste camp, which has around 40,000 people and Auto Mecca which has 15,000. Our work in these camps includes constructing latrine, hand washing and shower facilities. We are also doing hygiene promotion in the form of community health education, which means making sure communities take ownership of the work by linking with community sanitation committees and local community volunteers.

As part of this work, we are continually assessing not only the quantity, but also quality of the services we provide. It is obviously important that there is sufficient number of latrines for population sizes. The SPHERE Project defines the minimum standards and ratios that humanitarian agencies should strive for throughout all sectors within an emergency response. For example one toilet to 20 people, a figure that is frequently difficult to achieve within the initial phase of an emergency, but which acts to guide minimum standards.

However, in addition to the numbers of latrines provided, it is also essential that we assess and meet locally acceptable quality standards. For the hygiene promoter this is a crucial part of our role. All health promotion work strives to limit the barriers that prevent good health and hygiene behaviour.

To ensure that toilet design, location and maintenance act to support, rather than obstruct successful toilet use, we need to make sure that the use of the latrine facilities that we put in place is the preferred choice for the population using them. Site visits and observational walks allow us to see how well latrines are used and maintained, as well as whether the local populations are using other sites as latrines, defecating in the open (an issue that any festival goer may have experienced), returning to their ruined houses to defecate in existing latrines or defecating in plastic bags.

Boys brainstorming good toilet design

Focus group discussions are also useful. In the urban camps of Port-Au-Prince, community members complained they did not like the design of the latrines, so I met with the sanitation committee of the camp to discuss latrine design. The camp is made up of people from a number of populations who come from diverse communities affected by the earthquake so we are potentially working with population groups who may have very different original experiences of hygiene practices and latrine design, management and maintenance.

We also need to take into account that the effects of a major disaster and change of normal environment, with vastly reduced resources and support systems, frequently leads, at least at initial stages of an emergency, to highly compromised health behaviours. In effect people don’t necessarily behave as they would…again, something that festival goers may appreciate.

Dramatic increases in the population of these camps means we need to work with them in smaller groups or zones in order to be able to respond effectively. To identify the layout and demographic mix within the camp, we completed a community mapping exercise, in which people developed their own overview of the camp, adding various water and sanitation details, where there are toilets and open areas people have been using, where they access water,  dangers like areas of large fly or mosquito populations.

Community sanitation mapping

It also showed us where there were populations with no latrine or water sources, providing an overview that is difficult to gain otherwise, and all from a community perspective.

Our aim is to have the sanitation committee identify managers for these zones who will organise latrine attendants and garbage cleaners to improve environmental hygiene and latrine cleaning.

Following the mapping, we began our focus group discussions. We did this with both adults and children, to see if there were specific needs for children we should also consider. Firstly we brainstormed, ‘what makes a good toilet?’ The factors they came back with were many, but included: a seat with a lid, a solid structure made from wood, that it can be locked, enough space, cleanliness, availability of toilet paper and hand washing facilities. It isn’t rocket science, but we need to ensure that we are aware of these things in our planning.

Girls designing toilets

There are currently four different types of latrines in the camp. To get feedback on each of them we visited them individually….and the committee explained their likes and dislikes for each design. This then led to discussions about what they really wanted.

Wooden latrines

Following visits to the latrines, brainstorming and the Focus Group discussion, the steering group divided in to groups of men and women and designed their perfect toilet. The designs were then presented and discussed by the whole group. A final design was agreed by all.

New latrines under construction...

New latrines under construction...

As a result of this exercise asking communities what they wanted, the Red Cross has designed a prototype which will be presented to the sanitation committee as soon as possible. We hope that through this work we are now able to provide secure, safe and desirable latrines which will not only improve the living conditions in the camp but perhaps restore some dignity for the earthquake affected people in Haiti.

...and the finished product!