The effect of financial inclusion on open defecation and sharing of toilet facilities among households in Ghana

Globally, and in Ghana, a lot of people do practice open defecation as well as share toilet facilities with other households. Meanwhile, open defecation in particular, is associated with numerous negative health and economic effects. To this end, a number of empirical studies have been conducted on the determinants of access to sanitation facilities among households in Ghana. Nonetheless, while financial inclusion (sustainable ways of ensuring easier accessibility to cheap and useful financial products and services among individuals/firms) can enhance the ability of households or individuals to afford toilet facilities, hence, could help in curbing open defecation and sharing of toilet facilities among households, the previous studies on Ghana did not pay attention to it. This study therefore uses data from the 7th round of the Ghana Living Standards Survey (GLSS7) to examine the association of financial inclusion with open defecation and sharing of toilet facilities among households in Ghana. The binary logit regression is used as the empirical estimation technique. The results show that, financial inclusion in general is associated with lesser likelihood of open defecation and sharing of toilet facilities among households in Ghana after controlling for welfare quintile, urban or rural residence and other covariates. Moreover, while informal financial inclusion is statistically insignificant, formal financial inclusion is found to be associated with reduced open defecation and sharing of toilet facilities among households. Thus, in the attempt to eliminate open defecation as well as reduce the sharing of toilet facilities among households in Ghana, conscious efforts should be devoted towards enhancing formal financial inclusion.

Willingness to pay for improvements in rural sanitation: Evidence from a cross-sectional survey of three rural counties in Kenya

Poor sanitation worldwide leads to an annual loss of approximately $222.9 billion and is the second leading cause of Disability-Adjusted Life Years (DALY’s) lost due to diarrhoea. Yet in Kenya, the slow rate and levels at which the household’s access improved sanitation facilities remain a concern, and it is unknown if the cost of new technologies is a barrier to access. This study assessed the maximum willingness to pay (WTP) for SAFI and SATO sanitation products and identified those factors that affect the willingness to pay (WTP) valuation estimates by households in three counties in Kenya. It used quantitative economic evaluation research integrated within a cross-sectional survey. Contingent valuation method (CVM) was used to determine the maximum WTP for sanitation in households. We used the logistic regression model in data analysis. A total of 211 households were interviewed in each county, giving a total sample size of 633 households. The mean WTP for SAFI latrines was $153.39 per household, while the mean WTP for SATO pans and SATO stools was $11.49 and $14.77 respectively. For SAFI latrines, households in Kakamega were willing to pay $6.6 more than average while in Siaya, the households were willing to pay $5.1 less than the average. The main determinants of households WTP for the two sanitation products included household’s proximity to the toilet (p = 0.0001), household income (β = .2245741, p = 0.004), sanitation product (β = -2968.091; p = 0.004), socioeconomic status (β = -3305.728, p = 0.004) and a household’s satisfaction level with the current toilet (β = -4570.602; p = 0.0001). Increased proximity of households to the toilet, higher incomes, and providing loan facilities or subsidy to poor households could increase the demand for these sanitation technologies.

When pits fill up: Supply and demand for safe pit-emptying services in Kisumu, Kenya

Improving sanitation conditions in low-income communities is a major challenge for rapidly growing cities of the developing world. The expenses and logistical difficulties of extending sewerage infrastructure have focused increasing attention on the requirements for safe and cost-effective fecal sludge management services. These services, which are primarily provided by the private sector, include the collection and treatment of fecal waste from latrine pits and septic tanks. To determine the degree to which market forces can promote safe fecal sludge removal in low-income neighborhoods of Kisumu, Kenya, we compared household willingness-to-pay for formal pit emptying with the prices charged by service providers. Through surveys of 942 households and a real-money voucher trial with 646 households, we found that stated and revealed demand for formal emptying services were both low, with less than 20% of households willing to pay full market prices. Our results suggest that improving fecal sludge management in these neighborhoods via the private sector will require large subsides, ranging from 55.1-81.4 million KES (551,000-814,000 USD) annually, to address the gap between willingness-to-pay and market prices. Raising and administering subsidies of this scale will require the development of a city-wide sanitation master plan that includes investment, management, and regulatory procedures for fecal sludge management. In the absence of government investment and coordination, it is unlikely that the private sector will address safe sanitation needs in low-income areas of Kisumu.

Assessing the Demand for Plastic Latrine Slabs in Rural Kenya

Improving access to safe and affordable sanitation facilities is a global health priority that is essential for meeting the United Nation's Sustainable Development Goals. To promote the use of improved sanitation in rural and low-income settings, plastic latrine slabs provide a simple option for upgrading traditional pit latrines. The International Finance Corporation/World Bank Selling Sanitation program estimated that plastic slabs would have a 34% annual growth, with a market size of US$2.53 million in Kenya by 2017. In this study, we examined the commercial viability of these plastic latrine slabs in rural Kenya by evaluating a financing and distribution model intervention, documenting household slab sales to date, and assessing consumer exposure and perceptions. We also determined household willingness to pay through a real-money auction with 322 households. We found that no households in our study area had purchased the plastic slabs. The primary barriers to slab sales were limited marketing activities and low demand compared with the sales price: households were willing to pay an average of US$5 compared with a market price of US$16. Therefore, current household demand for the plastic latrine slabs in rural Kenya is too low to support commercial distribution. Further efforts are required to align the price of plastic latrine slabs with consumer demand in this setting, such as additional demand creation, product financing, and public sector investment.

Opportunities and barriers to effective operation and maintenance of public toilets in informal settlements: perspectives from toilet operators in Kampala

Although classified by the Joint Monitoring Programme (JMP) as unimproved sanitation facilities, public toilets still play a critical role in eliminating open defecation in informal settlements. We explored perspectives of toilet operators on opportunities and barriers to operation and maintenance (O&M) of public toilets in informal settlements. A cross-sectional study design was used. Up to 20 in-depth interviews were used to obtain data on the experiences of public toilet operators. Thematic content analysis was used. Ressults show that opportunities for improving O&M include; operation of public toilets is a source of livelihood; operators are knowledgeable on occupational risks, and the community is involvedin sanitation activities. Barriers to effective O&M include; high operation costs, failure to break even and a lack of investments in occupational health Therefore, there is need to recognise the significance of public toilets as a viable alternative to open defecation in areas where ownership of private sanitation facilities is difficult. Failure to observe the health and safety of toilet operators may further compromise O&M.

Drivers of women's sanitation practices in informal settlements in sub-Saharan Africa: a qualitative study in Mathare Valley, Kenya

Despite evidence suggesting women are disproportionately affected by the lack of adequate and safe sanitation facilities around the world, there is limited information about the factors that influence women's ability to access and utilize sanitation, especially in sub-Saharan Africa. The purpose of this study was to explore factors influencing women's sanitation practices in informal settlements in Nairobi, Kenya. Information from 55 in-depth interviews conducted in 2016 with 55 women in Mathare Valley Informal Settlement in Nairobi was used to carry out cross-case, thematic analysis of women's common sanitation routines. Women identified neighborhood disorganization, fear of victimization, lack of privacy, and cleanliness/dirtiness of facilities as important factors in the choices they make about their sanitation practices. This suggests that future sanitation-related interventions and policies may need to consider strategies that focus not only on toilet provision or adoption but also on issues of space and community dynamics.

Rapid monitoring and evaluation of a community-led total sanitation program using smartphones

India accounts for around 50% of the world's open defecation, and under a World Bank initiative, a rural district was selected to be the first open defecation-free (ODF) district in Punjab. Considering this, the current study aims to evaluate the application and impact of a smartphone-based instant messaging app (IMA) on the process of making Fatehgarh Sahib an ODF district. The District Administration involved the Water Supply and Sanitation Department, Non-government Organizations, and volunteers to promote the process of a community-led total sanitation. Proper training was provided to the volunteers to spread awareness about the triggering events, health impacts of open defecation, and monetary benefits of building new individual household latrine (IHHL). IMA was used as an aid to speed up monitoring and for the evaluation of a sanitation program. All the volunteers were connected to an IMA. This helped in providing a transparent and evidence-based field report on triggering events, follow-up activities, validation of existing IHHL, and monitoring of construction of new IHHL. IMA is a cost-effective tool as it is already being used by the volunteers and requires no additional cost (on the user or on the project) but requires a training on ethical uses of mobile and data safety.

The Clean India Mission: Public and animal health benefits

The Clean India Mission is a national campaign that aims for complete elimination of open defecation from the country. In India, 564 million people do not have access to toilets and defecate in the open environment. The 'Millennium development goals' have given increased weightage to elimination of open defecation for improving health, nutrition and productivity of developing country populations. The Indian economy bears an estimated annual total loss (in terms of health, education, access time and tourism) of US$ 54 billion due to lack of toilets, poor hygiene and over US$ 38.5 billion in treatment costs for diseases occurring due to poor hygiene. Out of 1415 human pathogens, at least more than 10% of pathogens are transmitted through the faecal-oral route. The practice of open defecation helps pathogens persist in the environment and cause diseases. This review focuses on the current status and harms of open defecation, as well as the public and animal health benefits of implementing 'The Clean India Mission' in India.

Importance of triggers and veto-barriers for the implementation of sanitation in informal peri-urban settlements - The case of Cochabamba, Bolivia

An estimated 2.4 billion people lack access to improved sanitation which has devastating consequences for human health and the environment. Understanding what constitute sanitation demand is crucial for accelerating the spread of improved sanitation. This study aims to understand the adoption mechanisms for improved sanitation. An informal peri-urban settlement in Cochabamba, Bolivia was selected as a case study to understand adoption patterns. Various qualitative methods of data collection and analysis were employed. The findings showed that pour-flush toilets was the only preferred sanitation alternative at the study site. An adoption framework for waterborne toilets was developed based on diffusion of innovation theory. Factors that influence adoption were identified. Some functioned as triggers and initiated adoption, whereas some factors blocked adoption and constituted veto-barriers. Most factors were connected to the individual household situation and its members, but neighborhood development also affected pour-flush adoption. Based on adoption time the residents were divided into the following adoption groups: first adopters, early majority, late majority, laggards and non-adopters. Each adoption group followed its own adoption route with specific characteristics and respective triggers or veto-barriers. We argue that the strong demand for waterborne toilets in peri-urban areas need to be recognized and the developed framework could be used for customizing sanitation improvement programs for certain target groups.

The true costs of participatory sanitation: Evidence from community-led total sanitation studies in Ghana and Ethiopia

Evidence on sanitation and hygiene program costs is used for many purposes. The few studies that report costs use top-down costing methods that are inaccurate and inappropriate. Community-led total sanitation (CLTS) is a participatory behavior-change approach that presents difficulties for cost analysis. We used implementation tracking and bottom-up, activity-based costing to assess the process, program costs, and local investments for four CLTS interventions in Ghana and Ethiopia. Data collection included implementation checklists, surveys, and financial records review. Financial costs and value-of-time spent on CLTS by different actors were assessed. Results are disaggregated by intervention, cost category, actor, geographic area, and project month. The average household size was 4.0 people in Ghana, and 5.8 people in Ethiopia. The program cost of CLTS was $30.34-$81.56 per household targeted in Ghana, and $14.15-$19.21 in Ethiopia. Most program costs were from training for three of four interventions. Local investments ranged from $7.93-$22.36 per household targeted in Ghana, and $2.35-$3.41 in Ethiopia. This is the first study to present comprehensive, disaggregated costs of a sanitation and hygiene behavior-change intervention. The findings can be used to inform policy and finance decisions, plan program scale-up, perform cost-effectiveness and benefit studies, and compare different interventions. The costing method is applicable to other public health behavior-change programs.

Supply and Demand for Improved Sanitation: Results from Randomized Pricing Experiments in Rural Tanzania

Improving access to sanitation is a global public health priority. Sufficient consumer demand is required for sanitation coverage to expand through private provision. To measure consumer demand for hygienic latrine platform products in rural Tanzania, we conducted a randomized, voucher-based real-money sales trial with 1638 households with unimproved latrines. We also evaluated multiple supply chain options to determine the costs of supplying latrine platform products to rural households. For concrete latrine SanPlats, 60% of households were willing to pay US$0.48 and 10% of households were willing to pay US$4.05, yet the average cost of supplying the SanPlat to households was US$7.51. Similarly, for plastic sanitary platforms, willingness-to-pay (WTP) dropped from almost 60% at a price of US$1.43 to 5% at a price of US$12.29, compared to an average supply cost of US$23.28. WTP was not significantly different between villages that had participated in the National Sanitation Campaign and those that had not. Randomized informational interventions, including hygiene data-sharing and peer-based exposure to latrine platform products, had minimal effects on WTP. In conclusion, current household demand for latrine platform products is too low to achieve national goals for improved sanitation coverage through fully commercial distribution.

Towards sustainable sanitation management: Establishing the costs and willingness to pay for emptying and transporting sludge in rural districts with high rates of access to latrines

Motivation

Proper management of fecal sludge has significant positive health and environmental externalities. Most research on managing onsite sanitation so far either simulates the costs of, or the welfare effects from, managing sludge in situ in pit latrines. Thus, designing management strategies for onsite rural sanitation is challenging, because the actual costs of transporting sludge for treatment, and sources for financing these transport costs, are not well understood.

Methods

In this paper we calculate the actual cost of sludge management from onsite latrines, and identify the contributions that latrine owners are willing to make to finance the costs. A spreadsheet-based model is used to identify a cost-effective transport option, and to calculate the cost per household. Then a double-bound contingent valuation method is used to elicit from pit-latrine owners their willingness-to-pay to have sludge transported away. This methodology is employed for the case of a rural subdistrict in Bangladesh called Bhaluka, a unit of administration at which sludge management services are being piloted by the Government of Bangladesh.

Results

The typical sludge accumulation rate in Bhaluka is calculated at 0.11 liters/person/day and a typical latrine will need to be emptied approximately once every 3 to 4 years. The costs of emptying and transport are high; approximately USD 13 per emptying event (circa 14% of average monthly income); household contributions could cover around 47% of this cost. However, if costs were spread over time, the service would cost USD 4 per year per household, or USD 0.31 per month per household—comparable to current expenditures of rural households on telecommunications.

Conclusion

This is one of few research papers that brings the costs of waste management together with financing of that cost, to provide evidence for an implementable solution. This framework can be used to identify cost effective sludge management options and private contributions towards that cost in other (context-specific) administrative areas where onsite sanitation is widespread.

Ensuring sustainability of non-networked sanitation technologies: an approach to standardization

Non-networked sanitation technologies use no sewer, water or electricity lines. Based on a review of 45 commercially distributed technologies, 12 (representing three concepts) were selected for a detailed audit. They were located in six countries of Africa and Asia. The safety of users was generally assured and the costs per use were not excessive, whereas costs were fully transparent for only one technology surveyed. A main drawback was insufficient quality of the byproducts from on-site treatment, making recycling in agriculture a hygienic and environmental risk. Further, no technology was sufficiently mature (requiring e.g. to shift wastes by hand). In order to promote further development and give producers of mature products a competitive advantage, the paper proposes a certification of technologies to confirm the fulfillment of basic requirements to make them attractive for future users.

[Dry toilets: a means of alternative sanitation]

OBJECTIVE

Evaluating dry toilet use in a rural area of Colombia.

METHOD

Fifteen families were selected by convenience sampling from the rural area of a municipality in the Cundinamarca department in Colombia. A dry (composting) toilet was installed in one house and used for demonstration purposes over a five-month period. An ex-post evaluation was made concerning technical and economic matters.

RESULTS

A dry toilet is easy to construct/install and has environmental benefits associated with less contamination of water sources reduction and a reduced amount of chemical fertilizer. Dry toilets’ construction and operating costs may represent savings of Col$616973456 (US$308487) in the municipality being studied, compared to the costs involved in conventional toilet use. However, cultural barriers were found regarding their use.

DISCUSSION

A large percentage of households in many countries’ rural sectors do not have a sewerage system for disposing of human waste. This situation creates significant challenges regarding environmental health and ecosystem conservation. Dry toilets represent an environmentally-acceptable solution from a technical and economic perspective; however, work is required concerning social and cultural factors producing cultural perceptions and prejudices about handling excreta to provide the necessary coverage and produce a significant impact on people’s awareness.

The child health implications of privatizing Africa's urban water supply

Can private sector participation (PSP) in the piped water sector improve child health? I use child-level data from 39 African countries during 1986-2010 to show that PSP decreases diarrhea among urban-dwelling, under-five children by 2.6 percentage points, or 16% of its mean prevalence. Children from the poorest households benefit most. PSP is also associated with a 7.8 percentage point increase in school attendance of 7-17 year olds. Importantly, PSP increases usage of piped water by 9.7 percentage points, suggesting a possible causal channel explaining health improvements. To attribute causality, I exploit time-variation in the private water market share controlled by African countries' former colonizers. A placebo analysis reveals that PSP does not affect respiratory illness, nor does it affect a control group of rural children.

Vermicomposting toilets, an alternative to latrine style microbial composting toilets, prove far superior in mass reduction, pathogen destruction, compost quality, and operational cost

Composting toilets aim to recycle excrement into safe, stable humus. Preceding this, low costs, low risks, and mass reduction should be ensured. Source separating vermicomposting toilets (SSVCs) outperformed mixed latrine microbial composting toilets (MLMCs) in all categories. MLMCs: incurred ten times greater operational costs; created 10x more operator exposure; employed no proven pathogen reduction mechanism since solid end-products averaged 71,000±230,000CFU/g (fecal-origin) Escherichia coli and 24±5% total solids, consistently failed NSF/ANSI Standard 41; failed to reduce volatile solids compared to raw fecal matter; increased total contaminated dry mass by 274%, and produced alkaline end-product (8.0±0.7) high in toxic free ammonia (Solvita® 2.6±1.5). SSVCs have low maintenance costs and risks; adequate worm density for pathogen destruction (0.03±0.04g-worm/g-material); reduced E. coli 200±244CFU/g in neutral (7.4±0.3), stable (60±10% volatile solids), and mature (4±0 Solvita® NH(3)) end-product.

Potential fresh water saving using greywater in toilet flushing in Syria

Greywater reuse is becoming an increasingly important factor for potable water saving in many countries. Syria is one of the most water scarce countries in the Middle East. However, greywater reuse is still not common in the country. Regulations and standards for greywater reuse are not available. Recently, however, several stakeholders have started to plan for greywater reuse. The main objective of this paper is to evaluate the potential for potable water saving by using greywater for toilet flushing in a typical Syrian city. The Sweida city in the southern part of Syria was chosen for this purpose. Interviews were made in order to reflect the social acceptance, water consumption, and the percentage of different indoor water uses. An artificial wetland (AW) and a commercial bio filter (CBF) were proposed to treat the greywater, and an economic analysis was performed for the treatment system. Results show that using treated greywater for toilet flushing would save about 35% of the drinking water. The economic analyses of the two proposed systems showed that, in the current water tariff, the payback period for AW and CBF in block systems is 7 and 52 years, respectively. However, this period will reduce to 3 and 21 years, respectively, if full water costs are paid by beneficiaries. Hence, introducing artificial wetlands in order to make greywater use efficient appears to be a viable alternative to save potable water.

[Performance evaluation of rural latrine renovation in key schistosomiasis control areas, Jiangsu Province]

OBJECTIVE

To evaluate the hygienic, environmental, social and economic benefits achieved by rural latrine renovation in key schistosomiasis control areas, Jiangsu Province.

METHODS

Eights villages (evaluation villages) that finished and the three villages (control villages) that did not finish the latrine renovation work were sampled and investigated through field visits, questionnaire, referring to information and so on, to collect relevant data, and human waste samples were detected for laboratory indicators in hygiene and environment, in key schistosomiasis control areas in three counties (cities, districts), Jiangsu Province.

RESULTS

A total of 11 villages and 220 households were investigated. In the evaluation villages, the owning rate and quality conformity rate of three-format sanitary latrines were 98.6% and 98.8%, respectively. The human schistosome infection rate, intestinal parasite infection rate, the incidence of intestinal infectious diseases, and related medical costs decreased by 100%, 44.5%, 34.2% and 82.8%, respectively, compared with those before latrine renovation. In laboratory testing, the removal rates of fecal coliform values, CODcr, BOD5 and ammonia nitrogen in the third cell of household latrine were 99.99%, 68.50%, 63.17% and 52.30%, respectively, compared to those in the first cell. The village appearance had changed fundamentally, the villagers were satisfied with the latrine renovation, and their health knowledge and health behavior improved significantly.

CONCLUSIONS

Rural latrine renovation in key schistosomiasis control areas has got great achievements in hygienic, environmental, social and economic benefits. It plays an important role in the promotion of schistosomiasis control, economic development and social harmony.

Follow-up of a low cost latrine promotion programme in one district of Amhara, Ethiopia: characteristics of early adopters and non-adopters

OBJECTIVES

To verify reported construction of 22 385 household latrines in 2004, after community mobilization, as part of a trachoma control programme in one district of Amhara, Ethiopia, and to explore characteristics of early latrine adopters and non-adopters.

METHODS

We used a two-stage cluster sample survey design to randomly select eight sub-districts and 160 households listed as having built a latrine, and visited them to verify presence and use. Household heads were interviewed to determine latrine cost and knowledge, attitude and practice regarding latrines. Non-latrine adopting neighbours were interviewed for comparison. We estimated district latrine ownership and calculated adjusted odds ratios for factors associated with latrine use.

RESULTS

Latrines were present in 87% (95% CI 77-97) of listed households; 90% (81-99) were in use. Among all district residents we estimated ownership as 50.2% (44-56) and use as 45.2% (36-55). Of latrine owners who had built in 2004, 69% (53/77) had spent nothing on their latrine, those who paid spent an average of US$4.0 [standard deviation (SD) US$3.6]; overall the median cost was US$0 and the mean US$0.80 (SD US$1.7). Household heads adopting latrines were 1.9 times (95% CI 1.3-2.8) more likely to have any education and 1.5 times (95% CI 1.1-2.0) more likely to have a larger family than non-adopting neighbours. Cleanliness (48%, 56/116) and health benefits (42%, 49/116) were the most frequently reported advantages of latrines.

CONCLUSION

The latrine promotion programme dramatically increased latrine access and use at very low cost. The method of community mobilization used could be an effective way of reaching millennium development sanitation targets.

Cost effectiveness of a latrine revision programme in Kabul, Afghanistan

INTRODUCTION

We assessed a household latrine revision intervention implemented in Kabul, Afghanistan for evidence of a reduction in diarrhoeal disease.

METHODS

A case-control design involving 1238 cases and 625 controls was used. Logistic regression modelling was performed both for children < 5 years and < or = 11 years, and the parameter estimates were later used with results from a stratified cluster sample survey. This survey used a verbal autopsy methodology to enable an estimation of the number of deaths averted over a 1-year period. A cost-effectiveness analysis using direct and indirect costs for the intervention was then conducted and the results compared with primary health care interventions identified from a Medline search.

FINDINGS

Conditional logistic regression showed that patients were less likely than controls to live in households with revised latrines (odds ratio (OR) 0.57, 95% confidence interval (CI) = 0.42-0.77 for children < 5 years, and OR 0.53, 95% = CI 0.41-0.67 for children < or = 11 years). The results from the survey of cause-specific mortality by verbal autopsy enabled estimation of the number of deaths averted over a 1-year period due to the intervention; these estimations were 235 (95% CI = 109-360) for children < 5 years and 285 (95% CI = 180-397) for children < or = 11 years. Estimates of cost effectiveness ranged from approximately US dollars 1800 to US dollars 4100 per death averted depending on age and payer perspective.

CONCLUSION

These estimates are conservative because only 1 year of effectiveness is considered, yet they compare favourably with a review of other paediatric interventions. These results are important because funding for sanitation interventions is often limited by the belief that the interventions are not cost-effective.

The benefits of a lending library for female urinals

Reduced mobility, physical weakness or other disabilities can all contribute to continence problems (McIntosh, 1998). The ability to transfer from a bed or chair to a commode may be a critical factor in deciding whether patients can be discharged home or into residential care. Also, patients--particularly women--may be prescribed continence pads simply because they cannot access the toilet or commode rather than having a diagnosed bladder condition.

Review of current technologies for urinary incontinence: strengths and limitations

A wide range of continence products is available, and this paper focuses on products to prevent incontinence (such as urinals and commodes) and to contain or manage urinary incontinence (such as absorbent pads, penile sheaths and urethral catheters). Drawing on results from published clinical evaluations at the Continence Product Evaluation Network at UCL and at other centres, the strengths and limitations of the major categories of incontinence products currently on the market are reviewed. It is concluded that, although products for continence have improved considerably over the last 20 years, there is considerable scope for the designer and engineer to improve on current products.

How you spend your pennies ... factors affecting the efficiency of human waste disposal systems (re-usable and disposable) and their cost

Both re-usable and disposable systems have their merits and problems. The disposable system, being fully integrated, appears to be steadily gaining market share compared with the re-usable system. Since its introduction, the success of the re-usable system has been limited by the use of pans not designed for automatic processing. Where the 'perfection' pan has been superseded by 'open' shaped receptacles and those used in commode chairs, cleaning effectiveness can be improved by a factor of 10. For this and other reasons, nursing involvement in the re-usable system can be high while the 'perfection' pan is in use. A work study exercise to compare nursing involvement in re-usable and disposable systems is under way. When selecting a human waste disposal system for any site, it is vital that all disciplines discuss and decide objectives. The equipment usage, space, site conditions, availability and quality of supplies (eg water, electricity), the costs of maintenance, nursing time and other expenditure must be considered. The disposable system is capable of high process rates (more than double that of the fastest re-usable system). Its capital cost is currently about 1,000 pounds less than an average re-usable system, but in the busiest wards, revenue costs may be higher. In such wards the space for disposable receptacle storage can be as much as five to ten times machine volume. The design of macerators is generally simpler (having less components) than washer-disinfectors. Monitoring and maintenance involvement are likewise expected to be lower, particularly in hospitals with modern drainage systems.(ABSTRACT TRUNCATED AT 250 WORDS)

Incontinence aids for home use

Specific knowledge of the relative merits and costs of equipment and techniques will enable individualized incontinence management for greater patient comfort.