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.

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.

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.