Please join the USAID Water Office for this first in a series of webinars to better understand the USAID Water and Development Strategy and how its principles provide the foundation for Agency water programming.
The first webinar on April 28, 10:00-11:00 am EDT, will focus on Sanitation, with presentations by USAID’s Katy Sill and Jesse Shapiro to discuss: the impacts of sanitation, critical challenges to improving sanitation, the sanitation ladder and service chain, and programmatic interventions to improve sanitation.
Register for the webinar at: http://irgltd.adobeconnect.com/e7sfvzo6b16/event/registration.html
USAID’s Water and Development Strategy seeks to improve health outcomes through the provision of sustainable water supply, sanitation and hygiene (WASH) and enhance food security through the sustainable and more productive management of water in agriculture. This webinar series will include sessions on Sanitation, WASH and Nutrition, Sustainability of WASH Services, Drinking Water Quality, and Agricultural Water Management.
For additional information and a full list of webinars in the series, see the attached flyer, or visit the Water Strategy Webinar Series webpage.
Filed under: Progress on Sanitation, Sanitation and Health, Uncategorized Tagged: USAID, webinars
Editorial – Is it possible to reach low-income urban dwellers with good-quality sanitation? (Full text) by David Satterthwaite, Diana Mitlin, and Sheridan Bartlett.
Container-based sanitation: assessing costs and effectiveness of excreta management in Cap Haitien, Haiti. (Full text) by Sebastien Tilmans, Kory Russel, Rachel Sklar, Leah Page, Sasha Kramer, and Jennifer Davis.
Container-based sanitation (CBS) – in which wastes are captured in sealable containers that are then transported to treatment facilities – is an alternative sanitation option in urban areas where on-site sanitation and sewerage are infeasible. This paper presents the results of a pilot household CBS service in Cap Haitien, Haiti. We quantify the excreta generated weekly in a dense urban slum,(1) the proportion safely removed via container-based public and household toilets, and the costs associated with these systems. The CBS service yielded an approximately 3.5-fold decrease in the unmanaged share of faeces produced, and nearly eliminated the reported use of open defecation and “flying toilets” among service recipients. The costs of this pilot small-scale service were higher than those of large-scale waterborne sewerage, but economies of scale have the potential to reduce CBS costs over time. The paper concludes with a discussion of planning and policy implications of incorporating CBS into the menu of sanitation options for rapidly growing cities.
Filed under: Uncategorized Tagged: drainage
Encouraging sanitation investment in the developing world: A cluster-randomized trial. Science, April 2015, DOI: 10.1126/science.aaa0491
Authors: Raymond Guiteras1, James Levinsohn2, Ahmed Mushfiq Mobarak2,*
+ Author Affiliations
1Deptartment of Economics, University of Maryland, College Park, MD 20742, USA.
2School of Management, Yale University, New Haven, CT 06520, USA.
↵*Corresponding author. E-mail: firstname.lastname@example.org
Poor sanitation contributes to morbidity and mortality in the developing world, but there is disagreement on what policies can increase sanitation coverage. To measure the effects of alternative policies on investment in hygienic latrines, we assigned 380 communities in rural Bangladesh to different marketing treatments—community motivation and information; subsidies; a supply-side market access intervention; and a control—in a cluster-randomized trial.
Community motivation alone did not increase hygienic latrine ownership (+1.6 percentage points, p=0.43), nor did the supply-side intervention (+0.3 percentage points, p=.90). Subsidies to the majority of the landless poor increased ownership among subsidized households (+22.0 percentage points, p<.001) and their unsubsidized neighbors (+8.5 percentage points, p=.001), which suggests investment decisions are interlinked across neighbors. Subsidies also reduced open defecation by 14 percentage points (p<.001).
Filed under: Economic Benefits Tagged: sanitation investment
Recognition of the human rights to water and sanitation by UN Member States at the international level
All UN Member States have recognised that the human right to water and the human right to sanitation are part of binding international human rights law.
This publication gathers the evidence of the universal recognition of the human rights to water and sanitation: it gives an overview of the most important resolutions and declarations that recognise the human rights to water and sanitation, including the positions that individual states have taken when those documents were adopted. For 77 countries, it also lists their individual positions and how these have changed over time.
The document has previously served as an internal reference guide for Amnesty International and WASH United. We are publishing it to help others identify the position that their country has taken on the human rights to water and sanitation, to advocate for the rights in their own national contexts, to ensure that these rights will not be ignored in the formulation and implementation of national water and sanitation laws and policy, and to help advance strategic litigation before national, regional and international justice mechanisms.
Gonzalez, C., Khalfan, A., Lande, L. van de, Neumeyer, H. and Scannellad, P., 2015. Recognition of the human rights to water and sanitation by UN Member States at the international level : an overview of resolutions and declarations
that recognise the human rights to water and sanitation. London, UK and Berlin, Germany: Amnesty International and WASH United. 124 p.
Filed under: Policy, Publications Tagged: Amnesty International, right to sanitation, right to water, WASH United
Webinar: ‘Results based financing for sanitation – do the costs outweigh the benefits?’ – 29 April 2015, Sustainable Sanitation Alliance
A webinar on ‘Results based financing for sanitation – do the costs outweigh the benefits?’ will take place on Wednesday 29th April 2015 at 13:00 (UTC/GMT). Three speakers with very different backgrounds will discuss what, from their perspectives, we know and don’t know about the questions “Do the costs outweigh the benefits of results based financing for sanitation, and what are the right conditions for it to work?”
This webinar will have ample room for discussions and inputs by the participants. Each of the speakers will only give short (5 minutes) inputs to set the scene. The panel of speakers includes:
- Minh Chau and Per Ljung of Thrive Networks (formally East Meets West), speaking on their Community Hygiene Output Based Aid (CHOBA) Program in Vietnam. Minh Chau is now with Results for Development Institute in the U.S.
- David Erdhart and Will Goldenberg of CASTALIA Strategic Advisors (U.S.) speaking on their review of Results Based Financing in WASH.
- Robert Chambers, Institute of Development Studies (UK) offering his views on a wider development perspective on Results Based Financing.
This webinar, open to all, is being organised under the Bill & Melinda Gates Foundation’s Knowledge Management initiative for their Building Demand for Sanitation (BDS) program. It is supported by Stockholm Environment Institute and the Sustainable Sanitation Alliance (SuSanA) secretariat.
To find out more or to join the discussions that will take place before and after the webinar, please click here.
To register please click here.
Webinar moderation / organisation: Peter Feldmann / Pippa Scott, both with Euforic Services, UK
Webinar technical host: Arno Rosemarin (SEI, Sweden)
Filed under: Uncategorized
Orlando Hernandez – Behavioral Challenges and Potential Solutions to Reach Universal Sanitation Coverage
Behavioral Challenges and Potential Solutions to Reach Universal Sanitation Coverage by Orlando Hernandez, USAID/WASHplus Project and Senior Monitoring and Evaluation Advisor, Global Health, Population and Nutrition (GHPN), FHI 360.
The comments below are from Dr. Hernandez’s participation at the World Water Forum 2015 and then posted to the Sanitation and Water for All website.
Behavior change specialists rely on frameworks to dissect a problem and define a strategy to address it. The Water Improvement Framework (WIF), previously named the Hygiene Improvement Framework (HIF) developed in connection to USAID WASH projects some 15 years ago, is one such framework. Given its openness and comprehensiveness, the WIF has stood the test of time. Other donors and implementation agencies are thinking along the same lines as there are other similar frameworks developed by WSP, SVN, the London School of Hygiene and Tropical Medicine, among others.
The WIF is a three-legged stool which brings together: 1) supply, 2) demand, and 3) the enabling environment. It suggests that behavior change (BC) strategies are more than mere promotion, channels and messages. They bring a human dimension to the WASH sector, and when based on the WIF’s the three elements, it guides us to design, implement and evaluate WASH activities.
Behavior change frameworks require us to segment our audiences as social groups involved in development are not monolithic. One obvious breakdown in sanitation is a split between urban, peri-urban and rural dwellers. The needs, preferences, sanitation practices and certainly resources of urban, peri-urban and rural populations may be different. With growing urbanization throughout the developing world, coverage in peri-urban areas represent a challenge, especially when we think of tenants living in crowded quarters with no services.
Addressing appropriate sanitation practices in peri-urban areas will require appropriate sanitation options that would allow peri-urban residents to dispose safely of human feces. There are recent innovations which make us think about the importance of ‘human centered design’ for identifying effective supplies and products required to carry out an action. A first step in behavior change is to have the right enabling products as well as the needed access to such a product that a targeted population needs to have in order for a promoted practice to occur.
Sanivation in Kenya, for example, has developed the Blue Box. This is a container-based toilet that is placed in any room in someone’s home and serviced regularly by Sanivation’s Toilet Service Representatives. Sanivation then transforms the collected material in high-performing charcoal briquettes, which are resold on the market. Blue Box clients get a toilet and services to remove fecal matter from their homes for US$7/month.
This approach is based on research suggesting that 50% of Kenyans were planning to invest in improved sanitation, but that many of those living in peri-urban settings may be paid monthly salaries and could have no savings to construct a toilet, may have no space to build a latrine, or be moving away to another location in the near future and do not want to make permanent home sanitation improvements that would be forced to leave if and when they do move. The Blue Box toilet relies on a subscription service, has come to be perceived as a status symbol, and has a marketing strategy that relies heavily on word of mouth. There are other similar options to – dwellers: loowatt in Madagascar, Sanergy also in Kenya, etc.
We are probably all too familiar with the experience of easy latrine in Cambodia designed also using human centered design principles by iDE to come up with a toilet that responded to sanitation needs and preferences of rural residents. Three principles guided the design of these toilets as products that will be purchased by consumers to satisfy their needs. These principles can be referred to as those that meet the three A’s of a marketable product: aspirational, accessible and affordable. Cambodia was a country with 20% rural sanitation coverage when the work of IDE started.
Formative research conducted identified the characteristics of an attractive rural sanitation option. These rural consumers were interested in having a pour flush toilet with an off-set pit and a concrete superstructure that may constructed in due time once resources become available. Such a product was baptized as the easy latrine and ended up being the appropriate technological option for rural Cambodian households. Project implementers in Cambodia resolved production and supply chain issues and more quickly than expected sales and coverage increased considerably.
Universal coverage requires eliminating open defecation as a first step, and such a goal will not be achieved if open defecation is not eradicated in large countries, including India. The Government of India has a program that subsidizes latrines so households have no economic barriers to overcome in order to have latrines at home. Subsidies resolve an important barrier helping to increase access. However, access is a necessary but not a sufficient condition for use of an installed technology to use.
Access does not mean use or correct use. The Research Institute of Compassionate Economics (RICE) at Emory University, with Gates funding, has clearly demonstrated the multiple motivational barriers have to be overcome especially in Northeast India to get people that may have latrines constructed at home at the government’ s expense to accept having them installed, and also in using them.
The research conducted by RICE at Emory has demonstrated that family members in rural settings have morning walks, leaving home to breathe clean air in the woods as they wake up, and that at the end of their walk they defecate before returning home. In addition to enjoying a morning walk, there is a preference to leave their fecal matter away from home. We will be challenged to bring human centered design to address not only the specifications of on-site sanitation, but possible the characteristics of off-site sanitation.
Perhaps we need to think about the possibility of setting up public toilets in current open defecation sites. I know that off-site defecation may not be counted as part of meeting universal coverage, but we may forced to expand our definitions to take into account special circumstances affecting millions of people.
Rural sanitation offers other challenges that we should be prepared to address, even we have detected the appropriate technology as was the case in Cambodia. CLTS has been used in many countries, supported by donors and adopted by many public and private implementing agencies. However, it is an approach that is implemented in different phases including pre-triggering, triggering, adoption, sanitation facilities construction and certification.
It is certainly an approach that requires considerable institutional implementation capacity in addition to involvement of central and local government officials, community mobilizers, masons, lenders, etc. It is also an approach that moves at its own pace, village by village. The presence of multiple villages will require multiple implementation teams. I should add that participatory approaches are likely to be more effective than top down approaches that offer cookie cutter solutions.
A review of rural sanitation programs implemented in the past few years in Latin America has demonstrated that even when institutional capacity is in place, solutions exclusively from the desk of technicians that do not incorporate community members to the process of change may backfire.
Now, let me turn to a related topics: consistent use over time for all family members. Implementers of CLTS programs in multiple countries over time are beginning to generate data that helps to see what even when there is the right technology and the right institutional support to increase coverage, we may be confronted with the problem of recidivism.
Some of these implementing agencies are indicating that in some instances up to 30% of households with sanitation coverage may come back to open defecation . So, one challenge is how to make sure that family members continue to use available sanitation over the long run. We will also be concerned with the fact that the feces of all family members should be disposed of hygienically.
And in this regard, the disposal of child feces will emerge as a larger challenge than we think. Families that have access to sanitation facilities should use them to dispose of child feces. Some studies in which I have been involved open the door suggest that this is not necessarily done. If there is recidivism among adult family members, there may not be consistent hygienic disposal of the feces of younger family members, even when latrines are available.
Habit formation concepts are beginning to offer a new way of thinking regarding consistent use of a practice over time. They suggest that to instill sticky habits we must help construct routines that are driven by external cues and are repeated over time automatically.
Settings must be stable so that external cues remain constant. In addition, habit formation principles suggest that we must try to piggyback practices onto existing habits. Studying what sequence of events occur when we engage in cleaning up a child may help identify how the appropriate disposal of these feces can be integrated to such a sequence.
Universal coverage often means on-site sanitation for households. However, there is a homeless population of over a billion individuals in the world, data that was recently shared with be by a colleague from Bangladesh attending this forum.
But if the current proposal stands, the Sustainable Development Goals will define universal sanitation including both households and institutional settings, namely schools and health facilities. The WIF can be of use when deciding how to tackle behavioral issues in school populations and clients and staff at health facilities.
The health and nutrition and nutrition benefits of WASH investments may not be reached if we ignore handwashing with soap at critical junctures, before handling food and after potential contact with fecal matter. Future handwashing promotion programs targeting households should focus on having households set up permanent handwashing stations near toilets or places where food is handled, and ensuring that these stations are duly supplied with soap and water, if no tap are available.
The challenges presented by handwashing promotion are large, but it has been done for a long time now and we have different ways of tackling them. That, nevertheless, is a different discussion that we can pursue at another time.
I hope that these remarks help us have an eagle’s view at the behavior change challenges ahead of us and some potential ways to address them. We must be open to technological innovations but also to innovative behavior change approaches and new ways of tracking our achievements. I also hope that it stimulates your thinking and generates discussion.
Filed under: Hygiene Promotion Tagged: behavior change
SHARE – A New Training Guide on Menstrual Hygiene Management, 2015. | Source: SHARE website, April 13, 2015 |
SHARE and MHM
SHARE has long been endeavouring to address the research gaps relating to MHM. In 2012 we published the Menstrual Hygiene Matters manual which features examples of good MHM practice and offers guidance on building competence and confidence to break the silence surrounding the issue, and in 2013 we supported a systematic review exploring the health and social effects of MHM.
Developed by WaterAid, this new training guide is our latest contribution to building the knowledge base around MHM and raising awareness of the issue globally. It builds on the Menstrual Hygiene Matters manual and presents a range of plans, handouts, presentations and films that a facilitator could use when facilitating sessions or workshops on MHM amongst development practitioners. These interactive plans and accompanying resources explore the key issues and components of MHM programmes and can be adapted depending on the context, participants and time available.
The guide in action
The training guide and its various components were tested by WaterAid in its country programmes, with local staff and (I)NGOs, and at international training forums and conferences such as the 2014 Brisbane WASH Conference.
We hope that it will be an invaluable tool to those wishing to integrate MHM into their development programming.
If you use the training the guide or the resource book to complement your programming, we’d love to hear from you. Please get in touch to tell us what you thought: email@example.com
• Download the Training Guide
• View the Menstrual Hygiene Matters manual
• Check out the training tools in action at Brisbane
• Read the systematic review
• Find out more about our work on MHM
Filed under: Uncategorized Tagged: menstrual hygiene
Today sees the launch of Public Finance for WASH, a research and advocacy initiative aiming to increase awareness of domestic public finance and its critical importance for water and sanitation provision in low-income countries. Check out our website www.publicfinanceforwash.com.
This is a collaborative initiative between IRC, Water & Sanitation for the Urban Poor (WSUP), and Trémolet Consulting. A key aim is to offer easy-to-read but rigorous information about domestic public finance solutions: our first three Finance Briefs are now available for download from our website, and over the coming year we will be building a comprehensive resource library.
And just to make sure we’re on the same page: what exactly is domestic public finance? Essentially, it’s money derived from domestic taxes, raised nationally (e.g. by the Kenyan government) or locally (e.g. by Nairobi’s municipal government). This money is going to be critical for achieving the water and sanitation SDGs: so how can we all work together to ensure that what we’re doing is supporting (not inhibiting) the development of effective public finance systems? And how can public finance be spent in ways that catalyse the development of dynamic markets for water and sanitation services?
To find out more, please check out the website. If you’d like to become involved in any way, get in touch!
Filed under: Africa, East Asia & Pacific, Europe & Central Asia, Funding, Latin America & Caribbean, Policy, Publications, Sanitation and Health, South Asia, Web sites Tagged: finance, publicfinance, rural sanitation, sanitation, urban sanitation, water
But, around the world, one in every 50 births leads to heartbreak for parents, as their precious newborn son or daughter will die before they are a month old.
In 2013, over 2.7 million babies died in their first four weeks of life. This is overwhelmingly a problem of the developing world – with over 99% of neonatal deaths occurring in low and middle income countries.
In the year the world replaces the Millennium Development Goals with the Sustainable Development Goals, it is time to ensure that the next generation of children is given the best start in life – a healthy start.Download
- Healthy Start: the first month of life >
- Un départ sain: le premier mois de la vie >
- Começo saudável: o primeiro mês de vida >
Filed under: Uncategorized
As part of the AfricaSan 4 conference convened by the Government of Senegal from May 25th – 27th, 2015 in Dakar, the African Ministers’ Council on Water (AMCOW) is pleased to invite entries for the AfricaSan Awards 2015.
The awards are dedicated to recognizing outstanding efforts and achievements in sanitation and hygiene in Africa which result in large-scale, sustainable behavior changes and tangible impacts. The aim is to raise the profile of sanitation and hygiene by drawing attention to successful approaches, promoting excellence in leadership, innovation and sanitation and hygiene improvements in Africa.
The awards are open to all individuals and institutions working in the sanitation and hygiene sector from countries of each award region.
The Technical Committee has streamlined the AfricaSan Awards to cover the critical sectors of the sanitation sector. The 2015 Awards will be in the following categories:
- RESEARCH & TECHNICAL INNOVATION: to honour individuals and institutions who through research and development have contributed to the improvement of technical solutions for sanitation services and products to make them affordable, reliable, and sustainable.
- YOUTH AWARD: to honour exceptional youth (under the age of 25) or agencies that promote water and sanitation that affect youth, whose work has/have made a significant impact upon children or youth.
- LOCAL GOVERNMENT LEADERSHIP AWARD: to honour outstanding local government or utility leadership whose policies or actions have promoted innovation, enhanced capacity, mobilized resources or generally created an enabling environment for improvement in sanitation delivery.
- HYGIENE AWARD: to be awarded to individuals or agency/business with outstanding initiatives or progress to promote good hygiene in relation to water and sanitation.
- IMPACT AT SCALE AWARD: presented in recognition of outstanding initiatives with impact at a significant scale (i.e. city-scale; district-scale, country-scale)
- INTEGRITY AWARD: presented to individuals or agencies that have made extraordinary progress in fighting corruption and improving governance or transparency in sanitation or hygiene service delivery.
Filed under: Uncategorized
Antananarivo – March 25, 2015 — Today, a high-level delegation of global sanitation and hygiene experts arrived in Madagascar for the biannual Steering Committee meeting of the Water Supply and Sanitation Collaborative Council (WSSCC), a United Nations body devoted solely to the sanitation and hygiene needs of vulnerable and marginalized people around the world.
During the visit, the Steering Committee will see WSSCC’s Global Sanitation Fund (GSF) programme in Madagascar, locally known as the Fonds d’Appui pour l’Assainissement (FAA), in action. Developed and guided strategically by a diverse group of national stakeholders, the FAA is facilitated by Medical Care Development International (MCDI) and implemented by 30 sub-grantee organisations. It has evolved into a driving force in the national movement to end open defecation, which adversely affects the health, livelihood and educational opportunities for 10 million people in Madagascar and some 1 billion worldwide.
The five-day Steering Committee visit is dedicated to reinforcing the country’s top-level political commitment to a new “National Road Map” for the water, sanitation and hygiene sector that aims to end open defecation (ODF) in Madagascar by 2019. Madagascar’s most senior politicians, including President Hery Rajaonarimampianina, Prime Minister Jean Ravelonarivo, the President of the National Assembly, and Dr. Johanita Ndahimananjara, Minister of Water, Sanitation and Hygiene, have committed their support to achieving ODF status.
“Since 2010, Madagascar has made tremendous progress in ensuring access to basic sanitation for the rural population of the country, by introduction and scaling up of Community Led Total Sanitation (CLTS),” said Dr. Chris W. Williams, Executive Director of WSSCC. “Nearly 1.4 million people now live free of open defecation in over 10,900 communities throughout the country, one of the best examples of how individual and local initiative can lead to collective, transformative change for an entire country.”
The visit also coincides with heightened global awareness of sanitation in 2015. The United Nations Secretary General and Deputy-Secretary General have launched a Call to Action on Sanitation, encouraging global institutions, governments, households, the private sector, NGOs, and Parliamentarians, to eradicate the practice of open defecation.
“FAA has become an important catalyst for the initiation and creation of a national, regional and local movement in favour of eliminating open defecation,” said Dr. Rija Lalanirina Fanomeza, GSF Programme Manager, MCDI. “A wide spectrum of sanitation and hygiene stakeholders in Madagascar are actively collaborating to have maximum impact on the ground.”
Ever since President Rajaonarimampianina’s government came into power in January 2014, sanitation has received special attention, and the need for achieving an open-defecation free Madagascar has been considered inevitable by the highest political leadership of the nation.
During the visit, the delegation will visit villages which are now free of open defecation, and those that are not, in order to gain a firsthand understanding of the how and why people change and sustain their sanitation and hygiene behaviours.
Filed under: Uncategorized
Thursday, March 26th SuSanA will host a webinar on “Broadening the Horizon of Sanitation Monitoring : Operationalising the Sanitation Ladder in Post-2015”
On Thursday, March 26 at 15:00-15:45 CET, the Sustainable Sanitation Alliance (SuSanA) will host a webinar on the topic of “Broadening the Horizon of Sanitation Monitoring: Operationalising the Sanitation Ladder in Post-2015”. Registration for the webinar will take place here: http://www.susana.org/en/webinar-registration.
This webinar is a follow-up to “The Sanitation Ladder: Next Steps”, the first thematic discussion in SuSanA’s new Thematic Discussion Series. This 3-week thematic discussion (from Feb 9-27) had lively discussions on the development of the sanitation ladder and a functions-based ladder, the post-2015 agenda and monitoring challenges, and the way forward. A synthesis of the discussion can be found here.
The 45-minute webinar will feature a short summary of the thematic discussion, then two leading questions will be provided for discussion, with input from the Thematic Leads Elisabeth Kvarnström and Ricard Gine, and the floor will then also be opened to input and questions from those in attendance.
For any questions, please post on the discussion forum or contact us at firstname.lastname@example.org.
We look forward to your input and involvement in the webinar!
Filed under: Uncategorized
The role of water, sanitation, and hygiene in reducing schistosomiasis: a review. Parasites & Vectors, March 2015.
Authors: Jack ET Grimes, David Croll, et al
Schistosomiasis is a disease caused by infection with blood flukes of the genus Schistosoma. Transmission of, and exposure to, the parasite result from faecal or urinary contamination of freshwater containing intermediate host snails, and dermal contact with the same water. The World Health Assembly resolution 65.21 from May 2012 urges member states to eliminate schistosomiasis through preventive chemotherapy (i.e. periodic large-scale administration of the antischistosomal drug praziquantel to school-aged children and other high-risk groups), provision of water, sanitation and hygiene (WASH) and snail control.
However, control measures focus almost exclusively on preventive chemotherapy, while only few studies made an attempt to determine the impact of upgraded access to safe water, adequate sanitation and good hygiene on schistosome transmission. We recently completed a systematic review and meta-analysis pertaining to WASH and schistosomiasis and found that people with safe water and adequate sanitation have significantly lower odds of a Schistosoma infection. Importantly though, the transmission of schistosomiasis is deeply entrenched in social-ecological systems, and hence is governed by setting-specific cultural and environmental factors that determine human behaviour and snail populations.
Here, we provide a comprehensive review of the literature, which explores the transmission routes of schistosomes, particularly focussing on how these might be disrupted with WASH-related technologies and human behaviour. Additionally, future research directions in this area are highlighted.
Filed under: Uncategorized
A new report by the World Health Organization (WHO and Unicef provides an “alarming picture of the state of WASH in health care facilities”.
Drawing on limited data from 54 low- and middle-income countries the report concludes that 38% of the facilities lack access to even rudimentary levels of water, 19% lack sanitation and 35% do not have water and soap for handwashing.
In addition, “training and capacity building to ensure there are sufficient resources and personnel to operate and maintain WASH facilities and enable health care staff to deliver hygiene behaviour change messages is urgently needed”, the report says.
“While the situation appears bleak, there are a number of global initiatives for which WASH in health care facilities is a foundational element and examples of national governments taking the initiative to improve standards, implementation and monitoring”, the report concludes. Through coordinated, global action, with leadership from the health sector, WHO and Unicef believe that all health care facilities can have adequate WASH services.
Besides the full report, you can also download:
- 10 key findings
- Q&A on WASH in health care facilities
- Simple solution improves water and sanitation in Zambian health-care facilities
Cronk, R. & Bartram, J., 2015. Water, sanitation and hygiene in health care facilities : status in low and middle income countries and way forward, Geneva, Switzerland: World Health Organization (WHO) and Unicef. x, 38 p. : 8 boxes, 2 fig, 8 tab. Avaialable at:
Filed under: Hygiene Promotion, Publications Tagged: health care facilities, unicef, World Health Organization
In connection with last week’s WSSCC-UN Women side event on the Commission on the Status of Women, WSSCC Executive Director published a new blog on the Huffington Post. It begins:
“In 1995, global rights activists sent a powerful message about the urgent need for gender equality in political, civic, economic, cultural and social life. Two decades later, women and girls have made powerful strides in closing the gender gap.”
Read the full article at:
Filed under: Uncategorized Tagged: gender, menstrual hygiene, sanitation
New York, NY, March 13, 2015 — Today the Water Supply and Sanitation Collaborative Council (WSSCC) and UN Women revealed that women and girls in Central and West Africa lack access to clean water, private spaces for managing their menstruation, and clean, functioning toilet facilities. In a series of studies, developed within the Joint Programme on Gender, Hygiene and Sanitation in West and Central Africa, researchers drew upon the Sustainable Development Goals (SDGs) prepared by the Open Working Group and the Secretary General’s Synthesis Report on the Post-2015 development agenda.
The studies provide critical information about sociocultural taboos on menstrual hygiene and linked knowledge and practices in the region in order to highlight an area of global neglect with deleterious consequences for for the education, mobility and economic opportunity for women and girls, societies, and economies.
“Few people talk about how menstruation can be managed with dignity and safety,” said Dr. Chris Williams, Executive Director of WSSCC. “As a result of this, women and girls often choose to limit their cultural, educational, social and economic activities while menstruating, missing school, work and play.”
At an event hosted by the Permanent Missions of Singapore and Senegal to the United Nations, Government representatives, policymakers, researchers and development practitioners articulated the need to talk about this neglected area in women’s health and education- menstrual hygiene management. Informed by evidence from Central and West Africa, South Asia and wider, the discussion took stock of the gross neglect of this issue in awareness, policy, facilities and monitoring.
“There is a general culture of silence surrounding all aspects of menstruation,” said Dr. Josephine Odera, Regional Director and Representative of the UN Women Regional Office for West and Central Africa. “This silence is exacerbated by taboos and myths that perpetuate practices that women and girls believe and how they manage their menstruation from personal hygiene to the cleaning and disposal of used materials.”
Key findings from the reports included:
- At present, there are no public policies in West or Central Africa mentioning menstrual hygiene management. Although women manage the water, sanitation and hygiene services in their households and community and are key users as mothers and caregivers, they are not consulted in the design and maintenance elements of sanitation and water facilities. Since 2013, India’s sanitation policy and guidelines include menstrual hygiene management as a key element of the national campaign to achieve a clean India.
- A lack of information, inadequate sanitary infrastructure and the persistence of certain beliefs have a negative impact on girls’ education, on female health and on women’s potential for economic empowerment. Half of all schools surveyed in the Kedougou region of Senegal did not even have toilets and 96% of the women surveyed said they did not regularly go to work while they were menstruating.
- The majority of respondents in all regions surveyed said that toilets are the most common places for the disposal of used menstrual pads or cloths due to the absence of a waste management system.
- 90% of the women and girls interviewed in Kedougou have undergone female genital mutilations. Nearly a quarter of them reported infections during their menstrual period, suggesting a link between this practice and increased vulnerability to infections.
Key policy recommendations from the event include the following:
- Member states must break this silence, articulating menstrual needs in policies, budgets, programmes and monitoring systems and calling upon the global community to empower women and girls by guaranteeing safe menstrual hygiene management.
- Menstruation is an indicator of female health and vitality. Sexual and reproductive health and rights advocacy and programmes must ensure knowledge, safe conditions and dignity so that the trauma at puberty is replaced by pride and confidence.
- Citizens, the media, schools and colleges, health practitioners, mothers and fathers must talk about menstruation and enable safe, dignified management in order to replace shame with pride.
- Safe spaces for changing, cleaning and washing and drying at home, school, the market and work must be ensured for women and girls everywhere. This means changing the design, construction and maintenance of water, sanitation and hygiene facilities to serve a human lifecycle by age, gender and physical ability.
- Half of humanity is female. Women and girls menstruate as this enables them to have babies and reproduce humanity itself. The silence, taboos, and stigma linked to menstruation violates a host of human rights.
The Water Supply and Sanitation Collaborative Council is at the heart of the global movement to improve sanitation and hygiene, so that all people can enjoy healthy and productive lives. Established in 1990, WSSCC is the only United Nations body devoted solely to the sanitation needs of the most vulnerable and marginalized people. In collaboration with our members in 150 countries, WSSCC advocates for the billions of people worldwide who lack access to good sanitation, shares solutions that empower communities, and operates the Global Sanitation Fund, transform lives in developing countries through sustainable behaviour change.
Filed under: Uncategorized
Issue 181| March 6, 2015 | Community-Led Total Sanitation
This issue focuses on recent CLTS studies, reports, blog posts, and videos. Included is a new issue of Frontiers of CLTS on sustainability; reports on the health impacts of open defecation; videos and reports on CLTS programs in Ethiopia, Ghana, India, Indonesia, and Kenya; and other studies/resources.
Sustainability and CLTS: Taking Stock. Frontiers of CLTS: Innovations and Insights, Issue 4, Feb 2015. S Cavill. Link
There are multiple and complex challenges associated with achieving sustainability. Habits are hard to break and so sustainability of behavior change continues to be a major preoccupation. The CLTS and WASH communities need to continue to share learning and insights and to draw practical conclusions that lead to better practice. Action learning that is grounded in field realities, open-mindedness, mutual respect, and sharing is the way forward. The accessibility of the four evaluations in the opening pages of Frontiers sets a good precedent.
Other issues covered in this series of Frontiers of CLTS are: Issue 1: Participatory Design Development for Sanitation | Issue 2: How to Trigger for Handwashing with Soap | Issue 3: Disability—Making CLTS Fully Inclusive |
Webinar on Participatory Design Development for Sanitation – March 26, 2015, 6–8 a.m. EDT. Link
Ben Cole will be discussing his experiences in applying participatory design to accompany and extend Malawi’s national CLTS program since 2012. Participatory design is a natural extension to the processes applied in CLTS programs. Mr. Cole’s work in three rural districts of Malawi demonstrates the immense potential that participatory design can offer to CLTS programming. It offers a low-cost engagement tool that can support traditional follow-up approaches to CLTS programming.
Talking Shit: Is Community-Led Total Sanitation a Radical and Revolutionary Approach to Sanitation? Wiley Interdisciplinary Reviews: Water, Jan/Feb 2015. M Galvin.Link
In contrast to past approaches, one of CLTS’s main tenets is strictly no subsidies of finance or materials. In the absence of monitoring and evaluation systems, it is not clear whether its immediate achievements are sustainable. In addition to questioning its sustainability, it is essential to examine CLTS through the analytical lens of power dynamics and human rights.
Lessons from Pakistan’s Approach to Total Sanitation. CLTS Blog, Feb 2015. J Myers, CLTS Knowledge Hub. Link
Pakistan represents an excellent example of adaptations being made to the traditional CLTS process due to local conditions. It is due to conducting CLTS in areas recovering from the 2010 floods that some of these adaptations have been made.
Realizing the Right to Sanitation in Deprived Urban Communities: Meeting the Challenges of Collective Action, Coproduction, Affordability, and Housing Tenure.World Development, May 2015. G McGranahan, International Institute for Environment and Development (IIED). Link
Serious institutional challenges are associated with low-cost sanitation in deprived urban communities. These include a collective action challenge, a coproduction challenge, a challenge of affordability versus acceptability, and a challenge related to housing tenure. This paper examines these challenges, revealing both the importance of community-driven sanitation improvement and its difficulties. The nature of the challenges, and the means by which two successful community-driven initiatives have overcome them, suggest that while recognizing the human right to sanitation is important this should not be taken to imply that typical rights-based approaches are the appropriate means of realizing this right.
Why Do Sanitation Campaigns Fail? People, Spaces, Deliberation blog (The World Bank), Feb 2015. S Chattopadhyay. Link
This blog discusses the findings of a Lancet paper that looks at the impact of India’s Total Sanitation Campaign on the coastal Puri District in Odisha. The study found that the rural sanitation program did not reduce exposure to fecal matter. A few reasons for the failures demonstrated by the Odisha study: without total coverage, the gains from improved sanitation cannot be realized in a community. And unless all families adopt hygienic sanitation practices, a sanitation program will not make a dent in the incidence of disease prevalence.
The False Dichotomy Among Sanitation-for-All Advocates. People, Spaces, Deliberation blog (The World Bank), Feb 2015. S Chattopadhyay. Link
While sufficient evidence exists from locations using the CLTS approach that households construct latrines and start using them, little evidence is available showing that these latrines continue to be used in the long term. For instance, a study from Kenya, Uganda, Ethiopia, and Sierra Leone reveals a slippage rate of nearly 90 percent, meaning nearly 90 percent had gone back to unhygienic sanitation practices over a period of two years after the intervention. The study calls for identifying ways to help families upgrade their sanitation infrastructure alongside greater follow-up and continuous health messaging. CLTS does not address this infrastructure gap, neither does it support the poorest families in need of usable and lasting toilets.
What Explains Widespread Open Defecation in India? Links Between Widespread Open Defecation and Culture, 2015. S Vyas. Presentation
Caste, and concepts of purity and pollution, make India unique and pose particular challenges for use of simple latrines in rural north India.
The Asian Enigma: Exploring the Causal Linkages between Undernutrition and Insanitation in Children with Reference to India, 2015. F Kuriakose. Link
This paper proposes to trace the relation between undernutrition and insanitation in India and its effects on children under 5. The study is based on secondary data. Questions of nutritional sufficiency and sanitation facilities are examined in the theoretical framework of the Capabilities Approach developed by Amartya Sen and Martha Nussbaum. The paper concludes that universal access to sanitation is an integral step in eliminating nutritional deficiencies in children.
How Does Health Promotion Work? Evidence from the Dirty Business of Eliminating Dirty Defecation, 2015. P Gertler. Link
This study estimates the causal relationship between village open defecation rates and child height using experimentally induced variation in open defecation.
Triggering Five Pillars of Community Based Total Sanitation in Ende District–Indonesia, 2015. STBM Indonesia. Video
To change hygiene and sanitation behavior of the Tiwerea community in Ende District, Plan Indonesia collaborated with the district government to trigger community-based total sanitation (CBTS). This video shows the community going through each of the five pillars of the CBTS process.
Social Network Predictors of Latrine Ownership. Social Science & Medicine, 125 (2015). H Shakya. Link
Results show that, controlling for the standard predictors of latrine ownership such as caste, education, and income, individuals are more likely to own latrines if their social contacts own latrines. Interaction models suggest that this relationship is stronger among those of the same caste, the same education, and those with stronger social ties. The results suggest that interventions designed to promote latrine ownership should consider focusing on those at the periphery of the network. The reason is that they are less likely to own latrines and more likely to exhibit the same behavior as their social contacts, possibly as a result of the spread of latrine adoption from one person to another.
Can Smartphones Solve India’s Sanitation Monitoring Conundrum? WaterAid Blog, Jan 2015. A Hueso. Link
The new sanitation campaign in India, the Swach Bharat Mission, is about to bring some changes in terms of monitoring, primarily through the use of smarter technology, which will allow the inclusion of photographs and GPS geo-tags of the latrines that are being constructed in rural areas. This is intended to improve the accuracy of the monitoring system, which has been very poor in the past. But can smartphones really solve India’s sanitation conundrum?
2014 STUDIES AND RESOURCES
Urban Community-Led Total Sanitation (UCLTS), 2014. Plan India. Video
This case study is about a slum in Madanpur Khaddar in South Delhi. Plan India and its partner organization helped establish women’s groups to manage the community toilet, solid and liquid waste management, etc. Children’s groups were also created to monitor the hygiene practices and usage of facilities.
Community Led Total Sanitation in Keiyo North, Kenya, 2014. World Vision. Video
This video shows public health officers supported by World Vision Kenya conducting CLTS triggering at the Songeto/Rimoi Community Health Unit located in Keiyo North subcounty in Rift Valley Province.
Explaining Obstacles to ‘Total Sanitation’ in India with Spatial Methods: Evidence from the District Level Household Survey, 2014. G Pierce, University of California, Los Angeles. Link
Inadequate toilet use directly contributes to high rates of morbidity and mortality in India. Despite a strong research focus on sanitation solutions, understanding of the determinants of toilet use in India is remarkably poor. This paper uses spatial analysis techniques to explain variation in sanitation use at the district scale. A test of global spatial autocorrelation confirms that sanitation use is strongly clustered geographically, and spatial clustering remains robust after controlling for socioeconomic explanations. In addition to providing an empirical model of toilet use, this paper suggests that variation in regional adoption of use must be incorporated into future national program design.
Child Feces Disposal, 2014. Water and Sanitation Program; UNICEF. Link
Safe disposal of children’s feces is as essential as the safe disposal of adults’ feces. This series of country profiles provides an overview of the available data on child feces disposal in 26 locations. Each brief concludes with ideas to consider, based on emerging good practice.
Key Findings of a Sanitation Supply Chains Study in Eastern and Southern Africa, 2014. UNICEF. Link
While capacity and materials to provide sanitation services are generally available at district levels, provision of services to households at the community level remains fragmented. Prices for basic sanitation materials differ significantly between countries impacting product options and business models. Innovation in sanitation product design and availability is taking place, but there is room for more.
The Role of Local Government and Community Structures in Community Led Total Sanitation (CLTS) Monitoring, n.d. M Namwebe, Plan International. Link
Local level participatory monitoring has proven effective in tracking progress toward open defecation free (ODF) attainment and sustaining ODF status through the use of existing structures like the local government and community resource persons. Furthermore the linkage between monitoring at the local/program level and the government/national-led monitoring system has enhanced the keeping of real time data on ODF status in the country. In turn this has supported decision making and the feedback mechanism.
Filed under: Progress on Sanitation, Sanitation and Health Tagged: Community-Led Total Sanitation
Why Latrines Are Not Used: Communities’ Perceptions and Practices Regarding Latrines in a Taenia solium Endemic Rural Area in Eastern Zambia
Why Latrines Are Not Used: Communities’ Perceptions and Practices Regarding Latrines in a Taenia solium Endemic Rural Area in Eastern Zambia. PLoS Neg Trop Dis, Mar 2015.
Authors: Séverine Thys , Kabemba E. Mwape, et al.
Livestock owners from small scale farms are most vulnerable for Neglected Zoonotic Diseases (NZD) in developing countries and their risk behavior leads to more intense and complex transmission patterns. 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. However the socio-cultural determinants regarding its control remain unclear. We hypothesize that via a bottom-up culture-sensitive approach, innovative control strategies can be developed that are more adapted to the local reality and more sustainable than current interventions.
By assessing the communities’ perceptions, practices and knowledge regarding latrines in a T. solium endemic rural area in Eastern Zambia, we found that more than health, seeking privacy underlies motivation to use latrines or not. The identified taboos related to sanitation practices are in fact explained by the matri- or patrilineal descent and because men are responsible for building latrines, sanitation programs should focus more often on men’s knowledge and beliefs. In order to contribute to breaking the vicious cycle between poverty and poor health among livestock owners in developing countries, disease control strategies should always consider the socio-cultural context.
Filed under: Africa, Sanitation and Health Tagged: latrines, porcine cysticercosis, Zambia
How Bangladesh turns toilet waste into high-value compost – in pictures |Source: The Guardian, Feb 27 2015 |
Scientists in Bangladesh are working on ways to treat toilet waste in rural areas and use it to develop safe, nutritious compost for food crops. Led by the school of civil engineering at Leeds University, the Value at the End of the Sanitation Value-Chain (VESV) project aims to help reduce reliance on imported inorganic fertilisers and provide potential business opportunities for waste transporters and compost producers in a country where access to sanitation is now widespread but challenges of managing waste remain.
These bypass the problem of installing sewerage infrastructure in densely populated rural areas, but the challenge is what to do with the waste when the pits are full. If treated carefully, this waste could provide a local source of organic matter and plant nutrients such as nitrogen, potassium and phosphorus. All photographs by Neil Palmer/IWMI.
- See the rest of the photo essay.
Filed under: Research Tagged: Bangladesh, compost, excreta reuse
TROPICAL MEDICINE & INTERNATIONAL HEALTH – FEB/MAR 2015
To identify household-level factors associated with influenza among young children in a crowded community in Dhaka, Bangladesh. Case households were more likely than controls to have crowded (≥4 persons) sleeping areas and cross-ventilated cooking spaces. Case and control households had similar median 24-hour geometric mean PM2.5 concentrations in the cooking and sleeping spaces. Handwashing with soap was practiced infrequently, and was not associated with pediatric influenza in this community. Interventions aimed at crowded households may reduce influenza incidence in young children.
Getting the basic rights – the role of water, sanitation and hygiene in maternal and reproductive health: a conceptual framework. (Full text)
WASH affects the risk of adverse maternal and perinatal health outcomes; these exposures are multiple and overlapping and may be distant from the immediate health outcome. Much of the evidence is weak, based on observational studies and anecdotal evidence, with relatively few systematic reviews. New systematic reviews are required to assess the quality of existing evidence more rigorously, and primary research is required to investigate the magnitude of effects of particular WASH exposures on specific maternal and perinatal outcomes.
LANCET INFECTIOUS DISEASES – FEB 2015
Editorial – Prioritising clean water and sanitation (Free full text but registration required)
Sanitation is the single greatest human achievement with regard to health, yet in much of the world it is underappreciated or inaccessible. Talha Burki investigates. “Currently, the popular approaches to sanitation place a lot of responsibility on individuals and households and not as much on governments”, adds WaterAid’s Yael Velleman. In the UK, it was legislation that led to universal access to improved sanitation. “Ultimately, it was political will and public finance that pushed that drive—I wonder whether we now expect low-income countries to do something we have never done ourselves”, said Velleman. Pollock advocates a return to a health-for-all approach, attending to the building blocks of public health, such as sanitation and nutrition, and directing major investment into infrastructure and monitoring systems. “I can’t understand why we’re prioritising clinical trials in Africa, and not prioritising clean water”, she told The Lancet Infectious Diseases.
INT JNL ENV RES PUB HEALTH – FEB 2015
Inadequate water, sanitation and hygiene (WASH) represent an important health burden in the Philippines. The non-governmental organisation Fit for School intends to complement its handwashing programme in schools with sanitation interventions. The objectives of this mixed-method study therefore were to describe WASH practices and their impact on childhood diarrhoea in the Philippines, and to examine socio-cultural and environmental factors underlying defecation and anal cleansing practices in Northern Mindanao. When adjusting for non-modifiable factors, susceptibility and socioeconomic factors, WASH factors failed to show a statistically significant effect. Defecation and anal cleansing behaviours were constrained by the physical environment, particularly the lack of clean, safe, comfortable and private facilities. Individual determinants of behaviour were influenced by habit and motivations such as disgust, with some evidence of planned behaviour. Where available, water was the preferred material for anal cleansing. This study combines nationally-representative quantitative data with local in-depth qualitative insights, constituting critical formative research in the development of effective and appropriate interventions.
EPIDEMIOL INFECT – MAR 2015
Evaluation of the impact of a simple hand-washing and water-treatment intervention in rural health facilities on hygiene knowledge and reported behaviours of health workers and their clients, Nyanza Province, Kenya, 2008. (Full text)
Many clinics in rural western Kenya lack access to safe water and hand-washing facilities. To address this problem, in 2005 a programme was initiated to install water stations for hand washing and drinking water in 109 health facilities, train health workers on water treatment and hygiene, and motivate clients to adopt these practices. In 2008, we evaluated this intervention’s impact by conducting observations at facilities, and interviewing staff and clients about water treatment and hygiene. Of 30 randomly selected facilities, 97% had water stations in use. Chlorine residuals were detectable in at least one container at 59% of facilities. Of 164 interviewed staff, 79% knew the recommended water-treatment procedure. Of 298 clients, 45% had received training on water treatment at a facility; of these, 68% knew the recommended water-treatment procedure. Use of water stations, water treatment, and client training were sustained in some facilities for up to 3 years.
BMJ OPEN – FEB 2015
The prevalence of stunting ranged from 25% to 50% across the three studies. Compared with open defecation, household access to toilet facility was associated with a 16–39% reduced odds of stunting among children aged 0–23 months, after adjusting for all potential confounders. Household access to improved water supply or piped water was not in itself associated with stunting. The caregiver’s self-reported practices of washing hands with soap before meals or after defecation were inversely associated with child stunting. However, the inverse association between reported personal hygiene practices and stunting was stronger among households with access to toilet facility or piped water. Improved conditions of sanitation and hygiene practices are associated with reduced prevalence of stunting in rural India. Policies and programming aiming to address child stunting should encompass WASH interventions, thus shifting the emphasis from nutrition-specific to nutrition-sensitive programming. Future randomised trials are warranted to validate the causal association.
JNL WATER HEALTH – MAR 2015
Assessment of a membrane drinking water filter in an emergency setting – (Abstract/order info)
The performance and acceptability of the NeroxTM membrane drinking water filter was evaluated among an internally displaced population in Pakistan. The membrane filter and a control ceramic candle filter were distributed to over 3,000 households. Following a 6 month period, 230 households were visited and filter performance and use was assessed. Only 6% of the visited households still had a functioning filter, and the removal performance ranged from 80 to 93%. High turbidity in source water (irrigation canals) together with high temperatures, and large family size were likely to have contributed to poor performance and uptake of the filters.
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Dan Campbell, Knowledge Resources Specialist
Filed under: Hygiene Promotion, Research