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Editor’s Note: This blog post, by Bill Gates, first appeared on Gates' personal blog, Gates Notes. The original post can be accessed here.

I watched the piles of feces go up the conveyer belt and drop into a large bin. They made their way through the machine, getting boiled and treated. A few minutes later I took a long taste of the end result: a glass of delicious drinking water.

The occasion was a tour of a facility that burns human waste and produces water and electricity (plus a little ash). I have visited lots of similar sites, like power plants and paper mills, so when I heard about this one—it’s part of the Gates Foundation’s effort to improve sanitation in poor countries—I was eager to check it out.

The water tasted as good as any I’ve had out of a bottle. And having studied the engineering behind it, I would happily drink it every day. It’s that safe.

Here’s a short video from my visit in November, which explains how it all works:



Why would anyone want to turn waste into drinking water and electricity?

Because a shocking number of people, at least 2 billion, use latrines that aren’t properly drained. Others simply defecate out in the open. The waste contaminates drinking water for millions of people, with horrific consequences: Diseases caused by poor sanitation kill some 700,000 children every year, and they prevent many more from fully developing mentally and physically.

If we can develop safe, affordable ways to get rid of human waste, we can prevent many of those deaths and help more children grow up healthy.

Western toilets aren’t the answer, because they require a massive infrastructure of sewer lines and treatment plants that just isn’t feasible in many poor countries. So a few years ago our foundation put out a call for new solution.

One idea is to reinvent the toilet, which I’ve written about before.

Another idea—and the goal of the project I toured—is to reinvent the sewage treatment plant. The project is called the Omniprocessor, and it was designed and built by Janicki Bioenergy, an engineering firm based north of Seattle. I recently went to Janicki’s headquarters to check out an Omniprocessor before the start of a pilot project in Senegal.

The Omniprocessor is a safe repository for human waste. Today, in many places without modern sewage systems, truckers take the waste from latrines and dump it into the nearest river or the ocean—or at a treatment facility that doesn’t actually treat the sewage. Either way, it often ends up in the water supply. If they took it to the Omniprocessor instead, it would be burned safely. The machine runs at such a high temperature (1000 degrees Celsius) that there’s no nasty smell; in fact it meets all the emissions standards set by the U.S. government.

Before we even started the tour, I had a question: Don’t modern sewage plants already incinerate waste? I learned that some just turn the waste into solids that are stored in the desert. Others burn it using diesel or some other fuel that they buy. That means they use a lot of energy, which makes them impractical in most poor countries.

The Omniprocessor solves that problem. Through the ingenious use of a steam engine, it produces more than enough energy to burn the next batch of waste. In other words, it powers itself, with electricity to spare. The next-generation processor, more advanced than the one I saw, will handle waste from 100,000 people, producing up to 86,000 liters of potable water a day and a net 250 kw of electricity.

If we get it right, it will be a good example of how philanthropy can provide seed money that draws bright people to work on big problems, eventually creating a self-supporting industry. Our foundation is funding Janicki to do the development. It’s really amazing to see how they’ve embraced the work; founder Peter Janicki and his family have traveled to Africa and India multiple times so they can see the scope of the problem. Our goal is to make the processors cheap enough that entrepreneurs in low- and middle-income countries will want to invest in them and then start profitable waste-treatment businesses.

We still have a lot to learn before we get to that point. The next step is the pilot project; later this year, Janicki will set up an Omniprocessor in Dakar, Senegal, where they’ll study everything from how you connect with the local community (the team is already working with leaders there) to how you pick the most convenient location. They will also test one of the coolest things I saw on my tour: a system of sensors and webcams that will let Janicki’s engineers control the processor remotely and communicate with the team in Dakar so they can diagnose any problems that come up.

The history of philanthropy is littered with well-intentioned inventions that never deliver on their promise. Hopefully, these early steps will help us make sure the Omniprocessor doesn’t join the list. If things go well in Senegal, we’ll start looking for partners in the developing world. For example I think it could be a great fit in India, where there are lots of entrepreneurs who could own and operate the processors, as well as companies with the skill to manufacture many of the parts.

It might be many years before the processor is being used widely. But I was really impressed with Janicki’s engineering. And I’m excited about the business model. The processor wouldn’t just keep human waste out of the drinking water; it would turn waste into a commodity with real value in the marketplace. It’s the ultimate example of that old expression: one man’s trash is another man’s treasure.

Copyright 2010 Gates Notes, LLC

Top Five Blog Posts of 2014

As 2014 comes to a close, we’re looking back and taking stock of the variety of topics featured on the WASHfunders blog this year – from corporate philanthropy and sector sustainability to newly produced WASH resources. Our countdown of the top five most popular blog posts from 2014 reflects this variety.

5. Pre-paid Meters: Bringing Affordable Water to the Slums of Kampala

After visiting WaterAid’s WASH programs in Kampala, Uganda, Senior Communications Advisor for WaterAid America, Libby Plumb, illustrates how the adoption of prepaid water meters has helped to increase access to safe water in the city’s slums.

4. Let’s Not Forget the Role of Philanthropy in Solving the Global Water Crisis

In November, Dr. Greg Allgood of World Vision wrote about the legitimate role that philanthropy and charity play in WASH service provision. In his post, Dr. Allgood observes that while business solutions currently dominate conversations around the global water crisis, hundreds of millions of people without WASH services are not served by these for-profit models and that, instead of favoring one approach above the other, both are needed.

3. Bio-toilets: Transforming Indian Sanitation

In India, achieving access to sanitation in areas without sewage infrastructure is a challenge that is increasingly being addressed through the production and provision of composting toilets. In his post from August, Sanjay Banka, Director at Banka BioLoo, describes the process by which these toilets break down waste and the business model that his company employs to ensure sustainability while producing a high-quality product.

2. 5 Questions for…David Auerbach of Sanergy

As a participant in our ‘5 Questions’ series, David Auerbach of Sanergy explains his organization’s approach to addressing the entire sanitation value chain by building franchise network of micro-entrepreneurs who purchase and operate Sanergy’s Fresh Life Toilets in the slums of Nairobi.

1. Evidence-Based Development: A Trend Whose Time Has Come? The Case of Chlorine Dispensers for Safer Water

The most visited blog post of 2014 was the first in a series of three posts written by staff at Evidence Action about their Dispensers for Safe Water (DSW) initiative. In this post, Evidence Action Executive Director, Alix Zwane, lauds the growing support for data-driven development. She points to the DSW as one such example of a WASH innovation whose scaling was justified by the rigorous testing that found it to be a sustainable and cost-effective means of increasing access to safe water.

We aim to represent the diversity of issues, challenges, and innovations that make up the WASH sector and to succeed in doing so, we need your help! To contribute a post to the WASHfunders blog in 2015, contact us at washfunders@foundationcenter.org. Thanks for reading and Happy New Year!

Toilet Board Coalition

Launched as part of last month’s celebrations for World Toilet Day, the Toilet Board Coalition is a business-led initiative that aims to develop commercially scalable solutions in response to the global sanitation crisis.

Initiated by Unilever in 2012, the Toilet Board Coalition brings together a number of businesses, government agencies, and other WASH organizations. In addition to Unilever, Coalition members from the business sector include Kimberly Clark, LIXIL, and Firmenich, as well as other funders and NGOs such as Stone Family Foundation, WaterAid, Water and Sanitation for the Urban Poor (WSUP), and the World Bank’s Water and Sanitation Programme.

The Toilet Board Coalition brings together the technologies, expertise, and resources of its diverse membership to identify, develop, and scale market-based solutions in sanitation.

One pilot business model already supported by the Coalition is the Clean Team project, based in Ghana. The project, which is run by WSUP and uses toilets designed by Unilever, offers fee-based waste removal services that provide households with a cheap and clean alternative to public toilets while supporting the supply-side structure through the employment of sales and maintenance staff.

Toilet Board Coalition develops initiatives to fight the sanitation crisis.” Unilever Press Release 11/19/2014.

Tim Smedley. “World Toilet Day: business steps in to tackle open defecation with affordable toilets.” Guardian 11/19/2014.

Global efforts to provide improved water and sanitation for all are gaining momentum, but serious gaps in funding continue to hamper progress, according to a new report from the World Health Organization on behalf of UN-Water.

The UN-Water Global Analysis and Assessment of Sanitation and Drinking-Water (GLAAS 2014), published biannually, presents data from 94 countries and 23 external support agencies. It offers a comprehensive analysis of strengths and challenges in water, sanitation and hygiene (WASH) provision within and across countries.

“Water and sanitation are essential to human health. Political commitment to ensure universal access to these vital services is at an all-time high,” said Dr Maria Neira, Director of the WHO Department of Public Health and the Environment. “International aid for the sector is on the rise. But we continue to see major financial gaps at the country level, particularly in rural areas.”

Strengthened political commitment

Two thirds of the 94 countries surveyed recognized drinking-water and sanitation as a universal human right in national legislation. More than 80% reported having national policies in place for drinking-water and sanitation, and more than 75% have policies for hygiene.

This strengthened political commitment at national levels is reflected in global discussions around the post-2015 Sustainable Development Goals (SDGs). Universal and equitable access to water, sanitation and hygiene have been proposed as global targets by the Member State working group tasked with developing the SDGs.

“Now is the time to act,” says Michel Jarraud, Chair of UN-Water and Secretary-General of the World Meteorological Organization. “We may not know yet what the post-2015 sustainable development agenda will look like. But we do know that water and sanitation must be clear priorities if we are to create a future that allows everyone to live healthy, prosperous and dignified lives.”

Increased aid, better targeting of resources

International aid for water and sanitation is on the rise: According to the report, financial commitments for WASH increased by 30% between 2010 and 2012—from US $8.3 billion to $10.9 billion.

Aid commitments are increasingly targeted to underserved regions, notably sub-Saharan Africa, Southern Asia and South-eastern Asia. GLAAS 2014 also highlights the strengthened targeting of WASH resources for the poor: more than 75% of countries reported having specific measures in their national plans to provide water and sanitation for low-income populations.

“For our partners, especially at country level, GLAAS is key for achieving sound, evidence-based decision-making,” says President John Agyekum Kufuor, Chair of Sanitation and Water for All. “The report guides governments in knowing where progress in WASH is being made and where more resources need to be allocated.”

Still major gaps

Despite these gains, 2.5 billion men, women and children around the world lack access to basic sanitation services. About 1 billion people continue to practice open defecation. An additional 748 million people do not have ready access to an improved source of drinking-water. And hundreds of millions of people live without clean water and soap to wash their hands, facilitating the spread of diarrhoeal disease, the second leading cause of death among children under five.

Many other water-borne diseases, such as cholera, typhoid and hepatitis, are prone to explosive outbreaks. Poor sanitation and hygiene can also lead to debilitating diseases affecting scores of people in the developing world, like intestinal worms, blinding trachoma and schistosomiasis.

The report cites a number of key challenges, including:

  • Insufficient financing: Though international aid for the WASH sector has increased, national funding needs continue to outweigh available resources. Eighty per cent (80%) of countries reported that current levels of financing are insufficient to meet their targets for drinking-water and sanitation.
  • Funding gap in rural areas: While a vast majority of people who lack access to basic sanitation live in rural areas, the bulk of financing continues to benefit urban residents. Expenditures for rural sanitation comprise less than 10% of total WASH financing.
  • Weak national capacity to execute WASH plans: Despite strong political support for universal access to water and sanitation, fewer than one-third of the countries surveyed for this report have national WASH plans that are being fully implemented, funded and regularly reviewed.
  • Critical gaps in monitoring: Reliable data is vital to identify gaps in access to WASH services and inform policy decisions. Though many countries have WASH monitoring frameworks in place, a majority reported inconsistent or fragmented gathering of data and weak capacity for analysis.
  • Neglect for WASH in schools, health facilities: Water and sanitation services in schools can ensure that children, especially girls, stay in school and learn lifelong hygiene habits. In health clinics, WASH services ensure the privacy and safety of patients, particularly expectant mothers during delivery, and are essential to prevent and respond to disease outbreaks. Yet, GLAAS data indicates that less than 30% of surveyed countries have national WASH plans for institutional settings that were being fully implemented, funded and regularly reviewed.

The GLAAS report and related press materials (press release, fact sheet and frequently asked questions) are available online here.

See a related blog post by John Oldfield, CEO of WASH Advocates, here.

UN reveals major gaps in water and sanitation – especially in rural areas.” World Health Organization, UN-Water Press Release 11/19/2014.

We’re pleased to share that a recently released report from New Philanthropy Capital recognized WASHfunders.org as a top innovation in global philanthropy. The report, 10 Innovations in Global Philanthropy, praises the information on funding flows available through WASHfunders’ mapping tool and notes that the site reflects the broader push for open data in the philanthropic sector.

WASHfunders was also selected as the ‘Experts’ Top Pick’ among the innovations featured within the report, with Cath Tillotson of Scorpio Partnership commenting that, “If you define innovation as doing something differently, bigger or better, WASHfunders ticks all the boxes.”

WASHfunders and other innovations featured in the report will be discussed on a webinar to be held Wednesday, November 12th. Registration information and additional details are available here.

NPC’s report has been covered widely in philanthropic circles. Additional coverage includes an interview with WASHfunders’ lead, Seema Shah, on Philanthropy Age, a write up on Pro Bono Australia, and a mention on Health Affairs. In August, our Twitter feed was also cited as a top ten Twitter influencer in water and development by the Guardian.

We’re honored to receive the recognition and understand that the value of WASHfunders ultimately depends on our engagement with -- and usefulness to -- those working in the WASH sector! To contribute case studies, suggest recommended reading for the Knowledge Center, or submit a guest blog, contact us as washfunders@foundationcenter.org

Dr. Cristina Rumbaitis del Rio, Senior Associate Director at Rockefeller Foundation
Dr. Mary Renwick, Director of the Water Innovation Program at Winrock International

Editor’s Note: This guest post was co-authored by Dr. Mary Renwick, Director of the Water Innovation Program at Winrock International, and Dr. Cristina Rumbaitis del Rio, Senior Associate Director at Rockefeller Foundation. In their post, Dr. Renwick and Dr. Rumbaitis del Rio discuss the advantages of Integrated Multiple-Use Water Services (MUS) and describe SolutionMUS, the implementation methodology developed by Winrock International to scale up this integrated approach to water service provision. On November 13, they’ll be presenting a funder webinar on ways to sustainably improve people’s health and livelihoods through investments in integrated water services. For more information and to RSVP for the event, contact Ryan Leeds at RLeeds@rockfound.org.

For over two billion people living in absolute poverty, water is everything. Access to safe and sustainable water increases peoples’ resilience and improves their health and livelihoods by supporting their basic needs -- from drinking, hygiene, and sanitation to food production and income generation. Unfortunately, the way in which policymakers and water sector architects design and deliver water services to poor communities is often disconnected from the way these communities actually use water. 

A woman displays her local beer brewing process in rural Burkina Faso. Increased access to water means that women are able to expand their income generating activities. Credit: Winrock International

A woman displays her local beer brewing process in rural Burkina Faso. Increased access to water means that women are able to expand their income generating activities. Credit: Winrock International

The current approach to water service delivery usually focuses on providing water for a single use -- typically drinking or irrigation. Not surprisingly, once the water is available people begin using it for all their needs. This means that drinking water systems are used for watering livestock, producing food and supporting small water-dependent enterprises such as brickmaking or beer brewing. Likewise, irrigation water is used for drinking, bathing and other unplanned uses such as watering livestock and home gardens. The use of single-use systems for unintended purposes is a widespread phenomenon that often leads to inadvertent yet serious consequences including the spread of disease, overuse of resources, user conflict, and system breakdown. Ultimately, this gap between planned services and actual needs undermines the intended goal of water service provision -- improved health and livelihoods -- and leads to sustainability problems for water services and resources. 

SolutionMUS

SolutionMUS is a tested methodology for putting MUS into action. Water--Integrated water services provide water for drinking, other domestic needs, and livelihoods. Health--Hygiene, sanitation, and nutrition programs deepen health benefits. Livelihoods--Crop, livestock, and enterprise programs increase income, food security, and resilience. Environment--Source protection, ecosystem, and waste management programs boost environmental sustainability.

Integrated Multiple-Use Water Services (MUS) support transformative change by providing water services that meet peoples’ multiple domestic and productive water needs. MUS use communities’ self-identified needs as a starting point to plan, finance, and manage integrated water services. In addition, MUS take into account all potential water sources (rain, ground and surface water) to design financially and environmentally sustainable water services that meet actual consumer needs and preferences.

In the past 15 years, a growing body of evidence indicates that planning and managing water services for multiple uses can enhance health, improve food security, increase incomes, and reduce workloads for women and children (Loevinsohn et. al., 2014; Evans, et. al., 2013; Hall, et. al 2012; Renwick, et al., 2007; van Hoeve and van Koppen, 2005;  van Hoeve, 2004; Waughray, Lovell, and Mazhangara,1998; VanDer Hoek, Feenstra, and Konradsen, 2002;  Molle and Renwick, 2004). Results from on-the-ground programs in Burkina Faso, Nepal, Niger, Tanzania and other locations suggests that MUS provide the following significant advantages over single-use services:

  • More income and benefits (improved health, nutrition, time savings, food security and social empowerment) for a wider range of people;
  • Decreased vulnerability and increased resiliency for households through diversified livelihood strategies and increased food security;
  • Enhanced reduction of poverty using methods that address the multiple dimensions of poverty simultaneously such as poor health, inadequate resources and lack of skills; and
  • Increased sustainability of water services through productive water use that generates enough income to cover on-going operation, maintenance and replacement costs.
A woman uses a treadle pump at a collective garden for women in Niger. Credit: Winrock International

A woman uses a treadle pump at a collective garden for women in Niger. Credit: Winrock International

Interest in MUS has accelerated as more implementers, governments, and donors design, invest in, and implement integrated development programs. Correspondingly, the demand for a well-defined, evidence-based implementation methodology has grown. Winrock International has addressed this methodological gap by developing SolutionMUS, an open initiative to scale-up multiple-use water services (MUS). SolutionMUS provides a clear conceptual framework, step-by-step implementation guidance and a range of illustrative examples from different contexts. SolutionMUS draws on internationally recognized best practices and builds on and complements the efforts of other early MUS innovators. The approach extends beyond integrated water services by using targeted, cost-effective programs to amplify benefits in health, nutrition, food security, income generation, livelihoods diversification, and environmental sustainability. Since 2005, Winrock has worked with local and international organizations to develop, test and refine the SolutionMUS approach in partnership with local governments, local and international non-governmental organizations, and the local private sector. Our efforts in seven countries have improved the health and livelihoods of 500,000 people.

SolutionMUS is flexible. It does not need to be a stand-alone approach, but can add value to ongoing efforts to provide water services to people living in poverty. Major features of the approach include:

  • A clear, consistent conceptual framework, technical standards, and step-by-step process;
  • Impact-boosting programs that enhance people’s health and livelihoods, and contribute to environmental sustainability;
  • Rigorous field testing and evaluation;
  • An active learning and sharing platform to encourage continuous improvement; and
  • A growing package of technical support and training products for implementers, funders, policymakers, and researchers.

Want to learn more?

Join us on Thursday, November 13 at 11:30 ET when Rockefeller Foundation, along with Winrock International, will host a funder webinar on integrated water services. The webinar will explain how you can:

  • Achieve a higher return on every dollar spent on water services;
  • Ensure the sustainability of your investments; and
  • Tackle the multi-dimensional aspects of poverty, improve health and nutrition, increase food security, diversify livelihoods, and protect the environment.

Please RSVP here to participate in the webinar or contact Ryan Leeds (RLeeds@rockfound.org) for additional information. 

Greg Allgood, MSPH, PhD, Vice President at World Vision

Editor’s Note: This guest post is authored by Greg Allgood, MSPH, PhD, Vice President at World Vision, where he helps lead their water, sanitation, and hygiene efforts. He is also the retired Founder of the P&G Children’s Safe Drinking Water Program. In his post, Dr. Allgood affirms that, despite recent focus on innovative business solutions in WASH, philanthropic institutions play a crucial role in solving the global water crisis. He also encourages implementing organizations to participate in a survey sponsored by World Vision that will generate aggregated estimates of the number of people reached with WASH. The survey can be accessed here.

I applaud the work to create sustained business models providing clean drinking water; however, we need to remember that philanthropy has a critical role in reaching the poorest of the poor.  

As a person who spent 27 years with the private sector, I know the power of brands and the resources that can be mobilized based on using a for-profit model. And I believe that everyone should have clean water as well as adequate sanitation and hygiene that is sustained. But, I also know that the base of the pyramid -- the billions of people living in poverty -- represent a diverse population. Unfortunately, there are hundreds of millions of people who do not have clean water and cannot currently afford to pay for access to water.

In my visits to villages in the developing world, I frequently meet with people who do not have the resources to invest in clean water. Women have told me that they’d gladly pay for water if they had the money, but they can’t even afford the few pennies it takes to buy salt. People like these are probably best served by a philanthropic model that builds up the capacity of the community instead of investment in a for-profit model that may quickly fail and discourage future private sector investment.

In the development community, it seems recently that the voice for innovative business solutions to solve the global water crisis is drowning out the legitimate role of philanthropy. Both are needed. My organization, World Vision, -- like many other non-profit groups -- reaches into the hardest to reach places to provide clean water. We are playing a role to help enable governments to serve their people with clean water and to lift communities out of poverty so that the private sector can function.  

Through its WASH programming, World Vision reaches one new person with clean water every 30 seconds. Credit: World Vision

Through its WASH programming, World Vision reaches one new person with clean water every 30 seconds. Credit: World Vision

Furthermore, I frequently hear that charity isn’t going to solve the problem of the global water crisis. This is a misleading statement. Philanthropy or charity is playing a big and critical role in solving the global water crisis. But, I agree that philanthropy alone will not solve the crisis. We need philanthropic and private sector investment as well as governments all playing their role.  

The good news is that there’s growing confidence that we can solve the global water crisis by 2030. The scale of current efforts is estimated to reach 50,000 people a day in Sub-Saharan Africa with clean water. For perspective, World Vision, one of the largest providers of clean water, is reaching one new person with clean water every 30 seconds. And, we have plans to do even more. 

While it’s true that there is still a gap that we need to fill to make sure that everyone has clean water, dignified sanitation, and proper hygiene, isn’t it best that we give adequate voice to the role of charity in solving the global water crisis? 

In order to better quantify the role of philanthropy in doing their share to help solve the global water crisis, World Vision has commissioned a survey by KPMG. We are asking WASH implementing organizations to participate in a brief survey. It should take less than 20 minutes to complete. The survey results from all responding organizations will be used by KPMG to generate an aggregated estimate of the people who will be reached this year and next year with WASH. The overall purpose is to show the progress being made and the gaps needed to fill in order to solve the global water crisis. We anticipate that the combined tally of people being reached will be significant and help give a stronger voice to the legitimate and critical role of philanthropy.

Here is a link to the survey: KPMG World Vision survey

 

 

Leith Greenslade, Vice-Chair at the MDG Health Alliance

Editor’s Note: This guest post was authored by Leith Greenslade, Vice-Chair at the MDG Health Alliance, a special initiative of the Office of the United Nations Special Envoy for Financing the Health Millennium Development Goals. To coincide with the Global Day of Action for Child Survival, Leith writes about the relationship between toilets and childhood stunting, describing the scope of the problem and discussing the potential for improved sanitation through public-private partnerships. The original version of this post appeared here.

October 16th is Global Day of Action for Child Survival and I’m thinking about my mother…

“Don’t ever, ever eat in the toilet!” When I grew up I imagined every mother in the world admonished her children with this warning. If you’ve grown up hearing this message, as so many children in middle and high income countries have, you simply cannot think of food and toilets in the same sentence without some discomfort. And yet it turns out the relationship between food and toilets is much more positive than our mothers ever led us to believe. 

Quite simply, children who grow up in communities who use toilets are less likely to be malnourished and children who grow up in communities that defecate openly are much more likely to become what is called “stunted”, a horrible word that means much more than just being too short for your age and describes a condition that slows mental as well as physical development preventing children from reaching their full potentials.

How does the relationship between toilets and stunting work? The evidence is rolling in. Children who grow up surrounded by feces -- animal and human -- ingest it constantly which can trigger a disorder of the small intestine called “environmental enteropathy”. The intestinal walls of children who have this condition constantly "leak" bacteria into the blood stream causing chronic low-grade infections that consume vast amounts of energy to fight, leaving less nutrients available for growth. 

Small problem?…Not exactly. An estimated 1 billion people practice open defecation globally and 165 million children are stunted, with the greatest concentrations of both in countries like India, Indonesia, Pakistan, Ethiopia, Nigeria, Sudan, Nepal, China, Niger, Burkina Faso, Mozambique and Cambodia. In these countries, open defecation and childhood stunting have enormous health and economic costs. Globally, they are major contributors to the 6.3 million child deaths that occur each year, most from infectious diseases such as pneumonia and diarrhea, cost hundreds of billions of dollars in medical treatment for those who get sick, and significantly depress economic growth and development.

India is the eye of the storm with the world’s highest concentrations of open defecation (600 million), stunted children (62 million) and child deaths (1.3 million). To accelerate investments in reducing open defecation and improving child nutrition in India, the United Nations Foundation, the MDG Health Alliance and WASH Advocates co-hosted a discussion in September with leading experts to explore how public-private partnerships could tackle the sanitation/nutrition challenge in a more integrated way.

Participants included the Public Health Foundation of India’s Ramanan Laxminarayan, UNICEF’s Sanjay Wijesekera, Jean Humphrey from Johns Hopkins School of Public Health, Analia Mendez of Unilever, Lucy Sullivan from the 1000 Days Initiative, and Gardiner Harris from the New York Times, whose scathing article on the lack of access to toilets in India inspired the conversation. The discussion was in support of the UN Secretary-General’s Every Woman Every Child movement.

The panel acknowledged that food interventions alone can close only about a third of the average growth deficit of Asian and African children and that the global development community has substantially underestimated the contribution of sanitation and hygiene to childhood growth. Although there was agreement that increasing access to locally designed, manufactured and marketed toilets in participation with the private sector is a critical part of the solution (with Jim McHale from American Standard sharing details of their success in Bangladesh with the SaTo toilet and Analia Mendez outlining Unilever’s new Uniloo project), the panel argued for a big push to increase demand for toilets.

Gardiner Harris cited the recent SQUAT survey that revealed a strong preference for open defecation among older males in India and the work of the Rice Institute’s Dean Spears which shows that Hindus are 40% more likely than Muslims to practice open defecation, a factor that accounts for the large (18%) child mortality gap between Hindus and Muslims. Experts agreed education efforts and incentives to encourage toilet use should target the sub-populations most resistant to change.

Despite barriers on both the demand and supply sides, panelists acknowledged that political commitment for ending open defecation has never been stronger. At the global level the United Nations Deputy Secretary-General, Jan Eliasson, is leading the End Open Defecation campaign and the Indian Prime Minister, Narendra Modi, announced the Swachh Bharat Mission with the goal of ending open defecation in India by 2019, to coincide with Mahatma Gandhi’s 150th birthday. There is now an opportunity for  other stakeholders, especially the private sector, to fully engage with these public partners to drive down open defecation rates and simultaneously invest in child nutrition interventions. By delivering sanitation and nutrition investments together to the largest populations of children living in the open defecation communities, the deaths of many more children could be prevented and the lifelong impacts of stunting dramatically reduced.

Almost fifteen years ago the Millennium Development Goals (MDGs) set out to halve child hunger, reduce child deaths by two thirds and double access to toilets. With just 450 days left until the MDG deadline, the world has managed to reduce childhood stunting by 35%, child mortality by 50%, and those without basic sanitation by 30% -- impressive, but not enough to achieve the targets. In the time remaining, we need to pull out all stops to build new public-private partnerships to invest aggressively in integrated sanitation and nutrition solutions prioritizing the largest populations of children who grow up constantly exposed to feces.  

If you have ideas for a new sanitation/nutrition public-private partnership in any of the countries listed above please contact me at lgreenslade@mdghealthenvoy.org or send an email to everywomaneverychild@unfoundation.org.

Editor’s Note: This guest post is co-authored by Jonna Davis, Senior Program Manager for Dispensers for Safe Water in Kenya, and Nabil Mansouri, Program Manager in Malawi, both of Evidence Action. Jonna and Nabil describe how the program maintains user adoption rates in Kenya, Uganda, and Malawi. To learn more about Dispensers for Safe Water, read Evidence Action’s post for WASHfunders on the evidence-based origins of the program. Another post describes strategic efforts to diversify the initiative’s financing models.

On the face of it, Dispensers for Safe Water is easy to understand. Dispensers for Safe Water is a fast-growing initiative of Evidence Action that provides access to clean and safe water for close to three million people in Kenya, Uganda, and Malawi. It is slated to grow to 25 million users in the next five years. We do this by installing and maintaining chlorine dispensers directly at the water source where people in rural areas fetch their water. 

Customers simply add half a teaspoon of diluted chlorine to the jerry can in which water is typically collected, dosed correctly to safely disinfect the drinking and cooking water. Chlorine, of course, is a very effective additive to water used around the world in sanitation systems that kills 99.9% of harmful bacteria that, in turn, cause diarrhoea and other water-borne diseases such as cholera. 

Using the dispenser simply means turning a knob to release a dosed amount of diluted chlorine into the jerry can used for water collection. Credit: Evidence Action

Using the dispenser simply means turning a knob to release a dosed amount of diluted chlorine into the jerry can used for water collection. Credit: Evidence Action

Conveniently, chlorine dispensers are installed directly at the water source -- such as a borehole or simply an unprotected spring -- and are very easy to use. We see sustained adoption rates between 42% and 80% (such in Malawi where we have just begun an aggressive expansion).

We keep tabs on these adoption rates by regularly sampling cooking and drinking water in people’s homes to determine whether there is actually chlorine present in their water.

But getting people to use the dispensers to make water safe to drink is not achieved by the installation of dispensers alone. As we have seen time and again, a new gadget in and of itself is not enough for behaviour change to occur. We see high and sustained rates of adoption because Dispensers for Safe Water is more than just the dispenser. It’s the underlying foundation of community engagement, delivery, and ongoing maintenance that makes the program effective. 

Here is how it works:

Expanding into a new areas involves significant preparation weeks ahead of the actual installation. Dispenser for Safe Water team members meet with community leaders to get their approval for a dispenser as well as to familiarize these key stakeholders with how and why dispensers work. After approval is granted, we work with those leaders to engage users in the ‘barn raising’ of the actual installation of the dispenser. 

Dispenser for Safe Water community education meeting in Malawi. Credit: Evidence Action

Dispenser for Safe Water community education meeting in Malawi. Credit: Evidence Action

There are additional community meetings to elect a community ‘promoter’ -- typically a respected person in the community -- who is charged with maintaining and refilling the dispenser, and who reports any problems. The promoter also educates community members on how chlorine and the dispenser work, and why it’s important to disinfect the water. 

The promoter is a very important part of the success of the dispenser in a given community. Adoption rates have been as much as 17 percentage points higher when the promoter's water tests positive for chlorine than when s/he does not.

Once the promoter is in place and installation and community education meetings have been completed, there is the ongoing maintenance of the dispensers. Dispensers that are empty or in disrepair are not going to be used by our customers over time. We know that the biggest driver of decreased adoption is empty or poorly maintained dispensers, which is why we have developed such a strong “last mile” delivery and maintenance network.

A promoter is trained on how to refill and maintain the dispenser she is responsible for in Malawi. Credit: Evidence Action

A promoter is trained on how to refill and maintain the dispenser she is responsible for in Malawi. Credit: Evidence Action

Evidence Action maintains the dispensers through a network of circuit riders on motorbikes who visit a target number of dispensers daily in their catchment area, deliver a three-month supply of chlorine to the promoter in charge of the dispenser in a given village, and repair anything that needs to be fixed.

Promoters and circuit riders use mobile phone technology for tracking this work--for issuing and resolving maintenance tickets, checking off steps in the supply chain and other tasks.  

Tracking dispenser maintenance issues with mobile phones at the water points in Western Kenya. Credit: Evidence Action

Tracking dispenser maintenance issues with mobile phones at the water points in Western Kenya. Credit: Evidence Action

Economies of scale, combined with efforts to optimize the supply chain in the maintenance phase, ensure that the cost for Dispensers for Safe Water at scale is very low: just 50 cents per person per year. This makes Dispenser for Safe Water one of the most cost-effective WASH interventions with sustained high adoption rates on the market. With community engagement, promotion, and ongoing maintenance, users have a reliable product that is consistently used over time.

H2infO

Editor’s Note: This guest post is authored by our colleagues at the U.S. Water Partnership, who announced the launch of H2infO, a new web platform that provides global access to U.S.-generated data and knowledge on WASH. The official launch, hosted by Catherine Novelli, Under Secretary of State for Economic Growth, Energy and the Environment, took place yesterday afternoon at the U.S. State Department.  

Taking the first step in combating a problem is often the most challenging. For infants, that exhilarating first step unleashes a new freedom that takes them to new places (and sometimes trouble). Unfortunately, thousands of children may never take that first step or will experience increased difficulty due to stunting, as a result of unsafe water, inadequate sanitation and poor hygiene.

While water challenges vary across the globe, these issues are solvable. However, decision makers worldwide need to be equipped with the right tools to harness innovative technologies, expertise and resources to build sustainable solutions. Accessing useful information is the first step for designing these lasting solutions, but finding the right type of information can be a daunting task for users in developing countries.

In response, the U.S. Water Partnership (USWP) announced the launch of H2infO – a new platform that offers the global community easy on-line access to a growing library of U.S.-generated water data and knowledge. The United States has information and solutions to share.  However, our knowledge has been too fragmented for accessible use – until now. 

Launched on October 6, H2infO harnesses U.S.-based information and connects people to the data, knowledge and resources they need to address water challenges.  The portal currently hosts over 3,000 resources from leading institutions and more resources will be centrally accessible as this interactive tool continues to expand.. 

Step 1 – Visit H2infO

H2infO was developed by the U.S. Water Partnership, a public-private alliance formed to unite and mobilize U.S. expertise, resources and ingenuity to address water challenges where needs are the greatest. The U.S. Department of State provided additional support in the development of H2infO. The 3,000 resources currently hosted on H2infO are exclusively from U.S. Water Partnership members, a growing coalition of over 90 partners, including 19 federal agencies, academia, private companies, foundations and NGOs. Additional resources will be added to the portal regularly.

Step 2 – Explore the resources

H2infO was designed to help create catalytic solutions to diverse water challenges throughout the developing world. The portal serves as a water resource librarian – directing users to resources and linking them to relevant websites. Policymakers, service providers and service developers worldwide are able to access resources to engage in the following USWP themes: WASH, integrated water resource management, efficiency and productivity, and governance. Available H2infO resources range from training manuals and water scarcity maps to case studies and project reports.

For example, a policy maker in Angola can learn from experiences in Arizona on how to best manage water resources in times of drought; NGOs in the field can easily find training manuals to help design programs that build on decades of experiences; and lessons on trans-boundary water management in the Colorado River Basin can help build good neighbors in international river basins.

Step 3 – Build your toolset

H2infO recognizes the value of connecting multiple stakeholders to contribute resources from federal agencies, private sector, civil society and universities.  Water challenges cut across multiple sectors such as health, energy, and food.  A robust set of tools prepares decision makers to navigate these diverse sectors to build lasting solutions.

Climate change and population dynamics are among the factors to add stress on global demand and water supply. Decision makers around the world will increasingly search for available data and information on these topics. H2infO is the first installment of the U.S. Water Partnership’s commitment to the President’s Climate Data Initiative, which is a key deliverable of the President’s Climate Action Plan to cut carbon pollution in America, prepare communities for the impacts of climate change and lead international efforts to address this global challenge. A recent White House Council on Environmental Quality fact sheet recognized H2infO as a platform to help create a “virtual community of practice to share data, experiences, lessons and practices,” consistent with the goals of the Initiative.

The U.S. Water Partnership is excited to work with partners in the water sector to build on this platform and expand the diverse library of resources.  H2infO is now live at www.H2infO.us

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