Rural Sanitation Sustainability Dynamics: Gaining Insight through Participatory and Simulation Modeling

Improved sanitation provides many benefits to human health and well-being and is integral to achieving Sustainable Development Goal Six. However, many nations, including most of sub-Saharan Africa, are not on track to meeting sanitation targets. Recognizing the inherent complexity of environmental health, we used systems thinking to study sanitation sustainability in Uganda. Our study participants, 37 sanitation actors in three rural districts, were engaged in interviews, group model building workshops, and a survey. The resulting model was parametrized and calibrated using publicly available data and data collected through the Uganda Sanitation for Health Activity. Our simulations revealed slippage from improved sanitation in all study districts, a behavior reflected in real interventions. This implies that systemic changes-changes to the rules and relationships in the system-may be required to improve sanitation outcomes in this context. Adding reinforcing feedback targeting households’ perceived value of sanitation yielded promising simulation results. We conclude with the following general recommendations for those designing sanitation policies or interventions: (1) conceptualize sanitation systems in terms of reinforcing and balancing feedback, (2) consider using participatory and simulation modeling to build confidence in these conceptual models, and (3) design many experiments (e.g., simulation scenarios) to test and improve understanding.改善环境卫生可为人类健康与福祉带来诸多裨益，亦是实现可持续发展目标6（Sustainable Development Goal Six）的核心要件。然而，包括绝大多数撒哈拉以南非洲国家在内的诸多国家，均未能按计划达成环境卫生相关目标。鉴于环境卫生领域的内在复杂性，我们采用系统思维对乌干达的环境卫生可持续性展开研究。本研究纳入37名来自3个农村地区的环境卫生行动者作为研究对象，通过访谈、群体模型构建研讨会以及问卷调查的方式开展数据收集工作。研究所构建的模型依托公开可用数据与乌干达卫生环卫项目（Uganda Sanitation for Health Activity）采集的相关数据完成参数化与校准。模拟结果显示，所有研究区域的环境卫生水平均出现下滑，这一现象与实际干预措施中的表现相吻合。这意味着，在该场景下改善环境卫生成效，或许需要推行系统性变革——即对系统内的规则与关系进行调整。针对家庭对环境卫生感知价值设置的增强反馈机制，为模拟结果带来了积极向好的前景。最后，我们为环境卫生政策或干预措施的设计者提出以下一般性建议：（1）从增强反馈与平衡反馈的视角对环境卫生系统进行概念化构建；（2）考虑采用参与式建模与模拟建模的方式，以提升相关方对这类概念模型的认可度；（3）设计多组实验（例如模拟场景）以验证并深化对相关问题的认知。