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Table of Contents
Women as acceptors of improved water and sanitation technologies: Considerations for project planning
Women as users of improved water and sanitation technologies: Factors in project implementation
Women as managers of water and sanitation facilities: Including them in training
Women as agents of change in water and sanitation: Implications for evaluation
DO NOT REMOVE STAPLE
RESERVE DESK ORIGINAL
WASH TECHNICAL REPORT NO. 11
THE ROLE OF WOMEN AS PARTICIPANTS AND BENEFICIARIES
WATER SUPPLY AND SANITATION PROGRAMS
Prepared for the Office of Health
Bureau for Science and Technology
Agency for International Development
under C-Task 51
Mary L. Elmendorf, Ph.D.
Raymond B. Isely, M.D., M.P.H., D.T.M
Contract No. AID/DSPE-C-0080
Project No. 931-1176
TABLE OF CONTENTS
SUMMARY .......... ... .... ..... .................. iii
ACKNOWLEDGEMENTS. .................................... iv
1. INTRODUCTION.......................... ......... .... 1
1.1 Women and Sanitation........................... 2
1.2 An Approach to Understanding Women's Roles....... 2
1.3 Relationship to Primary Health Care.............. 3
2. WOMEN AS ACCEPTORS OF IMPROVED WATER AND SANITATION
TECHNOLOGIES: CONSIDERATIONS FOR PROJECT PLANNING... 4
3. WOMEN AS USERS OF IMPROVED WATER AND SANITATION
TECHNOLOGIES: FACTORS IN PROJECT IMPLEMENTATION..... 8
3.1 Education of Women as Users of Water Supply and
Sanitation Facilities................................. 8
3.2 Women as Water and Sanitation Promoters.......... 9
3.3 Attention to Supportive Social Structures....... 9
-.4-- _Communcaltion bThrough Explanation and Demonstra-
tion ... .. .. .... ....................... .. 10
4. WOMEN AS MANAGERS OF WATER AND SANITATION FACILITIES:
INCLUDING THEM IN TRAINING.......................... 11
4..1 Women as Managers........................ ....... 11
4.2 Women as Trainers........... ... .*..... ...* 13
5. WOMEN AS AGENTS OF CHANGE IN WATER AND SANITATION:
IMPLICATIONS FOR EVALUATION....................... 15
5.1 Household-Level Effects............. ............ 15
5.2 Community-Level Effects................. ....... 15
5.3 Implications for Evaluation Design............... 16
5.4 Implications for Evaluation Methodology.......... 18
6. RECOMMENDATIONS ................ .................. 19
6.1 Planning, Implementation and Evaluation.......... 19
6.1.1 Project Planning Guides................... 19
6.1.2 Project Implementation Guides............. 20
6.1.3 Project Evaluation Guidelines............. 20
6.2 Possibilities for Future Research............... 21
BIBLIOGRAPHY.. ...... ......................... .... 23
A Model for the Evaluation of Water Supply and
Sanitation Projects in Developing Countries:
Illustrating the Broad Role of Women............. 17
In this paper based on an extensive review of both the pub-
lished and unpublished literature, arguments are made that
women should be given prime consideration as acceptors, users,
managers, and diffusers (change agents) for the introduction
of innovative water supply and sanitation technologies. Spe-
cific strategies for involving women in each of these roles
are recommended with examples given from water supply and san-
itation and other related projects in the field.
The time and effort of many people went into the development
of this report. Many made contributions at its formative
stages. In addition, the draft was distributed to relevant re-
gional and technical offices within the Agency for Interna-
tional Development with a request for comments and sugges-
tions. And finally a meeting was held among interested readers
in order to reach a general consensus on the final form the
paper should take. We are therefore grateful to many for their
contributions and specifically to Barbara Pillsbury and
Barbara Kennedy who provided especially thoughtful comments
The importance of community participation for water and sani-
tation policy and program planning has been raised repeatedly.
The role of women is so interrelated with effective community
participation that it must be analyzed simultaneously with
community participation in order to develop program objectives
or to prepare meaningful guidelines (Kalbermatten, 1981).
That women in rural and urban fringe areas around the world
understand the urgent need for improved and more accessible
water for domestic consumption _is-well understood and docu-
mented. Many women spend from four to eight hours a day
drawing, -carrying, managing and using water (White et al,
1972; Elmendorf, 1980; O'Kelly, 1978; Russell, 1979; UNICEF,
1976; Whiting and Krystall, 1977). Women themselves are well
aware of the time and energy spent in obtaining this basic
necessity and thus of the time and energy lost from more pro-
ductive tasks. Many of them, however, are not aware of al-
ternative sources of water or of how to become involved in
improving existing supplies. Only by being included early in
the project planning stages will their participation be as-
sured and alternative options realized.
For example, when only "community leaders" are involved in
---- nj-eds ansBgisirts d-^Lwomer--are -not -donmestic--water- s-larely-- -
given priority-as:::an--urgent: community need (Miller and Cone-,
1982; Nieves, 1980; and Elmendorf, 1978 and 1982). On the
S other-hand,-when community-needs assessments include the views
of women, water for home consumption seldom fails-to be among
the top three felt needs.
Women may not be aware of the germ theory of disease or may
not be-able to see a direct relationship between improved wa-
ter.supply and health but once water is more accessible they
quickly evaluate the benefits in terms of improved health and
reduced -fatigue. The women of Chan Kom in Yucatan noted an
increase of diarrheal disease after a pump breakdown and re-
quested repairs to the water system (Elmendorf, 1978).
Women also are well aware of additional time and energy sav-
ings, and the possibilities for additional productive activi-
ties. This new time may be used in a variety of ways: in
income producing activities such as growing food for sale in
the market, or cottage industries or other commercial activi-
ties, employment as health promoters in agricultural exten-
sion, or in water and sanitation service operations and main-
tenance, or simply better care and nurturing of themselves and
their families- (Elmendorf, 1981; Isely, 1980; Whiting and
Krystall, 1977). No matter the activity, they contribute to
improving the quality of life for their families and commu-
nities. Women are also quickly aware of the physical exhaus-
tion they feel when piped water systems break down and they
have to return to the old routines of drawing and hauling over
1.1 Women and Sanitation
Just as for water, the perceptions of women are essential in
early planning for sanitation. As motherscaring for and toi-
let .training infants, and as the primary users and caretakers
of new latrines their preferences and opinions must be consid-
ered (Elmendorf, 1981; Isely, 1981). Locations and types of
latrines should be planned after consultation with women to
assure access to water needed -for sanitary latrine use. For
instance many latrines are ,still built 15 meters from an
abandoned well or kitchen door even after potable water is
piped to an accessible stand pipe or patio connection. Such
distances diminish latrine use by women and children and re-
duce the likelihood of post-defecation handwashing (Pineo and
1.2 An Approach to Understanding Women's Roles
This paper discusses some of ithe important-ro.es- of-wce-,s--
they relate to improvements in water supply and .sanitation
technology and suggests ways to improve project design and
hoGpeully to diminish failures. The four key ideas include-:
Women as acceptors: considerations for project plan-
Women as users: factors in project implementation.''
L Women as managers: including them in training. I0-
w- Women as 'change agents: implications for proj ec t2.
It is important to be aware that women's roles and the dgree-
of community organization will vary greatly from country to
country; in fact, from community to community (Krug et-al,
1976). Certain generalizations can be made, but models for
maximizing participation in group action must be carefully
selected, based on respect for and understanding of the social
and cultural realities of a community. Formal and informal
networks of communication and decision-making, including wom-
en's power within households and communities, need to be rec-
ognized (Elliott and Sorsby, 1979; Blair, 1980; Dixon, 1980),
1.3 Relationship to Primary Health Care
Water and sanitation should be considered in the broader con-
text of "Health for All by the Year 2000" (World Health Orga-
nization, 1978). Primary health care, which has emerged as
the .leading strategy for meeting health needs in developing
countries, includes among other elements community participa-
tion, universal coverage, and appropriate technologies for im-
proved water and sanitation. The approach places emphasis on
health education in the broadest sense. In many instances pri-
mary health-care workers may be the most apt-to provide needed
personnel for water supply and sanitation programs at the com-
munity level, especially with respect to user education, stim-
ulating community participation and long term operation, main-
tenance, and repair of facilities.-The very fact that health
education is already a part of ithe agenda of many primary
health care workers may provide an opening wedge for water
supply and sanitation programs (McGarry, 1977).
For maximum project benefits educational components should be
related to community members and the key change agents, many
of wh-om are women. In addition, water supply and sanitation
improvements are closely linked ito reducing the workload of
women, a result with profound implications for reaching
primary health care objectives (Isely, 1980). Thus, the con-
cept, and methods discussed in this paper are firmly linked to
the broad aims of both the Water and Sanitation Decade and the
Health for All by 2000 movement.
WOMEN AS ACCEPTORS OF IMPROVED WATER AND SANITATION
TECHNOLOGIES: CONSIDERATIONS FOR PROJECT PLANNING
It is primarily women that use new water systems. Their role
as household managers means that in food preparation, washing
and bathing women are the primary users and mediators between
the water source and the household. Any planned change in wa-
ter availability or excreta disposal should be based on infor-
mation about their present knowledge, attitudes, and prac-
tices. Careful observation and discussion, not just standard
KAP surveys, are needed to get at perceptions and beliefs
about water preferences and defecation behavior. The choice
of water for drinking, cooking, laundry, bathing, and ,other
household functions is a result of women's careful decisions,
based on what they have learned from their mothers and grand-
mothers, and on their observations of the costs and benefits
of any change.
Decisions about drinking water are often based on sensory or
macroscopic perceptions--color, taste or smell--rather than
microscopic qualities of technical purity.. Decisions not to
use improved drinking water facilities such as tube wells or
piped- water are. often. related --o unpleasant- taste--or-smel'l-.. -
-such as that given by iron sulfide or chlorine. The-processing
of water also affects its perceived quality. In many cultures
there; are beliefs abotit hot and cold food and drink which in-
--- -fluence--water- -use. -For example, in some societies-cold---baled
water is acceptable for-daily-use, but warm boiled water is
just for invalids. Boiled water, even though cool, is consid-
ered hot unless specifically designated as cold boiled water
after which it is no longer considered medicinal. Understand-
ing. these beliefs and practices is likely to lead to more suc-
cessful attempts to introduce change.
The importance of understanding attitudes toward excreta can-
not be overemphasized. The widespread perception that chil-
dren's feces are "harmless" (Imboden, 1968) can condition a
continuous link in chains of reinfection, whether the feces
are thrown on a nearby garbage heap or diapers are washed with
dishes in an urban home with a newly installed standpipe. In
many cultures infant feces, even though not considered "harm-
less," are not perceived as the harmful germ laden carriers
they so often are (Imboden, 1968; Feachem et al, 1978; Elmen-
dorf, 1980). These factors should be understood and analyzed
and consideration of them should be included in the planning
and preparation of educational approaches.
In some areas women and children use the same latrines, but in
many places the children defecate just outside because they
are afraid of falling through the large opening or because the
latrines are far away and the interiors are dark. These two
problems have been solved in a very innovative way in Sri
Lanka where especially designed low cost small water seal
latrines are available. These latrines are installed near the
house for the children. The child-size latrine is placed with-
out any walls under the eaves of the home just outside the
kitchen door so that mothers can easily train toddlers to use
it, and it can double as an informal bathing area. Bath water
is used to flush the latrine.
A commonly held belief in Honduras (that women should not use
the same latrine as men lest they become pregnant) limits the
use of even household latrines to female members of the family
(Eoff, 1977). Fear of menstrual blood also limits male use of
latrines. In Tanzania it is believed that the excreta of fa-
thers and daughters should not be mixed (Hall, 1978). In Nic-
aragua, women did not like to use the new latrines because the
metallic sides were 10 inches of.f the ground so that their
feet were visible. Other.latrines were not used because the
sides came to the ground and made a warm resting place for
snakes (Rodriquez et al, 1982).
Such beliefs are very important for planning. They explain in
part wy- a study of 120 villages in Bangladesh showed that la-
trines were used by only 12.8 percent of the children, while
adult use (mostly women) was 59.9 percent (Skoda et al, 1978).
A. similar study of 525 latrines in India showed that many more
women used the latrines than men, whereas children's feces
were thrown-on garbage heaps.
With- respect ~to the introd-uction of excreta disposal facili-
ties, limitedd attention has been given to matters of local
S'-a w era_-lsAh-Bst, &n.- case study of water supply
and excreta disposal in -Colombia revealed that families pre-
ferred brightly colored cement stools and slabs to drab gray
facilities- (Rodriquez et al, 1982; Elmendorf and Buckeles,
1980)PX, Similarly, in the Yucatan women expressed a preference
for an aesthetically attractive latrine with a shiny porcelain
seat .oz~a brightly painted cement .floor or stool even if the
cost 'a.nd labor involved were much more (McGarry and Elmendorf,
One other factor to be discussed with women in early planning
is the reuse of gray water for. flushing water-seal latrines.
Even though more labor is involved in carrying water, such fa-
cilities may be preferred. Wqmen are the key agents for ac-
ceptance, use and maintenance'of new facilities in the home,
and planners can benefit from incorporating their beliefs and
wishes into programs. As Feachem has noted, it is essential
that. planners in making "designs take account of user prefer-
ences and of the socio-economic setting of the project"
This approach which focuses on the product from the point of
of the 'consumer has been described as "user-choice" (Kirkby,
1973) and elaborated on in relation to implications for plan-
ning delivery systems by Whyte and Burton (1977). Draft guide-
lines for relating the user choice to national planning for
community education and participation have been suggested
(Whyte, 1980; Elmendorf, 1981a). Whyte has developed a check-
list system for:
1) Identifying national experience in community partici-
2) Assessing the social and economic potential for com-
3) Anticipating problems in project implementation.
4) Setting program objectives and priorities.
6) Manpower for community education and participation.
7) Project allocation and initiation.
8) Project planning and design.
10) Administration-, operatilon,- and--maintenance.- ---
11) The education component.
_12) Performance evaluation-and progress monitoring.
Alastair White (1981) has elaborated the same concept into
community participation options for different types of social
systems and agencies. Although not enough emphasis is placed
on the need to understand women's roles,. careful analysis of
social organization, formal and informal, is discussed with
references to specific cases.
Social and cultural variations in water related beliefs and
practices are to be expected from country to country and even
from region to region within countries. However, there are a
number of similarities with respect to beliefs and practices
regarding water and excreta. For example, a recurring theme in
many cultures is the idea that the stools of small children
are innocuous and therefore need no special handling. Taboos
are also common regarding the mixing of the stools of men and
women--which is felt in many areas to make either one sterile.
Latrines, as a result, are often used only by women. Streams
and pools not infrequently are perceived to be the habitations
of spirits and thus not to be disturbed. Other cross-cultural
examples of fears and constraints are numerous. Because of the
similarities in attitudes and perceptions surrounding water
and excreta there are often generally replicable knowledge,
attitude and practice survey instruments for certain cultural
and geographic areas, particular those of similar size and
environment. Despite these similarities, however, for purposes
of effective project design, more detailed information con-
cerning variations is needed at least on a regional basis.
Failure to account for variation among populations may lead to
inappropriate project design and ultimate project failure.
If communities or households feel that new facilities are
theirs,,they are much more apt to fully accept, use and main-
tain them.,Simple adaptations at the local level increase po-
tential for adoption. Feachem noted and various studies ver-
ify (Elmendorf and Buckles, 1980) that "in general, the design
issues that will be improved through user participation are
minor in their engineering or financial consequences, but ma-
jor in the potential effect upon:acceptance and correct use of
the new facilities."
In some instances effective community participation may slow
down or stop a project. In Mexico, the Mazauwas in El Nopal
would not accept a water installation connected only to some
houses, nor wells accessible to clusters of huts. The commu-
nity decided that everybody should have a household water sup-
ply at once or everybody would continue walking to the rather
distant and poorly maintained well (Iwanska, 1971).
A Maya community in Yucatan also delayed the construction of
latrines until a model appropriate to their perceived needs
and_ the- sniecjific environmenita-L-and geological-requir-emen-ts.-o--- ---
their limestone soil- could--be-designed and demonstrated (Mc-
Garry and Elmendorf, 1982). Even though some may consider
thesecases f- ailures~-botf-communities-were ready to work for
what they felt they needed, and unwanted facilities were not
installed to fall into disrepair.
Although the number of successful rural water and sanitation
schemesis much smaller than that of those that failed or
achieved only limited success, .there is increasing evidence
that the user-preference approach combined with community par-
ticipation _is a viable strategy (Miller and Cone, 1982; Buck-
les, 1981; Jorgensen, 1980). The hidden participant accepting
or rejecting a new water supply or sanitation technology is
most often a woman.
WOMEN AS USERS OF IMPROVED WATER AND SANITATION
TECHNOLOGIES: FACTORS IN PROJECT IMPLEMENTATION
A central question confronting each new water and sanitation
project at the threshold of its execution is whether or not
the new facilities, once installed, will be used by those for
whom they are intended. Facilities, regardless of the excel-
lence of construction and function, will not achieve their ob-
jectives .if they are not used. Achievement of program objec-
tives will also be affected by users of the facilities. In the
frequent preoccupation with ultimate outcomes of water and
sanitation improvements, these questions, like so many other
important intervening variables,' 'may be overlooked. Women as
the primary users of water the world over and as frequently
the first to6 use sanitary installations may thus not be .sin-
gled out for the intensive user education so necessary for a
3.1 Education of Women as Users of Water Supply and
New knowledge that results from, education or training must be
related to local beliefs and- bahaviorf systems a- -otd' i--i -
the preceding section on women as acceptors. Linkages between
the old -and new must be found.
Hygiene education, particularly personal and household pro-
9grams, therefore, first of all should be focused on women,
bearing in mind four primary strategies:
1) Increasing knowledge of the water/health and the ex-
2- Promoting, positive attitudes toward proper and hy-
gienic use of the water supply, transport vessels,
and storage receptacles, and the use and care of la-
trines by women and their children. It will also be
necessary for such vessels, receptacles and cleaning
materials or supplies to be locally available and at
prices within reach of the population.
3) Promoting water handling, excreta disposal, and food
preparation practices that contribute to better
health: use of clean covered transport and storage
vessels, hand washing after defecation and before
food preparation, toilet training of toddlers,.proper
disposal of infants' stools, and covering left-over
4) Promoting, where possible and acceptable, the appro-
priate reuse of wastewater and excreta and building
linkages between the two by careful planning based on
use of space and existing practices.*
Although these emphases would be the same for any other group,
women alone are in a position to realize the cognitive, atti-
tudinal, and behavioral outcomes desired. During project im-
plementation certain conditions make it more likely to achieve
these outcomes among women including:
3.2 Women as Water and Sanitation Promoters
Women themselves have been found to be the most effective per-
ipheral agents in family planning, nutrition, home extension
and other programs where women are the primary targets
(Storms, 1979). Women workers generally understand more intu-
itively the problems and issues faced by other women and re-
lated more naturally to other women. In Ghana effective use
has been made of home extension agents to deliver combined nu-
trition, family planning, agricultural extension, and child
health -education services.** So in the promotion of proper
use o-'-wa&ter and sanitation facilities, women should be re-
cruited as health inspectors, assistant sanitarians, agricul-
tural extension workers, and primary health care workers who
deliver these educational services.
3.3 Attentieont- to Supportive Social Structures
: Secondic_, __if-womesn-are. to.,benefitt from user education ser-
vices the program should focus not only on information and
motivation for individuals, but on the strengthening of exist-
ing women's groups or the creation of new ones as necessary to
build-peer support for desired change. Savings and loan asso-
ciationsV- ;family planning groups, religious organizations,
tribal societies, and kinship and friendship networks need.to
be identified and be recipients of program inputs (Buckles,
1982). In addition to the enhancement of women's groups, other
ways should be found to mobilize the more general' community
* Study of two Egyptian provinces revealed that families pre-
ferred to use the same water for washing clothes, vegeta-
bles, and finally dishes in that order. It seems that it
is not so much the reuse of water that is detrimental to
health as the sequence of its reuse. Also significant is
the fact that multiple uses were. directly related to
scarcity of water and to the arduous task of transporting
it. (Simpson-Hebert, 1979)
** Personal communication, Elizabeth Brabble, American Home
organization in support of user education of women. Where
necessary and feasible, women should participate in community-
wide organizations.in order to forge those supportive links.
Certain sites may also lend themselves to more effective de-
livery of services than others: markets, clinics, hospitals,
washing sites, grain grinding sites, etc. (Colle and Colle,
1977). Schools may well serve as an effective vehicle for
reaching young girls who are already intensely interested in
motherhood and household management and long experienced in
hauling, water. At each of these sites where women gather,
user education can be delivered to a group which will provide
the individual woman with peer support. In addition, school
children, both boys and girls, can become teachers of their
younger siblings, leading to changed customs and behaviors in
the home and giving further support to their mothers.
3.4 Communication Through Explanation and Demonstration
When field workers from the Diarrheal Disease laboratory in"
Bangladesh were contemplating their hygiene education program
as a part of a new water and sanitation effort at Teknaf, they
tested specially prepared educational materials among the lo-
cal population, mostly women, but found that most were unin-
telligible to the target aud-i-nce.* -Objects---in the.-d-. ign-s -
were not even recognized for what they were. In the Cameroon
Wisely et al (1980), in testing materials, found nearly a 25
percent rate of non-comprehension of visual images. At pres-
ent, it is not known-what proportion of rural populations, and
particularly women, in developing countries do not perceive
the meaning of visual representations. The implications for
water and sanitation user education are extremely important.
Instead of heavy initial investment in educational materials,
efforts should be directed at developing locally pre-tested
materials, demonstration models, and communication skills
among-field workers (Srinivasen, 1977; Clark, 1979). The wa-
ter and sanitation facilities and their proper use, can all be
developed as demonstrations. Mass media campaigns can be used
as reinforcements (Smith, 1980).
If the above modes of project implementation can be adopted in
one form or another in water and sanitation projects and in
water and sanitation components of other projects, the chances
of project success may be enhanced, at least to the extent
that health, economic and social benefits are dependent on
proper use of improved technologies.
* Dr. Mujibur Rahaman, personal communication, Dacca, Bangla-
desh, International Center for Diarrheal Disease Research.
WOMEN AS MANAGERS OF WATER AND SANITATION
FACILITIES:-INCLUDING THEM IN TRAINING
It has become overwhelmingly clear from both research and
field observations (Warford and Saunders, 1976; Elmendorf,
1978; Burton, 1979) that. the main obstacle in the use and
maintenance of improved water and sanitation systems is not
the quality of technology, but the failure-"in qualified human
resources and, in management and organization techniques, in-
cluding a failure to capture community interest" (Nieves,
1980). An appalling 35 to 50 percent of systems in developing
countries become inoperable after five years (Imboden, 1977;
Warford and Saunders, 1976; White et al, 1972).
4.1 Women as Managers
Women are, of course, managers of household water supplies.
Whether it is recognized or not, they also have a strong po-
tential role as managers of community water supplies. Women
are for one bound more tightly to .the household than their.
male counterparts who must often leave the community in search
of work. Women are usually responsible for either obtaining
water or seeing that it is available for daily use and decid-
ing how and where it is to be used and for what. In addition,
in many diverse areas of the world women select water sources,
and some-piy key roles in seeing That Tunds--an6dor-i borel-B r---
available to maintain them. Women--thus make ideal candidates
-for- trai~~ng in iwa-ter -supply and sanitation management and
Several tasks in the maintenance and repair of new water sup-
ply and -snitation facilities must be learned by someone in
the community. Among these tasks are .monitoring systems for
leaks and other defects, keeping stock of spare parts, over-
seeing-a small budget, doing routine maintenance and minor re-
pairs, maintaining liaison with local authorities and district
and regional technical services, and training other community
and household members in maintenance and repair techniques.
Women, as those who already exercise considerable influence
over water sources and uses, should be in a good position to
benefit from training for such tasks. In Angola, where women
have been recruited as water source monitors, the breakdown
rate has fallen decidedly.* As an adjunct to an agricultural
development project in Bolivia, bi-lingual indigenous women 17
* Dr. Nimi Divengele Ambrosio, personal communication, Direc-
torate of Maternal and Child Health Services, Ministry of
to 25 years of age were trained to administer immunizations,
provide information on child nutrition, and lecture on the
proper maintenance of water and sanitation facilities. A num-
ber of these young women are now in complete charge of repair
and maintenance of the facilities (Stein, 1977). Armed with
such skills and with information about alternative water
sources, women can plan for more accessible and more reliable
water .sources for their households and communities. Other
results of training would be an increased sense that a water
source or a sanitation facility belongs to the community and a
greater willingness to change from an old water source to a
new one managed by the community or from defecating in the
bush to using a latrine built and maintained by the household.
It has often been suggested that when people participate in
planning and/or implementation bf a project they will collec-
-tively consider the project theirs and have a sense of re-
sponsibility for its care and; maintenance. Feachem et al
(1978) have questioned whether people always feel this way.
In fact, it is suggested that in some instances some villagers
have felt that they made their contribution at the construc-
tion stage of a project so it was more than ever the responsi-
bility of the government to maintain it. Alastair White notes
that outsiders' expectations about community participation are
based on what they themselves would or think they would re-
spond to. But communities-are not individuals.- To speak. f-"a
community having a commitment to a project can only be a meta-
phor for a range of attitudes among individuals, none of whom
may value the project highly in relation to their own private
-affairs--(Whte,--1981). If-we-accept this concept, however,
and- recognize at the same-time that a large proportion of the
participants are women, for whom the importance of the project
has understood value, the chances for collective approval and
continued support is much greater.
These latter considerations have implications for both the
substance and the form of training. In the first place im-
pro3ed'facilities, while they should be appropriate, need not
be crude or even simple. The idea that the technology is too
complex for simple rural folk of developing countries is' a
myth and a rather unconvincing one at that. Broken and inop-
erative water supply schemes and abandoned latrines are to be
seen in environments where village skills extend to maintain-
ing and repairing bicycles, transistor sets, irrigation pumps,
ceiling fans, air conditioners and a variety of small indus-
trial machines and tools (Feachem, 1980). We could add sewing
machines, ancient pedal models and electric ones, that are
kept running by women.
Of course the new skills required for the effective management
of improved technologies must be added to these existing
skills, but most women are eager for any information or skill
that promises to make life better for themselves and their
4.2 Women as Trainers
The Bolivian women mentioned earlier could easily add house-
hold and community water management to their repertoire of
training skills. Since women have main responsibility for the
young, they are also valuable as trainers of others in the use
of water and sanitation facilities. The central role that
women play in socialization and in health education and health
care networks as well as their permanence within the household
makes them more suitable as managers and trainers for water
and sanitation projects at the community and household level.
In many cultures women both as trainers and as trainers of
trainers are more effective and are sometimes required if
females are being trained. Every effort should be expended to
recruit women for these roles. IThe key is task specific
training which includes information necessary for women to
practice, teach and supervise others.
Learning all the skills mentioned earlier, but particularly
those related to training and liaison work, will be more ef-
fective if training is experiential rather than merely didac-
tic- (Stetart and Rull, 1981). In other words, training should
be treated as an opportunity for trainees to acquire needed
skills in a real-world context while supervised and supported
by technical staff with a-minimum of-time spent merely acquir-
ing information. This approach has proved to be effective in a
number of programs for training community level workers (Aus-
tin. 197C:. r7 y 1. __R____ __
Many people have pointed out the need for putting desired
: change within the -world--view--and the political realities of
local communities (Foster, 1973; Paul and Demarest, 1979;
Pillsbury, 1978; Freire, 1970; -Srinivasan, 1977; Clark, 1979
and otherss. Roark (1981) has suggested that the-mobilization
of local systems of learning may be a key to finding useful
combinations of effective and appropriate water and sanitation
technology with community participation. And the training pe-
riod should not be looked upon as all that is necessary for a
woman to function as a manager of water and sanitation ser-
vices. Effective training, in fact, adopts methods, content
and length of the program to the needs and capacities of the
target audience. Such training focuses on introducing trainees
to problem-solving skills in the training period, while fore-
seeing the necessity of support and supervision as the trainee
continues to learn in subsequent periods .(Austin, 1979). In
fact, this follow-up training can serve several purposes,
including increased status for the trainee and as a basis for
later evaluation and monitoring of systems. In Upper Volta,
for example, animatrices (female extension workers) will be
the major collectors of data for evaluating a rural water
supply project (Roark, 1981).
Since 1972 communities in Paraguay have been selecting local
literate people, many of whom are women, for special training
to carry out basic surveys including assessment of attitudes
toward water, excreta and garbage. The communities choose the
kinds of services and school sanitation education they want as
well as help in the actual construction of the water supply
systems. After special training, the responsibility for man-
agement and maintenance of the system is assumed by an elected
water board (Cardenas, 1978).
There needs to be a critical look at costs and benefits of all
training"programs including those for water and sanitation, as
decentralization, coordination, and.regional planning of inte-
grated development programs move forward. Use of existing
cadres of trained female community workers (such as
animatrices rurales in Francophone Africa) should be promoted.
Special modules on water and sanitation and environmental
health, including technical aspects, can be introduced into
their training. This type of-integration can lead to reduced
costs and more nearly integrated field programs, and can focus
on priority areas as defined by communities: health,
education, nutrition and water supply areas which often cut
across disciplinary boundaries (Government of Sri Lanka,
Such expansion of training programs _does no.t as Feachem __
writes, "always require the government to increase its overall
program costs by the employment, training, supervision, and
transportation of the teams of community level workers that
are-necessary- for successful community involvement." The key
to-success seems to be flexibility, combined with decentral-
ization -at the-:regi-onal, district, -and village- levels, and
carefully planned coordination with various departments and
agencies--governmental and private (Warren, 1980).
WOMEN AS AGENTS OF CHANGE IN WATER AND SANITATION:
IMPLICATIONS FOR EVALUATION
The roles of women as diffusers of improved water and sanita-
tion technology and as agents of behavior change must be taken
into account in evaluating project effects. This contention
holds true whether one is concerned with household or commu-
nity-wide effects and needs to be incorporated into both ex-
ternal and self evaluations (Elliott and Sorsby; 1979, Dixon,
1980; Feuerstein, 1979).
5.1 Household-Level Effects
To a'large extent the achievement of household level benefits,
both health and social, are dependenton the ability of women
to diffuse information, attitudes, and water and sanitation
related behavior to other household members. As carriers of
water where household taps do not :exist, women influence di-
rectly the volume consumed (White et al, 1972) and thus the
possibility of achieving health effects related to increased
volumes of water (i.e., decreased diarrheal morbidity, dimin-
ished .skin infections, trachoma,' and other so-called water
washed diseases). As the selectors of water sources, women
determine the quality of water delivered to the house based on
-hir- pr tions of what is a_.ood and acceptable_ source. As
-those who -select_ the-.transport_ .and_ storage vessels, wash them,
and cover them, women influence both the volume of water con-
- -smaed- (si-ze=of: contai-ner) _.(Whi.-te. et aL,_ -1972) and its quality.
Finally, as those who .feed and care for infants and small
children they determine decidedly the hygiene of their eating
and drinking utensils and the quality of the water they drink
and thus are responsible to a considerable degree for the re-
covery of--the infant or toddler with diarrhea (Smith, 1980).
All potential health benefits of improved water and sanitation
are in turn influenced by the woman's behavioral change in re-
sponse to perceived dangers inherent in excreta, unclean
hands, leftover food, uncovered water, and flies (Smith,
1980). It is she who forms a constant link in the chain of
contamination from feces to fingers to food, and she who in
turn can break' the chain by latrine use, hand-washing, and
protection of left-over food.
5.2 Community-Level Effects
In the vast majority -of communities where a single water
source serves from 30 to 200 or more persons, the achievement
of health and socio-economic benefits and their evaluation
also depends a great deal on the role of women. Women as the
drawers of water control to a great extent the possible con-
tamination of the source through the manner in which they use
the installation. For example, in the case of open wells, the
use of a clean bucket and the prevention of spilt water run-
ning back into the well depends on the positive actions of
women. The prevention of Guinea worm transmission requires,
in part, the cooperation of women in order to prevent water
running over hands and feet back into the well. Women are
also among the first to notice defects in the structure of the
well or breakdowns in the pump or other lifting mechanisms;
and therefore, they are frequently in a good position to call
attention to these problems, apply simple solutions, or ar-
range for repairs if possible. In these and other ways the
role of women must be accounted for when one attempts to eval-
uate the community level outcomes of introducing improved wa-
Regarding sanitation, although .most installations for excreta
disposal are at a household rather than a communal level, the
crucial role of women as the most frequent users of such fa-
cilities (Belcher and Vazquez-Calcerrada, 1972; Elmendorf and,
Buckles, 1980) should be remembered where communal sanitation
blocks and other forms of public sanitation installations are
the prevailing pattern. The installation of handwashing fa-
cilities and the provision of soap may depend for their ef-
fectiveness on focusing user education effortsat women ...-,-
5.3 Implications for Evaluation Design
Warner (1975) has suggested that evaluation of water and.sani-
tation improvements should be viewed in three stages (see fig-
-Stage 1 Project Operation
In this phase the functional or engineering aspects
of the project are assessed and the system itself is
the object for evaluation by the potential users for
appropriateness to their needs and their ability to
operate and maintain it.
Stage 2 Project Performance
This stage concerns a process evaluation of the use
of facilities in which individuals and communities as
users form the object for evaluation. In fact, it is
important to distinguish between the kinds of usages
and various treatments from the source to the ulti-
mate use. Women as carriers, managers and manipula-
tors of water merit key consideration at this stage
Stage 3 Project Impacts
This final or end-stage evaluation encompasses mea-
surements of the health, social/organizational, eco-
nomic, and administrative effects of the facilities
on individuals, households and communities. At this
point outside evaluators and techniques are impor-
tant, but eliciting participatory evaluation by women
as well as men adds needed insight into community and
personal perceptions of the project impacts as mean-
ingful additions to the quantitative data.
At each stage of evaluation, whether one is describing the
function of a pump or its use by villagers, if one is to ef-'-
fectively evaluate results one must account for the role of
women as diffusers of knowledge'- attitudes, and behavior as-
sociated with new water and sanitation technologies. (See
figure for an` evaluation model incorporating women's roles.)
In effect, if one has not included the role of women as a key
moderating variable, one is likely to miss a large share of.-.
the factors explaining the end-products of a given project.
5.4 Implications for Evaluation Methodology
_Externally administered evaluations of water and sanitation .
projects have the-obvious-advantages of-expert"design, use of.
valid measures, and access to facilities for data management.
Achieving interpretable-results, however, in the case of water
and sanitation projects may involve sharing a part of the re--
-sponsibility for carrying out the design, execution, and in- -
terpretation of the evaluation--- with the users themselves.1:Y,
(Cole-King, 1980; Aller-Atucha and Crone, 1980). Valid expla-.&-
nations of results of water and sanitation projects demand
that women be entrusted with the responsibility of identifying
/ criteria for each stage of the evaluation, for the collection
and recording of data, and for a share in the interpretatiO:
of results. Only thus will reliable collection of evaluati
data-be achieved. With a stake in the outcome of the evalua .
tion, women will be more likely to see that-the necessary car -
is taken to select feasible data items and to collect them re-.
liably. At the same time they will feel responsible for sug-1
gesting modifications or changes in the facilities themselves
based on interpretation of the data gathered. In Honduras, the
women not only collected the survey data but organized a work-
shop to analyze it and prepared a final evaluation document
(Feuerstein, 1979; Cardenas, 1978).*
See also Heather Clark, presentation at the Workshop on Wa-
ter Supply and Sanitation co-sponsered by the National Coun-
cil for International Health and WASH, Washington, DC, No-
vember 2-4, 1981.
6.1 Planning, Implementation and Evaluation
There appears to be sufficient evidence for assuming that the
success of water and sanitation projects in developing coun-
tries depends to a significant extent on the role of women as
participants in improving technologies as well as beneficia-
ries of such technologies. Futhermore,, there is already suf-
ficient experience on which to base women's participation in
the concrete planning, implementation :and evaluation of proj-
ects.' Some of these concrete ideas have been discussed above.
They can be summarized as a series of program guides that may
be useful in project design and redesign in the field. These
guides are organized under three subheadings: water supply and
sanitation planning (i.e. project identification and project
paper generation), implementation (contractor and technical
resource selection, work plan development, etc.) and evalua-
tion (continuous monitoring and mid-project and end-project
6.1.i Project Planning Guides
S* Project planning should include the gathering of informa-
- - --- -t~-oa c--:Tw- pe-a&&p::t-.-QfS.- w-w-nt -ist -aeeep-t-able-- --- -
S. -s-tandards -vis-a- --vs=quan -iVty--, q_ quality, reliability, -and
accessibiilty of water.-If such information is not already
available, then primary-data gathering may be necessary.
Informa-tion is also needed about women's perceptions of
appropriate management of excreta disposal,-including the
management of the feces of infants and small children.
.To the extent feasible, standard surveys should, be. used
.,:,.for regions with intra-community variations...
Such'information can be used in siting water sources (dis-
tance, reliability, etc.), selecting of sources (taste,
color, smell), and selecting of technology (i.e. whether
operable by women and children or not).
Based on such information,. separate latrines for men,
women and small children may be needed, or latrines may
have to be designed with certain preferred colors, ma-
Use should be made of Anne Whyte's "Guide for Design of a
National Support Programme for Community Education and
Participation in Water Supply and Sanitation" as a frame-
work for planning for women's participation at the na-
tional level. Another useful manual has been produced by
the UNICEF East Asia and Pakistan Regional Office entitled
"Toward a Programmer's Guide." It provides a succinct
treatment of many of the planning issues basic to women's
.6.1.2 Project Implementation Guides
* Women should be made the primary focus of user education
accompanying water supply and sanitation programs, with
implications for selecting women as health promoters,
designing educational programs which address groups of
women in markets, clinics, at bus stops, etc. Educational
materials should be designed.for non-literate women using
women in illustrations and should be based on women's
preferences for water characteristics and excreta disposal
Themes of education programs should have specific behav- .
ioral objectives relevant to women, such as changes in
practices relating to water handling, excreta disposal, -^
and food preparation and storage.
Water and sanitation user education for women should also
take advantage of women's social support systems composed
of friends and -kin -so-as -to -einforce-behavior-change -
Women, where culturally acceptable, should be participants
in the structures of community participation such as vil-
lage- health--commkttees --Where--women are restricted so--
cially, specific women's -groups- may be a viable alterna-
tive, especially- since the same women may share water
gathering and child care activities.
Wfrere culturally feasible women should be trained in the
technical and managerial aspects of local water supply and.
sanitation facilities as standpipe -guardians, as water 7
caretakers, as latrine inspectors, with concrete responsi- I
abilities for operations, maintenance and simple repairs.
Some of the above women could be trained as the trainers -
of other women in job specific skills.
Some women should also be trained as supervisors at dis-
trict, regional and national levels. They could be re-
cruited from the ranks of nurses, midwives, and laboratory
6.1.3 Project Evaluation Guidelines
Both continuous and periodic evaluations of water supply
and sanitation programs should deliberately examine both
the role women have played in the program and the benefits
that have accrued to women as a result of the program. For
example, questions should be asked about water transport,
storage, and use in the home that reflect a comprehension
of women's role. Likewise questions about latrine use
should focus on who uses the latrine (women? children?)
and on whether women as food-handlers wash their hands.
Thus the true benefits of proper programming may be un-
covered. These considerations pertain whether one is de-
signing an evaluation at the household or at the community
level; whether one is assessing project operations, proj-
ect use by the community or project benefits.
If these rough guides can in fact be used in Agency proj-
ect design, implementation, and evaluation, their impact
may be far-reaching for achieving objectives, sustaining
results and replicating or spreading benefits.
6.2 Possibilities for Future Research
Several important questions remain unanswered, some of which
appear critical for future research and/or program planning
1. Tfow can local learning systems in which women play a
key role be tapped so as to enhance the adoption of
new water and sanitation technologies?
2. Urrder what conditions (time, place, circumstances)
.- C--. -_ -m-s- eptJ-rve -to -water-use- ed-cat&tion-n-a-nd/---- --
or-sanitation-use-education?? Which approaches result-
in specific behavioral-outcomes? How can mass media
reinforce and support local efforts to change beha-
Many of the approaches suggested above have been
Tested only with special pilot projects where careful
-and sometimes charismatic leadership or generous
/ -funding have been the rule, both of which are un-
likely in ordinary circumstances. Concerted efforts
at more general user education aimed at women need to
be mounted and systematically evaluated.
3. How can the participation of women in the repair and
maintenance of water and sanitation installations be
linked to opportunities for income generation?
This research question has important implications for
both off-farm employment and water and sanitation
programs. It calls for immediate exploration of such
possibilities as utilizing existing skills of women
in leatherwork, (cups, valves), pottery (pour flush
toilets, puddled clay for well encasements), weaving
(latrine enclosures), pipe fitting, chlorination
(Rodriguez et al, 1981), and commerce.
4. What are the differences in the results of evalua-
tion, whether mid-term or .at. project completion,
where women's participation is accounted for, as
opposed to where it is overlooked? The response to
this question has important policy implications not
only for the design of meaningful evaluations but
also for water and sanitation programs that can be
influenced by evaluation results. Unless such ques-
tions are asked in the evaluation of a project, con-
clusions about the effect of such participation can-
,not be drawn and policy and program changes will not
Women's central and primary roles in food prepara-
tion, water use, socialization and health care, as
well as their roles as the mainstays of the household,
demand their recognition in future research design
and program implementation.
Aller-Atucha, L.M., and C. Crone, "A Participatory Methodology
for Literacy and Health Education: The IPREFA Integrated
Project in Choloma, Honduras," Assignment Children,
UNICEF, Vol. 51/52, 1980, pp. 141-162.
Austin, J.H., "How Will Developing Nations Train Their
Manpower for Quality Water Management?" Proceedings of
Dialogue in Development: Towards the 21st Century, Tel
Belcher, J.C., and P.B. Vazquez-Calcerrada, "Cross-Cultural
Aspects of Sanitation Norms," Proceedings of the Third
World Congress of Rural Sociology, Baton Rouge, LA, 1972.
Blair, P., "Programming for Women and Health," Agency for
International Development/Office of Technical Resources,
Buckles,. P.K., "The Introduction of Potable Water and La-
trin-es: A Case Study of Two Rural Communities in Guate-
mala-,' M.L. Elmendorf, editor,_1982.
Burton, .I., Policy Directions for Rural Water Supply in Devel-
oping Countries, Agency for International Development Pro-
gram Evaluation Discussion Paper No. 4, Washingtor, DC,
-Cardenas., M., Community-Participation-and Sanitation Education
:i-a iWater- Supply-ajcai-aniLtation Programmes in Rural Areas
of Paraguay, UNICEF/World Health Organization, Joint Com-
mittee .on Health Policy, Geneva, 1978.
-Clark, N., "Tracing the Learning Approach," World Education
Reports, -November, 1979. .
SCole-King, S., "Health and Development: Anatomy of Decision
Making," Proceedings of the International Health Confer-
ence (NCIH), Washington, DC, 1980.
Colle, R., and F. de Colle, The Communication Factor in Health
and Nutrition Programs: A Case Study from Guatemala, World
Health Organization, Geneva, 1977.
Dixon, R.B., Assessing the Impact of Development on Women,
Agency for International Development Program Evaluation
Discussion Paper No. 8, Washington, DC, 1980.
Elliott, V., and V. Sorsby, An Investigation into Evaluations
of Projects Designed to Benefit Women (mimeo), Agency for
International Development, Washington, DC, 1979.
Elmendorf, M.L., "Community Participation: A Human Dimension
with Promise and Problems," Safe Water and Waste Disposal
for Health: A .Reference Manual. National Demonstration
Water Project, Washington, DC, 1981.
SField notesfrom Sri Lanka, Excerpts in Decade Plan
for Water Supply and Sanitation, American Public Health
Association, Washington, DC, 1980.
"Public Participation and Acceptance," Environmental
Impacts of International Civil Engineering Projects and
Practices, American Society of Civil Engineers
Publications, New York, NY, 1978.
editor, "Seven Case Studies of Rural and Urban Fringe
Areas in Latin America,' "'Appropriate Technology for Water
Supply and Sanitation, Vol. 8, to be published in 1982 by
The World Bank, Washington, DC, 1982,
and P.K. Buckles, Sociocultural Aspects of Water Sup-
ply and Excreta Disposal, World Bank, Washington, DC,
Eoff, G., "Las Catanas: A Case Study of a Traditional Subsis-
tence Oriented Peasant Community" (mimeo), United States
Agency for Internationa1 -.Development-, Honduras,- -197 7- ----
Feachem, R., "Rural Water and Sanitation," Proceedings of the
Royal Society, London B 209, 1980, pp. 15-24.
Fea.chem, R.G., et al, Water Health and Development: An Inter-
disciplinary Evaluation, Tri-Med Books, London, 1978.
Feuerstein, M., "Participatory Evaluation: An Appropriate
Technology for Health Education Programmes," Proceedings
of the 10th International Conference on Health Education,
-London, September, 1979.
Foster, G.M., Traditional Cultures and Technological Change,
Harper, New York, NY, 1973.
Freire, P., Pedagogy of the Oppressed, Seabury, New York, NY,
Government of Sri Lanka, Plan for the Drinking Water Supply
and Sanitation Sector in Sri Lanka for the Decade (1981 -
1990), Ministry of Local Government Housing and Construc-
tion, Colombo, 1980.
Hall, B.L., Mtuni Afya: Tanzania's Health Campaign, Clearing-
house on Development Communication Publication 9, Washing-
ton, DC, 1978.
Imboden, N., Induced Change in Health Behavior: A Study of a
Pilot Environmental Sanitation Project in Uttar Pradesh,
Publication No. 356, Planning Research and Action Insti-
tute, Lucknow, 1968.
"Planning and Design of Rural Drinking Water Proj-
ects," Experiences in Rural Development, Occasional Paper
No. 2, Organization for Economic Cooperation and Develop-
ment ,Centre, Paris, 1977.
Isely, R.B., '"Targeting Sanitation Programs Where It Counts:
Mothers of Small Children," Proceedings of the Congress of
the World Federation of Public Health Associations, Cal-
"The Relationship of Accessible Safe Water and Ade-
quate Sanitation to Maternal and Child Health," Water and
Management, 1981, (in press).
,et al, "L'image en tant qu'auxiliare educatif: com-
ment 1'adapter au milieu desire," Africa Health, 1981, (in
Iwanska, A., Purgatory and Utopia, Schenkman Press, Cambridge,
Jorgensen, K., Water Supply Problems in Rural Africa: The Im-
i nc.atinfofor Women. Centre_ for Development Reseaircb., _Co-._ .
- albermatten-, J., "Guidelines.for Project. Monitoring and Reap-
pra-sal," Proceedings of the Annual Meeting of the Ameri-
can Society of Civil Engineers, New York, NY; 1981.
-Kirkby-~ .U.,: "The Development of a User-Choice Approach in
Rural2-Water Supply," Rural Water Supply and Sanitation,
Working Paper 7, International Development Research Cen-
Si tre- Lausanne, 1973.
Krug, R.E. et al, '"Measuring Village Commitment to Develop-
ment" in Values and Development: Appraising Asian Experi-
ence,: MIT Press, Cambridge, MA, 1976, pp. 104-132.
McGarry, M.G., "Village Water, Health, and a Potential Role
for Family Health Care," Proceedings of the Fourth Inter-
national Health Conference, National Council for Interna-
tional Health, Washington, DC, 1977.
McGarry, M.G., and M.L. Elmendorf, "What is Appropriate Tech-
nology? A Maya Village Asks," in Elemendorf, editor, 1982.
Miller, F.C., and C.A. Cone, "Latrines in Valuc: A Twenty Year
Perspective," in Elmendorf, editor, 1982.
Nieves, I., "Beyond Survival Skills: Providing Basic Services
to Satisfy the Needs of Poor Women" (mimeo), Paper pre-
pared for the United States Agency for International De-
Nieves, I., and W.T. Farrell, "Behavioral and Social Aspects
of Technology Diffusion and Decisionmaking in Marginal Ur-
ban Communities in San Salvador," in Elmendorf, editor,
O'Kelly, E., Rural Women, Intermediate Technology Development
Group, London, 1978.
Paul, B.D., and W.J. Demarest, "Intercultural Health Programs:
The Problem of Community Participation" (mimeo), Stanford
University, Palo Alto, CA, 1979.
Pillsbury, B., Reaching the Rural Poor: Indigeneous Health
Practioners are There Already, Agency for International
Development Program Evaluation Paper No. 1, Washington,
Pineo, C. and M.L. Elmendorf, "Observations of Rural Water
Supply and Sanitation Programs in Eight Developing Coun-
tries," in Elmendorf, editor, 1982.
-Roark, P., The Role of Women in Successful Water Supply Proj-
ects, Agency for International Development, Washington,
-Rodriguez, R.L.-, C. Pineo, and M.L. Elmendorf, "Nicaragua:
Country Report"-in-Elmendorf, editor, 1982.
Russell, A., "Report on the Situation of Women in the Target
Villages of the UNICEF Domestic Water Supply Project in
Dahr El Ghazal Province, Sudan" (mimeo), UNICEF, 1979.
Simpson-Hebert, M., "Sociocultural Factors: Implications for
Project Design" (draft), UNDP Global Project, Egypt, 1979.
Skoda, J.D., J. Medis, J. Bertrand and M. Chia, A Survey in
Rural Bangladesh on Diarrhoeal Morbidity, Water Usage, and
Related Factors, UNICEF/World Health Organization, Geneva,
Smith, W.A., "Media and Health Practices Results of Honduras
Field Investigation, Academy for Educational Development,
Report No. 14, Washington, DC, 1980
Srinivasan, L., Perspectives on Non-formal Adult Learning,
World Education, Boston, MA, 1977.
Stein, J., Water: Life or Death, International Institute for
Environment and Development, Washington, DC, 1977.
Steuart, G.W., and C. Rull, Training of Rural Development
Workers in Health Education, Water and Sanitation for
Health Project, Technical Report No. 1, Arlington, VA,
Storms, D., Training and Use of Auxiliary Health Workers: Les-
sons from Developing Countries, American Public Health As-
sociation, Washington, DC, 1979.
UNICEF, '"Alleviating Women's Burdens," Assignment Children,
Vol. 34,' 1976.
UNICEF East Asia and Pakistan Regional Office, "Toward a Pro-
grammer's Guide: Report of a Regional Water and Sanitation
Workshop," Bangkok, 1981.
Warlord, R..J., and J. J. Saunders, Village Water Supply, The
Johns Hopkins University Press, Baltimore, MD, 1976.
Warner, D.B., and J.S. Dajani, Water and Sewer Development in
Rural America, Heath, Lexington, MA, 1975.
Warren, D., "Primary Health Care. Training for Indigeneous
Healers in Ghana" (mimeo), Proceedings of the meeting of
the Society for Applied Anthropology, Denver, 1980.
White, A., Community Participation and Education in Community
Water and Sanitation Programmes: Methods and Strategies,
worm-a neaxtn urganiza-tion Internatiol-Rna RTfehreti CeTiter-
f-or-Community Wa-ter-Supply,-The-Hague, 1981.
White, A.U., and G.F. White, "Behavioral Factors in Selection
of Technologies," American Society of Civil Engineers,
197a8, Reprint 3453.
White, G.F., D.J. Bradley, and A.U. White, Drawers of Water:
Domestic Water Use in East Africa, University of Chicago
Press, Chicago, IL, 1972.
Whiting, M., and A. Krystall,. "The Impact of Rural Water Sup-
ply Projects on Women" (mimeo), CARE, Nairobi, 1977.
Whyte, A., Extension of Community Participation in Water and
Sanitation in Developing Countries, Institute for Environ-
mental Studies, Toronto, 1979.
Draft Guide for the Design of a National Support Pro-
gramme for Community Education and Participation in Water
Supply and Sanitation, World Health Organization/Interna-
tional Reference Centre, The Hague, 1980.
Whyte, A., and I. Burton, "Water Supply and Community Choice"
in Feacham, R., M. McGarry and D. Mara (editors), Water,
Waste and Health in Hot Climates, Wiley, London, 1977.