Journal of Quality in Health Care & Economics (JQHE)

ISSN: 2642-6250

Case Report

100 Acres Free, Why Need Latrines

Authors: Rajapaksa Hewageegana NS*

DOI: 10.23880/jqhe-16000421

Abstract

The “100 Acres” case study in Badulla district Sri Lanka illustrates the challenges of implementing sanitation projects in culturally sensitive areas. In 2000, the Regional Director of Health Services discovered funds for latrine construction, aimed at reducing open defecation and improving sanitation in the district. Open defecation was recognized as a health risk, leading to diseases like soil-transmitted helminths, diarrhea, and effects on outside health. The initial plan targeted schools, but the apathy of the principal became evident when he indicated that the surrounding open land was sufficient for the sanitary purposes of students, underscoring a lack of buy-in for latrines. Shifting the focus to plantations, where open defecation was more common, the project collaborated with plantation managers to identify needy areas. Although latrines were built and well-maintained, only a small percentage were used as intended. Through interviews, reasons for non-usage included cultural preferences for open, airy spaces and discomfort with enclosed areas. The project then employed a behavioral change strategy, moving through a phased approach to gradually ease residents into using latrines. The community gradually adjusted to the change, starting with open pits and adding incremental structures like partial walls and eventually a roof. This method allowed for a more culturally sensitive approach to sanitation, increasing usage over time. The study emphasizes the importance of understanding community values and involving residents in project design. Behavioral change is a slow process that requires trust and adaptation, especially in projects that alter daily habits. By respecting cultural preferences and implementing phased adoption, the project achieved more sustainable outcomes, demonstrating the necessity of aligning health interventions with local norms for genuine impact.

Keywords: Behaviour Change Communication; Cultural Sensitivity; Building Community Consensus (BCC); SDG Goals; Badulla District Sri Lanka; Latrine Usage; Sanitation Interventions

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