How does sanitation contribute to good quality of life? qualitative research in maputo, mozambique to identify capabilities

Ross, Ian (1); Dreibelbis, Robert (1); Adriano, Zaida (2); Cumming, Oliver (1) (2019). 'How does sanitation contribute to good quality of life? Qualitative research in Maputo, Mozambique to identify capabilities' Paper presented at the annual conference of the HDCA 2019, London, UK.


Background: Sanitation has value to people for reasons that extend beyond the prevention of infectious disease. However, it is hard to gauge the degree of benefits such as privacy and safety in the absence of quantitative means of measuring them. Consequently, these benefits are left out of economic evaluations and improvements in sanitation are undervalued. This study aimed to understand what people value about sanitation, to inform the development of a quantitative measure of sanitation-related quality of life (SanQoL).

Methods: We employed the capability approach to explore what women and men valued about sanitation in low-income neighbourhoods of Maputo, Mozambique. The capability approach focuses on what individuals “have reason to value” in what they can be and do. We undertook 19 in-depth interviews and 8 focus group discussions, to identify how good or bad sanitation helped or hindered the achievement of a good life. We used framework analysis to identify capabilities that were attributes of SanQoL, and used pile sorting and triadic comparison exercises to rank them.

Results: Five capabilities emerged as being the most important sources of value: (i) Freedom from disgust avoiding unpleasant sights and smells in the toilet such as faeces and flies; (ii) Privacy – not being seen while using the toilet; (iii) Safety – reduced risk of physical or sexual assault; (iv) Health – reduced risk of infectious disease; (v) Freedom from shame – having dignity and pride.   

Conclusions: These sources of value were in line with what has been identified as drivers of toilet uptake in rural settings. However, ‘shame’ in relation to smells and neighbours was given more emphasis, possibly due to the densely-populated urban setting.

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