WASHplus Benin Carries Out Experimental Urban CLTS

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WASHplus with local implementing partner ABMS/PSI improves hygiene conditions through behavior change and community mobilization in two peri-urban neighborhoods of Cotonou, the largest city of Benin. Wedged between the Atlantic Ocean and lagoons, Cotonou is floodprone and its slum neighborhoods experience cholera outbreaks during the rainy season. After promoting handwashing with soap and chlorination of household drinking water in 1,700 households, the pressing issue of open defecation came up time and again. The few public latrines are rickety structures built over the lagoons, but most residents prefer open defecation to these unsafe facilities. WASHplus connected with the provincial office of the Ministry of Health (MOH) responsible for sanitation in these zones to join in a first-ever (for Benin) experiment in community-led total sanitation (CLTS) adapted for peri-urban settings.

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After adapting and testing CLTS tools for this new setting, all decision making and influential (social, religious, and governmental) persons from the two target neighborhoods were invited for an institutional “pre-triggering” prior to involving the entire community. They saw results of a simple survey situating the open defecation spots and public and household toilets. Community triggering was carried out on May 13. About 75 residents assembled in an open space, and two trained MOH facilitators led the group through the mapping exercise and a calculation of health-related household expenses. The Walk of Shame was not carried out as the event was far from the open defecation place. The result in urban areas is not necessarily a decision to construct latrines, and in this case, the group decided to create a special task force to follow up the decisions to destroy the open defecation places and work with the rest of the community to come up with solutions, especially concerning work with managers for the improvement of public latrines. The residents expressed a desire for modern toilets and said they were prepared to pay for them.

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CLTS in this setting is different from rural settings, where the local chief has the power to convene and order people to implement decisions. These neighborhoods are extremely heterogeneous. Also, open defecation is forbidden by law, and the residents were reluctant to admit to the practice or to identify the open defecation places, thus the pre-survey came in handy. The participation of the “chef quartier,” the highest ranking local official, provided assurances that the decisions will receive strict follow-up. Plans are underway to replicate the triggering in the other zones of this very extensive neighborhood.

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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.

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.

Celebration Marks End of Open Defecation in Three Villages in Mopti Region, Mali

The WASHplus Project, funded by the United States Government via USAID, triggers change in sanitation practices through the community-led total sanitation (CLTS) approach with a “plus” component that includes an emphasis on hand washing with soap after using the toilet. In Mali the plus component also signifies supply-side interventions to develop and promote low-cost latrine models appropriate to the unique environmental conditions in each district coupled with training community-based masons to build robust latrines using local materials. To complement the CLTS-driven approach in rural areas, WASHplus is beginning a sanitation marketing activity to engage materials suppliers and local entrepreneurs to market a line of aspirational sanitation products in Mopti’s urban areas. The WASHplus project is led by FHI 360 globally. In Mali, WASHplus activities are implemented through CARE International and two Malian NGOs, YAG-TU and Sahel Eco.

Recently the WASHplus Project in Mali organized public ceremonies to certify Open Defecation Free (ODF) status of three villages in the Mopti Region. These villages, each of which are located in priority areas for USAID’s Feed the Future and Global Health initiatives, were recognized as being the first in their municipality to reach ODF status.

From September 25th to 27th 2014, the USAID/Mali Director Gary Juste, accompanied by the Governor of Mopti Region, and the National Director of Sanitation led certification ceremonies in three villages in the presence of national and regional authorities, the CARE Mali Country Director, as well as local officials and residents from the villages. All three villages reached or exceeded the targeted criteria for certifications. The village of Allaye-Daga built 31 latrines against a target of 28. Wendeguele achieved 150% of their latrine target, and Kanikombole built 28 latrines against a target of 10. Local community leaders, women and youth all recognized the importance of the project and the impact safe disposal of human feces with have on the health and nutritional status of the populations, especially children under five. In the village of Allaye Daga, there was not a single latrine before the project, but now everybody uses latrines and the community has adopted social conventions to deal with noncompliance with ODF standards.

Photos from the certification ceremonies are posted below. These photos and description of the certification ceremonies were originally published on the USAID website here: http://www.usaid.gov/news-information/photo-gallery/certification-end-open-air-defecation-ceremony and here: http://www.usaid.gov/mali/news/usaid-promotes-hygiene-and-sanitation-through-innovative-approach

The Mayor of Sio hands out certificate to the village chief
The Mayor of Sio handing certificate over to the chief of the village of Wendeguele. Photo credit: USAID Mali.
Youth in Kanikombole vow to abide by hygiene and sanitation standards
Youth in Kanikombole vow to abide by hygiene and sanitation standards. Photo credit: USAID Mali.
USAID WASH Adviser engages communities on WASH
USAID WASH Adviser engages communities on WASH. Photo credit: USAID Mali.
Girls stood up against open-air defecation
Community-Led Total Sanitation benefits girls in Kanikombole. Photo credit: USAID Mali.
Communities in KaniKombole recognize USAID through a special award handed out to USAID WASH Advisor (Right)
Communities in KaniKombole recognize USAID through a special award handed out to USAID/Mali WASH Advisor (Right). Photo credit: USAID Mali.
USAID/Mali Director and Mopti Governor pose after unveiling the certification plaque. Photo credit: USAID Mali.
USAID Director (right), WASH Adviser (midlle), and Health Office Director
USAID/Mali Director (right), WASH Adviser (middle), and Health Office Director. Photo credit: USAID Mali.
There is the toilet!! Mopti Governor and USAID Director pointing to it
There is the toilet!! Mopti Governor and USAID/Mali Director pointing to it. Photo credit: USAID Mali.
USAID Director and Mopti Governor unveil certification sign board in Wendeguele
USAID/Mali Director and the Governor of Mopti unveil the certification sign board in Wendeguele. Photo credit: USAID Mali.
Mopti Governor and USAID Director visit a latrin under construction
Certification of End-of-open air defecation ceremony: Mopti Governor and USAID/Mali Director visit a latrine under construction. Photo Cresit: USAID Mali
USAID Director hand out certification for Allaye-Daga to Mopti Governor
USAID/Mali Director hand out certification for Allaye-Daga to Mopti Governor. Photo credit: USAID Mali.
USAID Director admires certification plaque for Allaye-Daga
USAID/Mali Director admires certification plaque for Allaye-Daga. Photo credit: USAID Mali.

Highlights from the University of North Carolina 2014 Water and Health Conference

WASHplus had a significant presence at the UNC Water and Health Conference held in October 2014. Staff participated in or lead panels on topics ranging from the theory and practice of habit formation as it relates to hand washing to HIV and MHM to integrating WASH into nutrition. WASHplus also presented a poster on its approach to collecting, curating, and disseminating WASH sector knowledge and information. Links to WASHplus staff presentations at UNC materials can be found here.

WASHplus Presentations at 2014 UNC Water & Health Conference 

Below are highlights from the conference, compiled by WASHplus. 

WATER

Water Systems and Household Water Treatment and Storage 

  • Vestergaard has developed a water filter that may be used by vendors in developing countries to sell treated water to consumers. This unit has a cost of US$310, but they are attempting to have vendors recover the cost by selling water through jerrycan users as well as consumers that may be interested in buying cups of safe water. The jerrycan sales include a jerrycan swap program component which allows water sellers to exchange a consumer-owned jerrycan with one clean one offered by the vendor through this program.
  • Edema Ajomo from the Water Institute at UNC suggested that the following factors influencing the sustainability and scale-up of HWTS programs:
    • User preferences: culture and norms may determine people’s choices (“Black-colored filters are evil because everything that is that color is evil’; “I just cannot stand the smell of chlorinated water”.
    • Integration and collaboration: piggy-back HWTS interventions with other interventions already with known track in the field (‘Add HWTS lecture to a sanitation lecture or promotion activity”) and seek inter-ministerial collaboration
    • Have clear standards, certification and regulation procedures for HWTS
    • Availability of resources: address financial resources needed for consumers to buy promoted HWTS products, but also ensure that there are trained human resources and the necessary supply chain to repair/replace technologies purchased by consumers
  • A study from Bangladesh on POU suggested that direct observation of water treatment in homes may provide a more accurate picture of practices as opposed to chlorine residuals which is considered a more objective measure than self-reports.

Public Financing for Water System Services

IRC, WSUP, and Tremolet Consulting have formed a working group exploring avenues for public financing for WASH services at the local government level. Their work suggests that both taxes and tariffs will need to grow at local governance levels in order to support water services in the long term. The focus of the working group is exploring methods of growing those, or other, revenue streams to finance the life cycle costs of water and sanitation delivery systems.

WSUP is currently conducting research on the role of advocacy at the local level, as well as some experimentation with “sanitation surcharges” attached to municipal water fees in order to cover district government costs of monitoring, enforcing, and supporting sanitation (i.e., a tax that supports the Environment Health Department to conduct its duties).

Water Point Mapping

This was an interesting presentation from the MWA based on their Lazos de Agua work in Central America. They used AKVO-FLOW for a baseline on 1009 households which categorized results into four areas based on the water service level ladder defined by IRC – quantity, quality, accessibility, reliability. The visuals on results were very arresting – for example, you could see what locations scored high on certain dimensions of service but when all four dimensions were considered, few were receiving high levels of water service.

The Global Water Challenge is attempting to compile a global database of all water points (whether collected by govt. NGO, researcher, etc.). They are currently working on a core data set based on what they found to be common denominators.

SANITATION

What To Do with Infant Poo!

Session jointly sponsored by UNICEF, the Water & Sanitation Program of the World Bank, and the USAID/WASHplus Project.

Although the impact of poor sanitation is often measured on children under five, little is known about what happens to the feces OF children under 5. Most sanitation interventions target adults and school aged children.

A reanalysis of DHS/MICS data by UNICEF and the Water & Sanitation Program of the World Bank shows that only 39%-47% of caregivers in 78 low and middle income countries reported using an improved type of feces disposal for their children under five (Null & Reese, 2012 and 2013). Poor, rural and younger children are most at risk for unsafe disposal and its associated impacts.

There are only a few programs focusing on young children’s sanitation, and we have little evidence base for effective strategies for safe disposal of child feces. Significant knowledge gaps must be filled before comprehensive practical evidence-based policy and program guidance will be available. Some organizations and experts are working to fill that gap and have published a number of recommendations and possible methods for incorporating child feces management into existing programs.

The standing room only session at UNC began with a brief overview of the findings from the DHS analysis, and focused on giving an overview of programs and policies by governments and organizations throughout the world which have been implemented to increase the safe management of child feces. Leaders of these programs presented their work in small participatory group discussions. Two sub-sessions focused on the WASH Benefits studies in Kenya and Bangladesh, large RCTs that among other variables are looking at the uptake and impact of several ‘enabling’ technologies for improved infant feces management, technologies like child potties and pooper scoopers to dump open air child feces into the latrine. A third session by the USAID WASHplus project shared the WASHplus experience in Bangladesh, where they are beginning to identify a series of ‘small doable actions’ by age cohort (infant, toddler, young child) to facilitate safe disposal of feces. The last of four sessions focused on the work of WaterShed in Cambodia, also highlighting a range of ‘enabling technologies’ including potties and child-friendly squat mats, to encourage improved infant feces management and document the outcome of these improved practices. WaterShed was successful in improving practices through the use of promotion and enabling technologies.

The final part of the session invited participants to critique a series of recommended actions, organized by categories of increasing demand, improving supply and strengthening the enabling environment. These actions are based on the available evidence base, which though still not comprehensive, allow for pioneering programming to move forward the best practice in this emerging area. Based on participant input, they will be revised and disseminated to guide programming globally.

Confronting the Challenge: Sanitation Behavior Change in Rural North India

Convened by Bill and Melinda Gates Foundation plus the RICE Institute from Emory

Despite large government and NGO programs, despite substantially increased public spending on sanitation, and despite sustained economic growth, open defecation is declining slowly in rural “Hindi heartland” north India. If the international community is going to stop open defecation by 2030 as advocated by the SDGs under discussion, the preference for open defecation that exists in India will have to be addressed. Widespread resistance to using simple latrines in the rural north Indian plains states is a human development challenge, which others refer to as a crisis, and a serious puzzle: this is an area of the world where open defecation is most common and where high population density most raises the human and economic costs of open defecation. And 80% of rural households in India are believed to practice open defecation.

Evidence is now accumulating from many sources that north Indian states present a unique challenge: what worked in Bangladesh, Southeast Asia, or sub-Saharan Africa is unlikely to work here. Below are some of the possible explanations why:

Many people prefer defecating in the open, and believe it is healthier and nicer.

  • Many people may be willing to accept a latrine that they can repurpose, but they have little desire to use one.
  • Millions of households have working latrines that some household members use, but others do not. This is not captured in household-level survey data.
  • Rural north Indian villages are deeply socially fragmented. Any approach that depends on villagers coming together as a “community” will likely fail. In Indian English, the word “community” means common caste or religious group, not geographic neighbors.
  • Many people believe that the proper, religiously pure, and socially acceptable place to put feces is far from one’s own house.
  • Open defecation is an accepted part of life. Indeed, for some people, pit latrines are a disgusting notion!

Rural north India is not “just one place” or “merely one part of a big country,” and concern ourselves with other pockets where open defecation remains but is in the process of going away. How can we learn, tinker, and experiment in Northern India? How can we adjust what worked elsewhere to the different context of rural north India? How can we prevent millions of child deaths and stunted bodies and lives?​ The answer may partially lie in being consumer oriented and in getting the consumers’ voice be heard instead of implementing vertical sanitation programs which may fail.

Evidence of the Efficacy, or Lack Thereof, of CLTS

A number of evaluations examining the health impact of CLTS implementation were conducted, all of which suggest limited ability to trace CLTS back to concrete health metrics. Tom Clausen of Emory/LSHTM did a large randomized control trial on WaterAid’s heavily subsidized sanitation work in India as promoted by the Indian government’s Total Sanitation Campaign, and found no significant health impact: no change in diarrhea, anthropometric measurements such as stunting, or intestinal worm infection. The study found that latrines were being used by less than 70% of the community members (perhaps due to the nature of the approach). It was therefore not surprising that the RCT, despite costing 4.2M dollars to complete, did not detect any change in health outcomes. The findings support the notion that sanitation coverage must reach close to 100% in order to reduce pathogen transmission from the environment to the level which results in health impacts.

Amy Pickering of Stanford did a large 2-year trial of UNICEF’s CLTS work in Mali. She found no effect on diarrhea in ODF certified communities, but did find a significant effect on stunting. The difference in their findings may be due to population density, and baseline sanitation status in Mali vs. India. In essence, CLTS impact goes a longer way in Mali, where population density and baseline sanitation is lower.

Why is CLTS Successful?

The UNC Water Institute has conducted a series of studies with PLAN, looking at the enabling factors for successful CLTS, as well as modalities of CLTS that result in greater and sustained ODF certification among communities. Overall, research suggests that CLTS (even combined with sanitation marketing and other approaches) is not an intervention that works everywhere.

CLTS appears most effective in areas where baseline sanitation coverage is low, but has diminishing returns as sanitation coverage is higher/increased. Similarly, while it does create demand for unimproved toilets, it only minimally impacts uptake of improved toilets and returns are diminishing as coverage increases. As such, it may not be the most appropriate intervention in communities that have even 50% latrine coverage. It is increasingly clear that CLTS needs to be considered more dynamic – what are the various modalities of CLTS that we can implement based on the community and environmental factors.

HYGIENE

The Theory and Practice of Handwashing Habits, organized by USAID/WASHplus and partners including the Water and Sanitation Program, London School of Hygiene & Tropical Medicine, and the Global Public Private Partnership for Handwashing with Soap.

This session focused on the seven principles of habit formation, explored how they could be applied to the handwashing arena, and discussed applications where enabling products have been developed and tried as cues to guide practices and habit formation. Potential implications for future handwashing programs were discussed, beyond the mere creation of cues.

Diarrheal disease accounts for 11% of child mortality worldwide. Yet, there is a cost-effective way of reducing diarrheal disease in children under five and in turn reduce child mortality: handwashing with soap at critical junctures, especially among caretakers, grouped into two large categories, before food handling and after contact with fecal matter. Handwashing with soap at such junctures can reduce diarrheal incidence by up to 43%.

Handwashing promotion has been an important part of many WASH interventions and such programs have been able to increase handwashing practices among target populations using a variety of approaches. More recently, these approaches rely on conceptual framework that argue in favor of using psychosocial determinants and emotional appeals. Such frameworks have their origin in reflective psychology which suggests that behavior is volitional and guided by factors internal to the individual.

Handwashing programs constructed on reflective psychology theories and models have proven effective to generate behavior change. However, is there any evidence that they have been useful in helping to maintain the practice overtime? Research on the sustainability of handwashing practices overtime is inconclusive. Yet, interpretations of findings overtime suggests that factors in the context in which individuals behave may be partially responsible for their perdurance.

A couple of studies argue in favor of the presence of water and soap as contributing factors to handwashing sustainability. Such suggestions point in the direction of the science of habits which proposes that factors initiating practices are not the same as those that maintain them. Whereas reflective psychological models may explain the practice of new behaviors, reflexive models offer an explanation for keeping them alive.

WASHplus Project in Kenya Shares Experiences in Transitioning Workshop

By George Nyairo Obanyi, FHI 360

george_obanyi1About the Author: George Nyairo Obanyi is the Information Officer for FHI 360/Kenya based in Nairobi. George provides communications support to the country office and field programs.

The USAID-funded WASHplus project ended its four years in Kenya with an experience-sharing workshop for key stakeholders held in Nairobi on September 25th 2014.

Representatives from USAID, government, other partners and community members converged for the one-day event during which the project showcased its achievements through plenary presentations, video shows and a photo gallery.

Kenya is one of seven countries where the WASHplus project works with partners to create supportive environments for healthy households and communities by creating and delivering interventions that lead to improvements in water supply, sanitation, and hygiene (WASH) and household air pollution.

In Kenya, the project partnered with the Ministry of Health to strengthen the capacity in public and private sectors as well as communities to implement sustainable WASH interventions.

WASHplus introduced and successfully promoted the small doable action (SDAs) concept, which has been accepted by government and other WASH actors to encourage hand washing, use of latrines, menstrual hygiene management and water treatment and safe storage.

Another key WASHplus achievement was its pioneering role in promoting inclusive sanitation approaches under an innovative, value-added community-led total sanitation (CLTSplus) approach to promote open defecation free (ODF) communties, which was successfully piloted in two rural counties and one urban site.

In its role as a national mechanism, the project helped to develop policies and training guides including a training curriculum for WASH-HIV integration and a module for training community volunteers.

Other notable achievements include:

  • Over 650 trainers from government and 8,000 CHWs trained on WASH-HIV integration and inclusive sanitation through Community Strategy
  • Improving access to sanitary pads for girls and women in communities
  • Community volunteers and leaders trained to help make supportive devices for individuals with disabilities

Interventions initiated and supported by WASHplus have now been transitioned to the government and other USAID-supported health projects.

Kenya’s deputy Chief Public Health Officer Dr John Kimani addresses the WASHplus Kenya end-of-project experience-sharing workshop held in Nairobi on September 25th 2014. Photo: Elisha Ratem
Kenya’s deputy Chief Public Health Officer Dr John Kimani addresses the WASHplus Kenya end-of-project experience-sharing workshop held in Nairobi on September 25th 2014. Photo: Elisha Ratem

Speaking at the experience-sharing workshop, the Deputy Director for Public Health at Kenya’s Ministry of Health, Dr. John Kariuki, said the WASHplus program had made strategic contributions to improving WASH interventions in the country.

“County legislators should now invest money to continue the process,” he said. “As we have worked with WASHplus, we will as a Ministry continue to give policy direction and guidelines to the counties.”

Said Dr. Kariuki: “The biggest lesson is about equity and sanitation. We cannot talk about a county being ODF if the people who are disabled or the old people are not using latrines. They are Kenyans and have a right to sanitation.”

The official urged stakeholders to lobby county governments to allocate funds for WASH activities:  “It does not happen automatically. You must be proactive, not wait for thing to happen.”

Representatives of organizations that partnered with WASHplus also praised the project for helping to shape the WASH interventions. Charles Ngira of the NGO Plan International said: “We should be talking of inclusive CLTS, not just CLTS. This model will totally solve our sanitation problem.”

Dr. Kariuki called for integrated CLTS programs that promote practices such as hand washing, menstrual hygiene management, the work of traditional birth attendants and air pollution, among other aspects.

“Let’s use CLTS as a vehicle to ensure we improve the health of our people,” he said.

“Sanitation has improved but we need to address equity and inclusion,” said Dr. Mores Loopapit, deputy project director of the USAID-funded APHIAplus Imarisha. “There is need to consider health outcomes in studies on access to hygiene and sanitation.”

Simon Makori, associate director of APHIAplus Nuru ya Bonde, urged stakeholders to support community health volunteers because they play a critical role on promoting WASH practices.

“Community health workers should be engaged in income-generating activities for sustainability,” he said.

For more information about the project, visit the WASHplus Kenya page: http://www.washplus.org/countries/kenya

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Pic-4_Makena presents

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WASHplus Kenya End of Project Experience Sharing Workshop and Report

From January 2010 to September 2014 WASHplus worked with the Kenyan government to generate demand for sanitation; improve water, sanitation, and hygiene (WASH) practices among all households; and introduce simple supportive technologies to vulnerable households. The project supported the Ministry of Health (MOH) and its partners to integrate improved WASH practices into HIV policies, programs, and training. To do so WASHplus worked within existing structures under the MOH, such as the departments of Environmental Health, Sanitation and Community Health Services and the National AIDS and STI Control Program, as well as with other U.S. government bilateral partners—the APHIAplus projects and Centers for Disease Control and Prevention partners.

The two WASHplus program components—integrating WASH into HIV and advancing improved sanitation uptake—worked together to improve WASH practices across Kenya. The program objectives were to:

  • Assist government and NGO programs in Kenya to integrate improved WASH practices into HIV policies and programs, with special emphasis on inclusive approaches
  • Support uptake of improved sanitation practices using a community-led total sanitation (CLTS)-plus approach
  • Help to build a vibrant private sector to address demand for sanitation especially focused on quality latrines that meet minimum standards

What started as an activity to integrate sanitation and hygiene practices into HIV/AIDS care and support programs has grown over the years into a holistic approach to prevent diarrhea among households at risk. USAID’s WASHplus project helped communities and households in Kenya make the connection between improved sanitation, healthy hygiene habits, and positive outcomes for people living with HIV and AIDS (PLHIV), their families, children, the elderly, and other vulnerable households. Along the way WASHplus technical support, participatory training, partner engagement, and behavior change efforts yielded valuable lessons for other countries battling to improve sanitation and health outcomes in the context of uncertain funding. Innovation, flexibility, and commitment to working hand-in-hand with the government proved to be keys to the project’s success. With the government’s endorsement and adoption of WASHplus’s signature approach, small doable actions are likely to continue to resonate with many audiences long after the WASHplus transition.

On September 24th the WASHplus Kenya project held an end-of-project experience-sharing workshop in Nairobi. Photos from the workshop are presented below. The WASHplus Kenya end-of-project report “Integrating WASH into HIV Interventions and Advancing Improved Sanitation Uptake” can be downloaded from the WASHplus website.

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Kenya’s deputy Chief Public Health Officer Dr John Kimani addresses the WASHplus Kenya end-of-project experience-sharing workshop held in Nairobi on September 25th 2014. Photo: Elisha Ratem
Kenya’s deputy Chief Public Health Officer Dr John Kimani addresses the WASHplus Kenya end-of-project experience-sharing workshop held in Nairobi on September 25th 2014. Photo: Elisha Ratem
Kenya’s deputy Chief Public Health Officer Dr John Kimani addresses the WASHplus Kenya end-of-project experience-sharing workshop held in Nairobi on September 25th 2014. Photo: Elisha Ratem
Caroline Vata, a government public health officer, presents a case study during the WASHplus Kenya end-of-project experience-sharing workshop  of in Nairobi September 25th 2014. Photo: George Obanyi
Caroline Vata, a government public health officer, presents a case study during the WASHplus Kenya end-of-project experience-sharing workshop held in Nairobi on September 25th 2014. Photo: George Obanyi
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Evelyn Makena, WASHplus manager in Kenya, makes a presentation during the end-of-project experience-sharing workshop held in Nairobi on September 25th 2014. Photo: George Obanyi
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Charles Odira of Plan International makes a point during the plenary session of an experience-sharing workshop held in Nairobi on September 25th, 2014 to enable other partners scale up its approaches. Photo: Elisha Ratemo
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A community health volunteer admires his own photo displayed in  gallery showcasing achievements of WASHplus program in Kenya. This was during the Kenya end-of-project experience-sharing workshop held in Nairobi on September 25th 2014 to enable other partners scale up its approaches. Photo: Elisha Ratemo
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Public Health Officer James Yatich explains about a commode he improvised for chronically ill patients. The innovation was displayed in a gallery showing the works of WASHplus program in Kenya over the past four years. Photo: Elisha Ratemo