Editor's Note: In this post, Anita Zaidi, Director of the Enteric and Diarrheal Diseases (EDD) program at the Bill and Melinda Gates Foundation, discusses how we can use data-driven approaches to defeat diarrheal diseases. This post originally appeared on Huffington Post, to view the original article please click here.
When I was a young girl in Pakistan, my mother would remind me daily to only drink boiled water. We almost lost my sister to severe diarrhea and my mother was determined to make sure this didn’t happen to our family again.
Back then, I didn’t fully understand her. It wasn’t until years later, when I became a pediatrician and a child health researcher, that I realized how deadly watery stools can be.
Unlike for adults, the rapid loss of liquids caused by severe diarrhea can bring children and babies to the brink of death in a matter of hours. Last year alone, over half a million children under five died from diarrheal diseases - that’s more than one every minute. And for those that survive, the resulting rapid dehydration and metabolic disturbances can lead to long-term damage to the gut and increased risk of malnutrition.
The sad truth is that the ripple effects of something as seemingly simple as a case of childhood diarrhea often extend far beyond health: children miss out on school, treatment costs can drive their families into poverty and in many countries, nursing a sick kid back to health can use up resources that are needed for other essentials like food or education.
Shockingly, although the illness touches almost every family on the planet at one time or another, the primary bugs that cause diarrhea remained obscure until recent years.
In the early 1900s, many members of the scientific community accredited causes as varied as changes in seasons, feelings of panic, teething or capillary restriction. And while we’ve known for decades that water, sanitation, hygiene, bacteria, viruses and parasites play a role in diarrhea, it wasn’t until 2013 - when the Global Enteric Multicenter Study (GEMS) released - that we were able to identify the top four culprits.
The study, which looked at 22,000 kids across seven countries in sub-Saharan Africa and South Asia, was game-changing. Not only did it identify the pathogens that cause half of all cases of diarrhea in developing countries, it also singled out the biggest offender: rotavirus.
Based on the study, the global health community rallied behind prioritizing the need to get children life-saving rotavirus vaccines. But even so, we still had an imprecise understanding of these bugs.
That changed a few days ago.
The Lancet just published a reanalysis of samples from GEMS. The updated study looked at the same samples as before, but used more sensitive and advanced diagnostic methods that were able to identify the cause of diarrhea for approximately 90% of all the cases. For the first time in human history, we can identify almost all of the bugs that cause diarrhea - and what you can identify, you can prevent.
While the updated study confirmed that rotavirus remains one of the top causes of diarrheal diseases, we also learned that a bacteria unrecognizable by most, Shigella, is responsible for more illness than we previously thought.
In a world where cholera, typhoid and dysentery are well known as common diseases, it turns out that the greatest killers of children have almost no name recognition amongst parents or policymakers.
So what can we do?
For starters, most children can be saved with the solutions we have today and raising awareness of these is key. My mom was right, boiling drinking water is essential in many parts of the world. But we can also prevent diarrheal disease by improving immunization rates, community sanitation practices and encouraging moms to exclusively breastfeed throughout early infancy to build babies’ immune systems.
Furthermore, increasing access to prevention and treatment tools is critical to give all children the chance they deserve. It is essential to make sure that life-saving oral rehydration solutions and zinc therapy are quickly available.
Vaccines for Shigella don’t yet exist but are being studied and developed by scientists, and we need to support and speed up that research. However, vaccines for rotavirus are available now, and we need to make sure every child in the world gets them. Since 2013, the number of countries that have introduced rotavirus vaccines into their national immunization programs has increased from 17 to 81. Despite this, only 15% of the children in the world’s poorest countries have access to it.
There is much to do, and scientists, while mighty, cannot do it alone. Governments have a pivotal role to play to ensure children everywhere have access to these lifesaving tools. This will require increased political will including increased financial commitments and policies that prioritize child health.
Every child should have the opportunity to live a long, healthy and productive life - and it’s up to us to make sure they have that chance.
Editor's Note: In this post, Vincent Masterson, an International Education & Training Advisor at CAWST, discusses the importance of training people how to be effective WASH promoters in order to achieve real behavior change in communities. This post originally appeared on CAWST's blog, to view the original post please click here.
When designing training, program managers often include only technical knowledge. Subject matter knowledge is essential, but developing skills to present and communicate information, relate to target audiences, and disseminate complex information for the purpose of learning are equally important.
Take the case of Community WASH Promoters. They certainly need to know how to treat water, how to collect rainwater safely, how to build a basic latrine, and to understand the importance of handwashing. To be effective in their role’s objective of achieving behaviour change in their communities, however, it is also crucial for them to have interpersonal and observational skills. They need to identify WASH issues in a household, effectively deliver key messages using education materials, actively listen, ask questions, and fill out forms.
We have spent 15 years listening to our clients who work with Community WASH Promoters and collected learnings from program managers about what has worked and what has failed in the implementation of their programs. Across continents and cultures, one of the top challenges they have shared is getting people to change their behaviours. Although WASH organizations clearly see the link between improved WASH and improved health, this is not always the case for community members.
We have listened to our clients’ challenges and designed a new Community WASH Promotion workshop. In addition to WASH technical knowledge, it teaches participants how to be effective WASH promoters, and provides them the forum to practice that role in a safe simulation setting.
Only one-third of our Community WASH Promotion workshop covers technical knowledge of WASH. The rest of the time is allocated to preparing participants to perform their role effectively. The entire first day of the training is used to prepare Community WASH Promoters to think critically about the reasons why community members may have difficulty, or may not want, to change their behaviour and adopt healthy WASH practices. They learn how to actively listen to understand the needs of community members, and then practice on-the-spot modifying their key messages to meet those reasons.
Two important traits of being an effective trainer are: 1) Delivering the information in such a way that it is relevant to the experience of the learner; and 2) Creating the opportunity for the learner to use the newly acquired knowledge and skills in real life. We use the Kirkpatrick framework in our instructional design process, which gives us the ability to focus on the behavioural outcomes of how the learner will use the information in real life. Community WASH Promoters will be much more effective in their role if they are given the opportunity to practice and receive feedback on their performance in that role.
The implications of this instructional design approach are profound. As program managers, we need to assess not the knowledge of the Community WASH Promoter, but their ability to create positive behaviour change and impact in their communities; and the way this workshop was designed, does exactly that. This workshop focuses on the result of their work, rather than their knowledge.
CAWST’s new Community WASH Promotion workshop will be piloted in Kenya in October.
Editor's Note: In this post, Edson Monteiro, a WASH Project Officer at UNICEF Angola, highlights UNICEF's partnership with Andrex to bring a Community Led Total Sanitation (CLTS) programme to rural villages in Angola. This post originally appeared on UNICEF's site, to view the original post please click here.
I recently returned from a trip to visit rural villages in Angola to look at the impact that UNICEF’s sanitation partnership with Andrex is having on children and families there. It’s incredible to think that seven out of ten people living in rural Angola do not have a clean, safe toilet to use. This has a huge impact on the health of Angola’s children and is one of the reasons the country has the highest rate of child mortality in the world.
As I began my journey into the heart of Angola, I visited villages that were in different stages of learning about sanitation. Due to a number of reasons, such as the poor economic climate in Angola and the poverty that the country suffers, many people do not have access to basic sanitation. Without a toilet, the reality is that many people still have to go to the toilet out in the open, often in the bush or a lake and near their homes. This risks faeces contaminating their food and drink, causing sickness to children and families.
The first village I visited was called Calipanguela, located over an hour away from the nearest city, Nharea. The village is incredibly rural, with mud huts, dirt tracks and livestock. The process of educating the community about the importance of using a toilet, washing their hands and sanitation in general had not reached this village yet, but would start with a ‘Triggering’ meeting.
The meeting involves gathering all of the villagers together and sharing food and water between them. Then something shocking happens. To exemplify the danger of open defecation, the facilitators place fresh human faeces, found that day in the village, near the food and water they’d been sharing. The flies become instantly attracted and begin moving between the faeces, food and water.
The method is deliberately provocative. People immediately understand the danger of going to the toilet outside and realize they may have been eating food contaminated by their faeces. The village then designs an action plan to tackle the reasons why so many people go to the toilet outside, and to improve the health of the community.
I went on to the village of Luwawa, which was triggered a year ago. After being monitored on a monthly basis to ensure the community were using and maintaining their toilets, it was about to be awarded a certificate. Villagers no longer went to the toilet out in the open, and Luwawa had been declared ‘open defecation-free’. This is a huge honour in Angola, and to mark the occasion, there was singing, dancing, and a party.
Finally, to complete my journey, I visited a village that had been declared ‘open defecation-free’ for a year. Here I met a wonderful family, with a mother named Sabina, who wanted to share her story. Sabina is 39, is married, has four children, and lives in a village called Waleka.
Sabina told me about life before her village was triggered and her family built a toilet. “Before we had a toilet, we went outside to the bush to defecate, which made me feel uncomfortable. When we went to the toilet outside, I was worried about my family getting sick or being bitten by a snake.
“Defecating outside made my children sick; they were always ill. When they were ill, they didn’t manage to go to school.”
Sabina told me that it always smelt before the village was triggered and the toilets were built. Sometimes there would be faeces all around the village, and it didn’t feel clean. Now that they have all built toilets and been declared open defecation-free, she feels happy, and can see that there has been a reduction in illness for all of the villagers.
Sabina said: “Now there is a real change in the village. Now everything is OK.”
The Andrex partnership raises funds for UNICEF’s Community Led Total Sanitation (CLTS) programme, which empowers communities to build, maintain and take pride in their own hygiene and sanitation. The great work that the partnership has helped to fund was clear to see in all of the villages that we visited, no matter what stage of the journey they were in. 60,000 lives will be impacted this year thanks to the funds raised by Andrex for the UNICEF programme.
As I plan my next trip back to the villages, I feel confident that thanks to this partnership, villagers will continue to feel empowered to use their toilets and benefit from the programme.
Editor's Note: In Part Two of this series on wastewater treatment, Craig Fairbaugh, a Research Fellow at Engineering for Change, highlights technologies that meet the challenge as described in E4C’s Solutions Library. Part One of this series can be found here.
Designers and engineers have long recognized the need for wastewater treatment in developing communities but often are met with the challenges of no piped sewer system, high capital investment, and limited technical skills necessary for operation and maintenance. Enter decentralized wastewater treatment; a solution that treats waste effectively on site and requires no existing piped infrastructure. Decentralized anaerobic treatment systems have existed since the 1800s as septic tanks, but in order to meet the Sustainable Development Goals with a rapidly growing population in the developing world, engineers are attempting to design solutions that are affordable, scalable, more effective, and easier to maintain.
The Engineering for Change Solutions Library features technology reviews of three solutions for decentralized wastewater treatment: Biopipe, the Biofil Digester, and DEWATS.
Biopipe is a decentralized pipe network that treats domestic wastewater for reuse in irrigation and secondary applications (but not for drinking). The system is comprised of a tank, pipe modules, circulation and water pumps, and a UV filter. Bacteria lining the inside of the pipe remove microbiological pathogens, similar to the treatment processes that occur naturally in river beds.
Biopipe is making the transition out of the prototype phase with a recent exclusive distribution deal for Asia and Africa with Metito, a water management design and engineering firm in emerging markets.
The Biofil Digester mimics the natural world with a process similar to the natural decomposition that occurs in soil on a forest floor. Developed in Ghana, the typical digester is housed in a 2’ x 2’ x 6’ concrete structure. Liquid waste rapidly separates from solid as it filters through a layer of permeable pavement. Macro-organisms in the soil below break down pathogens. The digester can be connected to an existing toilet or septic system, is scalable to meet small or large demands, and produces no waste product. The Biofil Digester can be installed above or below ground in a concrete structure with a “microflush” option which conserves the amount of water needed for flushing. Since 2008, more than 4500 Biofil Digesters have been installed across Africa and South Asia.
While the Biopipe and Biofil Digester are manufactured treatment systems, BORDA’s Decentralized Wastewater Treatment System (DEWATS) is a technical design approach to treating wastewater at the household and community level. Founded by the Bremen Overseas Research and Development Association, DEWATS uses physical and biological treatment mechanisms such as sedimentation, floatation, aerobic, and anaerobic treatment to remove pathogens from household wastewater. These treatment stages are commonplace in centralized systems, but what separates the DEWATS design approach is employing a passive system (no power required), low maintenance requirements, and construction from affordable and locally available materials. Hundreds of DEWATS treatment systems have been implemented and are currently operational across Africa, South Asia, and Southeast Asia.
In a recent expansion of our Solutions Library, E4C added these three technologies as examples of decentralized treatment, which has the potential to scale up and meet needs in cities and rural communities. Visitors to this web site know better than most that wastewater treatment is often overlooked in discussions about global development. With these new additions and more sanitation technology planned for the future, we hope to draw attention to the options available to those in need.
Editor's Note: In this post, Susan Davis, Executive Director of Improve International, discusses water usage around the world. This post originally appeared on Improve International's blog, to view the original post please click here.
I got this email from Stuart, one of our board members, yesterday:
“For June, R. and I used 2,000 gallons. That is 66.67 gallons a day. There is no way I could carry that amount of water each day to my home. Plus, what is it all used for? I guess shower and flushing are the biggest daily user. Is there an amount that we should try to strive for? 30 gallons a day, 10, 5?
Then I think about the homeless that have no access to water; all of the drinking fountains in the city are gone. And the 2,000 gallons costs me $49.69. 2 cents a gallon. And people complain about the cost of their water bills? And people pay $2 for a 12 oz. bottle of water at the curb market?
It is amazing what we take for granted.”
First of all, yes, it is amazing what we take for granted. Secondly, I thought I would share my answers to Stuart’s questions, in case you are curious. I don’t have any information on how Atlanta’s homeless access water; I hope someone is addressing this.
Is there an amount that we should try to strive for?
If you’re curious about how much water poor people in developing countries use, there’s a blog for that! In summary, people who have to walk long distances or wait in long lines and carry that heavy water home don’t use nearly as much as people who have taps in or near their homes. People use more water after an improved water supply is provided.
What is it all used for?
On average, approximately 70 percent of that water is used indoors, with the bathroom being the largest consumer (a toilet alone can use 27 percent!).
In developing countries, people without reliable, in-home water access use water for different purposes from multiple sources with different profiles in terms of convenience, quality, reliability, cost and access rights, across different seasons and years. Water use varies by climatic zone, type of water source and system, distance to water source, season (rainy or dry), household size, housing type, and income. There is also great variation between countries, between villages, and even between households within the same village.
Why do people complain about their water bills?
Good question. In East Africa, as in many developing countries, water is significantly more expensive for people who do not have piped water to their homes, especially in in urban areas, where many people depend on water vendors and other private suppliers (Porras et al, 2001).
Those of us who have good quality, reliable water that comes to our homes for a relatively low price all day every day, might take a moment to appreciate it.
Editor's Note: In this post, Sam Drabble, Research and Evaluation Manager at Water & Sanitation for the Urban Poor (WSUP), discusses some best practices for those looking to improve sanitation on a citywide level.
The concept of improving sanitation on a citywide basis, rather than looking at individual communities or projects, is gaining increasing traction in the WASH sector.
World Water Week in Stockholm, in late August, was a clear example. In a specific session on citywide sanitation, Guy Norman from WSUP spoke about our experiences in Kumasi, Ghana’s second largest city. The session drew upon a sector review, led by WaterAid, which has documented successes in Kumasi, as well as Vizag (India), another city where WSUP is playing a key role.
Citywide sanitation is undoubtedly a complex approach, but essential if we are to reach scale in urban contexts. It requires coordination between the many organisations engaged in service provision—local government, regulators, NGOs, donors—and in some cases, the development of a citywide sanitation plan that sets out a roadmap for future service provision and investment.
Here are five insights for those who are attempting to implement citywide sanitation improvements, based on our experiences:
Understand the city before designing the solutions
We say it often, but it can never be said enough: there is no one-size-fits-all solution to urban sanitation! Our experience underlines that every city—and in many cases, individual low-income communities—have their own set of conditions.
Kumasi is a case in point. The sanitation landscape in Kumasi has three interesting features: 1) an unusually high number of pay-per-use public toilets (the leading form of sanitation in urban Ghana, with around 700,000 people using one in Kumasi each day); a high proportion of compound housing in low-income communities, where tenants will often share a living space with more than 20 other people; and 3) the existence of a bylaw, longstanding but not properly enforced, which requires compound landlords to provide an in-house toilet for their tenants.
Our support to Kumasi Metropolitan Assembly (KMA), predominantly funded by USAID and the Bill & Melinda Gates Foundation, evolved as a response to these features. Since 2011 we have worked with KMA to improve the standard of public toilets in Kumasi. This is an interim solution, but a pragmatic one, given these toilets already proliferate throughout the city.
By improving the standard of service, we improve the level of sanitation until the longer term solution gains traction: a five year compound sanitation strategy, targeted at landlords and centred around improve mediation and enforcement of existing bylaws.
Other ongoing activities in Kumasi include continuing to invest in Clean Team, a containerised toilet business that we established in 2013; and strengthening the back end of the sanitation chain by training tanker operators and rehabilitating the sludge dumping site at Dompoase.
Adopt a step-by-step approach
When we imagine a citywide sanitation programme being implemented, we might picture a range of activities being rolled out simultaneously across the city. In reality, as with so much in life, we come unstuck if we try to do too much at once. The task of achieving citwide sanitation coverage is massively daunting, but becomes more manageable if we break it down.
This is how Greater Vizag Municipal Corporation (GVMC), with WSUP’s support, decided to tackle the challenge of achieving open defecation free (ODF) status across the 78 wards that form the city. GVMC’s ongoing ‘ward by ward’ approach began by mapping open defecation levels in every ward to establish the baseline situation.
Those wards with low levels of open defecation (OD) were targeted first to achieve ODF status relatively quickly: this set an example for other wards by demonstrating that ODF status is attainable, and helped to build momentum as the focus moved to areas of the city with progressively higher levels of OD. These latter wards required more time for implementation, reflected in the staggered implementation timeline: one month was allocated to achieve ODF status for 20 of the initial wards and two months for the next group of 28 wards.
Sanitation planning is about the process, not the final document
In a session at World Water Week, Arne Panesar from GIZ emphasised that city sanitation plans should be seen as primarily about a process, not the production of a document. This resonated with our experience: in some cases, a lot of time and resources go into producing a document that sits on the shelf.
However, the process—creating a dialogue between the key institutions, mapping the current sanitation status of the city, and identifying the gaps and bottlenecks in service provision and how these could be addressed—is of enormous value in itself, above all because it engages the institutions who are ultimately responsible for providing the services.
Faecal sludge management (FSM) service provision needs to be made more systematic
One area where we believe citywide sanitation plans do have huge value to add is in promoting the systematic provision of FSM services. As discussed in Stockholm, a problem at the moment is a lack of good tools for estimating the costs of different citywide approaches (sewerage, FSM, or combined sewerage and FSM).
A particular problem is that FSM systems—transfer stations, trucking systems, etc.—tend to just randomly develop; if FSM systems were designed by engineers in the same way that sewerage systems are, they’d presumably be cheaper and more effective. We think the question of how to develop systematic FSM services that cover the full sanitation chain—and how these can be better integrated in citywide sanitation plans —is potentially an interesting area for future research.
There is more to stopping faecal contamination than providing improved toilets
At World Water Week, we were struck by some emerging findings from the Sanipath research team at Emory University, who are analysing faecal contamination pathways in Maputo (this work is linked to the USAID-funded MapSan evaluation of our Japan Social Development Fund-backed communal sanitation programme).
Sanipath’s early analysis of results suggests that a very important source of faecal contamination is salad vegetables produced in the environs of Maputo. This is very relevant for us: it suggests that even if we were able to provide perfect toilets in Maputo’s low-income communities (and convince people to wash their hands after each use), people might still get disease from lettuce and tomatoes because untreated waste is being used for crop irrigation elsewhere.
This final insight acts as a reminder that city sanitation is extremely complicated: the more evidence we have about what is really going on, both in the communities where we work and across the city as a whole, the better.
Editor's Note: In this post, Melissa Moy, Special Projects Associate for Glasspockets, discusses how Olypmian Neymar leverages his fame and global platform to draw attention to issues around clean water and sanitation, as well as education and health services for children. This post originally appeared on the Glasspockets Blog, Transparency Talk. To view the original post, please click here, and for more information about Olympians and their philanthropy, visit Glasspockets’ Going for Gold.
In the midst of Olympic fever – when Brazil advanced in the quarterfinals – soccer phenom Neymar posted updates on Facebook and Twitter.
He paused to promote his treasured Insituto Neymar Jr., which provides free education and health services for children in his impoverished hometown.
“One of my greatest achievements in life, to have the joy of creating the Instituto Neymar Jr. and see those smiles,” Neymar wrote on his personal Facebook page. “Thank you God for making me able to give joy to the lives of these children and their families!”
As one of the world’s best athletes and a Spanish FC Barcelona player, Neymar has earned comparisons to former Brazil and Santos forward Pele. He’s racked up four consecutive Player of the Year awards, the 2011 FIFA Goal of the Year and league titles for Barcelona and Santos. In July, Neymar inked a 5-year contract extension with Barcelona, with an annual $16.9 million salary.
On the flip side, Neymar has also gained notoriety for partying with celebrities and repaying $51.7 million in fines and back taxes for tax fraud related to endorsement deals. His temper has led to multiple penalties; and critics have questioned his conduct and sportsmanship. Following Brazil’s first gold medal win in Rio, Neymar famously resigned as Brazil’s team captain. However, the national team has not yet ruled out his return.
Neymar is a gifted athlete with an impressive online presence: more than 58.7 million Facebook likes; 57 million Instagram followers; and 24 million Twitter followers. Earlier this year, ESPN dubbed him the world’s fourth most famous athlete, and Neymar topped U.K. media analysis firm SportsPro’s list as the most marketable athlete in 2012 and 2013.
What’s interesting is how Neymar leverages his fame and global platform to draw attention to the causes he cares about.
Neymar has targeted his philanthropy efforts toward impoverished communities in Brazil with a focus on clean water and sanitation, as well as education and health services for children.
The fiery and energetic Neymar has regularly partnered with Waves for Water to bring clean water ccto impoverished areas in Brazil. In 2011, only 48% of rural Brazilian residents had adequate sanitation and 87% had access to improved water, according to our data on WASHFunders.org. Additionally, 3.53 deaths per 100,000 Brazilians were attributed to diarrheal disease.
In 2014, Neymar leveraged his celebrity to new heights in a partnership with PayPal and Waves for Water through a global campaign tied to the 2014 World Cup held in Brazil.
Since more than 3.2 billion people watched at least one live minute of the 2010 tournament in South Africa, this global water campaign banked on the World Cup’s popularity and PayPal’s global platform.
The strategic campaign cleverly allowed fans to buy water filters for Brazilian cities with the bonus of an homage to the donors’ home countries. For example, donations from the United States were used to buy water filters for Sao Paulo, where the U.S. soccer team stayed during the tournament. And PayPal partner eBay auctioned off autographed Neymar memorabilia to boost the campaign proceeds.
However, Neymar’s heart remains with his hometown. In December 2014, Neymar launched the Instituto Neymar Jr. in Praia Grande, a coastal city outside of Sao Paulo.
The facility, which provides education and health services for children, is just a few blocks from where Neymar grew up on B Street in an impoverished community plagued with crime, drugs and unemployment. It was in this neighborhood that Neymar played street games and futsol, an indoor version of soccer.
The soccer star values the opportunity to give back to his community, and he said it spurs him to excel professionally. “It makes me really happy to do something for these kids and their families,” Neymar said in an in an ESPN story.
Neymar donated $6 million to the facility and also attracted additional sponsorship contributions to support the effort. About 2,400 children, ages 7 to 14, attend the facility for two hours before or after school. The children have free access to computers, dental and medical services, and can study English, Spanish and Portuguese. Additionally, adults attend vocational classes in the evenings.
The institute is a family affair. Neymar’s mother serves as the chief executive of the institute, and Neymar and his father spend time with the children.
“I could not come to Brazil and not visit (the institute),” Neymar said. “It’s my family’s dream, and I am always happy every time I visit. It makes me want to keep growing this and doing this the right way.”
With Neymar’s huge success and talent in sports, marketing, social media, endorsements and philanthropy at age 24, Neymar knows no limits.
The next few years will be an exciting time for Neymar and soccer fans. He will no doubt seamlessly continue to navigate player contracts and lucrative endorsement deals – $23 million in 2016 – with global brands like Nike, Red Bull, Gillette and Panasonic.
With his tremendous fan appeal, social media and online presence, one can only imagine the awareness and improvements Neymar can bring to social justice issues in Brazil as well as the impact and influence he can wield in the philanthropic sector, from local to global levels. All that to say… More, please.
Editor's Note: In this post, Marc Gunther, a reporter at Nonprofit Chronicles, discusses approaches to sanitation problems worldwide. This post originally appeared in Nonprofit Chronicles, to view the original post please click here.
It’s easy for most of us to take the simplest things–like flushing a toilet–for granted. Yet almost 2.4 billion people lack access to modern sanitation, and nearly 1 billion practice open defecation, according to the World Health Organization. The problem is worst in rural areas of sub-Saharan Africa and south Asia, particularly India.
What’s to be done?
That’s hard to know, says Seeking Sanitation Success, an excellent report commissioned by Catholic Relief Services:
Very little information on sustained solutions is available, making funders and practitioners in the sector vulnerable to repeating mistakes or investing in unproven approaches.
The report also found:
There has been no NGO-led sanitation approach that leads to success at scale (depending on the definition).
The report was written by Susan Davis, who is the founder of Improve International, a small NGO aimed at improving the quality and sustainability of water and sanitation projects in poor countries. By phone, she explains that most progress in delivering modern sanitation has been led by governments, and not NGOs.
That doesn’t mean that NGOs can’t play a constructive role, she says. They can advocate for government action, they can help spur behavior change around sanitation (which is harder to do than you might think) and, importantly, they can help figure out which of the many approaches to sanitation work best.
This is an all-too-familiar story in global development. We don’t know enough about what works. Programs are under-studied. Results are under-reported, if they are reported at all. Successes are trumpeted. Failures, not so much. Followup is rare.
“People aren’t really paying attention to what happened 10 years ago,” Davis says. “We’re more excited by innovation.”
A NONPROFIT FOCUSED ON EVIDENCE
Helping governments, foundations and nonprofits use evidence to improve their impact is the purpose of IDinsight, a nonprofit that I profiled in the July issue of The Chronicle of Philanthropy. My story, Data at the Speed of Life [subscription required], explains how IDinsight does high-quality, affordable research to enable nonprofits to learn quickly, adjust their programs and make more of a difference.
IDinsight’s work is valuable because too many leaders in global development “lack the evidence they need to make well-informed decisions,” says Neil Buddy Shah, IDinsight’s CEO and founding partner. This isn’t something you’ll read about on the websites of charities that help the global poor, but it’s true.
While reporting on IDinsight, I came across one of its clients, a Colorado-based nonprofit called iDE (it stands for International Development Enterprises) that stands out because it is committed to learning, to measuring its impact, to transparency and to developing market-driven solutions to global poverty. (All my biases!)
Which brings us back to toilets.
Traditional approaches to sanitation have provided free community latrines or toilets to all, driven by the belief that if-you-build it-they-will-come. But absent strong reasons to change behavior, these projects have disappointed. Put bluntly, people continue to crap outside, the way their parents and grandparents did. Numerous other strategies have been deployed to end open defecation which, in case you didn’t know, can spread disease, pollute waterways and contaminate fruits and vegetables growing nearby.
iDE favors an approach known as sanitation marketing, which sets itself apart by treating households as consumers, not as beneficiaries. The NGO has been working in Cambodia since 2009, with the support of US AID, The World Bank, The Bill and Melinda Gates Foundation (which paid for the research with IDinsight), the Stone Family Foundation and the government of Australia.
It is getting results. iDE’s work in Cambodia has grown into “the largest-scaled improved rural sanitation project” led by an NGO anywhere in the world, according to Yi Wei, who directs iDE’s global WASH (Water, Sanitation and Hygiene) initiative.
THE RIGHT PRODUCT AT THE RIGHT PRICE
Sanitation marketing aims to (1) increase the demand for toilets and (2) to strengthen the private sector’s capacity to supply them. This is Econ 101. "Everything we do is market-based,” says Chris Nicoletti, the global IQ director at iDE, who oversees its work on measurement. “It’s very much our ethos.” To succeed, iDE and its local partners need to design and make the right product and sell it at the right price.
Their product, known as the Easy Latrine, was developed in the late 2000s with the help of Jeff Chapin, a designer on leave from the renowned design firm IDEO. It’s been modified since then but remains a simple, low-tech, low-cost concrete latrine that came about using the principles of human-centered design, which is a fancy way of saying that Chapin and iDE listened to their customers at every step of the process. It’s made by local manufacturers and costs roughly $36, before delivery and installation, which brings the price up to about $50. A growing number of customers add what’s called an Easy Shelter, a cement structure that provides privacy to latrine users and costs another $200 or so. (That’s price-competitive, more than shelters made of sheet metal and less than those made of bricks, I’m told.)
Latrines sold slowly at first. A World Bank Field Note from 2012 found that households bought 10,621 latrines from local private enterprises in the first two years, results it called “promising.” WHO’s most recent estimate, also from 2012, is that 8.6 million Cambodians practice open defecation. How could iDE speed adoption?
Being a learning organization–seeing what works and what doesn’t–was key.
To improve the sales process, iDE worked with Whitten & Roy Partnership, or WRP, a global consulting firm, to train the Cambodian rural sales agents who go door to door selling toilets. “They get very high-quality training on how to sell,” Nicoletti says. “They are mentored, managed and trained by WRP.” WRP found, among other things, that sales commissions at first weren’t high enough to motivate the agents, so the commissions were increased. Instead of wielding Powerpoint presentations, Cambodian salespeople go door-to-door with flip charts to guide them through their spiel.
IDinsight was brought in to see if offering financing would help, as I wrote in the Chronicle of Philanthropy:
To test the market, IDinsight ran a set of randomized, controlled trials. Nearly 90 percent of Cambodian consumers, they found, were unwilling to pay the market price for a latrine, which ranged from $35 to $55. But when they were offered a 12-month loan, half of these same consumers agreed to pay $50.
Meantime, iDE worked to simplify and consolidate the supply chain and help local government officials promote improved sanitation. “The iterative approach is part of our DNA,” Yi Wei says. “There’s always room for improvement, and the market is always evolving.”
All the tweaks made a difference. Latrine coverage in Cambodia had grown by about 1.5 percent a year from 1992 through 2012. Since then, coverage has increased by 6.4 percent a year in the seven provinces where iDE works. Cumulatively, iDE has sold 238,406 latrines through its network of about 100 latrine producers and 300 sales agents. Program costs per unit have dropped, as volumes grew. Here’s an iDE website with more information.
WHAT HAPPENS NEXT?
That’s the good news, but issues remain. For now, there’s no single strategy for disposing of the waste after the latrines fill up, which takes months or years.
Susan Davis of Improve International says that, without a plan to recycle or dispose of sludge, the program can’t be called a success, yet. “We as a sector have focused on getting people to stop going outside and start using a toilet,” she noted. “What happens next?”
iDE is seeking “a commercially viable fecal sludge management solution,” perhaps by creating businesses to collect the waste and turn it into fertilizer, Nicoletti says. The Stone Family Foundation and the government of Australia continue to support iDE in Cambodia but the Gates Foundation no longer supports the work, unfortunately; it’s been pushing a a buzz-generating challenge to reinvent the toilet.
A couple of closing thoughts: First, solving hard problems like sanitation takes time. To tackle them, grantmakers need to commit for the long term, particularly as nonprofits like iDE demonstrate progress and a willingness to learn. It’s tempting to turn to the next new thing, before we even know whether the last old thing has worked.
Second, iDE’s commitment to research does not appear to be rewarded in the nonprofit “marketplace,” such as it is. Without shared metrics around success and with little transparency in the sector — as I blogged about last year in Water Taps and Information Gaps — the work of one NGO can’t be compared with another. Flashy websites and marketing claims (“every dollar goes directly to clean water projects”) carry the day.
Yi Wei asks: “How are we ever going to use resources more efficiently if we are not going to be more transparent and accountable?”
Fortunately, people at IDinsight tell me there’s more demand for their work than they can handle. That’s a sign that more foundations and charities, like iDE, want to learn how to do what they do better.
Here’s an excellent video about iDE’s work in Cambodia:
Editor's Note: In this post, Jayde Bradley, Advocacy Coordinator at WaterAid UK, reflects on what was learned at the recent High Level Political Forum on Sustainable Development. This post originally appeared on WaterAid's website, to access the original post click here.
When policy makers gathered recently at the UN in New York, WaterAid was there to highlight the importance of water, sanitation and hygiene (WASH) in achieving Agenda 2030. Advocacy Coordinator Jayde Bradley reflects on what was learned.
Nearly 300 days after UN member states adopted Agenda 2030, I visited New York for the 2016 High Level Political Forum on Sustainable Development (HLPF). The HLPF is the not particularly catchy name for an annual summit at the UN where countries come together to share how Agenda 2030 implementation is going at the national level and discuss the big challenges on the path to achievement of the Global Goals.
Member states and representatives from civil society, academia, the private sector, and more filled the corridors of the UN’s basement to discuss the progress being made. The main item for discussion was the first ever set of so-called Voluntary National Reviews, for which 22 countries had volunteered to report back to the UN on their Agenda 2030 plans. This included countries where WaterAid works, such as Madagascar, Uganda and Sierra Leone, as well as high-income countries such as France, Germany, and Finland.
So what did we glean from discussing this big Agenda in the Big Apple? Here are my top five discoveries.
1. Process over progress
Most member states were keen to emphasise that we are still in the ‘early days’ of implementing the Global Goals. There was much discussion surrounding the processes that need to be put in place to take the Agenda forward, rather than the progress that should already have been made.
But already the clock is ticking very loudly – we are more than six months into year one and urgent action is essential to achieve the progress needed before 2030. As Elizabeth Stuart of the ODI said during the summit: “Agenda 2030 implementation is like a pension…the longer you leave paying in, the less rewards you see.”
2. Bringing Agenda 2030 home
One of the recurring challenges for member states that came up during the HLPF was how to move Agenda 2030 on from being a UN-led process coming out of New York to nationally owned action plans, with participation from a key range of stakeholders, including civil society, citizens and many more.
Some governments have taken great steps forward on this front – Sierra Leone has published a simplified version of the Sustainable Development Goals for its Parliament and the public, and Germany shared their platform at the HLPF with a representative of civil society to present their plans on implementation. But much more needs to be done to ensure all of us, everywhere, can play our part in achieving the Global Goals.
3. The challenge of ensuring no one is left behind
The theme of this year's HLPF was ‘ensuring that no one is left behind’. Agenda 2030 means ending extreme poverty and creating a more equal world for everyone everywhere, and prioritising actions to reach the most vulnerable and marginalised people. The importance of data – especially disaggregated data to capture information about the hardest to reach groups – was raised time and again throughout the HLPF. Many countries also highlighted the huge capacity gaps that are preventing this from happening.
4. The low profile of WASH
WASH received a relatively low profile throughout the HLPF, and just a handful of mentions by member states in the Voluntary National Review presentations – for example Sierra Leone, which highlighted sanitation as one of the areas where the most progress was needed.
Although WaterAid participated in discussions where WASH has not always been present (for example about health and improving the lives of women and girls [see below]), the HLPF was another reminder that there is still much to do to ensure actions to achieve Goal 6 are prioritised to help achieve the entire Agenda 2030. Our HLPF Storify gives a snapshot of what we got up to while we were there.
5. Integration wins buzzword bingo
Achieving the Global Goals will require a transformation in how the WASH and other sectors work, especially with each other. Discussions identified this ‘integration’ across different issues as a key challenge – and opportunity – on the path to achieving the Global Goals.
WaterAid’s global Healthy Start campaign is just one example of bringing together two interconnected sectors (health and WASH) to reach common advocacy goals – in this case that WASH is essential to improving health and nutrition outcomes for newborn babies and children. Margaret Batty, WaterAid’s Director of Global Policy and Campaigns participated in an ‘Every Woman, Every Child’ side event at the HLPF to make just this point.
Overall it was good to be part of these discussions: there was a high level of engagement from a range of different countries and groups, and the summit provided a necessary global level moment for countries to share learnings and challenges in this early phase of Agenda 2030 implementation. But we are already more than halfway through year one of Agenda 2030 – the most important message for all of us to take home from New York was the need to now turn these words into action.
Editor's Note: In this post, Tal Woolsey, an International Technical Advisor with CAWST who works in areas across Africa, including Zambia, Ethiopia and Uganda, tells a powerful story of what capacity building means in the WASH sector. This post originally appeared on the CAWST blog, to view the original post click here.
The term capacity building is used a lot in international development and the water sector. It’s a nice, compact phrase that tries—but fails—to capture just how powerful it can be in peoples’ lives.
Sure we need clean, universal phrases to help standardize communication, but they can sterilize emotion and impact: the very things that compel us to take action.
Robinson Mufumbilwa’s story is what “capacity building” means to me. It takes more than two words to communicate his story, and stories like his. But it’s these stories that leave me with no doubt about the effect of “capacity building” on a person’s life, and how it empowers that person to then impact others.
It was 2009 and I was in Zambia as a CAWST International Technical Advisor, working with a local organization called Seeds of Hope. I was sitting in a quiet room when suddenly there was a knock on the door, and a young man walked in, introducing himself as Robinson. He had completed a three-month community development program through a local college, been to a biosand filter seminar and was raring to go. The problem was, he didn’t really know how to go. He was excited and was hoping Seeds of Hope would commit to building biosand filters in his village.
I told him to remember what he’d learned about needs assessments. They were the best way to get an agency to commit because they helped to determine whether there was demand or need for filters in a village. I told him it wouldn’t take much more than some photocopying and going door to door in his village, and asked how much he thought it would cost.
Robinson said he thought it would cost about 50 Kwacha, the equivalent of nine Canadian dollars, which I told him didn’t sound like all that much.
Not much, but it was money Robinson didn’t have. So I pulled the equivalent of ten dollars out of my pocket and gave it to Robinson, who thanked me and walked out of the room.
Over the next few weeks, I visited several other African countries as I continued my work for CAWST. I never thought I’d see Robinson again and if I did, I guessed he had spent his money on something other than doing a needs assessment in his community.
Much to my surprise, when I returned to Zambia weeks later, I found Robinson sitting in an office at Seeds of Hope with a neat stack of papers on his lap, waiting to speak to someone. He had all these sheets of his needs assessment, and they had been compiled into percentages of houses visited and so on, all the stuff he’d learned to do.
Robinson wanted to hand the pile of information to someone at Seeds of Hope. So, I advised him to go straight to the Biosand Filter Centre and to present his research directly to management. That’s exactly what Robinson did. Through his research, Seeds of Hope understood the need and subsequently supplied filters to people in his village.
Three months passed when I again found Robinson, this time working in the Biosand Filter Centre, building the very filters that would benefit his village with his own two hands.
In later years, I returned to Zambia to teach seminars on rainwater harvesting, monitoring and evaluation, water quality testing and so on. Robinson was a participant in all of them, an avid learner and an increasingly valuable asset.
In 2012 I discovered Robinson had become Manager of the Biosand Filter Centre. Since then, he has been going through the CAWST Competency Validation Process and has achieved the designation of Lead Trainer. He has delivered training in Zambia, Ethiopia, Uganda, Malawi and, I expect as time goes by, many more African countries. He has become a leader and a subject matter authority in water issues.
I often wonder what would have happened if Robinson hadn’t taken that first seminar on the biosand filter and what would have happened if I didn’t have ten bucks in my pocket that day.
For me, this is the story of capacity building. Investing in knowledge and people is what makes a difference. Yes, it’s capacity building, but what does that really mean? It is believing in human beings and their ability to learn, to teach and to change lives. It’s an idea that may take longer to communicate, but which is far more compelling.