Preliminary Assessment

The Preliminary Assessment

Step 1: Choosing Target Neighborhoods

Target neighborhoods selected for the exposure assessment should be representative of key risk conditions associated with a broken sanitation chain. If neighborhoods have not yet been selected, the city official key informant interviews will help the team to identify low-income areas in the city.

Note: If the implementing team has pre-determined in which neighborhood(s) they will work, this step may be skipped. The name of the neighborhood(s) can be added to the printable behavioral surveys and can be entered into the mobile device.

The following conditions should be considered to identify and prioritize the target neighborhoods: coastal zones, area with large open drains, areas prone to flooding, squatter settlements, areas with large markets, areas with urban agriculture, areas with primary schools, and areas with highest population density. Depending on the city, the team might also wish to ensure a balance of religious or cultural groups and a mix of socio-economic levels because of the different sanitation and hygienic practices and cultural norms associated with these groups. Table 1 is an example of how to describe potential target neighborhoods by key risk conditions.

Once the neighborhoods of concern are identified, the exposure assessment team should determine how many of those neighborhoods can be included in the exposure assessment based on available time and resources.

Step 2: Interviewing Key Informants

As a part of the preliminary assessment necessary to move forward with the SaniPath exposure assessment tool, a series of key informant interviews are recommended. If the implementing organization does not already have target neighborhoods in mind, we recommend starting with an interview with a city official in order to identify potential target neighborhoods. After identifying potential target neighborhoods, we recommend conducting key informant interviews with community leaders along with a transect walk in each target neighborhood in order to better characterize them.

The goal of key informant interviews is to identify target neighborhoods and potential sources of fecal contamination at the city and neighborhood level. To identify city officials or key informants to interview, the exposure assessment team should consider:

● Who is making sanitation policy and/or investments at the city level? It is possible that a donor organization could plan an urban area without government involvement?

● Who manages the budgets and is responsible for implementing such policies and/or investments?

● Who is advising sanitation policy?

● Who is focused on low-income urban neighborhoods? Insecure land tenure and lack of government approval for sanitation investments in unplanned settlements can be major roadblocks to sanitation improvements.

Key informants might include representatives of City Department of Engineering / Infrastructure or Department of Water Resources, Work & Housing, or Public Health. Supplemental information might be obtained from CBOs or NGOs that focus on hygiene or that work on slum-dwellers’ rights or housing. There is no suggested number of key informants to interview; the team will have to determine whether they have obtained enough information to move forward with the exposure assessment process.

The interview with the community leader(s) is intended to identify the characteristics, amenities, and main problems of the neighborhood. It allows a more detailed comparison to other neighborhoods to plan survey activities and environmental sampling. There are two components of the meeting with the community leader: (1) an interview and (2) a transect walk through the neighborhood. The key informant interview/transect walk should take place in every neighborhood targeted for the exposure assessment. Collected data will be used to inform which pathways should be included in the exposure assessment.

The interview at the neighborhood level should be conducted with a person who is a recognized community leader in the neighborhood. This may be the leader of a neighborhood association, the CBO leader, the chief, or the chief’s assistant. The participant must be a resident of the neighborhood and be knowledgeable about the local community.

It is likely that enumerators will be meeting with key informants in their offices. Each interview should take approximately two hours. What the team learns in the key informant interviews will be combined with observations from the transect walk to select pathways of exposure for the exposure assessment.

Step 3: Performing Transect Walks

The purpose of the transect walk is to identify key locations within each target neighborhood where people could potentially come into contact with fecal matter. The transect walk can also be used to construct a neighborhood map if a map is unavailable. This is done by taking the GPS coordinates of the community boundary and other key points during the transect walk.

An interview with a key informant - such as a community leader or local government official - is required before a transect walk is undertaken. The exposure assessment team member should invite the key informant to join him or her on the walk through the target neighborhood. This can take about an hour or more, depending on the size of the neighborhood.

The transect walk should include visits to the following sites:

• Public / Shared toilet(s)
• Open defecation area(s)
• Open drain(s)
• Waste disposal site(s)
• Flood area(s)
• Market(s)
• School(s)
• Community center(s)
• Houses of Worship (i.e. Churches, Mosques, Temples)
• Food vending area(s)
• Public tap(s)
• Ocean/surface water area(s)
• Any additional sites identified by the key informant as locations where people could come into contact with fecal matter

Step 4: Selecting Relevant Pathways

The exposure assessment will generate “risk profiles” for the following exposure pathways (as relevant for any given neighborhood). Each possible path of exposure shown in Table 2 is called a pathway in the SaniPath Tool, and each will have a unique risk profile after all data is collected and analyzed. You will select risk profile pathways based on the information gathered from the key informant interviews and transect walks through target neighborhoods. The tool will allow the team to determine which pathways of exposure will be considered in the assessment, based on the team’s answers to a series of questions.

Step 5: Preparing the Preliminary Assessment Report

Data for the report outlined below will come from several sources including the key informant interviews, the transect walks, and any maps of target communities.

The report should cover the following topics:

1. An overview of sanitation infrastructure in the city (including both private and public: schools, community facilities, large work places if relevant)
   1. Summary of key informant interviews: who was interviewed and key findings
   2. List of neighborhoods where fecal contamination is of concern
   3. Nature of waste treatment
2. Overview of target communities
   1. Specify relevant neighborhoods for the exposure assessment (this will guide sampling, household surveys, community meetings)
   2. Explanation of how and why target communities were selected
   3. Description of demographics of each target community
   4. Describe community based organizations or community leaders who could help with the assessment
3. Observations from transect walk
   1. Detailed description of the sanitation infrastructure in the target communities
   2. Public: schools, community facilities, large work places if relevant
   3. Are there any sewage treatment facilities in the city or specific neighborhoods (e.g., settling ponds)?
   4. Descriptions of behavioral observations for pathways without an environmental microbiology component
   5. Practices for disposing of sewage (as relevant: description of municipal treatment plant(s), settling ponds, dumping sites, how private latrines are emptied, disposal of children’s feces, etc.)
   6. Practices for solid waste management as this relates to human waste (use of polythene bags as toilets, children’s feces in rubbish)
   7. Qualitative information on possible human exposures to solid waste
   8. Flooding
4. Define pathways to be considered in assessment and why they were selected
5. Maps of each target community (Optional, see Gmail, Strava, Ona, and Maps Training)
   1. Location of key points in community, both public and private: schools, community facilities, large work places if relevant
   2. Identify potential places to take environmental samples
   3. Optional: more detailed mapping of drain networks and flood areas