In the earthquakes that hit Nepal in April and May 2015, hundreds of thousands of people were lost their homes and access to water and food. The foundations of life had been shaken apart and the risks of disease and serious infection increased for many affected communities. The earthquake destroyed many water assets – reservoirs, pipelines and drinking water sources and toilets, returning some districts into open defecation zones.
From November 2015, PHASE Nepal, with financial support from Diakonie Katastrophenhilfe, has been working in six communities in the Sindhupalchok district  to rebuild and rehabilitate water assets. About half the projects are completed, the remainder are ongoing.
In mid June 2016, PHASE Nepal carried out a survey of 600 households – 100 in each village – to find out attitudes, habits and knowledge relating to hygiene and sanitation. The majority of respondents were from the Tamang ethnic group, the largest Tibeto-Burman group in Nepal, and 60% were male, 40% female. Only 57.2 % of respondents had completed primary education, and 68.8% depend on farming and agriculture for their livelihood.
Collating these survey results is extremely useful for PHASE Nepal and will form the base for sanitation & hygiene education activities that will be run in the communities, in schools, with mothers groups and DWUCs (drinking water user committees). There is a need to raise awareness on water quality, household waste and waste water disposal. There is much room for improvement in the habits of hand washing, especially when it comes to feeding children. Communities also need more information on the risks of keeping animals at home and support to change this. The risks of open defecation need to be reinforced, especially linked to the risks of diseases transmitted by flies.
As we identify knowledge gaps, we can direct awareness raising initiatives and training to address them and further empower the Sindhupalchok communities, giving them the tools and knowledge to improve health and hygiene, creating a brighter future for the generations to come.
The survey results
- 93.7% received water by pipeline. Before pipelines were installed, many – and some still do – have to walk for 30 minutes to access clean water.
- 36% use water purification methods, including chlorine, boiling and the SODIS  method. 37.5% learned about purification techniques from the radio, 33.7% from organizations.
- 71% were aware of water borne diseases; of those, 95.3% knew about diarrhoea, fewer respondents knew about jaundice, typhoid or worm infections. Information on water borne diseases came from health workers (40.4%) and the radio (35%).
Hand washing habits
- 52.3% knew about the six steps of hand washing  from health workers and organisations. Almost all of those surveyed washed hands before eating, but only 6.8% washed hands before feeding their children. 83.7% washed hands after using the toilet, 43.5% before cooking.
- Most people thought that hand washing was only for the sake of hygiene; 51% understood that it is also a way of preventing the spread of diseases.
Household waste and animals
- 41.9% disposed of household waste haphazardly, anywhere they could; a smaller group used it for manure and an even smaller group disposed of it in a pit. 82.3% threw wastewater – containing soap, detergents, skin cells and bacteria – directly on to the fields, 8.3% collected it in a pit and only 6.3% used a septic tank.
- 64% keep their animals away from the home, 31% keep them near and 5% keep them in their homes.
- As of July 2016, 91.3% had toilets at home, a smaller group had none or were using temporary facilities.
- 74% knew that flies transferred the bacteria that cause diarrhoea, although fewer knew that flies can transmit jaundice, typhoid, worms and eye infections as well.
- Only 40.3% of respondents had soap and water available at or just outside their toilet to facilitate hand washing; the remaining 59.7% did not.
- At the end of the project – in November, after all trainings have been conducted – another survey will take place to see how the behaviour and knowledge regarding sanitation and hygiene has improved in the project areas.