Memoire Online - Sanitation in urban and peri-urban areas of Cap-Haitien: the promotion of different latrine options through a social marketing approach

Sanitation in urban and peri-urban areas of Cap-Haitien, Haiti: The promotion of different latrine options through a social marketing

Abstract

This dissertation presents a study done in Cap-Haitien, Haiti with the non-governmental organisation Oxfam, aiming at analysing the sanitation situation in urban and peri- urban of the city, and putting forward recommendations to implement in a development project.

Urban slums pose unique problems given the high level of poverty, low implication

of public services and lack of infrastructure. Excreta management has a particular inci- dence on water-related diseases, yet sanitation coverage is frequently low in these areas. Some technical solutions exist, but the problems of pit emptying and raising demand for latrines have to be addressed. Social marketing can be a way to raise demand and work towards sustainable sanitation.

A range of tools have been used for the research, including interviews with key infor- mants, field visits, a household survey, a workshop with partner organisations, a focus group discussion to assess the willingness to pay, and a pilot test of an ecological latrine.

Findings indicate that the low existing coverage comes mainly from the inadequa- tion of past and current practices: the outcome of previous supply-led subsidised pro- grammes is an unsustainable sanitation system, with expensive latrines, and unreliable and unsafe emptying services.

Alternatives would need to be suited to the particular constraints expressed in each area. Ecological sanitation could have some potential where urban agriculture is prac- tised, with a simple model such as the Arborloo. In low-lying areas with higher hous- ing density, improved products such as small low-cost latrines could raise demand, but would need to be coupled with a reliable emptying system. First assessments of the will- ingness to pay are encouraging but need further research; more links between the public and private sectors would also be necessary, especially regarding the final disposal.

This research encourages Oxfam to investigate the sanitation marketing option, while still being flexible to adapt solutions to the local context. Future research could also be done to compare Cap-Haitien's situation with other cities of the developing world.

Acknowledgements

I first thank Oxfam for making this placement happen, and in particular my supervisor

I am deeply indebted to Guettie Noël who acted not only as my translator, but also

as my assistant and facilitator during the study, and whose work also helped me to understand the Haitian culture; many thanks also go to her welcoming family.

I am grateful to Sonia Heaven, my supervisor in the United Kingdom, for her contin- uous support and advice, and to Ben Fawcett for sharing his experience and suggestions.

This research was to a great extent done in collaboration with the London School

of Hygiene and Tropical Medicine, and in particular with Steven Sugden who kindly accepted to come to Cap-Haitien, and Beth Scott who advised me with the demand tool.

Oxfam staff in Cap-Haitien was always supportive and contributed to the success of

the research: many thanks to Laurence Hamai, Samuel Mondestin, Anne-Flore Leroy, Hernal Cadet, Jean-Reynald Etienne, Valery Laguerre, Berly Raphaël, Nadège Joanis Noël, Gemps Célestin and to Haiti programme manager Yolette Etienne.

I received useful advice from the WASTE institute, thank you to Arnold van de Klun- dert and Mirjam Geurts.

Final thanks go to inhabitants of Cap-Haitien who participated in the survey, those who accepted to spend some time for interviews, women from Fanm pa chita for their participation in the focus group discussion, and the Roboam family for accepting to test

1.1 Context of research . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9

1.2 Sanitation and urban slums . . . . . . . . . . . . . . . . . . . . . . . . 12

1.3 Structure of the dissertation . . . . . . . . . . . . . . . . . . . . . . . . 13

2.1 Approaches to sanitation . . . . . . . . . . . . . . . . . . . . . . . . . 15

4.1 Programme . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 23

4.2 Methodology . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 23

4.3 Limitations . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 30

5.1 Areas of the city . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 32

5.2 Sanitation situation . . . . . . . . . . . . . . . . . . . . . . . . . . . . 35

5.3 Inappropriate practices . . . . . . . . . . . . . . . . . . . . . . . . . . 44

5.4 Alternative options . . . . . . . . . . . . . . . . . . . . . . . . . . . . 48

6.1 Limitations of the research tools . . . . . . . . . . . . . . . . . . . . . 56

6.2 Is sanitation a priority? . . . . . . . . . . . . . . . . . . . . . . . . . . 58

7.1 Achievements . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 61

A	List of appendices		67
B	Semi-structured interviews		68
C	Focus group discussion		69
D	Sustainable excreta disposal		70
E	MDG calculations		72
E.1		Population and coverage estimates . . . . . . . . . . . . . . . . . . . .		72
E.2		Cost of a latrine . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .		73
E.3		Total cost to achieve the MDGs . . . . . . . . . . . . . . . . . . . . . .		74

F.1 Components . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 75

1.1 Map of Haiti . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 10

1.2 Aerial view of Cap-Haitien. . . . . . . . . . . . . . . . . . . . . . . . . 11

2.3 A «frogman» in a latrine pit, in Dar-Es-Salaam . . . . . . . . . . . . . . 21

5.8 The finished test Arborloo in Mansui . . . . . . . . . . . . . . . . . . . 51

5.1	Summary of differences between the areas	. . . . . . . . . . . . . . .		34
5.2	Defecation methods in each area . . . . . .	. . . . . . . . . . . . . . .		36
5.3	Sustainability of current sanitation options, result from the Oxfam-GTIH-
	MSPP workshop . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .		45
E.1	Population and latrine coverage estimates . . . . . . . . . . . . . . . .		73
E.2	Cost of some elements of a «standard» latrine . . . . . . . . . . . . . .		74
E.3	Total cost to achieve the MDGS in Cap-Haitien . . . . . . . . . . . . .		74
F.1	Components of a low-cost latrine . . . . . . . . . . . . . . . . . . . . .		76
F.2	Detailed pricing of a low-cost latrine elements . . . . . . . . . . . . . .		77
F.3	Financial viability calculations . . . . . . . . . . . . . . . . . . . . . .		80

Arborloo A type of ecological latrine, in which a fruit tree is planted in the pit after use; also known as the «single-pit walking latrine».

Gourde The local currency (also written Gde or HTG), fairly stable during the re- search at 38-39 Gdes = US$ 1, often rounded at 40 Gdes = US$ 1. Haitians frequently count sums bigger than 5 Gourdes using the non-existent Haitian Dollar (HT$), with 5 Gdes = HT$ 1, and HT$ 7,7 - 8 = US$ 1. During in- terviews and discussions, the Haitian dollar was the preferred currency.

EPPLS Entreprise Publique de Promotion de Logements Sociaux - Public Enter- prise for Promoting Social Housing

MINUSTAH Mission des Nations Unies pour la STAbilisation en Haïti - United Na- tions Mission for Stabilisation in Haiti.

PHAST Participatory Hygiene And Sanitation Transformation PROTOS PROjectgroep Technische OntwikkelingsSamenwerking vzw NGO Non-Governmental Organisation

1 Introduction

In the city of Cap-Haitien in Haiti, the British Non-Governmental Organisation (NGO) Oxfam, the Belgian NGO PROTOS and the local NGO GTIH have successfully obtained funding from the European Union (EU) in order to conduct a 4-year project in Water and Sanitation, directed at poor areas of the city. The project includes the rehabilitation

of the water supply system, creation of drainage channels for rainwater, implement- ing a solid waste management scheme, a «social engineering» part aimed at improving people's behaviour, and the reinforcement of public services. In order to gain a better understanding of how the sanitation part should be achieved, a 3-month research has been carried out in Cap-Haitien.

1.1 Context of research

Haiti is located on the island of Hispaniola in the Caribbeans, West of the Dominican Republic (map on Figure 1.1 below). Despite becoming the first independent «Black Republic» in 1804, it has since known numerous authoritarian regimes and presidents elected for life. In the second half of the 20th century, the ruling of the father and son Duvalier and their secret police organisation (the «bogeymen»), then of Jean-Bertrand Aristide have left Haiti as the poorest country in the Western hemisphere and one of the Least Developed Countries (LOC, 2005).

In 2004, the Aristide government was overthrown by rebels, starting a period of riots and violence until the intervention of the multinational force from the United Nations,

the Minustah. In early 2006, elections were held and René Preval became president, promising peace and stability. The Minustah is still present in the country.

Haiti's economy is largely based on agriculture (70% according to CIA, 2006), mostly small-scale subsistence farming, and informal economy. Unemployment rates are be- tween 50% and 70% (ibid.). Cash crops include coffee, mangoes, sugarcane and rice, though prices have collapsed due to massive imports from the USA. The external debt has reached US$ 1.4 billion in 2006, 11% of the Gross Domestic Product (GDP), but Haiti will not qualify for debt relief programmes before 2009; inflation is above 20%

and the GDP growth is negative since 2000, reaching now -3.5%. With regard to these

figures, Haiti is «becoming poorer every day» (as it is commonly heard locally).

Population is estimated at 8.53 million inhabitants, of which 2.5 to 3 million in the capital Port-au-Prince. The terrain consists mainly of rugged mountains with small coastal plains and river valleys. Heavy deforestation for charcoal production has af- fected all but 2% of the original forest cover, leading to desertification, soil erosion and more recurrent floods.

Cap-Haitien is the second biggest city in Haiti after Port-au-Prince; it comprises 120,000 inhabitants officially, but between 500,000 and 800,000 according to more recent sur- veys. Situated in the Nord department, it used to be the historical centre of Haiti and the preferred destination for tourism, with favoured beaches, a harbour for cruise ships and historical sites. Since the 1970s, poverty and emigration from rural areas have trans- formed the city. In the 1980s, Cités were constructed as cheap housing areas close to

the mangrove, with basic infrastructure. However, areas have also emerged at the same time on the mangrove, often by dumping solid waste in it to create a firmer ground¹.

The city now comprises the historical centre, with mountains on the West and low- lying lands in the South and East. The city has progressively expanded South and East over the mangrove, and West as slums developed over the hillside. Figure 1.2 below presents an aerial view of the city and Figure 1.3 is a view from a nearby hilltop. Hur- ricane Jeanne badly affected the North of the country in 2004, causing heavy floods, mudslides and about 3,000 deaths, a significant part of them in Cap-Haitien.

An assessment was carried out in Port-au-Prince and Cap-Haitien in 2003 for Oxfam

(Walden et al., 2003), focusing on water, sanitation and health. It reported a deteriora- tion of health conditions and put forward recommendations which were used to create

The city centre is visible in the North, and the hills on the West. Recent expansion of the city are visible in peri-urban areas in the South, and dense slums are located in the

Oxfam has been doing development projects in Haiti for 30 years, and humanitarian in- terventions after the 2003-2004 crisis. In Cap-Haitien, a project financed by DIPECHO has been supporting disaster preparedness and mitigation work by the creation of Lo-

cal Committees for Civil Protection (KLPS) in order to reduce vulnerability to natural disasters.

Oxfam has started a 4-year water and sanitation project in summer 2006 together with partners PROTOS and GTIH, with funding from the European Union, in order to improve access to safe water and sanitary conditions in poor areas of Cap-Haitien. it includes the rehabilitation of the water supply system in low-lying lands, where water is currently

trucked; provision of sanitation services, including storm water / wastewater drainage and solid waste removal; improving the health behaviour of the targeted population; and building the capacity of the public sector (Oxfam, 2006).

Regarding excreta management, the project includes a «definition of an acceptable model of familial or multi-familial latrine»; a budget of US$30,000 is allocated to la- trine building, for about 100 pilot latrines. The project states that in target areas, open defecation is practised by 44.2% of respondents², plastic bags are used by 33.8%, 19.4%

1.2 Sanitation and urban slums

About 900 million people were considered slum dwellers in the world in 2005 (Garau

et al., 2005); this represents about one third of urban dwellers in developing countries. Combined to the high birth rate in these countries, emigration from rural areas is the major growth factor in developing cities, with immigrants choosing to turn away from their isolation in hope of better education and jobs. However, municipalities are often not prepared to welcome this mass influx, resulting in unplanned and often «illegal» settlements. 78% of urban citizens are slum dwellers in the least developed countries. UN-Habitat (2003) estimates that there would be 1.5 billion slum dwellers by 2020. However, poverty reduction strategies are still largely focused on rural development, according to Mitlin (2004), and municipalities treat slums at best by ignoring them, but

also by seeing them as a «problem» or by bulldozing them (Garau et al., 2005). Two

common approaches have been tried since the late 1960s, slum upgrading and housing finance systems. Slum upgrading is often done at small scale, unable to reach most of

the slum dwellers; housing financing systems often comprise «inappropriate conditions for the slum dwellers» (ibid.).

«by 2020, improving substantially the lives of at least 100 million slum dwellers, while providing adequate alternatives to slum formation.»

which is a twofold challenge, as it addresses both issues of present slums and future housing policies. Most recent operational recommendations comprise the recognition of slum dwellers as active agents of development, improvements of governance, supporting pro-poor policies and empowering local actions (ibid.).

«Halve, by 2015, the proportion of people without sustainable access to safe drinking water and basic sanitation.»

If the world population without access to safe drinking was around 1.1 billion in 2000, there were 2.4 billion without access to sanitation according to WHO-UNICEF (2000). Poor sanitation is responsible for the propagation of feacal-oral diseases, such as diar- rhoea (4 billion cases annually and 2.2 million deaths) or intestinal worms (ibid.). It is estimated that water, sanitation and hygiene interventions can reduce diarrhoeal diseases

The urban poor, and especially the children, are known to be more at risk (Mara,

1996a). But sanitation interventions are harder to conduct in slums: high population densities mean that many technological options are not feasible; slums are often situ- ated on low-value land, such as flood-prone areas or unstable hill slopes; high levels

of poverty mean that the beneficiaries' contribution or willingness to pay would be low and a project would have to invest more for the same result.

1.3 Structure of the dissertation

This dissertation presents the research and its findings. A summary of the literature review can be found in Section 2, presenting the different approaches of sanitation and

the principles of sanitation marketing. Section 3 (page 22) describes the objectives and

sub-objectives of the research, and the methodology is presented in Section 4 on page

Findings from the study are shown in Section 5 on page 32, presenting the division of

the city in typical areas, a review of the defecation practices and associated technologies,

an analysis of the situation, and possible options which can be implemented in order

to achieve sustainable sanitation. Section 6 (page 56) discusses the limitations of the study, and the possibility that sanitation may not be a priority. Conclusions are finally presented on page 61 with recommendations for the project and future research.

2 Background: Sanitation and

Marketing

In this dissertation, the term of «sanitation» refers to excreta management, which is one part of environmental sanitation. Environmental sanitation comprises the safe disposal

of human excreta, wastewater and rainwater, and solid waste (Cairncross & Feachem,

The last point is subject to debate, in order to consider a sanitation system «ecological»

or not (see Winblad & Simpson-Hébert, 2004). This literature review develops several aspects of sanitation which are relevant to the research. First, different approaches of sanitation are considered (Section 2.1), Section 2.2 presents in more detail the concepts behind sanitation marketing, and the particular problem of pit emptying in urban areas

2.1 Approaches to sanitation

Sanitation has been approached in various ways in the past. The stress is now put more

on «sustainable sanitation» and «improved sanitation» as proposed by the MDGs and

the Water and Sanitation Programme (WSP). If «improved sanitation» is clearly defined

by the WSP (as including sewer / septic tanks / pit latrines, but excluding bucket, open and public latrines, see WHO-UNICEF, 2000), «sustainable sanitation» remains a blur concept, for which definitions are hard to find in literature. An attempt to define it is presented in Appendix D on page 70, extracted from Jenkins & Sugden (2006).

For Black (1998), the last 30 years can be divided in several types of approaches for water and sanitation programmes. The «appropriate technology» phase from 1978 to

1988 focuses on low-cost technologies, mostly proposed by engineers from developed countries; the Water and Sanitation decade introduced then a change from hardware to

software between 1988 and 1994. As the urban sanitary crisis was growing, policies

Latrine construction programmes driven by the supply side are still frequently found. Mukherjee (2000) claims that many failures in past sanitation projects come from «myths»: that sanitation coverage directly has a health impact (while it requires also some be- haviour change), that demand-responsive approaches do not work for sanitation (while

they seem even more important than for water projects), that water supply and sanitation should always come as a «package» (but users perceive it often very differently, and the levels of demand are rarely similar).

For Klundert & Scheinberg (2006), sanitation is too often the «poor parent» of water programmes, which adopt «the well-known rural water and sanitation approach». Jenk-

ins & Sugden (2006) criticise this integration with the water supply side by noting the differences in timescale, decision-making processes, time to create demand and skills required between water supply and sanitation.

The question of subsidy is also criticised (ibid.), as incorrectly applied subsidies cre-

ate dependency, poor use of public money, absence of replication and affordability, and often the inability to reach the poor.

Ecological sanitation (or «eco-san») is based on three principles: preventing pollution rather than trying to control it, sanitising the excreta, and re-using it for agricultural purposes (Winblad & Simpson-Hébert, 2004). Several systems exist for this purpose,

all transforming human excreta into compost, such as double-vault dehydrating toilets, biogas production systems, the Arborloo, etc. For Morgan (1999), «Ecological sanita- tion is a system that makes use of human waste and turns it into something useful and valuable with a minimum of risk of pollution of the environment and with no threat to human health.»

Supporters of ecological sanitation claim that it can address many of the issues of urban development, such as water pollution, food insecurity, low income and of course poor sanitation facilities (Winblad & Simpson-Hébert, 2004). It is however criticised by Klundert & Scheinberg (2006) based on experiences in African cities, for three reasons: ecological sanitation is largely based on the willingness from the users to handle dry

faeces, which is far from evident in most cities¹; many systems are based on urine

¹Even Winblad & Simpson-Hébert (2004) acknowledge that «faecophilic societies» are rare and quote

separation, yet urine is rarely collected and ends up polluting the groundwater; other

on-site sanitation systems are often used in parallel with eco-san, ecological toilets do not fill up and are rarely emptied.

Sugden (2006) classifies ecological latrines in five types. Of these five types, only two latrines do not imply urine separation (the double pit composting latrine and the single

pit walking latrine), and only one does not rely on manual handling of the composted faeces: the single pit walking latrine, also known as the Arborloo.

«This is the simplest type of latrine and the one that involves the least amount of behaviour change from the conventional pit latrine. Anybody who has planted a tree in a full latrine pit can be said to be practising eco- sanitation.

A shallow pit (1.2 m recommended) is dug and a slab and easily movable superstructure placed on top of it. The family uses the latrine, adding the mixture of soil and ash after each use, until it is three quarters full (usually between 4 and 9 months). After this the slab and the superstructure are moved to another pit. A layer of soil is added to the full pit and a sapling placed into the soil. The tree grows and utilises the compost to produce large, succulent fruit. After a few years of latrine movement the result is

an orchard that is producing fruit with a real economic value. The super- structure can be made from any locally available materials e.g. grass, reeds etc.»

See Figure 2.1 below for its representation. The Arborloo can have the following im- pacts:

However, it still relies on the presence of urban agriculture, sufficient space for digging

the pits, and the lack of reluctance from the users to eat food which has grown using such a fertiliser.

The Total Sanitation Campaign (TSC) is an alternative developed in India, for rural ar- eas, by the Department of Drinking Water Supply (DDWS, 2005). Its aim is to eradicate open defecation and improving sanitation facilities with no or low subsidy, by using par- ticipatory tools within the community to create change and raise demand for improved sanitation. Reports claim that this option can achieve 100% coverage in a community (ibid.), yet it is not clear whether it can be applied to urban sanitation as well.

Demand-oriented policies correspond to what Heierli et al. (2004) call «the new paradigm»,

in reaction to traditional subsidised programmes. They advocate a greater involvement

of the private sector to provide better solutions and create demand, along with a stronger public sector to encourage desirable behaviours and discourage bad ones. One of the ideas of this new paradigm is to use marketing as a tool to raise demand and provide more suitable sanitation options; the so-called «sanitation marketing» is described in the next section.

2.2 Sanitation marketing

The main motivation behind sanitation marketing is the observation that, in many coun- tries, most latrines are privately acquired rather than provided by sanitation programmes (Jenkins, 2004). According to Cairncross (2004):

mand, a marketing approach encourages the private provision of household sanitation, while simultaneously promoting new demand. [...] Marketing consists of activities by which you reach customers and persuade them to buy and use a product or service.»

· «It ensures that people choose to receive what they want and are willing to pay for.

· Provision of hardware is not enough, and marketing (with its four component strategies) is proven and highly effective way to build demand.»

For sanitation programmes, marketing essentially means: using a commercial approach

for delivering sanitation products and services; building the private sector to make it sustainable, by removing constraints; use marketing techniques and promotion to raise demand; and develop partnerships between the public and private sector.

Marketing is formed of the «four core P's»: Product, Price, Place and Promotion; social marketing adds sometimes a fifth P, Policies, to refer to partnerships with the public sector (Heierli et al., 2004). In sanitation, the four P's can be described as follows (Cairncross, 2004):

Product: The «product» can refer to a latrine, or to a service such as pit emptying. It must respond to what people want, and be innovative to alleviate the constraints people face.

Price: Most of those who need sanitation are poor, and can least afford it. Costs must

be kept low, different products must be marketed within a range of prices includ- ing very low-cost options to release demand.

Place: Potentially each household has to be reached by the supply chain, for example

Promotion: It includes advertising techniques but also ways to raise attention such as promotional offers or vouchers, demonstration latrines, credit system, etc.

Jenkins & Sugden (2006) distinguish four phases in a sanitation marketing programme, whose aims are to analyse the three aspects of demand, supply and environment. Phase one is a rapid initial assessment of sanitation coverage, demand and industry; phase two

is an in-depth assessment researching the service providers, communication channels,

levels of demand and policies development. It leads to a strategy implemented in phase

The present research is focused on the qualitative consumer research and the con- sumer sanitation demand baseline survey, in phase two.

2.3 Latrine pit emptying

Apart from sewered systems and ecological sanitation, most low-cost sanitation systems rely on emptying at some point. Options for sustainable latrine pit emptying are limited. The «classic» view on the topic as mentioned in many textbooks (Mara, 1996a; Pickford,

1995) is to use vacuum tankers or a form a sewerage (settled or simplified). Field manuals like Pickford & Shaw (1999) quote the same techniques, or sometimes the use of double-pit latrines, allowing the contents to settle and to be removed by hand when all pathogens have died. However, those techniques have drawbacks limiting their use in urban environments: vacuum tankers are expensive to operate as they consume too much fuel, they wear rapidly and can access neither high-density housing areas, nor peri-urban squatter settlements given their size (Muller, 1997). Sewerage systems require investment, careful operation and maintenance, are not suited to any type of terrain and definitely not to flat areas next to the sea (Mara, 1996b). Double-pit latrines require space for digging, but also for the superstructure in case of dry pits.

Other systems have been developed, most notably the Vacutug (see Figure 2.2 below)

and affiliated systems, which involve a smaller vacuum tanker with either a mechani-

are self-propelled (Maqunieta, Vacutug), other are trailer-mounted (Minivac, Micravac) and the MAPET is pushed/towed manually. First reports on these systems are usually positive, especially when they come from the organisation which promotes them such

as UN-Habitat for the Vacutug (Wegelin-Schuringa & Coffey, 1998). However, later reports such as Klundert & Scheinberg (2006) state that the MAPET has failed because

of high transportation costs, lack of network transfer points, and the diversion of fund- ing to other projects. The Vacutug is in operation in Dar-Es-Salaam, but only one such device is still operational and needs subsidies to operate (ibid.) There is no evidence that the Micravac, Maqunieta or Minivac have gone beyond the pilot project phase.

The two common alternative in absence of these systems is either to build a new la- trine if there is enough space, or to use pit emptiers who do it with buckets and shovels, such as the vyura («frogmen») of Dar-Es-Salaam (Figure 2.3). As they have to work

in the pits, their working conditions are unsafe; the transport of excreta remains an un- solved problem; the cost can be as high as with mechanical emptying devices according

to Still (2006); the emptiers often have to break the slab, adding the repairing cost. Despite this, emptiers are the de facto solution where nothing else exists.

3 Objectives

The main objective was originally to produce a methodology which Oxfam can use in

the rest of their project regarding excreta management. After consultation with Oxfam staff in England, it was proposed that the main objective should be revised to an evalu- ation of the excreta management situation in Cap-Haitien, and putting forward recom- mendations for possible options. The originally suggested methodology was to involve Sanitation Marketing; further discussion with Steven Sugden for the London School of Hygiene and Tropical Medicine (LSHTM) helped to understand this topic, and to realise that marketing is only part of the available options.

1. Gain an understanding of Cap-Haitien's situation, the problems of sanitation in slums, and social marketing techniques by completing a literature review.

2. Analyse the sanitation situation in Cap-Haitien: Identify the different stakeholders (public, private, beneficiaries, NGOs...) and their capacities, analyse the current defecation practices.

3. Analyse social, economic, cultural and motivating factors affecting sanitation choice in Cap-Haitien, and identify problems and constraints.

4. Put forward recommendations which could be implemented as part of the EU Water & Sanitation project, and identify limitations of such recommendations.

The original final objective proposed by Oxfam was to design a methodology for pro- moting different latrine options which could be implemented within the project. How- ever, this was found to be both too restrictive (as it was limited to «latrine options» thus hardware) and too wide (as designing a whole methodology could be considered out of

4 Description of research

4.1 Programme

The research was divided in three parts: the background literature review (Section 2) was carried out in May, June and early July 2006, along with meeting Oxfam staff in Oxford to get information on Haiti. Eleven weeks were then spent in Cap-Haitien, and

the dissertation and reports were written back in England. The original work programme

· 2 weeks for the introduction, semi-structured interview with main stakeholders

(Section 4.2.1), visiting the area (Section 4.2.2) and investigating past projects.

· 1 to 2 week to prepare the survey, test it, and plan where to do it in terms of target areas and number of households.

· 2 to 3 weeks were left for further work depending on the survey results, which could include focus group discussions and / or in-depth interviews.

This programme was mostly followed for its first part; after the survey, the researcher was very fortunate to have Steven Sugden, from the London School of Hygiene, to come during a week and perform some of the activities with him. Thus the final three weeks consisted in conducting a focus group discussion (Section 4.2.4), organising a workshop with partner organisations (Section 4.2.5), following up a part of the survey in Mansui, testing the Arborloo in this area, and presenting findings to the staff.

4.2 Methodology

A range of key informants were interviewed in a semi-structured way, in order to get

a better idea of the different stakeholders in sanitation in Cap-Haitien. The objectives were different for each organisation, but usually included: the level of involvement

in sanitation; its capacities, assets, current and past projects; its problems and possible

solutions; the relationships the organisation has with other organisations from the public and private sector and NGOs; the way sanitation is perceived and addressed.

· The City Council, with Mr. Paul Calixte, deputy Mayor, as they have built three public latrines in the city centre.

· The Ministry of Public Health and Population (MSPP); partly with Dr. Robert Jasmin, head of the Ministry for the Département du Nord, and partly with the seven technicians responsible for sanitation. The MSPP used to be responsible for latrine construction and latrine pit emptying some 15 years ago.

· The Délégation is the governing body of the Département du Nord (North Re- gion). The researcher met the Délégué (head of the Délégation) who is aiming at coordinating the actions of all NGOs in the area.

· The local NGO GTIH (Groupement Technologie Intermédiaire Haïti), with Wedner Saintidor, head of the Cap-Haitien office. GTIH takes part in the EU-funded project, and is supposed to be responsible for the sanitation part.

· The EPPLS (Entreprise Publique de Promotion de Logements Sociaux), with Henry Claude Hilaire, which is an autonomous organisation involved in social housing countrywide; they are also managing the communal latrines in those housing es- tates.

· Through EPPLS, it was possible to get in contact with bayakous, who are the people emptying latrines. A meeting was organised at daytime, but it was not possible to meet them while they were working, as they only work at night. The meeting was nonetheless useful to understand their working conditions.

· The organisation FEKOKAP (Fédération des Comités de Quartier de Cap-Haïtien), with Dr. Daniel Albert. It is a federation of local area committees, and has fi- nanced some small water & sanitation-related projects in the last years, including

· The private company Jedco which is the only company doing latrine pit emptying

in the city. The researcher met Jacques Pierre, local manager, on two occasions.

· The private company SaniPlus was interviewed on the phone as they do not have

an office in Cap-Haitien. They are involved in the management of hospital haz- ardous waste, and it was thought that their business model could be applicable to the project.

In addition, the researcher met representatives from various CBOs. Only two of these

CBOs were currently doing activities related to sanitation, but most of them were willing

to, presumably because they knew Oxfam had money to spend in this area. The only

organisations even slightly involved in sanitation were ORCH (Organisation pour la

rénovation du Cap-Haïtien) removing solid waste in the city centre and UJDM (Union des Jeunes De Marchand) who renovated an old public latrine. Other organisations interviewed included the Comité Solidarité de Madeline (involved in social housing), Comité APUP (involved in «road building» by buying solid waste) or Comité Ti Marc (involved in cleaning drainage channels)

The interviews were semi-structured, meaning that the researcher used a set of ques- tions or topics as a guide during the conversation, but the questions were not formal:

the aim was also to let the interviewees speak by themselves, so that they could express their own perceptions and problems. See Appendix B on page 68 for an example of questions asked, in this case with the head of the MSPP.

· to analyse rapidly the existing sanitation conditions in different areas; this in- cluded visible practices but also an inspection of communal and public latrines, when possible.

· to identify physical constraints such as soil conditions, water table proximity, wa-

· to try to identify human constraints such as level of poverty, access to services, etc. : during those visits, it was often possible to meet a member of a local com- mittee who would act as a key informant, leading to other key people in the area.

· using those results, divide the city in different types of areas with regard to the possibilities and limitations for potential sanitation solutions. By doing so, it would then be possible to try an option as a pilot project in a given area, and then

This division has not been made solely using the field visits but also using feedback from the interviews, and experience from Oxfam staff; as most of them are locals and have grown up in Cap-Haitien, their experience and perception of the city has helped

Once this classification into different areas has been done, a household survey has been undertaken in sample areas. The objectives were to answer questions from this research and also to be useful to the local staff by providing valuable information on current practices. Thus, the objectives were:

· to have a better idea of current defecation and associated practices (such as hand-

· to get data on the possibilities for sanitation marketing, which includes the level

of demand for improved products, the state of the current supply chain and com- munication channels.

A first questionnaire was used as the basis for this survey, coming from past surveys conducted by the London School of Hygiene and Tropical Medicine (LSHTM); the ques- tionnaire was mainly aimed at gauging the demand for improved latrine products and services, thus called «the demand tool». It was altered to include specific objectives for this research. The final questionnaire is included in Appendix G on page 82; before reaching this form, it undertook several alterations, using comment from various people including local Oxfam staff, the researcher's supervisor and academics from LSHTM.

It was decided to switch from closed questions to more open questions, without hav- ing tickboxes matching possible answers; open questions avoid influencing the respon- dent and allow the researcher to analyse the results without having a fixed workframe in mind. The aim was not so much to get proportions of people in a given situation as to

The final questionnaire comprises 5 sections: Socio-demographic aspects, current defecation practices, latrine owners, non-latrine owners, and economics. The respon- dents would answer either section 3 (latrine owners) or 4 (non-latrine owners), which limited the total time per interview to less than 20 minutes. The questionnaire comprised

an additional «Observations» part. The interviews started with an opening statement in- troducing the researcher and the assistant, explaining the aim of the study and asking politely whether selected people would have 20 minutes to spare; a closing statement thanked them and asked for additional comments or queries.

The questionnaire was tested with some Oxfam staff members, and subsequently in the field. The order of the questions appeared to be a sensitive topic. It was decided to keep

the most sensitive questions for the end. Surprisingly, these were about income and occupation, which seem to be quite sensitive with Haitians: these questions had to be asked tactfully and sometimes with explanations regarding their purpose. Conversely, asking about current defecation practices was not perceived as offensive even by people who practise open defecation; this may have been helped by the fact that the assistant

introduced herself as a Public Health Ministry worker, who are known to deal with such

Another issue was about the different latrine types: the original form included the question «Which type of latrine do you think is best», which appeared to be a meaning- less question in Cap-Haitien: either people had «a latrine», or they had none, as many thought that only one type of latrine exists. Finally, a supplementary question was added about public toilets: what respondents would think of one in the area, and how much they could pay to go in one. It was added partly in order to assess their willingness to pay

for sanitation, but partly because the local Water and Sanitation engineer liked the idea

of communal or public toilets, obviously as they are easy options from an engineering point of view.

The survey was conducted in four different zones, reflecting the analysis described in Section 4.2.2: Bas-Ravine, Shada, Petite-Anse and Mansui were surveyed. No zone was surveyed for the fifth type of area (better quality housing) as it was felt that they were less of a priority. A total of 103 households have been interviewed, from 20 to 34 in each area depending on the variety of responses. The choice of interviewees was restricted

to the heads of households only, in order to be able to ask about intention to buy or household income. This restriction could have led to a majority of male interviewees and thus a gender bias; however a previous survey (Valdez, 2005) has shown that almost half of the heads of households are women, which also appeared in this survey as 60%

The choice of households had to be random; however the limited time of this study meant that it was not possible to adopt fully random methods as recommended in hand- books such as Gosling and Edwards (2003). Instead, a pseudo-random method was chosen, as advised by Oxfam staff, which seems a common practice: starting from a central place in the area, the researcher would follow a certain line and pick the tenth house (or fifth house in less densely populated areas) on the right, then the tenth (resp. fifth) on the left, and so on. This would be repeated in different directions, in order to cover most of the area.

While the questionnaire was written in French to allow easy analysis further on, the questions were asked in Creole, either by the researcher for simple ones or by his as- sistant for more complex questions. Most of respondents did not speak much French and gave their answers in Creole, which could usually be understood by the researcher but were translated anyway. All households were surveyed by the researcher and his assistant, without the need for a team of interviewers.

Data was analysed using a simple spreadsheet. While making statistics was useful, noting down key sentences said by respondents was particularly useful to determine trends. Part of the analysis can be seen in Appendix H.

During the survey, it was found that one of the areas (Mansui) had benefited from

a USAID-funded latrine-building programme two years before, and all beneficiaries of this programme who were interviewed during the survey said they were dissatisfied with their latrine, for various reasons. It was decided to investigate this further by interview- ing other USAID latrine owners in the area. The whole questionnaire was too long to be used again; an informal interview took place instead with available households, concen- trating on how satisfied they were with their latrine and what were its advantages and drawbacks.

Following the survey and consultation with Steven Sugden, it was found that the area of Shada could be an interesting target area for a product-service package design approach (see Section 5.4.3). Some more in-depth study of the demand and real willingness to pay was required, and it was decided to conduct a focus group discussion (FGD) in this area. Given the time available, it was possible to carry out only one FGD, but more would be necessary in order to get more meaningful results.

The objectives of this FGD were both to complete the survey's shortcomings and to help design the product-service package:

· Know their aspirations: the survey only asked what they would do first if they had a bit more income. While this gives an idea of their immediate priorities, it

did not inform about their aspirations and values, which are relevant to the way a product would be promoted.

· Know more about demand for improved products, and their willingness to pay for

a particular product or service (in this case, for a low-cost latrine and a regular emptying service).

· Address the constraint of space by asking which size could be reasonably accom- modated by most households.

The questions asked can be seen in Appendix C on page 69. During the survey, a woman was interviewed who belongs to a group called Fanm pa chita («Women not sitting down»), a organisation of women who remove mud and place cement blocks on

the ground during heavy rainfall. She was willing to show their main defecation area and to explain her perception of the problems in the area. For the FGD, the researcher

returned to her and asked if he could talk with a small group of women from this organ-

isation. Nine women ended up taking part in the discussion, and one man who «helps the organisation» came after twenty minutes. The discussion lasted about 2 hours.

Two pitfalls had to be avoided during the FGD. The first was to avoid «leading» the group, while still keeping the discussion focused on the selected topics. The discus- sion actually started in «led» way, but soon became a discussion within the participants with minimal input from the researcher; this produced useful comments. The second pitfall was to avoid being perceived as members of an NGO, as they are known to pro- vide «everything for free», or at least this is the common perception¹; but in order to assess the willingness to pay, this would have been problematic. At the beginning of the discussion, the researcher introduced himself as «a student»², yet at a given point the participants understood he was working for an NGO and the change in behaviour was quite marked: when asking about «a possible price for a low-cost latrine», the price they suggested changed to a quarter of its previous value after this «understanding».

As part of the objective «putting forward recommendations», it was considered useful during Steven Sugden's visit to organise a workshop with partner organisations (Oxfam, GTIH and MSPP). The workshop took place on two mornings with about 10 participants from these organisations, mainly water and sanitation engineers and public health work- ers. The main objectives were to define together the terms of «sanitation», «sustainable» and «excreta management» which appear in the EU project: its goal uses overused and ambiguous, but fashionable, development phrases, which tend to be misunderstood by partners; a second objective was to discuss current practices on sanitation in Cap-Haitien and potential solutions.

In particular, engineers tended to see sanitation only as the provision of drainage channels and sometimes solid waste management; very little was known about latrines apart from «simple» construction rules, inevitably leading to high-cost latrines, not even

to mention latrine marketing or promotion. It was felt that, without getting these key people to understand the concepts behind sanitation marketing, any recommendation would be lost and replaced by the «usual» practice.

A range of tools was used during the workshops, including computer presentations, active participation when drawing an F-diagram³, debates between participants and

brainstorming. The outcomes were much more precise (and agreed) definitions of «sus-

¹It was admitted by Haitians themselves, as some of them claimed that «whenever there is an interna-

³This is the common name for a diagram showing possible transmission routes of faecal-oral diseases and ways to stop them; participation was achieved by using wet toilet paper representing the faeces and how they end up in water, on hands, etc.

tainable sanitation», yet it was felt that more work needs to be done in order to internalise

4.3 Limitations

The research activities were facilitated in a number of ways: first, the dry season and absence of significant hurricanes allowed easy access to all areas. The security situa- tion in Cap-Haitien was good enough to allow the researcher to go in all areas without restrictions, except at night, contrary to other cities like Port-au-Prince in which some areas are forbidden to foreigners and NGO staff due to high levels of violence. Oxfam had developed good relationships with the local population, most notably by setting up about 20 KLPS (local committees for civil protection). The language barrier was not high as Haitian Creole is derived from French, and the researcher learnt enough Creole

to be able to ask most questions and understand their answers by himself. Yet, what most facilitated the research was the presence of an assistant, Guettie Noël, who acted both as a translator and facilitator during fieldwork, who had experience in research, who worked for the Ministry of Public Health and had good knowledge on sanitation. She also attenuated the possible gender bias as the researcher is male; finally, she had a «pro-poor» attitude which helped to reach the poorest during visits and interviews, and hear what they had to say.

On the other hand, it is possible that the translations have hidden some aspects to

the researcher, especially during the Focus Group Discussion as discussions went much faster. The fact that the assistant was of Haitian culture may have introduced a bias

as well, for instance on an occasion during the survey, when she refused to enter a house because she had seen clear signs that it was the house of a voodoo sorcerer. This occurred only once, however.

Other aspects constrained the research. Most notably, as the researcher was working

for an NGO, its objectives had to fit in the project and at some point, local Oxfam staff had requests which would not fit in the research. Oxfam staff was interested in getting results which would be useful for the water and sanitation project as a whole, whereas

the researcher was concentrating on excreta management. Local staff was also keen to have the researcher work in certain areas where Oxfam has already done other projects:

the local committees were asking for help with their water and sanitation situation, and

the researcher was directed to areas which were not always the most appropriate or urgent. As a result, the areas considered in the survey are a mix of Oxfam target areas (Shada, Mansui) and non-target areas (Bas-Ravine and Petite-Anse).

The researcher, as an outsider, was also subject to a certain extent to the biases pro- posed by Chambers (1983): the «spatial bias» (staying on the main road) was avoided

by going as far as possible in each zone and including remote areas in the survey. Dur-

ing early field visits, however, limited time did not allow the researcher to go far from

the main roads. The «project bias» (going in areas where there have been projects) was clearly present as Oxfam directed the objectives of the research. During fieldwork, the researcher was less submitted to pressure. The «person bias» (meeting elite and active males) was in part avoided with the help of the assistant; but it was striking that al- most all representants from organisations were male, as well as most participants in the workshop. The «professional bias» was perhaps the most marked, as the researcher was concentrating on his topic; it was in part compensated by being attentive to other com- ments, unrelated to sanitation, which could also indicate that other issues could have a higher priority than sanitation; see also the Discussion part on page 56.

Finally, the limited time added a constraint: more time would have allowed to perform some follow-up on the ecological latrine experiment in Mansui, to do a few more FGDs, and possibly to investigate more the possibilities of the product-service package (see on page 51) by involving local masons and bayakous in the process.

5 Results and analysis

5.1 Areas of the city

After visits and interviews, it was possible to determine five types of areas in the city, with regard to housing, wealth level and type of sanitation. These areas are presented with, for each of them, an example zone of the city which was explored in more detail during the research:

1. Established high density housing within flat areas of the city (A), with for example the zone of Shada.

2. Emerging low density housing areas being built on low lying reclaimed land (B), exemplified by Petite-Anse.

3. Established low density housing areas built on the slopes above Cap Haitien (C), with the zone of Mansui.

4. Established high density housing areas built on the slopes above Cap Haitien (D), with the zone of Bas-ravine.

5. Established better quality housing in wealthier areas (E), with the zone of Champin.

On top of this, the city centre is a separate case: as the historical centre of the city, and

the only «legal» part of it in official population counts, it represents less of a priority for sanitation as houses often have septic tanks with flush-toilets; solid waste is more of an issue. The city centre was not taken into account during the study, and is not targeted

by the sanitation project. Table 5.1 on page 34 summarises the physical differences between the four zones surveyed, and Figure 5.1 represents these areas on a map.

These areas are typified by Shada, between the «new bridge» and the airport. It has a boundary of the river to the west and is build on land reclaimed from the river delta. The housing in Shada is haphazardly laid out and constructed from cement block and corrugated galvanised sheet. Large quantities of solid waste accumulate on the river banks. The common excreta disposal practices used in Shada are

· Open defecation, usually on the river banks on the accumulations of solid waste.

· Plastic bags, which are then thrown on to the piles of solid waste or on the roofs.

· Public toilets managed by CBOs and financed by the federation area committees.

5.1.2 Emerging low density housing areas being built on low lying land reclaimed from mangrove swamps - B

These areas are typified by Petite Anse, which can be divided into two broad sections; better quality housing situated close to the road and poorer quality housing being de- veloped on land reclaimed from Mangrove swamps and the sea. The land is being reclaimed by the dumping of solid waste purchased for between US$ 4 and US$ 8 a load¹. The housing is currently low density laid out on a rough grid pattern, although this is likely to change as the density increases. The housing is constructed mainly from timber frame, wicker and mud walls with roofs.

Open defecation is widely practised and takes place mainly in the sea or behind the walls of partly built houses.

5.1.3 Established low density housing built on the slopes above Cap Haitien - C

These areas are typified by Mansui which is situated on the hill slopes above the middle class housing area of Bel-Air. Part of the land belongs to the Hotel Beck which no longer operates as the owner died about a year ago. This has had an impact on the local economy as the hotel employed many of the residents. The land is steep and there are signs of erosion. Oxfam staff are concerned that deforestation due to the stripping out

of trees from the hillside for charcoal burning is going to increase the risk of flooding in

the area at the bottom of the slope. Banana trees, planted by the local householders, are common.

This area was recently targeted by a USAID-funded latrine building project which appears to have had mixed results (see Section 5.3.2, page 45). Those without a latrine

¹A truckload of «poor» solid waste (containing slow-decomposing plastics) can be bought for US$ 4,

a truckload of «better» waste (e.g. the mixture of sludge and waste blocking drainage channels) is bought for US$ 8; for comparison, a truckload of earth for building costs around US$ 40.

These areas are typified by Bas-Ravine which is situated on a steep hill slope above the city. Houses in this area have been built on a steep hillside and as the land is becoming limited, they are also beginning to be built in the ravine bed where they will be very vulnerable to flooding. The paths in this area are narrow and eroding. Solid waste and plastic bags containing faeces are routinely thrown into the ravine. Only the houses on

the top of the hill have some land on which they could practise urban agriculture.

A few public latrines can be found as well as some private latrines, but plastic bags seem to be widely used.

These areas are typified by the the Cités (Cité du Peuple, Champin), mainly situated on

the West bank of the river. They have been built in the 1980s in a planned manner as cheap accommodation blocks with basic infrastructure for new immigrants from rural areas. They are characterised by wider streets, often with concrete on the ground and some drainage channels, however regularly filled with solid waste. Communal latrines

are placed within each block, but the majority of them is either full or broken down. As

a result, wealthier people have a latrine or toilet inside their house while poorer people use plastic bags and go near the river. Latrine building would be difficult as not so much area is available and many landlords are absent.

Area Example zone	A Shada	B Petite-Anse	C Mansui	D Bas-Ravine	E Champin
Housing density	High	Medium	Low	High	Medium
Slope	Flat	Flat	Steep	Steep	Flat
Ground	S & SW	M	RE	RE	S & C
Water table	High	Very high	Low	Low	High
Water	Trucking	HP	Springs	Springs / HP	HP
City centre	Close	Remote	Remote	Close	Medium
Access to road	Good	Medium	Poor	Poor	Good
Passageways	Narrow	Mixed	Narrow	Narrow	Wide
Urban agriculture	None	Rarely	practised	Rarely	None
Wealth	Poor	Poor/medium	Poor	Poor	Medium
Population	70,000	75,000	40,000	40,000	100,000

C = Concrete; HP = Handpumps. «Population» designates the approximate population

5.2 Sanitation situation

In this section, different aspects of the sanitation situation in Cap-Haitien are shown:

defecation practices are estimated using the survey, for different areas. Technologies

are reviewed, regarding public and communal toilets, private latrines, and the special case of overhung latrines over water. Pit emptying is also considered.

Past reports on defecation practices in Cap-Haitien are rare; the only figures available come from a PHAST workshop done in 2005 in flood-prone areas (including Petite- Anse and zones comparable to Shada), reporting that 44.2% of the 500 respondents practised open defecation, 33.8% used plastic bags, 19.4% went to the sea or river, and

2.6% used a latrine². The survey gave some more information as results could be related

to each area; they are shown in Table 5.2 below. Note that the cumulative percentage can be higher than 10 %, as some respondents quoted two methods: those using public latrines often use another form at night or for their children, usually a bucket or plastic bag.

It presents a situation where open defecation is high, between 50 and 75% (see Figure

5.2 below); the low percentage in Bas-Ravine comes from the more common use of plastic bags which are discarded in the ravine bed, and buckets emptied the same way. Public latrines are claimed to be used in Shada and Bas-Ravine. However, in both zones people admitted that «they do not always go to the public latrine», and then use buckets or plastic bags. The shared latrines in Mansui come from the USAID-financed programme detailed in Section 5.2.4 on page 38. Overhung latrines on water are used only in Shada, by 7 interviewees (21%).

Method	Shada	Petite-Anse	Mansui	Bas-Ravine	Total
Private latrine	3 %	16 %	10 %	33 %	15 %
Shared latrine	-	-	20 %	4 %	5 %
Public latrine	21 %	-	-	25 %	13 %
Neighbour's latrine	3 %	20 %	20 %	17 %	14 %
Overhung latrine	21 %	-	-	-	7 %
Bucket / potty	9 %	20 %	5 %	17 %	3 %
Plastic bag	9 %	4 %	-	21 %	9 %
Open defecation	74 %	72 %	55 %	25 %	58 %

The level of satisfaction is detailed in Appendix H. Most inhabitants are dissatisfied

with their current defecation practices, which is not much surprising. In each area, the only persons who are either «happy» or have an «average opinion» are those who own a latrine; the only exceptions are a person in Bas-Ravine who «does not mind using plastic bags», and another person in Shada who lives next to a recently built public latrine. Conversely, some latrine owners were not satisfied with it, particularly in Mansui, as detailed in Section 5.3.2.

There are about 15 public toilets in the city, built mostly during the last five years. Seven

of them have been financed by FEKOKAP, and are managed by local committees; three have been built by the city council in the city centre; others have been built by local organisations. Most of those toilets are unclean and / or are not heavily used. The only

²Source: Report from the PHAST (Participatory Hygiene And Sanitation Transformation) survey, where

500 people were asked confidentially about their defecation method; carried out in early 2005 in the zones of Conasa, Fougerolles, Fort Saint-Michel and Petite-Anse.

A woman from a women's organisation wanted to show this area during the survey. It

notable exceptions are the public toilet block next to the market in the city centre, which

is heavily used by sellers (mostly by the women and children) even if smelly and a bit expensive (3 Gourdes); and a public toilet built by a local CBO in the area in Conasa, which is quite pleasant and well managed, but seems to be restricted to close neighbours

as it attracts less than 50 people per day according to the managers. Usual prices are 1

Many of these toilets seem to have been built for political reasons, given their loca- tion: either in visible places (tourists' market, harbour avenue) or in «politically active» areas, like Shada or Bannann which are well-known for their very vindictive inhabitants. Management seems to be poorly done: money does not seem to be collected and saved efficiently, most toilets have broken parts (usually the door or the roof) and have raw faeces visible on the seats during the visit; two of them have full pits, yet the commit- tees invariably answer that «[they] do not have money to perform repairs or empty the pits», and ask for assistance.

It can be reasonably said that, without the provision of an emptying system and reli- able management systems, public toilets will only have a limited impact on the sanita- tion situation and do not correspond to a form of «sustainable sanitation».

There are around 95 communal toilet blocks, found in the Cités in planned mid-density urban areas, built in the 1980s to answer the migration from rural areas. Each block has 6 to 8 chambers, sometimes with a shower and / or a basin for laundry nearby

(see Figure 5.4). Over time, the pits have filled up and the superstructures have been degraded, to the point that most of those communal toilets are now out of order. The

EPPLS (managing organisation) estimates the cost of emptying and repair at more than

2 million Gourdes (US$ 52,600), however the EPPLS is heavily indebted due to most tenants not paying their rent.

There is no clear management system for these toilets: neighbours are supposed to take care of them, a system maybe sufficient for daily cleaning but unable to cope with repairs and emptying. Even if repaired and emptied, the toilets would not be sustainable

as the same problem is likely to happen after a few years. When talking with residents, they say that the pits now fill up in about three years only, due to residual solids in the bottom which cannot be emptied.

Three private latrine building programmes have been done in Cap-Haitien in the last 15

years. In all these projects, materials were given to beneficiaries and masons were paid

by the project; beneficiaries had to dig the pit, sometimes transport the materials if they lived in remote areas, and possibly give a hand during the building. There is no evidence

of any further participation of beneficiaries, especially during the planning phase. It can also be noted that in all instances, the projects were implemented in areas where the main members of organisations lived.

The first and most important one has been run by the MSPP in 1990 with funding from

the German organisation Hydroplan. About 500 latrines were built in three different areas of the city (Sainte-Philomène, Petite Anse and Cité du Peuple). There were two

This block is one of the best maintained; maintenance of a few toilet blocks in Nan

different but still similar types of latrines, one for areas with a high water table, the other

for areas on the hillside: both had a 1.5 to 2 m deep pit lined with cement blocks, a 10

cm thick concrete slab with a pedestal, a 4» PVC ventilation pipe and a superstructure

in cement blocks with galvanised iron roof. Each latrine used to cost about US$ 30, but MSPP technicians estimate that it would now cost about US$ 250 to build the same. Many of these latrines are now full or broken down.

The partner organisation GTIH has built about 20 latrines in 2003, each for two fami- lies, in parallel with drainage and pathways improvement projects. Materials have been given but almost no follow-up was done, ending in latrines only partly built or used as showers.

The organisation AMPB (Association des Militants Progressistes de Bel-Air) has built

40 latrines in 2004, with financial support from USAID, mostly in the area of Mansui. Latrines are shared between houses and usual have two chambers, and otherwise are similar to the latrines built by the MSPP (Figure 5.5 below). A more detailed evaluation

Data on private owned latrines is scarce outside of the projects mentioned above. Most results come directly from field visits and the survey undertaken in this research; how- ever, the low coverage of private latrines means that only a few results were obtained. Only 23 households surveyed had a latrine; of them, 4 had obtained one from the US- AID programme; another 7 respondents had an unfinished one, and a person had a full

latrine pit so could not use it. This leaves only 11 households (out of 103) with a fully constructed latrine in usage.

Results from the survey and from field visits tend to indicate that only three types of latrines can be found: flush toilets, «standard» latrines and «wooden» latrines (latrinn bwa). Flush toilets were not found during the survey but can be seen in wealthier areas and in the city centre, where space and revenue is available for septic tanks. «Wooden» latrines represent the low-cost option, which is not highly regarded, consisting of a shallow pit covered with wooden planks and a basic superstructure. Surprisingly few of these latrines could be found, only in the areas uphill.

The «standard» latrine corresponds to those introduced by the MSPP in 1990: 2 - 3 m deep pit lined with cement blocks, thick reinforced concrete slab, a seat, a ventilation pipe, a superstructure with cement blocks and a corrugated iron sheet roof. All intervie- wees who had started to build a latrine wanted this type, as it is supposed to be «more hygienic», or because «if you build a latrine, you have to build one like this!»

Some interviewees were in the process of building a latrine, having either a dug pit or sometimes a slab already in place, and waiting until they had enough money to carry

on building. The total time to build a latrine seems to spread amongst several months, with two persons aiming to finish it after two years. The reason is that latrines are

usually expensive (see also Table E.2) and that building is incremental: the latrine is

The owner usually contacts a mason (called Boss maçon or simply Boss), who gathers

a team of labourers if needed; it is often someone else who digs the pit, either the owner or separate workers, who can be recommended by the mason. If the mason is working on several constructions, he buys a truckload of gravel and sand and uses it

for all constructions; however, for elements which have to be bought one by one (such

as cement blocks or a ventilation pipe), this is usually the owner's responsibility. The masons are paid either on a daily basis, or more frequently for a given work; labourers

Amongst the 23 latrine owners who were interviewed, 6 did not know why the latrine was built as they moved in an already equipped house; 3 more had built their latrine

to replace an old one. For the remaining, the main reasons for building a latrine were either to avoid going to the nature (5) or they built it at the same time as their house or shortly after (5), saying that it should be an integral part of their house. Another reason was «for the visitors» (2).

Amongst those who do not own a latrine yet but who have the intention to build one,

the main reason varied depending on the area: in Bas-Ravine, the majority (5) said they wanted a latrine because «it is more practical than going to the public latrine or using plastic bags»; in Shada, people said that «we don't want to go at night, because then

we can be attacked», or «we don't want to go to the sea anymore because we have to cross the main road, which is dangerous for children». Example of recent assaults and accidents have been quoted in Shada and in Mansui, though it is unknown whether it was to impress the researcher (as suggested by his assistant) or about actual events.

Other motivations seem to be more marginal, and include, in decreasing importance order, «for the visitors», «because it is necessary» (without explaining further despite questions), «for the house I am currently building», and «for health / cleanliness».

The respondents without a latrine were asked for the main constraints they face which prevent them from having one. The money constraint was the main one in all areas, quoted by 53 % (Bas-Ravine) to 100 % (Mansui) of respondents; it was sometimes precised, with interviewees saying that the price of materials keep increasing (Shada)

or that there was too much unemployment (Petite Anse). The space constraint was mentioned in Shada mainly (27 %). Other constraints appear to be more marginal, and include «I have other priorities» (2 in Bas-Ravine, 1 in Shada), soil erosion (Bas-

Ravine), «I want a really good one, but I can't afford it» (Mansui), «my wife does not

want us to have a latrine because it will smell bad» (Shada), «I have too many children»

or «I am pregnant and I can't think of any future plan right now» (Petite-Anse).

One person living in Mansui also said that werewolves (lougawou) live in latrine pits, and it would be dangerous to go to the toilet at night, which made him prefer a bucket.

Overhung latrines can be found near the river, which is actually an estuary with sea water, and on the seafront. They are simply built on wooden stilts and covered with locally available materials such as rice bags or more often cloth. Faeces are dropped in

While overhung latrines pose the same health and environmental hazards as open defecation, they provide privacy and protection, particularly for women. In many cases, they also provide revenue for their owner: in the zone of Shada, most people who use overhung latrines have to pay 1 Gde each time; one person said he pays 2 Gdes every time. However, 92 % of those who practise open defecation go near the sea (the remain- der uses a terrain owned by the Ministry of Transport and Public Works), most of them

on designated areas, and said they prefer the discomfort rather than paying 1 Gourde every time.

Two interviewees also said they had the intention to build an overhung latrine, in order to create revenue. One of them had already stolen wood for this.

There are two ways of emptying latrine pits in Cap-Haitien: the first is the private com- pany, Jedco, which operates two vacuum tanker trucks of 2500 and 3000 gallons capac-

ity (10 - 12 m³). They work on contract only, and most of the time for the UN forces

of the Minustah, whose bases have many septic tanks. The emptying cost is around

10,000 Gdes (US$ 250) per truckload. The location of their two dumping grounds is not precisely known, and the local manager was reluctant to give that information. It is possible that the trucks dump their contents in the mangrove in uninhabited areas.

The other way to empty a latrine pit it to ask a «bayakou», the usual name for people whose job is to empty pits. The bayakous interviewed said they work at night, usually in teams of 3 to 5, using shovels and buckets, with limited protection gear. The emptying cost varies depending on the source: the MSPP director quotes an average of 5,000 Gdes (US$ 120) for a private latrine with a medium pit, interviewees in the survey quoted prices from US$ 60 to US$ 150, and the bayakous interviewed said that emptying a communal latrine with a larger pit costs 20,000 Gdes (US$ 520). This is a significantly higher price per load than from Jedco, yet the size of their trucks and their contract- based work prevents them from operating in poorer and denser areas. The bayakous often have to break the slab, which adds the repairing cost for the user.

The bayakous suffer from poor working conditions, which is in part the justification

for their high rate of pay: they use créolène, a liquid disinfectant, to attenuate the smell, but they are still forced to enter the pits to empty them; finding solid waste is not unusual

in the pits, and Public Health workers have reported bayakous treading on hazardous medical waste and being infected. They also suffer from an «illegal» status after some

of them had dumped a pit contents in the sea, close to the city centre: offenders have been imprisoned and the city council claims to be willing to find a suitable dumping site, however the bayakous doubt that a solution will be found.

Usually, the pit content is transferred to another pit dug right next to it. The bayakous

interviewed claimed to transport it on about 2 km when a pit cannot be dug, e.g. when

the water table is too close. There have been reports of a pit contents dumped in front

of a bank in the city centre, and another case of faeces bought from bayakous in order

The MSPP used to have a emptying machine, consisting of a self-propelled 2.5 m³vacuum tanker with a 1.4 m³trailer tank, donated by a German cooperation in 1990 (see the trailer on Figure 5.9, page 53). It was in operation for 5 years, after which it broke down and could not be repaired given the lack of spare parts; the machine and

the trailer are now rotting in the MSPP yard. The MSPP subsequently used bayakous

to perform the emptying with a truck to transport the pit contents in drums. The truck broke down as well in 2000, however, and the MSPP lacked funds to hire bayakous anymore and stopped emptying pits.

5.3 Inappropriate practices

During the research, it appeared that the current practices in sanitation are inappropriate

in several aspects: the technology choices were considered as «not sustainable» during

the workshop with partner organisations; the past project in Mansui was evaluated by using survey results, showing that its positive effects are in fact very limited and that

it had potentially negative effects, such as discouraging non-beneficiaries to build their own latrine; finally, current practices and technologies are compared with the Millenium Development Goals.

During the workshop, the participants were presented with the different defecation prac- tices currently in use in Cap-Haitien, after which some of the latrine options were exam- ined in relation to their sustainability; the criteria for sustainability were the five given

in Appendix D on page 70. The results are shown on Table 5.3, examining the sustain- ability of overhung latrines, public latrines and USAID-financed private latrines. There were some disagreements: for instance, the impact on health of a private latrine is posi- tive, until it has to be emptied. As no reliable and safe emptying system exists currently, results are mitigated.

It is interesting to note that overhung latrines, even if they appear «disgusting» and «unsafe», are not necessarily «less sustainable» than other systems: as they are built by inhabitants, they are more likely to suit their immediate needs, and are more likely to

be built again during the next 20 years. It was the only system for which there could be

a small chance of having a high coverage maintained, and which could be maintained over a prolonged period of time.

One of the outcomes of the workshop was to show that current latrine options are not sustainable; objections were raised, that a bit more money would be enough to make a

subsidised programme sustainable, and that latrine building programmes at least have a

positive impact even if they are not sustainable. The next part address these objections.

Table 5.3: Sustainability of current sanitation options, result from the Oxfam-GTIH- MSPP workshop

Criteria \ Type of latrine	A	B	C
Consistently used	Y/N	N	Y
100% coverage maintained	y/N	N	N
No significant risk for health	N	Y/n	Y/n
No significant degradation of environment	N	Y/n	Y/n
Maintained over 20 years	Y	N	N/y

· Column A designates overhung latrines; column B are public latrines; Column C

· Y means that the criteria is met, N that it is not met, and a mixture of both ex- presses a disagreement between participants

One of the private latrine building programmes could be evaluated through the survey results: the USAID-financed project was conducted in the zone of Mansui in 2004, which means that all latrines were still in operation. The project was run by a local organisation, AMPB (Association des Militants Progressistes de Bel-Air), concerned with development of the area around Bel-Air, including Mansui. According to members

of the organisation³, 40 latrines had been built in the end of 2003 and beginning of 2004,

about half of them in Mansui. All materials were paid for by the project, as well as labour; beneficiaries only had to dig a pit and help transport the materials uphill from

It is still unclear how beneficiaries were chosen, as nobody could explain the selection process. Most of these latrines were located in the lower part of Mansui called Cité Ma Gloire, with the higher part of Mansui obviously ignored. During the survey, 6 persons (out of 14 without a latrine) had dug a pit and were «waiting for the project to come and give [them] materials»; none of them had the intention to go further without a project to help them. Some more pits could be spotted in the area, often filled with solid waste - but without a latrine over them.

³The organisation manager could not be reached, he is supposed to be in Miami now. The new manager

did not know much about the financial details of the latrine building project, but was able to indicate how the project was conducted.

As part of the survey, beneficiaries were identified and interviewed about their latrine.

12 families were available and were asked whether they were satisfied with their latrine, using a 5-point scale⁴. Results were:

· 2 interviewees were «very happy», with comments like «we avoid all microbes»

or «it is our greatest treasure» (this latrine was even decorated and fitted with a curtain);

· 2 were «happy», commenting with «we wouldn't have come if there had not been

· 3 had an average or no opinion, with comments like «we have to use it anyway; it smells bad but we put ash and lime in the pit to disinfect.»

- «As we have to share it with neighbours, there was an argument, then a fight and as a result a part of the latrine was broken; we still use it because we have no choice»;

put solid waste in it, as we have nowhere else to put it»; «the pit will be full

- «We already had a big latrine, which is unfinished [no roof and doors] but which suits us; we received one of these new latrines from the project but their pit is too small, we prefer the old one»;

- «I have to share with another family, but the latrine is close to their house

and not mine; it is too far to go at night, especially as I am an old person living on my own».

This frustration was shared by other interviewees without a latrine, who claimed that

the project leaders were «corrupt», rumours could be heard that «only 5 latrines had been constructed, and only for the elite», «someone told me that one family received three latrines», and so on. The researcher's findings tend to show that these rumours are wrong, yet their existence shows potential problems.

On the other hand, two respondents of the survey had their own latrine, which did not come from the project. One of these was a simple wooden latrine on a large pit, clearly unfinished, and the other was a more «classic» latrine, complete but showing signs of amateur construction; both were built 3 years ago, one year before the programme. The owners both said that they were frustrated that they had done so much efforts, when

they could have waited one year and «get one almost for free»; yet, they said they were

⁴In Creole, the question asked can be roughly translated as «How happy are you with your latrine?»,

the 5-point scale corresponding to «very happy», «happy», «average / no opinion», «unhappy», «very»

happy with their latrine. Comments were «Whatever we have, it is better than going

It would be tempting to draw conclusions solely from those results, but more evidence from similar projects would be needed in order to confirm the analysis. The fact that only two interviewees had a latrine outside of this project is not representative enough.

It is still striking to note that 8 out of 12 beneficiaries were neither «very happy» nor «happy» with their latrine, despite the fact that they received it almost for free. The reasons expressed were mostly about the difficulties to share and the small size of the pit. According to Bernard Pierre, the new head of AMPB, sharing was imposed in order

The flaws of this project can be seen as follows: the lack of consultation and partic- ipation have led to an inappropriate choice of beneficiaries; poor communication has

led many people to «prepare for the project» without benefiting, causing much frustra- tion; the supply-led approach (i.e. imposing the type of latrine) does not fit particular needs and does not correspond to the desire of owning a latrine rather than receiving

it, as proven by comments like «I own it» or «we prefer the old one». People who had made efforts beforehand, such as those who had already built their latrine, have not been rewarded and may well end up being discouraged from doing it another time.

Finally, the project did not consider sustainability: most pits will be full in the coming years, and poor access mean that bayakous would not be able to access the area; even if they could access, the pit contents would be very hard to transport and would probably end on the slopes, negating any health benefits of the latrines. The heavy superstructures would be also hard to move above a new pit, which means that most of the project's investment would have been useless.

The overall aim of the EU-funded project run by Oxfam, GTIH and PROTOS states: Contribute to poverty reduction and sustainable development through achiev-

ing the MDG and WSSD⁵objectives specific to water and sanitation in poor areas of Cap-Haitien.

Estimates have been made to know what would be needed to achieve the MDG related

to sanitation, in the city of Cap-Haitien; calculations are detailed in Appendix E. About

30,000 families will need to have access to «improved sanitation» by 2015, which ex- cludes communal and public latrines (see Table E.1); Figure 5.7 below presents a graph

comparing the population and coverage in 1990 and 2003, with estimates for 2015. If a

«traditional» approach is chosen, where materials and labour are paid, the total cost of a latrine is around US$ 300 (Table E.2); this figure has been confirmed when investigating past projects and by GTIH engineers.

the construction of those 30,000 latrines. Even then, there would still be 36 % of the population of Cap-Haitien i.e. 187,000 inhabitants without latrines, and the absence of

a reliable emptying system means that most pits would be full after 5 to 10 years⁶. The

EU-funded project currently has US$ 30,000 available for latrine building. This can also

be compared with the original ideas proposed by local engineers, featuring communal latrines with raised chambers to avoid floods: they cost 18,640 Gdes each (US$ 466) according to previous experiments in the city of Gonaïves, without consideration for their emptying or daily maintenance.

5.4 Alternative options

During Steven Sugden's visit, the possible options were reviewed, in order to achieve sustainable sanitation in some areas of Cap-Haitien. The areas and their characteristics were reviewed and some options discussed, which has ultimately led to a joint report written for Oxfam, GTIH and PROTOS. Part of this work is out of the scope of this dissertation, but the researcher's work was used to devise these options. The following sections summarise the recommendations and the research's input in them.

⁶If one wants to be cynical, he could say that Oxfam should start the project in 2012, so that most latrines

The workshop was used to reflect on the situation with partner organisations, and to discuss the possible alternative solutions.

The question «Why do you want to do this project?» generated a debate which high- lighted some differences in opinion between the partners. These are likely to need revisiting and reinforcing in the future, but after some discussion it was agreed (per- haps reluctantly by some of the participants) that the project was a health, and not an infrastructure project. Any infrastructure provided by the project has be capable of be- ing maintained, be accessible and be affordable to the intended target beneficiaries and have a positive impact on their health. An explanation of the transmission patterns of faecal-oral diseases was done using the F-diagram.

The group was asked to define the concepts of «sanitation» (assainissement) and «sus- tainable» (durable). The group definition of sanitation was:

· «It includes water management (wastewater, rainwater), solid waste management, excreta management⁸(construction, emptying), and drinking water».

The input of workers from the Ministry of Public Health is visible from the last two items. Steven Sugden suggested five items for a definition of «sustainable sanitation», which can be seen in Appendix D, page 70. These are:

2. The community / society is maintaining latrine coverage at 100% without external support,

The following options have been discussed during the workshop, in the light of these definitions.

⁷In French, this is translated by the adjective sain, which applies both to a person («healthy») and to an environment («clean»).

⁸«Excreta management» translates better the French Gestion des excréta than the more usual «Excreta

When walking through the Mansui area, small banana tree outcrops can be seen close to most of the houses. These are planted by the occupants of the houses and on investiga- tion it was found that the crop is eaten, rather than sold to supplement income; «We eat them when we can afford a little oil to cook them in» explained Mrs Accilien Roboam during an in-depth interview. She knew the trees would grow better with fertiliser, but she could not do this as artificial fertiliser is too expensive. She also grows papaw and granadilla. The land in the area is poor and has a thin covering of soil from which water

is quickly lost. Digging a deep pit is possible, but very hard work as many rocks have to

be removed. Mrs Roboam lives with her husband Tibo, who used to work as a carpenter

Her grandmother used to live in the country where she apparently used to defecate

by hanging her backside over a low hanging bough of a tree and defecating on the ground below after which it was spread on the ground to act as fertiliser. The practice

of ecological sanitation is therefore not new and unlikely to present any major cultural obstacles. Apparently the practice was stopped because they were told it presented a health risk.

Those elements indicate that the area of Mansui could be considered for an eco- sanitation approach based on the Arborloo design. One resident stated he had build a wooden platform for a latrine instead of the usual concrete slab. This low cost option would be a good starting point for designing a low cost Arborloo. Cheap superstructures

The interview with the Roboam family revealed that they had started to dig a very large pit for a latrine one year ago, about 4 m deep and lined with rocks. A mason was raising it by about 40 cm using rocks and cement; Tibo Roboam wanted to finish the latrine in the next 6 months, «if he manages to get enough money». This denoted a strong motivation towards getting a latrine.

In order to know whether the Arborloo could be an appropriate solution for Mansui,

the researcher first talked about the Arborloo with the Roboam family, then spent two days with them to construct a simple Arborloo together. The pit took less than three hours to dig, wood was bought as a gift to make the slab and a seat (for less than US$

20), and the superstructure was made out of branches and rice bags (Figure 5.8 below). The outcome of this test is not known yet, as it takes about five months to fill up the pit, and some eight more months for the banana trees to bear fruits. Those outcomes can not

be included in this dissertation but will be useful to the ongoing project, if follow-up is correctly done; Oxfam is now supposed to do the follow-up.

If the latrine works as expected, Mr Tibo Roboam could be involved in the promotion

of this latrine, and his carpenter skills could be used to create seats for latrines; a price

of about US$ 20 may be small enough to allow families to buy this themselves, without

the need for an external organisation to intervene. Other areas than Mansui could also

be suitable for this kind of sanitation; urban agriculture being a requirement, peri-urban areas located in the West, South and South-East could be considered as well.

The area of Shada presents more challenges given the high population density and high space constraint, the proximity of the water table, the high level of poverty and the difficulty to access narrow paths. During the survey in this zone, dissatisfaction with current defecation practices was clear with 94 % of interviewees either «unhappy» or «very unhappy»; 73 % of those without a latrine expressed an intention to get one, yet only 14 % of them had a higher level of intention (by identifying a site, digging a pit

or quoting some prices). The main constraint expressed was money (100 % of those with an intention to build), followed by space (27 %). Amongst the 8 people without an intention to get a latrine, 4 said they lacked money, 3 that they lacked space available, and 1 was going to move shortly.

No sanitation technology could work in this area without addressing those two con- straints of money of space: the answer would be to design a latrine which is both afford-

able and small. Possible designs are presented in Appendix F.1.1 and prices compared in

Table F.1. The main idea would be to give people the choice between multiple options: they would be free to choose expensive latrines in bricks if they want and can afford it, but there would also be cheap options available. In order to reduce the cost of the main elements, the cheapest option would feature a pit lined with a 200 litres drum and a simple wooden slab. Local masons and GTIH engineers were asked for realistic prices, and it was found that the cheapest design would be between US$ 25 and US$ 37. An intermediate design, with a domed concrete slab, a pedestal and a simple superstructure with a ventilation pipe would cost between US$ 100 and US$ 125.

· The real willingness to pay is unknown; the focus group discussion was used to estimate it.

· Local engineers raised the point that such a cheap model would be «unacceptable» because «it does not conform to the standards». During the workshop, there were discussions about the purpose of a latrine and whether the project should promote «low standard» latrines.

· A small pit means that emptying is required more often, creating the need for a reliable pit emptying system.

Pit emptying is a key issue in here. A possible solution would be to have a micro- enterprise responsible for this, hiring bayakou using dedicated tools, such as a hand- pump for latrine pits currently being designed; the bayakou would thus work in better conditions. They would transfer the pit contents to a transfer station, and from there a regular emptying would be done by vacuum tankers such as those from Jedco. Payment would be made to this micro-entreprise, who would in turn pay the bayakou, hence en- suring that there is no illegal dumping. To reduce the cost, the transfer station could

be towable to the final disposal site (Figure 5.9). The detail of these solutions can be found in Appendices F.1.2, F.1.3 and F.1.4 on page 77. In order to make this business sustainable, there has to be a profit to allow for expansion; calculations can be found in table F.3.

The Focus Group Discussion with women from Shada was used to get a better idea of

the willingness to pay, both for a latrine and for its emptying. The questions generated a debate between participants themselves. It appeared that, as women, they did not know

the price of a latrine, only knew that it was unaffordable, and decided to ask a man; this

It could be converted into a towable transfer station for decreasing transport costs.

man was also a member of the organisation, as women said that «they needed a man to take care of this kind of technical issues».

When asked about «an affordable price for a small latrines», the debate first gave

the impression that HT$ 800 to HT$ 1000 (US$ 100 to 125) would be worth giving consideration: most participants said that «they could afford a latrine at this price», but that «[they] knew that some of their neighbours couldn't». However, at a certain point

the man «understood» that the researcher was working for an international NGO, and the discussion switched from a debate to something closer to a negotiation, as participants then tried to lower the price to see «if it was possible». One older woman, who had not talked much before and seemed one of the poorest, said that HT$ 200 (US$ 25) would be

a low enough price for her. All other participants agreed and said that they would «bang their heads on the ground to raise money, if a latrine was this cheap». It is unknown how reliable those figures are, and it can be expected that the actual willingness to pay would be somewhere in between.

As for the emptying price, the first reaction was that «emptying should be a public service, done for free by the MSPP!», as it used to be this way some 15 years ago. The concept was further explained, which led to price bids between HT$ 20 and 70 (US$ 2.5

- 8.75) for emptying a full drum (200 litres); this amount was less than expected, which

led to further ideas, particularly for the final disposal. Participants also said that they would like to see how it works, and that they may then be convinced to change their minds.

Shada is known for having a very dense housing arrangement, which does not leave enough space for latrines; during the survey, this constraint was claimed by a quarter

of interviewees. Yet, by exploring the area and asking random households if it was possible to visit their compound, it was found that many of them had at least a very small backyard, some unused space, or part of a blocked passageway which is considered as part of their compound. There could thus be a possibility that a small latrine could be accommodated by most households.

To investigate this further, participants of the Focus Group Discussion were asked what size would fit in all or almost households, by laying planks of wood on the ground and creating a square, then asking «if a latrine was this big, would you have room for one in your house?». After discussion, a 1 by 1 m latrine could be accommodated by most of the group, but there could be issues with the landlord if the latrine was to be placed inside the house.

In other areas, the constraints would be too high to implement one of these forms of sustainable sanitation: in Petite-Anse (and other areas of type B), the proximity of the water table and the recurrence of floods make digging any pit, however small, almost impossible at low cost; transport is also very difficult. However, this area develops very rapidly, and it can be expected that within a couple of years, access or at least the nature

of the ground will have improved, and living conditions will resemble those in Shada. The product-service package for Shada may already be «exported» to non-flood-prone areas of Petite-Anse, close to the main road.

In the Cités and other areas of type E, space is available for building latrines and ac- cess is easy, potentially allowing an emptying system to be implemented; more residents would be able to afford it than in other zones given the higher wealth level. However, there are still space constraints and the fact that the ground is often made of concrete which could limit designs to high cost options only. As the EPPLS wants to rehabili- tate communal latrines instead of promoting private latrines, there could be a conflict of interests.

In Bas-Ravine and other areas of type D, the steep slopes and the high housing density prevent the use of a low-cost design. Any latrine would need a reinforced pit to avoid collapsing, due to erosion of the soil; as access is hard, pit emptying and transport of waste out of the area would be difficult or at least very expensive; there is not enough space for urban agriculture, except on the top of the slopes. A cheap and probably preferred way of emptying would be to knock a hole in the side of the pit and let the contents drain downhill, cancelling the health benefits previously acquired. Solid waste

would also be hard to remove, so a collection of plastic bags would probably not be

For Bas-Ravine, a possible solution would be to let GTIH improve drainage channels and passageways: as this would improve access, the conditions for a better emptying system might be fulfilled in the future. Areas like Bas-Ravine are the most problematic

6 Discussion

6.1 Limitations of the research tools

The research methodology has its limitations regarding the objectives, most notably as

the survey has not answered a number of points related to sanitation marketing, and as the focus group discussion results are subject to caution.

The survey was inadequate in a number of ways: it was originally designed in the same way as the «demand tool» of London School of Hygiene and Tropical Medicine. How- ever, it was found that this tool works well in areas with already a substantial sanitation coverage: as it is supposed to assess the demand for improved latrine products, such products have to exist and be known by a part of the population at least. Here, the fact that only 23 households own a latrine, of which 11 are currently complete and in use, does not allow to make generalised conclusions. More latrine owners should have been interviewed in order to have a better idea of the process of latrine acquisition, the supply chain, and the constraints they are facing.

The survey failed to answer questions related to sanitation marketing. The level of demand and the communications channels are notably hard to estimate, as well as will- ingness to pay; the focus group discussion was more useful in this case. The survey has also been conducted in areas which may not have been the most appropriate: according

to Steven Sugden, the high constraints faced in Bas-Ravine and Petite-Anse are limiting possible solutions for sustainable sanitation, and by using the field visits, it could have been decided not to perform the survey in these areas.

However, the survey was also used to get data on defecation practices and people's opinion about sanitation, which is relevant to the Oxfam project and the research alto- gether. A possible way to use the survey to the best would be to repeat it with the same interviewees in a few years, after the project will have hopefully implemented some ex- periment or pilots; such as survey would enable to assess the viability of the solutions, but also to examine changes in people's attitudes regarding sanitation.

The area of Bas-Ravine was the first to be surveyed; given the lack of experience from

the researcher, the first households in this area were less rigorously interviewed and the

questionnaire had to be reviewed after surveying ten households. In particular, there was

confusion on the question «Do you have the intention to buy/build a latrine?» which was asked in a different way and did not allow to know the actual level of intention. Many respondents answered that «yes, I will build a latrine in the near future, because Jesus will help me!»

A new survey would have to include other questions related to the intention to get a latrine, in order to avoid the dichotomous choice «intention / no intention» and allow for several levels of intention.

The results from the focus group discussion should be used with caution; the objective was to get an idea of the willingness to pay in Shada for a low-cost latrine and asso- ciated emptying service. However, the fact that participants wanted to see whether the researcher belongs to an NGO turned the discussion into a negotiation rather than an actual discussion. It is expected that the figures of HT$ 200 for a latrine and HT$ 20 for emptying 200 litres are too low compared to the actual willingness to pay. During the discussion, comments were «I could afford a latrine for HT$ 800, but my neighbours couldn't, I think they could pay only HT$ 200», «if I save HT$ 5 every day, I could afford a latrine at HT$ 1000 after a year», «If a latrine costs HT$ 200, we would jump,

One argument frequently repeated during the survey and the discussion was the in- ability to save money, as «every little coin which enters my pocket on a given day goes out of it before the sun sets!» (heard multiple times during the survey). However, half of

the participants in the FGD were tenants, with the usual tenancy system in Cap-Haitien

of affermage: a tenant who lives in a house affermée pays his rent once a year, and rents

of several thousands Haitian dollars per year are not unknown. This indicates some form

of saving mechanisms. The precise proportion of tenants versus landlords is unknown and depends on the area: more people are tenants in emerging areas like Petite-Anse than in established areas like Mansui.

To have a better idea of the actual willingness to pay, other discussions would need

to be done, preferably with other types of groups such as men, masons, members of the local civil protection committees, and groups from the Northern part of Shada; in-depth interviews would also be appropriate to identify the money and space constraints more precisely.

The workshop was a useful tool to reflect on the current situation and discuss possible al- ternatives (see Section 5.4.1). As it brought together people from various backgrounds,

including civil and water engineers, public health technicians and NGO managers, dif-

ferent ideas and opinions were expressed before coming to a common understanding of

the concepts of sanitation and sustainability. However, for many of them this was done with reluctance, as it was different from their usual practices. Given this reluctance,

it is possible that they will return to their usual practices, which may be appropriate

for building water systems and storm drainage channels, but maybe not for a sanitation marketing system.

6.2 Is sanitation a priority?

The question of knowing whether «sanitation is a priority» is important as the research concentrated solely on excreta management, which is not the main part of the Oxfam project. Interviews with key informants helped to understand the local organisations' priorities, and the survey did the same for people's priorities and opinions. Given the poor state of sanitation, the implications on health are great; diarrhoea is reported by Walden et al. (2003) as a major concern in most areas. Undoubtedly, improving excreta disposal would lead to great improvements in health. However, some other aspects may

The survey has shown that handwashing is poorly done: when asked «When do you wash your hands?»¹, 21% of the respondents quoted «before eating / preparing food»,

19% «after going to the toilet» and 7% «after changing my baby's nappies»; 29% said they wash their hands «after work», and 52% were either evasive or answered that they can not enough wash their hands due to water shortages. Only 6% mentioned soap. Given the higher impact of handwashing on faecal-oral diseases than any other form

of intervention (including toilets and improved water supply), it would be necessary to prioritise the promotion of handwashing.

An issue which made the local engineers reluctant to work in certain areas is the fact that the latter are considered «illegal»: areas like the North of Petite-Anse or Mansui have been created in an unplanned manner, due to massive emigration from rural ar- eas. They fear that any intervention would bring more inhabitants in those areas, which present too many hazards (flooding, erosion...) to be viable. A related problem, partic- ularly visible in Petite-Anse, is that housing seems out of control of the public service.

A person said he had bought his «land» (actually about 20 m²of mud almost at sea-

level: see Figure 6.1 below) for US$ 200, from the previous owner; a local organisation claimed to «give land for free to the poor», but another person showed a contract with

¹The actual question in Creole was closer to «At which points of the day do you wash your hands?»

this organisation, with a price for the land. Unless the issue of land tenure is addressed,

In low-lying land like in Shada and Petite-Anse, drinking water comes either from handpumps if boreholes have been drilled, or from trucks which bring water from distant boreholes. The price of water is high, with families in Shada paying an average of 23

Gourdes (US$ 0.60) every day for water. Improving the water system would allow those families to have more water for (hand)washing, but would also release funds.

The area in the North-East of Petite-Anse (pictured) is advancing on the Mangrove.

The survey included the question «if you had a small improvement in your revenue, what would do with it?», in order to evaluate people's aspirations. It did not work as in- tended, as it highlighted people's immediate concerns rather than long-term aspirations. The focus group discussion tried to address this by asking what they would do if they received a significant amount of money, and why they would do this.

In the survey, 53% of interviewees answered that they would «use this small amount

of money to buy something in bulk and sell it, in order to make more money»: this is supposed to be typical of the Haitian way of thinking, much oriented towards trading according to Walden et al. (2003). 20% answered they would improve their house, and

20% answered they would invest in a latrine, though this may have been influenced as

the question was asked at the end of the survey. «Education» and «more water» were also quoted on a few occasions.

The focus group discussion surprisingly led to the same sort of answers, with about half of the women saying that they would also «expand their business» with this money.

They were asked «why do you want to do this», in order to investigate their actual

inspirations. Two of them said that «they love trading, buying and selling things», and

the rest of the participants had comments like «I want to move in a house which actually belongs to me», or «I want to prepare the future of my children by saving». It did not seem that sanitation was high on their agenda.

A concern which appeared in side comments during the survey was the lack of health and education facilities in the area of Petite-Anse, far from the city centre where they

7 Conclusion

The aim of the research was to analyse the sanitation situation in Cap-Haitien and for- mulate recommendations, using on a sanitation marketing approach. Several research tools have been used, including semi-structured interviews, field visits, a household sur- vey, a workshop with partner organisations, a focus group discussion and a pilot test. Interviews and visits have allowed to divide the city in similar areas, distinguishing low-lying land and zones on the hillsides, emerging and established areas, dense and less dense housing areas, amongst other characteristics. Five main types of areas have been identified, on top of the city centre which is not usually targeted given better living conditions. An example zone for each type of area was also chosen for more in-depth investigation, namely Shada as the most well-known central dense slum, the emerging zone of Petite-Anse partly built over the Mangrove, the peri-urban zone of Mansui in

the hills, Bas-Ravine on the slopes close to the city centre, and Champin in the Cités. All but Champin were investigated during the survey.

The visits also allowed to review the existing sanitation options in use in Cap-Haitien. The dozen public latrines are inadequate, poorly managed and are likely to be out of order after a few years. The few communal latrines in the Cités which are not either broken or with full pits are also poorly managed and likely to be full after a short time. Private latrine building programmes have been rare, with only three of these in the last

15 years; only the first one seems to have had a significant impact; all programmes heavily subsidised the latrines and promoted expensive options, with little evidence of participation from the beneficiaries.

Defecation practices, according to the survey results, are appalling, with 58% of respondents practising open defecation and only 15% owning a latrine, those figures reaching their extreme values of respectively 74% and 3% in Shada. Plastic bags and buckets are also used in Bas-Ravine (38%), while overhung latrines are in use in Shada (21%), often for a fee of one Gourde. Dissatisfaction with those practices is general, the few exceptions being some private latrine owners.

Most private latrines are expensive, around US$ 300, and require a long acquisition process. The main reasons for building a latrine seem to be the building of a house, to avoid going to nature, and for visitors; those with an intention to get a latrine usually say

they want one for practical reasons, or for improved security, especially at night. The

main constraint is money, hence the price of a latrine; space issues are also mentioned

in Shada. Pit emptying services are limited between Jedco and its expensive vacuum tankers, and the bayakous who empty pits manually and work in poor conditions.

An analysis of current practices has revealed that they are not compatible with «sus- tainable sanitation», whose criteria have been defined during the workshop. The MDGs have little chance of being achieved if supply-led programmes continue to be done, like

the recent project in Mansui; an evaluation of this project has revealed that its impact is not as high as expected, and could even have reduced of inhabitants to build their own latrines and have divided the community.

Findings from this research therefore urge the need for a radical change in the way sanitation is approached in Cap-Haitien.

Possible alternatives have been proposed with the help of the London School of Hy- giene. Given the presence of urban agriculture in some peri-urban areas like Mansui,

an approach based on ecological sanitation could be tried, using its simplest model, the Arborloo. it would have several impacts including improved health, creation of fertiliser without the need to handle compost, stabilisation of the soil, and possibly improved nu- trition and livelihood. The Arborloo can be built at a low cost, suiting the users' needs.

A pilot has been tried with a family in Mansui, as they are willing to improve their sanitation and keen to test this kind of latrine; follow-up is now needed to assess the suitability of this option, and possibly to promote it in case of success.

In established high-density areas like Shada, located in low lands, a proposed option would feature a product-service package, by marketing low-cost and small latrines cou- pled with a reliable emptying and disposal system. The current proposal does still have shadow areas regarding the users' willingness to pay, the feasibility of low-cost empty- ing and the availability of a dumping site. Willingness to pay would be better estimated

by further focus group discussions with varied types of groups (men / women, mem- bers of the KLPS, masons, neighbouring areas), and in-depth interviews with selected inhabitants. Finding a suitable solution for the final disposal requires cooperation or a partnership with the public authorities, and particularly the MSPP.

Financial viability calculations could still be refined by examining different business models and considering best case / worst case scenarios. The project should seek advice from experienced micro-entreprises managers and entrepreneurs, who would have a more valuable input than sanitation officers for this part of the project.

In order to develop a common understanding of sustainable sanitation, and re-inforce

found to be focused too much on hardware and on water, which is only one side of the «water and sanitation» sector. The main aim of the project, i.e. improving health con- ditions in Cap-Haitien, has to be stressed again to avoid it being only an «infrastructure project».

Developing sustainable excreta management for any of the poor areas of Cap Hai- tien is not going to be an easy process. Using a sanitation marketing based process to provide low cost building, emptying and transfer services to the poor living in the high density areas is an option worthy of further experimentation and behaviour trials, but its success will require a dedicated team, flexibility and determination. An easier option from a project management perspective is to use a traditional supply driven approach and provide a subsidy for building the latrines. Whilst this option is easier to manage, it will not lead to sustainable sanitation, only have a very limited impact on public health, and be insignificant with regard to help Haiti achieve the sanitation MDG.

Future research in Cap-Haitien would have to address this study's shortcomings: in particular, the demand tool needs to be improved and tested again for areas with low coverage; one way would be to conduct the survey with the same households, once a pilot has been set up and its effects can be evaluated. A new survey with the same households done after two or three years can indicate how new products and services have penetrated the market.

Pit emptying appears to be a recurrent problem, and Cap-Haitien is only one of the numerous examples where appropriate solutions are hard to find. The use of a direct- action handpump for small pits coupled with a low-cost transport system would be an interesting alternative to bulkier systems, but still has to prove its effectiveness. The provision of low-cost latrines and the sustainability of the whole sanitation system is highly dependent on emptying.

The categorisation of the city into several typical areas has helped to devise possible solutions: this approach could be generalised by comparing with other cities in Haiti, and with cities in other developing countries. The comparison of different contexts, along with an evaluation of past and current practices, would allow to create a hand- book, presenting different options suitable for each context, as well as bringing together current ideas in sanitation such as ecological sanitation, total sanitation or sanitation marketing, which are too often considered separately.

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barrios del municipio de Cap-Haitien, departamento Norte, Hayti, June 2005, Annex

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Wegelin-Schuringa M. and Coffey M., 1998, Small Pit Emptying Machine: an Appro- priate Solution in Nairobi Slum, IRC International Water and Sanitation Centre

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Appendix A

· Appendix B: Sample of topics for a semi-structured interview with the head of

· Appendix D: Possible definition of sustainable sanitation, by Jenkins & Sugden

· Appendix F: Detailed description of the product-service package introduced in

(«Haiti trip report.doc» and «Rapport - Assainissement à Cap-Haitien.doc»).

· Notes taken during the semi-structured interviews (subfolder «Interviews»).

· Detailed results of the survey («Résultats Enquête.xls» and other files in subfolder

· Instructions for the follow-up of the Arborloo in Mansui («Suivi toilette écologique.doc»)

· Full-resolution photographs illustrating this dissertation (subfolder «Photos»).

Note that many documents on the disk are written in French as they were used during the study.

Appendix B

Semi-structured interviews

This set of questions was used for interviewing the head of the Ministry of Public Health and Population (MSPP) of Cap-Haitien, and also used (with some minor alterations)

for other semi-structured interviews. The questions were not asked directly but rather served as guidelines during the interview, in which the research tried to let the intervie- wees speak by themselves, in order to understand their own issues and perceptions.

· What is the MSPP role regarding sanitation in Cap-Haitien, and in excreta man- agement?

· Which links does the MSPP have with the city council, the private sector, NGOs?

· Which resources does the MSPP have (human, financial, physical...)? Where does

· Have studies already been carried out about the sanitation situation? Which are

· Which projects have already been tried in Cap-Haitien for sanitation, and how successful were they?

· Does the MSPP provide services to «illegal» settlements and slum areas? Are there different strategies depending on the type of area (hillside, periurban...)?

· Which are the main problems, and how could the MSPP work better in the future?

· Are you aware of the EU-financed project, and are you going to take part in it?

Appendix C

Focus group discussion

- Dig in to know their aspirations: if housing is mentioned, ask what is wrong with your current house? why is having a nice house important?

· We have done a survey and found that you are dissatisfied with excreta disposal.

- We have engineers working on this, we need to give them a cost to design to. What should it be?

· Space: If we designed a latrine which takes 1 x 1m, would you find space for it?

Participants in the discussion: Mmes Bertha Michel, Evelyne Duvercin, Iniose Planor, Janine Pierre, Jasmine Laguerre, Jasmine Zulma, Liliane Paul, Mulène Timète, Philia Alcyanas Jean (all members of Fanm pa chita) and M. Philoclès Marcelin.

Appendix D

Sustainable excreta disposal

by Steven Sugden, included in the joint report; from Jenkins & Sugden (2006) Sustainable excreta disposal can be said to have been achieved when:

2. the community / society is maintaining latrine coverage at 100% without external support,

Consistent use: To have an impact on public health, latrines have to be used at all times by all members of the family. This is in fact more difficult to achieve than it may at first appear. Children are often scared of the monsters their brothers have told them live in the dark pit latrines; latrines can harbour snakes making use dan- gerous in the dark; and latrines sited a distance from the house are inconvenient, particularly when it is dark and open defecation nearer home is an easier option. Communal latrines which are locked at night, or unused because of fear of attack,

do not allow for consistent use either, and are often not designed for children's use.

Maintaining coverage at 100% without external support: Villages and commu- nities grow, either by increasing the area they occupy or their density. Populations can double in size within 10 years and a project achieving 100% latrine coverage

in 1995 may only have 50% coverage in 2005. Any system developed for build- ing latrines needs be able to continue building and repairing them after external funded has ended and has to ensure that community members do not become dependent on subsides or outside organisation to achieve this.

No significant risk to community health from disposal techniques: The de- sired health impacts of latrine use are quickly lost if using the latrine results in

nates entering into the water supply via the ground water or in a high density urban setting, by not using a pit emptying service and letting the pit contents flow

No significant degradation of the environment: There is also a growing con- cern about the impact latrine building has on the environment. Designs requiring the use of local bricks needing firewood to make will have an environmental im- pact. Traditional latrines can have a local adaptation of using slow growing hard woods, such as mahogany, to support the platform. This has become necessary as the local softwood suffers from termite attack causing latrine collapse, but hard- wood supplies in many areas are rapidly dwindling and latrine building can add

Can be maintained over a prolonged period i.e. 20 years: Behaviour change, latrine building and demand creation are slow processes that take time and other resources to stimulate. Any delivery system developed has to meet the needs of households who are slow to adopt latrine usage and change their behaviour. The slowest tend to be the poorest, least educated and most risk averse members of the community. The delivery system itself must be financially sustainable, be locally available and meet evolving needs over time.

There has been debate within the sector about widening the definition of sustainable sanitation to include the principle that waste should be considered a resource and that sustainable sanitation is only achieved when the nutrients in waste are returned to the land. It is argued that the western style of waste treatment, where the nutrients eventu- ally end up as pollution in the world's rivers and oceans, is globally unsustainable. This has resulted in the promotion of ecological sanitation which is based on composting hu- man waste and using it as fertiliser. This is a persuasive argument in the right context. If

a community is predominantly agriculture based, soil fertility is declining and the cost

of artificial fertiliser is increasing, the adoption of ecological sanitation is rational and can have a large impact on the household economy.

Achieving these five criteria is not an easy process and cannot be done by using

a one-off, technically-led, supply-driven, hardware-based approach. It requires long term commitment and sustained management from the public bodies responsible for public health, but public bodies can not do this alone; effective partnerships with the private sector latrine builders / service providers are needed. Just as curative health is not considered to have been improved by the provision of a hospital; excreta disposal and the associated public health benefits cannot be considered to have been achieved with the simple provision of latrines.

Appendix E

MDG calculations

The following tables were used to calculate how much money would be needed in order

Using the division in zones performed in Section 5.1 and the coverage data from Section

5.2.1, it is possible to derive estimates regarding achievement of the MDGs. Population data was obtained from one of the few sources available, from 2003¹; the city centre and two peripheral areas were voluntarily ignored, given their higher wealth level. The population figures group all similar areas together; population is extrapolated forward and backwards with an assumed growth rate of 4 % (suggested by GTIH staff). The MDG 7 states «Halve the proportion of people without access to safe sanitation by

2015»; this proportion has to be calculated using 1990 figures, from which the MDGs were set.

«Coverage» is an indication of the coverage of «improved sanitation» as defined by the

Water and Sanitation Programme; figures differ slightly from the survey results to reflect

the variety of the zones: in particular, Petite-Anse comprises many medium-income houses which have sanitation, like the Cités. «Access» indicates the number of persons with access to improved sanitation. The coverage in 1990 was estimated given the researcher's knowledge of the sanitation situation at this time, using indications from the MSPP staff; the coverage was lower given the lack of previous sanitation programmes and some emerging zones, except in the Cités where the communal latrines were in much better state than now.

It appears that the current coverage in those areas is around 28 %, coincidentally the same as in 1990, which means that the number of families with improved sanitation has progressed (due to sanitation programmes and private acquisition), their proportion has remained stagnant. In order to achieve the MDGs, the 72 % proportion without

¹Estimates of population data by zones and by gender, done by Oxfam within the DIPECHO project in

Area	A	B	C	D	E	Total
Population in 2003	70,000	75,000	40,000	40,000	100,000	325,000
Coverage in 2003	3 %	40 %	10 %	10 %	50 %	28 %
Access in 2003	2,100	30,000	4,000	4,000	50,000	90,100
Population in 1990	41,174	44,115	23,528	23,528	58,820	191,165
Coverage in 1990	0 %	24 %	0 %	5 %	70 %	28 %
Access in 1990	0	10,588	0	1,176	41,174	52,938
Population in 2015	112,072	120,077	64,041	64,041	160,103	520,335
Access target by 2015	71,726	76,850	40,986	40,986	102,466	333,015
Additional access by 2015	69,626	46,850	36,986	36,986	52,466	242,915
Additional families	8,703	5,856	4,623	4,623	6,558	30,364

Areas type A are similar to Shada, B to Petite-Anse, C to Mansui, D to Bas-Ravine,

sanitation has to be halved by 2015, i.e. there must be only 36 % without sanitation or

64 % of the 2015 population with improved sanitation. This is reflected by the «Access target by 2015» line, with the «additional access» line representing the difference with

By assuming an average family size of 8, the number of families to provide with sanitation can be obtained, which is also the number of private latrines. Finally, about

Table E.2 below shows details of the cost of a latrine, according to various sources. Main sources were local masons who were interviewed during the survey, and engineers working for GTIH in sanitation who had experience of construction projects; secondary sources are estimates by inhabitants, and indications by latrine owners. Some prices are standard over the whole city, such as bags of cement, but other prices seem to vary more consequently with the zones and the person interviewed.

A price of around US$ 300 was most often quoted, with a maximum at US$ 375. It should be noted that labour cost, while originally calculated per day, is often paid «for

the work done» independently of the length of time it might take; this is particularly the case for subsidised programmes.

Element	Price (US$)
Element	Standard	Minimum	Maximum
Digging a 2 m deep pit	37	15	60
1 bag of cement	5.9
1 load of sand	37.5
1 load of gravel	37.5
140 cement blocks (pit)	52.5
120 cement blocks (superstructure)	45
3 sheets of corrugated iron (roof)	6	5	10
1 seat	12.5	7.5
1 PVC ventilation pipe	6	5
Overall cost of materials	203	80	270
Labour (per day)	12	7.5	22
Total cost	312.5	170	375

Using the prices and the number of families to serve as shown above, it is possible

to calculate how much subsidy is needed if those latrines are to be fully funded by a project, in order to achieve the MDGs.

It should be noted that even by providing this, it would still leave 36% of the popula-

Appendix F

Product-service package

1. Designing and developing low cost, low space latrines which are affordable to the poor

2. Developing reliable affordable, safe pit emptying services to take excreta from the pit to a transfer tank.

3. Providing bulk transport services from the transfer tank to the final disposal site

This approach is based on the need to remove the two main constraints facing the res- idents; lack of space and money. The way to make a latrine smaller and cheaper is to reduce the size and cost of all the components, including the pit, so as to make the cap- ital cost low enough to be affordable (and desirable) for the majority of the households. This process of reducing the pit size automatically decreases the time it takes for the pit

to fill and the need is introduced for more frequent emptying. This emptying service has

to be provided by small scale private sector operators whose development, capacity and commercial viability is one of the keys to making this approach sustainable. The small scale emptiers dump the waste into a transfer tank, which when full, is taken for final disposal.

The price of current latrine design built by the local masons is around HT$ 2,500 (US$

310) and unaffordable to the urban poor. International Development Enterprises (IDE)

Miniaturisation: This asks the questions are large 3m deep pits necessary? Will a 1m

Affordability to the poor is always important. Are expensive concrete slabs absolutely necessary? Are there cheaper alternatives?

Expandable: This enables households to build latrines in small affordable sections.

House building processes in developing countries are incremental i.e. the owner first saves to buy the land, then saves to pay for the cement for the foundations, then for the bricks, etc. It is not all done at once as in Northern countries, and house building is matched with the family income flows, avoiding the need for banking services.

Component

Standard design

Low-cost option

Ultra-low-cost

option

Pit

2 m deep, 1 m

square, block lined

1 m deep, 60 cm

diameter, plastic drum lining

1 m deep, 60 cm

diameter, plastic drum lining

Slab

Rough cast, 8cm

thick, iron bar reinforced, fitted with concrete pedestal.

80 cm diameter x

5cm thick concrete dome slab with pedestal

80 cm diameter

wooden platform with squat hole

Ventilation pipe

100 mm diameter

plastic pipe

100 mm diameter

plastic pipe

None

Superstructure

Cement block with

galvanised tin door

Wooded frame

covered with sacking

Provided by owner

to a minimal level

Roof

Galvanised tin

Provided by owner

to a minimal level

Price

HT $2,500

(US$ 312)

HT$ 800 - 1,000

(U$ 100 - 125)

HT$ 200 - 300

(US$ 25 - 37.5)

The price of different items can be detailed below. Original figures come from local

masons or are rough estimates; prices were refined during the workshop and by working with a local GTIH engineer:

The process is made expandable by having the components inter-changeable. A household may be able to afford only a wooden slab in the beginning, but over time could afford to upgrade to a concrete slab and vent pipe.

Assessing the willingness to pay for an unseen product and service is a difficult pro- cess and at best only gives a feeling of demand. When costs were discussed in a Focus

Element \ Source	First estimates		Workshop		GTIH Engineer
Element \ Source	HT$	US$	HT$	US$	HT$	US$
Essential items
1m pit digging	120	15	30	3.75	50	6.25
200 l plastic drum	100	12.5	100	12.5	50	6.25
4 blocks (bottom)	12	1.5	12	1.5	12	1.5
Concrete domed slab	200	25	120	15	150	18.75
Sub-total	432	40.5	262	32.75	262	32.75
Superstructure
Wood					35	4.37
Cloth					20	2.5
Tin roof					40	5
Sub-total	300	37.5	200	25	95	11.87
Extra
Ventilation pipe	50	6.25	40	5	45	5.65
Seat	100	12.5	60	7.5	100	12.5
Sub-total	150	18.75	100	12.5	145	18.15
Total	882	96.75	562	70.25	502	62.77

would be given consideration and HT$200 was defiantly affordable and they «would hit

[their] heads on the ground to raise the money». Another interesting aspect to the capi-

tal cost discussion was that the women did not know the cost of the existing traditional latrine design, they just knew it was unaffordable. The problem they say with a small

The issue of space was discussed by laying planks of wood on the ground and asking

«If the latrine design was this big, would you have room for one in your house?» Al- though space was often given as a constraint in the survey, it would appear that a 1m

x 1m latrine design could be accommodated by the majority of the group. The main issues were whether it could be placed inside the house and the relationship with the landlord.

The effectiveness of this process is dependent on whether the customers pay sufficient funds to sustain the commercial viability of a pit emptying service: Revenue from cus- tomers > emptying costs + profit. The commercial viability of the emptying service is dependent upon Productivity rate and dumping charges.

This is a long list of variables and our knowledge of how they apply to a place like Shada

is limited. It is possible to assume that if an emptying service was established for the current latrine coverage it would not be viable as there are simply not enough latrine pits

to empty. The development of the emptying service must therefore go hand in hand with

the development and promotion of lower cost, smaller, latrines. Any subsidy should be not given for the building of latrines, but instead used as a buffer to cover the initial start

up losses and there after gradually reduced as the demand for the emptying services increases and commercial viability is established.

Shada has the following disadvantages in the development of an emptying service,

· Low percentage coverage and usage of latrines with no pits currently in need of

· None of the current emptying equipment, (the Vacutug or MAPET) will fit through

· All the houses are relatively close to a main road and therefore average distance from households to transfer points will be low

F.1.3 Providing bulk transport services from the transfer tank to the final disposal site

Jedco is the only company in Cap Haitien with the equipment or capacity to suck waste out of a transfer tank and transport it to a final disposal site. Their main customer is the UN who have a strong presence in the city and require their septic tanks to be regularly emptied. There is no competition and this allows Jedco to charge around US$250 per trip. Jedco are interested in expanding their business, but whether they would be willing

The Ministry of Public Health and Population (MSPP) were once donated a small vacuum tanker under a German funded project, but this fell into disrepair when a vital spare part could not be obtained. They are now rotting in the MSPP yard and could be relatively inexpensively adapted to provide a towable transfer station.

There is no sewage treatment works in Cap Haitien and dumping waste in a mangrove swamp at the cities boundary seems to be an accepted practice. This is far from satisfac- tory, but probably the least worse alternative and certainly preferable to dumping waste

in the river next to the housing settlements. It is difficult to predict at this stage, but the project could have problems gaining permission to adopt a similar practice. Officials tend to feel more comfortable denying permission for any changes which they feel may leave them open to criticism in the future. Granting permission to dump what could be large quantities of raw faecal waste in a ecologically sensitive wetland may just regarded

The initial calculations for the commercial viability of the emptying operation were based on fees a family of 3 adults would pay per month for using the public latrine. This amounted to approximately 90 Gdes (US$ 2.25) per month. During the FGD it became apparent that this was considered too much and the women said they had to compare

Income per trip
Willingness to pay	120 Gdes
Expenses per trip
Bayakou pay	25 Gdes
Barrow boy pay	12,5 Gdes
Equipment	2,5 Gdes
Dumping fee	?
Moving transfer station	15 Gdes
Total	55 Gdes
Balance per trip	65 Gdes
Expenses per day	530 Gdes
Minimum to break even
Trips	8.15
Bayakous	1.02
Latrines needed	367

the price with open defecation, not the public latrine fees, as this is what they currently practised. It was difficult to assess the willingness to pay for an emptying service as by this stage the group was beginning to realise that we were discussing an NGO project who are known to give everything for free. However, as a best guess, the following calculations are based on a willingness to pay 120 Gdes (US$ 3.15) for emptying 100 l

Capacities
Emptying every	1.5 months
Quantity to empty	100 litres
1 bayakou serves daily	8 latrines
Transfer station capacity	2,000 litres
Emptied every	2.5 days
Daily wages
Bayakou	200 Gdes
Barrow boy	100 Gdes
Staff	400 Gdes
Nightwatch	100 Gdes
Costs and maintenance
Moving transfer station	300 Gdes
Equipment maintenance	320 Gdes
Station maintenance	30 Gdes

If each latrine fills in 1.5 months, one Bayakou could serve 367 latrines with a profit

Shada has a population of around 20,000 comprising of 2,400 families. In theory this could be served by 10 Bayakou providing a profit for the managing organisation of HT$33,000 per month. From this the organisation would have to provide some form

of management and office space, but it is these types of calculations that indicates the potential of «the fortune at the bottom of the pyramid».

This calculation is based on an ideal situation and too many assumptions are used which need to be further research and tested. Economies of scale could bring down some costs just as easily as a willingness to only pay 150 Gdes for emptying 200l could

make the entire process unprofitable. It does however give an indication of the potential

of a sustainable form of excreta management in what would be usually considered to be

Government has a role in protecting the public health of its citizens. When visiting all of

the areas in Cap Haitien, particularly the high density areas, it is clear that public health

is being compromised and raises the question what could and should the government be doing for the residents of areas like Shada?

Mrs Guettie Noel, a Public Health Technician from the Ministry of Public Health and Population stated that it was their job to empty the latrine pits, but they found this impossible because they did not have the equipment of the resources. The MSPP could present an argument that they do not need a PPP if Oxfam simply donated a new vacuum tanker to their ministry. An MSPP operated emptying service is likely to be unsustainable and only partially benefit the poor, but refusal could result in the MSPP proving difficult over refusing final disposal sites and possibly applying over-zealous building regulations latrine design. The project needs to develop good relationships with

the MSPP and continually point out that removing the excreta from areas like Shada has

a significant impact on public health and the productivity of the residents, and that it is

If the MSPP could be persuaded to cover the cost of taking the waste from the transfer station and for final disposal, the commercial viability of the emptying service will be significantly easier to achieve.

There are a variety of organisational arrangements possible for private sector latrine building, emptying and transfer services. Which is most suitable would need further discussion, but an initial suggestion would be to have one organisation overseeing the whole process and to manage the Bayakou in providing the building and emptying ser- vices. The organisation would need to be experienced in programme management, have

the capacity to keep accurate accounts and be able to monitor the various processes. Oxfam's project partner, GTIH, could be ideal in this role.

Appendix G

Survey questionnaire

The questionnaire on the following pages, in its French version, was used during the whole survey, with a slightly different version used for the first ten households. All intermediate versions can be found on the disc.

The table on the following page presents a summary of the survey results, which have been used in this dissertation. More detailed results, which were less relevant to the dissertation (for use by the Oxfam project, for instance) are included on the disc.