WASHplus Attends National Sanitation Conference in Kenya

In April 2014, the Ministry of Health in conjunction with partners hosted the 1st National Sanitation Conference in Nairobi, “Accelerating Access to Improved Sanitation under Devolution: Making the Right a Reality.” More than 200 participants from 47 counties attended, including county health officials and NGO and development partners. As a key partner in the sector, and the national facilitator for the Hygiene Promotion Technical Working Group, WASHplus/Kenya played a major role in planning and preparing for the conference. WASHplus exhibited various products, including WASH-HIV integration training guides and job aids, fact sheets, posters, banners, and success stories. Samples of improvised toilet seats created to improve sanitation access and tippy taps were also displayed. The small doable actions and inclusive sanitation concepts elicited a lot of interest; participants about taking the concepts to scale in other counties. This conference marked a turning point for Kenya as the country seeks to make the right to sanitation a reality as stipulated in the constitution of Kenya 2010. Cabinet secretaries from each of the 47 counties have since committed to increased budgeting for sanitation.

Below, Evelyn Makena, WASHplus Kenya country program manager, talks about the WASHplus program with Cabinet Secretary for Health James Macharia at the National Sanitation Conference in Kenya. Photo credit: George Obanyi/FHI 360.

kenya sanitation conference

 

Musings from Mopti

Rural Water Supply Network

Well digging - Mali (RWSN/Skat) Well digging – Mali (RWSN/Skat)

by Jonathan Annis, WASHPlus

I’ve spent the last week in the Mopti Region of northern Mali supporting a USAID/WASHplus WASH & Nutrition initiative led by CARE. While behavior change communication related to household- and community-level sanitation, hygiene, and infant nutrition practices is the primary focus of the project, a small sum of funds is dedicated to rehabilitating community water supplies.

The conditions in Mali, as in much of the Sahel, have attracted a plethora of international NGOs, foundations, and do-gooders of every size and intention; increasing access to safe water is a focal point of many of their interventions. The functionality of rural water supplies in Mopti is difficult to ascertain. A number of my colleagues agree that the database of water points maintained by the regional office of the Ministry of Water includes less than 50 percent of the water points existing in the…

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Simple Commodes for HIV/AIDS Patients

James Yatich, a public health officer in Kenya’s Central Province, has been supporting frontline community health workers involved in home-based care for people living with HIV.

James realized that bedridden clients who could not use the toilet on their own posed a major challenge. “When I told them that they had to use the toilet to prevent diarrhea, they asked me how?”

In June 2012, James finally found a solution after attending a WASH-HIV integration training workshop organized for government public health officers under the USAID-funded WASHplus project. During the training, participants learned about the small doable action approach and supportive technologies to improve water, sanitation and hygiene practices.

Small doable actions are incremental, feasible steps to improve practices. Using knowledge acquired from the training, James returned home and started working on the design of a simple aid to help bedridden patients and the elderly “go to the toilet” in a dignified way. The result was a homemade commode that can be made from locally available materials and yet ensure proper disposal of fecal waste.

“I sketched a design and asked a carpenter to make one piece for demonstration,” says James. “We used mainly leftover pieces of wood and furniture and the cost came to just 200 shillings (about US $ 2.50). But the cost can be negligible if the materials are available in homesteads.

The improvised seat is placed where the patients can easily reach it and lined with disposable plastic bags that are readily available. It can be used by bedridden clients and the elderly, especially those who are overweight and cannot easily be supported by others.

“We don’t see very many bedridden patients, but even one such patient can pose a big challenge to the family and needs assistance,” says James.

According to James, the technology gives patients independence and dignity as they do not need a caregiver to hold them on the toilet seat. It also allows the caregiver to do other chores rather than take the patient to the toilet – which can happen frequently for patients with diarrhea.

Asked why he had not thought of the solution earlier, James says: “It could not have been developed earlier because we were not able to conceptualize the link between hygiene and HIV until we went for the training.”

James now wants to share his idea and is looking to work with local stakeholders to train community health workers to make the portable toilet seats for their clients.

Central Provincial Public Health Officer Samuel Muthengi says the region has high latrine coverage at 97 percent but usage is a challenge for bedridden patients and the elderly. If such a simple technology is replicated, it can help improve disposal of fecal waste.

See a demonstration of a simple commode made with easy to find materials. It can be used by elderly with limited mobility or HIV/AIDS patients or others who are weak and unable to walk far. 

 

A String, a Jug, and a Bucket

Blind Danson Mwangi walking to the latrine using the string 6

In Kenya WASHplus and the Ministry of Health (MOH) are training community health workers and recruiting natural leaders to advance sanitation among vulnerable households. Using a small doable action approach, trainees work with households to make simple  improvements to ensure all family members can access a latrine and a hand washing station. This often means that community health workers are improvising and innovating to help address the particular needs of a given family. The following three stories illustrate simple innovations that made a profound impact on individuals’ lives.

WASHplus Toilet Solution Puts a Smile on a Grandmother’s Face

Maria Njeri sits by her bed with an eager face.  Said to be over 100 years old, she is blind and cannot walk. A team from the USAID-supported WASHplus project and the Ministry of Health is visiting the grandmother in the Maai Mahiu area of Nakuru County in Kenya’s Rift Valley region. They want to find out first-hand how community health worker volunteers trained by the project are helping Maria cope with the daily challenges that elderly people like her face.

When her daughter and granddaughter are away during the day, she has no one to help her to the latrine, located a few meters from the house. A small bucket indoors is her only alternative, but it is not easy to use because of her old age and ailing legs. The strain can be unbearable and sometimes she does not make it to the bucket in time.

The WASHplus program trains public health officers and volunteers to find alternative solutions to make it easier for elderly people like Maria to practice good hygiene. Maria’s plight came to light when local volunteers went round the village to educate people. They helped the family members devise a solution to Maria’s mobility problems—an improvised toilet seat with the bucket fixed at the bottom, which is comfortable and easy to clean. The team also attached an arm string to the roof to help Maria stand and exercise. Her joy is evident. With regular exercise the pain in her legs is gone and she no longer dreads using the toilet.

Maria’s neighbors, also elderly women in their 60s and 70s, have also benefitted from the intervention. One neighbor, Naomi Muthoni, describes what she learned at a community meeting: “We were taught that after every visit to the toilet, you must wash your hands with water and soap, or use ash. We wash hands all the time and make our children also wash their hands. Our children used to defecate openly in the garden and in the bushes around our homesteads,” she adds. The community is strict about reminding them to use latrines and ensuring that all neighbors have tippy taps (a simple water-saving hand washing device) installed. Since these approaches were adopted, the community has seen a reduction in diarrhea among its children.

Elderly Mother and Son Benefit from Simple Innovation

At 80 years old Leah Njoki still has the energy to do most of her chores and work on her small farm; her only problem is failing memory and pain in one of her legs. Mrs. Njoki was among the first people to adopt the good hygiene practices promoted by WASHplus after a visit by health worker volunteers, who were promoting community-led total sanitation.

Mrs. Njoki says health workers taught her how to keep her latrine clean and the importance of using it instead of defecating in the open to prevent disease. A lot has changed since that visit. She recalls days when she never washed her hands after using the latrine. Sometimes she would wash in kitchen containers, not knowing the health risks. Now she and her grandchild always wash their hands after visiting the toilet using soap or ash. She has installed a tippy tap near the toilet. Previously she used to put water in a basin for hand washing. The same water was used over and over.

The grandmother has also benefited greatly from an arm string that health workers fixed in the latrine to help her support herself and reduce the strain on her bad leg. “Whenever I have a problem getting up, I support myself with the arm string” she says.

Mrs. Njoki’s second son, Paul Mwaura, who lives in another district, is amazed by the innovations his mother has adopted. Paul’s right leg was amputated following a road accident in 2003, and he walks with crutches. Using the pit latrine is usually a big challenge because he has to balance on his good leg. He found out that with the string, he can balance with ease. “These days when I go to the toilet I don’t fear falling down, since there is a string to support me. Now if I find someone else with a problem similar to mine I will inform them also about the innovation,” he says. Mr. Mwaura plans to install a string for support in the latrine back at his new home along with a tippy tap.

A Simple String Solves Problem for Blind Youth

Three years ago Danson Ndung’u was a popular mechanic and driver in Nairobi’s biggest slum Kibera. Today he can neither drive nor fix cars. The 20-year-old’s career ended when a violent mob beat and blinded him during election year violence in 2010. The attack changed Danson’s life for good, ending his promising career, independence, and ability to support his mother and four younger siblings.

After three months in the hospital, he struggled to adapt to the fast-paced lifestyle of home and moved to a quieter rural area, Sision Village in Maai Mahiu, Rift Valley, to live with his married elder sister. In the serenity of the village, Danson slowly began to cope with life as a blind person. He enrolled in a knitting course at Thika School for the blind.

Whenever he came home for holidays, Danson felt robbed of his privacy. He felt helpless having to depend on somebody to get him to the toilet, a few meters from the house. Even though he has learned to use a white cane, he still finds it hard to move around at home because of the rocky terrain.

Peter Maina Njoroge, a WASHplus-trained volunteer, visited Danson’s home and heard about the challenge Danson faced reaching the toilet. Although Mr. Njoroge and his colleagues had not come across such a problem before, they quickly came up with a solution. They tied a blue nylon string running from the house to the toilet to guide Danson. This simple modification worked. Two months later Danson reports, “I can now go to the toilet alone even when there is no one around. Before I used to wait for them to come from the farm so that one could come and help me.”

Although he still faces many challenges in moving around his village, the simple string has eased his life and given him back his privacy. To him it is a step toward regaining the joyful life he once had.

Sealing Leaky Pits: One Small Doable Action at a Time

bangladesh-pits “Many families in the community did not have latrines, and among those who had a functional latrine, most of those had leaching cracks in the pits. When the outreach staff explained to us the diagram of feces transmission and said having cracks in the pits is similar to defecating in the open, we all agreed to mend the pits.” She adds, “I have three daughters and if mending this crack brings good health and growth to them, why would I not do that?”

Zannat Begum has lived in Khaspara village, one of WASHplus’s rural intervention communities, since she was married 15 years ago. Her husband is a fisherman and spends most of his time away from home like the majority of the men in the neighborhood. At part of its planning process, WASHplus conducted a community situation analysis in Khaspara and identified several poor sanitation practices.

Most of the latrines in the area traditionally drained into canals or ponds to avoid the need for cleaning/desludging by hand, but this practice contaminates open water sources. Since the analysis, this practice has started to change.

Zannat and her neighbors learned about the risk of diarrhea due to leaching latrines during a mother’s group session and is now the proud owner of a newly rehabilitated latrine. Many other leaky pits in the community have been sealed to prevent feces from contaminating open water.

One of Zannat’s neighbors was unable to buy rings and slabs for her latrine and instead built a robust structure out of bamboo, wood, and plastic sacks. Although the latrine does not meet all the criteria of an improved facility, this “small doable action” approach has stopped the practice of open defecation.

Zannat says, “Many families in the community did not have latrines, and among those who had a functional latrine, most of those had leaching cracks in the pits. When the outreach staff explained to us the diagram of feces transmission and said having cracks in the pits is similar to defecating in the open, we all agreed to mend the pits.” She adds, “I have three daughters and if mending this crack brings good health and growth to them, why would I not do that?”

This is one example of how WASHplus and its local implementing partner WaterAid are working in targeted, hard-to-reach, marginalized communities in Bangladesh to improve sanitation status not only by promoting fixed point defecation but also by gradually moving households up the sanitation ladder toward more hygienic feces management.

Photo credit: Mustafa Kamal Sikder