Rural sanitation interventions have had mixed long-term success, and ecological sanitation (ecosan) interventions are no exception. There is an urgent need to better understand what factors influence users’ adoption and sustained use of ecosan, and what barriers exist, but to date only a few studies exist.

To maximize learning from an ecosan project in El Alto, Bolivia, two follow-up studies were undertaken. One was a household survey and another, some years later, used the photovoice methodology to explore ecosan users’ experiences and perceptions.

The studies found that there was a significant, measurable and sustained reduction in incidence of diarroheal disease among households that had installed an ecosan unit. However, this reduction was smaller in lower-income households.

The studies also identified some barriers to ecosan use, particularly linked to service delivery and age, which led to residents adopting some risky practices. And there was also evidence that users inadequately understood the links between hygiene and reduced pathogen transmission.

The study provides new evidence of the benefits of ecological sanitation use as well as suggesting areas where interventions can be strengthened.

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