Water-related diseases, in particular diarrhea, are widely recognized as a major threat to public health, especially in the developing world. It is estimated that globally 19% of all infectious diseases are related to water, sanitation and hygiene risk factors. Nearly two million children die annually from diarrheal diseases. Epidemiological investigations have shown that even in the absence of toilets, diarrheal morbidity can be reduced with the adoption of improved hygiene behaviours. In South Africa the provision of basic infrastructure such as water and sanitation has been an important part of the social contract between the African National Congress–led government and its constituencies. In Johannesburg, a privately managed parastatal company – Johannesburg Water – has been contracted to deliver water and associated services in the city. As part of their water service delivery and improvement of services, the company has opted for various methods of delivery, some of which include the use of prepaid water meters and yard taps. A large pilot project of water service delivery through prepaid water meters has been embarked upon in Soweto. The research question asked in this study is: Do households respond differently to hygiene and handwashing interventions depending on the water systems and payment systems? More specifically, is there a difference in handwashing behaviours between caregivers living in households with in-house prepaid water meters as compared to caregivers living in similar households with deemed consumption accounts for water? If so, why? Hygiene education materials developed by Cape Town’s Khayelitsha Water and Sanitation Programme, were used to educate the selected sample households in Soweto with respect to hygiene practice, particularly those aspects related to pathogen transfer. Each household in the Soweto case study was visited; the caregiver and all other interested members in the household were then given the intervention. Data were then collected via observation of the carriers at the selected households. The observations were carried out by trained researchers using both a general and a structured questionnaire. Of the 107 households surveyed, 51 had prepaid meters and 56 were operating on deemed water consumption.
MSP Occasional Paper No.13