This is a methods case study that looks at photovoice as a method to improve participation. In this case study, photovoice is used as a participatory visual method in which participants had to use disposable cameras to capture their daily sanitation experiences.
Problems and Purpose
Photovoice is a participatory action research method that enables access to knowledge of vulnerable groups/participants who are usually excluded from research. The implementation of the photovoice method by the Politics and Urban Governance Research Group(PUG) sanitation project was to understand the lived sanitation experiences of some marginalized individuals in the BM Section informal settlements of Khayelitsha, through a visual presentation of their daily sanitation experiences. The photovoice aspect of the project aimed at determining whether the designs of Container-Based Sanitation (CBS) are inclusive or increase disparities within and between vulnerable groups and individuals. In this context, their aspect of vulnerability refers to people who are mostly marginalized in society, such as people living with disabilities, women, elderly people, homeless people, and children, who suffer the most from the consequences of structural violence. The purpose of using the photovoice method was to document, examine, and understand the lived experiences of accessing sanitation by some of the most marginalized residents in the BM Section of Khayelitsha, whilst also amplifying their voices to share what is most important to them regarding sanitation. The photovoice methodology allows a community (participants) to use photographs to document sanitation issues that are prevailing in the community or at an individual space, and then select an environment ( eg., focus groups, individual interviews, or a workshop) to discuss these matters, represent them and ultimately for social change.
Background History and Context
BM Section is an informal settlement located in one of the biggest townships in Khayelitsha, Cape Town. In this context, an informal settlement refers to residential areas where there are no permanent housing structures (houses are built with materials such as zinc sheets, cupboards, or timber). The township itself was established in the 1980s as part of the apartheid-segregated planning of Cape Town. The township was established as a formal area, but over time it expanded to a mixture of formal and informal housing settlements. Informal settlements in South Africa are regarded as illegal settlements, with security of tenure issues, and the BM Section is no exception. The lack of land tenure results in limited investments from the residents and the City of Cape Town, which impacts the provision of services such as sanitation.
The rapid migration of people to cities puts pressure on existing public infrastructure such as sanitation and people often opt for cheaper ways of accommodation and build informal settlements usually on the outskirts of the city. This leads to an increase in the demand for basic services such as housing, electricity, and water and sanitation facilities. The CoCT provides free water and sanitation services in all informal settlements in Cape Town. In the BM Section, the CoCT provides four types of free sanitation (see image 1): Portable Flush Toilets (PFT) the only form of private CBS, which are colloquially referred to as ‘pota-pota’, communal full flush toilets (sewer), shared chemical toilets (often referred as uMshengu), and shared container toilets (with a detachable 200-liter tank).
The introduction of Container-Based Sanitation by cities is aimed at creating more inclusive and sustainable sanitation for the urban poor. The World Bank Report defines CBS as, consisting of an end-to-end service that is provided along the whole sanitation service chain, excreta is collected in sealable, removable containers, where it is transported to semi-centralized facilities to be safely treated, disposed of, and reused. The Joint Monitoring Programme (JMP) recognizes Container Sanitation (CBS) as an improved sanitation solution. Container-based sanitation has been provided by Non-Governmental Organizations, such as Sanergy in Nairobi, Sanima in Lima Peru, and Soil in Cap-Haitien, and several city municipalities such as the City of Cape Town are adopting CBS as part of their CWIS approach . As much as CBS is seen as an improved sanitation solution for the urban poor or informal settlements, there is limited research on how users experience or engage with CBS in their day-to-day lives.
The Politics and Urban Governance Research Group (PUG) (www.pugresearch.org.za) has been working on a global comparative study called ‘Scaling Up Off-Grid Sanitation’ (SOS) to understand the lived experiences of accessing sanitation in informal settlements. The SOS project focuses on container-based sanitation (CBS) as an emerging off-grid sanitation option across four city contexts Cap Haitien (Haiti), Lima (Peru), Nairobi (Kenya), and Cape Town (South Africa ).CBS provides a unique living experiment and their research sought to understand how off-grid services might be scaled up, managed, and regulated. In trying to understand how ordinary people in informal settlements engage with CBS in their daily lives, the SOS project initially used three primary data collection methods, an open data kit (ODK) survey, interviews (for the political economy insights of the research), and the photovoice method. The ODK survey is quantitative and focuses on the daily tasks respondents undertake with regard to day-to-day tasks of Container-Based Sanitation (CBS) users and non-users, while interviews have focused on the political economy analysis of CBS, not individual lived experience.
A point of concern for the SOS project was the inclusiveness of CBS for vulnerable residents, whether the designs of CBS were inclusive or increased disparities within and between vulnerable groups or individuals, and the other two methods (ODK and PEA interviews) did not fully address this. The photovoice method was initiated to understand the lived experience of accessing CBS by some of the vulnerable groups in the BM Section. The photovoice methodology enabled participants to visually reflect on their lived sanitation experiences in the BM Section or their households.
Image 1: Map of the BM Section and the four different types of toilets provided in the BM Section. Credits; Dr Mmeli Dube(PUG Researcher )
Organizing, Supporting, and Funding Entities
The photovoice research was funded by the Politics and Urban Governance Research at the University of the Western Cape Group(www.pugresearch.org.za). This group was funded by the SOS project which was funded by the UK’s Global Challenges Research Fund (GCRF), grant number (ES/T007877/1).
Participant Recruitment and Selection
The participant recruitment and selection process started in early January 2023. The initial timeline for the photovoice project, the taking of photos, selection, and captioning, and discussion of the photos with respondents was for it to run for three months. The initial plan of the project was to recruit 10 -15 participants along axes of vulnerability such as, e.g., gender, (dis)ability, income, class, religion, and ethnicity in the BM Section. The project already had 100 participants participating in their ongoing ODK survey within their current research area of the BM Section in Khayelitsha. Given the sensitive nature of the study, the photovoice research purposively sampled more than 20 participants along with vulnerabilities such as gender, (dis)ability, income, class, religion, and ethnicity. The participants were both female and male participants and they were also CBS users and non-users, a CBS ‘user’ refers to an individual who uses Portable Flush Toilets (PFT ), and a ‘non-user’ is someone who uses shared facilities, such as the chemical toilets, full flush toilets, and container toilets (a form of CBS).
Some of the participants who were already participating in the ODK survey were identified through the demographics section of the survey. The demographic section of the survey encompasses information about their demographics (age, gender, employment, race, sex, and income). Some of the selected participants for the photovoice project fall outside the ODK survey but they still live in the BM section. The selected ODK participants had to also identify individuals with vulnerabilities within their households, potentially with disabilities. The researchers identified participants beyond the ODK survey data in the BM community, who were affected by a shock (floods, fire outbreaks, retrenchments, or a life-changing situation). The participants were purposively selected because the study aims to investigate the lived experiences of sanitation along many axes of vulnerability, for example, gender, (dis)ability, income, class, religion, and ethnicity. Unlike the ODK survey and interview participants who were selected based on the location of their residence, photovoice participants were purposively selected with attention to different forms of vulnerability that have the potential to be most marginalizing.
After the recruitment and selection process through ODK survey data and identifying participants outside the ODK survey. The PUG sanitation research team reached out to the participants via a phone call or sent a text message to inform them about the project and to whether they were interested in participating in the photovoice project. During the phone calls, they were informed that the project involved taking photographs within their households and discussing how their vulnerabilities impact their use of CBS services. Out of more than 20 identified participants, only 15 participants (9 females and 6 males) consented to participate in the project. There was limited compensation in this study. Participants were given R50 per week (period of four weeks) to cover data and other costs associated with the study.
Methods and Tools Used
The research used Photovoice, as a visual participatory technique. Photovoice is a Participatory Reflection and Action method that encourages participants to lead the research process as they visually narrate and represent their everyday experiences . Photovoice is a research method in which individuals take photographs to document their lived experiences, and it has been used by several researchers working in the field of sanitation. The photographs are then used as probes for discussion between participants and researchers. Photovoice is a method widely thought to deepen researchers’ understanding of the lived experience.
What Went On: Process, Interaction, and Participation
The notion of participation in photovoice refers to the engagement of participants in a democratic knowledge-production process. For this section of the case study, data emerged from the photovoice training, photovoice caption and selection of pictures, and individual interviews with participants. There were three consecutive photovoice rounds during the data generation period.
Training of participants
After participants were selected, in February 2023, PUG researchers held a 4-hour training workshop to introduce the photovoice methodology and discuss the research questions with the selected participants. Out of 15 selected participants for the photovoice research, only 14 participants participated in the photovoice training workshop. In the first part of the meeting, the researchers presented a brief overview of the photovoice project and its objectives for social enhancement in their community. Participants were issued with consent forms and ethics information sheets (including information on how their privacy will be protected ) researchers explained the consent forms and the information sheet to the participants. During the training workshop, researchers explained what is expected from them or their roles as participants in the research process, that their roles in the project include taking pictures of their sanitation experiences and then discussing the selected pictures with the researchers privately. The research team neither attempted to influence nor to define themes that might emerge from the photos, rather they had a discussion with the participants to prompt ideas of what might be captured through photos. The participants were encouraged to lead the research process as they were expected to visually narrate their everyday encounters with sanitation services within their places of settlement.
The Dollie House Productions (a service provider with experience in photovoice research), facilitated the training process. The training workshop was guided by a training curriculum from Dollie House Productions. The training curriculum offered by the Dollie House included training participants in photography and ethical issues related to the privacy, anonymity, and confidentiality of research participants (refer to image 2). Participants along with researchers were provided training on the photovoice data collection process. Researchers were in constant communication with the participants throughout the workshop, to ensure compliance with such principles and to assist when participants have questions. In terms of technology, the participants were issued with disposable cameras that were not difficult to use. The disposable cameras have 39 shots per camera and are usable in dark spaces.
In the second part of the workshop, the participants were given a practical training test on how to use disposable cameras in enclosed spaces since they had to take pictures sometimes inside their homes. The practical session of the workshop started with a casual conversation among participants about the prevailing conditions at BM- Section that affect their daily encounters with sanitation services, the use of alternative sanitation practices (plastics known as flying toilets, and buckets ), and their security concerns when using communal toilets in BM, especially at night, the stench from blocked drains and unsupervised communal / container toilets emerged during the conversation. This discussion demonstrated that participants were aware of the sanitation challenges happening in their community and they already had an understanding of what kind of pictures were expected from them. After the training participants were given four days for the initial photo-taking period. The research team worked with participants to ensure everyone was comfortable with using their cameras. Participants with disabilities were assisted by their family members for photo taking (they were also required to attend the training session) or participants from the research project. Participants were issued journals to record comments when they were doing the photography.
Image 2: Training content by the Dollie House Production.
Image 3: Photovoice training session, the discussion among participants, and the practical training test.
Captioning and selection of images
A key component of photovoice is the sharing of photographs to initiate a critical dialogue, as photovoice prioritizes the interpretation of photographs more than the actual photographs themselves. After the initial photo-taking period, PUG researchers held a captioning and selection workshop in Isivivine Hall, in Khayelitsha. The session was facilitated by the service provider ‘The Dollie House Production’ which specializes in photovoice work and has also worked on similar projects. The team of researchers reviewed the images with the participants to narrow them down to the images needed for the project, this was also done in consultation with the Dollie House. In this session, participants had to select approximately 5 pictures that best described the sanitation situation in their households or communities. During the session participants individually shared their pictures with corresponding stories with the group in an effort to situate the content of the photographs in their own experience. Photographs were projected onto a large screen for shared visibility. Participants who were absent during the photo selection and captioning workshop were sent their images via WhatsApp and the researchers asked them to select their images and then describe what is happening in the photographs. The researchers scheduled individual interviews with the participants to discuss the selected photographs.
Photovoice prioritizes the interpretation of images more than the images themselves.To have an in-depth understanding of their lived experience of accessing sanitation, PUG researchers scheduled individual interviews with participants. The interviews were conducted in person preferably in their homes in BM Section. The individual interviews were conducted for two days, a day after the selection and captioning of photos workshop. The researchers reshared the selected printed photographs with captions with the participants and triggered the conversation using an interview guide. The purpose of the individual interviews was to capture a detailed conversation about the pictures the participants had chosen, as some details might have been omitted during the selection and captioning of pictures process. The interviews were conducted in IsiXhosa(the participants' home language) as it is the only language the respondents were familiar with. During the interviews, participants were probed for more information or explanations about the photographs they had chosen that describe their sanitation situation.
During the interviews, participants went beyond sharing their sanitation experiences, they expressed their expectations from the project. What they hope the project will bring to thier community.
“ I was interested in taking this picture because our project is about toilets. There might be a difference if I can report this matter on this project, and show the conditions we live in and situations around toilets because we are the same as those who don't have toilets. We don't have toilets. I am interested in showing that here is the proof, not just saying it verbally but showing the proof that our toilets are blocked and we are using one toilet.” (Participant 12 )
Another participant shared that they hoped the photovoice project could create a space or facilitate a dialogue where they could connect with the City of Cape Town to talk about the sanitation situation in informal settlements.
“I will be glad if you invite them and say here is the research we have done, have your say, and then we will give the residents of BM a chance to have their say about what they are experiencing. You will tell them that these photos were not taken by you they were taken by people who are experiencing these conditions” ( Participant 11).
Influence, Outcomes, and Effects
This study's ethical clearance was granted by the University’s Humanities and Social Sciences Research Ethics Committee (HSSREC) in 2023 to conduct photovoice research at the BM Section. All the data, photos, and information used in this section were consented to by the participants, and the researcher was given permission to use the pictures.
Results (Intended Results from the Initiative)
The attractiveness of photovoice is the use of images and written captions as a way of collecting narratives of people's lives. The photovoice method was perfectly suited to capture their lived experiences of accessing sanitation in their communities and also within their households. Out of 15 recruited participants only 13 participants, participated in the photo-taking process and also in the individual interviews. Photovoice promotes collective critical consciousness and empowerment through dialogue and representation, mobilizing and inspiring participants into social activism that can improve their lives. Freire’s argument has been well established in the case study, Freire believed that through a collective process of introspection, reflection, and discussion of images, communities would be able to uncover social and political constructions that shape their marginalization. There were moments of knowledge creation and consciousness during the photovoice process, during the interviews, participants reflected on the photo-taking activity; The photo-taking process contributed to the change of perspective while taking photographs. Pertaining to the change of perspective while taking pictures, participants emphasized that the camera lens allowed them to discover sanitation issues in their community.
“When I was taking the photos, it wasn't pleasant because you go around and look at all the places and you look at them because some things you see are far away. Now I'm taking a photo. That's where I saw and realized a lot of pain and people's safety that doesn't exist and dirt. That's where I saw that people’s health is at risk. Because some things you see are far away when someone tells you that there is something there, you don't even get close now, I had to get close and see it”.
“From my side, it is exciting because talking about what you are experiencing in these photos on a daily basis. So, this is what we are showing you and fortunately, you do not experience it if you stay far away. We are photographing something that you should know and also have a picture of BM, know the situation here and also for someone who does not live here to see it”
Another aspect that was discussed by the participants during the interview process was the power of the project to have an influence on the community. “After I took this picture, one person came and asked me why I was taking the picture. I said that I was doing research on access to toilets, then a few days after I took the picture the toilet was fixed.”
empowerment through photography
Photography is particularly suited for capturing the physical environment and the results from the research reflected this. Participants captured their sanitation experiences using the disposable cameras, and later the disposable cameras were sent to the service provider for the production of images. The most important component of photovoice is the interpretation of images by participants and this is related to the co-construction of meaning. The photographs produced by the participants serve as a foundation for reflective discussions in which emerging interpretations are elaborated on by the participants. The images prompted different kinds of reflection on their lived sanitation experiences. Most participants captured the physical nature of their sanitation facilities and attached meaning to their images.
“This is my favorite picture. Here in this picture is the Mshengu (Chemical Toilet) that was positioned wrong, its level was not right, when you enter it, you will find it to be unstable and it is tilting.”
Image 4: Picture by a Photovoice participant with a Caption
Photovoice was also a powerful mechanism for depicting a range of risks (such as security and health) associated with the use of both shared and individual toilet facilities. In the photos, participants took pictures of the shared toilets and the unhygienic conditions of the toilets which expose females to infections.
“This toilet is blocked because most toilets in the abortion (Ablution) blocks are not working, someone might have used the toilet when it is already blocked”
Image 5; Picture by a Photovoice participant with a Caption
Dissemination of findings
The notion of dissemination of findings draws attention to the notion of “giving participants a voice”.Giving voice requires sound research to be conducted, producing reliable, and valid research findings that all stakeholders involved in the research can share. These considerations bring to attention who findings will be shared with, what findings will be shared with the audience, and in what ways will the findings be shared. The rest of the findings from the photovoice research will be disseminated through many channels such as the anticipated photovoice exhibition, policy briefs, and also publishing of academic papers, and a Masters research thesis.
Photo exhibition: The PUG SOS project aims to have a photovoice exhibition towards the end of the year(16 November 2023) as part of the dissemination of findings. The exhibition is a key part of the dissemination of findings from the SOS research project. The participants and researchers were formally trained to undertake Photovoice by Dollie House, a specialist in this field. The respondents who took the photographs will co-facilitate the exhibition with the researchers. The exhibition will thus facilitate the dissemination of data regarding the impact of CBS on some of the vulnerable individuals and groups in informal settlements like the BM section. Photovoice data will enable participants (residents of informal settlements) to use visual evidence to recognize and voice their problems and potential solutions to policymakers. Academics, students, civil society actors such as CBS advocates, the City of Cape Town officials, and Councilors (policymakers), among others, will be the target audience. Evidence also suggests that photovoice exhibitions are empowering to participants who often lack opportunities to have their voices heard elsewhere.
Research: Research has been conducted, participants went to their communities and captured their lived sanitation experiences. The photos have been produced with their captions and the researcher conducted interviews with the participants to get an in-depth knowledge of the photos. Now the researchers are working on two publications for the entire photovoice project.
Social Change: There has not been any known improvement in the sanitation situation at the BM Section. The findings from the photovoice research resulted in a collaboration between PUG and the City of Cape Town. Researchers from the SOS project are working with the City of Cape to find ways in which technology can be a feasible form of communication where residents from the BM Section ( which is the primary targeted location) can report any sanitation-related issues through the app's information systems.
Analysis and Lessons Learned
Photovoice as a participatory action research method is theoretically underpinned by the principles of photography, critical pedagogy (empowerment education by Freire), and questions inspired by feminism. These theoretical frameworks of photovoice need to be applied in order for the photovoice process to be implemented effectively and ethically. The PUG photovoice project enabled a space where participants could freely reflect on thier sanitation challenges through visual representation(photography). The participants were fully aware of the research process from the beginning, researchers informed the participants about the research process and they were issued an information sheet that stipulated the intentions of the project and their roles as participants. Considering the information above is evident that PUG researchers considered all the necessary theoretical framings of the photovoice methodology throughout the research.
Throughout the research process, participants felt empowered to share their experiences and actively participated in the entire photovoice process. Reflective photography is an important aspect of both photovoice and the education empowerment theory. Through reflective photography, empowerment education kickstarted, and participants were able to attach meaning to their pictures through a series of dialogues between the researcher and the participants. In his empowerment education theory, Freire believed that through a collective process of reflection, thoughtfulness, and discussion of pictures, communities will be able to unfold social and political constructions that perpetuate their marginalization. Through going around in the community and capturing sanitation issues, participants became aware of larger social issues surrounding access to sanitation services in BM Section.
The notion of including “participants' voices” in policy dialogues sits literally and figuratively at the heart of the photovoice approach. Wang (2003) elaborates that by using self-produced image exhibitions, photovoice can be used to influence how a community’s public presence is redefined and how social issues are understood and responded to. In this approach, participants are seen as the experts in communities, because they know the challenges happening in the community and what kind of interventions are needed. The dissemination of findings from the photovoice project conducted by PUG serves as part of giving voice to the participants.
The research did not capture the individual experiences of the participants involved in the photovoice project. These are the shortcomings that should be considered when conducting a photovoice research project, there should be a part where participants reflect individually on the project, and whether the entire process was insightful and helpful to them. PUG researchers should conduct additional research(follow-up interviews) on the individual's experience (participants ) during the photovoice project. The insights from the research will be very helpful in providing more in-depth knowledge about how the participants felt during the photovoice research.
Dube, M., Anciano, F. and Mdee, A., 2023. The Illusion of the Container-Based Sanitation Solution: Lessons from Khayelitsha, South Africa. Water Alternatives, 16(3), pp.849-868.
Bhakta, A., Fisher, J. And Reed, B., 2019. Unveiling hidden knowledge: discovering the hygiene needs of perimenopausal women. International Development Planning Review, 41
Dube, M., Anciano, F. and Mdee, A., 2023. The Illusion of the Container-Based Sanitation Solution: Lessons from Khayelitsha, South Africa. Water Alternatives, 16(3), pp.849-868.
Freire, P., 1970. Cultural action for freedom (pp. 476-521). Harvard Educational Review.
Liebenberg, L., 2018. Thinking critically about photovoice: Achieving empowerment and social change. International Journal of Qualitative Methods, 17(1), p.1609406918757631.
Wang, C., & Burris, M. A. (1997). Photovoice: Concept, methodology, and use for participatory needs assessment. Health education & behavior, 24(3), 369-387.
Sutton-Brown, C.A., 2014. Photovoice: A methodological guide. Photography and Culture, 7(2), pp.169-185.
Plunkett, R., Leipert, B. D., & Ray, S. L. (2013). Unspoken phenomena: Using the photovoice method to enrich phenomenological inquiry. Nursing Inquiry, 20(2), 156-164.
- Image 1: Dr Mmeli Dube, (2023)UWC Research week PowerPoint slides
- Image 2; Lindokuhle Mabaso(2023) ; Powerpoint presentation.
- Image 3; Lindokuhle Mabaso(2023) ; Powerpoint presentation.
- Image 3&4 ; Photovoice participants;
The project is still in its earliest stages, there is no coverage on whether the findings from the project contributed to social change or influenced any policy. Researchers from the project are working towards this by collaborating with the City of Cape Town. An additional article will be uploaded once there are changes in policy or in BM Section.