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WHO strengthens focus on water, sanitation and hygiene to accelerate elimination of neglected tropical diseases

28 August 2015 11:32 (America/New_York)

August 27, 2015 –  WHO strengthens focus on water, sanitation and hygiene to accelerate elimination of neglected tropical diseases | Source: World Health Organization

27 August 2015 –– The World Health Organization (WHO) today unveiled a global plan to better integrate water, sanitation and hygiene (WASH) services with four other public health interventions to accelerate progress in eliminating and eradicating neglected tropical diseases (NTDs) by 2020.

International Trachoma Initiative (ITI)

“Millions suffer from devastating WASH-related neglected tropical diseases – such as soil-transmitted helminthiasis, guinea-worm disease, trachoma and schistosomiasis – all of which affect mainly children” said Dr Maria Neira, WHO Director for Public Health, Environmental and Social Determinants of Health. “Solutions exist, such as access to safe water, managing human excreta, improving hygiene, and enhancing targeted environmental management. Such improvements not only lead to improved health, but also reduce poverty.”

Related links

Targeted water and sanitation interventions are expected to bolster ongoing efforts in tackling 16 out of the 17 NTDs, which affect more than 1 billion of the world’s poorest and most vulnerable populations.

A recent report showed that in 2015 more than 660 million people did not have access to improved water sources. The WHO/UNICEF Joint Monitoring Programme for Water Supply and Sanitation report also showed that almost 2.5 billion people lacked access to improved sanitation. Open defecation and lack of hygiene are also an important risk factors for the transmission of many NTDs. Over half a million lives are lost each year as a result of NTDs.

“Joint planning, resourcing and delivery of WASH interventions are key to eliminating neglected tropical diseases and in achieving many public health and human development goals” said Dr Dirk Engels, Director of the Department of Control of Neglected Tropical Diseases. “The benefits are enormous – from alleviation of suffering through improved outcomes to healthier, wealthier and happier families, communities and nations.”

Filed under: Uncategorized Tagged: neglected tropical diseases

Sept 23, 2015 – Creativity in Behavior Change Symposium

28 August 2015 10:57 (America/New_York)

Whether it be washing hands with soap, driving sanitation demand, or purifying water, almost every area of public health requires behaviour change. The field of behaviour change is transforming.

There is a growing evidence base to suggest that traditional health education messages are insufficient to achieve sustained change and that more might be achieved by being more creative, for example by learning from product marketing, psychology and behavioural economics. 

The ‘Creativity in Behaviour Change Symposium‘ will bring together behaviour change practitioners from academia, government and the private sector with the ambition of sparking an ongoing network of collaborators.

In addition to creative case studies and provocative discussions the event will feature interactive activities throughout the day, a ‘behaviour change cinema’ which will screen materials from creative projects from around the globe and there will be a ‘soap box’ where anyone can share their big ideas for the future of behaviour change.

For those who are not in the UK, all the sessions will also be filmed and available on our website at

Filed under: Hygiene Promotion Tagged: behavior change, handwashing

WASHplus Weekly: Focus on WASH & Innovation

28 August 2015 10:16 (America/New_York)

Issue 204 | August 28, 2015 | Focus on WASH & Innovation

This issue features some of the many innovative water supply, sanitation, and hygiene (WASH) programs, products, and services that are currently underway. Please contact WASHplus if you have other innovative resources that we can include in a future issue on innovation. Included are resources from WASHplus, the Global Public-Private Partnership for Handwashing, USAID, DFID, and others. Also included are recent videos on sanitation in floating communities, information on Shit Flow Diagrams, the SlingShot water purification system, sanitation innovation through design, and innovative financing methods.


Breaking the Cycle: Small Doable Actions in WASH to Improve Child Health. J Rosenbaum, WASHplus; FHI 360. Video
WASHplus’s Julia Rosenbaum discusses the power of small doable actions in WASH programs. This approach to behavior change encourages households to adopt feasible actions and enabling technologies to move them toward ideal hygiene and sanitation practices.

Handwashing and the Science of Habit Webinar, 2015. Webinar
USAID/WASHplus and the PPPHW co-hosted a webinar with David Neal, Ph.D., from Catalyst Behavior Sciences and the University of Miami. In this webinar, Dr. Neal emphasized ways to apply the basic science of habit and behavior change to real world health interventions and program delivery, with a focus on behavior change for handwashing with soap.

USAID Development Innovation Ventures (DIV). Website | Ensuring Access to Safe Water
DIV is an open competition supporting breakthrough solutions to the world’s most intractable development challenges—interventions that could change millions of lives at a fraction of the usual cost. The Ensuring Access to Safe Water section of the DIV website has summaries of three projects: Bringing Safe Water to Scale, Monitoring Clean Drinking Water through Technology and Open Data, and Making Water Filtration Affordable for Kenyan Households.


Financing for Development: Innovative Financial Mechanisms for the Post-2015 Agenda. World Water Week 2015. Video
This session discusses how to generate an enabling environment and targets questions such as: What innovative financing mechanisms must be developed to achieve the water-related Sustainable Development Goals? What are the existing strategies already addressing this issue? What can we learn from other sectors and regions?

Vote for Your Favorite Water Idea, 2015. Link
As part of World Water Week 2015, people can vote for one of ten innovative ways to conserve and manage water resources.


Can Innovation Prizes Help Address Water and Sanitation Challenges? 2015. S Trémolet. Link
This paper helps identify how innovation prizes can be used to address intractable issues in the WASH sector. It also presents a number of areas where innovation prizes could be used to either trigger genuine innovation or promote scaling up of existing innovations in the WASH sector.

Can Innovation Prizes Help Address Water and Sanitation Challenges? 2015. Video
Ideas to Impact WASH Theme Leader Sophie Trémolet introduces the WASH prize concept. The Ideas to Impact program  has developed a four stage guide to assess whether and how prizes will be effective in particular contexts. Using this guide as a framework, we undertook a broad review of the WASH sector to identify unresolved challenges that could potentially be overcome with the help of innovation prizes.

Case Study: Innovation in Water, Sanitation and Hygiene, 2015. H Rush, DFID. Link
To help us understand the WASH innovation ecosystem, we use two main conceptual frameworks. The first is an idealized model of the system dynamics of innovation, identifying the different stages and activities typically involved in innovation (recognition of need, generation of new ideas, creation of plausible inventions and solutions, development and implementation of potential innovations, and diffusion of innovations). The second, which we refer to as the Rs framework, seeks to uncover the detailed factors influencing how this system operates using the following headings: resources, roles, relationships, rules, routines, and results.


Introducing Sanitation in Floating Communities, 2015. Video
Wetlands Work! Ltd. has created the HandyPod that addresses wastewater treatment for individual houses in floating communities in Cambodia and elsewhere.

“SlingShot”: How an Innovation Mindset Can Change the World. Getting Smart, July 2015. B Lathram. Video
The award-winning film “SlingShot” focuses on Dean Kamen and his work to solve the world’s water crisis. Kamen invented the Segway, and and his latest passion is the SlingShot water purification system, created to obliterate half of human illnesses on the planet.

The Need for Urgent Innovation in WASH, 2015. Video
In this TEDx Talk Konda Vishweshwar Reddy shares his experiences with some of the best innovations in the WASH field. However, he found that most innovative designs had some local or cultural constraints.

Innovation in Urban Sanitation: FaME and U-ACT Research in Sub-Saharan Africa, 2015. SANDEC EAWAG. Video
In sub-Saharan Africa sanitation needs of the majority of the urban population are met by onsite sanitation technologies. These technologies can provide sustainable and more affordable sanitation compared to sewer-based systems. The FaME (Faecal Management Enterprises project researched innovative solutions to increase access to sustainable sanitation services.

Jasmine Burton – Innovation to Sanitation through Empathic Design, 2015. Video.
Driven by a passion for serving others, Jasmine Burton not only sought a path to an education, but also a path to becoming a humanitarian for developing nations. Through the social impact organization, Wish for Wash, Jasmine is bringing innovation to sanitation through empathic design. In 2014, she and Team Sanivation won the GT InVenture Prize for their innovative and affordable mobile toilet product design, SafiChoo.

Bindeshwar Pathak – Technological Innovations Made the Difference in the Lives of Untouchables, 2015. Video
Dr. Pathak, sanitation crusader, has contributed to solving problems of open defecation and removing the inhuman practice of manual scavenging associated with untouchability by inventing appropriate, affordable technology for household toilets with minimum water use that dispenses with manual scavenging. He maintains 8,000 self-sustaining “pay and use”based public toilets and was awarded the Padma Bhushan and Stockholm Water Prize for his work.

US Envoy Applauds Sulabh’s Innovative Efforts to Improve Sanitation, 2015. Video
US Ambassador to India Richard Verma visits the headquarters of Sulabh International to witness the award-winning organization’s innovative sanitation and behavior change work.


Shit Flow Diagrams (SFDs) Website. Link
SFDs are a new way of visualizing excreta management in cities and towns. SFDs show how excreta is or is not contained as it moves from defecation to disposal or end-use, and the fate of all excreta generated. An accompanying report describes the service delivery context of the city or town.

SFD (Shit Flow Diagram) Promotion Initiative. Link
This library entry contains background documents and results for a grant which is funded by the Bill and Melinda Gates Foundation and led by Arne Panesar.

World Design Impact Prize 2015-2016. Website
The World Design Impact Prize recognizes and encourages industrial design-driven projects that benefit society and reflect the expanded field of industrial design. Nominated projects in the WASH sector include:

  • Happy Tap – The HappyTap is the first ever mass-produced handwashing device that is not only affordable but children love to use.
  • eSOS Smart Toilet – The eSOS smart toilet is in the heart of the novel eSOS (emergency Sanitation Operation System) concept that offers sustainable, innovative, holistic, and cost-effective sanitation solutions for emergencies.
  • Warka Water – Warka Water is an alternative water source designed to serve rural populations located in isolated regions where conventional pipelines and infrastructure will never reach and where water is not available from wells.
  • Sanir Community Sanitation Centres – The Sanir Community Sanitation Centres  and Water Diverting Toilets try to answer this challenge especially for densely populated informal settlements. CSC toilet waste is dried, converted to syngas, and fed into a fuel cell.
  • LifeStraw® Community – LifeStraw® Community is a high-volume water purifier with built-in safe storage that converts microbiologically contaminated water into safe drinking water.

Five Innovative Projects Promoting Menstrual Hygiene Around the World. Positive News, Aug 2015. Link
Menstrual hygiene continues to be one of the most pressing issues facing women in developing countries. Here, Thorsten Kiefer looks at five innovative program around the globe that aim to raise awareness.

An Innovative Solution to Menstrual Hygiene in Developing Countries. Fastcodesign, Aug 2015. M Miller. Link
Flo is a kit for washing, drying, and storing sanitary pads. It includes a detachable device used for spinning the pad dry and hanging it up in privacy, as well as a pouch for transporting.

Could This “Drinkable Book” Provide Clean Water to the Developing World?Smithsonian Magazine, Aug 2015. K Nodjimbadem. Link to article | Link to The Drinkable Book |
The Drinkable Book’s pages are infused with bacteria-killing silver nanoparticles and is a patent-pending water purification system.  Silver nanoparticles release silver ions, which render disease-causing microbes that get near them inactive, explains John Tobiason, professor of environmental engineering at the University of Massachusetts Amherst.

Filed under: Uncategorized Tagged: innovation

The role of mobile in improved sanitation access

26 August 2015 11:34 (America/New_York)

How can mobile channels can support sanitation service delivery while building new engagement models with customers in underserved settings? A new report [1] by the GSMA Mobile for Development Utilities Programme reviews opportunities and case studies.

The report begins with an overview of global sanitation access in 2015 and the different approaches currently being used to improve access. This is followed by a review of the potential uses of mobile channels in the sanitation value chain including examples of current applications.

Source: Nique, M. & Smertnik, H., 2015. The role of mobile in improved sanitation access. GSMA Mobile for Development Utilities Programme

The report concludes with recommendations for future work: a better understanding of the role and impact of mobile in the sanitation sector; a collaborative approach to mobile technology integration; grant support for developing and piloting innovative solutions; and rigorous monitoring and evaluation of the impact of these innovations in the service delivery.

An annex provides three short case studies on sanitation organisations currently using mobile tools in their service delivery model:

  • SOIL, Haiti – mobile customer relationship management (CRM) platforms and mobile customer payments
  • X-Runner, Peru – mobile CRM platforms and mobile for logistic solutions
  • IDE Cambodia – mobile CRM and supply chain management (SCM) platforms for local entrepreneurs

[1] Nique, M. & Smertnik, H., 2015. The role of mobile in improved sanitation access. London, UK: GSMA Mobile for Development Utilities Programme. 30 p. : 8 fig., 1 tab. Available at:

GSMA is an association of mobile operators and related companies. The GSMA Mobile for Development Utilities Programme aims to improve access
to basic energy, water and sanitation services in underserved
communities using mobile technology and infrastructure.  The Programme receives support from the UK Department for International Development.

In October 2014, the GSMA and DFID announced an additional £6M in funding for the 2nd phase of the Mobile for Development Utilities Programme. This includes a £3.2M innovation fund. So far  two grants were awarded to sanitation organisations:

  • Loowatt in Madagascar to develop and test an ICT platform and mobile application to improve the coordination of waste collection logistics and customer service associated to their waterless toilets for households in an urban area of Antananarivo;
  • Sanergy in Kenya, in partnership with SweetSense, to develop and test the use of sensors to determine the fill levels of Fresh Life Toilets, operator-owned waterless toilets designed for informal settlements.

Filed under: Funding, Publications Tagged: GSMA Mobile for Development Utilities Programme, IDE Cambodia, mobile phones, SOIL, X-Runner

Now available on WSUP-website for free download: masters-level professional training module “Water and Sanitation for Urban Low-Income Communities”

25 August 2015 12:28 (America/New_York)

WSUP/WEDC have developed a teaching resource on urban WASH that is now available online for free, It aims at helping the urban WASH sector to professionalize. We hope it will be for academics and practitioners to use or adapt if they feel it can be of value to them.

In short: this is a masters-level professional training module called “Water and Sanitation for Urban Low-Income Communities”. It was primarily designed to give engineering masters students in low-income countries an overview of things they need to know in order to apply their technical skills in low-income communities, and that’s how WSUP and WEDC are currently using it, in partnership with universities in Africa and Asia. But of course it may be adaptable to other teaching contexts.

It’s designed for classroom delivery, over about 45 hours of contact time. It’s made up of 16 thematic units, and within each unit the materials essentially comprise a Powerpoint presentation plus Lecturer Notes outlining the unit’s aims and content, and providing guidance on how to deliver the class. Some units are flexible in content, to enable adaptation to local contexts.

It can be delivered as an off-the shelf package; or you might want to cut-and-paste parts of it into your own materials; or you might simply use it as guidance in developing other materials.

It’s absolutely free to download, but we do ask that you fill in a brief Use Request Form explaining who you are and how you might use it: evidently, it’s useful for us to be able to communicate this to the funder of the work (DFID).


For information, we expect to have a French-language version available within the next few months.

The module was developed by (alphabetical order): Louise Medland, Guy Norman, Brian Reed, Pippa Scott, Regine Skarubowiz, and Ian Smout; inputs also came from Richard Franceys and Valentina Zuin.

Filed under: Africa, East Asia & Pacific, Education & training, Europe & Central Asia, Latin America & Caribbean, Middle East & North Africa, Sanitation and Health, South Asia, Water Supply Access Tagged: urban sanitation, urban water and sanitation

The disgust box: a novel approach to illustrate water contamination with feces

24 August 2015 9:34 (America/New_York)

Below are links to 5 Aug 2015 studies on digust, handwashing and maternal mortality, handwashing and NTDs, water quality awareness and breastfeeding and household characteristics and diarrhea.

The disgust box: a novel approach to illustrate water contamination with feces. Health & Science Bulletin, June 2015.


Inadequate drinking water, sanitation and hand hygiene are responsible for approximately 800,000 deaths per year in low and middle-income countries. We evaluated the benefits of a behaviour change communication method to motivate water treatment practices in urban low income communities in Dhaka. We used a device called the ‘Disgust Box’ to provide a vivid demonstration of how piped water is contaminated with faeces to motivate people to chlorinate water. Most of the respondents were able to recall the demonstration at both four-month and one year qualitative assessments. At four months, the majority of participants stated that they still felt disgusted by the demonstration and mentioned it as a motivator for water chlorination. However, after one year, despite being able to recall the demonstration, disgust was no longer mentioned as a motivator to chlorinate water. The Disgust Box has the potential to be an effective communication method to motivate water treatment but additional research is necessary to establish a more sustainable approach to reinforce behaviour change.

Using Observational Data to Estimate the Effect of Hand Washing and Clean Delivery Kit Use by Birth Attendants on Maternal Deaths after Home Deliveries in Rural Bangladesh, India and Nepal. PLoS One, Aug 2015. Authors: Nadine Seward, et al.


Our evidence suggests that hand washing in delivery is critical for maternal survival among home deliveries in rural South Asia, although the exact magnitude of this effect is uncertain due to inherent biases associated with observational data from low resource settings. Our findings indicating kit use does not improve maternal survival, suggests that the soap is not being used in all instances that kit use is being reported.

Assessment of water, sanitation, and hygiene practices and associated factors in a Buruli ulcer endemic district in Benin (West Africa). BMC Public Health, Aug 2015.


BU is an important conditions in the district of Lalo with 917 new cases detected from 2006 to 2012. More than 49 % of the household surveyed used unimproved water sources for their daily needs. Only 8.7 % of the investigated household had improved sanitation facilities at home and 9.7 % had improved hygiene behavior. The type of housing as an indicator of the socioeconomic status, the permanent availability of soap and improved hygiene practices were identified as the main factors positively associated with improved sanitation status.

Country characteristics and acute diarrhea in children from developing nations: a multilevel study. BMC Public Health, Aug 2015. Authors: Ángela María Pinzón-Rondón, et al.


The household characteristics associated with diarrhea in this study were as follows. (1) Number of household members: This was associated with diarrhea on bivariate correlation but not on the multivariable model, probably due to other household conditions included in the present study that may be associated with overcrowding. (2) Type of residence: Bivariate correlation showed that children from rural areas were more likely to present with diarrhea, as described previously in the literature [36]. This association disappeared on multivariable models, probably due to the introduction of household wealth in the multivariable models. (3) Nuclear families: Children from nuclear families had 5 % smaller odds of developing diarrhea than did children from non-nuclear families. This outcome is probably secondary to the described effect of social stability that a nuclear family structure has on child health [37]. (4) Sanitation: Adequate sanitation conditions helped prevent diarrhea. It has been estimated that approximately 88 % of diarrhea-induced deaths in the world are attributable to inadequate water supplies, poor hygiene and unsanitary conditions [38].

Water Quality Awareness and Breastfeeding: Evidence of Health Behavior Change in Bangladesh, June 2015. Author: Pinar Keskin, et al.


Decades of nation-wide campaigns regarding water safety in Bangladesh have cautioned households about the dangers of water-borne diseases from surface water and, more recently, arsenic contamination from certain tubewells. In addition to switching to uncontaminated well water, mothers can also protect their young children by breastfeeding longer. We study whether mothers modify their behavior in response. We exploit geographic variation in exposure to arsenic and time variation in whether children were born before or after the most recent campaign. In addition, we exploit geographic variation in the cost of switching to an arsenic-free well, namely the distance to nearby uncontaminated wells. We find that mothers breastfeed their children longer in contaminated areas and that this change is driven by households that have less access to clean wells. We also find that very young children in contaminated areas are more likely to be exclusively breastfed. This behavior change is consistent with the separate spheres model of intra-household bargaining where men have authority over certain decisions (which well to use), but women are able to influence other decisions (how to feed their children). Consistent with this breastfeeding response, we find suggestive evidence of relatively lower mortality rates and incidence of diarrhea for infants in more contaminated areas.

Filed under: Uncategorized Tagged: disgust, handwashing, hygiene

Overview of sustainable sanitation events at the World Water Week in Stockholm

20 August 2015 12:04 (America/New_York)

The Secretariat of the Sustainable Sanitation Alliance (SuSanA) has compiled a flyer of all SuSanA events and partner of SuSanA events during the World Water Week which is now available for download. This will help you to get an overview of many exciting sessions and events around sustainable sanitation!

For all those, who are not able to go to Stockholm, we will livestream the 20th SuSanA meeting on Saturday 22 August.

Please follow this link for more information and to watch the livestream:

Filed under: Uncategorized

Introduction to the Treatment of Urban Sewage – free online course

16 August 2015 5:20 (America/New_York)

TU Delft offers a free 7 week online introductory course on urban sewage treatment starting in April 2016.

The course consists of 6 modules:

  1. Sewage treatment plant overview
  2. Primary treatment
  3. Biological treatment
  4. Activated sludge process
  5. Nitrogen and phosphorus removal
  6. Sludge treatment

The instructors are Prof. Jules van Lier, Environmental Engineering and Wastewater Treatment, and wastewater Assistant Prof. Merle de Kreuk.

View the course introduction video

Introduction to the Treatment of Urban Sewage is part of TU Delft Water Management XSeries on edX.

For $50 participants can get a Verified Certificate for the course.

Filed under: Education & training, Wastewater Management Tagged: sewage treatment, training courses, TU Delft, urban sanitation

WASHplus Weekly: Focus on Community-Led Total Sanitation (CLTS)

14 August 2015 9:57 (America/New_York)

Issue 202 | August 14, 2015 | Focus on Community-Led Total Sanitation (CLTS)

This issue updates the March 6, 2015 Weekly on CLTS. Studies and resources in this issue include a webinar series on what constitutes success for CLTS, new reports from the UNC Water Institute and the Institute of Development Studies, a presentation by Kamal Kar on CLTS and scaling up, and a UNICEF report on CLTS in fragile and insecure contexts. Also included are recent studies on the health impacts of open defecation in India and Nepal and a Waterlines review on the safety of burial or disposal with garbage as forms of child feces disposal.


What Constitutes Success for CLTS? Measuring Community Outcomes and Behavior Changes, 2015.
The webinar had a chat show format where, following a panel interview, the audience will have the chance to interact with the panelists. This webinar was organized under the Knowledge Management initiative of the Building Demand for Sanitation (BDS) program of the Bill & Melinda Gates Foundation. Organizers included Euforic Services, the SuSanA secretariat and the Stockholm Environment Institute.

  • Introduction (Part 1 of 4) by Pippa Scott. Link
  • Chat show (Part 2 of 4). Speakers: Ada Oko Williams, Technical Support Manager, Sanitation and Hygiene, WaterAid UK; Darren Saywell, Senior Director, Water, Sanitation and Health, Plan International USA and others. Link
  • Feedback from breakout rooms (Part 3 of 4). Link
  • Closing panel (Part 4 of 4). Link

Seminar: CLTS at Stockholm World Water Week, August 23rd, 9:00 – 10:30, FH 202. Link
In this 90-minute event, speakers from Plan International and the Water Institute at UNC will discuss with the audience the results of an operational research program on the role and potential of local actors to sustain CLTS outcomes. Highlights will be shared from activities in 10 countries across Africa, Asia, and the Caribbean.


CLTS in Cambodia: An Implementation Learning Brief, 2015. V Venkataramanan, et al. UNC Water Institute. Link
This learning brief by the Water Institute at UNC shares key findings and implications from a case study of CLTS implementation in Plan International Cambodia program areas. The brief suggests how Plan International Cambodia staff can work with partners on developing a systematic approach to community selection, strengthening CLTS facilitation, and standardizing monitoring and evaluation processes.


CLTS Learning Series: Implementation Case Studies from Indonesia, Laos, Nepal, and Uganda. 2015. V Venkataramanan, UNC Water Institute.
The Learning Series is a collection of seven country case studies on CLTS implementation prepared by the Water Institute at UNC. Four new country reports by the Water Institute at UNC highlight the roles of local actors throughout CLTS implementation and illustrate a range of factors for improving program outcomes for Plan International country offices in Indonesia, Laos, Nepal, and Uganda. A cross-country synthesis, guided by the goal of assessing different approaches to CLTS implementation, will be produced at the end of the series.

  • CLTS in Indonesia: An Implementation Report, 2015. Venkataramanan V. UNC Water Institute. Link
  • CLTS in Nepal: An Implementation Report, 2015. Venkataramanan, V. UNC Water Institute. Link
  • CLTS in Uganda: An Implementation Report, 2015. Venkataramanan, V. UNC Water Institute. Link
  • CLTS in Cambodia: An Implementation Report, 2014. Venkataramanan, V. UNC Water Institute. Link
  • CLTS in Laos: An Implementation Report, 2014. Venkataramanan, V. UNC Water Institute. Link

Frontiers of CLTS: Innovations and Insights: Breaking the Next Taboo – Menstrual Hygiene within CLTS, 2015. S Roose. | Link | The Frontiers of CLTS Series |
This issue of Frontiers of CLTS illustrates how Community-led Total Sanitation (CLTS) programmes can be expanded to address menstrual hygiene management (MHM) in schools and communities to alleviate these stresses on women and girls. It shares learning, recommendations, innovations and experiences from Plan International, WaterAid, WSSCC, UNICEF, WASH United, Grow and Know and USAID/WASHplus.

Frontiers of CLTS: Making Sanitation and Hygiene Safer- Reducing Vulnerabilities to Violence, 2015. S House. | LinkThe Frontiers of CLTS Series |
looks at good practices within organisations to ensure that those working in the sector know how to programme to reduce vulnerabilities to violence and to ensure that sector actors also do not become the perpetrators of, or face violence. It also points out areas in which CLTS methodologies, if not used skilfully with awareness and care, can run the potential risk of creating additional vulnerabilities, for example as a by-product of community pressure to reach ODF.

Final Report: Impact Evaluation of Community-Led Total Sanitation (CLTS) in Rural Mali, 2015. M Aluza. Link
The CLTS campaign was highly successful in increasing access to private latrines, improving the quality of latrines, and reducing self-reported open defecation. Access to a private latrine almost doubled among households in CLTS villages (coverage increased to 65% in CLTS villages compared to 35% in control villages). Self-reported open defecation rates fell by 70% among adult women and men, by 46% among older children (age 5-10), and by 50% among children under five. Children too young to use latrines were also more likely to use a child potty in CLTS villages. The program also increased perceived privacy and safety during defecation among women. These results were sustained over time.

Community-led Total Sanitation (CLTS): Challenges of Nation-wide Scaling up and Sustainability, 2015. Link
Dr Kamal Kar, the pioneer of CLTS, spoke about the challenges of nation-wide scaling up of CLTS, especially in the run up to the Sustainable Development Goals (SDGs) with a particular focus on new strategies of some African nations on national scaling up. He also discussed second and third generation challenges of CLTS such as sustainability, inclusion and waste containment.

Analysis of Behavioral Change Techniques in Community-Led Total Sanitation Programs. Health Promot Int, Mar 2015. R Sigler. Abstract
The aims of this study are to (i) show which behavior change frameworks and techniques are the most common in CLTS interventions; (ii) describe how activities are implemented in CLTS interventions by region and context; and (3) determine which activities program implementers considered the most valuable in achieving open defecation free (ODF) status and sustaining it. The results indicate that a wide range of activities are conducted across the different programs and often go beyond standard CLTS activities.

CLTS in Fragile and Insecure Contexts: Experience from Somalia and South Sudan, 2014. UNICEF. Link
CLTS has been very successful in Somalia and South Sudan: Somalia has gone from zero ODF (Open Defecation Free) villages to 144 (self declared) ODF villages in 2 years and South Sudan declared 103 communities, 200,000 people in ODF communities in 2 years. CLTS is ideally suited for situations where access for aid workers is constrained since much of the action is community initiated rather than aid agency delivered.

CLTS in Fragile and Insecure Contexts, Waterlines, July 2015. N Balfour. Abstract
This article presents the experience of using the Community-Led Total Sanitation (CLTS) approach in a recent program in Somalia and explains some of the adaptations that were necessary to adjust to the specifics of a fragile and insecure context. The article goes on to explore the applicability of CLTS in fragile and insecure contexts more generally, using examples from South Sudan, Chad, and Afghanistan, and argues that in some ways it is an ideal approach for overcoming some of the challenges of working in these areas.

Community-Led Total Sanitation Mobile Surveillance, 2015. Akros. Link
Based on DHIS2 (District Health Information System), Akros partnered with the Government of Zambia to design a comprehensive WASH surveillance system that enables the rapid flow of village-based water and sanitation data. Almost 1,000 community-based volunteers in 28 rural districts across Zambia submit monthly data using simple Nokia feature phones. The data are submitted to a central server and immediately available to decision makers at district, provincial and national levels, allowing them to monitor and respond more quickly to sanitation concerns in each village, engage traditional leaders, and better target interventions.

Micro-Planning for CLTS: Experience from Kenya, 2015. UNICEF. Link
Micro-planning is a tool often used in the context of decentralisation to guide decisions and to monitor the achievement of objectives. It has been used in a variety of sectors including planning immunization to reach target children as well as in education to reach out-of-school children.

Process Documentation- Angul, 2015. V Bejjanki. Link
This document seeks to put forth the various change processes in place for achieving Open Defecation Free Villages through a CLTS Approach in Angul Block of Angul District in the state of Odisha. The document serves as a tool for other Districts and States to learn from and utilize as part of their sanitation programs and also to present evidence on replicability of this model across the country. It outlines the activities, interactions between stakeholders, issues and contextual factors during the plan, design and implementation of the Community-driven Sanitation Model.


Are Burial or Disposal with Garbage Safe Forms of Child Faeces Disposal? An Expert Consultation. Waterlines, July 2015. R Bain. Link
The importance of safe handling and disposal of child feces given its potential role in disease transmission are increasingly recognized. Household surveys demonstrate that the burying of child feces (‘dig-and-bury’) is common in several countries, especially in sub-Saharan Africa and South-east Asia. Disposal with garbage is widely practiced in middle- and high-income countries and is becoming increasingly common in urban areas of low-income countries. The safety of these two approaches is difficult to assess given the limited evidence available.

Management of Child Feces: Current Disposal Practices, 2015. E Rand. Link
Safe disposal of children’s feces is as essential as that of adults’ feces. Sanitation estimates are based on the household’s primary sanitation facility, and may overlook the disposal practices of young children feces. In many cases, children may not be able to use an improved toilet or latrine because of their age and stage of physical development or the safety concerns of their caregivers, even if their household has access to one.

Sanitation, Disease, and Anemia: Evidence From Nepal, 2015. D Coffey. Link
This paper is the first to propose the hypothesis that poor sanitation, a public good with other well-documented health externalities, significantly contributes to hemoglobin deficiency via its role in creating a poor disease environment. Researchers show that within regions over time, cohorts of children exposed to worse community sanitation developed lower hemoglobin levels and displayed higher anemia incidence. The results contribute to the basic science of anemia’s causes and suggest the possibility of new policy tools for reducing anemia in the developing world.

Psychosocial Stress Associated with Sanitation Practices: Experiences of Women in a Rural Community in India. Jnl Wat, San Hygiene for Development. January 2015. S Hirve. Link
This study examined sources of psychosocial stress related to the use of toilet facilities or open defecation by women and adolescent girls at home, public places, workplaces and in schools in a rural community in Pune, India.  Women resorting to open defecation feel stressed and harassed by community leaders trying to enforce open defecation-free policies. The study highlights the need for sanitation programs to consider the specific needs of women with regard to latrine maintenance, safety and privacy offered by sanitation installations.

The Short- and Medium-Term Impacts of Household Water Supply and Sanitation on Diarrhea in Rural India, 2015. E Duffo. Link
This paper estimates the impact of an integrated water and sanitation improvement program in rural India that provided household-level water connections, latrines, and bathing facilities to all households in approximately 100 villages. The estimates suggest that the intervention was effective, reducing such episodes by 30-50%. These results are evident in the short term and persist for 5 years or more. The annual cost is approximately US$60 per household, as compared to annual household consumption of approximately US$740.

WASH, Nutrition and CLTS: Revolutions in Insight and Action, 2015. R Chambers.Presentation
A presentation at the DSAI and Irish Aid Seminar on Nutrition and WASH: integration, research and future challenges held at Printing House, Trinity College Dublin, 19 May 2015.

Risk of Adverse Pregnancy Outcomes among Women Practicing Poor Sanitation in Rural India: A Population-Based Prospective Cohort Study. PLoS Med, July 2015. B Padhi. Link
This study provides the first evidence that poor sanitation is associated with a higher risk of Adverse Pregnancy Outcomes (APOs). While it is intuitive to expect that caste and poverty are associated with poor sanitation practice driving APOs, and additional confounders cannot be ruled out, results demonstrate that the association of poor sanitation practices (open defecation) with these outcomes is independent of poverty. Results support the need to assess the mechanisms, both biological and behavioral, by which limited access to improved sanitation leads to APOs.

Focus on Poverty: Using Disgust to Stop Open Defecation. SciDevNet, Apr 2015, R Williamson. Link
A community-led approach gets local people to realize they must end the problem. The World Bank thinks it is more important to provide subsidized toilets. But disgust backed up by evidence is likely to be more potent than cheap toilets or latrines.


Community-led Total Sanitation Website
Maintained by the IDS CLTS Knowledge Hub, the Community-led Total Sanitation website aims to be a global hub for CLTS, connecting the network of practitioners, communities, NGOs, agencies, researchers, governments, donors and others involved or interested in CLTS.

Plan International / UNC Water Institute: Testing CLTS Approaches for Scalability Website
Plan International USA’s Testing CLTS Approaches for Scalability project aims to advance rural sanitation efforts in Kenya, Ethiopia, Ghana, and worldwide by improving the cost-effectiveness and scalability of the CLTS approach. In collaboration with The Water Institute at the University of North Carolina, this goal will be achieved by collecting, critically evaluating, and disseminating lessons about overcoming common challenges to implementing CLTS at scale, based on applied research from interventions in Kenya, Ghana, and Ethiopia and case studies conducted in seven countries (Cambodia, Haiti, Indonesia, Laos, Nepal, Niger, and Uganda).

UNICEF – Monitoring Community Approaches to Total Sanitation (CATS)Website
Over 53 countries are implementing some form of community approach to eliminate open defecation, collectively called Community Approaches to Total Sanitation (CATS). CATS is an umbrella term developed by UNICEF sanitation practitioners in 2008 to encompass a wide range of community-based sanitation programming, including Community-Led Total Sanitation (CLTS), School-Led Total Sanitation (SLTS) and Total Sanitation Campaigns (TSC).
WASHplus Weeklies highlight topics such as Urban WASH, Household Air Pollution, Innovation, Household Water Treatment and Storage, Handwashing, Integration, and more. If you would like to feature your organization’s materials in upcoming issues, please send them to Dan Campbell, WASHplus Knowledge Resources Specialist, at

Filed under: Dignity and Social Development, Sanitation and Health Tagged: CLTS, Community-Led Total Sanitation

Are burial or disposal with garbage safe forms of child faeces disposal?

11 August 2015 12:07 (America/New_York)

Are burial or disposal with garbage safe forms of child faeces disposal? An expert consultation. Waterlines, July 2015.

Authors: Rob Bain, Rolf Luyendijk, et al. 

The importance of safe handling and disposal of child faeces given its potential role in disease transmission are increasingly recognized. Household surveys demonstrate that the burying of child faeces (‘dig-and-bury’) is common in several countries, especially in sub-Saharan Africa and South-east Asia. Disposal with garbage is widely practised in middle- and high-income countries and is becoming increasingly common in urban areas of low-income countries.

The safety of these two approaches is difficult to assess given the limited evidence available and we therefore sought the opinion of experts in the field of sanitation to support advocacy around the topic. We report the findings of an anonymous expert (Delphi) consultation on the safety of these two child faeces disposal methods. There was almost unanimous agreement these should be considered neither safe nor improved.

A range of arguments was provided to support this position, including proximity of solid waste and burial sites to the home and children’s play areas and that neither practice would be acceptable for adults. The consultation also highlighted gaps in the current evidence base that should be addressed to gain a fuller insight into the risks involved in these two forms of sanitation with a view to providing both programmatic and normative guidance.

In particular further work is needed to assess the potential for exposure to faecal matter in solid waste in low- and middle-income countries and to elucidate the predominant practices of child faeces burial including proximity to the home or infant play areas as well as depth of burial.

Filed under: Sanitation and Health Tagged: child faeces disposal

WaterAid/Cambodia – The HandyPod: sanitation for floating communities in Cambodia

10 August 2015 10:48 (America/New_York)

The HandyPod: sanitation for floating communities in Cambodia | Source: WaterAid, July 2015 |

Building safe and sustainable sanitation systems is a huge challenge for many poor communities, but when homes are built over water a new dimension is added. James Wicken, WaterAid Country Representative for Cambodia, looks at a new solution to the problem faced by Cambodia’s floating villages.

A challenging environment for sanitation

For Cambodia to reach the Government’s target of universal access to sanitation by 2025, people living in these types of areas need sustainable solutions. In Cambodia, an estimated 25-45% of the population lives in ‘challenging environments’ such as floating villages. It is often the poorest people who can’t afford to own land who live in such places, and these populations are expected to grow, especially in cities as poor people continue to migrate. Cambodia is not alone – these informal settlements are found in many countries, such as Myanmar, Malaysia, Nigeria and Indonesia. 

Because of WaterAid’s focus on equity and inclusion, these populations came on to our radar in our first year of work in Cambodia. WaterAid is partnering with a social enterprise calledWetlands Work! to test one potential solution – called the HandyPod – on the Tonlé Sap lake.

When people living in the lake’s floating villages – who number well over 100,000 – need to go to the toilet, they take a boat to a secluded spot on the lake, go into the surrounding forest, or at night may squat off the side of their floating house. This same water around the houses is used to wash dishes and clothes. Young children swim in it.

Introducing: the HandyPod

The HandyPod took Wetlands Work! years to design, test and redesign. Resembling a floating garden, or a child’s paddling pool with a garden in it, it contains a man-made wetland filled with water hyacinths.

In the system, a normal porcelain squat toilet on the back of a floating house connects to a drum where the anaerobic (oxygen-less) processes take place. From here, the waste passes through to the HandyPod floating nearby, where the roots of water hyacinths further break down the waste before it passes into the lake. Wetlands Work! regularly collects water samples in the area around the pods, to ensure the quality conforms to Cambodian standards.

Read the complete article.

Filed under: East Asia & Pacific Tagged: Cambodia, HandyPod

Aug 10 – Weekly Update of Selected WASH Studies

10 August 2015 10:16 (America/New_York)

Effectiveness of emergency water treatment practices in refugee camps in South Sudan. WHO Bulletin, Aug 2015. Authors: Syed Imran Ali, Syed Saad Ali & Jean-Francois Fesselet.

Current guidelines for free residual chlorine in emergency water supplies are not based on field evidence and offer inadequate protection after distribution in refugee camps in South Sudan. We recommend that the free residual chlorine guideline be increased to 1.0 mg/L in all situations, irrespective of disease outbreak, pH, or turbidity conditions. This is a tentative recommendation because the degree to which these findings can be generalized to other camps in different settings is unknown.

Nutrition in Ethiopia: An emerging success story? Author: Headey, Derek D.

Research does not always provide the results that we expect. At the recent conference on improving nutrition in Ethiopia, Together for Nutrition 2015, we learnt about the rapid progress in Ethiopia in child nutritional outcomes that are linked to improved birth size and, hence, improved maternal health. However, most of the improvement in maternal health seems related to better sanitation, rather than to diet, care, or health factors.

Diet and specific microbial exposure trigger features of environmental enteropathy in a novel murine model. Nature Communications, Aug 2015. Authors: Eric M. Brown, et al.

Here we demonstrate that early-life consumption of a moderately malnourished diet, in combination with iterative oral exposure to commensal Bacteroidales species and Escherichia coli, remodels the murine small intestine to resemble features of EE observed in humans. We further report the profound changes that malnutrition imparts on the small intestinal microbiota, metabolite and intraepithelial lymphocyte composition, along with the susceptibility to enteric infection. Our findings provide evidence indicating that both diet and microbes combine to contribute to the aetiology of EE, and describe a novel murine model that can be used to elucidate the mechanisms behind this understudied disease.

An internet-delivered handwashing intervention to modify influenza-like illness and respiratory infection transmission (PRIMIT): a primary care randomised trial. The Lancet, Aug 2015. Authors: Paul Little, Beth Stuart, et al.

Handwashing to prevent transmission of respiratory tract infections (RTIs) has been widely advocated, especially during the H1N1 pandemic. However, the role of handwashing is debated, and no good randomised evidence exists among adults in non-deprived settings. We aimed to assess whether an internet-delivered intervention to modify handwashing would reduce the number of RTIs among adults and their household members.

Associations between school- and household-level water, sanitation and hygiene conditions and soil-transmitted helminth infection among Kenyan school children. Parasit Vectors. 2015 Aug. Authors: Freeman MC, Chard AN, et al.

Results suggest mixed impacts of household and school WASH on prevalence and intensity of infection. WASH risk factors differed across individual worm species, which is expected given the different mechanisms of infection. No trend of the relative importance of school versus household-level WASH emerged, though some factors, like water supply were more strongly related to lower infection, which suggests it is important in supporting other school practices, such as hand-washing and keeping school toilets clean.

Modelling Optimal Control of Cholera in Communities Linked by Migration. Comput Math MethodsMed. 2015. Authors: Njagarah JB, Nyabadza F

A mathematical model for the dynamics of cholera transmission with permissible controls between two connected communities is developed and analysed. The dynamics of the disease in the adjacent communities are assumed to be similar, with the main differences only reflected in the transmission and disease related parameters. This assumption is based on the fact that adjacent communities often have different living conditions and movement is inclined toward the community with better living conditions. Our results indicate that implementation of controls such as proper hygiene, sanitation, and vaccination across both affected communities is likely to annihilate the infection within half the time it would take through self-limitation. In addition, although an infection may still break out in the presence of controls, it may be up to 8 times less devastating when compared with the case when no controls are in place.

Filed under: Uncategorized Tagged: bibliographies, cholera, handwashing

WASHplus Weekly: Focus on Animal Waste Management

7 August 2015 10:49 (America/New_York)

Issue 201 | August 7, 2015 | Focus on Animal Waste Management

This issue focuses on the management of animal waste and includes recent studies and resources on the environmental and health impacts of waste from domestic animals such as cattle, pigs, and chickens. Specifically, reviews of animal waste management by the International Livestock Research Institute, and diarrheal infections associated with animal husbandry are included, as well as aWHO fact sheet on Taeniasis/Cysticercosis, and country studies from Bangladesh, Egypt, Ghana, and more.


Global Assessment of Manure Management Policies and Practices, 2014. E Teenstra. Link
The study assessed livestock manure policies in 34 countries in Asia, Africa, and Latin America, then looked in depth at manure management practices in Bangladesh, Vietnam, Ethiopia, Malawi, Argentina and Costa Rica. The authors found wide variations in practice, with particular challenges in the handling of liquid manure; they also found government policies and lack of coordination often hindered the implementation of improved practices.

Manure Management Practices in Urban and Peri-urban areas of Tanzania pose a Public Health Threat, n.d. University of Copenhagen. Link
Livestock are increasingly kept in urban and peri-urban areas as a consequence of the growing urban demand for fresh meat and livestock products. Manure is a valuable byproduct of livestock production, but if it is not treated according to good manure handling practices, it may cause a public health treat due to the presence of pathogenic bacteria in the dung. A recent international research project working with cattle farmers in urban areas of Tanzania has documented that good manure handling practices are not always followed, and that this lead to direct human contact and environmental contamination with cattle manure.

A One Health Perspective for Integrated Human and Animal Sanitation and Nutrient Recycling, 2015. H Nguyen-Viet. | Order from CABI | Free View/Download
This chapter discusses a conceptual framework for integrated health and environmental assessment that combines health status, and the physical, socioeconomic and cultural environments in order to improve human health and minimize environmental impact. This concept’s application in the management of human and animal excreta in Vietnam is then described.

Review of Evidence on Antimicrobial Resistance and Animal Agriculture in Developing Countries, 2015. D Grace, International Livestock Research Institute. Link
This short paper identifies key evidence gaps in our knowledge of livestock- and fisheries-linked antimicrobial resistance in the developing world, and to document on-going or planned research initiatives on this topic by key stakeholders. The antimicrobial resistant (AMR) infections in animals that are of most potential risk to human health are likely to be zoonotic pathogens transmitted through food, especially Salmonella and Campylobacter. In addition, livestock associated methicillin resistant Staphylococcus aureus (LA MRSA) and extended spectrum beta lactamase E. coli (ESBL E. coli) are emerging problems throughout the world.

Biogas Production from Vietnamese Animal Manure, Plant Residues and Organic Waste: Influence of Biomass Composition on Methane Yield. Asian-Australas J Anim Sci. Feb 2015. T Cu. Link
Anaerobic digestion is an efficient and renewable energy technology that can produce biogas from a variety of biomasses such as animal manure, food waste, and plant residues. In developing countries, this technology is widely used for the production of biogas using local biomasses, but there is little information about the value of these biomasses for energy production. This study was carried out with the objective of estimating the biogas production potential of typical Vietnamese biomasses such as animal manure, slaughterhouse waste, and plant residues.


Human Diarrhea Infections Associated with Domestic Animal Husbandry: A Systematic Review and Meta-AnalysisTrans R Soc Trop Med Hyg, Mar 2014. L Zambrano. Link
Domestic animal husbandry, a common practice globally, can lead to zoonotic transmission of enteric pathogens. However, this risk has received little attention to date. This systematic review and meta-analysis examines the evidence for an association between domestic exposure to food-producing animals and cases of human diarrhea and specific enteric infections. Results suggest that domestic poultry and livestock exposures are associated with diarrheal illness in humans. Failure to ascertain the microbial cause of disease may mask this effect. Exposure to domestic animals should be considered a risk factor for human diarrheal illness and additional studies may identify potential mitigation strategies to address this risk.

Formative Research on Hygiene Behaviors and Geophagy among Infants and Young Children and Implications of Exposure to Fecal Bacteria. Am Jnl Trop Med Hyg, Oct 2013. F Ngure. Link
Researchers conducted and recorded WASH-related behaviors to identify pathways of fecal–oral transmission of bacteria among infants. Hand washing with soap was not common and drinking water was contaminated with Escherichia coli in half of the households. A one-year-old infant ingesting 1 gram of chicken feces in a day and 20 grams of soil from a laundry area of the kitchen yard would consume 4,700,000–23,000,000 and 440–4,240 E. coli, respectively, from these sources.

Status of Taenia solium cysticercosis and Predisposing Factors in Developing Countries Involved in Pig Farming. Int J One Health, Jan 2015. J Kungu. Link
Taenia solium cysticercosis is a disease of pig and human populations considered endemic in many developing countries in Latin America, Africa, and South East Asia, that has a serious impact on public health and agriculture. Poor pig production practices, poor hygiene, and sanitation habits have been important in the maintenance of the T. solium life-cycle. The major gaps identified in this review include current information on PC prevalence in pigs with few reports on the condition in humans in most developing countries.

Occurrence of Porcine Cysticercosis in Free-Ranging Pigs Delivered to Slaughter Points in Arapai, Soroti District, Uganda. Onderstepoort J Vet Res. 2015 Jun. Link
Poverty, hunger and the need for production of pigs with meagre or zero inputs have made most farmers release their pigs to range freely, thus creating a pig-human cycle that maintains Taenia solium, the pig tapeworm and cause of porcine cysticercosis, in the ecosystem. A preliminary study was designed to establish the prevalence of porcine cysticercosis by postmortem examination of the tongue and carcass of free-range pigs from February to April 2014 in Arapai subcounty, Soroti district, eastern Uganda. Out of 178 pigs examined, 32 were qualitatively positive for porcine cysticercosis, representing a prevalence of 18.0%. This high prevalence represents a marked risk to the communities in the study area of neurocysticercosis, a debilitating parasitic zoonosis. Proper human waste disposal by use of pit latrines, confinement of free-range pigs and treatment with albendazole and oxfendazole are recommended.

Linking Human Health and Livestock Health: A “One-Health” Platform for Integrated Analysis of Human Health, Livestock Health, and Economic Welfare in Livestock Dependent Communities. PLoS One, Mar 2015. S Thumbi. Link
This study platform provides a unique longitudinal dataset that allows for the determination and quantification of linkages between human and animal health, including the impact of healthy animals on human disease averted, malnutrition, household educational attainment, and income levels.

Taeniasis/Cysticercosis Fact Sheet, 2015. WHO. Link
Cysticercosis mainly affects the health and livelihoods of subsistence farming communities in developing countries of Africa, Asia, and Latin America. It also reduces the market value of pigs and cattle, and makes especially pork unsafe to eat. Cysticercosis is acquired when proglottids or eggs are ingested. It is a natural infection of pigs and cattle but, in the case of T. solium, it can also affect humans, usually when they swallow T. solium egg-contaminated soil, water or food (mainly vegetables). Taeniasis and cysticercosis are common in areas where animal husbandry practices are such that pigs and cattle come into contact with human feces.

A Short Review of Fecal Indicator Bacteria in Tropical Aquatic Ecosystems: Knowledge Gaps and Future Directions. Frontiers in Microbiol, Apr 2015. E Rochelle-Newall. Link
The primary sources of FIB in the tropics (humans and livestock) all contribute to the dissemination of FIB at the soil surface in cultivated lands and inhabited areas via open air defecation and latrines, manure application and livestock. The primary sources also directly contaminate adjacent aquatic ecosystems via direct waste and wastewater release. In humid, tropical zones rain events are often characterized by high intensities and depth. During these events, contaminated soils are washed off in overland flow that contains high suspended sediment loads.

Hepatitis E Virus Infection: A Zoonotic Threat. Adv. Anim. Vet. Sci, Nov 2014. V Saxena.Link
Hepatitis E is a virus mediated liver disease caused by hepatitis E virus (HEV). There are an estimated 3 million cases of acute HEV infection every year, causing 70,000 hepatitis E-related deaths worldwide. HEV is transmitted via the fecal-oral route. Contaminated water and food are main source of infection. Pigs, deer and other animal species may serve as a reservoir for HEV. This review highlights the current understanding of HEV infection in humans and animals.

Pathogen-Specific Burdens of Community Diarrhoea in Developing Countries: A Multisite Birth Cohort Study (MAL-ED). The Lancet, July 2015. J Platts-Mills. Link
Most studies of the causes of diarrhoea in low-income and middle-income countries have looked at severe disease in people presenting for care, and there are few estimates of pathogen-specific diarrhea burdens in the community. There was substantial heterogeneity in pathogen-specifi c burdens of diarrhoea, with important determinants including age, geography, season, rotavirus vaccine usage, and symptoms. Findings suggest that although single-pathogen strategies have an important role in the reduction of the burden of severe diarrheal disease, the effect of such interventions on total diarrheal incidence at the community level might be limited.


Bangladesh – Multidrug Resistant-Proteus Mirabilis Isolated from Chicken Droppings in Commercial Poultry Farms: Bio-security Concern and Emerging Public Health Threat in Bangladesh. Mar 2014. A Nahar. Link
This study describes the presence of Proteus mirabilis in Bangladeshi poultry samples. There is a need for a stringent surveillance system in Bangladesh for antimicrobial resistance monitoring and biosafety on P. mirabilis and other pathogens found in poultry products.

Egypt – Campylobacter Infections in Children Exposed to Infected Backyard Poultry in Egypt. Epidemiology and Infection, (4) 2014. W El-Tras. Link
Campylobacteriosis is a zoonotic disease which has a worldwide public health impact. The disease is endemic in Egypt; however, the epidemiology in animals and humans has not been fully characterized. The objective of this study was to compare the risk of Campylobacter fecal carriage in children exposed to Campylobacter-infected vs. non-infected backyard poultry and to identify risk factors for a backyard being classified as infected. Backyard poultry may present a transmission route of C. jejuni to children. Backyards with poor cleaning and disinfection, wet litter and manure disposed of within the backyard had increased odds of being positive for C. jejuni.

Ghana – Drinking Water from Dug Wells in Rural Ghana — Salmonella Contamination, Environmental Factors, and Genotypes. Int. J. Environ. Res. Public Health, 12(4) 2015. D Dekker. Link
The study results provide an overview of the level of contamination in wells with Gram-negative rod-shaped bacteria and on the presence of unusual Salmonella serovars seen infrequently in patients but more often in reptiles and poultry. Studying animal reservoirs would provide useful information to identify the source of such contaminations.

India – Cryptosporidium and Giardia in Humans, Domestic Animals, and Village Water Sources in Rural India. Am Jnl Trop Med Hyg, June 2015. M Daniels. Link
Cryptosporidium parvum and Giardia lamblia are zoonotic enteric protozoa of significant health concern where sanitation, hygiene, and water supplies are inadequate. Animal loading estimates indicate the greatest contributors of environmental oocysts/cysts in the study region are cattle. Ponds were contaminated with both protozoa, as were tube wells. Future research should address the public health concern highlighted from these findings and investigate the role of domestic animals in diarrheal disease transmission in this and similar settings.

India – Human and Animal Fecal Contamination of Community Water Sources, Stored Drinking Water and Hands in Rural India Measured with Validated Microbial Source Tracking Assays. Am Jnl Trop Med Hyg, July 2015. A Schriewer. Link
This study confirms an often suggested contamination link from hands to stored water in the home in developing countries separately for mothers’ and children’s hands and both human and animal fecal contamination. In contrast to MST markers, FCs provided a poor metric to assess risks of exposure to fecal contamination of human origin in this rural setting.

Latin America – Cysticercosis Burden of Disease in Latín America, 2015. J Torres. Link
Cysticercosis is caused by infection with the larval form (or cysticercus) of the tapeworm Taenia solium. The most important clinical manifestations are caused by cysts in invading the central nervous system known as neurocysticercosis, which is associated with significant morbidity and disability in Latin America. Taeniasis and cysticercosis occur globally, with the highest rates in areas of Latin America, Asia, and sub-Saharan Africa associated with poor sanitation and free-ranging pigs with access to human feces.

Madagascar – Complex Epidemiology and Zoonotic Potential for Cryptosporidium suis in Rural Madagascar. Veterinary Parasitology, 207 2015. J Bofager. Link
In this study system. Interestingly, C. suis was the dominant species of Cryptosporidium in the region, infecting humans, cattle, pigs, and rodents. This report represents the fifth confirmed case of C. suis infection in humans, and the first case in Africa. Few rural human and livestock populations have been screened for Cryptosporidium using genus-specific genotyping methods. Consequently, C. suis may be more widespread in human and cattle populations than previously believed.

Nepal – Cryptosporidium Infection Among the School Children of Kathmandu Valley.Journal of Institute of Medicine, Apr, 2015. D Bhandari. Link
The detection of Cryptosporidium oocysts and observance of diarrheal symptoms, together with the pattern of age-specific occurrence, livestock presence at home, consumption of untreated drinking water and raw vegetables/fruits consumption habit among infected children suggest that in low-income Kathmandu communities, cryptosporidiosis coupled with poor sanitary practice is a public-health issue causing potentially serious consequences.

Zambia – Why Latrines Are Not Used: Communities’ Perceptions and Practices Regarding Latrines in a Taenia solium Endemic Rural Area in Eastern Zambia. PLoS Negl Trop Dis, Mar 2015. S Thys. Link
Taenia solium cysticercosis is a neglected parasitic zoonosis occurring in many developing countries. Socio-cultural determinants related to its control remain unclear. Studies in Africa have shown that the underuse of sanitary facilities and the widespread occurrence of free-roaming pigs are the major risk factors for porcine cysticercosis. The study objective was to assess the communities’ perceptions, practices and knowledge regarding latrines in a T. solium endemic rural area in Eastern Zambia inhabited by the Nsenga ethno-linguistic group, and to identify possible barriers to their construction and use.
WASHplus Weeklies highlight topics such as Urban WASH, Household Air Pollution, Innovation, Household Water Treatment and Storage, Handwashing, Integration, and more. If you would like to feature your organization’s materials in upcoming issues, please send them to Dan Campbell, WASHplus Knowledge Resources Specialist, at

Filed under: Sanitation and Health Tagged: animal waste

Community-led Total Sanitation in Cambodia: Findings from an Implementation Case Study

30 July 2015 9:32 (America/New_York)

Community-led Total Sanitation in Cambodia: Findings from an Implementation Case Study, 2015.

This learning brief shares key findings from a case study of community-led total sanitation (CLTS) implementation in Plan International Cambodia program areas, focusing on the roles and responsibilities of local actors. Several implications are relevant for consideration by Plan International Cambodia and other sanitation practitioners. 

The brief is part of the CLTS Learning Series, a collection of seven country case studies on CLTS implementation prepared by The Water Institute at the University of North Carolina at Chapel Hill as part of the Plan International USA project, Testing CLTS Approaches for ScalabilityThe 4-page brief is based on the 40-page Cambodia Country Report.

Filed under: Uncategorized Tagged: Cambodia, Community-Led Total Sanitation

The Consequences of Deteriorating Sanitation in Nigeria

24 July 2015 9:52 (America/New_York)

The Consequences of Deteriorating Sanitation in Nigeria | Source: Council on Foreign Relations Blog, July 23, 2015 |

This is a guest post by Anna Bezruki, an intern for the Council on Foreign Relations Global Health Program. She studies biology at Bryn Mawr College.

According to the final report on Millennium Development Goals (MDGs) released earlier this month, more than a third of the world population (2.4 billion) is still without improved sanitation.

Children play at a slum in Ijegun Egba, a suburb of Nigeria’s commercial capital of Lagos, July 2, 2008. (Courtesy Reuters/George Esiri)

The target to halve the global population without adequate toilets by 2015 has not been reached. Consequently, sanitation has been pushed on to the post-2015 sustainable development goals (SDGs).

Although India is perhaps the most widely cited failure, accounting for roughly half of open defecation worldwide, it is at least making progress toward the SDG target. The same cannot be said for Nigeria. Lacking the political infrastructure to reform sanitation and faced with security and political concerns that overshadow development goals, Nigeria is struggling to reverse the trend.

Unlike in India, where the percentage of people with access to a toilet shared by only one family increased by eighteen points between 1990 and 2012, that percentage declined in Nigeria from 37 to 28 percent.

This incongruity is best illustrated by the fact that there are more than three times as many cell phones in Nigeria as people who have access to adequate toilets. This means thirty-nine million defecate outside, sixteen million more today than in 1990.

Poor sanitation contributes to diarrheal diseases and malnutrition through fecal contamination of food and water. One gram of feces can contain one hundred parasite eggs, one million bacteria, and ten million viruses.

Diarrheal diseases kill approximately 121,800 Nigerians, including 87,100 children under the age of five each year. Eighty-eight percent of those deaths are attributed to poor sanitation. Poor sanitation is thought to strain the immune system to the point that permanent stunting and other manifestations of malnutrition can result.

More than 40 percent of Nigerian children under the age of five are stunted, and malnutrition is the underlying cause of death in more than 50 percent of the approximately 804,000 deaths annually in the same age range.

The impact of inadequate toilets goes beyond hazardous exposure to feces. A survey conducted by WaterAid, a nonprofit organization focusing on providing safe water and sanitation access, in a Lagos slum revealed that the 69 percent of women and girls without access to toilets are at higher risk of verbal and physical harassment when they relieve themselves.

The effects of poor sanitation are also costing Nigeria economically. The Nigerian Water and Sanitation Program estimates that poor sanitation costs the country at least three billion U.S. dollars each year in lost productivity and health care expenditures.

While estimates vary, in 2011, Nigeria invested approximately $550 million, less than 0.1 percent of GDP, on sanitation, a number which has likely decreased since then. This is less than a quarter of the approximately $2.3 billion annually that would have been necessary to meet the MDG target.

It will take more than money and infrastructure to fix Nigeria’s sanitation. Even if investments were to sufficiently rise, the lack of a single government entity with complete responsibility for sanitation within the government, as well as widespread corruption and a lack of community support, would likely hamper efforts.

Providing latrines without first creating demand within the community has failed repeatedly, including in India, where latrines have been repurposed for extra storage. There are also other problems, like a treasury emptied by corruption and the war on Boko Haram, that top President Buhari’s agenda.

While these are immediate threats that require intense focus, sanitation is an essential long-term investment that will help Nigeria grow.  

Filed under: Africa, Dignity and Social Development, Progress on Sanitation Tagged: Nigeria

UNICEF Consultancy Assignment: Support for Private Sector Development of Low-Cost Sanitation Products

22 July 2015 10:18 (America/New_York)

UNICEF’s Eastern and Southern Africa Regional Office (ESARO) has recently engaged with a global private sector partner to conduct market research and test improved sanitation products with end-users. The intended outcomes of the project are: 1) detailed market information on the needs of the “base of the pyramid” (including both functionality of the products and price point); 2) a more thorough understanding of sanitation marketing techniques and the supply chain for difficult–to-reach communities; and 3) more appropriate and affordable sanitation products available on the local market

UNICEF is now seeking a consultant to document the ESARO project, conduct a lessons learned, and develop a standard methodology that can be replicated in other regions and countries. Depending on interest and commitment from WASH staff, the project envisions applying the methodology in other regional and country office programmes and their respective private sector partners.

For for information on this 6-month consultancy and how to apply for it please go to:

The deadline is  29 July 5:00pm CET.

Filed under: Uncategorized

Can WASH deliver more than just sanitation?

21 July 2015 7:00 (America/New_York)

Through successful WASH intervention, communities access a new service that improves their quality of life, and also learn about equity and inclusion.

Blog by development expert Suvojit Chattopadhyay

The abysmal state of access to safe water and sanitation facilities in the developing world is currently a major cause for alarm; 580,000 children die every year from preventable diarrheal diseases. This is due largely to the 2.5 billion people around the globe who do not have access to safe sanitation. Not only can an effective WASH intervention save lives, it can also engineer changes in the social fabric of communities that adopt these behavioural changes. This points to a key attribute of a successful WASH intervention – that through these programmes, communities not only access a new service that improves their quality of life, but they also learn from being part of a concrete intervention that emphasises equity and inclusion.

Let me explain how. Safe sanitation is essentially ‘total’. In a community, even one family practising open defecation puts the health of other families at risk. Also, unsafe sanitation practices pollute local potable and drinking water sources in the habitations. Together, this can undo any gains from partial coverage of WASH interventions. This much is now widely accepted by sanitation practitioners around the world. However, there remains a serious challenge when it comes to the implementation of this concept.

When a community is introduced to a WASH-focused behaviour change campaign, there are often variations in the levels of take-up in different families. This could be because of several barriers – financial ability, cultural beliefs, education levels, etc. In response, external agencies have many options. They can focus more on families in their behaviour change campaigns, offer them material and financial support or incentives, or exert peer pressure (which may in some cases become coercive, etc).

However, the best approach – whether facilitated by an external agent or not – is for a community to devise a collective response. The issue should be framed as a collective action problem that requires solving for the creation of a public good. In many instances, communities have come together to support the poorest families – social engineering at its finest. At its best, recognising the needs of every member of a community will lead to a recognition of the challenges that the typically marginalised groups face. It is this recognition that could prompt a rethink of social norms and relationships.

Read the full article on the WSSCC Guardian partner zone.

Filed under: Uncategorized Tagged: CLTS, equity, hygiene, inclusion, sanitation, WASH, water

Breaking the Next Taboo: Menstrual Hygiene within CLTS

20 July 2015 10:38 (America/New_York)

Breaking the Next Taboo: Menstrual Hygiene within CLTS.  Frontiers of CLTS: Innovations and Insights, July 2015.

Authors: Sharon Roose and Tom Rankin, Plan International and Sue Cavill, Independent Consultant

Most adolescent girls and women menstruate. This means that for five to seven days each month they bleed through their vagina. This monthly bleeding is often accompanied by abdominal cramps, headaches, mood changes and general lethargy all of which can be exacerbated by social stigma, myths and a lack of requisite infrastructure to manage menstruation safely, privately and hygienically. 

The accumulated impact of these issues have significant implications for women and girls and the potential to limit their opportunity for education, equality, income generation and societal participation, all of which hamper self-worth and confidence.

This edition of Frontiers of CLTS illustrates how CLTS programmes can be expanded to address menstrual hygiene management (MHM) in schools
and communities to alleviate these stresses on women and girls.

Its specific objectives are to:

  • Increase the awareness of policy-makers and practitioners on MHM.
  • Engender change by highlighting the synergies between MHM and
    CLTS programmes.
  • Share examples of how MHM interventions have been incorporated
    into CLTS and School-Led Total Sanitation (SLTS) programmes,
    drawing on the innovations and experiences of several organisations.
  • Summarise what can be done to improve MHM through CLTS

Filed under: Dignity and Social Development, Hygiene Promotion, Sanitation and Health Tagged: Community-Led Total Sanitation, menstrual hygiene management

WASHplus Weekly: Focus on WASH & Financing

17 July 2015 10:20 (America/New_York)

Issue 199| July 17, 2015 | Focus on WASH & Financing

Thanks to Jonathan Annis of TetraTech for suggesting this week’s topic. Resources and studies in this issue include 2015 discussion forums and webinars hosted by the Sustainable Sanitation Alliance (SuSanA), a series of WASH financing briefs, and new USAID Urban Pathway manuals.


Urban Sanitation Finance – From Macro to Micro Level, SuSanA Thematic Discussion, June–July 2015. Link
This discussion forum was structured along three themes: Public Finance, Microfinance, andCity Level Sustainable Cost Recovery and was supported by six experts on sanitation finance who provided leadership and addressed questions raised by forum users. Summaries of the discussions are available here.

Webinar about Results-Based Financing (RBF) for Sanitation – April 29, 2015. SuSanA. Link
This webinar was organized under the knowledge management initiative of the Building Demand for Sanitation program of the Bill & Melinda Gates Foundation. Peter Feldman moderated the webinar with support from Pippa Scott and Pete Cranston of Euforic Services. The Stockholm Environment Institute and the SuSanA Secretariat served as hosts.


Finance Brief 1: Domestic Public Finance for WASH: What, Why, How? 2015. G Norman. Link
This report defines domestic public finance as funds derived from domestic taxes, raised at the national or local level. Domestic public finance is only part of the solution to service delivery in poor communities; user finance and donor finance are also part of the mix. Likewise, domestic public finance forms part of a wider governance puzzle: improving WASH services requires not just more government investment, but also diverse other elements including (for example) clear institutional mandates.

Finance Brief 2: Universal Water and Sanitation: How Did the Rich Countries Do It?2015. Public Finance for WASH. Link
This finance brief briefly summarizes the history of water and sanitation services provision in the U.S., the U.K., and South Korea, and considers whether this historical experience is relevant to low- and middle-income countries today.

Finance Brief 3: Municipal Finance for Sanitation in Three African Cities, 2015. B Edwards. Link (Download free but registration required)
This discussion paper reports data on municipal public finance for sanitation in three African cities, based on in-country examination of available budget records: Ga West Municipality, part of the Greater Accra conglomeration in Ghana; Maputo, capital of Mozambique; and Nakuru County in Kenya, including the city of Nakuru.

Finance Brief 4: DRM and WASH in the Financing for Development Agenda, 2015. C Fonseca. Link
This finance brief summarizes the increasing relevance of domestic resource mobilization (DRM) in supporting the ambitious goals of the Sustainable Development Agenda. It details how DRM is understood in key documents being prepared for the Financing for Development global meeting and what needs to happen to make public and private domestic finance relevant for supporting universal access to water, sanitation, and hygiene.

USAID SUWASA Pathways for Urban Water and Sanitation, 2015. SUWASA. Link
The SUWASA Pathways are tools developed to share experiences, deliver key messages, and provide links to useful resources such as manuals, case studies, templates, and reports. The SUWASA Pathways were developed by the SUWASA team in consultation with project partners including officials from government ministries, municipalities and regulatory agencies, utility managers, managers of dedicated funding units, private operators, commercial bank representatives, civil society, and development partners. The objective of the pathways is to communicate complicated reform topics in a highly accessible manner to a broad range of sector stakeholders and to assist with envisioning and sequencing reform efforts.

Developing Microfinance for Sanitation in Tanzania, 2015. S Tremolet. Link
This report presents the findings of a one-year action research project on sanitation microfinance in Tanzania funded by SHARE. It describes the activities carried out under the action research and extracts emerging lessons on the potential for developing sanitation microfinance through capacity building and networking.

Embedding Access to Finance into Sanitation Programmes: A Step-by-Step Approach, 2015. S Tremolet. Link
This report, initially commissioned by WaterAid East Africa, proposes a step-by-step approach that NGOs or other public actors could take to identify what role(s) they can play in increasing access to finance for sanitation. The step-by-step approach involves an analysis of the sanitation microfinance market.

Review of Results-Based Financing (RBF) Schemes in WASH: A Report to Bill and Melinda Gates Foundation, 2015. Castalia Strategic Advisors. Link
This report investigates what works where, and why, in results-based financing (RBF) in WASH. In so doing, it also uncovers what does not work. It aims to create guidance for future interventions and identify areas for further research. RBF is an aid mechanism where payments are made upon verification of the delivery of desired outputs, or the performance of desired behaviors.

CO2 and H2O: Understanding Different Stakeholder Perspectives on the Use of Carbon Credits to Finance Household Water Treatment Projects. PLoS One, April 2015. S Summers. Link
Carbon credits are an increasingly prevalent market-based mechanism used to subsidize household water treatment technologies. This involves generating credits through the reduction of carbon emissions from boiling water by providing a technology that reduces greenhouse gas emissions linked to climate change. This study explores the perspectives of carbon credit and WASH experts on household water treatment carbon credit projects.

Pump-Priming Payments for Sustainable Water Services in Rural Africa. World Development, Oct 2015. J Koehler. Link
Using unique observational data from monitoring hand pump usage in rural Kenya, the authors evaluate how dramatic improvements in maintenance services influence payment preferences across institutional, operational, and geographic factors. Public goods theory is applied to examine new institutional forms of hand pump management. Results reveal steps to enhance rural water supply sustainability by pooling maintenance and financial risks at scale supported by advances in monitoring and payment technologies.

Mapping Current Incentives and Investment in Viet Nam’s Water and Sanitation Sector: Informing Private Climate Finance, 2015. N Trujillo, ODI. Link
This report summarizes findings from the application of a diagnostic tool as a first step to support governments and other stakeholders seeking to design interventions to mobilize private finance for climate-compatible development. Using this diagnostic tool in Vietnam’s water and sanitation sector allowed the authors to make two distinct sets of findings that are useful for actors who want to mobilize private climate finance.

Direct Support Post-Construction to Rural Water Service Providers, 2015. P McIntyre.Link
Community-based service providers need regular, structured support that goes beyond ad hoc technical assistance. Support can come from local government, central government, NGOs, or associations of service providers, or combinations of the above. Findings suggest that effective direct support costs in the range of US $1 to $3 per water user per year.

Economic Assessment of Sanitation Interventions in Southeast Asia: A Six-Country Study Conducted in Cambodia, Indonesia, Lao PDR, the Philippines, Vietnam and Yunnan Province (China) under the Economics of Sanitation Initiative, 2015. Water and Sanitation Program. Link
The type of sanitation evaluated in this study was human excreta management at the household level, focusing on both onsite and off-site sanitation options. Basic hygiene was also included, insofar as it affects health outcomes and intangible factors. In addition to human excreta management, the study considered interventions jointly addressing human waste with domestic wastewater management (especially in urban areas) and animal waste management (in the case of biogas generation).

Triggering Increased City-Level Public Finance for Pro-Poor Sanitation Improvements: The Role of Political Economy and Fiscal Instruments, Dec 2014. J Boex. Link
The goal of this background paper is to provide a general framework for understanding the political economy and fiscal determinants of sanitation service provision by urban local governments. The paper will review existing literature to begin answering several questions: what do we expect to influence spending on local sanitation? Do different fiscal instruments have an impact on expenditure levels? Do increased local revenues lead to increased expenditures over the long term? What role do different stakeholders play in determining expenditure levels?

Filed under: Economic Benefits Tagged: financing


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