Sanitation Programme

PROJECT IDEA: To provide Nosy Komba families with private bathrooms and to train local teams in the entire process of constructing and maintaining the bathrooms.




PROJECT LOCATION: Nosy Komba, Antsiranana Province, Madagascar

SECTOR OF THE INTERVENTION: WASH  (Water, Sanitation and Hygiene)

START DATE: July 2014


In Madagascar, life expectancy is around 64 years. In reality, many people die in their first decade of life from completely preventable diseases. (CIA, THE WORLD FACTBOOK 2015, People and Society). Only 9% of Malagasy people living in rural areas have access to improved sanitation facilities (2015 Update and MDG Assessment – WHO / UNICEF Joint Monitoring Programme). The island of Nosy Komba is no exception, with open defecation being the common practice. The inability to access a toilet leads to a multitude of water-borne diseases, such as cholera and typhoid. Diarrheal disease, a leading cause of childhood morbidity and mortality, is ubiquitous in areas of unimproved sanitation. Access to improved sanitation goes far beyond disease prevention. Improved sanitation in schools is shown to decrease the dropout rate, especially among adolescent girls. It also increases safety, especially among women and girls who may be targeted when accessing discrete locations alone. The dignity and empowerment provided to a household with a new bathroom is immeasurable.

The aim of the project is to provide all Nosy Komba families with a private bathroom in order to:

  • Reduce diarrheal disease prevalence
  • Avoid safety issues, especially for women 
  • Improve personal privacy and strengthen households by developing the domestic space
  • Prevent school dropouts, especially among adolescent girls, by providing a safe and dignified space for personal hygiene during their menstrual cycle

Through the implementation process we also aim to:

  • Train local builders to self-make each component of the bathroom (tank panels, squat toilet, sink, bricks) and produce them in series in order to replicate the project
  • Begin a local and sustainable enterprise

The programme aims to cover the entire island of Nosy Komba. To date, H4O has given access to private bathrooms to around 150 inhabitants of Antintorona village (20% of inhabitants). The programme began by selecting households located at strategic points such as shops with increased traffic, as well as households that guaranteed proper use and adequate maintenance. Bathrooms have also been built in the nursery schools in order to accustom children to their use at a young age. While bathrooms benefit all community members, the benefit to women and girls is especially significant. Going forward, we will begin implementation in all of the villages of the east side of Nosy Komba: Antintòrona, Antamotamo, Antrema and Anjiabè. From there, the project will move to the villages of the west side.

2 Local teams, each with 3 builders. They have acquired new competencies and obtained reliable employment.


  • Training of local builders on sizing a Septic Soakaway Pit
  • Selection of private houses to receive a bathroom, prioritizing by demonstrated need and commitment to upkeep
  • Building and self-making of each component of the toilet
  • The Programme is integrated with hygiene education and promotion activities in schools (see Hygiene Promotion Interventions)

Our analysis, based on a modified UNICEF KAP (Knowledge, Attitudes and Practices) survey, has been done in partnership with the School of Civil Engineering of the University of Leeds (MSc Water, Sanitation and Health Engineering). It consists of a GIS map, created through community surveying, which has allowed us to monitor and evaluate health conditions and demonstrated needs of the citizens of the island, in order to prioritise future interventions on Nosy Komba (see WASH KAP Assessment on Nosy Komba).

Patronage of:

  • City of Turin
  • Region of Piedmont


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