Good sanitation includes appropriate health and hygiene promotion. This implies that proper health and hygiene promotion would have the desired effect as part of sanitation service delivery. However, lessons learnt worldwide show that in the promotion of health and hygiene, it is not enough simply to provide facilities, because if people do not use the available facilities properly, conditions do not improve or the system breaks down. The Ottawa charter (WHO, 1986) suggests that effective health and hygiene promotion require the empowerment of local communities, collaborative partnerships and a supportive national policy environment. Against this background, the focus of this study is the extent to which health and hygiene promotion forms part of sanitation delivery programmes to informal settlements in the City of Cape Town. The investigation is confined to a comparative review of approaches to health promotion in 4 case Study sites (Khayelitsha, Joe Slovo, Kayamandi and Imizamu Yetho) in respect of community and household capacity to take responsibility for community based programmes, role-players forming collaborative partnerships across departments and implementation of health and hygiene aligned with national policy. Analysis of the case Studies highlights the ineffectiveness of once-off awareness campaigns and the need for a more comprehensive approach to health and hygiene promotion in line with the Ottawa Charter.
