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.

World Water Day: Providing Jobs, Empowering Lives

In 2011, USAID/Zambia invested $18 million in a four-year WASH in Schools program that covered half the districts of Eastern Province and provided enough resources to meet the sanitation facility, water points, and hygiene education needs of the school population of those districts. These numbered 200,000 students attending more than 400 primary schools. SPLASH (Schools Promoting Learning Achievement through Sanitation and Hygiene) was implemented from 2012-2015. The USAID funded WASHplus project, managed by FHI 360, implemented SPLASH in partnership with CARE.

When 21-year-old Masauso Zimba of Fyofyo village in Lundazi District had to drop out of school for lack of school fees, he was confronted with a grim job outlook. When the SPLASH project began building school latrines nearby, Masauso went to see what was going on, “I kept observing the construction, offered my services, and helped out here and there.”

After two weeks, he was hired to carry materials for the artisans constructing the latrines; all the while he continued to observe what the workers were doing during the construction. Not long after, the project sent out engineers to teach skills in basic construction.

 

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On-the-job training with SPLASH inspired Masauso to pursue an engineering degree

“I signed up and was trained. Now, I have building skills. And I have made enough money to go back to school where I want to study engineering and supervise artisans. I am so grateful to SPLASH and USAID for bringing a flicker of light in my dark tunnel.”

World Water Day: Building Latrines, Providing Livelihoods

In 2011, USAID/Zambia invested $18 million in a four-year WASH in Schools program that covered half the districts of Eastern Province and provided enough resources to meet the sanitation facility, water points, and hygiene education needs of the school population of those districts. These numbered 200,000 students attending more than 400 primary schools. SPLASH (Schools Promoting Learning Achievement through Sanitation and Hygiene) was implemented from 2012-2015. The USAID funded WASHplus project, managed by FHI 360, implemented SPLASH in partnership with CARE.

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Ananias stands outside the double ventilated improved pit latrine that he constructed

Twenty-two year old Ananias Shawa was hired as a helper by a local artisan when the SPLASH project started constructing washrooms and latrines at Chisomo Primary School, near his village in Chipata District in Zambia’s Eastern Province.

As a helper, Ananias learned to mix the concrete and also fetched water. He was a “daka boy,” which in the local language, means “concrete that has been mixed.” He easily met the job’s requirement, which was to be physically fit and willing to work hard. Ananias was not new to such work; he had been earning a living since he had to drop out of school in Grade 7 to help his struggling family.

During a visit to the Chisomo site, an engineer from the SPLASH Chipata District team encouraged Ananias to ask his supervisor, a local artisan and accomplished bricklayer, about learning to lay bricks for washroom construction. He also encouraged Ananias to learn through observation. Ananias followed the advice and was hired to take on the additional task of laying bricks.

He gained valuable knowledge and experience assisting the construction of a double ventilated improved pit (VIP) latrine and a washroom. He used his newly gained knowledge, along with technical support from the engineer and a supervisor, and completed construction of a single VIP latrine from scratch. The successful completion and job well done earned him another contract to construct a handwashing facility and a borehole fence.

Ananias earned K 2,650 for this work, an amount he had never earned before. He is grateful to the USAID-funded SPLASH project for the skills he has gained and for the WASH facilities at the local school that serves his community.

Ananias is not standing still; he is now focused on perfecting his construction skills to earn a certificate. And with the additional income he has earned, he is buying fertilizer as the farming season is now underway.

 

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.

Voices from Bangladesh: Reflections on SACOSAN VI

Reblogged from PPPHW blog.

julia rosenbaumBy Julia Rosenbaum, Senior Behavior Change Advisor USAID/WASHplus Project

I recently attended the 6th South Asian Conference on Sanitation (SACOSAN VI), held in Dhaka, Bangladesh. Given the clear ties between sanitation and hygiene, I was asked to provide commentary on the prevalence and discussion around hygiene at SACOSAN. A commentary on hygiene, however, first begs the question, “What is hygiene?”, as it means many things to many sacosanpeople. To some, hygiene pertains exclusively to handwashing with soap. To others, it includes food hygiene and treatment and safe storage of household water. To others, still, it means any “software” or promotional aspect of within water, sanitation, and hygiene (WASH) generally, such as behavior change. It is fair to generalize that hygiene was comprehensively defined at SACOSAN including the “software” side of WASH, specifically regarding sanitation, handwashing, and menstrual hygiene management.

A major theme throughout the conference was a renewed call for representation and inclusion through the human right to sanitation. This was true in terms of hygiene, too.

Representation and inclusion were perhaps best represented in a session that highlighted a new publication and spotlighted issues facing women, adolescent girls, the elderly, persons with disabilities, and those in the sanitation workforce. Leave No One Behind, a stunning new publication of Freshwater Action Network South Asia and the Water Supply and Sanitation Collaborative Council, seeks to give voice to those too often neglected and excluded from both political processes and access to sanitation and hygiene services. The objective of the publication and the initiative is to assure inclusion and representation, considered essential to achieving the newly agreed upon Sustainable Development Goals.

The session corresponding with the Leave No One Behind report illuminated the tremendous obstacles and humiliation suffered by these individuals and the corresponding consequences—including indignities, poorer health, and safety concerns. Yet, despite the many conversations about access, what was most poignant to me was the overall inaccessibility of the conference center despite efforts to find a more accessible venue. Clearly, in many contexts, access needs to be better ensured and not merely discussed. While the focus of this session was to highlight the “voices” of those featured in the report, there was a striking absence of positive examples and best practices that have been refined over the past decade and do provide access to many who might otherwise be left behind. Showcasing ways that access can be achieved—for instance, displays of simple latrine and handwashing station modifications to allow access to the differently abled, the elderly, the deaf, blind, and mute—or outlining inclusion strategies and approaches gaining prominence could have prompted session participants to not merely discuss the need for inclusion but also inspired action.

While I wish that the accessibility issues faced by participants had been addressed, there were many highlights of the conference. It was heartening to see participants spontaneously organize a special side session on menstrual hygiene management (MHM), as it was not prominently included in the program. Facilitated by WaterAid and featuring a wide range of panelists including government officials, global leaders, and community representatives, this lively session filled a gap and helped to prioritize menstrual hygiene management in the SACOSAN declaration and commitments.

The meeting’s hygiene promotion session was coordinated by the Afghani Delegation. The four technical papers that comprised this session—including one co-authored by USAID/WASHplus—comprehensively defined hygiene promotion. As a result, there was a large focus on sanitation best practice and innovation, such as improving sanitation and hygiene (mostly handwashing) practices in geographically-challenged areas, fostering strategies to improve sanitation coverage and developing approaches to improving sanitation practice (i.e., latrine use) and consistent and correct handwashing with soap. A forth session focused on MHM, and boldly shared the failures attributed to not thoroughly consulting with school girls and administration, as well as successes.

Hygiene was also prominent in a plenary session chaired by BBC Media Action (formerly BBC World Service Trust). Via a provocative video presentation, behavior change specialist Dr. Val Curtis with the London School of Hygiene and Tropical Medicine, highlighted three elements—surprise, revaluation, and performance—as fundamental and effective at improving WASH. This video was followed by prominent national journalists who discussed how to get the public to engage in topics considered unpleasant and often taboo by capturing audience attention and greater media visibility.

The linkages between sanitation and hygiene are clear, and it is encouraging that hygiene was featured prominently in the meeting’s Declaration and Commitments where every mention of sanitation included “… and hygiene”. I am hopeful that the calls for representation and inclusion of the vulnerable and underserved that were made during SACOSAN will lead to a truly enabling environment, and that we will learn from our oversights and collaborate going forward to improve access to sanitation and hygiene for all.

New Learning Briefs from WASHplus

thumb_WASH+Nutrition_IconThis first in the series of learning briefs, “WASH and Nutrition,” documents the project’s WASH and nutrition integration programming efforts to stimulate the discussion and improve the evidence base as well as share experiences and approaches to integrating the two sectors at the global and country level. Read the brief here.

SDA (1)The second in the WASHplus series of learning briefs, “Small Doable Actions: A Feasible Approach to Behavior Change,” takes a look at how WASHplus has applied the Small Doable Action approach to handwashing, water treatment, improved sanitation, menstrual hygiene management, and food hygiene. Read the brief here.

cltsIn its newest learning brief, “CLTS-Plus: Value-Added Sanitation Programming,” WASHplus describes how it incorporated additional elements into the innovative community-led total sanitation approach and customized its application to different countries and circumstances. Read the brief here.

WASHplus Presents Poster at ASTMH 2015

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@wasplusinfo’s Renu Bery presents a poster on integrating into at 2015 ASTMH Meeting!

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.

World Toilet Day = Systems Day = Nutrition Day

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’s 2015 Challenge Conference Deepening Systemic Engagement addressed an important question for systems thinking: “How do we as practitioners and change agents unify systems theory and practice to bring forth healthy and inclusive human development?”

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.

Improving Nutrition, One Latrine at a Time: WASH 1,000 Strategy in Ghana Takes Hold

By Christa Elise Reynolds, Knowledge Management Officer, JSI Research & Training Institute, Inc. with USAID SPRING.

Gmangun Charles, of Kubone community in Ghana, shows off his household’s new latrine. (Photo by David Nunoo, SPRING/Ghana WASH Advisor)
Gmangun Charles, of Kubone community in Ghana, shows off his household’s new latrine. (Photo by David Nunoo, SPRING/Ghana WASH Advisor)

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).