More than 1 billion people worldwide suffer from one or more painful, debilitating tropical diseases that disproportionately impact poor and rural populations, cause severe sickness and disability, compromise mental and physical development, contribute to childhood malnutrition, reduce school enrollment, and hinder economic productivity. Three of these diseases are directly linked to water, sanitation, and hygiene practices.
WASHplus designed and implemented a model integrated WASH-NTD program that was tested as a small pilot effort in Burkina Faso from 2015–2016. The objectives in Burkina Faso were to:
1. Promote coordination within government among sectors related to WASH-NTD integration
2. Develop a comprehensive implementation activity in several villages in one district
3. Share experience and lessons learned with other partners who may be able to advance or further develop this activity
4. Provide a toolkit for Burkina Faso and global partners to use
This toolkit is the result of the WASHplus project in Burkina Faso and has the following components.
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.
In October 2015, WASHplus presented a poster at the American Society of Tropical Medicine and Hygiene Annual Meeting on the current situation, intervention design, behavior change plan, and expected results of its Burkina Faso WASH and neglected tropical disease (NTD) pilot activity, called “How Can Integrating Sanitation and Hygiene into an NTD Control Program Accelerate Reduction in NTDs?” View the poster here.
A SPLASH staffer displays MHM materials at the end of project event. Hygiene Behavior Change Technician Mayombo Mandevu displays SPLASH menstrual hygiene management products, accomplishments, and stories at the end-of-project event.
WASHplus’s Schools Promoting Learning Achievement through Sanitation and Hygiene (SPLASH) project ended its four-year program with an event held on August 20 in Lusaka. The half-day event was designed to showcase the different activities that SPLASH carried out to deliver a truly comprehensive school WASH program, what was learned in the process, and most importantly, to advocate for WASH (water, sanitation, and hygiene) to be adopted nationally by the Ministry of Education (MOE) as a key element of quality education. To this end, SPLASH invited every provincial chief of the MOE to attend, along with a range of stakeholders from the WASH and education sectors. The 80 attendees were divided into groups and made the rounds to eight themed stations designed and manned by SPLASH and Government of Zambia partner staff. Each booth showcased a SPLASH intervention with its key activities, achievements, and lessons learned displayed on a poster. A flurry of publications were finalized for the event, including A Teacher’s Guide to Integrating WASH in Schools, School WASH Facilities Operations and Maintenance Guidelines, and two new stories from the field on integrating WASH into existing government programs and infrastructure and school enrollment.
To respond to the project objective of improving learning outcomes, SPLASH undertook a longitudinal study for three terms in 124 intervention and control schools. Results of this analysis by school term indicate a statistically significant effect of the intervention for all indicators tracked: student absenteeism (roll call and two-week recall), teacher absenteeism, and student-teacher contact time. It shows that WASH improvements in schools can reduce student absenteeism by up to 50 percent.
By Ron Clemmer, Strategy and Business Development Manager, WASH, FHI 360.
World Toilet Day is about more than toilets! It is about the whole system of the sanitation chain. This whole “system” of household latrines; school and health facility toilets; septage haulers; wastewater and septage treatment, reuse and disposal, has become more and more a focus of international development professionals. As with development practitioners in other sectors, we work in complex social systems that require organizational change, behavioral change, and personal change for transformative social change to result in sustainable impact. A systems lens helps us to see our roles in development programs to understand the impact that is needed in the big picture of the “system.”
FHI 360 brought together speakers who are leaders in the area of systems thinking and also practitioners who are implementing a systems approach for international development for the Challenge Conference. The keynote speaker was Otto Scharmer from the MIT Sloan School of Management, who with Katrin Kaufer co-authored, Leading from the Emerging Future: From Ego-System to Eco-System Economies.
Being the pragmatic engineer that I am, some of the presentations that peaked my interest the most were from FHI 360 colleagues discussing the application of systems approaches in their development programs. A systems approach that FHI 360 staff has developed in conjunction with USAID is SCALE (System-wide Collaborative Action for Livelihoods and Environment). Ten years of learning through the implementation of the SCALE systems methodology to accelerate broad stakeholder engagement in sustained collaborative action to address a complex development issues has now resulted in FHI 360’s development of SCALE+.
If you want to explore more of Deepening Systemic Engagement, the Challenge Conference highlight videos and materials can be found here.
World Toilet Day is also about more than toilets because of the significant impact of good sanitation on maternal and child health, neglected tropical diseases, HIV/AIDS, education, and nutrition. World Toilet Day has a special linkage to nutrition this year, and 2015 World Toilet Day was chosen as the day that WHO/UNICEF/USAID are releasing the important publication Improving Nutrition Outcomes through Water, Sanitation and Hygiene: Practical Solutions for Policies and Programmes. My FHI 360 WASHplus colleagues managed the development of this publication in collaboration with the publishing agencies. And the integrated activities in different countries implemented by WASHplus and its partners are contributing practical knowledge and tools that will help guide WASH-nutrition integration in the future.
ABOUT THE AUTHOR: Ron Clemmer joined FHI 360 in May 2015 after working with World Vision as Senior Technical Advisor for WASH for six years. Ron is passionate about building sustainable water and sanitation services through the public and private sectors, hygiene behavior change that becomes habit, and integrated programming of WASH with nutrition, HIV, neglected tropical diseases, education, and women’s empowerment.
By Christa Elise Reynolds, Knowledge Management Officer, JSI Research & Training Institute, Inc. with USAID SPRING.
Toilets might not be the first thing you think of in conjunction with basic human nutrition, but inadequate sanitation poses a real danger for 2.5 billion people around the world. When crops become contaminated through open defecation, communities are at risk for disease outbreaks and chronic malnutrition.
This November 19, designated as World Toilet Day, we are reminded of the people lacking access to toilets and improved sanitation. About 1.1 billion people defecate in the open, according to UN-Water. Diarrheal disease, which can prevent nutrients from being absorbed, is a common outcome of improper human waste disposal. This is an issue in Ghana, where approximately 19,000 people die yearly from diarrhea. Nearly 90 percent of those deaths can be attributed to poor water, sanitation, and hygiene (WASH), according to the Water and Sanitation Program.
At the Strengthening Partnerships, Results, and Innovations in Nutrition Globally (SPRING) project, funded by the U.S. Agency for International Development’s (USAID), we are working to improve nutrition through our “WASH 1,000 strategy,” a multifaceted approach stresses the importance of key household behaviors during the first 1,000 days, spanning the mother’s pregnancy to the child’s second birthday. Numerous factors influence a child’s well-being during this time. Our WASH 1,000 strategy focuses on four key behaviors: ensuring the child has a safe and clean play space, safely disposing of human and animal feces, handwashing at critical times, and using only boiled or treated water for the child’s consumption.
Mobilizing communities to build latrines is one of the first steps toward improving sanitation. Working with country partners, we facilitated discussions about the importance of latrines and sanitation in communities in the northern and upper eastern regions of Ghana, and participants have been receptive to the ideas. Installing tippy taps, or simple handwashing stations, near latrines and in households promotes handwashing after using the latrine and before meals, another WASH 1,000 goal.
“I am happy that I and my family do not defecate in the open again. I have restored my lost dignity,” said Gmangun Charles, a resident of the Kubone community in the Mion District of Ghana, who recently constructed a latrine for his household’s use.
Since February 2015, 47 household latrines have been built in the Kubone community. After learning about the benefits of using latrines, residents are increasing community awareness of open defecation’s health risks and shaming those who refuse latrines.
The link between open defecation, hygiene, and nutrition is not obvious and many community members may not be aware of the connection. Because people in the northern and upper eastern regions of Ghana often defecate on farm fields and near water sources, crops can become contaminated. Children might be exposed to human and animal feces while playing, which can lead to infection and diarrhea. Eating with unwashed hands can cause further contamination. Properly built latrines and use of tippy taps reduce this health risk. These latrines are a source of pride for the community members who build them, 14-year old Emmanuel Loteba said.
“Though the idea of feces getting into our foods is disgusting, I also felt guilty because we all defecate openly in this village. We were told that the best way to avoid contaminating our food and to live healthy lifestyles is to build household latrines,” Loteba commented.
Loteba lives in Boagnab Yare, a community in Ghana’s upper east region, where diarrheal disease and low nutritional absorption are common. He learned about the WASH 1,000 strategy through one of our trainings. In the Kugbar-Bulug community, another of our WASH 1,000 Ghana sites, 19 of 28 households have already built household latrines. Kwame Awin, a local farmer, is happy with his new latrine because he and his family can finally eat fresh beans from their fields without risking contamination.
World Toilet Day highlights the sanitation needs of billions of people around the world who can’t wait for better hygiene. By encouraging a more holistic understanding of nutrition as it is impacted by WASH, our work in Ghana has begun changing perceptions of latrines and sanitation in the country’s northern and upper eastern regions. SPRING continues to promote WASH 1,000 behaviors to communities and trainers so that they may improve sanitation access, nutrition, and health.
ABOUT THE AUTHOR/ PROJECT: Christa Elise Reynolds is a Knowledge Management Officer working on the USAID SPRING project at JSI Research & Training Institute, Inc. Funded by USAID, the Strengthening Partnerships, Results, and Innovations in Nutrition Globally (SPRING) project strengthens country efforts to scale up high-impact nutrition practices and policies. To learn more about SPRING visit the project website at www.spring-nutrition.org and follow @SPRINGProject2 on Twitter.
DISCLAIMER: The contents of this blog post are the responsibility of JSI, and do not necessarily reflect the views of USAID or the United States Government. SPRING’s work is made possible by the generous support of the American people through the United States Agency for International Development (USAID) under the terms of the Cooperative Agreement AID-OAA-A-11-00031 (SPRING), managed by JSI Research & Training Institute, Inc. (JSI).
The WASHplus is in Chapel Hill this week (October 26-29, 2015), presenting at the UNC Water and Health Conference organized by the UNC Water Institute. Conference presentationscan be viewed on the WASHplus website. Here are presentation highlights, captured from conference attendees’ tweets!
On Global Handwashing Day and every day we dedicate ourselves to increasing awareness and understanding about the importance of handwashing with soap to prevent diseases and save lives. Please see below handwashing resources developed by WASHplus on: the small doable approach to handwashing; how to make tippy taps for handwashing; making a habit of handwashing; and integrating WASH into nutrition and HIV programs.
How to Make Other Types of Tippy Taps, 2014. This pamphlet shows how to make Tippy Taps for handwashing from mineral water bottles, tin cans, and hollow tubes. The tippy tap is a hands free way to wash your hands and is especially appropriate for areas where there is no running water.
By Ron Clemmer, Strategy and Business Development Manager, WASH, FHI 360.
About the author: Ron Clemmer joined FHI360 in May after working with World Vision as Senior Technical Advisor for WASH for six years. Ron is passionate about building sustainable water and sanitation services through the public and private sectors, hygiene behavior change that becomes habit, and integrated programming of WASH with nutrition, HIV, neglected tropical diseases, education, and women’s empowerment.
“I was fortunate to attend last week’s World Water Week 2015 in Stockholm which included, among many other activities, attending three different water, sanitation, and hygiene (WASH) and gender sessions. Having five hours of presentations and discussion on WASH and gender issues in one day was remarkable. Great that gender had so much focus! One of the presentations I found fascinating was research on the psychosocial stress of women and girls related to WASH, presented by Robert Dreibelbis, from the University of Oklahoma. WASH programming can provide a good entry point for working with communities for many development goals, including empowerment of women and gender equity, was one of the conclusions of the session.
At World Water Week, I shared how the USAID-funded WASHplusproject, implemented by FHI 360, is strengthening girl’s and boy’s education by integrating and embedding WASH in Schools and providing support for menstrual hygiene management.
Photo Credit: German Toilet Organisation
World Water Week was part of two weeks of intense dialogue of women empowerment for me. The week before, I had multiple communications on women’s empowerment surrounding WASH with my FHI 360 colleagues working on the WASHplus project, as we have begun discussing how to support the representation of WASH issues at Women Deliver 2016 Conference. We discussed how WASH not only addresses health issues, but also influences safety, time poverty, and dignity for women and girls.
If you are not familiar, Women Deliver is a leading global advocate for girls’ and women’s health, rights, and wellbeing and brings together diverse voices and interests to drive investments and progress, particularly in maternal, sexual, and reproductive health and rights. The focus of the Women Deliver 2016 Conference will be on how development can best support girls and women, with a specific lens on health, rights, gender equality, education, and economic empowerment.
As the father of two young girls, I often think about girl’s empowerment and what that means for society at large. I am fortunate to work in an organization which empowers women and girls through not just the provision of improved WASH but also the integration of WASH into other development sectors to strengthen girls and women’s rights, health, and wellbeing.
Before I ran to the airport to catch my flight to Stockholm, I was involved in women’s empowerment in an entirely personal way. My 12 year old daughter was participating in her 3rd triathlon while my wife was enjoying listening to my younger daughter’s piano recital. We are grateful for the opportunities that our daughters have to flourish into empowered young women, as I strive in my work to contribute to the empowerment of less privileged girls around the world.”
WASHplus is implementing a pilot program in Burkina Faso that is designed to develop an integrated WASH–NTD model that can be scaled up in-country and replicated elsewhere. Burkina Faso is a country with very little latrine coverage, relatively poor hygiene practices, and pockets of high burden of disease related to water, sanitation, and hygiene. Without a serious focus on face washing and environmental cleanliness.
WASHplus is working in Burkina Faso to partner with stakeholders at district and provincial levels to implement a comprehensive WASH–NTD integrated program in one district. We will then document and disseminate the learnings gained through this pilot program. WASHplus will also engage multiple stakeholders inside and outside of government, including working with existing government structures at multiple levels, such as local government that has the mandate for water and sanitation at the local level. Typically, WASH and NTD programs have not worked together in Burkina Faso, though some precedence exists for inter-sectoral collaboration through the WASH-Nutrition group that has been spearheaded by UNICEF and embraced by government stakeholders.