Briefing Note: Moving Households Up the Sanitation Ladder
Background
DMDO’s latest community survey confirms a key challenge: although awareness of the health risks of poor sanitation is widespread, actual uptake of improved toilets remains low.
Starting from a very low base, DMDO has seen early signs of movement up the sanitation ladder, from open defecation and unsafe pits (‘Unimproved Sanitation’) to towards toilets with washable slabs and SATO pans (‘Improved Sanitation’).
However, the survey reveals that such improved facilities remain the exception, not the norm. Sustained progress will require us to shift from awareness to adoption, with clearer messaging and stronger delivery channels.
Key Findings
Limited Messaging Reach: The graphs below show that less than only half of respondents had received any messages about improving their toilets of which perhaps half took action. This is still an achievement but it does leave room for improvement.
Affordability is Perceived as a Barrier:
When asked why they haven’t upgraded, 80% said cost is the main obstacle. But deeper analysis suggests this is less about absolute affordability and more about perceived value.
(Interested readers can review the raw data themselves here.)
Affordability: Reframing the Narrative
The cost of upgrading from a Pit latrine with no slab (the majority’s status) is not prohibitive:
Adding Slab - ‘Pit latrine with slab’: TZS 50,000 (≈ $20)
Adding SATO pan - ‘Pit latrine with slab and SATO pan’: TZS 12,000 (≈ $5)
The cost of these upgrades are within reach for most households. We there think that the real barrier is that the benefits of upgrading are not yet clear or compelling enough to justify the cost. Where demand is low, any cost feels high. But when people understand how a small investment protects health, boosts productivity and avoids larger medical bills, they are more likely to act.
Revised Messaging Strategy
We will now focus on three behavioural levers, closely tied to movement up the sanitation ladder:
Economic Framing
New core message: “Save money and time—invest in your toilet, not in treatment.”
SMS example: “A toilet with a slab and SATO pan can stop disease before it starts. Avoid clinic costs—upgrade today.”
Clarifying What Counts as Improved
“A good toilet has a a covered pit, a washable slab, a SATO pan with walls, roof and a door. A clean pit is not enough.”
Access to Materials
People are more likely to act if they know where and how to get materials:
“Ask your CHW or Savings Group about SATO pans. Easy to install. Keeps away smells and insects. Less than $5.”
Delivery Channels
Mobile SMS - 60% of respondents are open to receiving messages via phone. We are communicating with district health officers on the Government protocals on sharing health messages to the community members through mobile phones. This will guide us on how we move forward on the part of SMS Compaigns. Our intention is to:
send short, targeted messages, linked to seasons, events and household needs; and
carry out ‘pulse surveys’ to track behaviour change among message recipients.
Community Health Workers (CHWs)
CHWs can:
Organize plays, meetings, and visits to explain benefits
Distribute supplier information and track pan sales
Report improvements by hamlet
Savings Groups
Groups can promote small loans or bulk purchasing of SATO pans
We will monitor pan uptake and latrine upgrades linked to group activity
Monitoring Success
Success will be measured through:
SMS follow-ups: comparing upgrades among recipients vs. non-recipients
CHW reports: toilet builds, pan sales, outreach events
Savings Group data: uptake of materials and financing schemes
Conclusion
We are committed to helping households climb the sanitation ladder. Improved toilets with washable slabs and SATO pans must become the new norm. This will not happen through awareness alone. We must strengthen perceived value to unlock demand and make upgrades feel urgent and achievable.
Our revised messaging and delivery approach aims to do that. We will report back in a few months’ time to let you know how successful we have been.
