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Water access and hand-washing programs in Guatemala help to reduce the transmission of diseases such as soil-transmitted helminths and trachoma. Credit: Stephanie Ogden

Water access and hand-washing programs in Guatemala help to reduce the transmission of diseases such as soil-transmitted helminths and trachoma. Credit: Stephanie Ogden

Editor’s Note: This guest post was authored by Stephanie Ogden, WASH/ NTD coordinator for Emory’s Center for Global Safe Water and the Task Force for Global Health. In it, she discusses the need for a coordinated partnership between the WASH and health communities to help control and eliminate neglected tropical diseases (NTDs). She outlines concrete measures that the WASH sector can take and provides examples of successful partnerships already under way.

Years ago, I trained women in rural and remote areas of Central America to be community visual health promoters. They knew the very basics of eye disease and visual impairments, and could offer solutions to simple problems, or referrals to expert, affordable care. But, we never thought of eye disease as related to water, sanitation, and hygiene (WASH). We never thought that encouraging families to wash their faces, or that ensuring water access and building latrines, could help to prevent blindness in one person every fifteen minutes worldwide. 

Now, at the Task Force for Global Health, I help coordinate WASH activities to control a group of diseases with tongue-twister names: soil-transmitted helminths, schistosomiasis, lymphatic filariasis and blinding trachoma. They are a diverse set of diseases that comprise a group known as the Neglected Tropical Diseases (NTDs). Together they account for nearly one billion cases of blindness, debilitating swelling of the limbs, chronic abdominal pain, malnutrition, and diminished livelihoods and well-being. Not to mention, the NTDs affect as many people with pain and suffering, lost educational opportunity, and economic loss as HIV or malaria. Many of these diseases can be treated with medicine, but they can only be prevented by improved access to water, sanitation, and hygiene.

The NTDs are diseases of poverty, and have been relatively neglected by research and large-scale political action. But, for years, the WASH sector has been working in and impacting the communities where these diseases are endemic. WASH programs have acted as a silent weapon against the NTDs, but this impact isn’t being measured. As it is, WASH has an underfunded and under-applauded role in ongoing NTD control strategies. More than just lip service, a coordinated, targeted approach between the WASH and health communities is needed to ensure long-term health gains in endemic areas. Real mechanisms for coordination, measurement, and monitoring must be established and supported from both sides of the sector divide.

Hygiene education materials in Lao PDR which depict common transmission pathways of intestinal worms. Credit: Kim Koporc

Hygiene education materials in Lao PDR which depict common transmission pathways of intestinal worms. Credit: Kim Koporc

Earlier this year, a global public-private partnership, formalized by the London Declaration on NTDs, pledged to eliminate or control 10 NTDs by 2020. In some ways, it seems like an easy win. A few pills can treat many of the current infections, and generous drug donations by companies, like Johnson & Johnson, Pfizer, and GlaxoSmithKline, have enabled countries to conduct mass drug administration (MDA) to treat infection at a national scale. But drugs do not prevent re-infection, nor do they address the underlying causes that lead to infection in the first place. The focus on NTDs must shift from treatment to a more balanced approach that includes both treatment and prevention. This is where the WASH sector is essential. After all, addressing the primary environmental factors that lead to transmission of disease, such as water access, safe excreta disposal, and hygiene, is the WASH sector’s bread and butter. While continuing its good work, the WASH sector should also push for partnership with the Health sector to measure impact beyond immediate WASH coverage. Both sectors must realize that eliminating the NTDs is a three-legged race. Treatment, through drug administration, and prevention, via WASH programs, are tied together, and one will cross the finish line only at the pace of both together.

There have been remarkable examples of joint-sector collaboration and integrated programs. The health and WASH communities continue to collaborate to eradicate guinea worm worldwide — a campaign that has been markedly successful from a disease control perspective; in twenty years, cases of guinea worm infection have dropped from 3.5 million to less than 5,000 globally. This shouldn’t be a one-off case of collaboration among sectors. We need more of this kind of joint-sector collaboration in order to reach the goal of controlling 10 NTDs by 2020. The health community and private partnerships have pledged to work together towards this goal, but the involvement of the WASH sector is indispensable. 

That is why it’s especially timely that Emory University’s Center for Global Safe Water, Children Without Worms (CWW) and the International Trachoma Initiative (ITI), have committed to a partnership that will help to encourage actionable dialogue and increased coordination between the NTD and WASH sectors. This partnership aims to call stakeholders in the WASH and NTD sectors to better understand each other, to define common indicators, explore integrated mapping and targeting, and determine further opportunities for collaboration. 

So how exactly should the WASH sector get involved? I suggest we start with the simplest measures:

  • Partner with the NTD sector to champion the role of WASH in prevention of the most common NTDs that affect more than 800 million people worldwide.
  • Hold WASH and NTD organizations jointly accountable for measuring and monitoring impact on decreasing the burden of disease.
  • Seize opportunities for integrated data collection regarding NTDs in WASH program areas.
  • Add WASH indicators to health programs, and NTD indicators to WASH programs, to help ensure the effectiveness and long-term sustainability of each.
  • Use these indicators to draw the connection between WASH programs and lowered NTD rates in annual reports and program assessments.
  • Continue to allocate resources to research and development of sustainable sanitation programs, as safe sanitation may have the greatest single impact on decreasing the burden of disease. 

The conversation about how these two sectors can work together is still in the early stages. What’s vital now is to promote dialogue and keep this momentum going. We know there is a critical link between improved WASH access and lower NTD rates, but we still have a lot to learn about how one affects the other. For example, what elements of WASH most effectively impact the transmission of diseases, like soil-transmitted helminths, schistosomiasis, and trachoma? Do all types of sanitation facilities have equal impact on reduction of these diseases? If not, which have the most impact? Collaboration, coordination, and open dialogue are important first steps in answering these questions. And ensuring partnership between the WASH and Health sectors — between treatment and effective prevention — is the only route to sustainable long-term control of disease.

Kurt Soderlund, CEO of Safe Water Network

Editor’s Note: This is the second post in our “5 Questions for…” series, where we pose five questions to foundation, NGO, and thought leaders in the WASH sector. In this post, Safe Water Network’s founding CEO, Kurt Soderlund, responds to our questions.

1. What is the number one most critical issue facing the WASH sector today?
Though billions of dollars are spent on water projects, very little has been directed at establishing a fact base for what works, what doesn’t, and why. As a sector, we can do more to validate which solutions:

  • are most reliable
  • meet quality standards
  • address behavioral challenges
  • are inclusive, and
  • ensure local ownership, participation, and buy-in

With this understanding, we can make a clear, compelling case for how money should be spent to develop and replicate the most impactful programs. We will also be well positioned to attract the level of investment necessary to scale up solutions that will deliver lasting benefits to the millions of people in need. 

2. Tell us about one collaboration or partnership your organization undertook and the lessons learned from that experience.
Organizing and aligning the capabilities of expert organizations is fundamental to our work and it’s why we have “Network” in our name. And because the challenge of providing safe water is immensely complex, our initiatives involve a variety of sector participants from different functional disciplines. Our collaborations include experts in engineering, public health, finance, and policy from government agencies, foundations, universities, the private sector and NGOs. We are fortunate to work with leading organizations like IBM, Johns Hopkins University Bloomberg School of Public Health, the Conrad N. Hilton Foundation, IFC, Tata trusts, National Bank for Agriculture and Rural Development, and Merck.

Our partnership with PepsiCo provides a good example of how we apply technical expertise and local knowledge. They are one of our founding partners and they continue to help us develop and standardize low-cost systems and operating models in off-grid areas.  PepsiCo associates work alongside our team, addressing technical and operating issues in the field. They are helping us improve our quality assurance and training programs.

Through this work we are collectively gaining a better understanding of what it takes to operate successfully in these challenging markets.

3. How do you work with local communities to promote project ownership and sustainability?
Installing a water purification system is the easiest part; long-term success hinges on ensuring local ownership and operational, financial and environmental sustainability. We start the process by involving the community in every step, from the initial assessment to the design, construction, launch and subsequent operation of the water system.

To ensure long-term success and maximum impact, we focus on gaining participation from as many households in the community as possible. We’ve targeted 75% household participation for those living near a distribution point as a key metric because at that level, there is sufficient participation to make a positive impact on health and – if priced appropriately – sufficient revenue to cover operating expenses.

To reach this goal, we educate families on the benefits of safe water and encourage them to use it for drinking, cooking as well as for their hygiene needs. We do this by taking advantage of the daily contact we have with the village from our facility, which acts as a community center, and with local operators and a network of volunteers, who advocate the adoption and use of safe water.

By leveraging this ‘operating footprint’ we create a critical mass that provides the community the economic and health incentives required to sustain the water station for the long term.

4. Tell us about an emerging technology or solution that excites you and that you think will make a big impact in the WASH sector over the next 5-10 years?
I am very excited about the work IBM is doing with us to deliver real-time reporting and analysis of site performance. Our decentralized water stations operate in areas difficult to access and where skilled labor is scarce. The Remote Monitoring System will upload real-time operational and consumer data through telemetry, working through a local cell phone service to a central location. This makes it much more efficient to quickly identify, troubleshoot, and resolve challenges in remote locations.

5. There are lots of great WASH resources, ranging from striking data visualizations to good, old-fashioned reports. What’s caught your eye lately (besides WASHfunders, of course)?
A new collaborative tool developed by Google called Fusion Tables that allows you to visualize large datasets on maps, timelines, and charts is quite impressive. The Pacific Institute and Circle of Blue worked with Google to upload an enormous amount of global water data. The result is a simple yet dynamic tool that lets users visually compare countries and regions by statistical indicators such as water availability, diarrhea deaths, and GDP per capita. This demonstrates just one example of how knowledge sharing technology can be used to better inform ourselves and the public of deep truths hidden in data.

Editor’s Note: Our Spotlight On... series shines a light on funders and NGOs working to bring critical solutions to water, sanitation, and hygiene issues. This guest blog, the second in our series, was authored by Maggie Kohn, director of corporate responsibility at Merck. A global health care company, Merck discovers, manufactures, and sells medicines, vaccines, and animal health products. Recently, Merck has become an emerging player in the WASH sector as well. 

Spotlight On... Merck

Merck and Safe Water Network are working together to bring sustainable water solutions to the rural poor in India. The new partnership will provide safe water access to another 20,000-30,000 people, such as this mother and child in Warangal in the southern Indian state of Andhra Pradesh.

I sense the question on everyone's mind when I introduce myself at a WASH event: "Merck is a global health care company. So, why is she here?" 

The explanation is quite simple: Merck's mission is to help the world be well. Clean water is at the foundation of this promise.

Merck's entrance into the WASH arena is relatively recent, and occurred in parallel with the expansion of our business into emerging markets such as India, Brazil, China, and countries in sub-Saharan Africa. As Merck began to ask local ministers of health in these countries how we could help them address their greatest health challenges, the issue that came up often was lack of access to clean water and its huge toll on the health of their people. 

Until the most basic health needs — access to food, water, sanitation, and hygiene — are addressed, large segments of populations in emerging markets cannot benefit from our products, including life-saving vaccines. For Merck to be a true partner and commit to helping our customers address their most formidable challenges, we realized WASH must be part of the overall strategy. 

Starting in 2010, we spent about a year determining how to "dip our toe" into the WASH field. While we have a long history in public-private health partnerships, none have been specific to clean water. Luckily, we found that many of our existing partners, including CARE, the World Bank, PSI, UNICEF, and the Bill & Melinda Gates Foundation, are also involved in WASH. We engaged them in conversations about their work, joined groups such as Global Water Challenge, and made connections with companies such as Coke, Dow, Pepsi, and P&G who are already doing good work in this field. We also talked to shareholders such as the Interfaith Center for Corporate Responsibility and became a signatory to the UN's CEO Water Mandate. 

These conversations confirmed for us the critical importance of addressing WASH (we were on the right path!), but also that we could not do it on our own. We needed to team up with the right partners. Many people we spoke with suggested starting with one geographic focus — rather than pilots in several countries, as we had initially been considering — and then expanding from there. Keeping their input in mind, we identified our initial focus area of southern and central India — both important markets for our business and both severely affected regions by WASH issues.

Our conversations also made us think hard about the kind of investment we wanted to make and the kind of impact we wanted to have. By that, I mean did we want to simply invest our money in bricks and mortar for hundreds of new water stations, which would basically require writing a check? Or did we want to invest in research-based projects that sought to determine the most effective ways to address the WASH challenge and thus create sustainable long-term approaches? What appealed to us about this latter approach is that we could apply the skills of our employees to help develop health impact studies, behavior change communications, and public advocacy outreach strategies. 

Out of this we developed our WASH strategy for India, which mirrors our core mission: to help the Indian population be well. Wherever we operate, the key to achieving this mission is a strong understanding of the health needs of our customers. Our strategy in India includes our products that address water-related diseases and our work with partners to change behaviors related to sanitation and hygiene. 

On World Water Day 2012, we announced a three-year partnership with the Safe Water Network (SWN). What we like about SWN is that they work through their projects to gain a better understanding of the environmental, socioeconomic, behavioral, and market challenges that prevent access to clean water. They pilot various approaches and models, and then take the learnings to identify sustainable models that can be scaled on a wide-spread basis. Our work with them will focus on Andhra Pradesh in southern India, where we will work to increase awareness of the importance of clean water and hygiene to drive behavior change. We plan to share key findings with the WASH sector and policy makers to help lead to more wide-scale change. Later this year, we will also be lending four or five Merck employees ("Fellows") to SWN for three to six months to work on a variety of projects, including a health outcomes assessment study, behavior change and quality assurance. These employees will benefit by gaining valuable insights about behaviors in these markets. 

We also decided to partner with UNHABITAT, Coca-Cola, and NDTV on a partnership called "Support My School" (SMS), which is working with local NGO partners to install water filtration systems, improved sanitation facilities, libraries, and new sports equipment to schools across India. In deciding to join, we felt that there is no place more important to start than with children. Not only do we want to improve the health of India's youngest citizens, but we want to ensure they are able to stay in school and get the education they need to lead India in the years to come. Children are also important messengers as they deliver WASH messages back to their families. In visiting schools outside Bhopal earlier this year, the impact was clear: the children were eager to show us their new latrines, and teachers indicated that attendance was up (some students were riding their bikes five miles to school). Students from near-by private schools had even switched to the SMS schools due to the better bathroom facilities. 

Our goals in both partnerships are to increase the number of people with access to clean water and increase awareness about sanitation and proper hygiene. In doing so, we expect to see decreased mortality and illness due to water-related disease, increased school attendance — particularly among adolescent girls, and increased economic productivity in those areas where we are focused — these will be the measurements we examine and build into our public reporting. 

While it's still early days for us, we've already learned a great deal. There are so many great partners out there and projects worthy of investment. But it's vital that we focus on what we want our impact to be and what we want to get out of this work as a business. This will not only lead to positive outcomes for the communities in which we invest, but also to the sustainability of Merck's involvement in this important space. 

Lisa Nash, CEO of Blue Planet Network

Editor’s Note: This post highlights Blue Planet Network’s long-standing peer review and crowd-sourcing platform, along with examples of collaboration and knowledge sharing among BPN’s members. It was authored by Lisa Nash, CEO of Blue Planet Network

What if there was a way for the WASH sector to unlock the hidden knowledge of sustainable safe drinking water and sanitation programs? 

Blue Planet Network (BPN), an online global platform and network of 90+ WASH funders and implementing organizations, is designed to encourage collaboration, increase impact, and promote a cross-sector focus on project results and lessons learned. This is complemented by an expert crowd-sourcing process — the heart of BPN. Members “peer review” other organizations seeking feedback on their project implementation plans. Utilized collaboratively in a safe space, the peer review process is aimed at unlocking the tremendous knowledge of the global WASH sector. After five years of peer reviewing and crowd-sourcing, we have seen an increase in member standards, discussion, and accountability. 

BPN’s WASH community began in 2006 when five WASH NGOs — recognized for their innovation and impact — came together to build a collaborative online forum to improve each other’s programs. Introducing the peer review concept was a new challenge; we knew it would take time to build a large community of NGOs and funders committed to sharing their valuable project knowledge for the good of the sector. Over time, however, these efforts paid off. Our members have shown us so many ways to use our platform.

The BPN member stories below show how the WASH sector — empowered by technology — can collaborate, share learning lessons, and continually help improve WASH sector program impact.

  • Photo by Annette Fay, Blue Planet Network

    Community Water Center (CWC) and BPN are developing a program in San Joaquin Valley, CA, to help 2,600 people living with nitrate and arsenic-contaminated drinking water. The groundwater has been contaminated with nitrates from the heavy agricultural pesticides used, and from naturally occurring arsenic. Project Well, a BPN member working on arsenic-free wells in West Bengal, India, will support CWC’s efforts by sharing their experience.
  • Aguayuda, from Colombia, changed their local staffing plans after applying for membership and discussing staffing options with BPN members Agua Para La VidaEl Porvenir (Nicaragua), and Agua Para La Salud (Guatemala). 
  • East Meets West (Vietnam, Cambodia) suggested improvements to hygiene practices of a project by Indian BPN member, Ekoventure, that reduced overall costs and improved project sustainability. 
  • The Chagrin Valley, Ohio Rotary Club, a BPN funding member, facilitated the independent monitoring of projects implemented by member Aqua Clara International in Kenya by local Kenyan Rotarians. 
  • “Peer visits” in 2011 were launched to empower members from a common region to connect with others in the field, suggest improvements, and train together. The Samburu Project hosted fellow members, Tanzania Mission to the Poor and Disabled (PADI), Aqua Clara International, Sabore Oyie in Kenya and Rajesh Shah of BPN to review their work in northern Kenya, suggest ways to improve sustainability, and share field experiences.  
  • Gram Vikas and WOTR, Indian BPN members — and the first two recipients of the Kyoto World Water Grand Prize — have advised members on their MANTRA and participatory watershed development programs. The 2012 Kyoto World Water Grand Prize winner, Katosi Women Development Trust (Uganda), is connected to BPN through a long-time member, Global Women’s Water Initiative, and we hope to promote collaboration among these grassroots leaders. 

We have seen a significant increase of funder interest in WASH projects because BPN directly connects funders to NGOs and project communities. Although funders may be continents away, they still have an up-close look and hands-on tool to monitor and track project planning, implementation, and impact through our platform. This transparent process increases funder engagement and builds confidence in future funding and investment.  

Funding ongoing monitoring efforts is also a cost-effective way to ensure investment dollars continue to have the impact funders seek. Currently, approximately 30 funders, WASH experts and observers, and over 60 international agencies track WASH projects on BPN’s online platform. 

Through our close work with WASH funders, NGOs, and communities, we have come to understand that there is no “one size fits all” solution to address the global WASH crisis. Each community and culture is unique, reinforcing the need for an innovative community-owned strategy. By bringing people together to transfer and share knowledge, we enable them to learn what’s been tried, what works, and what doesn't, and then to apply that knowledge to their own unique context. Establishing a culture of learning within and among organizations is vital to improve project outcomes, lower costs, and increase accountability.  

Building upon experience and member input, BPN is launching its next generation online platform, “BPN 2.0,” in late 2012. With the growing demand for BPN’s WASH platform, there also comes the need for expanded reporting and analytics, more funder-focused services, project post-implementation tracking, and simplified user experience. BPN will be sharing its work in the coming months with members and other interested organizations in the WASH sector. We look forward to learning from the experience of others to make our offering as valuable as it can be in our common effort to enable sustainable safe drinking water and sanitation for all.   

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