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.
The WASHplus Project, funded by the United States Government via USAID, triggers change in sanitation practices through the community-led total sanitation (CLTS) approach with a “plus” component that includes an emphasis on hand washing with soap after using the toilet. In Mali the plus component also signifies supply-side interventions to develop and promote low-cost latrine models appropriate to the unique environmental conditions in each district coupled with training community-based masons to build robust latrines using local materials. To complement the CLTS-driven approach in rural areas, WASHplus is beginning a sanitation marketing activity to engage materials suppliers and local entrepreneurs to market a line of aspirational sanitation products in Mopti’s urban areas. The WASHplus project is led by FHI 360 globally. In Mali, WASHplus activities are implemented through CARE International and two Malian NGOs, YAG-TU and Sahel Eco.
Recently the WASHplus Project in Mali organized public ceremonies to certify Open Defecation Free (ODF) status of three villages in the Mopti Region. These villages, each of which are located in priority areas for USAID’s Feed the Future and Global Health initiatives, were recognized as being the first in their municipality to reach ODF status.
From September 25th to 27th 2014, the USAID/Mali Director Gary Juste, accompanied by the Governor of Mopti Region, and the National Director of Sanitation led certification ceremonies in three villages in the presence of national and regional authorities, the CARE Mali Country Director, as well as local officials and residents from the villages. All three villages reached or exceeded the targeted criteria for certifications. The village of Allaye-Daga built 31 latrines against a target of 28. Wendeguele achieved 150% of their latrine target, and Kanikombole built 28 latrines against a target of 10. Local community leaders, women and youth all recognized the importance of the project and the impact safe disposal of human feces with have on the health and nutritional status of the populations, especially children under five. In the village of Allaye Daga, there was not a single latrine before the project, but now everybody uses latrines and the community has adopted social conventions to deal with noncompliance with ODF standards.
From January 2010 to September 2014 WASHplus worked with the Kenyan government to generate demand for sanitation; improve water, sanitation, and hygiene (WASH) practices among all households; and introduce simple supportive technologies to vulnerable households. The project supported the Ministry of Health (MOH) and its partners to integrate improved WASH practices into HIV policies, programs, and training. To do so WASHplus worked within existing structures under the MOH, such as the departments of Environmental Health, Sanitation and Community Health Services and the National AIDS and STI Control Program, as well as with other U.S. government bilateral partners—the APHIAplus projects and Centers for Disease Control and Prevention partners.
The two WASHplus program components—integrating WASH into HIV and advancing improved sanitation uptake—worked together to improve WASH practices across Kenya. The program objectives were to:
Assist government and NGO programs in Kenya to integrate improved WASH practices into HIV policies and programs, with special emphasis on inclusive approaches
Support uptake of improved sanitation practices using a community-led total sanitation (CLTS)-plus approach
Help to build a vibrant private sector to address demand for sanitation especially focused on quality latrines that meet minimum standards
What started as an activity to integrate sanitation and hygiene practices into HIV/AIDS care and support programs has grown over the years into a holistic approach to prevent diarrhea among households at risk. USAID’s WASHplus project helped communities and households in Kenya make the connection between improved sanitation, healthy hygiene habits, and positive outcomes for people living with HIV and AIDS (PLHIV), their families, children, the elderly, and other vulnerable households. Along the way WASHplus technical support, participatory training, partner engagement, and behavior change efforts yielded valuable lessons for other countries battling to improve sanitation and health outcomes in the context of uncertain funding. Innovation, flexibility, and commitment to working hand-in-hand with the government proved to be keys to the project’s success. With the government’s endorsement and adoption of WASHplus’s signature approach, small doable actions are likely to continue to resonate with many audiences long after the WASHplus transition.