WASHplus Work in Uganda Comes To A Close

Field activities came to a close in the last quarter of 2014 after about 20 months of support to three districts in Southwest Uganda to plan and implement WASH activities, bolstered by USAID WASH grants. In addition to direct technical support to the districts, WASHplus worked closely with USAID implementing partners including Community Connector, SPRING, STAR-SW, FANTA, and others to integrate aspects of safe and sufficient water, sanitation, handwashing, food hygiene, and MHM into HIV care and support as well as Feed the Future/nutrition activities.

WASHplus worked intensively this quarter with districts to complete revisions of capacity building materials used and improved throughout the almost two years of WASHplus assistance, and to complete a series of job aids to support outreach workers and clinical counselors to integrate WASH into their home-based and clinical practice. The job aids are available in two local languages, Rukiga and Rufumbira. Limited runs of materials were printed and distributed to development partners, while districts will use their USAID grant money to duplicate and disseminate materials. All materials are available on the WASHplus website on the Uganda page.

USAID grants were managed through the USAID Strengthening Decentralization for Sustainability project, with specialized technical assistance offered by WASHplus in areas including:

  • Facilitating CLTS
  • Making Schools WASH-Friendly (including appropriate hardware like rainwater harvesting for increasing water access and MHM to increase girls participation, attendance, and dignity)
  • Forming and supporting community WASH management structures such as water management committees to address O&M
  • Producing WASH tools and materials for behavior change, promotion, and negotiation

Districts and USAID implementing partners participated in the WASHplus closing event in December 2014, “Working with Districts to Improve Water and Sanitation to Improve the Health and Resilience in Southwest Uganda: Success, Opportunities, Challenges, and Lessons Learned.” The event celebrated accomplishments such as the institutionalization of WASH behavior change approaches like small doable actions. Notable in Uganda was the application of the small doable action approach to food hygiene, in conjunction with SPRING and Community Connector, to address local challenges of keeping food safe; issues of water quantity and access (constructing various “do-it-yourself” rainwater catchment systems); HIV care and support in the home and clinic; and home sewn reusable menstrual pads for women and girls of all ages. An end of project review was prepared for the event and is available here.

Links to resources from the WASHplus activities in Uganda are provided below.

WASHplus Uganda Project Transitions to Local Actors

Three girls sew their own menstrual pads.
Girls take menstrual hygiene management into their own hands as they make reusable menstrual pads, one of the many small doable actions WASHplus helped to promote in Uganda.

In November 2014 WASHplus concluded a busy year and a half of work in Uganda (May 2013–November 2014) to reduce diarrhea and improve the health and resilience of key populations in three districts—Kabale, Kisoro, and Kanungu. This multidisciplinary initiative focused on integrating water, sanitation, food hygiene, and hand washing into nutrition and Feed the Future activities as well as community and clinically based HIV activities. WASHplus also worked to strengthen the capacity of local districts to plan, budget, implement, and monitor water, sanitation, and hygiene (WASH)–related activities. A WASH forum was held in collaboration with USAID implementing partners December 2 to celebrate project accomplishments and mark the official transition to district actors. The project produced a number of publications and materials for field use that are now available, including training and resource packages on Integrating Safe Water, Sanitation, and Hygiene into HIV Programmes and Integrating Safe Water, Sanitation, and Hygiene into Infant and Child Nutrition Programmes, and job aids/assessment cards in English and two local languages—Rufumbira and Rukiga (available on the WASHplus website). Districts will reproduce these materials in even larger quantities using their USAID WASH grants. An end-of-project review is also available here.

Thoughts from SWWW: What Next for Handwashing?

 Woodburn_Hanna_2014by Hanna Woodburn

About the author: Hanna Woodburn is the Deputy Secretariat Director, Public Private Partnership for Handwashing (PPPHW). Follow her on Twitter @WASH_Hanna.

I’ve been at the 2014 Stockholm World Water Week (SWWW) for over three days now. As someone solidly in the water, sanitation, and hygiene sector, I’ve found the conference to be an interesting mix of people with a wide range of interests and technical backgrounds. In addition to my own session on the role of hygiene in achieving the full benefits of water investment, I’ve attended sessions on gender, inequity, WASH service deliver in emergencies, and more. These are my reflections both from these sessions and the many conversations that I have had with other attendees.

First, while much energy has been devoted by the Public Private Partnership for Handwashing (PPPHW) and others to the promotion of hygiene at the policy level, there are is a knowledge gap within the larger sector as to the definition and role of hygiene in development. And it’s true: hygiene can encompass many different specifics, such as menstrual hygiene management, food hygiene, facewashing, toothbrushing, and of course handwashing with soap. These behaviors, and their supporting “hardware”, such as materials and facilities, can be quite different from one another. They have different evidence bases, different measurements, and different challenges. This was a good reminder that there is more that we need to do within the hygiene sector to better communicate, educate, and advocate – not only at the global level, but also amongst our colleagues in the water and sanitation  sector.

Secondly, a word about working within a system. My favorite session thus far was convened by the GermanWASH Network and the German Federal Foreign Office on the subject of streamlining strategies for humanitarian aid within the WASH sector. This session included  a robust discussion on the role of governments, INGOs, and local actors in delivering WASH services within the humanitarian context. While there were many valid and salient points raised, this session for me emphasized the role that hygiene plays within a larger system. We actively work to promote integration of hygiene within correlate sectors, such as nutrition and education, but hygiene is also embedded within a context. And that context influences not only what program, but how, and what we measure. There isn’t a “magic bullet” or a “one size fits all” approach to hygiene behavior change. We need flexibility.

Finally, I’ve been struck by the number of people who have mentioned the need to move from conversation to action. There’s a great emphasis within the sector on ensuring that we not only have evidence, that we have perfect evidence, before moving to action. This can have an unintended consequence of stifling innovation and reducing our willingness to take risks. To be clear, I am certainly not advocating for acting foolishly, or minimizing the importance of strong evidence, but there is a feeling that there needs to be more room for failure and a greater aptitude for trying and doing, rather than being overly cautious where our knowledge is imperfect. Indeed, even projects that aren’t successful can contribute to our knowledge base about handwashing promotion and behavior change. PPPHW can contribute to innovation leadership within the hygiene sector.

I’m excited to take these and other learnings from the conference and apply them to our work in handwashing advocacy and knowledge leadership.

Uganda–Assessing Opportunities for WASH Integration


WASHplus staff accompanied STAR-SW, a USAID implementing partner, during an HIV Quarterly Pediatric Campaign Day at a district hospital in Kanungu District to observe and then discuss specific options for integrating WASH into HIV and nutrition programming. During Campaign Days, HIV-affected families are invited for family health and nutrition counseling as well as refills of HIV medications. Families come early and spend the day, receiving tea and lunch. The day culminates with a health education session. Various opportunities were identified for WASH integration in formal and informal settings. The current lack of hand washing stations/supplies means that lunch and tea provide a prime opportunity to demonstrate tippy taps, model proper hand washing, and later follow-up with a hands-on session on “how to make a tippy tap” while families wait for their turn with clinicians. WASHplus proposed training volunteer peer educators to deliver short, interactive sessions (like the tippy tap sessions) throughout the day in addition to their health education session to take advantage of the captive audience awaiting their turn for services.

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.