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Behavioral Drivers of Fecal Sludge Management in Rural Cambodia

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Background: Over two billion people worldwide use toilets with on-site containment of faces. In rural areas in particular, few options for safe fecal sludge management (FSM) currently exist, which often leads to the discharge of untreated fecal sludge into local waterways or agricultural lands. Unsafe disposal of fecal sludge has serious negative impacts on both public health and the environment. In Cambodia, 78% of people live in rural areas. Over the last ten years, sanitation coverage has dramatically increased. Most households install pour-flush toilet with underground pits to capture and store faces. As these pits fill, FSM emerges as a real challenge for the country’s rural sanitation. This qualitative study explores behavioral drivers of FSM practices in rural Cambodia. The results can help further inform the design of appropriate, sustainable solutions for safe FSM for Cambodia’s rural communities.

Methodology: In-depth, semi-structured interviews were conducted with 39 key stakeholders (e.g., households, local authorities, school teachers and religious leaders). Participants were selected from across 21 villages in three provinces in Cambodia. Participants’ sanitation facilities were observed to complete the study. Qualitative data was coded and analyzed using Atlas.ti 7.5.7.

Results: In rural Cambodia, households typically choose one of the five options to manage their fecal sludge: self-pit emptying, hiring a pit emptier, draining the pit, installing an extra pit, or building a new latrine. Among these options, hiring a pit emptying service (i.e., vacuum tanker sercice) is strongly preferred, although in practice households are more likely to empty pit themselves. While there is reported use of protective gear (e.g., gloves and mask) during manual self-pit emptying, there is no proper treatment of FS after pit emptying. FS is mostly reported to be immediately disposed of or mixed with water first before reuse as fertilizer. Several drivers, including risk perceptions, emotion, ability, access, service cost, physical environment, and attitude toward FS are found to influence households’ decision to empty and dispose of their FS. Other cross-cutting factors such as gender, season, past experience, and social dynamics are found to additionally affect the local FSM behaviors.

Conclusions: The results of the study demonstrate that current FSM practices in rural Cambodia pose significant public health and environmental risks. The lack of safe practices must be addressed to enable safe disposal or reuse of FS. Technological solutions for these rural areas need to address the elimination of smell, reduce disgust, and allow for the option to safely reuse FS. Behavior change strategies should focus on disgust as a key emotional driver to deter unsafe FSM practices. Certain population groups (e.g., adult men) may be targeted as they may be more at risk of exposure to the harmful effects of untreated FS.