It's a typical dry, scorchingly hot afternoon in the small village of Kafr Shanawan, located about 30km north of Cairo in Egypt's Lower Nile region. Local women congregate around the canal that crosses the community and diligently wash dirty pots and dishes. Clothed in bright, long dresses and head veils, they talk as they work, occasionally laughing at children playing in the water.

Underlying this seemingly routine situation are very real problems that face most Egyptian rural communities: poor water sanitation and unhygienic personal practices. The canal water in which the children wade is stagnant and fetid. Villagers not only wash dishes but sometimes dispose of sullage (dirty water) and septage (urine and stool) in the same canal where children swim in the hot summer months. The water is highly infected with bacteria and parasites that can result in water-borne diseases like bilharzia.

And the canal is only one aspect of village sanitation problems. Just a few metres away, animals roam around the houses, living in the same immediate area as humans and frequently transferring diseases and parasites to occupants. The lingering stench from the animals only adds to the sharp smell of the latrines, which are rarely built with proper ventilation or storage capacity. Food is generally prepared and cooked on the dirt floor in the adobe or red brick houses and villagers irregularly wash their hands before or after meals. This combination of poor hygienic practices with an unsanitary environment can lead to the transmission of faecal oral diseases such as dysentery, viral hepatitis and gastro-enteritis.

The issue of water and sanitation is not restricted to Egypt either. Reports from the World Health Organization (WHO) in the mid-1980s estimated that as much as 80% of all diseases in developing countries are related to unsafe drinking water and inadequate hygiene.

DYNAMICS OF HYGIENE

Since 1985, an IDRC-funded project has been addressing this issue, trying to understand the dynamics of rural water sanitation and general household hygiene in the two Northern Egyptian villages of Babil and Kafr Shanawan. Headed by researcher Mrs. Samiha El-Katsha of the Social Research Centre at the American University in Cairo, the study was designed to pinpoint specific problems and empower villagers, especially women, with the knowledge to develop sustainable solutions.

According to Mrs. El-Katsha, this research has required a great deal of groundwork. "There has never really been any study of rural water supply and management techniques in Egypt," she says. "We had to start from scratch and see what was really preventing effective hygiene and sanitation."

An essential part of this research was the understanding that women play a key role in household water collection, storage and use. "Because the woman, as mother and housekeeper, determines the appropriate hygienic use of water, her participation is vital in any efforts to halt the cycle of infection, especially for diarrhetic illnesses resulting from the faecal contamination of foods and household water," says Mrs. El-Katsha.

The research team was eager to increase awareness in village women and children of the relationship between hygiene, water use and disease. Mrs. El-Katsha and her colleagues devised health education programs and used specially-selected health promoters in the village to teach women and children about hygiene. Their most basic message to the villagers was that they were part of both the problem and the solution.

"In these villages, where many of the women are illiterate, there is little knowledge of the link between unsanitary conditions and disease," Mrs. El-Katsha says. "We had to teach them in very clear and basic terms how interconnected the processes were." Specifically, this involved a number of different methodologies and objectives. The research team trained more than 85 nurses, teachers and informal village leaders on how to impart basic health messages to women and children.

Existing health structures within the village were also used for hygiene promotion. Nurses in both Babil and Kafr Shanawan organized health education sessions for women who were bringing their children in for immunization. Teachers ran summer education programs where village children learned about hygiene and health through short skits and arts and crafts. In Kafr Shanawan, informal leaders conveyed health information to women who approached them at their homes for help or advice. Often, these informal leaders would observe unhygienic practices and suggest alternative methods of water sanitation.

GREATER AWARENESS

In all, these health promoters reached out to 712 households in Babil (15% of total population) and 322 households in Kafr Shanawan (8% of total population). Researchers evaluated changes in behaviour and retention of information in these households to see if their efforts resulted in better personal hygiene. In key areas such as water storage, food preparation, latrine upkeep and hand-washing, those households approached by the health promoters showed greater awareness of water sanitation issues and practised better household hygiene than those villagers who were not exposed to the research study.

"This increase in information retention and general awareness was an important step," says Mrs. El-Katsha. "But we realized we needed to do more." In this case, "more" meant realizing that it would be impossible to change hygienic practices related to environmental sanitation without improving the village surroundings. Researchers wanted to make sure they saw the forest as well as the trees.

They examined the major sources of water in the villages: wells and tanks, public standpipes, house connections, privately-owned handpumps, and irrigation canals. After doing tests based on both laboratory work and observation, Mrs. El-Katsha and her colleagues concluded that the villages suffered from the pollution of most water sources, poor maintenance of most water sources (especially storage tanks), unsatisfactory disposal of solid wastes and an ineffective sewage system, if there was one at all.

Both villages had similar environmental problems but in differing degrees of severity. In Babil, the priorities were to fix a standpipe used to distribute well-water and create a garbage collection system. While these problems also existed in Kafr Shanawan, the main problem there involved lowering the water table, which often rose to just one metre below the surface. Identification of the problems was the first step: next came the hard part of working toward solutions.

Some solutions that worked involved bringing PVC handpumps into Kafr Shanawan and fixing a standpipe in Babil. The testing of the Malaysian-made PVC handpumps allowed those villagers in Kafr Shanawan who lived far from water sources to have increased access to potable water. Villagers were eager to learn how to maintain and repair the pumps. Meanwhile, a group of women in Babil organized themselves and approached their representative on the village council for help in repairing the public standpipe. With some materials and supervision, they were able to fix the pipe, which is still in use today.

Other measures were less successful. A garbage collection system in Babil was shelved after only three months owing to administrative problems. Similar failed initiatives brought to light the thorny issue of community participation. "We learned in the process of trying to improve village surroundings that peoples' participation can be blocked by many extraneous factors," Mrs. El-Katsha says. "The relationship between government agencies and villagers was one of these factors."

COMMUNICATION GAP

Lack of communication between levels of government and cumbersome bureaucratic procedures were major obstacles in the path of improved sanitary conditions. The three levels of government in Babil and Kafr Shanawan -- governorate, markaz (county) and village council -- all share general responsibility for village sanitation but researchers noted little coordination of efforts. The result was, and still is, a considerable gap in communication between the levels of government and the villagers themselves. Many villagers complained of not knowing who to turn to for assistance in bettering sanitary conditions -- others were sceptical about any response from village or regional governing bodies.

This scepticism sometimes led to apathy. When researchers first went to the village of Babil, they investigated the problems of pollution and garbage strewn around public standpipes. The response from one villager seemed to encapsulate attitudes in the community: "the government is the one responsible for it." A willingness to put responsibility for village sanitation in the hands of the "government" is a significant constraint to community participation, Mrs. El-Katsha says.

PARTNERSHIP MODEL

But she views cooperation between government agencies and health promoters and active villagers as a crucial means of improving the environmental conditions in Babil and Kafr Shanawan. "We have to develop a new model of cooperation and participation when it comes to village health and hygiene issues," Mrs. El-Katsha says. "This model should be based on a partnership between decision-makers, administrators, and villagers that will enable them to communicate and work toward the same goals."

Although this goal is an ambitious one, the project has laid the groundwork for its achievement. With the project's conclusion, researchers have left the villages of Kafr Shanawan and Babil but they have also left behind the ideas of community participation and individual responsibility. The creation of village committees on environmental issues and the increase in villagers' awareness of personal hygiene have given project researchers hope that solutions to health problems will be sustained by villagers themselves. Mrs. El-Katsha's vision for the future of Babil and Kafr Shanawan is simple: the continued practice of personal hygiene, an awareness of environmental conditions and the willingness to participate in decisions about health and sanitation. This may or may not happen, she warns, but one thing is clear: many of the villagers now have within themselves the knowledge and ability to make many of their own decisions about water, health and hygiene.

FOR MORE INFORMATION, CONTACT:

Mrs. Samiha El-Katsha
Research Assistant
Social Research Center
American University in Cairo
113 Sharia Kasr El Aini Cairo, Egypt
Tel: (2) 355-6681, ext.6940
(2) 355-6701
Fax: (2) 355-7565

IDRC Reports is published weekly on-line by the International Development Research Centre.
Its aim is to keep an international readership informed about the work IDRC supports in developing countries as well as other development issues of interest.

Back to IDRC Homepage

Back to IDRC Reports Page