A new bathroom provides health dignity and empowerment to all

In the North-West of Madagascar, to date many people die in their first decade of life from completely preventable diseases. Open defecation is a widespread practice which poses multi-dimensional challenges for local communities. The inability to access a toilet leads to: water-borne diseases, such as cholera and typhoid; gender-based violence and school drop-outs for young girls, among others.

Through this project, H4O addresses the social, economic and environmental challenges by providing all Nosy Komba families with a private bathroom by training local staff. Ultimately, our project is contributing to increased women and girls’ safety as well as develop domestic space and household practices for numerous families.


A new bathroom provides health dignity and empowerment to all


About the Sanitation programme project

Key info

  • Project location: Antintorona, Antamotamo (Nosy Komba), Ratapenjiky (Nosy Mitsio)
  • Sector of intervention: Water, Sanitation & Hygiene (WASH)
  • Dates: 2014 – ongoing
  • Target: private Households, Schools, Healthcare facilities
  • Skills development: self-construction of each component of the bathroom, management of the construction enterprise

For who


The project ultimately benefits the entire targeted community, as it is structured as a public intervention. More specifically, the main beneficiaries are:

  • Households
  • School and healthcare facilities
  • Vulnerable women and girls
  • People with disabilities
  • Local constructors




Patronage of


Academic partnership



  • 2 local teams, each with 3 builders per village have acquired new competencies and obtained reliable employment in the construction of sanitation facilities
  • 438 inhabitants with improved sanitation facilities
  • 73 toilets new toilets built in domestic premises
  • 200 pupils of 2 schools (100 students, per each school)
  • 2 healthcare facilities improved

How the project impact in our Area

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

Health improvements

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  • Reduce diarrheal disease prevalence
  • Improve personal privacy and respect for individuals’ dignity
  • Improving residential space and domestic life thanks to the construction of a private bathroom

Women's empowerment

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  • Prevent school dropouts, especially among adolescent girls, by providing a safe and dignified space for personal hygiene
  • Avoid safety issues, especially for women

Skills development

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  • 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

Financial sustainability

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  • Set up a local and sustainable social enterprise that provides construction services for all the communities where the project is implemented

Description of the project

Why? For whom and through which interventions?

About the context

In Madagascar, 77.6% of the population lives with less than 1.90 USD per day, average age is 19.6 years and most deaths are associated with avoidable causes, first and foremost oro-faecal diseases (UNDP, 2019). Unicef-WHO (2017) state that most rural population lacks access to clean water (63.77%) improved sanitation facilities (83.39%) and access to products for appropriate personal hygiene (49.46%).
The inability to access a toilet leads to a multitude of water-borne diseases. Diarrheal disease, a leading cause of childhood morbidity and mortality, is ubiquitous in areas of unimproved sanitation. Lack of improved sanitation goes far beyond disease spread. It increases school dropout rates, especially among adolescent girls, who may not go to school during menstrual period. Moreover, women and girls can also incur physical abuse and violence when practicing open defecation.

How our research and evidence-based approach shapes our interventions

To shape our interventions, the project takes stock of the results of a modified UNICEF KAP (Knowledge, Attitudes and Practices) survey, which we implemented in partnership with the School of Civil Engineering of the University of Leeds (MSc Water, Sanitation and Health Engineering). The survey was piloted in the island of Nosy Komba and led to a GIS map, that allows to monitor and evaluate health conditions and demonstrate needs of citizens.

Core activities

  • Creating a community focus group by engaging key informants and local authorities
  • Training and skills development for two teams of local constructors in each area of intervention by the two H4O senior trainers
  • Increasing engagement and ownership of project beneficiaries (who actively contribute to the building of the sanitation facilities and household infrastructure)
  • Building and self-making of each component of the bathroom by the local team of builders
  • Integrating intervention with hygiene education and promotion activities in schools (see Hygiene Promotion Interventions)

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