Good practices for Social inclusion - Case studies and summary

Annex 1 : Community Self-Assessment Form
1. Who operates? Nobody  City-paid operator  Commercial operator  RW/RT paid operator
Local women volunteers  Local men volunteers
2. No. of toilets? For women  For men  For both 
Ever extended?  Yes, by community Yes, by other namely  ………. Not able  No need
3. No. of bathing cubicles? For women  For men  For both  Wastafel present? Yes  No

4. Soap to wash hands? Yes  No  Queuing at peak times? Yes  No 
5. Operator promotes handwashing? Yes  No 
6. Water supply? PDAM  Regular? Yes  No  Enough? Yes  No 
Stand-by? Yes, borehole with pump  Yes, handpump  No 
Did community arrange for stand-by? Yes  No 
7. Wastewater disposal? Septic tank  Community Treatment Plant  City sewerage  River

8. Excreta visible in toilets? Yes  No  Water seal? Yes, with water  Yes, no water  No

9. Bad smell? Yes  No  Cleaned after each use? With water  With water & soap  No 
10. Payments? per visit  by subscription  other  Details:……………………………
Did community set payments? Yes, leaders alone  Yes, by user consultation  No, others 
Amounts paid? Toilet …………..… Bath …………… Laundry ………………….……………
Soap …………… Water …………..…………..…………..
Are payments too high for some? Yes  No  What is
problem? ………………………………
11. All adults pay? Yes  No, some refuse No, poor are free  Children pay? Yes  No 
12. Income covers which costs? Operator fee  Water bill  Soap to clean 
Soap to wash hands  Carbol  Cleaning brush
Emptying Septic tank  Sewerage bill  Fuel bill 
General Upkeep (painting, repair doors, floor etc.) 
Expansion of MCK  Replacing worn out MCK 
13. Anyone pays some uncovered costs? No  Yes, RT RW City Other 
namely………….
14. Anyone pays all uncovered costs? No  Yes, RT RW City Other 
namely………….
Scores for Community Self-Assessment of MCK
A. Environmental Health Risks 41
41
Still to be included: provisions for menstrual hygiene
65