WASHplus Year Five Annual Report, October 2015

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In its Year Five Annual Report, WASHplus has stories to tell, results to share, events to celebrate, and studies that add to the evidence base. WASHplus activities serve as the backdrop for many stories: the Zambian school girl who has access to privacy and menstrual supplies when she needs them, the Malian household that can now build an improved latrine on their rocky soil, the mother in Bangladesh who understands the importance of a feces-free environment, the Nepali home breathing cleaner air as it trials an improved cookstove. And perhaps more compelling than the individual stories are the results the project is beginning to record through endline data collection in Kenya and formative research on school enrollment and in Zambia. Providing water, sanitation, and hygiene (WASH) infrastructure to schools is having a notable impact on enrollment. Community-led total sanitation (CLTS) may be inoculating communities exposed to cholera. Numbers also tell the story of the project’s impact. Look for a snapshot of those figures throughout the report.

The conclusion of field activities in Uganda and Zambia this year provided opportunities to reflect, celebrate accomplishments through end-of-project (EOP) events, and share lessons learned. Several articles were published this year in peer-reviewed journals and others submitted on topics ranging from consumer preferences and willingness to pay for improved cookstoves to habit formation and costing of handwashing. WASHplus also played a key role in preparing the joint document on WASH and nutrition for publication and distribution.

WASHplus’s focus on integrating WASH into other development initiatives enabled the project to get in on the ground floor on subjects that are gaining traction at USAID and globally, such as WASH and nutrition, neglected tropical diseases, and MHM. This integration focus dovetailed nicely with the project’s mandate to serve a technical leadership role, and project staff had many opportunities this year to share its work and lessons from the field on a global stage, strategize with partners on important advocacy issues, inform policy, and develop guidance in multiple countries. Also toward that end, WASHplus launched its first two learning briefs on small doable actions and WASH and nutrition. This series details the variety of approaches WASHplus uses to improve WASH and household air pollution (HAP) across its portfolio of countries.

And finally, it’s been an exciting year for innovation with pilot projects underway in Ethiopia and Bangladesh focusing on sanitation marketing and sand envelopment. These two efforts will add to WASHplus’s body of knowledge on sanitation innovation and aligns closely with USAID’s global interest on the topic. WASHplus is also documenting its fecal sludge management work in Madagascar to tell the next chapter in that story.

Changing WASH Practices in Southwest Bangladesh– One Small Doable Action at a Time

WASHplus’s Julia Rosenbaum co-presented a paper on “Changing WASH Practices in Southwest Bangladesh– One Small Doable Action at a Time” at SACOSAN 6 in Dhaka in January 2016. An abstract for the paper is provide below. Read the paper here.

Abstract: The global USAID WASHplus Project successfully increased access to water, sanitation and hygiene by applying a comprehensive and innovative approach in hard-to-reach areas of southwest Bangladesh. Rather than promoting ideal water, sanitation and hygiene (WASH) infrastructure and behavioral improvements, households were encouraged to take ‘small doable actions’ – feasible yet effective improvements – that moved toward the ideal practice. Through taking this approach, the project met and surpassed all project targets before the end of the project period. Project implementers worked with community members to develop age-specific behaviors for safely disposing infant and child feces and also for patching leaky latrines that dump feces back into the environment.

Citation: Rosenbaum, Hussain, Ferdous, and Islam, January 2016, Changing WASH Practices in Southwest Bangladesh– One Small Doable Action at a Time, FHI 360/Bangladesh, WASHplus Project, WaterAid/Bangladesh,  SACOSAN 6, Dhaka, Bangladesh.

 

When ODF is Not Enough: Presentatgion on at SACOSAN 6

When ODF is Not Enough: Using a Small Doable Actions Approach to Complement CLTS
and Get Faeces out of the Environment in Southwest Bangladesh,” Presentation by Julia Rosenbaum, Khairul Islam, Muhammad Faruqe Hussain, and Selina Ferdous, SACOSAN 6, January 2016, Dhaka, Bangladesh. See the presentation slides here.

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See the presentation slides here.

Bangladesh: Safe Infant Feces Disposal and Job Aids 

 

Bangladesh

In August 2015, months of collaborative planning bore fruit as WASHplus carried out a training of master trainers with WASH and nutrition partner SHIKHA. The training for project managers responsible for community and household level outreach focused on Why WASH Matters for Child Growth, and provided new information and skills for safe feces management in USAID Feed the Future areas. Workshop sessions focused on breaking the fecal-oral cycle through latrine improvements and introduced WASHplus’s small doable action (SDA) approach to safe disposal of infant feces. Through this training and subsequent field visits, WASHplus was able to finalize a menu of SDAs for various infant and young child age cohorts. Workshop participants also provided input into job aids to help implement the SDA approach in the field. A second training was held in October. A poster on the subject of infant feces disposal was presented at the Integrated Nutrition Conference, Nairobi, Kenya, in September. In addition, WASHplus has published flipcharts, flashcards, and other materials in Bangladeshi on topics ranging from latrine improvement to tube well construction to menstrual hygiene management. Access the tools here.

Bangladesh: Materials to Support WASH Improvement

Below are links to flipcharts, flash cards, pocket books and other materials in Bangladeshi to help improve WASH:

TRAINING MATERIALS 

OTHER MATERIALS

Behavior Change Strategy: Hygiene Promotion Guidelines for Bangladesh

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To see improvements in health, social, and economic well‐being of families in the project districts in Southwest Bangladesh, the WASHplus activity works towards three objectives:

Objective 1: Improved access to safe drinking water, improved sanitation, and hygiene practices of poor and marginalized people in the targeted upazilas (subdistricts)

Objective 2: Build community and local government capacity to operate and
maintain facilities, and demand increased allocation of funds to ensure sustainability and impact

Objective 3: Strengthen the evidence base and programming guidance for
coordinated WASH‐nutrition programming in Bangladesh

While the need for improved water and sanitation access is clear, there is consensus that no
health or other development objectives can be achieved without the consistent and correct
practice of a suite of water, sanitation, and hygiene (WASH) behaviors including:

  • Safe and hygienic disposal of feces, including infant feces
  • Consistent and correct handwashing at critical junctures, particularly after
    defecation and before food preparation and feeding/eating
  • Safe handling and storage of household water
  • Menstrual hygiene management (MHM)

WASHplus is managed by FHI 360 and implemented in southwest Bangladesh through an agreement with WaterAid, who in turn have engaged local partner organizations (PNGOs) to implement in their respective upazilas or subdistricts. To guide the systematic and theory‐based activities of the PGNOs, WASHplus has developed these hygiene promotion guidelines for its partner NGOs to coordinate its approach in the field. In addition, capacity‐building and on‐going support to NGOs is offered to support improved WASH practice and ultimate achievement of target goals

Expanding WASH Coverage in Bangladesh

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WASHplus mounted intensive, accelerated efforts in a new expansion subdistrict in the Khulna District in response to USAID interests in water technology innovations. It has also been working with a new local NGO partner, Shushilan, to begin installation of rainwater catchment and pond sand filtration systems. In the original four subdistricts, WASHplus continues to construct water points and latrines as well as train community members on operations and maintenance for the new WASH (water, sanitation, and hygiene) facilities.

The numbers tell the story: WASHplus is well placed to reach, and even surpass, its proposed targets for open defecation free (ODF) communities, number of new water points and latrines, and water and sanitation beneficiaries. This is happening despite the fact that flooding delayed the documentation of ODF communities, and storms damaged a number of new latrines. Fortunately, new construction standards meant that the latrines sustained primarily superficial damage, and households were resilient enough to make repairs. Also, WASHplus has surpassed the target for number of people gaining access to sanitation facilities by 691 (100.78 percent), and is 88 percent of the way toward the three-year beneficiary target for water access.

Q&A: What have we learned about consumer preferences of cookstoves in Bangladesh?

CROPPED-DerbyElisabethWASHplus Project’s Household Air Pollution Specialist Elisa Derby recently participated in an online Q&A session hosted and facilitated by The World Bank’s Clean Stove Initiative. The Q&A session focused on lessons learned about consumer preferences for improved cookstoves in Bangladesh, through the WASHplus project, and in Indonesia through the World Bank’s Indonesia Clean Stove Initiative. Key findings from the WASHplus consumer preferences study and related excerpts from the Q&A are provided below.

Key Findings: Understanding Consumer Preference and Willingness to Pay for Improved Cookstoves in Bangladesh

Methodology

  • “Trials of Improved Practices” testing user reactions to one of five different improved cookstoves (ICS) in 120 households.
  • Three-day kitchen performance tests (KPT) in 116 study households and 24 control households.

Cooking Practices

  • A major obstacle was that the cooking time was slower using the ICS.
  • Households prefer to cook rice for the whole day all at once in the morning during the three-month winter, rather than throughout the day, as is customary during the rest of the year.

Cookstove Preferences

  • At least two stoves were perceived as preferable to traditional stoves during the trials.
  • None as then produced met all consumer needs, and none met sufficient consumer needs to completely replace traditional stoves.
  • A vast majority believed ICS produced less smoke than their traditional stoves.
  • Participants widely complained of the inability to cook large volumes of food in large pots.
  • The horizontal fuel entry of ICS was not desirable. 

Fuel Saving

  • Homes using four out of the five improved stoves were found to use at least 16 percent to 30 percent less fuel than the control homes over the course of the KPT. 

Willingness to Pay and Decision Making

  • Certain stove features were valued, but the monetary worth of the stove was dramatically undervalued (most estimated them to be 1/2 to 1/4 of their actual calculated value).
  • Householders realized that metal stoves are expensive, but they were not ready to buy them at market price.
  • When given the stove as a gift in one village, almost all participants chose to keep the stove over a market value cash buy-back.

To learn more about WASHplus’ consumer preference study, download the brief “What Do Cooks Want? What Will They Pay? A Study of Improved Cookstoves in Bangladesh” and the full report “Understanding Consumer Preference and Willingness to Pay for Improved Cookstoves in Bangladesh.”

Q&A with Elisa Derby: What have we learned about consumer preferences of cookstoves in Bangladesh?

Elisa Derby has worked in the cookstoves sector for over a decade and manages Winrock International’s household energy and health program, with projects and partnerships that reduce fuel use and exposure to cooking-related household air pollution. This work incorporates field-based capacity building, formative research, network building, knowledge dissemination, grants management, and direct implementation activities. She is the household energy and household air pollution specialist for the WASHplus project, and supports WASHplus consumer preferences, needs and willingness to pay research, and other activities designed to support the Global Alliance for Clean Cookstoves mission and goals.

Q: What do you think was the most unexpected result stemming from your study? And how do you think this finding will likely impact the market (stove manufacturers) and future development initiatives?

A: Our willingness to pay results were the most surprising result from the WASHplus study in Bangladesh. Only one out of 105 study participants given the option to purchase the stoves at market value did so, although of the remaining 15 households given the stoves as gifts and then offered the option of a cash buyout at that same market value, only three chose cash; the other 12 preferred to keep their stove. People valued the stoves when acquisition barriers were removed, indicating a need for better financing options.

Q: The WASHplus study adopted the Trials of Improved Practices (TIPs) methodology. What makes this innovative and could you please explain how this methodology works?

A: The USAID Mission in Bangladesh enlisted WASHplus to help it assess consumer preferences and identify types of stoves that would be a good fit for its cookstove promotion program, as a follow-on activity to a cookstove market assessment already undertaken. Because cooking is such a personal experience and so integral to daily life, there’s no better way to get feedback on a particular stove type than to ask potential consumers to bring the stove into their homes and assess it as they go about their daily routine over a period of weeks. TIPs is an established qualitative methodology in the WASH sector and invites participants to interact with researchers and identify, discuss, and resolve barriers to using the new technologies through semi-structured “elicitation” questions. We gave each household one of five imported ICS models to evaluate, and used both qualitative and quantitative methods to gather data. The latter included monitoring wood and stove usage via KPT and stove use monitoring sensors for both traditional and improved stoves, as well as household air pollution in a subset of homes. We ended the trials with two different perceived value and willingness to pay approaches.

Q: How do you select five imported ICS models?

A: We chose the stove models based on regional availability, performance, and characteristics. All models were produced in China or India; only the Grameen Greenway stove was currently available for purchase in Bangladesh at the time of the study, albeit in small quantities, but others had potential to be manufactured and/or assembled in Bangladesh. They all met a minimum of Tier 2 fuel efficiency according to ISO IWA 11:2012 guidelines (the Tier 0 traditional baseline in Bangladesh is a hand-built, sunken-hole mud stove). Stoves were selected by characteristics (chimney/not, fan/not, portable/not), not by brand, to represent a range of stove types. An added benefit of using imported stoves with which consumers were not familiar was the avoidance of any influence of brand loyalty. Several of the manufacturers have made modifications to their stoves in response to consumer feedback from our study, and are exploring or already pursuing expanding their markets into Bangladesh. 

Q: Is there room for adoption of dedicated devices that would be efficient for specific tasks such as  water boiling or rice cooking? In other words, could the future be towards several types of efficient task-focused devices rather than trying to go for the “mythical” do-it-all-cleanly-and-efficiently-while-customer-friendly stove?

A: As a follow-up activity to the consumer research, we’re now doing customer segmentation and market strategy work in Bangladesh and one recommendation from that research is bundling the improved cookstoves with products like electric rice cookers, as the combination would then be expensive enough to trigger microfinance options, and the products would complement each other nicely, as the rice cooking is the weak point of many of the improved stoves. This is of course only possible for homes that are electrified, one of several customer segments. In my own kitchen I have an oven, stovetop, microwave, toaster, and coffee maker, and have been thinking of investing in a slow-cooker; I’m clearly no believer in a mythical do-it-all technology! 

Q: Is water boiling a main task in Bangladesh? It is an interesting finding in Indonesia. Almost all households only drink boiled water (this a common practice in China, too).

A: Unfortunately (for other health considerations!) boiling water for drinking or bathing is not common practice in Bangladesh.

Q: Bundling products with complementary functions sounds good. But I wonder how many households will invest in such bundle. If bundling products is not targeting poor households, then the households who choose the bundle probably don’t need microfinancing either.

A: For better or worse, there are many segments of “poor” in Bangladesh, and the poorest of the poor don’t usually have electricity, so the rice cooker bundling is a moot point for them anyway. Fortunately, we won’t have to just speculate how/whether this will work, as the WASHplus research findings and market strategies are directly feeding into the USAID’s Catalyzing Clean Energy in Bangladesh program, so they’ll be able to report back to us how/whether this has worked in the next couple years.

Q: Was the finding regarding “unwillingness of customers to chop wood” reported to stove manufacturers/designers (e.g., the tech. people)? What is their reaction to this issue? This is major in my mind, as it goes directly towards adoption and actual use … because the trend in adoption overall is towards devices that make life easier and (possibly more pleasurable), not that do good only if you follow a certain set of rules. And there may be some unintended consequences on the social side of this increase need for chopped wood.

A: Yes, all of our findings were shared with manufacturers. Fuel processing is always an especially challenging factor. We know that we get the most complete combustion and therefore cleanest burn from fuel with high surface/mass ratios, but of course any user would rather just throw a big log in the fire, not have to chop up the fuel or continuously feed it. I know many in our sector have high hopes for a fuel processing service solution—wherein entrepreneurs can make a living processing wood, or selling processed wood to users who then get a cleaner burn. I wish I had the answer!

Q: Based on the study, what do you think is the biggest challenge/barrier in promoting ICS in countries like Bangladesh and Indonesia? Was the lesson learnt from your study applicable for other developing nations as well?

A: I think the biggest challenge in our sector, regardless of where cookstoves are promoted, is that we don’t have biomass solutions that both burn cleanly (read: meets WHO air quality guidelines) and that users like to use and prefer over their traditional stove 100% of the time. So we see a LOT of stove stacking, and the benefits of ICS are watered down at best and completely negated at worst. But it’s entirely rational—if you spend 5-7 hours/day cooking, of course you’d rather do it on the easy-to-use stove than the “allegedly better but annoying to actually use” option, even though the latter may provide health benefits down the road. Everyone loves cooking on LPG (and I posit in most cases would do so almost exclusively were it not for cost), and I firmly believe that universal clean fuel access should be our end goal, but we need many really good biomass solutions in the meantime that cooks will use consistently, correctly, and exclusively, and we’re just not there yet. I’m grateful for the R&D funding that’s been brought to the table in recent years to support that work.

Q: I would be interested in hearing from the Bangladesh experience about distribution channels that were used to reach users in remote areas, in particular women. For example, there is an organization called Solar Sisters that is operating in several African countries, which trains and hires women entrepreneurs from the community to market and sell stoves. It seems like an interesting approach. What good steps and strategies were used to reach the end user beyond broad marketing?

A: As the WASHplus Bangladesh activity was a research study involving imported ICS not currently available in Bangladesh, we did not rely on any distribution channels, rather we selected the 120 participant households and brought them the stoves ourselves. Previous ICS promotion supported by the Government of Bangladesh has relied primarily on sanitation shops and NGOs for distribution. I expect that the USAID Catalyzing Clean Energy in Bangladesh project (which will be the implementation follow-on to the WASHplus research) will expand their distribution networks, and the Solar Sisters model may be a good fit—I’ll pass on the suggestion!

Q: Could you please share some key lessons learnt from your project, or essential take-aways, especially on those topics that have not yet been discussed in the above thread? Anything that might be helpful for future project development and design, social marketing, awareness campaign is warmly welcomed.

A: Some important take-aways from our research in Bangladesh is the need for larger and higher fire-power stoves for Bangladesh, and given the prevalence of mixed fuel use we also recommended the development of a mixed-fuel stove. Happily, several of the manufacturers we worked with have come out with larger/higher fire-power versions of their stoves to better meet Bangladeshi needs. Prakti has received Global Alliance for Clean Cookstoves funding specifically to develop a mixed-fuel stove for Bangladesh, which is already in prototype stage. Finally, I would say our findings underscore the need I think we all recognize for consumer-centered design, to really meet consumer needs while still achieving emissions reductions and efficiency goals.

The other take-away from our work in Bangladesh that we haven’t gotten into on this thread is the issue of quality control and durability. By way of background, Bangladesh has a long history of improved stove promotion over the decades, primarily focusing on variations of one type of artisanal clay (and more recently cement) chimney stove, generally called the Bondhu Chula, of which there are an estimated 500,000 still in use. We performed controlled cooking tests on both the imported and (expertly constructed) Bondhu Chula stoves, and they all demonstrated significant efficiency gains over the traditional stove. All of the chimney stoves were very successful in venting the smoke out of the kitchen. But in the field we saw a LOT of very smoky Bondhu Chulas. This is likely in part due to varying quality control prevalent with artisanal production. That said, even expertly constructed Bondhu Chulas depend on the user to keep the stove well-maintained.

The challenge with any chimney stove is that when not cleaned regularly, they can redirect all the smoke (maybe just as much as the traditional stove generates) back into the cooking area. In Bangladesh there isn’t a culture of chimney cleaning, and given that the Bondhu Chula has a cement chimney that must be cleaned from the top (unlike metal chimneys that you can clean just by banging on the side), and many homes have thatched roofs, this kind of cleaning can be next to impossible. So field testing for chimney stoves over time is really critical, especially in Bangladesh.

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

Self Supply at Scale: Lessons from Bangladesh

Reblogged from the The Rural Water Supply Network (RWSN) 

By Jonathan Annis

I recently traveled to southeastern Bangladesh to support WASHplus’s local implementing partner WaterAid as it begins a multi-year project in the coastal belt. The coastal belt is a marshy delta formed by Himalayan sediments transported thousands of miles by an extensive river network that settle as they reach the Bay of Bengal. Surface water is ubiquitous, and flooding—from tidal flows, excessive rainfall, or cyclones—is an annual event. I had never been in an environment so waterlogged.  

An estimated 70 percent of Bangladesh’s 150 million rural inhabitants use groundwater for drinking. Rural Bangladesh has an estimated 10 million shallow and deep tubewells. WaterAid estimates more than 80 percent of these have been installed by households without government subsidy.

The maturity and extensiveness of the self-supply service delivery model is astounding. Privately owned spare parts suppliers and pump vendors are commonplace in nearly every subdistrict or union throughout the coastal belt. Deep and shallow tubewells are most often fitted with a robust suction pump, known locally as the # 6, that easily lifts water from a static level of between 2–5 meters. Replacement parts are affordable; a local technician reported the average cost of a typical repair was less than 150 BDT or US $2.

Image

 Locally based drilling teams reach depths of 300  meters using entirely manual techniques (J. Annis,  2013)

Local drilling companies are equally as widespread. Deep tubewells are commonly drilled to between 250-320 meters (that is not a typo!) using manual methods for a cost of less than US $1,000 (including drilling, well components, and pump installation). The drilling method is really something to behold. Workers balance like acrobats on 8-10 meter high bamboo scaffolding to hoist a hose that injects water from a manually driven circulation pump into the hollow stem connected to a drill bit that is rotated continuously by two men. A team of 10 men can reach 300 meters in two to three days.

Yet despite having what seems like the ideal setting for sustainability, complications persist. Community water points, often funded by donors and aimed at the extremely poor (or hardcore poor as they are known in Bangladesh), frequently go unrepaired for long periods. Most families use private ponds for bathing and washing dishes, even though they often have access to a potable water point in their courtyard or a short walk away. Potable water apparently has little intrinsic value in the coastal belt, and when community water points break households typically either walk to the next pump or return to the pond.

Government regulation is another point of concern. The emergence of self-supply resulted from a combination of ideal hydrogeological conditions and perennial underfunding of the rural water sector. Annual budget expenditures for water supply are split 70/30 for urban and rural, though more that 70 percent of the population lives in rural areas. The explosion of self-supply since the mid-1970s has gone largely unregulated, and the high concentration of water points may have been an underlying factor of the arsenic and salinity problems detected in thousands of shallow wells beginning in the mid-1990s. As deep tubewells become more prevalent in areas like the coastal belt (an estimated 1 million have been installed throughout the country to date) history risks repeating itself. One community deep tubewell I visited, for example, was recently abandoned after a saline aquifer leeched into the deep water table. In such a case the well must be decommissioned to prevent localized salinity from spreading to other areas. This example supports the findings of USAID-funded research in eastern Madagascar indicating that regulation is critical for self-supply to be environmentally sustainable at scale.

To this point WASHplus is working with WaterAid to increase regulation of local government institutions, beginning with an asset inventory to register all the water points in a subdistrict followed by a permit system to document all new wells installed in each union. Eventually these measures will set the framework for periodic water quality and groundwater table monitoring to determine if the quality and capacity of the deep aquifer is being compromised. This WASHplus activity will also serve as a model for other unions and the Department of Public Health Engineering to ensure the self-supply approach is reaching its full potential without compromising the long-term health of the resource that is the key to its success.

About the Author: Jonathan Annis is a sanitation and innovation specialist with the USAID-funded WASHplus project (www.washplus.org). His views do not represent those of USAID or the U.S. Government.