The Use of Poo Bags for Safe Excreta Disposal in Emergency Settings | Sanitation | Waste Management

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Safe excreta disposal is a top priority in an emergency, but one that takes time and extensive resources to implement. This Technical Briefing Note examines the use of poo bags for safe excreta containment and disposal in urban emergency settings. The Brief also explores ways of building more complete excreta management systems to ensure not only safe disposal, but also to ensure the dignity and safety of users.
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  OXFAM Technical Brief – Poo bags for Safe Excreta Disposal 1 The Use of Poo Bags for Safe Excreta Disposal in Emergency Settings Safe excreta disposal is a top priority in an emergency, but one that takes time and extensive resources to implement. This Technical Briefing Note examines the use of poo bags for safe excreta containment and disposal in urban emergency settings. The Brief also explores ways of building more complete excreta management systems to ensure not only safe disposal, but also to ensure the dignity and safety of users. Introduction Safe excreta containment and disposal are critical components in an emergency public health response. Safe excreta management is one of the main barriers for preventing faecal-oral related diseases. From a public health perspective, there is little to choose between the various emergency sanitation technologies available, as long as the technology implemented is correctly used, well maintained and that personal hygiene issues are adequately addressed. This is particularly true in high population density urban environments, where the lack of space, poor access and cramped conditions limit the range of excreta disposal options that can be implemented. The use of Poo bags  provides a quick and effective means of containing both excreta and urine in the first phases of an emergency. Safe Excreta Management   Deciding what technological option to use for containing excreta in emergencies is not an easy choice for agencies. Each disaster, each affected community, each setting is often unique and must be considered on a case-by-case basis. However, the primary goal of any public health intervention is to prevent the transmission of faecal oral diseases caused by inadequate/unsafe defecation practices. Sanitation interventions require not only good technology, but also a heavy investment in terms of time and resources. Effective public health promotion and community participation are critical key elements of the sanitation response to be undertaken alongside the technical interventions. Sustainability is rarely a priority early in the emergency; however, the need to act quickly and decisively is critical in preventing potential disease outbreaks. Sanitation responses must be based on detailed needs assessments that identify the key sanitation problems, and the needs arising from these problems. A number of factors should be considered when planning the intervention. The Oxfam’s TB Notes 1, 2 & 7 give more details on key factors to consider when planning a response: http://www.oxfam.org.uk/resources/learning/humanitarian/index.html  Figure 1:  An area used for open defecation by 4,000 plus IDPs for 3 months. Haiti Earthquake, 2009.   Excreta Disposal - Key Concepts Immediately - 1 st  Phase Response ã Minimize high-risk practices (i.e. indiscriminate open defecation, flying toilets, etc.) ã Reduce the transmission of faecal-oral disease in high population density areas Stabilisation- 2 nd  Phase Response  ã Improve technical designs to increase usercomfort, dignity and physical safety ã Develop more sustainable excreta disposal systems that can be managed by the community Known Bag Usage - Past Emergencies  Anecdotal information from past emergency responses highlights a number of situations where bags of varying types were used as “defecation coping” mechanism: ã Philippines, 2009 – Typhoon response ã Haiti, 2008 – Hurricane response ã Indonesia, 2004 – Tsunami response ã Bangladesh, 1998 – Dhaka flood response Affected populations either continued their pre-emergency defecation practice (i.e. defecating in bags) or began using bags as a coping mechanism in response to the emergency. Often this was due to either the breakdown of their previous system or the inability to access other toilet options.  OXFAM Technical Brief – Poo bags for Safe Excreta Disposal 2 The Poo Bag Approach In rural emergency settings, land is often available to implement traditional sanitation approaches such as simple pit latrines. However, men, women and children living in an urban emergency context are often forced to adopt unsafe defecation practices due to the lack space, poor access, cramped conditions, and a whole range of other factors. As a result, they are left far more vulnerable, not only to potential disease outbreaks, but to physical dangers and gender based violence. During and after an emergency, populations will try to continue using their traditional defecation practices wherever possible. When this is not possible, people will adopt new “coping mechanisms”, and adapt to the new situation. Often, this will result in inadequate and unsafe defecation practices. When assessing the type of sanitation intervention needed, people’s previous practices and their current context must be considered. The opportunities and limitations of working in the new context must also be evaluated. Poo bags provide, not only, a flexible excreta containment option, but they also offer a rapid solution to problems of open defecation. Especially when other traditional emergency excreta disposal options are not possible/viable. Socio-cultural Considerations Effective excreta disposal systems often depend more on user perceptions rather than the technology itself. Numerous cases exist where users have rejected sound technical solutions due to social, cultural or religious preferences/taboos. Excreta disposal technologies work best when they are fully understood, managed, and supported by the target communities. Prior to starting any sanitation intervention, it is important to establish a good relationship with target users, which may require a competent translators and/or local staff. The affected community should be   consulted to ascertain how women, men and children manage defecation. It will also be necessary to consult the elderly and those with reduced mobility. The consultations should also be cross-referenced with observations in the field of the context and actual practices (i.e. ditches used, paths walked to field, etc.). The differing situations for men, women, children, elderly, and handicapped individuals should be analysed, as this is likely to have a big impact on eventual outputs.   To enable poo bags to function successfully, users need to understand why it is important to keep the environment free of faeces and how the bags can be used as an excreta containment tool. It is important not to focus on the bag, but rather to highlight the benefits of an effective excreta management system, where the bag plays a vital role in containing and storing people’s faeces. Effective public health promotion is crucial in understanding current practices and in raising awareness of the need for safe excreta management. Individuals within the target communities can be used to champion sanitation in their settlements/camps, and to assist in presenting messages and linking excreta management to broader health messages. Overall, agencies must be realistic with their target groups, as to if and when it will be possible to provide any bag based facilities. The system for disposing of and replacing the bags must also be clearly explained and be acceptable to everyone. Poo Bag Systems  Any Poo bag excreta disposal system must consider all of the following elements: 1.Hygiene promotion2.User interface3.Poo bag distribution4.Poo bag deposits and storage5.Poo bag collection and transport6.Poo bag treatment and/or disposal 1.Hygiene Promotion For any sanitation system to impact positively on the health and wellbeing of target groups, the system must be shown to function correctly and be properly maintained. Hygiene promotion is an essential component of the poo bag approach. HP will ensure bags are used correctly; that they are collected, removed from the site, and ultimately, safely disposed of. IEC materials must be designed specifically for the bag type, and for the collection system put in place. Contexts for the Poo Bag Approach ã 1 st  Phase response before emergency or semi-permanent latrines can be constructed ã Where latrines/toilets cannot be constructed ã Urban settlements or camps with 1. High population density 2. Limited open space 3. Inability to excavate 4. Low soil infiltration rate/high water table 5. Landownership issues 6. Insecurity concerns (i.e. night time, women) 7. Inaccessible for latrine emptying services ã To fill the gaps in toilet access in consultationwith specific individuals (i.e. women, children,elderly, people with limited mobility) Figure 2:  IEC materials designed for “in- home use” in Haiti. ( Left:   normal bags, Right:   Peepoo bags).    OXFAM Technical Brief – Poo bags for Safe Excreta Disposal 3 Ongoing hygiene promotion messages should include education on the importance of separation of bagged excreta from general household waste; provision of separate facilities for urine and excreta; disposal of children’s excreta; and vector control by ensuring “bag deposit drums” are correctly closed. In addition, adequate hand-washing facilities, complete with soap, must be provided. Further information on hygiene promotion approaches can be found in Oxfam TBN ##: http://www.oxfam.org.uk/resources/learning/humanitarian/index.html   Monitoring and evaluation    Ongoing monitoring is necessary to ensure bags are always disposed of in a suitable container/location and to ascertain user perceptions of the system. Sample forms were developed for the poo bag approach in Haiti and are adaptable to other settings. 2.User Interface Poo bag excreta disposal systems are intended to be low-cost and rapidly implemented, and not labour or resource intensive. Keep the technology as simple as possible. For  “in-home” only systems (i.e. household level provision), the minimum components are the bag for containing the excreta and eventually a container to facilitate bag use. Types of Bags Available  A wide range of bags are available on the market, with each type having specific advantages and disadvantages. Bag degradability will on depend on UV light, moisture, and oxygen availability. Globally, bag degradability terminology is not yet fully standardized. Table 1 (below), highlights the key parameters to be considered when designing a poo bag excreta disposal programme. Polyethylene Oxodegradable B   iodegradable   Peepoo    C  o  s   t $ $$ $$-$$$ $$$ (?)    S   i  z  e  Varies Varies Varies “small”    P  r  o  c  u  r  e  m  e  n   t Easy Moderate Moderate Not mass produced    E  n  v   i  r  o  n   i  m  p  a  c   t Polluting/ non degrading Degrades, but variable safety   Degrades, no impact Degrades no impact    D  e  g  r  a   d  a   t   i  o  n None Fragmentable  Aerobic or anaerobic (landfill) Complete degradation, can be rapid. May require composting Rapid, complete degradation    H  e  a   l   t   h   i  m  p  a  c   t None   None None Pathogen break down Table 1:   Criteria for Selecting a Poo Bag Type The choice on bag type will depend on a number of factors including “what is available locally” and the cost per unit. Ordinary plastic “non-degradable” bags can be used in the absence of other options, particularly at the start. As the response develops, other more “sustainable” options can be developed through the use of biodegradable bags, etc. However, a number of factors, including: user preference, impact on local markets, availability and cost per unit, etc. should all be considered. Independently of the bag type used, darker coloured bags are recommended for “obscuring” the contents, and decreasing the potential for shame/offence amongst users. Note:   Various powder and gel coagulants are available to solidify excreta by absorbing moisture. Handling and disposal is easier. However, the products are expensive and not recommended for large-scale emergencies. Containers (bag supports)    Where possible, a container should be used to support the bag for ease of use. Locally available containers, such as those recycled from food or drink packaging, can be used. Ensure the container is both clean and intact (i.e. will not cause bags to tear). Containers must also be sized correctly according to the volume of the bag being used (i.e. stretching bags will cause them to tear). Urinals Where possible, the provision of male and female urinals is recommended as an effective way of reducing overall operating costs. Providing urinals will decrease overall bag consumption, and ultimately facilitate handling bag contents, as they are likely to be less wet. A number of urinal designs are available using simple plumbing materials or by using recycled materials. The use of urinals will also decrease waiting time at cabins (especially for women). When soak-aways are built for urinals, one upgrading option to consider is the use of urine diversion (UD) bag toilets. This is particularly appropriate in smaller settlements/camps where PHP is feasible. Further details of urinal designs can be found in Oxfam GB fact sheets: LINK: Under construction   Figure 3:  “In-home” provision of locally available, recycled container with bag used in Port-au-Prince, Haiti    OXFAM Technical Brief – Poo bags for Safe Excreta Disposal 4 Communal Facilities and Commodes Where feasible, communal facilities for bag use should also provided. As a minimum package, an “in-home” system (bags + basic container) can be provided inside a basic superstructure at a communal location. Such a structure offers privacy and comfort for users, and is easy to manage through community toilet attendants. Improved options could include a simple commode system. 3. Poo Bag Distribution For “in-home” bag distributions, enlist the help of community leaders and volunteers from the target community. This is particularly relevant in large settlements/camps where programme teams may not have the capacity to reach the entire population. When biodegradable or Peepoo bags are being distributed, it is important to ensure 100% coverage and usage amongst the target groups, if the full environmental/health benefits are to be obtained. In the case of the Peepoo, no benefits will be obtained from the “pathogen die off” if coverage in not universal. “In-home” usage bags should be provided on a ratio of 1 bag/person/day . Where “in-home” bag distributions are not feasible (i.e. high risk bags will not be collected and properly disposed of), bags should be provided directly at communal facilities. “Communal” bag usage should be provided based on a ratio of 1 bag/person/day . However, extra provision should be made assuming a certain percentage of the population having diarrhoea. Extra bags can be provided at a ratio of 3 bags/person/day  for this percentage. If Poo bag approach is to be used for longer periods, the community should be empowered to take on the function of supplying themselves from commercial sources. To prevent the misuse of Poo bags, people should also be made aware of the importance and value of safe excreta disposal in their community. In Haiti, beneficiaries were found using bags for selling charcoal and vegetables. 4.Poo Bag Deposits and Storage To ensure the safe management of excreta, Poo bags will require a collection and storage system. The use of a designated “deposit container” will ensure the bags are collected at specific locations, and stored prior to removal off-site. Suitable storage facilities are essential to prevent the “flying toilet” phenomenon, which commonly occurs because there is no deposit system in place. The availability of storage containers can vary in post-emergency context. However, at minimum, deposit containers should have tight fitting lids for smell and vector control, and can be upgraded as the emergency Figure 4:   Rapid, low-cost toilet construction (left) by MSF-B for bag (right) used post-EQ in Cité Soliél, Haiti Figure 5:   Existing commode with low-cost modification of welded bucket that was the appropriate size of the Peepoo, Port-au-Prince, Haiti Figure 6:   Prefabricated commode (often available in Western nations) requires larger bags; used with a “grocery-style” bag in Port-au-Prince Haiti Figure 6:  Community-assisted distributions of “in-home” Poo bags. Port-au-Prince, Haiti  
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