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Editor's Note: In this post, Laura MacDonald, Knowledge and Research Coordinator at the Center for Affordable Water and Sanitation Technology (CAWST) provides an abridged summary of a conversation with a researcher about climate change and WASH. To dive into the technical details on this fascinating topic, please refer to Kristen Downs’ guest blog post: Ask a Researcher: Considering WASH in the context of climate change. This post originally appeared on the CAWST website, to view the original post please click here.

2016 has not been lacking in extreme events – the Fort McMurray wildfires, Winter Storm Jonas, Hurricane Matthew, record-setting average global temperatures – and it’s assumed that such events will be occurring with increasing frequency. Such extreme events are highly covered in the news and grab the public’s attention, often resuming the ongoing discussion around climate change and its potential impact on our daily lives. For water, sanitation and hygiene (WASH) practitioners, consideration of the potential impacts extends to vulnerable populations in developing countries and their access to safe water and sanitation. Given the inherent links between climate change and WASH, the increasing awareness of climate change and its impacts has led to a documented increase in requests to CAWST from WASH practitioners for more information on the subject. Specifically, CAWST clients are seeing a decrease in the reliability of water sources, leading to more people relying on surface water with a high level of microbiological and, increasingly, chemical contamination.

If you feel overwhelmed with the complexities of climate change, don’t worry – it’s normal.

Here are some basics you should know 
  • Weather, climate and climate change are different.
  • Climate change isn’t just about increased temperatures; it’s also about: (1) precipitation,  (2) sea level rise, and (3) extreme events.
  • Climate change will hit hardest in places where the population faces existing vulnerabilities, be they economic, social or environmental, and exacerbate these challenges.
  • WASH programs need to ensure they are ready to adapt to the local effects of climate. Because the effects can be so localized, it’s critical that local WASH practitioners observe climate-related impacts first-hand and take steps to integrate best practices into their programs to increase climate resilience.
What strategies, technologies and approaches can we use to address the WASH challenges posed by climate change?

When considering possible strategies and technologies to address the WASH challenges posed by climate change, it’s helpful to think about supply and demand. For example, from a supply side, as our clients have seen, an increase in temperature could reduce the availability and quality of surface water. On the demand side, higher temperatures could increase household demand for water to use for cooling, bathing, and watering crops. This is just one of many potential changes that can affect both the demand and supply side and will make it difficult to plan, implement, evaluate and support appropriate interventions. As WASH practitioners, however, we are equipped with a range of strategies and technologies that could be used to improve resilience. Strategies include protecting water sources to prevent water quality degradation and diversifying raw water supplies to address reduced water availability and quality. On the technology side, boreholes and rainwater collection could support diversification of supplies. These technologies, in addition to household water treatment, improved pit latrines and flood-proofed wells, could help protect against and address degradation of water quality.

What are the potential health impacts of climate change?

The health impacts of climate change will be both direct and indirect, and they are likely to be increasing and mostly negative. Specific to WASH, increasing water insecurity, degradation of water quality, and changes in the transmission of water-borne and water-washed infectious diseases are of particular concern. Researchers are working to better understand how climate change affects infectious diseases in different contexts. For example, some are studying the relationship between temperature and diarrhea as well as rainfall and diarrhea.

The hard truth is that climate change will make it more difficult to deliver sustainable WASH services. An uncertain question is when and in what situations climate change will go from exacerbating existing challenges to changing the game entirely, at which point the WASH sector would have to change paradigms and practices, not just put in additional effort and invest in best practices.

Encouraging recommendations

Ever-positive and insightful, though, Kristen wouldn’t leave us disheartened. Instead, she closed with the following recommendations:

  •  Increase the resilience of WASH systems and services.
  •  Increase the resilience of vulnerable populations.
  •  Contribute to gathering more information about the current and potential future impacts of climate change at the local level.

To learn more about these recommendations and dive into the details of what Kristen presented, you can read her technical blog post here.

Editor's Note: In this post, Pratibha Mistry, Senior Water and Sanitation Specialist at the World Bank, explores the opportunities and challenges around a water quality crowdsourcing initiative. This post originally appeared on the World Bank's Water Blog, to view the original post please click here

The recently released Contextual Framework for Crowdsourcing Water Quality Data lays out a strategy for citizen engagement in decentralized water quality monitoring, enabled by the “mobile revolution.”

According to the WHO, 1.8 billion people lack access to safe drinking water worldwide. Poor source water quality, non-existent or insufficient treatment, and defects in water distribution systems and storage mean these consumers use water that often doesn’t meet the WHO’s Guidelines for Drinking Water Quality.

The crowdsourcing framework develops a strategy to engage citizens in measuring and learning about the quality of their own drinking water. Through their participation, citizens provide utilities and water supply agencies with cost-effective water quality data in near-real time. Following a typical crowdsourcing model: consumers use their mobile phones to report water quality information to a central service. That service receives the information, then repackages and shares it via mobile phone messages, websites, dashboards, and social media. Individual citizens can thus be educated about their water quality, and water management agencies and other stakeholders can use the data to improve water management; it’s a win-win.

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Source: Figure modified from Hutchings, M., Dev, A., Palaniappan, M., Srinivasan, V., Ramanathan, N., Taylor, J. 2012.“mWASH: Mobile Phone Applications for the Water, Sanitation, and Hygiene Sector.” Pacific Institute, Oakland, California. 114 p.

Several groups, from the private sector to academia to non-profits, have taken a recent interest in developing a variety of so-called mWASH apps (mobile phone applications for the water, sanitation, and hygiene WASH sector).  A recent academic study analyzed how mobile phones might facilitate the flow of water quality data between water suppliers and public health agencies in Africa. USAID has invested in piloting a mobile application in Tanzania to help consumers test their water for E. coli.

What makes the crowdsourcing framework unique is its focus on developing a more holistic strategy for crowdsourcing. Here are six factors to consider when developing a water quality crowdsourcing initiative:

  • You’ll need an understanding of the local context (social, political, and environmental) if you’re going to meet community needs, win the buy-in of key partners, and conduct good environmental science. Project planning with the “Theory of Change” works backwards from the desired outcome and an understanding of the local context to identify the inputs that will help a project succeed.
  • collaborative approach to citizen science empowers participants and builds a sense of ownership.  Everyday people join a project out of curiosity or in the hope of personal gain. But their ongoing involvement hinges on the feeling that they are making a difference for themselves or for their communities.  Projects that recognize volunteers’ contributions, provide feedback, let people see the impacts of their work, and encourage a sense of community involvement are more likely to be sustainable. Distrust, particularly between scientists and project volunteers, undermines citizen science.
  • Participants want mobile applications that are not only useful but also easy to use, reliable, responsive, and trustworthy. Data dissemination – via the app or through other channels – should be developed to meet the needs of the various end users.  Of course, it’s also important to keep project goals in mind. App development for developing world markets is often hyper-local, because of the control that mobile network operators exert over systems and content.  This can limit scalability.
  • Don’t forget performance evaluation!  From spatial distribution of sampling to water managers’ response times after contamination events, the crowdsourcing framework includes guidance on indicators for measuring both the process and the outcome at every stage.
  • Good project design is the sum of social design, technical design, and program design.  Social design focuses on relevance and benefit to key actors in a socio-cultural context. This includes an awareness of user perceptions, collaboration, transparency, data privacy, and the like.  Technical design focuses on technologies and software, from data collection to data dissemination. Program design considers supporting political/agency infrastructure, performance metrics, and the project’s financial model.
  • Which water quality parameters will your project monitor? Available testing technologies, current water quality conditions, and local regulations will all affect your decision.  So will the current and future factors that might influence local water quality. These influences may be natural (geology, hydrology, etc.) or anthropogenic (sewage, urban runoff, industrial effluent, agrochemicals, mining waste, etc.). Citizen education about water quality is a major goal, so it’s also important to select parameters that are meaningful and relevant for local users.

Crowdsourced water quality monitoring offers a tantalizing promise of scale, spatial resolution, cost effectiveness, and local engagement, but it’s no simple task.  The conceptual framework underscores just how much thoughtful planning is needed for such a project to have a chance of sustaining.

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This flow chart highlights the social dynamics of a collaborative citizen science project. Source: Figure adapted from Rotman, D., Preece, J., Hammock, J., Procita, K., Hansen, D., Parr, C., Lewis, D., Jacobs, D. "Dynamic Changes in Motivation in Collaborative Citizen-Science Projects." Proceedings of the 2012 ACM Conference on Computer Supported Cooperative Work. pgs. 217-226.

Editor's Note: This post, written by Matt Hickman, discusses the partnership between Google and India’s Ministry of Urban Development (MoUD) to roll out a new Toilet Locator app in a country where only 36.4 percent of households have a toilet. This post originally appeared on Mother Nature Network, to view the original post please click here.

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Finding a clean, public toilet in Delhi (and potentially other major Indian cities) will soon be less of a health-compromising hassle thanks to Google Maps. (Photo credit: jenny downing/flickr)

World Toilet Day, an annual United Nations-sanctioned day of observance drawing attention to the 2.4 billion people around the world without access to clean and safe sanitation, dropped this past November in typically splashy fashion: a Coldplay and Jay-Z concert, the unveiling of a Gates Foundation poop smell-blocking perfume and enough well-meaning potty puns to last well into the new year.

While World Toilet Day is global in scope, much of the awareness-raising, activism-inspiring action this year — aforementioned Coldplay and Jay-Z concert included — was centered around India, a country where an estimated 70 percent of households in both rural and urban areas don’t enjoy the luxury of having a functioning commode. For a majority of India’s 1.2 billion citizens, defecating and urinating in the open is the norm.

Similar to other developing nations, cellphones are far more prevalent than toilets in India. As backwards as this may seem to Westerners, it’s a reality for millions of Indian households. According to a 2012 census, 60 percent of Indian households surveyed have one or more mobile devices while only 36.4 percent of households have a toilet.

Given these statistics, a new partnership between Google and India’s Ministry of Urban Development (MoUD) seems like a match in clean sanitation heaven: the introduction of a Google Maps tool that points users in the direction of toilets that are clean, safe and open for public use. As reported by the International Business Times India, the toilet-finder tool launched in December in Delhi, India’s second most populous city, before potentially becoming available in other major population cities, although the timeline is unclear.

How the app works

Of course, the tool, dubbed Google Toilet Locator, won’t solve India’s underlying toilet shortage problem or reverse cultural attitudes regarding al fresco urination. However, it does help on-the-go Delhi residents more easily find somewhere to go if need be. While we've written about urban toilet-finder apps in the past, those have been more or less spurred by convenience (and excessive drinking). Google Toilet Locator, piloted in a city of 25 million where public toilets are far and few between, is more driven by necessity.

An unnamed official with the MoUD explains to the IBTimes India that the Google Toilet Locator will pull up all known public lavatories — sulabh shauchalays — across the National Capital Region along with harder-to-find loos located inside of shopping malls, gas stations, hospitals, etc. Listing both deluxe flush situations and standard no-frills squat options, the tool itself is integrated into Google Maps. Mobile users simply must open the app and enter one of numerous keywords in English or Hindi — “toilet,” “restroom,” “lavatory,” “swachhata,” “shauchalay,” etc. — and they’ll be directed to the nearest option based on their location.

Just like a restaurant or retail establishment, Delhi residents — and visitors — can use Google Toilet Locator to rate and comment on specific public restrooms, either providing a glowing recommendation or warning others to stay away.

Explains an official with the MoUD: “The system being put in place relies heavily on crowdsourcing, with people's feedback helping fuel it. Therefore, if a person finds that a toilet is not clean, he or she can give it a bad review or rating, the facility for which is available on Google Maps.”

Considering that many Delhi residents who will be potentially using the app don’t have a toilet of their own at home, knowing if a public restroom is clean — or even open — is all the more important. Foreign tourists aside, for a large majority of folks using Google Toilet Locator, there isn’t the option of “holding it until I get home.”

Sanitation ... it's a work issue too

Google Toilet Locator is just one of many events and initiatives launched in conjunction with World Toilet Day, which as is tradition, boasts an annual theme. This past year, in order to spotlight the oft-overlooked link between economic livelihoods and sanitation, the theme was “Toilets and Jobs.”

For most, the topic of toilets and jobs usual revolves around ill-timed toilet paper shortages, privacy peccadilloes, rude noises or knowing to avoid the men’s room for at least 15 minutes after Ron from accounting goes in. For others, the workplace — and perhaps home, as well — might completely lack a clean, safe bathroom option. Poor sanitation has a direct link to economic well-being — that is, things like absenteeism, exhaustion and decreased productivity rise when employees don’t have access to a toilet at work or at home. In addition to impacting performance, the illnesses associated with poor sanitation keep workers off the job, sometimes temporarily and sometimes for good.

As the World Toilet Day website stresses, providing women with adequate and private bathroom facilities is of particular importance in developing areas.

And because it just wouldn't be World Toilet Day without a video featuring dancing animated poos, here's this past year's offering, which in keeping with the jobs theme, also features a variety of hard-working, life-saving "professional" toilets.

Editor's Note: In this post, Ammar Fawzi, Global WASH Advisor with GOAL, discusses the prospect of using smell-cancelling technology to combat global sanitation challenges in the future.

I recently attended the Global Toilet Business Innovation Summit hosted by The Toilet Board Coalition in Mumbai, India. The summit brought together key players from across the sanitation sector, but what was especially refreshing to see was the significant presence of the private sector – a sector often spoken of as the key to achieving success at scale, yet rarely actually in attendance at such summits. The range of the private sector attendees was broad, including large multi-nationals such as Unilever, Kimberly Clark Corporation, LIXIL and Firmenich, and over 75 small- and medium-scale entrepreneurs and businesses.

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Undoubtedly, one of the highlights of the three days was a talk from Firmenich on Eliminating the “yuck factor” with smell science. You might have already seen the video that they premiered at the event, or read about it on Bill Gates’ Blog. Essentially, Firmenich is working with the Bill and Melinda Gates Foundation to tackle latrine malodour with “smell-cancelling” technology. The argument is that too often toilets don’t get used because they smell bad, and to combat this, Firmenich researchers are working on developing fragrances that block certain receptors in our noses, making us unable to register certain malodours. Think of noise cancelling headphones for example, but using your nose instead of your ears. As Bill Gates himself puts it, “The question now is whether this technology is good enough to make a difference in communities with poor sanitation.”

Innovative solutions to tackling global water access, sanitation, and hygiene (WASH) issues are often a cause of much excitement, especially when a large multi-national company is seen to be working on something as exciting as this and is backed by the Gates Foundation. There is, after all, plenty of depressing statistics and indicators on access to sanitation in our sector, so why not afford ourselves the opportunity to get excited by something as pioneering and potentially as game changing as this? I would agree, however, perhaps the question that needs to be asked is not whether this technology is good enough to make a difference, but instead how can it make a positive difference?

Although smell-cancelling technology is still a long way from being usable and available, let’s just assume that it is ready to roll out and let me play devil’s advocate for a moment to pose some key questions about the potential impacts of this innovation:

  • Would you still be keen on using a latrine if there was poop all around the toilet even if there was no smell? This technology could be seen as a substitute for Operation and Maintenance (O&M) which will be required, perhaps more than ever, if a latrine has more users. Caretakers might feel that they no longer need to keep up hygiene standards - there is no smell, so it must be clean! Effective O&M from caretakers is often needed (but not always) to manage the emptying of pits, ensure there is access to water and soap, maintain hygiene, and collect user fees where relevant. Can we expect them to do all of this if they can’t keep a latrine clean and smelling decent without the use of this technology? Are we addressing a simple problem with a complex technical solution? Should we also be concentrating on behaviour change (people are embarrassed to be seen going to a latrine), increasing capacity, and promoting adequate monitoring with suitable incentives?
  • How will this technology be rolled out and integrated into existing supply chains so that it is accessible in hard-to-reach places in sub-Saharan Africa?
  • Public latrines aren’t always used as latrines. I’ve seen them used as homes, storage, and even a pigeon breeding home. What will happen if we make them smell too nice?
     
  • Flies are attracted to strong smells and there is a direct correlation between smell and presence of flies. I wonder, would this technology also work on pathogen vectors? It would be fantastic if it did, but if it didn’t, people might think their toilet is lovely when really there are many vectors spreading disease. Our overall target as professionals is to improve public health – not to increase latrine use. There is a case to be made that there is a logical and evolutionary reason for smell. In 2003, researchers at the London School of Tropical Hygiene and Medicine carried out a study on smell and our association with disease. One of the researchers on the team, Val Curtis, echoes a suggestion that goes back as far as Charles Darwin: that we think poop stinks for our own good. Our disgust towards certain sights and smells, said Curtis, is a “behavioural immune system”: an adaptation—biologically rooted, but tweaked by culture and social conditioning—that evolved to keep us from coming into contact with infection and disease. Perhaps we shouldn’t be playing with this formula.

I don’t mean to be all doom and gloom. One area where this technology could really have an impact is in container-based sanitation. Many of the enterprises like Clean Team, Sanivation, SOIL or Mosan working in and pioneering this approach, rely on business models where the collection of waste from households is every two or three days. This is how long it takes it starts to smell and it doesn’t become something you want in your house. But what if this technology could be used here? Collection time could be increased to perhaps five days or more and this could be a successful method for scaling up access to sanitation by making business models more attractive and cost neutral.

Refugee camps and those for internally displaced people might also provide a great opportunity to trial this technology. The O&M works differently in this setting, there is a reliable supply of international products making their way to the camp from the implementing partners, and the focus here is less on behaviour change and more on public health impact.

I congratulate Firmenich and the Gates Foundation on this project and their early results. Let’s hope that if the opportunity comes, we as a sector can utilise it in the most beneficial way possible.

Editor's Note: This post discusses the method of Community Led Total Sanitation (CLTS) and how we can ensure that sanitation is both sustainable and inclusive. This post originally appeared on the website of Institute of Development Studies, to view the original post please click here

Great strides have been made in improving sanitation in many developing countries, not least through Community Led Total Sanitation (CLTS), an innovative method developed to address the behaviours behind ongoing open defecation. CLTS has spread rapidly over the last 16 years and is now present in over 60 different countries. However recent research shows that more thinking and action is needed to ensure that sanitation efforts are sustainable and inclusive. A new book, entitled Sustainable Sanitation for All, examines how CLTS and the WASH sector more generally has and needs to continue to evolve to meet these challenges.

Creating an Enabling Environment for CLTS Sustainability drawing - credit: Barney Haward

Creating an Enabling Environment for CLTS Sustainability drawing - credit: Barney Haward

The urgency of the sanitation crisis cannot be underestimated. An estimated 2.4 billion people worldwide still lack access to adequate facilities, of whom 1 billion defecate outdoors. Faecally transmitted infections, poverty, and undernutrition reinforce each other.

In December 2015, a UN General Assembly resolution defined water and sanitation as two separate rights for the first time while the Sustainable Development Goals (SDGs) include the ambitious aim of universal access to improved sanitation by 2030, with targets that include the elimination of open defecation.

The achievement of open defecation free (ODF) status is increasingly being recognised as only the first stage in a long process of change towards Total Sanitation.

“Open defecation free is just a start, we need to maintain the gains, deal with the faecal sludge, resolve problems of menstrual and hand hygiene, and see sanitation businesses spread around the world.” Professor Val Curtis, Director of Environment Health Group at the London School of Hygiene & Tropical Medicine.

New book “Sustainable Sanitation for All” looks beyond open defecation free

With a particular focus on sustainability of behaviour change as well as physical infrastructure, post-ODF follow up and monitoring, and ensuring equity and inclusion, Sustainable Sanitation for All includes 18 contributions which look at cases from Asia and sub-Saharan Africa. Edited by Petra BongartzNaomi Vernon and John Fox, the book was produced by the CLTS Knowledge Hub, based at IDS and published by Practical Action.

Exploring current experiences, innovations and insights, the book addresses two key questions:

  • How do we reach the poorest and most marginalized, with toilets that are suitable to their needs?
  • How can we embed hygienic habits and create new social norms around sanitation behaviour?

In his foreword to the book, Robert Chambers writes, “The empirical evidence and analysis in the eighteen contributions made in this book show just how much has been learned. We have learned that without losing its core essence, CLTS must be adapted and evolved to fit national and local conditions.”

One-day meeting brings water and sanitation experts together on how to take forward and expand on CLTS

On 23 November, the CLTS Knowledge Hub brought together over 20 experts on sanitation (CLTS and WASH) to discuss the challenges and opportunities for making sanitation sustainable and inclusive and to elicit views on how to better meet the needs of the sector through its activities.

participants at the CLTS workshop - credit: E.Wilson - IDS

participants at the CLTS workshop - credit: E.Wilson - IDS

Diversity of contexts requires adaptable and pluralistic approaches

The huge diversity in contexts within which CLTS has been used suggests that the traditional approach needs to be adaptable to respond to different needs. The range of different experiences to learn from is much wider than it was just 5 years ago. There are now opportunities for pluralism and with that more openness and learning.

Inclusion needs to remain at the forefront of efforts to sustain ODF communities When done badly, CLTS has been known to exacerbate existing inequalities. Whilst in an ideal case scenario, the poor or less able are helped by the better off, in practice, this is often not the case. Since the poor and less able people find it the most challenging to access and sustain adequate sanitation facilities and bear the highest burden of disease it is imperative that better ways of reaching them and meeting their specific needs are found.

Do subsidies need to be revisited?

Whilst CLTS has always maintained a strong position against individual household hardware subsidies, it may now be time to look at how smart financing mechanisms could support efforts to make sanitation more inclusive.

In many cases, maintaining a position against subsidies is the right thing to do, in order to achieve the behaviour changes needed to achieve ODF. However, many present at the meeting agreed that a more nuanced and targeted approach to subsidies, for example through a voucher or rebate systems as described by Andy Robinson's book chapter, may add value.

Sanitation Marketing

We have come a long way since some of the early meetings and discussions when CLTS and sanitation marketing were presented as opposing approaches with practitioners aligning themselves to the different camps. Now there is a far more nuanced understanding and discussions are evolving around ways CLTS and sanitation marketing can complement each other and be phased together to ensure sustainable ODF communities.

Handwashing CLTS must be better linked together with other sanitation and hygiene concerns. One crucial area that was identified as a frontier we have yet to crack was handwashing. It is clear that more innovation is needed in order to influence handwashing behaviour in communities.

Editor's Note: This post explores ACTED's efforts to encourage good hygiene practices among Syrian refugees in the Dohuk governate in Iraq. This post originally appeared on ACTED's website, to view the original post please click here.

ACTED case workers conducting hygiene education activities with children in Syrian refugee camp - ACTED Iraq, 2016

ACTED case workers conducting hygiene education activities with children in Syrian refugee camp - ACTED Iraq, 2016

Today, 2.4 billion people in the world are struggling to stay well and keep their children alive due to the lack of access to hygiene and sanitation services. In recognition of the importance of addressing this global challenge, ensuring access to water and sanitation was listed as Sustainable Development Goal #6 in 2015.

Poor sanitation and children’s vulnerability

Inadequate provision of water and sanitation, and poor hygiene education affect people of all ages, but particularly compromise the well-being of children, who tend to be more sensitive to preventable diseases than adults. The integration of simple practices, such as hand washing and correct oral hygiene, in children’s day-to-day life can prevent the occurrence of a variety of conditions – from infections to tooth decay – that have both short and long-term impacts on their physical development. Keeping this in account, ACTED’s programme teams in Iraq have adopted a mainstreamed and multi-sectoral approach to target the water, sanitation and hygiene (WASH) needs of children and youth.

Hygiene promotion for young ages

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A clear example of this approach is the integration of hygiene promotion in ACTED’s child protection programmes. In ACTED’s child and youth friendly spaces in Domiz 1 and Domiz 2 Syrian refugee camps in Dohuk governorate in Iraq, hygiene promotion is a daily activity, implemented through awareness-raising sessions with children and youth. In order to get even the youngest ones involved, ACTED staff utilises participative methods for teaching good hygiene practices, including dramatizations, cartoon drawing, singing, peer-to-peer sessions, and short films. In recent activities, conducted in partnership with Medical Corps and Doctors Without Borders, awareness-raising campaigns were complemented by the distribution of toothpaste, toothbrushes and anti-lice shampoos to refugee families living in camps.

A multi-sectoral approach to water, sanitation and hygiene

ACTED’s comprehensive approach to providing water, sanitation, and hygiene does not only focus on encouraging good hygiene practices among the youngsters. Child Protection teams operating in Domiz 1 and Domiz 2 also conduct hygiene promotion campaigns with parents, caregivers, and volunteer committees with the focus on providing support to children and youth. These hygiene messages are shared with the community through providing information leaflets, ensuring that counselling sessions are available, and having dedicated awareness-raising activities on health and hygiene, such as the one organised in Domiz 1 refugee camp for parents whose children have been affected by lice.

Integrating hygiene promotion activities into child protection programmes allows ACTED not only to reach vulnerable children while most in need, but also to promote their physical well-being in the long-term.

Editor's Note: This post discusses the work of Water & Sanitation for the Urban Poor (WSUP) in Zambia to improve sanitation in low-income communities by trialing a pit-emptying service operated by a community-based organization. This post originally appeared on WSUP's blog, to view the original post please click here.

Providing sanitation services to unsewered parts of a city is complex. The challenge goes way beyond simply building toilets – its about finding financially viable ways to collect, treat, and dispose of waste.

WSUP’s new film tells the story of our work in Lusaka, Zambia, to improve sanitation in low-income communities by working closely with the utility, micro-enterprises, residents, and community-based organisations.

Because sewers haven’t been built where they live, low-income residents have to dig a pit for the waste from the toilet. When the pit fills up, residents have to dig another pit or empty the waste out by hand, sometimes dumping it illegally. This is clearly an unsustainable practice, made worse by the fact that in the rainy season, many of the pits flood – spreading faecal waste across the residential area.

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So to tackle this, in Lusaka we’ve been trialing a pit-emptying service for low-income customers, operated by a community-based organisation, the Kanyama Water Trust in partnership with the Lusaka Water & Sewerage Company. The service enables customers to have the sludge from their pits safely transported to a treatment facility, where it is processed and safely disposed of or resold as a soil conditioner and fertiliser.

So far, the scheme has benefited 25,000 people, such as Shawa Margarete, who lives in Kanyama, one of the pilot communities. Shawa (pictured below) says in the film that she is positive about the benefits that the service brings: “The service is worth the money that we pay for it”, she says. Mbewe Brown agrees: “This has really made our lives easier, because we had a really big problem and now, with the pit emptiers we have a service which is easily available,” he says.

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But the model still needs work. The service is generating income, but is not yet covering costs of collection, treatment and disposal. This is vital to achieve if the service is to be expanded to other urban communities in the country.

“Our priority at WSUP now is to see how this current model can be improved so that it can become more financially viable – because when it does so, we will be able to recommend it for scale up to other low-income communities,” says Reuben Sipuma, WSUP Zambia country programme manager.

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This film was produced in partnership with Sandec, the Department of Sanitation, Water and Solid Waste for Development at Eawag. It will feature in Eawag’s new online course on Planning and design of sanitation systems and technologies. To sign up for the course, click here.

Editor's Note: In this post, Guang Z. Chen, Senior Director of Water Global Practice at World Bank Group, discusses the role of World Bank and its partners in meeting the water-related challenges facing our world. This post originally appeared on The Water Blog of the World Bank Group, to view the original post please click here

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To many people, it is a surprise to learn that in an age of such advanced technology, at least 663 million people still lack access to basic needs, like safe drinking water, or that 2.5 billion people lack access to sanitation, such as a toilet or latrine. And while much progress has been made, receiving safe drinking water 24 hours a day, seven days a week simply by turning a tap is still a dream for many in the developing world.
 
Even fewer realize this is not just a problem for families, but also for those on which families rely and that also need water: the farmers who grow the families’ food, the environment that protects and sustains their homes and communities, the businesses that employ them, the cities that house them, the schools that educate their children, the clinics and hospitals that treat them, and even the power plants that generate their electricity.
 
Why does this challenge persist? How can this challenge be met? And an increasingly urgent question: is there enough water to go around?

Water is becoming increasingly scarce, including in places where it was once considered plentiful. Meanwhile, extreme water events, such as floods and droughts, are increasing in frequency and intensity because of climate change. Further, cities are growing faster than ever, which means more demand coming up against a decreasing supply.
 
This is an urgent challenge. Business as usual will see some areas lose up to an additional 6 percent off of their GDP growth by 2050. Something has to change.
 
I recently assumed the role as head of the World Bank Group’s Water Global Practice (GP)to help countries do just that. With a portfolio of roughly $35 billion in 170 water related projects globally, the World Bank Group is the largest external financier of water related development projects. In response to demand from countries for support in implementing these changes — in the form of Sustainable Development Goals (SDGs) related to water — we will leverage this portfolio and draw on a team of over 300 experts from 78 nationalities based in nearly 60 countries around the world to help our clients identify options for economically, environmentally and socially sustainable solutions tailored to their context. Success will require a focus on institutions, information, and infrastructure.
 
We will do this working with the United Nations, civil society organizations, the High Level Panel on Water, and other sectors like agriculture, environment, energy, urban development, and the climate policy community to help countries bring about that change in a way that acknowledges the right to water and sanitation for all, the value of water and water-related services, in behavioral, cultural, and economic terms, and the role of water in climate change adaptation and mitigation.
 
Today, many people have the false perception that freshwater resources are infinitely available and therefore of lesser value. This leads to behaviors like overconsumption and poor services. Given this, it is important to recognize the call to action by the High Level Panel on Water (HLPW), which met for the second time a few weeks ago at the UN General Assembly in New York. At that meeting led by World Bank President Jim Yong Kim and UN Secretary-General Ban Ki-moon, the HLPW launched an action plan to mobilize the global community around SDG 6 and related targets. I echo their call for a fundamental shift in the way the world thinks about and values water, with the vision of a future where individuals and societies automatically make better decisions with respect to water and how it is used and allocated.
 
However, I also believe donor support is one piece of a larger puzzle. Countries need support from their leaders, citizens, and neighbors to bring about this kind of change in mindset towards water stewardship.
 
At the World Bank Group, with an eye towards ending poverty by 2030 and promoting shared prosperity, we will do our part working with partners to drive towards the water related SDGs and continue building support for this change to encourage the political will and financial resources needed to help countries meet their targets with home grown, scalable, and sustainable solutions.
 
I am glad to see the Water GP has advanced in an area for which I have advocated for some time: connecting the water supply and sanitation subsector to broader water resources management. I also believe it is increasingly impossible to separate the Water agenda from the urban agenda, just as we cannot separate the climate and Water agendas. There is much we can do on Integrated Urban Water Management to help countries tackle these challenges.
 
Similarly, it is increasingly difficult for countries to separate water from agriculture, environment, energy, health, and others, which all rely on water. We’ll work closely with our colleagues in other GPs at the World Bank Group to help identify cross-sector solutions that could help our country clients leapfrog ahead.
 
We must also work hard to ensure focus on global trends does not take focus away from trends like slow progress in ending the practice of open defecation. Sanitation was the most off track of the MDGs, so we must continue the focus on the SDG targets for water supply and sanitation. In addition to our work on rural sanitation, we are intensifying our efforts on urban sanitation and fecal sludge management.
 
Thanks to support from bilateral donors, we will continue to supplement Bank operations with thoughtful analysis, cultivated partnerships, and advocating for high level support on issues like sanitation and climate change, which we hope will help us continue to be a reliable, effective partner for our clients.
 
Looking ahead, I do believe it is possible to achieve much together with our eyes set on the World Bank's twin goals of ending extreme poverty and boosting shared prosperity and the SDGs related to water. I look forward to hearing feedback from you during this journey together. 

Editor's Note: In this post, Eve Mackinnon, a researcher working on innovative responses and evidence-based solutions to the sanitation crisis, discusses how WASH programs in nurseries or child care centers could protect child health. Eve is a water, sanitation and hygiene practitioner with over five years of hands–on emergency humanitarian response experience across Asia and Africa. Her current research focuses on more effective, sustainable and safer sanitation management, across the entire sanitation service chain to deliver positive changes to the way that human waste is managed. 

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Although global death rates of children under five resulting from diarrheal disease has fallen from a global high of 1.2 million in 2000 to 500,000 in 2015, it still represents the second leading cause of morbidity for this age group. These deaths are mainly preventable; 88% of them are attributed to a lack of access to water, sanitation and hygiene (WASH). The significant decrease in the last 15 years is a major achievement largely due to improvements in access to better quality drinking water, toilets, and better hygiene and care practices. These changes prevent young children being infected with harmful microbes that come from drinking dirty water and living in dirty environments, and contracting severe diarrheal diseases, which without sufficient treatment or in vulnerable children ultimately leads to death. 

Of course diarrhea is not the only threat to infant and young children. Ongoing research indicates that the same WASH factors that lead to diarrhea, also lead to stunting and malnutrition in young children. This is because low level of exposure to harmful microbes damages the intestinal tract and prevents proper absorption of nutrients in children. Infants and children under five are more vulnerable to being infected by microbes and get ill far quicker. From a health perspective, the targeting of effective WASH infrastructure is crucial to reach the most vulnerable groups.

Provision of WASH programs for vulnerable children whilst at nurseries or child care centers could be the most efficient way to protect their health. In Naivasha whilst researching risks of diarrheal disease for my PhD case study, I was shown Vision Nursery. The nursery cares for on average around 40 children in one small room. There is no drinking water provision, only water stored in containers from a tap stand. The nursery has access to a child adapted toilet (a container based toilet, provided by Sanivation), a positive step in WASH provision, however, without handwashing or regular cleaning the use of the toilet carries its own risks. Moreover, the nursery is also host to resident chickens, which are major carriers of harmful bacteria and co-habitation with people is linked to malnutrition and stunting in children according to recent research. The mud and rough concrete floor means cleaning and hygiene is difficult to maintain. There is inadequate space and utensils to safely prepare the childrens’ meals, and food cannot be re-heated or stored in secure containers.

Despite all of these shortcomings, the nursery provides an essential service. The female entrepreneur who started Vision Nursery has been running it for almost seven years and rents the small space. She is constrained by small margins, high rents, and lack of borrowing power. Her operation is linked to the Kenyan flower industry- a global success story of export growth. Naivasha is an epicenter of this booming export center for flowers, and it is driven overwhelmingly by a female workforce.  The associated employment opportunities allow women to gain a regular income with positive consequences of independence, empowerment, and rising equality for women in Kenyan society. An unintended consequence of female empowerment is the growth in a secondary industry of local nurseries and childcare. There are little to no regulations for nurseries in Kenya, and if they do exist,  they are not enforced. This allows for poor standards to exist, particularly in regard to WASH provision.

Potential baby WASH strategies to combat infection at the nursery level focus on robust barriers to specific exposure pathways that are specific for infant behaviours. For example, ingestion of pathogens occurs indirectly when children place contaminated objects in their mouths. Termed ‘mouthing’ it is responsible for almost 90% of a child’s exposure in one study.

Other direct exposure pathways include placing of hands directly into mouths and touching dirty floors. It’s important to regularly disinfect toys and maintain hygienic floor surfaces—possibly through use of mats or plastic, washable floor covers. Informed WASH strategies should be developed which can identify a broad range of baby-specific exposure routes. Indeed these indirect routes may be far more of consequence for children than direct routes of drinking contaminated water and food, which are traditionally the focus of WASH household campaigns.

The safe disposal of faeces remains the primary barrier to prevent dispersal of pathogenic bacteria in the environment and subsequent exposure routes. Despite a recent systematic review of health impact from sanitation intervention that concludes there is a lack of robust evidence, provision of safe sanitation is ultimately necessary to reduce contaminated environments that occurs as a result of open defecation.

In addition to focusing on specific prevention strategies at the nursery level, it is also crucial to increase integration between WASH, early childhood development (ECD), nutrition, and maternal newborn and child health (MNCH) programming. In addition, it’s important that outcome and impact monitoring is not uniquely focused on reduction in diarrheal disease. Impact monitoring and value for money evaluations should also explore targets that are linked with nutrition, undernutrition, and height and weight. It is notoriously difficult to link specific WASH interventions with impacts, without radnomised controlled trials, due to the huge variety of exposure pathways and variables that exist.

The WASH and sanitation sector might consider moving its focus from mostly household WASH and school sanitation to specialist WASH needs during infant care. If children survive the first year they are less vulnerable to further infection or severe outcomes. Therefore, intentionally focusing on activities at this juncture, as well as better integrating our efforts with other sectors—as the new babywashcoalition.org does—could have an enormous impact on child health.

Editor’s Note: In this post, Amy Pickering (Stanford University) and Clair Null (Mathematica Policy Research), co-principal investigators of the Povu Poa Project in Kenya, describe how with funding from the USAID Global Development Lab’s Development Innovation Ventures program, they teamed up with Innovations for Poverty Action, and using a human-centered design process developed a new handwashing station for settings that lack piped water. In this article, the authors describe its methods and preliminary findings. This article was cross-posted with permission, to view the original article please click here.

A member of a focus group in Kisumu, Kenya, provides user preference input for a handwashing station customized for areas without access to piped water. Photo Credit: Noel Wilson

A member of a focus group in Kisumu, Kenya, provides user preference input for a handwashing station customized for areas without access to piped water. Photo Credit: Noel Wilson

The theme of this year’s Global Handwashing Day on October 15, 2016, was “Make Handwashing a Habit!” In places without access to piped water, new products and technologies are needed to make handwashing with soap convenient enough to become a habit. Handwashing with soap is a powerful weapon against diarrhea and respiratory illness, the leading causes of death among children under 5. It is estimated that handwashing with soap could save 1 million lives annually. Unfortunately, only 19 percent of the global population wash their hands with soap after contact with feces.

raditional handwashing with a basin. Photo Credit: Amy Pickering

raditional handwashing with a basin. Photo Credit: Amy Pickering

Without access to water on tap in the home, handwashing is inconvenient — using one hand to pour water over the other is awkward and requires more water than washing two hands together. Moreover, if everyone followed the standard recommendations about how often to wash their hands (after defecation, before cooking, before eating), women and children would likely have to spend more time fetching water from sources outside the home. Soap is another challenge — if left at locations where handwashing would ideally occur (near latrines, cooking areas, and eating areas), it is vulnerable to being wasted by children or stolen.

We set out to design a water- and soap-conserving handwashing system that could address the barriers faced by millions of people who don’t have access to piped water in their homes. We wanted it to be adaptable for a variety of contexts, ranging from space-constrained urban dwellings to schools with hundreds of students. For plastics manufacturers to produce it, the system needed to be a desirable product that consumers would want to buy. Our goal was to seed the market with a good idea and then let the private sector take over.

From Boring Bar Soap to “Cool Foam”

With funding from the USAID Global Development Lab’s Development Innovation Ventures program, our team of researchers from Innovations for Poverty Action partnered with engineers from Catapult Design to invent an innovative, appealing, and practical new handwashing station in Kenya. Using a human-centered design process, we started by holding focus groups and tinkering around with available handwashing products — buckets, pitchers, and tanks with taps — trying to locate features that would create value for a handwashing product. We watched people wash their hands using different types of handwashing stations and soap, interviewed them about their experiences, and engaged them in games and activities to reveal preferences that they might not have thought to explain.

Testing prototype handwashing stations in Kisumu, Kenya. Photo Credit: Noel Wilson

Testing prototype handwashing stations in Kisumu, Kenya. Photo Credit: Noel Wilson

We then brainstormed a large number of new concepts for handwashing products. We focused on water-frugal devices and soapy foam dispensers rather than regular soap or soapy water. We invited households to test out our models, lining up multiple options of water and soap dispensers side by side so we could see how users interacted with them and hear their opinions.

After several months of this exploratory and iterative design phase, we honed in on several key user design preferences: soap security, affordability, and adaptability. Ultimately we developed what is now branded as the Povu Poa, or “cool foam” in Swahili. The product comes in a pipe model, which can be hung from a tree or nail in a wall and is very portable. There is also a bucket model, which captures the runoff and has a larger capacity but is more cumbersome to move around. Both models incorporate a water-frugal swing tap that allows only a small amount of water to flow and a foaming soap dispenser. The dispenser transforms 5 grams of powdered soap and 250 milliliters of water into 100 handwashes, and both systems can be locked into place to reduce theft.

Povu Poa handwashing stations, as bucket (left) and pipe (right) models. Image Credit: Noel Wilson

Povu Poa handwashing stations, as bucket (left) and pipe (right) models. Image Credit: Noel Wilson

Importantly, the Povu Poa reduces the everyday cost of handwashing by more than half compared to conventional systems because of its exceptional soap and water efficiency. In Kenya, the cost of soap and water is only $0.10 per 100 handwashes using widely available powdered laundry detergent to make the foam. The Povu Poa is also adaptable to institutional settings; for example, the pipe model can be connected to large tanks for higher water storage capacity.

Prospects for Scale-Up

To understand the price that Kenyan households are willing and able to pay for the Povu Poa, we marketed and offered the products for sale to 200 households at varying price points. We also contracted a local Kenyan firm to create a logo and messaging for marketing the Povu Poa. We found that 78 percent of households bought the product at a price of $4, while approximately one-third (35 percent) bought it at $8. When offered side-by-side, the bucket model was more popular than the pipe, perhaps because it has a more familiar appearance or because it has a larger capacity.

Interestingly, among consumers who were only offered the pipe model, sales were almost identical to the bucket model and there is evidence that suggests some consumers would purchase the soap foamer alone. Even though the current estimated price point of a mass-produced Povu Poa is slightly higher at $12, we were very encouraged to see this real demand for a convenient and efficient handwashing system in Kenya. Notably, the Povu Poa could pay for itself with soap and water savings in 2.5 years for a family of five.

Currently, the Povu Poa is being field tested in 30 schools and health clinics in peri-urban Kenya to see if the product can increase handwashing rates among students, teachers, doctors, and nurses. We will use these longer-term evaluations to refine the product design and continue mass production discussions with plastic manufacturers in Africa.

“Foam is exciting,” said one head teacher, capturing a typical user reaction to the Povu Poa system. “It won’t be wasted.”

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