Community Participation in Water and Sanitation Development and the Impact on Health

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Community Participation in Water and Sanitation
Development and the Impact on Health

• Jennifer Lee
• Dissertation Proposal Defense
• Spring 2006

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Outline

• Background
• Theoretical Framework
• Research Questions
• Methodology
• Analytical Framework
• Discussion

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Importance of Water and Sanitation

• 1.1 billion individuals or 17 of the global
  population lack access to an improved drinking
  water source
• (e.g. household connection, public standpipe,
  protected dug well, or rainwater connection)
• 2.6 billion people or 42 of the global
  population lack improved sanitation facilities
• (e.g. connection to a public sewer, connection
  to septic system, simple pit latrine, or
  ventilated improved pit latrine)
• World Health Organization, 2004

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• Insufficient and unsafe water supplies and
  sanitation
• contribute to morbidity and mortality from
  infectious
• diseases
• Eighty-eight percent of diarrheal disease is
  attributed to unsafe water supply, inadequate
  sanitation and hygiene
• Each year, 1.8 million individuals die from
  diarrheal diseases (World Health Organization,
  2004)
• In addition, unsafe water and poor sanitation
  have a negative economic impact and impede
  development efforts
• United Nations Member States set out to halve
  the proportion of people without sustainable
  access to safe drinking water and basic
  sanitation by 2015 as one of its Millennium
  Development Goals (MDGs)

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Community participation

• In recent years, growing efforts focus on
  increasing community participation in providing
  safe water and sanitation (Hossain et al., 2004)
• Community participation was adopted as one of the
  key strategies of the International Drinking
  Water Supply and Sanitation Decade (1981-90)
• Process of community participation enables
  communities to undertake a variety of actions in
  other sectors which contribute to the social,
  economic and health well-being of the community
  (Eng, Briscoe, Cunningham, 1990)

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Indonesia

• USAID estimates that more than 75 million
  individuals lack access to clean water and over
  140 million lack adequate sanitation (United
  States Agency for International Development,
  2005)
• 31 of urban residents and 5 of rural residents
  had improved drinking water coverage
• In terms of sanitation, 61 of urban residents
  and 38 of rural residents had improved coverage
• Indonesia has a long history of community-based
  development programs

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Theoretical framework

• Neighborhood or contextual effects
• Increasing interest in social science and public
  health
• Social disorganization theory Examines
  social-interactional and institutional mechanisms
  hypothesized to account for neighborhood-level
  variations in a variety of phenomena, e.g.
  delinquency, violence, depression, and high-risk
  behavior especially among adolescents (Sampson et
  al. 2002)

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• Social disorganization theory
• Hypothesizes the existence of social processes or
  mechanisms (e.g. collective socialization,
  peer-group influence, and institutional capacity)
  that mediate the effect of neighborhood
  structural characteristics
• Many studies hypothesize a mediating process of
  community social organization on various outcomes
  but few measure it
• Collective efficacy
• Shared willingness among neighbors to intervene
  on behalf of the common good

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Research Questions

• How do community structural and social
  characteristics affect health outcomes related to
  water and sanitation (i.e. diarrhea, skin and eye
  infections)?
• How do community structural and social
  characteristics affect the likelihood that a
  particular community participates in water and/or
  sanitation development?

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• How do these characteristics affect the success
  of the project (measured by whether the community
  has improved water and sanitation facilities)?
• How does community participation affect the use
  of water and sanitation facilities?
• What is the effect of community participation on
  health outcomes related to water and sanitation
  (i.e. diarrhea, skin and eye infections)?

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Methodology

• Data are from the Indonesia Family Life Survey
• Longitudinal socioeconomic and health survey
• 3 waves collected in 1993, 1997, and 2000
• conducted by RAND, UCLA, and researchers in
  Indonesia (Frankenberg Thomas, 2000)
• The IFLS sample is representative of about 83 of
  the Indonesian population and contains over
  30,000 individuals living in 13 of the 27
  provinces in the country
• Contains individual, household and community
  level data

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• IFLS1 collected data from 90 communities, 7,224
  households, and 22,347 individuals
• Complete panel data, from all three waves, is
  available for approximately 91 of IFLS1
  households
• Interviews were conducted with the household head
  and his/her spouse, two randomly selected
  children of the head and spouse age 0 to 14, an
  individual age 50 or older and his/her spouse,
  randomly selected from remaining members

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Survey Instrument

• Multipurpose survey
• Collects extensive retrospective information
  about the lives of respondents as well as
  measures of health status, including
  self-reported measures of general health status,
  morbidity experience, and physical assessments
  conducted by a nurse (height, weight, blood
  pressure, pulse, hemoglobin level, lung capacity,
  etc.)
• The household questionnaires were organized
  similarly for each wave in order to allow
  comparisons

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• Divided in books, usually addressed to different
  respondents, and subdivided into topical modules.
  
• Topics include
• Household expenditures and knowledge of health
  facilities, household economy
• Individual adult information (i.e. education,
  marriage, work, migration, asset ownership,
  insurance coverage, health conditions, use of
  inpatient and outpatient care, participation in
  community development activities, etc)
• ever-married woman information (i.e. children
  ever born, pregnancy outcomes, health related
  behavior during pregnancy and childbirth, etc)
• child information (i.e. educational history,
  morbidities, self-treatment, etc)
• physical health assessments and cognitive
  assessments. Individual measures of health
  status were recorded for each household member

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Community participation module

• Both were asked about their participation in
• community meeting, cooperatives, voluntary
  labor, and program to improve the
  village/neighborhood
• Men were asked about participation in
• neighborhood security organization, drinking
  water system/supply, washing water system/supply,
  and system for garbage disposal
• Women were asked about participation in
• womens association activities, community
  weighing post, contraceptive acceptors group,
  and child development program

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Community Module

• Aspects of community life supplementary
  information about the availability of health
  facilities and schools in the area as well as
  general questions about family health and prices
  of basic commodities
• IFLS2 gathered data from two new sources in each
  community
• individual considered an expert in the adat
  (traditional law) about the customary laws that
  influence behavior in the community
• social activist in the community about a project
  in which he or she was involved, preferably one
  designed to improve water supply or sanitation
  facilities

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• Topics include information about the community
  (e.g. transportation, electricity, communication,
  etc.), availability of health services and
  schools, changes in community over time, village
  characteristics, traditional laws and customs,
  community organization, governance, etc.)
• Book PM, administered in IFLS2, asked about the
  background of a particular development project,
  its prospective benefits, project planning,
  management, implementation, funding, and about
  the history of development activities in the
  community

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Analytical Framework

• Descriptive analyses to get acquainted with the
  data and to examine bivariate relationships
  between variables
• Operationalize collective efficacy
• Multilevel statistical models to address the
  multilevel nature of the data

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Dependent variables

• participation in water or sanitation development
• participation in other programs or community
  activities (voluntary labor, program to improve
  the village/neighborhood)
• success of water and sanitation programs
  (self-reported and by availability of water and
  sanitation facilities and utilization)
• health outcomes shown by the literature to be
  linked to water and sanitation (i.e. repeated
  diarrhea, worm infestations, skin and eye
  infections and chronically challenged immune
  system) and changes over time

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Independent variables

• Community characteristics (residential mobility,
  distribution of income and education, ethnic and
  social heterogeneity, availability of facilities
  and services)
• participation in water or sanitation development
  project
• other measures of participation (voluntary
  labor, program to improve the village/neighborhood
  )
• characteristics of residents participating in
  development projects

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Main Source of drinking/cooking water (N 7,600)
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Where majority of householders go to the toilet
(N7,600)
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(No Transcript)
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Discussion

• Strengths of the study
• rich data on community participation
• developing country setting
• longitudinal data
• ability to measure relationship between
  community participation and health outcomes
• inform the design and implementation of water
  and sanitation projects in Indonesia and other
  poor countries
• expand knowledge about the similarities and
  differences in community processes and community
  mobilization across societies

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• Limitations of the study
• participation in water and sanitation programs
  was only asked to men
• Selection bias

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jlee118_at_ucla.edu