WASH-NTD Integration Program Model

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.

WASHplus Benin Carries Out Experimental Urban CLTS

DSC_0003

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.

SAMSUNG DIGITAL CAMERA

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.

IMG_1229

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: 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.

WWD pic 2

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.

 

World Water Day: Training WASH Service Providers

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.

SPLASH WWD 1

Under the SPLASH project, area water pump menders received technical and business training during a four day workshop. Trainees put their new knowledge and skills into practice by repairing broken water hand pumps.

A large component of SPLASH’s (Schools Promoting Learning Achievement through Sanitation and Hygiene’s) sustainability plan for infrastructure is to train a cadre of area pump menders (APMs) to rehabilitate, maintain, and repair the water points installed at schools and provide them with the tools they need to conduct the regular maintenance. Training has taken place in all four districts, with a total of 190 APMs trained and certified. Of these, 40 are women. During the five-day training program, APMs learn the intricacies of hand pump repair as well as business skills to enable them to become self-sufficient WASH service providers. SPLASH developed Operations & Maintenance Guidelines, which have been distributed to each school in all four districts, with an orientation session during distribution. The guidelines encourage the schools to engage local APMs to perform regular maintenance, and they include a space to record the contact information for the closest APMs for each school. The program involves mentoring where more experienced APMs helped mentor and supervise the trainees, who are being prepared to go out on their own.

WASHplus Year Five Annual Report, October 2015

WASHplus Year 5 Annual Report.png

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.

9 AM EST, Feb 16 Webinar: WASHing Away Diseases, Two Hands at a Time

WASH NTDs webinar

On February 18 at 9:00 AM EST, please join the Global Public-Private Partnership for Handwashing and the USAID/WASHplus project for a webinar discussing why water, sanitation, and hygiene (WASH) matter to neglected tropical diseases (NTDs), and addressing the need for new approaches for multi-sector initiatives to promote equity, poverty alleviation, health, and well-being.

Register here today!

Featuring experts from WaterAid, Sightsavers, the FHI 360-led USAID/WASHplus project, and USAID, this webinar is an excellent opportunity for those working in both WASH and NTDs to learn about the global landscape of WASH/NTD strategy and glean practical insights from projects that are operating in this context.

This webinar will include brief presentations on:

  • The link between WASH and NTDs
  • How we can work together to achieve common goals through the World Health Organization’s Joint WASH-NTD strategy; and
  • Integration in practice.

About the panelists:

  • Renuka Bery, MPH, Senior Program Manager for the USAID/WASHplus project, has an extensive background in WASH integration.
  • Sophie Boisson, PhD, Technical Officer for Water, Sanitation, Hygiene and Health at the World Health Organization (invited).
  • Edouard Tianhoun, RN, MSc, WASH-NTD Coordinator for the USAID/WASHplus Burkina Faso pilot project, has been in involved in WASH programs in his native Burkina Faso since 2011.
  • Yael Velleman, MSc, Senior Policy Analyst on Health and Sanitation, leads WaterAid’s strategy, advocacy, and research agenda on health.
  • Merri Weinger, MPH, Senior Environmental Health Advisor at USAID’s Bureau for Global Health, has over 30 years of experience in health programs at USAID, WHO, and PAHO.
  • Geordie Woods, MPH, Technical Adviser-NTDs at Sightsavers, specializes in health behavior and strategic communication with a technical focus that includes NTDs and WASH.

Following the presentations there will be a Question & Answer session.

Register now!

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.