Related Experiment Video
Updated: Aug 7, 2026

Comprehensive & Cost Effective Laboratory Monitoring of HIV/AIDS: an African Role Model
Published on: October 31, 2010
Barriers and enablers for group-based manual emptying services for onsite sanitation facilities in Nairobi, Kenya: a
Hiroaki Tomoi1, Bonface Butichi Ingumba2, Sheillah Simiyu2
1London School of Hygiene & Tropical Medicine, Keppel Street, WC1E 7HT, London, United Kingdom; School of Tropical Medicine and Global Health, Nagasaki University, 1-12-4 Sakamoto, Nagasaki, Japan.
Abstract:
Onsite sanitation, such as pit latrines, is essential to achieving universal access to safe sanitation, as outlined in Sustainable Development Goal target 6.2. However, manual emptying for pit latrines in low-income areas is often unhygienic, posing health and environmental risks. Enhancing the safety of these services increases costs, yet affordability for customers is essential. Thus, reducing service costs is a key priority. Group-based approach, where emptiers visit multiple toilets consecutively, has potential to improve both service efficiency and affordability. However, few studies have investigated its applicability to manual emptying. This paper aims to identify barriers and enablers for group-based manual emptying services in low-income neighbourhoods of Nairobi. We conducted 12 focus group discussions with landlords, tenants, and manual emptiers in the Korogocho informal settlement in Nairobi and interviewed 20 key informants from relevant sectors in Kenya. We identified five categories of barriers and enablers that affected general and group-based manual emptying: 1) funding, 2) expertise and equipment, 3) social and commercial habits, 4) physical conditions, and 5) regulatory systems. Of these, a norm that pits are not emptied until they get full, operating time constraints, fair and transparent pricing, and an organiser who can arrange group-based emptying from Category 3, and transport capacity from Category 4 specifically affected group-based manual emptying. Given that the barriers have a cascade structure, addressing some primary barriers such as capacity building and recognising manual emptiers' role in the sanitation policies could be effective ways to ensure safe and affordable emptying services.
Related Concept Videos
Methods Of Healthcare Delivery System
Managed Care System:
The managed care system is designed to control the cost while maintaining the quality of care. The patient's care from admission to discharge is planned by the primary care provider or the case manager, also known as the gatekeeper. In a managed care system, the number of care providers is limited...
Specialized Care Centers and Settings-II
Rural health centers are specialized care facilities in remote locations with very few medical personnel. The primary care providers who run the centers are mostly Registered Nurse Practitioners. Here, emergency treatment is provided to critically ill or injured patients before they are transferred to the closest hospital. Fortunately, due to advancement in technology, many rural healthcare facilities and professionals have easy access to diagnostic and treatment...
Healthcare Associated Infections II: Preventive Measures
The best practices for preventing healthcare-associated infections include hand hygiene, patient risk...
Handwashing I: Introduction and Types of Equipment
Hand wash basins in clinical areas should have faucets that can be turned on and off without using the hands; that is, they should be non-touch or lever-operated.
Surface Membrane Barriers
The outer layer of the skin, the epidermis, is a robust barrier comprising layers of closely packed keratinized cells. This dense arrangement prevents microbes from penetrating the body. The periodic shedding of epidermal cells...

