Conducting a household survey using DHIS2 to monitor sanitation access in Liberia

This abstract has been accepted at the 2024 DHIS2 Annual Conference

Conducting a household survey using DHIS2 to monitor sanitation access in Liberia

Background: County Wide Sanitation Activity (CWSA) is a USAID five-year initiative designed to assist the Government of Liberia to permanently end open defecation and achieve universal sustained access to basic sanitation across five counties. The activity implements a market-based sanitation strategy and uses DHIS2 to monitor toilet sales. To monitor progress against these goals, a household survey was conducted, and the questionnaire was digitized using DHIS2 so that activity data were housed in the same place. Methodology: Random sampling was used per county, and communities were randomly selected. 95% confidence level and 5% margin of error were used, resulting in a minimum sample size of 384 households (i.e., respondents) per county (total target sample size of 1920 respondents). Although the population per county differs, this minimum is sufficient to generalize results per county. Each enumerator worked in a different community to avoid double counting and then moved to unvisited community. The questionnaire was configured as an event program in DHIS2. The EquityTool survey was included to assess wealth quintiles. Results: 2175 households consented, representing 17,193 people. 90% were rural. Average household size was 7.7. 63.3% practiced open defecation, 9.1% accessed unimproved sanitation, and 26.0% accessed improved sanitation (11.4% limited, 14.6% basic). 71.5% were in the two poorest quintiles. Enumerators visited about 238 households per day. Key findings used to adapt programmatic activities: the main barrier to accessing and using a toilet was money (e.g., 79% reported money was an issue to purchasing and installing a toilet) and the need for behavioral interventions in some communities (e.g., more than 50% of households in Nimba county believed it was taboo to live near a toilet). Conclusion:¬¬¬¬ This activity showed that DHIS2 can serve as a reliable data collection tool for household surveys. The dashboards were flexible and nimble, enabling activity staff to monitor data submissions in real-time. It also enabled course correction, such as following up with specific subnational teams to update their tablets when the data quality table within the dashboard flagged that key data quality flags. Having these data within DHIS2 make it easier for decision-makers to dig deeper into the data and cross-reference with other data in the system, such as toilet sales. It will also ease the transition of the survey, data collection, and analysis processes to the government over the life of the project.

Primary Author: Luigi Nuñez

Liberia, DHIS2, household survey, sanitation, rural, EquityTool