Contact Mrs Nikki Shaw e-mail - email@example.com
THE NATA HIV/AIDS – SANITATION PROJECT
The scope of this project is to provide safe, sustainable sanitation systems for 80 HIV positive women in the village of Nata, Botswana. This is a pilot project, which aims to raise awareness of the links between sanitation and health and in particular sanitation and HIV; also to introduce safe sanitation solutions to the area, to nurture local understanding of the importance of sanitation, and to stimulate demand and encourage independent sanitation provision. Ultimately, the aim is to improve the health and economy of the entire village, and slow the HIV infection rate, through sanitation solutions.
The project will be carried out by the Nata AIDS and Orphan Trust in collaboration with the World Toilet Organization.
The Nata AIDS and Orphan Trust (“the Trust”)
Established in 2006, and approved as an official registered Trust (and legal non-profit organisation) in Botswana in January 2007, the Trust’s objectives are to promote HIV/AIDS awareness and assist those living with HIV/AIDS, as well as providing help and support for the Nata orphans and needy.
The World Toilet Organization (WTO)
The WTO is a global non- profit organization committed to improving toilet and sanitation conditions worldwide.
Statement of Need
“there [is] need for the establishment of an effective sanitation programme for rural communities to reduce HIV-related opportunistic infections” (The Herald,2006; reporting on a 2006 SIDA workshop).
Nata exhibits many typical challenges for sanitation provision: the majority of the population do not have any sanitation facilities, there is limited government support (no sewers or treatment facilities in the area) for sanitation provision, non-affordability by the poor and particularly the poor living with HIV/AIDS, and a narrow range of sanitation options currently available locally. However, the demand for sanitation exists and the organisational capacity to see this project through is already established.
HIV positive people suffer disproportionately from lack of safe sanitation: people with HIV/AIDS are more prone to diarrhoea (and suffer for longer with it), and are often not as strong or able to walk the distances required to find private areas to defecate. They have reduced immunity and so are more likely to pick up opportunistic sanitation-related diseases (andto then pass them on), increasing the community-wide incidence of sanitation-related disease.
In Nata, as throughout Africa, more women than men are infected with HIV. There are 21% more women than men in Nata; women also head up more than half the households, suffer greater poverty and inherit more AIDS orphans and AIDS related dependants than men.
For these reasons, we have chosen 80 women in Nata who are living openly with HIV/AIDS and currently have no sanitation facilities, nor means by which to pay for or construct such facilities, to be the beneficiaries of this pilot project.The scope of this project is to provide these 80 women with safe, sustainablesanitation systems.The intention is to bring these women and their families some relief, but with potential for far wider impact: when others see that living openly with HIV brings better health and greater dignity for the whole family than for those who hide or fear their status, they may be encouraged to come forward for HIV testing and treatment, ultimately interrupting the current rate of infection.
Backgroundand supporting information
At independence in 1966, Botswana was one of the least developed nations in the world. Over the next 30 years, good governance and economic management resulted in rapid economic growth, and Botswana rose steadily up the Human Development Index rankings: poverty fell, mortality rates plummeted, school attendance rose, access to health services and safe water (but not sanitation facilities!) increased to impressive levels, and significant advances in human rights and against discrimination were made. Botswana graduated to a Middle Income status nation.
Unfortunately, these gainsare in danger of being obliterated by an HIV/AIDS epidemic that has so far defied response measures.
At present, the Botswana Government finances the vast majority of an impressive and extensive anti-HIV/AIDS campaign, which sadly reduces the money the Government can allocate to other national demands.As expenditure on health increases, Government revenues are likely to contract. The capacity of the Government to provide essential services is being steadily reduced.
A variety of sourcesreport the population in Botswana with safe drinking water is 95-98%, with urban coverage at 100% and rural at 90%.Unlike for water, there is little mention of impressive levels of safe sanitation coverage in Botswana. Sanitation facilities are lacking nationwide, with coverage of improved sanitation estimated at around 55% in urban areas, and rural coverage below 30%. Open defecation is practiced widely.
Botswana’s villages and rural populations are scattered, often remote and often with small populations, making it difficult and expensive to install efficient water and sanitation facilities outside the major towns and cities. Botswana has an active NGO and CBO community, although these currently focus mainly on health, and mainly within the larger urban centres. Currently no NGOs or CBOs are dealing with water and/or sanitation (which have come to be seen as the Government’s responsibility).
See Appendix E for further details.
Nata is a village in the north-eastern part of Botswana, near the border with Zimbabwe. The village grew up around a major crossroads for trade and tourism, along the busiest route through the country.
Nata has a population of around 6,000 people (including associated principalities); the majority population lead an agrarian lifestyle, and there is widespread poverty.
Currentlyregistered at the Nata Clinic aremore than 700 people living with HIV/AIDS (PLWHA). This number does not even begin to reflect the total number of Nata residents infected with the virus, estimated at approximately 37% of the adult population.Nearly 50% of pregnant women in Nata test positive.
In Nata, a number of families haveconstructed pit latrines for themselves within theirerfs, and a smaller number have indoor flush-toilets connected to septic tanks. The rest of the village relieve themselves outdoors. This can and often does become a health hazard, particularly during rainy periods.
As Government coffers are being squeezed and NGOs are not currently engaged in any water and sanitation activities, sanitation provision will not be imminently forthcoming.
There are a number of operating NGOs, CBOs and community groups in Nata, and – uncommonly – one such organisation, the Nata AIDS and Orphan Trust(“the Trust”), has expressed an interest in promoting a sanitation project. It is our intention to make sure this enlightened wish is fulfilled, and as such we are seeking financial help to allow this project to happen.
To provide safe, sustainable toilets for PLWHA who currently have no means of acquiring sanitation facilities on their erfs. Eighty women currently living openly with the virus in Nata have been selected for the pilot project.
The project aims to improve the comfort, health, status and livelihood of people living with
HIV/AIDS (PLWHA) in Nata, Botswana, through provision of sustainable sanitation solutions, and through so doing, to encourage others to come forward for HIV testing. By encouraging more PLWHAto live openly with the virus and partake in the anti-retroviral (ARV), prevention of mother to child transmission (PMTCT), and HIV education programmes currently available to them, we can reduce the stigma attached to the disease, and slow the rate at which it is spreading.
It is an under-appreciated fact that sanitation is integral to achieving all of the Millennium Development Goals. This project highlights this fact, and will contribute to bringing increased awareness of linkages between sanitation and HIV, whilst at the same time directly contributing to achieving both MDG 6 (to combat HIV/AIDS and other diseases) and MDG 7 (which includes halving the number of people worldwide without access to safe sanitation).
It is also hoped that through this project will come an increased understanding of the benefits of sanitation, and the importance of sanitation solutions that do not pollute the environment,stimulating increased demand for safe sanitation facilities in Nata. For this project a number of community members will be trained – together with the beneficiaries – in latrine installation, operation and maintenance, and together with existing private sector players will be encouraged to market and sell sanitation products. It is envisaged that this will result in long-term employment opportunities, as well as increased access to safe sanitation solutions in Nata.
Ultimately the aim is to contribute to improved health and quality of life for all Nata residents.
Outcomes and community benefits
- Safe, sustainable sanitation for HIV positive Nata residents resulting in improved health and quality of life for these PLWHA and their families.
- A “Toilet Team” of Nata residents, trained in installation, operation and maintenance of complete sanitation solutions.
A number of intermediate and longer term outcomes from this project have also been identified:
- An increase in numbers of PLWHA coming forward for testing, as a result of witnessing the possibility of attaining a better quality of health and life if living openly with the virus.
- Increased awareness, throughout Nata, of the health and lifestyle advantages of safe, sustainable latrines, resulting in increased demand for sanitation products.
- Increased employment opportunities in the sanitation sector, and increased availability of appropriate solutions within local market channels.
- Reduced dependency on the Government for provision of services.
- Widespread adoption of safe sanitation and an associated reduction in open defecation.
- Increased awareness of the linkages between sanitation and health, and – more specifically – sanitation and HIV.
The diagram below presents the expected impact and outcomes of the project and the primary indicators that will be used to measure these.
Activites / Methodology
The Trust is managed by a Board of Trustees, all of whom are already established, active and trusted members of the Nata community. As a consequence, we embark on this project with full community immersion already established.
To achieve the primary objective and outcome – provision of safe sanitation for needy people living openly with HIV/AIDS – the Project will undertake the following activities.
Preliminary study and preparation
1) Identify the first group of PLWHA to receive the latrines in the pilot project (the beneficiaries)
2) Select the sanitation technology to be adopted for this project
3) Identify the team to implement the project
The first two of these – identifying beneficiaries and selecting technology – have already been completed, the third is underway. The processes and conclusions are outlined below.
- 1. Beneficiaries
There are currently more than 700 PLWHA registered at the Clinic. (A far greater number within the community are infected but have not registered with the Clinic.)
There are 21% more women than men in Nata; more than 50% of homes in Nata are female-headed. HIV has resulted in an increase in dependants, and women are inheriting more dependants than men. In general in Botswana, domestic duties fall to women and children.
Consequently, from the 700 registered PLWHA, the Nata Aids and Orphan Trust has selected 80 women living openly with the virus, and currently without any sanitation facilities in their erfs/compounds, to be the beneficiaries of this pilot project.
- 2. Technology
Water is a limited and valuable resource everywhere, and in particular in Botswana. The majority of erfs in Nata are not supplied with a water connection, and there is no sewerage system in Nata. In the light of these facts, using conventional water-borne sanitation systems is not considered the most appropriate technology for the area. Non-flush options are preferred.
Nata’s water supply is from groundwater, pumped and piped to public standpipes (and to limited private connections). Since the late 1990s Botswana has seen a rise in patients treated for diarrhoea, and at the same time reports have linked the design and location of pit latrines with groundwater contamination (supported by studies finding nitrate contamination in significant aquifers following successful pit latrine promotion). Therefore, options that can successfully treat the waste products prior to discharge are preferred to simple pit latrines.
Consequently, the product selected for this project is the Deico Mac Sanitation System. This system is non-flush, and so neither requires private water connections nor depletes water supplies. In addition, it is a full treatment system that destroys >99% of pathogens prior to effluent discharge, removing the risk to groundwater.
The particular model will be the DEICO MAC Model 1100, which is suitable for families and can be used by up to ten people per day. Provision will include all components in the typical layout below, and if not installed just outside an existing structure, a toilet superstructure will also be constructed (predominantly by the beneficiaries as far as possible).
The Deico Mac sanitation system has been successfully adopted in South Africa and the USA. See Appendix C for detailed information.
The Deico Mac comes with a hand operated mechanical agitator (or stirrer) which promotes more effective treatment (see Appendix C for details).This agitator must be turned a few times(for a few seconds only is all that is necessary) daily.
As with any sanitation system, the toilet and surrounds must be kept clean. This entails regular cleaning of the bowl using just water (no disinfectants can be used as they will interfere with the biological treatment processes). The toilets come with a rubber plunger that can be used if necessary to push solids through the outlet tube.
Anal cleansing must be done using water or paper (toilet paper or newspaper is ok) only.
Education on anal and toilet cleansing materials is vital. Educating recipients in maintenance, and in hygiene, is part of the scope of this project. Maintenance of each toilet will be the responsibility of the beneficiary; however, the Trust will request assistance from the local health department to carry out inspections, and the Trust will also provide follow-up checks, advice and expertise.
All installations will be provided with a system in close proximity for hand-washing with soap (or soap substitute); these will be separately drained so that the soap does not enter the digester.
As long as the bowl area is kept hygienic and the agitator is turned a few times daily, the Deico Mac has been found to operate safely and inoffensively for long periods, with a minimum life expectancy of 20 years. In fact, even systems that were poorly maintained or improperly used have been shown to quickly recover once the tank is adequately stirred, proving this technology to be highly resilient.
Potential for upgrades
Dieco Mac flushless toilet systems can be upgraded to use 2 litre flushing tanks. This does reduce the storage time and therefore effectiveness of pathogen removal, but still produces effluent of considerably safer quality than from septic tanks, and the effluent can be safely discharged to an underground soakaway.
Should there be widespread uptake of these toilets, Deico Mac systems can be connected to sewerage systems. Due to the small volumes and reduced peak loads released, even when using 2 litre cisterns, the effluent can be conveyed in shallow, small bore (PVC or HDPE) sewers, at great cost savings over conventional sewerage. This can ultimately be discharged into alocal treatment works, or to maturation ponds, water meadows or underground soakaways. Note that drainage from kitchens and bathrooms can also be connected to these same small bore sewers, downstream of the anaerobic system (first passed through a grease trap).
The effluent can also be put to use as a fertiliser for use in subsistence and local organic farming (see Appendix C).
- 3. Implementers
The team to implement the project consists of:
- Peter (Pedro) Martinez (Peace Corps worker in Nata) together with
- Mma Rancholo of the Nata AIDS and Orphan Trust
- World Toilet Organization staff member, to be based in Nata for the duration of the project, to ensure project compliance and effectiveness, and for reporting and feedback.
- Peter McClelland (inventor of the Deico Mac Toilet and Nata resident).
- A team from within the Nata community will be trained in the installation, operation and maintenance of the Deico Mac toilets(the “Toilet Team”). This Team will, at the same time, receive general training in the importance of safe sanitation and hygiene, as well as some basic teaching on the HIV virus and living with it. The Team will also be trained to install and maintain alternative appropriate sanitation options available locally. It is proposed that in the longer term this team can become active members in the Nata sanitation sector, finding employment installing and maintaining toilet facilities, and promoting better health and hygiene practices.
- The beneficiaries will be requested to assist in the installation and building, and will receive the same training as the ‘Toilet Team’, thereby creating both ownership of their toilets and further employment possibilities.
Promotion and capacity building:
- There are several active community groups in Nata. We will engage some or all of these groups for this project in various roles such as to promote good sanitation and hygiene awareness, and to spread messages on the HIV/AIDS and sanitation links. Some or all of the ‘Toilet Team’ may be selected from these groups, as they have proven themselves committed to strengthening the local community.
- Seloma Tiro will, as Chairman of the Nata AIDS and Orphan Trust, oversee and approve allocation of funds; however,
- Peter McClelland will hold the project purse, and will be responsible for day to day accounting, payment of salaries and bills, etc.
The following diagram illustrates the structure of the implementing team:
1- Training of the beneficiaries and the‘Toilet Team’in toilet construction (first week).
2- Installation of 80 toilets in the homes of the selected beneficiaries (up to a year, depending on productivity of Team!).
3- Training of beneficiaries in correct O&M of the Deico Mac sanitation systems (by Nata Toilet Team under supervision as necessary by project supervisors; ongoing throughout project).
4- Community meetings (by Kgotla) throughout the project to encourage widespread participation, discuss the importance of sustainable sanitation and hygiene, to advise on how to get involved or apply for a Deico Mac sanitation system, and to encourage private sector actors to become involved in the sanitation market. (project supervisors and Toilet Team; at least one meeting a month over the duration of the project).
See Appendix A for the programme.
5- Review existing sanitation options adopted and/or available in Nata.
6- Encourage ‘Toilet Team’ to continue their sanitation & hygiene promotion and provision, and to work with private sector players to expand the local sanitation market.
NOTE: Widespread evidence (predominantly from Asia) suggests that once the value and impact of improved sanitation is recognised, people will not often go back to open defecation. Furthermore, households can be assisted to move ‘up the sanitation ladder’, shifting from low-cost toilets to more expensive and stronger models when they have more money to invest. Once demand for latrines exists, there are numerous opportunities for local entrepreneurs to produce and distribute latrines and latrine upgrades. However, Appendix E following highlights how the geography, population statistics, health situation and nature of Botswana’s industries all contribute to reducing the favourability of a mass market economy, perhaps emphasising why projects need – at least until the health of the formerly successful, prosperous nation is restored – to retain more of the donor hardware provision model than the more appealing software-only approaches.
7- Evaluation and Review: to appreciate the success and effectiveness of this project and establish whether to pursue subsequent similar programmes (ie establish how best to expand this beyond this pilot project); to disseminate lessons learned.
To allow for all 80 systems to be installed correctly and to ensure adequate training, and sufficient awareness raising, education, and demand- and market-stimulation, we estimate the project should run for one year. See Appendix A following for timeline.
The total project costs are anticipated to run to US$107,000. See Appendix B following for an explanation and breakdown of costs.
Note that activities include promotion, training, transport of hardware, installation, demonstration and more, together with office set-up and mobilisation. We are only able to do all this for such a low budget becausethe Trust members all work entirely voluntarily.
APPENDIX A :
One system can be installed within hours. However, a more conservative estimate for installing both system and superstructure, and based on the implementing team being beneficiaries with HIV and semi-volunteers (with other commitments), allows for 3 days per system.
It is assumed that the team will become more expert with time and so other activities – like researching other sanitation options and enabling a local sanitation marketplace – are proposed to run concurrently with installations in the latter half of the year.
See excel sheet attached.It is proposed that the project runs for one year starting in January or February 2010.
Please note the following is based on the current exchange rate of approximately US$1 = P6.45
Item and description
Mobilisation and general running costs
Sundries: transport, office equipment, phone line for internet, promotional and educational materials, etc, all $100/month
Return flight for WTO staff member (estimate)
Office/home rent for WTO staff member, approx P3500/m including utilities
(1) Digestors (Model 1100) P2,200.00 for each, 80 number
(2) Buildings-complete: 1.1m x 1.1m including floor, door, and roof P1,700.00 each, 80 number
(3) Transport to Nata Village P275.00 each, 80 number
ADDITIONAL FACILITIES (Hygiene)
Handwashing facilities: these can be simple and made from locally available materials (tippy taps, etc) with soap nearby. We are hoping to get start-up hygiene packs donated
WTO staff member salary, $ 1250 per month
Toilet Team: 10 volunteers at US$150 per person per month
CBO participation: costs of events, remuneration; allow $150 per month
Add 10% to allow for unforeseen items, currency fluctuations etc
Cost in US$
$ 1 200
$ 3 000
$ 6 512
$ 27 287
$ 21 085
$ 3 411
$ 15 000
$ 18 000
$ 1 800
$ 9 705
Summary of Deico Mac Sanitation System
The Deico Mac complete sanitation system saves water, and can produce useful by-products (liquid fertiliser). Virtually no contaminants are discharged into the environment: All case studies to date report more than 98% e.coli removal. Tests have shown that although Ascaris is not killed in the digestion processes, settlement in the anaerobic tank eliminates Ascaris ova.
Although it has a higher initial capital cost, and requires marginally greater daily maintenance (to cleanse the pan and turn the agitator arm) than the simple pit latrine, the Deico Mac has considerable advantages over other options. Simple pit latrines and/or septic tanks discharging to soakaways is seen as a potential for environmental contamination of groundwater due to the lack of bacterial retention in such systems, whereas the environmentally friendly discharge of the anaerobically digested liquid from the Deico Mac toilets not only avoids groundwater pollution but may be utilised for Organic Agriculture. (Ascaris is not killed in the anaerobic digestion process, but if the resulting effluent is directed to crops through a process of ground filtration it will still be a safe and rich liquid fertiliser.)
The Deico Mac is distinguished from competitors by the hand operated mechanical agitator which promotes more effective digestion by circulating fresh nutrients and breaking down floating mats that inhibit the decomposition process. In addition, mixing in the bottom of the tank puts the sediment in suspension for longer and reduces the likelihood of the tank sludging up and requiring vacuum tanker de-sludging, resulting in a system with a very long useful life.
Nearly all solids are broken down and digested, and the effluent would at worst be compared with thick fluid; consequently there is virtually no chance of blockage in the outlet pipes.
Discharge is only 1.2 litres per person per day in fully utilised waterless systems, with effluent stored for 58 days prior to discharge, which is a major factor in the high level of pathogen breakdown. The digester tank is sealed, so there is no risk of groundwater contamination even if in areas with a high water table.
The system produces little or no smell if operating normally. It can be connected to squatting slab or pedestal toilet as per user preference.
The Deico Mac Model 1100 which will be used in this project has the following specification:
Tank dimensions: 1.270mm high x 740 mm x 740mm wide.
Weight with all components is 40kg.
The unit is supplied with all pipes and fittings as well as a toilet seat and bowl or squatting slab.
HIV/AIDS and Sanitation
HIV destroys defence cells (commonly referred to as T cells, or CD4 cells) which are part of the body’s immune system, resulting in PLWHA becoming immune deficient. Consequently much lower viral loads cause infections than would do in healthy persons; this is illustrated by the following:
Source: IFH 2003
Figure 3.4 Illustrating infection risk increase with respect to nature of infecting
micro-organism and susceptibility (immuno-status) of the host
Consequently, opportunistic infections that a healthy body would successfully fight off attack PLWHA; and each opportunistic infection weakens the defence further, shortening the lives of the PLWHA. Hence it is vitally important PLWHA avoid opportunistic infections as far as possible.
One of the most common opportunistic illnesses worldwide is diarrhoea. Studies consistently link as much as 80% of diarrhoeal incidence to poor WASH conditions, via contaminated water supplies, poor hygiene or unsafe disposal of faeces. Over half of patients suffering from HIV/AIDS have chronic diarrhoea (WELL, 2003); for these people a latrine nearby is essential for the health of themselves and those around them, and for simple human dignity.
Sanitation is also vital for home-based care of PLWHA. As care moves into the community, a UNDP report states that “for households in Botswana... with inadequate sanitary conditions, home-based care poses a real danger to both patients and carers” (UNDP, 2000). Latrines must be close to weak patients if they are to use them. For bed-ridden patients there must be nearby facilities for safe human waste disposal.
In a report discussing a diarrhoea outbreak in Botswana in 2006 a Botswana newspaper reported: “In persons with healthy immune systems, symptoms usually last about one to two weeks and those with a weak immune system such as those with HIV/AIDS they may be severe and could lead to serious or life threatening illness” (BOPA, 15 March 2006). Protecting PLWHA from such infections improves their health, and allows them to live, and contribute to their families and nation, longer (WELL, 2003).
APPENDIX E: Botswana Overview
Government: Botswana is a stable, democratic nation with a record of good governance, with heavy investment in human development, including education and health.
Geography: Botswana is a large (585 370 km2), land-locked country dominated by the Kalahari Desert. Botswana suffers low and erratic annual rainfall (averaging from 250mm in the south west to 650mm in the north east) and high evaporation rates. The majority of the country is semi-desert with surface water sources concentrated to the north and east.
Climate: Botswana summers are hot, with rainfall concentrated in these summer months. The winters are cold and dry, particularly harsh on a population living in mud and block houses without formal heating, and on children without ample clothing or shoes.
Demographics: current estimates put the population of Botswana at around 1.7 million.
Gender: About 50% of all households are female-headed, and female-headed households have more dependants and fewer able-bodied adults (UN, 2002a). Half the female-headed households live below the poverty line compared with 44% of male-headed households (UNDP undatedc), and the severity of poverty was greater in female-headed households (UN, 2002a). Female-headed households also take on most of the care of the sick (WHO, 2003b).
At primary and junior secondary school female enrolment is generally slightly higher than male, but by the final school years and tertiary education males dominate (UN, 2002a). Although female literacy is generally higher, women remain comparatively under-employed and underpaid. In the year 2000, two-thirds of female farmers had no cattle while only one-third of male farmers had none; and the female farmers with cattle had six to the male farmers’ 20 (UNDP, 2000).
Females in Botswana have a higher HIV infection prevalence rate than males (NACA, 2005b). Data from the 2004 Botswana AIDS Impact Survey were used by others to estimate that there are 256,206 HIV-infected Batswana, made up of 98,423 males, and 157,783 females, between the ages of 15-49 (Smart, 2006): that is 1.6 times as many women as men.
Most men choose not to test for HIV status, even if their partners have tested positive.
Economy: Despite achieving the status of a middle income nation, poverty and unemployment remain widespread, and the development needs of Botswana are similar to those of the least developed countries: Diseases like HIV/AIDS, malaria and TB are rife; there is a severe shortage of skilled human resources; poverty is widespread, and the economy relies on the export of few commodities.
Botswana’s main economic sectors are small employers, and the wealth unevenly dispersed. A third or more of the population lives in poverty; around a quarter are unemployed.
The country is constrained by its small population (with markets too small to support employment creation of any scale), lack of employment diversity (disproportionate dependence on mining which is a low employer, and a climate not favourable to arable farming), high transport costs as a result of being land-locked, and a widely dispersed population making service provision costly and complex.
Health and HIV/AIDS: HIV/AIDS: Botswana has one of the highest HIV/AIDS prevalence rates in the world, with official Government figures quoting approximately 17% for the whole population (18 months plus) and around 25% for the adult population (15 to 49) (CSO, 2006). (Other organisations challenge these figures and put their estimates much higher, some approaching 40%.) Investment in public health in Botswana is being diverted to deal with the HIV/AIDS epidemic that threatens to cripple the nation.
BOPA (2006), 15 March 2006: Diarrhoea kills over 300, Daily News Online. Botswana Press Agency, Botswana. <https://www.gov.bw/cgi-bin/news.cgi?d=archive>
(Other articles referred to include:
08 September 2006: Residents complain of salty water
31 March 2006: Africa wants special attention
21 March 2006: 404 die of diarrhea)
CSO (2006) Stats Update – June 2006. Central Statistics Office, Botswana. <https://www.cso.gov.bw/html/statsup/Web-StatsupdateJune2006_2.pdf > (21 May 2006)
Connell Manthe & Partners Inc (1993) Report on the use of small bore sewers in association with anaerobic digestors, Randburg, South Africa
The Herald (2006) Zimbabwe: Sanitation Crucial in Fight Against HIV/AIDS. The Herald (Harare). May 8, 2006. <https://www.pronutrition.org/archive/200605/msg00036.php> (9 November 2006)
IFH (2003) Guidelines for Prevention of Infection and Cross-Infection in the Domestic Environment: Focus on Home Hygiene Issues in Developing Countries. International Scientific Forum on Home Hygiene, Intramed Communications s.r.l., Milan. Also available at <https://www.ifh-homehygiene.org/2003/2public/IFH-Guidelines%202002_last.pdf> (22 May 2006)
IRC (Kamminga, E and Wegelin-Schuringa, M) (2005) HIV/AIDS and Water, Sanitation and Hygiene. A series of Thematic Overview Papers, IRC International Water and Sanitation Centre. <https://www.irc.nl/page/3462> (11 May 2006) or <https://www.irc.nl/content/download/4199/48511/file/hivaids.pdf> (26 November 2006)
Kgalushi, R.; Smits, S. and Eales, K. (2004) People living with HIV/AIDS in a context of rural poverty: the importance of water and sanitation services and hygiene education: a case studyfrom Bolobedu (Limpopo Province, South Africa). The MVULA Trust and IRC. <https://www.irc.nl/page/10382> (24 May 2006)
Lombard & Associates (1989) Monitoring of Macgas unit digester effluent fifth sampling, Kloof, South Africa
MWA (2004) Quality of Life: Exploring the links between living with HIV/AIDS and safe water and sanitation. Millennium Water Alliance. <https://www.mwawater.org/pdf/MWA%20H2O%20HIV%20final%20404%20(2).pdf#search='water%20HIV'> (04 May 2006)
NACA (2005b) UNGASS 2005: 2005 Progress Report of the National Response to the UNGASS Declaration of Commitment on HIV/AIDS. National AIDS Coordinating Agency, Ministry of State President, Botswana. <https://www.unaids.org/unaids_resources/UNGASS/2005-Country-Progress-Reports/BOTSWANA_en.pdf> (19 November 2006)
Nata Village Blog (current). The Nata Village Blog, Nata AIDS and Orphan Trust. Found at <https://natavillage.typepad.com/> (02 November 2009)
Rivett-Carnac, J.L. (undated) An evaluation of the effectiveness of an anaerobic, non-flush, communal toilet system (biodigester), Institute of natural Resources, Pietermaritzburg, South Africa
Smart, T. (2006) HIV prevalence among young women in Botswana falls to lowest level since early 1990s, but stillhigh. Aidsmap news, Thursday, September 28, 2006. <https://www.aidsmap.com/en/news/F9AEAA98-D76B-49D0-BCE7-37B081FC2979.asp> (25 October 2006)
UN (2002a) Botswana Country Profile. Country profile prepared for the Johannesburg Summit 2002: the World Summit on Sustainable Development. <https://www.johannesburgsummit.org/html/prep_process/national_reports/botswana_natl_assess.doc> (29 March 2006)
UNDP (2000) UNDP Botswana Human Development Report 2000: towards an AIDS-free generation. United Nations Development Programme, Botswana. Also available at: <https://www.unbotswana.org.bw/undp/docs/undp_bhdp.pdf> (24 April 2006)
UNDP (undatedc) Poverty Reduction, Botswana. United Nations Development Programme, Botswana. <https://www.unbotswana.org.bw/undp/poverty.html> (24 May 2006)
WELL(van Wijk, C) (2003) HIV/AIDS and water supply, sanitation and hygiene (WELL Factsheet).WELL: Loughborough University, UK. Available at: <https://www.lboro.ac.uk/well/resources/fact-sheets/fact-sheets-htm/hiv-aids.htm> (25 February 2006)
WHO (2003b) WHO Country Cooperation Strategy: Botswana, 2003-2007. World Health Organization, Brazzaville. <https://www.who.int/countries/en/cooperation_strategy_bwa_en.pdf> (02 June 2006)
 An ‘erf’ is a southern African term for a small piece of land; in Nata a family will live on an erf which will generally be fenced, and have one or more shelters, typically made of mud or concrete blocks
 A Kgotla is both a public meeting place and the name for the meetings held there. Every village in Botswana has at least one Kgotla, usually under or around a large tree. The meetings are generally presided over by the Village Chief and/or the Village Development Committee.