Editor's Note: In this post, Agha Ali Akram of Evidence Action, explores why despite the availability of inexpensive and easy-to-use technologies and simple behaviors that can prevent diarrhea, social scientists have found it challenging to get high adoption rates and maintain participation amongst poor households, even when the technology is provided free. Ali Akram conducted this work independently and the following does not reflect the views/opinions of Evidence Action. This post originally appeared on DefeatDD's website, to view the original post click here.
Despite the availability of inexpensive and easy-to-use technologies and simple behaviors that can prevent diarrhea, it was an unpleasant surprise for me to learn that it kills more than half a million children a year, predominantly in the developing world. More troubling still, social scientists have found it challenging to get high adoption rates and maintain participation amongst poor households, even when the technology is provided free. This got me curious: why is this the case?
What I Did: The Experiment
In a randomized controlled trial in Karachi, Pakistan, I test the hypothesis that perhaps families need tools that clearly demonstrate the impact of health interventions – in this case, chlorine tablets for water purification.
Info-Tool required weekly recording of diarrheal incidence and monthly comparison to a reference level.
I provided households with a simple visual tool (called Info-Tool) to help them assess the efficacy of using tablets. Info-Tool allowed households to record incidences of diarrhea using simple bar charts. Additionally, at the end of each month, I provided them a bar chart of the normal rates of diarrhea they could expect for that month. Diarrhea varies with season, so the norm I provided was a moving monthly reference (related to the number of children under five in the household) and Info-Tool allowed households to visually compare their bar charts to the reference level.
Form of the experiment: control group in blue and treatment in green.
The experiment had a control group and treatment group, and rolled out in three phases. In Phase 1, which lasted three months, the treatment group used Info-Tool and built up a pre-tablet record of diarrhea prevalence. Info-Tool allowed them to understand where their levels tracked in comparison to the provided reference. In Phase 2, which also lasted three months, the treatment group continued to use Info-Tool but both groups were offered the option of accepting free chlorine tablets. In Phase 3, I discontinued the treatment group’s use of Info-Tool but both groups continued to receive freely provided chlorine tablets.
What I Found: Remarkable Results
Chlorine tablet use was significantly and persistently higher in the treatment group. At 74 weeks from the start of tablet delivery (beginning of Phase 2), the treatment group was almost twice as likely as the control group to accept the tablets, with the control group acceptance rate at 26% and the treatment group at almost 60% (see Figure 3).
Two results really struck me. First, my data show that as we enter the subsequent summer season (near the 46 week mark), both groups demonstrated higher tablet acceptance. Significantly, the treatment group’s summer increase in uptake was higher than the control group. To me, this suggests an impact of Info-Tool on households’ fundamental understanding of disease seasonality i.e. households seemingly better understood the “dynamics” of diarrhea.
A more striking result to me, however, was the fact that children in treatment households tended to measure significantly better than control households on health outcomes such as weight (22% gain), height (6% gain), and mid-upper arm circumference (3.5% gain). This suggests that the use of tablets had real measurable health impacts.
Predicted probability of accepting offered chlorine tablets by treatment arm. The x-axis has time (weeks) while the y-axis shows predicted probability of uptake in a given week. The control group is shown in blue while the treatment group is shown in red. Dotted vertical lines indicate specific dates and phases of the experiment.
The results suggest that allowing households to track and reference their disease prevalence increased their ability to detect the efficacy of chlorine tablets, thus making the intervention far more successful. More specifically, I believe that households were able to better learn about the effectiveness of tablets because Info-Tool provided a more precise signal about tablet effectiveness. It is also apparent that households possess a general sense of the seasonality of the problem but with the augmented learning from the Info-Tool, treatment households show a higher likelihood to accept offered tablets as the “danger” (summer) season started.
What this Means: Policy Recommendations
I believe this study points the way forward in two important ways. First, it demonstrates a powerful new way to address a major global health challenge i.e. under-five diarrhea with its associated health costs. I found that the intervention had strong and persistent effects a year after it began, inducing people to adopt chlorine tablets when they otherwise would not have.
Second, it confirmed to me that people can and do make beneficial health decisions – we’ve just got to help them “see” that those decisions have real benefits. Giving people clearer signals on how they benefit from their use of supposedly beneficial technology sparks greater participation. Moreover, I can imagine analogues to this technique being applied to other domains where health technology adoption is critical such as adoption of anti-malarial bed-nets and drug regimens for diseases like TB and HIV.
Editor's Note: In this post, Kylie Bates, Director of GameChangers, an organization that uses partnerships to make sport and communities stronger, discusses how sports organizations and organizations that solve water, sanitation and hygiene issues can join forces for change.
I am in sitting under a mango tree in Munda in the western province of the Solomon Islands, exchanging banter and observations with a group of teenage girls as they pull on their shoes and adjust their shin pads. The coach blows a whistle in the distance and within seconds the group is on the field, contracting and expanding again to run through kaleidoscopic drills. Three girls are left sitting under the tree and when I ask them why, they explain they each have their period. It is an awkward conversation and a common issue. Each member of this training squad misses one in four weeks of training due to menstruation.
Taking part in this soccer program also means the girls will probably be among the 20% to 35% of Solomon Islands teenagers who get to finish high school. One father boasts his daughter is the hero of their village when she teaches the boys new drills and tricks. He says she is starting to change people’s minds about what girls are capable of doing. The girls don’t know it yet, but they will eventually be the backbone of the national soccer team. Being on the field, not under the mango tree, sends their life on a new trajectory.
The other main thing holding these girls back from playing and performing in their sport is surprising due its abundance on this tropical Pacific Island: water.
People who play and organise games of sport need to be free from diseases that stop them in their tracks for days or weeks. They need to be free from bacteria spread by unclean water, poor hygiene behaviour, and open defecation. Adolescent girls and young women need convenient and effective ways to manage menstruation so they can confidently take part in all activities. They need the option of using hours usually absorbed walking long distances to water sources, or looking after young brothers and sisters who have infectious diseases, to train and play. In some countries buying water is expensive, leaving no discretionary income left for sport participation. More parents would support their daughters to play a sport if there was a toilet close to the playing field that was both clean and safe.
Reaching universal access to water, sanitation and hygiene will require US$24 billion, plus more to ensure sustainable water management. The effort pays off. For every $1 invested in water and sanitation, an average of at least $4 is returned in increased productivity. Hygiene promotion is the most cost-effective health intervention according to the World Bank.
Perhaps as important as monetary value, reaching water, sanitation and hygiene targets requires the mobilisation of more diverse organisations that have a vested interest in the well being of their associates.
There are over 700 national sports federations in the Pacific region that have the capacity to regularly convene players, organize events, and support representative teams. Over 30 regional confederations support the national federations. Many more organisations fund, provide services to, and partner with these federations. If the more than 700 organisations that look after games of sport in the Pacific region want to flourish, then they have a vested interest in the water, sanitation, and hygiene experiences of their players both at home and on the field.
Just as organisations that are interested in water, sanitation and hygiene are valuable to games of sport, sports have unique attributes to help progress community development objectives. Sports offer three platforms:
1. Platform for change
Sports bring people together regularly in situations where they are with their peer groups and usually a coach or mentor. For example, when girls and young women play games of sport they develop a greater ownership and understanding of their bodies. They gain access to a safe space to grow and explore and connect with peers for social support, and learn to challenge norms and stereotypes. This creates an ideal environment for behaviour change in other areas that matter to adolescent girls, including menstrual hygiene management. As a result of Women Win’s Building Young Women’s Leadership Through Sport program in seven countries, 84% of girls had improved menstrual hygiene management compared with 49% previously.
2. Platform for advocacy and influence
The people who govern and lead games of sport often govern and lead in other parts of the community. Mobilising local resources is a key component of achieving the sustainable development goals. While there are varying reports on the degree to which they are effective in changing behaviour, they do play a role in raising awareness and contributing to highly visible conversations. In some cases there is the opportunity to train high profile athletes to play key roles in water, sanitation and hygiene activities. For example, Mrs. Lua Rikis, the captain of Papua New Guinea’s national netball team has joined the WaterAid office in Papua New Guinea. Part of her role is to engage and support Netball PNG in incorporating hygiene behaviour change and water and sanitation initiatives that are equally relevant to netball’s own mission and strategic priorities.
The organisations that govern games of sport care about the well being of people who play their sport. Many sports have child protection policies, gender inclusion policies, and disability inclusion policies. If protecting participants’ health and safety is seen as part of the sport federation’s role, then the case can be made for sports to have water policy that describe the standards of water, sanitation, hygiene required as a prerequisite for sport participation and, importantly, help sports achieve these standards. This is especially significant for events where travelling teams rely on organisers to provide satisfactory facilities.
3. Platform to raise funds
The work of both sport and water organizations is enhanced and enlarged when there is more money available. Together, the two make a strong proposition for a funder.
For sports, partnerships with development organisations provide the design, monitoring, and evaluation rigor needed to set up an effective program. For development organizations, sports provide the profile, reach, and accessibility needed to make an impact. All of these elements are attractive to donors that are also interested in diplomatic outcomes via sport. WaterAid’s sport-based program funded by the Department of Foreign Affairs and Trade in Papua New Guinea is blazing trails for new forms of sport and development organisation partnerships. It is also piloting new ways to engage netball players in Australia in advocacy and fundraising via connections with netball players in Papua New Guinea.
Major sport events are also effective major fundraisers. UNICEF’s fundraising initiatives at the Glasgow Commonwealth Games raised almost AUD10 million. Tackle Hunger, a partnership between the World Food Program and the Rugby World Cup, raised almost AUD3 million. The potential of these relationships has not been thoroughly explored nor consistently applied. There is an opportunity for sports sponsorship to connect to sport event fundraising, that goes on to fund sports based programming that contribute to water, sanitation, and hygiene outcomes.
When I talk to colleagues in both the water and sport businesses, I hear that the hardest thing is knowing where to start. It is also the most simple. Ask for a meeting, figure out what you want, take the first step.
Editor's Note: In this post, Jonathan Evans, Mariana Gallo, and Alivia Knol of the Centre for Community Organisation and Development (CCODE), discusses how the EcoSan toilet system has helped to combat Malawi's sanitation crisis.
With implications in areas as diverse as nutrition, education, and health, the lack of proper sanitation and hygiene is considered one of the greatest barriers to global development. In Southern Africa, Malawi is all too familiar with these far-reaching consequences. Diarrheal disease is currently the fifth cause of death in Malawi and it is estimated that poor sanitation costs the country approximately US$57 million each year.
Malawi’s sanitation crisis is perhaps most evident in the nation’s capital city of Lilongwe, and the industrial center of Blantyre. A combination of factors including a lack of a sewage treatment system, poor access to water, and a lack of space result in a complex sanitation challenge for the cities’ slums.
Currently, the most widespread model of sanitation toilet in these informal settlements is the pit latrine. Pit latrines are often smelly, fragile structures that are unsafe for children and are subject to overflow during the rainy season. Once a pit latrine becomes full, it is common for a completely new pit to be dug, making the system unsustainable. Open defecation is also commonly practiced in urban Malawian slums, with terrible health consequences.
The Centre for Community Organisation and Development (CCODE), in partnership with the Federation of the Rural and Urban Poor of Malawi, has been installing an alternative system called the Ecological Sanitation (EcoSan) toilet in Malawi since 2005. EcoSan toilets are dry-composting latrines, where the human waste is mixed with soil or sawdust to decompose in anaerobic conditions, producing as a result a compost that is odorless and safe to handle. Though there is a reasonable investment of training, and money required at the installation of an EcoSan toilet, the numerous long-term benefits of this system result in overall savings. This is in sharp contrast to pit latrines, which are quite cheap in the short run, but very costly in the long run. When maintained properly, EcoSan toilets can function with minimal water supply, and will produce a dry compost final product that is not unpleasant or difficult to empty.
When dirt and soot are periodically added to the collection chamber, the EcoSan toilet can turn human waste into manure that is used as fertilizer in gardens and farms. This fertilizer can be used by EcoSan owners in their own fields, or can be sold to other farmers. This capability is not only environmentally friendly, but is a source of great monetary savings (sometimes even earnings) for the EcoSan owner.
One unforeseen benefit that has emerged in the implementation is that the EcoSan toilet has become a status symbol in the community. The sturdy, odor-free design is something that EcoSan owners take great pride in, which in turn motivates their neighbors to seek out a similar toilet for their house.
The primary drawback of the EcoSan system is the cost. The current cost of a unit is around of US $215, which includes materials and labor. This is a significant sum of money for most households in the slum areas of Lilongwe and Blantyre. To overcome this obstacle, CCODE and the Federation work to provide loans to access them, and support village savings and loan groups as a way to increase investment capacity. Other solutions have come from the beneficiaries themselves: some groups have agreed to pool their money together to pay for a toilet to be installed in one house with the understanding that everyone who contributed money will be able to use the toilet. Once they’ve saved enough money, they will pay for a toilet to be installed for the next family, and so on. This solution is not ideal, but it’s nevertheless a way to increase access for a population that would normally never be able to afford such a toilet.
Another challenge with EcoSan toilets is that they are not maintenance-free. When the toilets are not properly taken care of, they can start to smell, get clogged up, or attract flies. These issues are all completely avoidable, but the owner must be committed to the necessary upkeep. CCODE and the Federation ensure that each and every household that gets an EcoSan toilet also receive the necessary information and training to use and maintain it properly.
Despite these challenges, the EcoSan toilet is proving to be the most adequate solution to the sanitation and hygiene crisis in Malawi. Not only does it save space and money in the long term, but it also contributes to the achievement of one of the UN’s Millennium Development Goals of Ensuring Environmental Sustainability. However, without adequate financing for impoverished households to install EcoSan toilets, they wouldn’t be accessible to the people that need them the most.
With the help of local savings and loans programs like the Federation of the Rural and Urban Poor, and the work of numerous NGOs throughout Malawi, access to improved sanitation will continue to expand, if not as quickly as perhaps it could. Nevertheless, every single toilet that is installed means less danger for children, less exposure to disease, and less damage to the environment. There is certainly a long way to go, but progress is being made every day.
Editor's Note: In this post, Heloise Greeff Marais, Doctoral Researcher in the Water Programme, Computational Health Informatics Lab and Smith School of Enterprise and the Environment at the University of Oxford, discusses the opportunity for multidisciplinary collaboration in the WASH sector.
I’m a robotics engineer from South Africa. I like technology, control theory, and data science – mostly things that don’t (and can’t) get wet! I know very little, if anything, about marine governance science, watershed management, or international water law. So why am I in a two-week intensive research course focussing on water, climate, and society?
Over the last decade, the need for multidisciplinary teams has been widely published, however, this approach remains poorly applied outside of the healthcare sector. Collaboration is too often treated like a minor add-on to a project; considered an inconvenience that only causes delays in decision points.
It can be uncomfortable to leave the familiarity of our professional scope. Sometimes rather unpleasant. Like being an adult at kindergarten. It’s scary.
Relationship building is a two-way street. More specifically, capacity building of professionals should begin at an individual level through personal development before we can expect changes at an institutional and societal level.
So, who invited the mechatronics engineer to the water event? No one. Her curiosity and compassion led her here.
To ensure universal drinking water access by 2030, we need to not only invest in capacity building of the local communities we engage, but also the professionals we rely on. Proposed integrated approaches for water interventions focus on breaking down the silos that exist between governments, donors, and local communities, yet, often overlook their own expert role.
The people (like me) who help develop the technologies, models, and infrastructure needed to achieve water security, may not always have in-depth knowledge of climate change impact factors or socio-economic dynamics related to water.
The water sector is particularly exposed to the effects of climate change. Although the impacts will be felt by developing and developed countries alike, unfortunately, it is the most marginalised who will be particularly vulnerable to the uncertainties in future weather patterns.
Recognising the pivotal role of water in climate change adaptation presents many opportunities for sustainable development. Innovative technologies and suitable implementation strategies for adaptation and mitigation are urgently needed. And with them will come the engineers, the techies, and the geeks who design them.
The Oxford Smart Handpump, which I work on, is a brilliant example of the potential impact of a social innovation emerging from successful cross-functional collaboration towards a common goal: universal drinking water security. Open communication and continuous feedback between engineers and geographers ensure a more robust technology while maximising social impact.
A two-week course on water and society by no means makes me an expert in the field of climate change or water security. But it does do something much more powerful: it begins to break down the silos that exist between different professional fields that evidently share a passion.
Social and natural scientists think, argue and view the world differently than engineers. But by entering a world in which I am considered an “outsider” and acknowledging that I lack speciality skills and insights, I make room for other people’s gifts. Making ourselves vulnerable is not easy and some may consider it a liability. But I recognise that technical expertise alone will not enable me to deliver the most impactful innovation.
In short, collaboration is not only a good investment, but also a necessity.
Water is pure. It cleans, renews, and gives life. But water is complex, water policy is messy and global water laws are murky. Impactful innovations require multi-dimensional approaches and unconventional expertise. It needs multidisciplinary teams.
So, who will invite the mechatronics engineer to the next water event? Everyone. I hope.
Editor's Note: Reaching the new Global Goals for safe water and sanitation will take an enormous investment. Learn how Kenyan banks and utilities — with some international support — are making water access a commercially viable business, while serving the needs of the poor. This post originally appeared on Medium and was published by the USAID Water Team. To view the original post click here.
Peaceful, jacaranda-shaded Embu, Kenya resembles many small cities in East Africa: bustling on market days, dusty and a little sleepy the rest of the week. But, water is always a major concern of its residents.
Though Embu is situated near several rivers in the shadow of Mount Kenya, the county government struggles to bring water to the town and neighboring villages through an aging network of leaky pipes dating to the 1970s. Currently, more than half of people in Embu do not have access to improved water service.
“People used to spend half a day collecting water — and water quality was very poor,” said H.M. Kerungendo, the managing director of the Embu Water and Sanitation Company (EWASCO).
Globally, satisfying water and sanitation needs will take enormous investments that are beyond the ability of Official Development Assistance (ODA) or public financing alone. In Kenya, water utilities face an estimated $2.6 billion financing gap — or more than 10 times the Kenyan government’s budget for water supply and sanitation for 2015–16.
Closing these gaps will require new solutions and new funding sources, including mobilizing domestic capital and capacity.
Bringing Water Utilities out of the ‘Shadows’
In Embu, expanding access to water services came in the form of a unique partnership among a bank, a utility company, the U.S. Agency for International Development (USAID) and the World Bank’s Water and Sanitation Programme (WSP).
In 2011, WSP released a shadow credit rating report that helped attract commercial bank interest in the water sector. Establishing credit ratings helps financial institutions to understand how the water service providers will be able to service loans, and makes the lending to the water sector more attractive and transparent.
In 2012, as part of a strategy to connect local utilities to local financial markets and reduce their reliance on central government transfers and donor support, USAID provided a loan guarantee through its Development Credit Authority to Kenya Housing Finance (KHF), a local financial institution. Under the terms of the agreement, USAID agreed to take 50 percent of the repayment risk on each loan KHF made to water companies.
The credit guarantee was complemented by capacity building efforts provided through USAID and the International Finance Corporation (IFC). USAID’s advisors helped Mr. Kerungendo and his EWASCO colleagues develop a proposal for a loan from KHF and a business plan to support loan repayment. The IFC also worked with EWASCO to undertake an audit that led to improvements in their business processes, financial management and planning.
This support helped make the Embu water utility more attractive as a potential borrower to Kenyan lenders.
From Loan to Pipeline
In May 2014, KHF approved a nearly $1 million loan to EWASCO — the largest commercial loan ever made to a Kenyan water utility.
“The guarantee allowed my bank to make a loan to EWASCO, our first loan in the water sector”, says Anne Murugu, a KHF Loan Officer. Kenyan banks have historically shied away from the water sector, due to borrowers’ lack of collateral and borrowing experience.
Over the following year, the utility used the loan proceeds to install 18 miles of new pipe in peri-urban areas of Embu county, significantly improving the water supply for 100 schools, 15 clinics and 50,000 community members.
“We had lots of problems regarding water. Before the pipeline, we would wake up very early and walk up to 9 kilometers to fetch water. We spent hours searching for water because it was rationed”, recalls Jemimah Wagathare, a resident of Embu’s suburbs.
By bringing these pieces together — the needs of people with financing and technical solutions, Kenya and its global partners are creating the foundation for a sustainable, inclusive and commercially viable water sector.
A special thanks to Glenn Pearce-Oroz, Heather Skilling, and Brook Adam for their contributions to this article. To subscribe to Global Waters magazine, click here. For more information about the Sustainable Urban Water and Sanitation in Africa (SUWASA) program, see “Changing the Landscape for Africa’s Urban Water Services.” For additional information:
Editor's Note: In this post, Dylan Lunney, Director of Communications for OHorizons, discusses the Low Tech, High Thinking approach to creating affordable, simple solutions that can have a meaningful impact on WASH issues.
Low-tech, scalable, local solutions present an exciting opportunity to address the water, sanitation, and hygiene (WASH) objectives laid out in goal number six of the United Nation’s Sustainable Development Goals (SDGs).
There is no one-size-fits-all solution to tackling WASH issues, but in order for development projects to be successful and sustainable, communities should not be bystanders in projects that are designed to help them. This belief is underscored within SDG 6 section 6.6b
In addition, solutions addressing the challenges of people living in poverty should be designed by carefully examining and accounting for the needs, practices, and available resources of the end-user. This seems like a basic, self-evident concept, however the history of water development projects demonstrates otherwise.
Take for instance that the cumulative cost of failed water systems in sub-Saharan Africa alone was estimated to be $1.2 billion to $1.5 billion from 1987-2007. The poster child of this development design failure is the PlayPump, an initially highly-touted safe drinking water ‘solution’ that quickly failed when it turned out that kids would have to ‘play’ for 27 hours a day to filter the intended amount of water. Development projects that fail to incorporate the needs, skills, habits, and resources of the end-user don’t produce their intended result—in this instance providing safe drinking water—and they are an enormous waste of money, time, and resources. Instead, beneficiaries should be involved in identifying the technology and approach that will benefit them most and the community should be directly involved in the building and maintaining of their local infrastructure.
OHorizons, where I work, is part of this appropriate design movement in WASH global development. We call our design process Low-Tech, High-Thinking.
A lot of attention is given to the newest app or high-tech gadget. You’ve probably heard of Bill Gate’s highly celebrated machine that turns human waste into water. It’s impressive. It’s also impractical for most poor, rural communities, where the water and sanitation crisis is particularly dire, who likely don’t have the infrastructure or funds to build or maintain this $1.5 million dollar facility that is roughly the size of two school buses.
The core belief behind the Low-Tech, High-Thinking movement is that it takes just as much creativity and ingenuity to create affordable, simple solutions that can have a meaningful impact on a global scale. Understanding the systemic underlying causes along with listening to and learning from the end- user, is a vital part of this design process. Adhering to the following principles can also help guide this process and ensure a solution is truly centered around the beneficiaries and the environment in which they live:
Simple: Anyone, regardless of education level or expertise, should be able to develop and implement a solution with minimal instruction.
Low-cost: The solution should be affordable to the end-user.
Locally-sourced: 100% of the materials, tools, and labor should be available locally.
Flexible: Every community is different and has different resources available to them; solutions should be flexible enough to adapt to varying local conditions.
Open-source: Solutions should be freely available to anyone who would like to utilize them.
OHorizons has used this approach to engineer a Wood Mold for the production of concrete BioSand Filters (BSFs). BioSand Filters (BSFs) are a low-tech, household appliance that use sand, gravel, and natural biological processes to filter pathogens out of water, making it safe for drinking. We’ve made our step-by-step construction manual open-source so that local organizations can manufacture BSFs for a fraction of the upfront costs of the traditional steel mold. Our Molds make more than 50 concrete filters without an issue due to the use of our patented collapsible inner core and 2” x 2” supports that hold the outer walls of the Mold together with bolts rather than screws, which strip the wood. This innovation allows more people to get safe drinking water at an exponentially faster rate.
There exist many other fantastic household level solutions that follow similar design parameters. Two of my favorites are the Tippy Tap for hand-washing and the C.R.A.P.P.E.R. for toilets.
The Tippy Tap is a hands free way to wash your hands and is especially appropriate for rural areas where there is no running water. It is operated by a foot lever and thus reduces the chance for bacteria transmission as the user touches only the soap. They’re also very easy to build and can be made with basic, low-cost materials.
The organization Toilets for People (TFP) has designed a high-quality composting toilet that they’ve appropriately named the C.R.A.P.P.E.R. (compact, rotating, aerobic, pollution-prevention, excreta reducer). It’s user-friendly and easy to maintain, can be made from locally available materials for about $100, and is being built around the world by NGOs serving their communities.
Here’s a video of TFP in Peru with their NGO partner Amazon Promise, building 17 CRAPPERS:
Toilets for People’s founder Jason Kass, is a passionate ambassador for bridging the gap between the appropriate technologies already out there and creative implementation on the ground.
As we continue to develop solutions for water, sanitation, and hygiene, one area to think seriously about investing in is low-tech, human-centered design projects that transform beneficiaries into local change makers. Harnessing the power of people through Low-Tech, High-Thinking Design can and should play an important role in helping ensure availability and sustainable management of water and sanitation for all by 2030!
Editor's Note: In this post, Rob Goodier, Engineering for Change News Editor, discusses the new Solutions Library and how it can be used to increase effectiveness in the WASH sector.
Reinvention of the wheel is a common mistake in global development, and the water, sanitation and hygiene sector is not immune. There must be hundreds of prototypes languishing on closet floors and hard drives after failing to reach the market while proven, off-the-shelf filters, chlorinators and so on may be acceptable for the job.
The same goes for choosing the right product for each context. We have to start with what’s meeting (and not meeting) the users’ needs in order to avoid wasted investment. And we have to do it throughout the value chain.
That’s why Engineering for Change has built a new Solutions Library of hundreds of products that meet basic needs. The products cover nearly every aspect of global development, including dozens in the water and sanitation sector.
The Solutions Library is a due diligence resource, a living database of neutral, performance-based information. The entries help answer three important questions for global development technology:
- Which solution is appropriate for the context and constraints?
- What has scaled and what has stalled?
- Does the solution perform as expected?
We have heard from engineers and others in global development that answering those three questions has been difficult. Practitioners are starved for high-quality information. Another thing we’ve heard often from global development professionals is that new, unproven gadgets get as much, if not more, attention as proven products.
Repeated mistakes can slow global development efforts. It has been hard to find information about so-called “prior art,” the wheels that have already been invented. That leads to undeveloped prototypes or, worse, the rusted-out bones of dead projects that were delivered and then failed.
The reasons for failure can be technical, cultural, financial or a combination thereof, but the end result is the same: wasted investment. Our answer is normalized, objective data that is rigorously harvested and reviewed by experts. Practitioners can reduce the risk of failure and spend their money wisely with our side-by-side comparisons of the products that can meet their goals.
That’s why we did this. We believe the Solutions Library is the first stop in the decision for which technology will be the best fit in any given context. It is a work in a constant state of flux, with periodic updates that incorporate suggestions from our network of development engineers and other professionals. As you explore the resource, please share your ideas and tips based on your experience. We hope to include the advice of the WASH community in our improvements.
Please visit the Solutions Library, share it with colleagues and collaborators and contribute. Real working solutions start here: solutions.engineeringforchange.org.
Editor's Note: In this post, author Indrias G. Kassaye discusses how a UNICEF-supported rehabilitation project is bringing clean water back to schoolchildren and villagers in Masorie, Sierra Leone. This post originally appeared on UNICEF's website and has been reposted with permission. To view the original post, please click here.
As Rosemarie Yema Blake pushed down on the water pump, a government technician held a plastic bottle under the spout to collect a sample from the gushing stream. Ms. Blake is an engineer from UNICEF’s NGO partner Living Water, and her most recent project brought her to an abandoned well at the Harry C Primary school in Sierra Leone’s Western Rural district. Students waited in anticipation to learn if, for the first time in more than a decade, the well would produce clean water.
“The water was not good to drink before – it was corrosive and had metallic content,” said Earnest Joko Henry, head teacher at the school. “The well had lots of debris in it. And the people here said that rebels had been killed and thrown in the water during the war, so they refused to drink it.”
The well had remained unused by the school and the villagers since Sierra Leone’s Civil War, which lasted from 1991-2002. Instead, students ventured to another well outside the school compound – a journey that cut into their class time.
“When the children came to school, they had to go and fetch water to fill all the buckets for hand washing, which meant they only started their school day at about ten,” said Mr. Henry.
Clean water returns
With support from UNICEF, the well and pump at the school were recently rehabilitated. The final step in the rehabilitation process is testing the water, and the technicians confirmed that it was safe for the community to use, including for drinking. With one final chlorination, the well got the all-clear.
“This is the only deep well in the community that doesn’t dry up during the dry season,” said Mr. Henry. “There are about 450 people living in this and the surrounding two villages and they all depend on this well. We are therefore very happy that it has been rehabilitated.”
And from now on, students at the school no longer have to leave the school compound to get water.
“Every morning we clean the pump and area around the well,” said 12-year-old Ali Kabia, the president of the school’s Child Health Club. The club works together with the School Management Committee to manage water, sanitation and hygiene (WASH) at the school. “The water from the well is good now, so we are not afraid to use it and we are happy for that.”
Since the rehabilitation, it has also become much easier for students to do the routine hand-washing that is part of the infection prevention and control procedures set up during the recent Ebola outbreak.
“We wash the buckets and get water to wash the class and for hand-washing,” said 12-year-old Zeyneb Koromah, Ali’s deputy in the club. “We fill the handwashing buckets and make sure all children wash their hands with soap. And then we check their temperature before they can enter the class. We have good toilets for boys and girls, and separate ones for the teachers. We take turns scrubbing the toilets and making sure they stay clean.”
In Sierra Leone, only 63 per cent of the population has access to safe drinking water. Improved sanitation facility coverage is even lower at 13 per cent. Having adequate water and sanitation facilities in schools is critical for ensuring a conducive learning environment for students, but only 23 per cent of schools have a functioning water supply.
UNICEF is supporting the rehabilitation of water supply systems in 170 schools and 84 health facilities in eight districts in Sierra Leone as part of its support to the Government’s post-Ebola recovery programme.
Editor's Note: In this post, Caitlin Gruer, Program Associate for WASH & Health at PLAN International USA, discusses the issues surrounding menstruation around the world and how we might address those issues. This post originally appeared on Huffington Post, to view the original post please click here.
Even in the best circumstances having your period can be an unpleasant experience, but for many women and girls around the world, it presents a serious problem.
In low income countries, many women and girls don’t have access to affordable and hygienic feminine products; instead they are forced to use improvised materials like rags or leaves, which are not only uncomfortable but can also lead to infection or embarrassing leaks.
This isn’t just a “third world problem.” Many women and girls in the USA also struggle to access the hygiene products that they need. Homeless women in particular struggle to obtain these products, which despite high demand, are frequently unavailable at shelters and food banks.
And, it’s not just homeless women and girls who face these problems. Feminine hygiene products are expensive—the estimated cost of a year’s supply is $70—and they are not covered by food stamps. Periods are a significant expense, made even more expensive by the fact that in 40 states nationwide, tampons are considered a “luxury” and so are taxed.
Women and girls also need access to safe, private, clean bathrooms or latrines with a place for washing up so that they can manage their periods and keep themselves clean. However, for homeless women in the US, and women and girls in low income countries, this is often difficult to find, if not impossible. One in three people worldwide don’t have access to a toilet—that’s a lot of women left searching for a private place to go.
Compounding these issues, is the fact that menstruation is an incredibly stigmatized topic worldwide. In most cultures, including our own, menstruation is not openly discussed. If girls are lucky, they may learn about the menstrual cycle as part of their school curriculum, but in many places worldwide not even that happens.
Harsh social taboos also limit the roles and actions of women and girls while they are menstruating. For example, in some parts of India, women and girls may be excluded from eating with their families or bathing when they have their periods.
It’s difficult to imagine that in 2016, a simple biological process experienced by 800 million women and girls every single day can be such a problem, but it is.
It’s an education problem: When girls don’t have access to the supplies and facilities they need, they may miss school during their periods. Even if they do attend school, they may be distracted, anxious and uncomfortable. This can have a serious impact because educated girls are more likely to earn a good income, are less likely to be married as a child, and are more likely to raise healthy babies.
It’s an economic problem: When women have to miss work because they are unable to manage their periods in the work environment, they lose out on potential income. When feminine hygiene products are expensive (due to taxes, limited supply, etc.), many women and girls have to make critical choices between buying these products and other necessities.
It’s a dignity problem: Women and girls shouldn’t have to suffer from anxiety, embarrassment and discomfort because of a natural process, but in almost every country they still do.
There is hope though. Recently, the issue of menstruation has been gaining attention, and an increasing number of organizations are working to combat this issue. To address all aspects of this problem, approaches must be comprehensive:
Improve access to supplies: Women and girls need access to affordable, safe feminine hygiene products. That’s why child rights organization Plan International has partnered with social enterprise BeGirl in Ethiopia to provide girls with access to their reusable panty-pads. And why, Camions of Care—founded by Nadya Okamoto, a member of Plan’s Youth Advisory Board—works to collect and distribute hygiene care packages to nonprofit partners across 10 states in the US.
Improve access to facilities: Women and girls also need proper sanitation facilities, which is why Plan engages in a human centered design process to create girl-friendly facilities in schools, health clinics and communities.
Improve knowledge and reduce stigma: But providing facilities and supplies isn’t sufficient—the stigma of menstruation must also be addressed through large-scale behavior change. Internationally, Plan is working to break the silence surrounding this topic by providing women and girls with education and information on menstruation and options for managing their periods. In addition, Plan engages men and boys in discussions about menstruation because they have a critical role to play in changing societal attitudes and creating a positive environment. On the domestic front, Camions of Care is also working to raise awareness about menstruation, and to reduce the stigma.
Through the work of these organizations and others like them, a lot of progress has been made, and we’re just get started. Menstruation is still an uncomfortable topic for most people to talk about, and it remains underfunded, under researched, and underrepresented in global policy. However, by breaking the silence that surrounds this issue, raising awareness and combatting taboos, and ensuring access to supplies and facilities, we are changing the way this issue is addressed.
So this Menstrual Hygiene Day (May 28), I challenge you to join the conversation, because #MenstruationMatters, period.
Editor's Note: In this post Susan Davis, Founder and Executive Director of Improve International, discusses all of the possible definitions of sanitation success. This post originally appeared on Improve International's website, to view the original post click here.
During a recent desk review, we found there is no one widely accepted definition of sanitation success, even for broadly used approaches like community-led total sanitation.
Some consider long-term success to be the movement of households up the “sanitation ladder,” the idea of incremental progression between service levels of different quality. Success for sanitation marketing efforts can include an increase in local businesses who are investing in sanitation to expand their business, sales to target households, and number of households who are investing their own money into a toilet sold by these partner businesses. We realize we haven’t captured all possible definitions of sanitation success, but wanted to share what we found.
3iE: Sustained use is defined as the continued practice of a WASH behavior and/or continued use of a WASH technology at least six months after the period during which there was external support to community groups, leaders and volunteers in the form of training, supervision and feedback, distribution of technology, or provision of communication materials.
Global Sanitation Fund (GSF): The GSF works towards attainment of universal access to improved sanitation, which they measure using these indicators: number of people with access to improved sanitation, number of people living in open-defecation free environments, and the existence, and evidence of use, of a dedicated place for handwashing and availability of soap or ash (as a proxy for people washing their hands at critical times). The GSF includes in its description access to improved sanitation by all members of a community and proper handling, storage and treatment of human waste, but these are not included in their results.
Government of India: ODF is the termination of fecal-oral transmission, defined by a) no visible faces found in the environment/village; and b) every household as well as public/community institutions using a safe technology option for disposal of faces. A safe technology option means no contamination of surface soil, ground water or surface water; excreta inaccessible to flies or animals; no handling of fresh excreta; and freedom from odor and unsightly condition.
IRC Water and Sanitation Centre: The sanitation service level framework evaluates the services provided by the delivery of safe latrines using four indicators:type and accessibility of latrines to households (in line with national norms); use of sanitation facilities by members of the household;cleanliness, maintenance and pit emptying of the facilities; and environmental safety of fecal waste.
Joint Monitoring Programme (JMP): A sanitation facility is considered improved if it hygienically separates human excreta from human contact, but this indicator does not address the subsequent management of fecal waste. Safe management comprises several stages along the “fecal waste management chain,” from containment through emptying, transport, treatment, and reuse or disposal.
Netherlands Water Partnership: Sanitation facilities are only sustainable when people make their own choices and own contribution towards obtaining and maintaining them. People have to experience the toilet as an improvement in their daily life. Sanitation systems have to be embedded in the local institutional, financial-economic, social-cultural, legal-political, and environmental context.
Sustainable Sanitation Alliance (SuSanA): The main objective of a sanitation system is to protect and promote human health by providing a clean environment and breaking the cycle of disease. In order to be sustainable a sanitation system has to (1) promote health and hygiene effectively, (2) be financially and economically viable, (3) socially acceptable and institutionally appropriate, (4) technically appropriate including operation and maintenance (O&M), and (5) protect the environment and natural resources.
UN Sustainable Development Goal 6: Ensure availability and sustainable management of water and sanitation for all. Targets include:
6.1 By 2030, achieve universal and equitable access to safe and affordable drinking water for all
6.2 By 2030, achieve access to adequate and equitable sanitation and hygiene for all and end open defecation, paying special attention to the needs of women and girls and those in vulnerable situations
6.3 By 2030, improve water quality by reducing pollution, eliminating dumping and minimizing release of hazardous chemicals and materials, halving the proportion of untreated wastewater and substantially increasing recycling and safe reuse globally
6.4 By 2030, substantially increase water-use efficiency across all sectors and ensure sustainable withdrawals and supply of freshwater to address water scarcity and substantially reduce the number of people suffering from water scarcity
6.5 By 2030, implement integrated water resources management at all levels, including through transboundary cooperation as appropriate
6.6 By 2020, protect and restore water-related ecosystems, including mountains, forests, wetlands, rivers, aquifers and lakes
6.a By 2030, expand international cooperation and capacity-building support to developing countries in water- and sanitation-related activities and programmes, including water harvesting, desalination, water efficiency, wastewater treatment, recycling and reuse technologies
6.b Support and strengthen the participation of local communities in improving water and sanitation management
WaterAid: Sustainability is about whether or not WASH services and good hygiene practices continue to work and deliver benefits over time. No time limit is set on those continued services, behavior changes and outcomes. In other words, sustainability is about lasting benefits achieved through the continued enjoyment of water supply and sanitation services and hygiene practices.
Water For People: Water For People envisions sanitation success in steps, summarized as follows:
- Family forever. “a loved latrine is a used latrine and household defecation behavior will be changed Forever.”
- Sanitation Business Forever. This moves the focus to sustainable service delivery.
- Forever sanitation services at scale. Any person with a pit latrine in any part of a city or district should be able to easily access the sanitation service they require, not just the ones in the relatively limited geographical area covered by the entrepreneurs supported as part of step 2. (Sugden, 2013).
WSP: The World Bank Water and Sanitation Program used the following performance indicators to rate relative success of sanitation case studies:
- Prevalence of open defecation
- Hygiene behavior
- Access to sanitation by the poor
- Environmental sanitation improvements
- Extent of self-financing
- Program cost per household
- Range of toilet components and designs utilized
- Local availability of sanitation wares and services
- Regular support and monitoring
- Implementation at scale
What’s your organization’s definition of sanitation success? Let us know in the comments section below or contact us.