Frontiers of CLTS Issue 4: Sustainability and CLTS- Taking Stock, 2015.
There have been several useful studies on sustainability that have highlighted some of the different aspects as well as the complexities involved. However, it is unclear how much of the learning from these studies has been built into current and future programming and practice.
Based on existing research and our own understanding, this issue of Frontiers of CLTS is an attempt at an up to date synthesis of where we are at the beginning of 2015.
In the issue, we identify some priority areas for learning: How to phase in sanitation marketing; Post-ODF engagement of government, NGOS, donors and others; How to ensure equity and inclusion; How to transform social norms; Monitoring, learning, changing.
Filed under: Uncategorized Tagged: CLTS, Community-Led Total Sanitation
Issue 179| Feb 20, 2015 | Focus on WASH & Nutrition
This weekly contains recent webinars, articles, and reports on issues related to WASH and nutrition integration. Included are a policy brief on food hygiene, a handwashing and sanitation study in Tanzania, an overview of the nutrition situation in Asia, a review of the health impact of household water treatment, and other resources.
Global Maternal Newborn Health Conference, Oct. 18–21, 2015, Mexico City. Link
The year 2015 is a critical milestone in international development: the deadline for the Millennium Development Goals (MDGs) and the anticipated adoption of an ambitious new agenda, the Sustainable Development Goals. This USAID– and Government of Mexico–sponsored conference will offer the first opportunity for the global maternal and newborn health communities to discuss and strategize the new goals. The conference will have a technical focus, highlighting strategies and lessons from programs, policies, research, and advocacy for improving both maternal and newborn health.
WEBINARS/BLOG POSTS/TRAINING MATERIALS
Integrating Safe Water, Sanitation, and Hygiene into Infant and Child Nutrition Programmes: A Training and Resource Pack for Uganda, 2014. WASHplus. Link
The overall objective of this resource pack is to facilitate the training of village health teams, community knowledge workers, peer support groups, and other outreach workers on how they can help household and community members overcome, or change, the many daily obstacles to improved water, sanitation, and hygiene (WASH) practices in the home.
Webinar on Multi-Sectoral Approaches to Improve Child Growth through WASH, Nutrition, and Early Childhood Development, Jan 2015. WASHplus; CORE Group; Clean, Fed & Nurtured. Link
WASHplus collaborated with the CORE Group’s Nutrition and Social and Behavior Change working groups to host a one-hour webinar on multisectoral approaches to improve child growth and development, with a focus on improving the community knowledge of practice and sharing integration efforts for early childhood development, nutrition, and WASH integration. The Clean, Fed & Nurtured community of practice explained why WASH, nutrition, and early childhood development should be integrated.
Progress in Reducing Child Under-Nutrition: Evidence from Maharashtra. Economic & Political Weekly, Jan 2015. S Jose. Link
Assessing the progress made in reducing under-nutrition among children who are less than 2 years old in Maharashtra between 2005–2006 and 2012, this article points out that child under-nutrition, especially stunting, declined significantly in the state during this period. It holds that this decline can be associated with the interventions initiated through the Rajmata Jijau Mother-Child Health and Nutrition Mission, which began in 2005, and that this indicates the critical role the state can play in reducing child under-nutrition in India.
Policy Brief: Complementary Food Hygiene—An Overlooked Opportunity in the WASH, Nutrition and Health Sectors, 2015. SHARE. Link
This policy brief highlights the often overlooked opportunity to improve health outcomes by addressing complementary food hygiene. It outlines SHARE’s contribution to narrowing the evidence gap concerning the relationship between food hygiene and child health, indicates opportunities for future research, and offers insights that could influence policy and improve programming in the WASH, nutrition, and health sectors globally.
WASH and Nutrition Case Studies, 2014. WASHplus. Link
These 12 case studies were collected as part of putting together a joint donor document on Integrating Water, Sanitation, and Hygiene into Nutrition Policies and Programmes, which will soon be published by UNICEF, USAID, and the World Health Organization. In selecting these case studies, priority was given to activities that achieved measurable nutrition-related impact.
Benefits and Costs of the Water Sanitation and Hygiene Targets for the Post-2015 Development Agenda: Assessment Paper, 2015. G Hutton, The World Bank. Link
Within the area of water and sanitation the targets with the highest benefit-cost ratio are: basic water and basic sanitation in rural areas and eliminating open defecation in rural areas. Other valuable targets in this focus area include: basic sanitation and basic water in urban areas.
Post-2015 Consensus: Water and Sanitation Perspective, 2015. D Whittington. Link
The author reviews the Guy Hutton assessment paper (above) and argues for a carefully done cost-benefit analysis to show that many WASH interventions are economically attractive investments.
Greater Investment in Water, Sanitation and Hygiene is Key to the Fight Against Undernutrition, 2015. C Denis, Action Contre La Faim. Link
The report concludes that the WASH sector must be funded at levels that reflect its impact on under-nutrition and that strategies and programs for fighting under-nutrition must incorporate a long-term multisector component that includes WASH targets and indicators.
Water, Sanitation and Hygiene: Determining a Health Goal that Works for All, 2015. WaterAid. Link
Access to basic drinking water, sanitation, and hygiene is vital to improving health and quality of life globally. As discussions on the post-2015 framework and the Sustainable Development Goals reach their crucial final phase, WaterAid is calling for WASH to be recognized as a key influential factor to be closely integrated into any health goal and priorities taken up by governments and civil society.
Promoting Handwashing and Sanitation Evidence from a Large-Scale Randomized Trial in Rural Tanzania, 2015. B Briceño, The World Bank. Link
This paper presents the results of two large-scale, government-led handwashing and sanitation promotion campaigns in rural Tanzania. For the campaign, 181 wards were randomly assigned to receive sanitation promotion, handwashing promotion, both interventions together, or neither. One year after the end of the program, sanitation wards increased latrine construction rates from 38.6 to 51 percent and reduced regular open defecation from 23.1 to 11.1 percent. Households in handwashing wards showed marginal improvements in handwashing behavior related to food preparation, but not at other critical junctures.
Culture and the Health Transition: Understanding Sanitation Behavior in Rural North India, 2015. D Coffey. Link
This paper draws on new qualitative and quantitative data to examine the cultural meanings of latrine use and open defecation. It finds that beliefs, values, and norms about purity and pollution of private spaces and of bodies help explain widespread open defecation, and that renegotiation of caste and untouchability complicates the adoption of simple latrine technologies.
Policy Memo on Toilet Technology & Culture, 2015. RICE Institute. Link
This notes asks why rural India has uniquely high rates of open defecation. It first explains that the “usual suspects”—GDP, poverty, education, water access—are not to blame for widespread open defecation in rural India. Second, it discusses how the sanitation technology used in rural India differs from the rest of the developing world—in short, very few rural Indian households use latrines with inexpensive underground soak pits. Third, it presents qualitative and quantitative evidence that Hindu practices of purity and pollution, as well as India’s unique history and renegotiation of untouchability, complicate the adoption of the kinds of simple, inexpensive latrines that have been used to reduce open defecation in other developing countries.
Nutritional Status of Women and Children: A 2014 Update on Nutritional Status by Sociodemographic and Water, Sanitation, and Hygiene (WASH) Indicators Collected in Demographic and Health Surveys, 2014. M Kothari, PATH. Link
To provide current context, this report looks at stunting in the framework of common WASH indicators. This report provides a descriptive analysis of the status of women and children in the context of nutrition, breastfeeding, complementary feeding, anemia, dietary diversity, and micronutrient supplementation. The report also provides information on the nutritional status of women and children, with data disaggregated by selected WASH indicators.
Large Decrease in Child Stunting in Bangladesh Despite Limited Improvement in Children’s Food Intake, 2014. M Jain, HarvestPlus, International Food Policy Research Institute. Link
Bangladesh recorded one of the fastest reductions in child stunting between 1997 and 2007. The author does a descriptive decomposition analysis of this rapid decrease, focusing on the role of nutrient intake relative to other important child health inputs, such as maternal health, sanitation, maternal education, and access to health services. Among other factors, maternal health and access to sanitation were found to be the largest drivers of the growth of children across time. Maternal education and access to health services also have a positive, but non-robust, association with growth.
Overview of the Nutrition Situation in 11 Countries in Asia, 2015. FANTA III. Link
FANTA conducted a critical review of the nutrition situation in 11 countries in Asia, which is presented by region (South-Central Asia and Southeast Asia) and by country. The two nutrition overview reports and 11 country profiles provide an in-depth analysis of the key drivers of malnutrition;,current statistical nutrition data and trends for each country, and recommendations for areas to invest in to improve nutrition.
Professor Cairncross at the STOP Stunting Conference, 2014. SHARE. Video
In this video Sandy Cairncross, SHARE research director, shares his thoughts on why reducing stunting is such a priority for South Asia. Professor Cairncross attended the STOP Stunting Conference in New Delhi (November 2014) to deliver a presentation on the links between sanitation and stunting.
Household Water Treatment and Safe Storage to Prevent Diarrheal Disease in Developing Countries. Current Environmental Health Reports, Jan 2015. T Clasen. Link
Household water treatment and safe storage, such as boiling, filtering, or chlorinating water at home, have been shown to be effective in improving the microbiological quality of drinking water. However, estimates of their protective effect against diarrhea, a major killer, have varied widely. While results may be exaggerated because of reporting bias, this heterogeneity is consistent with other environmental interventions that are implemented with varying levels of coverage and uptake in settings where the source of exposure represents one of many transmission pathways.
Household Sanitation and Personal Hygiene Practices are Associated with Child Stunting in Rural India: A Cross-Sectional Analysis of Surveys. BMJ Open, Feb 2015. J Rah. Link
Improved conditions of sanitation and hygiene practices are associated with reduced prevalence of stunting in rural India. Policies and programming that aim to address child stunting should encompass WASH interventions, thus shifting the emphasis from nutrition-specific to nutrition-sensitive programming. Future randomized trials are warranted to validate the causal association.
Risk Factors Associated with Recurrent Diarrheal Illnesses among Children in Kabul, Afghanistan: A Prospective Cohort Study. PLoS One, Feb 2015. A Aluisio. Link
Maternal handwashing and improved sanitation facilities were protective, and represent important prevention points among public health endeavors. The discrepancy between soap availability and use suggests barriers to access and knowledge, and programs simultaneously addressing these aspects would likely be beneficial. Enhanced maternal education and economic status were protective in this population, and these findings support multisector interventions to combat illness.
Age-Related Factors Influencing the Occurrence of Undernutrition in Northeastern Ethiopia. BMC Public Health, Feb 2015. A Degarege. Link
The objective of the current study was to assess the prevalence of under-nutrition in different age groups and examine the relationship of the disease to parasitic and socioeconomic factors among communities in Harbu Town, northeastern Ethiopia. The odds of under-nutrition significantly decreased with an increase in the age of individuals. The odds of under-nutrition in the 5 to 19 years age group was significantly higher in those who did not wash their hands before eating than in those who did. The prevalence of under-nutrition in children younger than 5 years was significantly lower in those whose families were educated and had a family size less than five compared to those with illiterate families and a family size greater than five.
Assessing Factors that Lead to Use of Appropriate Technology: Handwashing Stations in Mali, West Africa. Journal of Water, Sanitation and Hygiene for Development, In Press 2015. C Naughton. Abstract/Order info
This study presents results of a mixed methods approach and comprehensive monitoring strategy of five use variables (use of soap, handwashing station functionality, presence of cleansing agent including soap or white ash, ground wetness, and amount of water in the jug) over two years for 42–64 appropriate technology handwashing stations located in two communities in Mali. Six factors were studied as potentially critical for lasting use of handwashing stations (gender, educational training, water proximity, seasonality, wealth, and station adoption). Statistically significant results include: a 29 percent decrease in use of soap between the dry and rainy seasons; a 35 percent decrease in stations with cleansing agent (e.g., soap or white ash) present over one year; greater station use in wealthy households; and greater use of stations built by women in one community.
The WASH Approach: Fighting Waterborne Diseases in Emergency Situations.Environmental Health Perspectives, Jan 2015. W Nicole. Link
Poor hygiene and fecal contamination were major factors in one of the world’s biggest outbreaks of hepatitis E, which began in October 2007 and persisted for a couple of years. This outbreak affected camps for internally displaced persons (IDPs) in northern Uganda’s Kitgum District, infecting more than 10,000 people and killing 160, mostly pregnant women and young children. Other recent hepatitis E outbreaks have occurred among refugees and IDPs in Kenya, South Sudan, and Chad.
The Other Asian Enigma: Explaining the Rapid Reduction of Undernutrition in Bangladesh. World Development, Feb 2015. D Headey. Link
Although South Asia has long been synonymous with persistent and unusually high rates of child under-nutrition—the so called Asian Enigma—Bangladesh has managed to sustain a surprisingly rapid reduction in the rate of child under-nutrition for at least two decades. This unheralded success is investigated through a regression and decomposition analysis of changes in child growth outcomes across five rounds of Demographic and Health Surveys from 1997 to 2011. Among the findings: rapid wealth accumulation and large gains in parental education are the two largest drivers of change, though health, sanitation, and demographic factors have played significant secondary roles.
Hand-to-Mouth Contacts Result in Greater Ingestion of Feces than Dietary Water Consumption in Tanzania: A Quantitative Fecal Exposure Assessment Model.Environmental Science & Technology, Jan 2015. M Mattioli. Link
Contaminated drinking water and hands are two important environmental transmission routes of diarrhea-causing pathogens to young children in low-income countries. The objective of this research is to evaluate the relative contribution of these two major exposure pathways in a low-income country setting. The model outcome is a distribution of a child’s daily dose of feces via each exposure route. The model results show that Tanzanian children ingest a significantly greater amount of feces each day from hand-to-mouth contacts than from drinking water, which may help elucidate why interventions focused on water without also addressing hygiene often see little to no effect on reported incidence of diarrhea.
Reducing Child Undernutrition: Past Drivers and Priorities for the Post-MDG Era.World Development, Apr 2015. L Smith. Link
As the post-MDG era approaches in 2016, reducing child under-nutrition is gaining high priority on the international development agenda, both as a maker and marker of development. Revisiting Smith and Haddad (2000), this article uses data from 1970 to 2012 for 116 countries, finding that safe water access, sanitation, women’s education, gender equality, and the quantity and quality of food available in countries have been key drivers of past reductions in stunting. Income growth and governance played essential facilitating roles. Complementary to nutrition-specific and nutrition-sensitive programs and policies, accelerating reductions in under-nutrition in the future will require increased investment in these priority areas.
Seasonal Variation of Fecal Contamination in Drinking Water Sources in Developing Countries: A Systematic Review. Science of the Total Environment, May 2015. C Kostylaa.Abstract/order info
Accounting for fecal contamination of drinking water sources is an important step in improving monitoring of global access to safe drinking water. Fecal contamination varies with time while its monitoring is often infrequent. This study sought to understand seasonal trends in fecal contamination to guide best practices to capture seasonal variation and ascertain the extent to which the results of a single sample may overestimate compliance with health guidelines. The findings from 22 studies from developing countries were analyzed. Fecal contamination in improved drinking water sources was shown to follow a statistically significant seasonal trend of greater contamination during the wet season. This trend was consistent across fecal indicator bacteria, five source types, and across both rural and urban areas. Guidance on seasonally representative water quality monitoring by the World Health Organization and national water quality agencies could lead to improved assessments of access to safe drinking water.
WASHplus Weeklies highlight topics such as Urban WASH, Household Air Pollution, Innovation, Household Water Treatment and Storage, Hand Washing, 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 email@example.com.
Filed under: Sanitation and Health Tagged: WASH nutrition integration
President Mamnoon Hussain will inaugurate the 2nd Pakistan Conference on Sanitation (PACOSAN II) that is being held from 17-18 February 2015 at the Sareena Hotel in Islamabad.
Even though Pakistan has achieved a significant reduction in open defecation, it is still practised by 41 million people.
Filed under: Campaigns and Events, Progress on Sanitation, South Asia Tagged: PACOSAN, PACOSAN II, Pakistan
Sustainable Sanitation Alliance is holding a 3-week thematic discussion on the topic: the sanitation ladder
“The Sanitation Ladder: Next Steps” thematic discussion is the first discussion in the newly launched Thematic Discussion Series from the Sustainable Sanitation Alliance (SuSanA)!
This first thematic discussion is taking place from February 9-27 2015 on the SuSanA Discussion Forum. Up-to-date bi-weekly summaries of the discussions will be posted. On Thursday, February 20th, a webinar will be led by the thematic leads to discuss the key issues from the discussion. The exact time of the webinar will be posted next week.
The discussion focuses on the development of the sanitation ladder, the post-2015 agenda and monitoring challenges, and the way forward. Three thematic experts are providing leadership throughout the discussions: Patrick Bracken, a Water and Sanitation Specialist from AHT Group AG, Elisabeth Kvarnström, a senior consultant with Urban Water Management, Inc., and Ricard Gine, WASH researcher from the Universitat Polècnica de Catalunya.
To participate in the discussion and for more information, please see: forum.susana.org/forum/categories/185-th…on-ladder-next-steps.
Filed under: Campaigns and Events, Progress on Sanitation Tagged: monitoring, sanitation ladder
Link to reports: www.post2015consensus.com/water-and-sanitation
Here, Copenhagen Consensus Center has just released its latest research on water and sanitation targets for the post-2015 development agenda. Guy Hutton, Senior Economist, at the Water and Sanitation Program (WSP), World Bank writes the main report, with research assistance provided by Mili Varughese, Operations Analyst at WSP.
Guy Hutton, Senior Economist for the World Bank’s Water and Sanitation Program, writes a paper examining the costs and benefits of ending open defecation and providing universal access to water and sanitation. He finds that in general, it is more cost-beneficial to serve rural populations since they save more time from having improved access to water and sanitation facilities. Additionally, it is more effective to provide for the poorest, because they start with poorer health and have greater capacity to improve from access. Regardless of location and income, providing water and sanitation passes a cost-benefit test.
Dale Whittington, Professor, Departments of Environmental Sciences & Engineering at University of North Carolina, makes a critical examination of the assessment paper, noting several challenges with the benefit-cost calculations. In particular, he outlines concerns with how time savings are calculated, the likelihood of 100% take up of the interventions, assumptions around the cost base and how sensitivity analysis is applied in the paper. Despite these issues, Whittington agrees that water and sanitation interventions are likely to be cost-beneficial, though very sensitive to local conditions.
Dale Whittington also writes a stand-alone paper on water resources management targets. In a thought-provoking discussion he argues that global average benefit-cost ratios for water resource management investments are not useful because investments must be analyzed at the local level. Secondly, he suggests that it would be wrong for low-income countries to prioritize health interventions over large scale water infrastructure, since the latter are a necessary pre-requisite for the former.
Mary Ostrowski and Allan Jones of the World Chlorine Council present their views on the ‘safely managed drinking water service’ aspect of the proposed WASH targets. They argue that the most effective way to check drinking water quality is testing for the chlorine residual to ensures that the water is safe and free from disease causing germs.
Filed under: Progress on Sanitation Tagged: Post-2015 indicators
WATERLINES – JANUARY 2015 (Complete issue)
Guest editorial: tackling the stigma and gender marginalization related to menstruation via WASH in schools programmes (abstract/order info)
Menstrual hygiene management has been defined as: ‘Women and adolescent girls using a clean menstrual management material to absorb or collect blood that can be changed in privacy as often as necessary for the duration of the menstruation period, using soap and water for washing the body as required, and having access to facilities to dispose of used menstrual management materials’ (UNICEF and WHO, 2014). However, menstrual hygiene is not just about the management of the menstrual period but also the need to address societal beliefs and taboos surrounding the issue.
Until recently, the development sector including WASH (water, sanitation and hygiene) had not explored and attempted to address the challenges related to Menstrual Hygiene Management (MHM), an important issue affecting the health, dignity and privacy of millions of girls and women on a daily basis. It is great to have a whole issue of Waterlines dedicated to MHM, as it will help us, the maledominated, engineering-based sector, to increase our understanding of this aspect of the development work we do on a daily basis.
Putting the men into menstruation: the role of men and boys in community menstrual hygiene management (full text)
This paper examines how men and boys have an essential role in effective menstrual hygiene programmes and describes an initiative to engage men and boys in Uttar Pradesh, India. As a result of the initiative, men and boys have begun to talk about menstruation more freely and are better able to support the MHM needs of women and girls within the household, community, and school.
Adolescent schoolgirls’ experiences of menstrual cups and pads in rural western Kenya: a qualitative study (full text)
A randomized controlled feasibility study was conducted among 14–16-year-old girls, in 30 primary schools in rural western Kenya, to examine acceptability, use, and safety of menstrual cups or sanitary pads. Focus group discussions (FGDs) were conducted to evaluate girls’ perceptions and experiences six months after product introduction.
Mainstreaming menstrual hygiene management in schools through the play-based approach: lessons learned from Ghana (full text)
The study objective was to identify and document the effectiveness of the play-based approach in promoting menstrual hygiene management (MHM) in schools and share lessons learned. The study used a mix of approaches including qualitative and quantitative techniques. The author carried out an exploratory evaluation on the promotion of MHM activities as part of WASH in Schools programmes in 120 public schools in Ghana. Comparison was drawn between 60 schools currently using the play-based approach in promoting MHM, and 60 schools which are not using the play-based approach.
Developing games as a qualitative method for researching menstrual hygiene management in rural Bolivia (abstract/order info)
In 2012, Emory University and UNICEF conducted a multi-country formative study to gain a global perspective of girls’ experiences. A compendium of tools was created to ensure investigation of common themes across all settings. This paper describes the process of adapting the focus group discussion (FGD) tool for Bolivia into a board game as a method to ease girls’ discomfort discussing menstruation and elicit richer data.
Filed under: Dignity and Social Development, Hygiene Promotion, Uncategorized Tagged: menstrual hygiene management
Rural Consumer Sanitation Adoption Study: An Analyis of Rural Consumers in the Emerging Sanitation Market in Cambodia, 2014.
WaterSHED has published the findings from its comprehensive review of rural consumer sanitation adoption in Cambodia. The study evaluates WaterSHED’s Hands-Off sanitation marketing program, which was designed to catalyze the market for improved sanitation in rural Cambodia by stimulating household demand and improving the supply of affordable sanitation options for rural households.
The study confirms that the WaterSHED program has resulted in a substantial acceleration in improved latrine coverage and usage in the study areas. Household consumers are now able to access an improved latrine more easily and more cheaply than before.
New distribution and sales mechanisms are increasing household awareness of and exposure to more affordable latrine products and increasing motivation to invest in an improved latrine.
Enterprises are demonstrating that they serve at least some segments of the previously unserved rural market.
Nonetheless, significant challenges still remain. The study reveals a number of opportunities to break down remaining barriers to uptake of improved latrines and to further evolve WaterSHED’s market-based approach.
Filed under: East Asia & Pacific, Economic Benefits, Progress on Sanitation Tagged: Cambodia, latrines, WaterSHED
When we go to the supermarket, our decision-making is considerably aided by having the price, ingredients and source of goods clearly labeled. This allows us to rapidly compare the characteristics, perceived benefits, and price of different products to make what is usually an informed and instantaneous purchase decision.
When it comes to making investment choices for public programs, we do not traditionally have the same luxury of information. The full benefits and costs of those interventions, including the long-term costs to maintain and operate a service, are rarely understood or taken into account in the decision. As a result, public decisions are usually made based on the most visible costs (capital investment required from the public budget), historical choices and the political process.
To reduce the detrimental effects of these influences, we need to move public sector decision making more towards the supermarket model, and increase the availability of key information so that decisions can be more rational, consistent, and transparent.
Since 2007, the Water and Sanitation Program (WSP), part of the World Bank’s Water Global Practice, has been attempting to put a price on sanitation by essentially understanding two sides of the same coin: what the costs of current inaction on sanitation are (i.e. how much poor sanitation costs households and the wider economy) and how much acting will cost (i.e. increasing access to sanitation services).
When it comes to acting, we need to understand the alternatives. What technology option best suits the preferences and local practices, available land, population density, disposable income, and willingness to pay of different population groups? What are the benefits of different technology options? And who is able to pay for the costs of behavior change, capital investment and sustained service delivery?
Read the complete post on the World Bank Water Blog, Jan 2015.
Filed under: Dignity and Social Development, Economic Benefits, Progress on Sanitation
WSP – 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)
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.
Excerpts: The present study has presented evidence on the costs and benefits of sanitation improvements in different programmatic and geographical contexts in Southeast Asia. This evidence enables explicit comparison of sanitation options on the basis of their relative merits and thus informs both public and private decisions on sanitation investment.
The high socioeconomic returns of sanitation investment indicate that it should be promoted as a central development priority. The economic evidence generated in this study has demonstrated the importance of improved sanitation for a number of development outcomes, including public health, the natural environment, education, economic development, social outcomes, gender equality, and poverty alleviation. Improved evidence on the costs of sanitation and those potentially willing to pay for it, gives an evidence base for sanitation planners and providers on which to estimate the market size for sanitation goods and services.
Filed under: Economic Benefits, Sanitation and Health
World Bank – Promoting Handwashing and Sanitation Evidence from a Large-Scale Randomized Trial in Rural Tanzania
Promoting Handwashing and Sanitation: Evidence from a Large-Scale Randomized Trial in Rural Tanzania, 2015. World Bank.
Authors: Bertha Briceño, Aidan Coville, Sebastian Martinez
The association between hygiene, sanitation, and health is well documented, yet thousands of children die each year from exposure to contaminated fecal matter. At the same time, evidence on the effectiveness of at-scale behavior change interventions to improve sanitation and hygiene practices is limited.
This paper presents the results of two large-scale, government-led handwashing and sanitation promotion campaigns in rural Tanzania. For the campaign, 181 wards were randomly assigned to receive sanitation promotion, handwashing promotion, both interventions together, or neither. One year after the end of the program, sanitation wards increased latrine construction rates from 38.6 to 51 percent and reduced regular open defecation from 23.1 to 11.1 percent.
Households in handwashing wards show marginal improvements in handwashing behavior related to food preparation, but not at other critical junctures. Limited interaction is observed between handwashing and sanitation on intermediate outcomes: wards that received both handwashing and sanitation promotion are less likely to have feces visible around their latrine and more likely to have a handwashing station close to their latrine facility relative to individual treatment groups.
Final health effects on child health measured through diarrhea, anemia, stunting, and wasting are absent in the single-intervention groups. The combined-treatment group produces statistically detectable, but biologically insignificant
and inconsistent, health impacts. The results highlight the importance of focusing on intermediate outcomes of take-up and behavior change as a critical first step in large-scale programs before realizing the changes in health that sanitation and hygiene interventions aim to deliver.
Filed under: Africa, Hygiene Promotion Tagged: handwashing, Tanzania
SuSanA has developed a page which contains presentations from FSM3, the 3rd International Faecal Sludge Management Conference, Hanoi, Vietnam, January 2015.
Below is a partial listing of some of the presentations:
- Turning the tide on Fecal Sludge Management: Almud Weitz, Principal Regional Team Leader at Water and Sanitation Program East Asia & the Pacific and South Asia – World Bank, Indonesia
- Market Structuring of Fecal Sludge Management for the Benefit of Poor Households in Dakar: Mbaye Mbeguere, ONAS, Senegal
- On-site Sanitation Systems and Willingness-to-pay of Emptying in urban areas in Indonesia: Reini Siregar, Water and Sanitation Program World Bank, Jakarta, Indonesia
- Septage Management: An option for improved sanitation in Tripura: Ashutosh Jindal, Urban Development Department, Government of Tripura, India
- Political economy analysis (PEA) of FSM services: Ian Ross, Oxford Policy Management, Oxford, United Kingdom
- A Technology Applicability Framework to enable sustainable sanitation technology introduction: Alison Parker, Cranfield Water Science institute, Cranfield University, Bedford, United Kingdom
- Status of Faecal Sludge Management in Botswana: Review of Policies and Practices: Phillimon T. Odirile, University of Botswana, Mopipi, Botswana
Filed under: Campaigns and Events Tagged: faecal sludge management
Issue 176| Jan 30, 2015 | Focus on Fecal Sludge Management (FSM)
This issue highlights the recent conference on fecal sludge management in Vietnam; many of the abstracts from the conference are now available. Also included are new reports and articles from IRC; Water For People; the International Institute for Environment and Development; and country reports from Senegal, Vietnam, and Zambia. Also included are links to FSM tools and innovative organizations working on FSM issues.
FSM3, 3rd International Faecal Sludge Management Conference, Hanoi, Vietnam, January 18–21, 2015. Conference website | Conference abstracts page set up by SuSanA
The purpose of this conference was to present innovative solutions to FSM issues. Also, Jonathan Annis from WASHplus made a presentation on low-cost technologies to improve traditional sludge practices in Madagascar. Link to WASHplus presentation.
Achieving Systemic Change in Faecal Sludge Management, 2015. G Galli, IRC. Link
FSM is a critical element of sanitation in dense urban centers, but poor practices are causing disease outbreaks. The multiple actors, institutions, and organizations involved in urban sanitation can address the problem by acting in coordination to shift the focus from building infrastructure to providing and maintaining safe services under government leadership. This briefing note proposes a process for achieving transformational change.
Strengthening Public Sector Enabling Environments to Support Sanitation Enterprises, 2014. Water For People. Link
Water For People is piloting sanitation business approaches and seeks to discover under what conditions these approaches are successful. Public sector influence is one condition that has the potential to facilitate or hinder private sector sanitation endeavors. This study aims to understand: 1) how the public sector enabling environment can facilitate or hinder low-cost sanitation enterprises and 2) how NGOs can effectively engage the public sector to support sanitation businesses. Data were collected from Water For People staff and partners in nine countries, and summary case studies were coded to identify prevailing themes.
Triggering Increased City-Level Public Finance for Pro-Poor Sanitation Improvements: The Role of Political Economy and Fiscal Instruments, 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?
Realizing the Right to Sanitation in Deprived Urban Communities: Meeting the Challenges of Collective Action, Coproduction, Affordability, and Housing Tenure.World Development, Apr 2015. G McGranahan. 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.
Faecal Sludge to Fuel: Revenue to Improve Sanitation Services. Eawag News, July 2014. M Gold. Link
Cities in sub-Saharan Africa grapple with the management of fecal sludge from onsite sanitation technologies. A lack of funding for sanitation services results in the dumping of fecal sludge directly in the urban environment. Revenues generated from using dried fecal sludge as a combustible fuel in industries could provide an incentive to improve fecal sludge collection, transport, and treatment services.
Faecal Sludge Management (FSM) Book: Systems Approach for Implementation and Operation, 2014. L Strande. Link
This is the first book dedicated to fecal sludge management. It compiles the current state of knowledge of this rapidly evolving field and presents an integrated approach that includes technology, management, and planning. It addresses the planning and organization of the entire fecal sludge management service chain, from the collection and transport of sludge and treatment options, to the final end use or disposal of treated sludge.
Finding Short- and Long-Term Solutions to the Developing World’s Sanitation Crisis. NPR, Jan 2015. B Hardzin. Link
Jan-Willem Rosenboom is a senior program officer for Water, Sanitation and Hygiene at the Bill and Melinda Gates Foundation. He says the organization realized it was effective at community-level work but did not have a good way to deliver services on a large scale. He also argues that throwing money at the world’s water and sanitation system won’t solve the problem.
SANIPATH Rapid Assessment Tool – Website
The SaniPath Rapid Assessment Tool aims to assess exposure to fecal contamination in urban, low-income settings. The tool is under development by the Center for Global Safe Water at Emory University with funding from the Bill & Melinda Gates Foundation. The tool guides users in collecting much needed data on exposure to fecal contamination in low income, urban neighborhoods, and synthesizes these data for community, government, and service providers’ decision-making.
Sanitation Service Chain and Service Delivery Assessment Scorecard – Link
This Water and Sanitation Research Brief describes the Sanitation Service Chain which sets out the interlinked steps required to deliver urban sanitation and the Service Delivery Assessment Scorecard which analyzes the enabling environment, the level and management of budgets and other inputs needed to develop adequate fecal sludge management services, and the factors contributing to service sustainability.
Diagnostics and Guidelines for Fecal Sludge Management in Poor Urban Areas – Link
A presentation by Isabell Blackett at the 3rd International Faecal Sludge Management Conference.
Urban Sanitation Status Index: A Tool for Prioritizing Interventions – Link
Page 30 has an abstract of a presentation on the Urban Sanitation Status Index (USSI) which was developed to assess sanitation status at a neighborhood level. The USSI acts as a strategic tool for sanitation managers and decision makers in Maputo.
Innovation in Urban Sanitation: FaME and U-ACT Research in Sub-Saharan Africa, 2015. 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) andU-ACT projects researched innovative solutions to increase access to sustainable sanitation services.
Uganda: Health Risk Assessment along the Wastewater and Faecal Sludge Management Chain of Kampala, 2015. S Furimann. Video
This video is an assessment of health risks along the major wastewater channel in Kampala, Uganda. The visualization brings to bear the context of wastewater reuse activities in the Nakivubo wetlands and emphasizes interconnections to disease transmission pathways.
SuSanA Playlist – This playlist contains all filmed presentations of the Second International Faecal Sludge Management Conference in Durban, South Africa, October 2012 (46 total). Link
Senegal: Report of the Situational Analysis of Fecal Sludge Management Sector in Tambacounda, Executive Summary, 2014. USAID. Link
In Senegal, the improvement of the lives of people through efficient and appropriate sanitation is a priority for the government and its development partners. However, political and strategic directions of the government have long advocated “all for the sewer” to the detriment of individual draining systems, even though about 75 percent of the population uses individual draining systems. The National Sanitation Office of Senegal continues to make significant efforts to help improve the offerings of fecal sludge management services.
Vietnam: Rural Sanitation Rapid Market Scan Report, 2014. Population Services International (PSI). Link
Leveraging PSI Vietnam’s understanding of rural markets and consumers, the rapid sanitation market scan was designed to identify practical insights from rural households and community influencers, as well as rural supply chain actors linked to sanitation product and service provision. This report describes the market scan findings and offers concrete recommendations to inform future programs.
Zambia: FSM Services in Lusaka – Moving Up the Excreta Management Ladder, 2014. Water and Sanitation for the Urban Poor. Link
Despite most residents of African and Asian cities depending on non-sewered sanitation, only a handful of sanitation authorities have addressed the management of fecal sludge from these systems. This Practice Note describes the launch of an FSM service in the peri-urban area of Kanyama, Zambia.
INNOVATIVE FSM SOLUTIONS
- Clean Team/WSUP - Link
- Loowatt - Website
- Sanivation - Website
- Sanergy - Website
- Sustainable Organic Integrated Livelihoods (SOIL) – Website
PREVIOUS WASHPLUS WEEKLIES ON FECAL SLUDGE MANAGEMENT
WASHplus Weeklies highlight topics such as Urban WASH, Household Air Pollution, Innovation, Household Water Treatment and Storage, Hand Washing, 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 firstname.lastname@example.org.
Filed under: Progress on Sanitation, Sanitary Facilities Tagged: faecal sludge management
A Bangladesh government official has disclosed that the 6th South Asian Conference on Sanitation (SACOSAN-VI) will be held in Dhaka on 16 January 2016. Bangladesh hosted the first edition of SACOSAN in 2003.
Manjur Hossain, a senior secretary of the Local Government Division (LGD) of the Ministry of Local Government, Rural Development and Cooperatives was speaking at the 7th inter-country working group (ICWG) meeting of SACOSAN. The meeting was hosted by LGD from 27-28 January 2015 in Dhaka.
Also at the meeting was Md Akram Al Hossain, coordinator of the SACOSAN-VI secretariat and Joint Secretary, Upazila Branch at LGD.
Related website: SACOSAN-V
Filed under: Campaigns and Events, Progress on Sanitation, South Asia Tagged: Bangladesh, SACOSAN, SACOSAN VI
We would like to announce our next practice-oriented Eawag course on the topic of “Systematic Behaviour Change in Development Projects”. The applied course will take place on March 5 – 6, 2015, at Eawag Dübendorf.
The course will enable participants to plan, design, and evaluate evidence-based behaviour change campaigns. The participants will learn how to conduct a quantitative survey of behavioural determinants, how to identify the required behaviour change techniques and how to prove the effects and effectiveness of these techniques.
A live presentation of Dr. Kamal Kar about the CLTS<cltsfoundation.org/> approach and a Q&A session will be an integrated part of the course.
Participating in the course via internet using a video connection is available. For registration please click www.eawag.ch/lehre/peak/kurse/index_EN
Suzanne Benz and Evelin Vogler Committee’s office PEAK
P.O.Box 611 CH-8600 Dübendorf
This article can be downloaded/viewed free of charge for the next 10 days
“All we want are toilets inside our homes!” The critical role of sanitation in the lives of urban poor adolescent girls inBengaluru, India. Environment and Urbanization, April 2015. by Anupama Nallari.
This paper describes how lack of access to adequate sanitation facilities affects the lives of adolescent girls in urban poor India. It draws specifically on the experiences of four adolescent girls, each living in one of four settlements in Bengaluru, India, and conversations with a larger group of girls.
Findings reveal that where sanitation facilities are sorely lacking, adolescent girls face many deprivations (education, free time, privacy and independent mobility) and risks (sexual harassment and assault, health risks, etc.), and that this inadequacy can be a structural pathway for cyclical gender-based disempowerment and injustice.
Filed under: Uncategorized
At the 14th World Toilet Summit 2015, BRAC received the “Hall of Fame Award” for significant contributions to the sanitation sector in Bangladesh.
On 20 January, BRAC received the “Hall of Fame Award” for significant contributions to the sanitation sector in Bangladesh. The award was handed to Dr. Akramul Islam at the 14th World Toilet Summit 2015 in Delhi by Dr. Subramanian Swamy MP, Former Minister of India, and Jack Sim Founder of the World Toilet Organization in the presence of Minister Devendra Chaudhry, Special Secretary, Ministry of Power India.
Bangladesh has made remarkable progress in providing basic sanitation services to its people. It is now estimated that throughout Bangladesh, 57% use sanitary latrines, while a mere 3% of the people still practise open defecation.
Over 8 years, the BRAC WASH programme reached more than 66 million people, about half of the rural population of Bangladesh. It has successfully worked to improve household sanitation by creating demand for hygienic latrines while supporting an extensive supply chain and local businesses. Current coverage with hygienic and adequately maintained toilets is 82% in the 152 districts where BRAC has worked. All these successes have been underpinned by a strong provision of service to the poor and ultra-poor and by a unique hygiene promotion programme focusing on universal use and sustainability of services in communities, households and schools.
IRC is a knowledge partner of BRAC WASH since 2005.
Filed under: Campaigns and Events, South Asia Tagged: BRAC, BRAC WASH II programme, World Toilet Organization, World Toilet Summit, World Toilet Summit 2015
WHO is launching a global plan of action to improve access to WASH at all health care facilities. This kind of intersectoral collaboration is set to become a major theme in the post-2015 development agenda.
Better access to water, sanitation and hygiene (WASH) in health care facilities is crucial for mothers and babies to stay healthy. It is just as important as curative measures says Dr Maria Neira, the Director of Public Health and Environment at the World Health Organization (WHO) . She announced that WHO will launch a global plan of action by March 2015 on improving access to WASH at all health care facilities .
In December 2014, a group of academics and representatives from WASH and maternal and newborn health (MNH) agencies, including WHO, presented a call to action for intersectoral collaboration . They backed up their call with recent SHARE-funded research, which found that less than a third of births in Tanzania take place in a setting with safe water and sanitation . Forthcoming WHO research surveyed health care facilities in 54 low-income countries and found that 38 percent did not have an improved water source, while 50 percent lacked improved sanitation .
Back in 2012, Simavi commissioned IRC to carry out a review of how access to safe water, sanitation and application of hygiene practices can affect maternal health . The review concluded that “some very basic elements of human development related to water, sanitation and hygiene that were accepted in the 19th and early 20th centuries are still unavailable to a large proportion of pregnant women in the 21st century”.
Embedding WASH in other sectors will increase the health, social and economic benefits of the proposed Sustainable Development Goals (SDGs). An international group of WASH NGOs, led by Simavi and IRC, launched a call in December 2014 to incorporate WASH targets for schools, health centres and the workplace in the post-2015 development agenda..
This all contributes to the growing realisation that “access to WASH facilities at home is simply not enough to achieve complete behavioural change and sustainable impact” . Intersectoral collaboration is set to become a major theme for the global development sector in the future.
 Better WASH = healthier mums and babies, SHARE, 17 Dec 2014
 Jóźwiak, G. Get ‘back to basics’ on WASH, Devex, 12 Jan 2015
 Velleman Y, et al., 2014. From joint thinking to joint action : a call to action on improving water, sanitation, and hygiene for maternal and newborn health. PLoS Med,11(12): e1001771. doi:10.1371/journal.pmed.1001771
 Benova, L, et al, 2014. Where there is no toilet : water and sanitation environments of domestic and facility births in Tanzania. PLoS ONE, 9(9): e106738. doi:10.1371/journal.pone.0106738
 Shordt, K. and Smet, E., 2012. Getting it right : improving maternal health through water, sanitation and hygiene. Simavi: Haarlem, The Netherlands. Available at: http://www.ircwash.org/sites/default/files/Shordt-2012-Getting.pdf
 Terpstra, J. Shouldn’t schools and work places have clean water and decent sanitation too?. IRC, 8 Dec 2014
 IRC, 2014. The need for water and sanitation in schools, health centres and at the workplace. Available at: http://www.ircwash.org/sites/default/files/institutional-wash-event-twopager-final.pdf
Originally published on the IRC website on 19 January 2015
Filed under: Campaigns and Events, Hygiene Promotion Tagged: health care facilities, maternal health, maternal health services, neonatals, SDGs, World Health Organization
How does India’s new large-scale sanitation monitoring effort compare with similar initiatives in Bangladesh and Indonesia?
According to some media the Indian government has unleashed “toilet police” or “toilet gestapo” into the country . In fact, the central government has instructed local officials to take photographs of new toilets to prove that they have not only been constructed but are also being used. If states don’t upload photos by February 2015, the water and sanitation ministry has threatened to withhold funding from a new national sanitation programme .Open defecation free by 2019
Prime Minister Narendra Modi launched the Swachh Bharat (Clean India) Mission on 2 October 2014. His aim is to attain a 100 per cent open defecation free India by 2019. Since the launch over half a million household toilets have been constructed .
By implementing “real time monitoring” the government hopes it can correct past mistakes caused by ineffective monitoring and wasted investment in sanitation. The 2011 census revealed that 43% of government funded toilets were either “missing” or non-functional.. Now the government wants to show that its investments in sanitation are delivering lasting results.
The Ministry of Drinking Water and Sanitation is appointing around 2 dozen additional staff including two Joint Secretaries and 4 Directors to strengthen the implementation and monitoring of the Swachh Bharat Mission. An Expert Committee for innovative sanitation technologies and a national telephone helpline for rural water supply and sanitation are other new initiatives that will support the Mission .Smile please!
Local officials charged with monitoring toilet construction and use need to download an app on a mobile device. The app allows them to upload photos as well as the personal data and geo-coordinates of the beneficiaries to a public website. Progress is slow though: as of 14 January 2015, data of less than half a percent (2,383) of the newly constructed toilets has been recorded. Data collected before 2015 does not include toilet use.How do other countries carry out large-scale monitoring?
Compared to examples of large-scale sanitation monitoring in Bangladesh and Indonesia, the toilet use indicators collected in India – is the toilet in use, is it clean and is water available – are rather limited.
The BRAC WASH programme in Bangladesh uses benchmark indicators developed by IRC for questions like: do all household members use toilets, do they use them at all times, and are there provisions for handwashing and pit emptying .
In Indonesia IRC has helped design a monitoring system for the SHAW (Sanitation, Hygiene and Water) programme, where every three months 20,000 community volunteers visit more than 300,000 households. For SHAW monitoring is not merely an accountability tool as it is in India, but a way to motivate and encourage people to improve their sanitation facilities and hygiene behaviour .
India’s decision to track toilet use as part of its new monitoring initiative is a major step forward. From its neighbours India can draw valuable lessons on how to monitor sanitation as a sustainable service that benefits all. .
 Letter to Principal Secretary/Secretaries in charge of Rural Sanitation all States and UTs. Ministry of Drinking Water & Sanitation, 05 Dec 2014,
 Unused rural toilets to face public scrutiny, The Hindu, 01 Jan 2015
 Tiwari, R. The case of the missing toilets. India Today, 02 Oct 2014. See also: Hueso, A. & Bell, B., 2013. An untold story of policy failure : the Total Sanitation Campaign in India. Water policy ; 15 (6), pp.1001–1017. DOI: 10.2166/wp.2013.032. and Hueso, A., 2014. The untold story of India’s sanitation failure, Addendum. Community-Led Total Sanitation.org, 11 Mar 2014
 Nationwide monitoring of use of toilets will be launched from January, 2015, PIB, 31 Dec 2014
 IRC – Monitoring at scale in BRAC WASH
 Baetings, E., 2014. How are you and how is your loo?. Available at: http://www.ircwash.org/blog/how-are-you-and-how-your-loo
Originally posted on the IRC website on 14 January 2015
Filed under: South Asia Tagged: Bangladesh, BRAC WASH II programme, India, Indonesia, monitoring, open defecation, rural sanitation, SHAW programme, Swachh Bharat, toilets
BRAC plans to expand its scope beyond WASH to water security and from rural to urban areas, as well as moving from service provider to facilitator.
The BRAC WASH Programme is rebranding. For 2016-2020 it will be renamed as the BRAC Environmental WASH Programme. This reflects the planned gradual expansion in scope beyond WASH towards water security and from rural areas towards low income small towns, urban areas and coastal areas. Specific areas of intervention include solid waste management at scale, faecal sludge management, water security and quality, enhanced secondary school programmes and alternative sanitation technologies at scale.
There will be a gradual shift in operating styles from direct service to facilitation, advocacy and joint implementation, learning and monitoring the impact of programmes. Operational partners will include Government at all levels, civil society, the private sector and other NGOs already operating in the same regions. Planning and budgeting will need to be flexible and adapted to specific regional needs, requiring on-going investment in staff and partners capacities.
The strategy builds on ten years of experience in large-scale rural WASH programming. Ongoing support to the rural population will continue and be enhanced, for example, dealing with the well-known challenge of sanitation in difficult hydrogeological settings, and will be integrated into other local BRAC programmes. Staffing will be reduced where earlier programmes have achieved their objectives and appear sustainable within existing institutional structures.
In terms of its financing, a mix is envisaged of grants, joint implementation of programmes with government and multi-lateral institutions and business models that apply market solutions to large scale change. Cost sharing and user payment in some activities will remain a feature of the programme. Direct BRAC support is being applied to programme development and piloting, for example, alternative water services in the coastal region.
Read the draft version of Strategy 2016 – 2020 BRAC Environmental WASH programme : everyone, everywhere, all the time.
See also IRC’s webpage on the BRAC WASH Programme.
The news item was orginally published on the IRC website on 16 January 2015
Filed under: Policy, Publications, South Asia Tagged: Bangladesh, BRAC, urban sanitation