Editor’s Note: We pose four questions to Lisa Nash, CEO of Blue Planet Network, on how collaborative partnerships can scale the impact of multi-sector programs.
Tell us about the H20+ Uganda initiative BPN helped to launch last year.
H20+ is a multi-sector initiative designed to eliminate the root causes of poverty. We developed the H2O+ initiative to reduce morbidity and mortality rates, and promote economic development in Uganda by integrating five related initiatives: (1) improved access to sanitation; (2) improved access to safe water; (3) improved community hygiene practices; (4) strengthened capacity at district and community health facilities; and (5) increased school enrollment of girls.
H20+ was piloted successfully in Pallisa, a district in Southeast Uganda, in 2012. The program brings clean water solutions and improved capacity to health clinics as well as communities. Five borehole wells were constructed near health clinics providing 6,392 villagers living in these five communities with direct access to clean water. Additionally, those traveling from afar to these health clinics will have access to clean water, which we have calculated as approximately 4,000 visitors per year per health clinic. Because of the strategic placement of the wells, the program will benefit 25,600 people annually in these five communities.
How did BPN set up a private-public partnership to launch H20+ in Uganda?
Once we formed the H2O+ concept, we identified key players at the local, regional, national, and international levels to build a unique collaborative model that could be replicated across Uganda. With a network of nearly 100 WASH members working in 27 countries, we invited one of our members, International Lifeline Fund (ILF), to take the lead on implementing the program. ILF is a nonprofit whose mission is to reduce human suffering through WASH initiatives, fuel-efficient stove programs, and micro-enterprise. They have constructed more than 200 borehole wells in Uganda serving over 150,000 people. Their demonstrated expertise in Uganda and entrepreneurial approach aligned well with the H2O+ model.
H20+ was launched in partnership with ReachScale, a company that brings social innovators, including corporations, NGOs, and governments, together to scale initiatives that increase innovation and impact.
Management Sciences for Health played a critical role in the planning stages of H2O+. They manage healthcare clinics throughout Uganda, and around the world, and implement WASH activities through advocacy, community mobilization, and hygiene and health education.
Local governments in the district of Palissa and community leaders were involved in H2O+ planning, baseline research, and analysis and implementation. Africa AHEAD joined H20+ and will introduce Community Health Clubs in Phase II as the best way to ensure a community-led approach to water and sanitation program development.
What was BPN’s approach to integrating the 5 related initiatives (water, sanitation, hygiene, health, and education) and identifying metrics?
The H20+ initiative recognizes that health, water, sanitation, hygiene, and education are inextricably linked at the local level, as shown in the diagram below. H2O+ partners have experience leveraging their work to solve multiple community issues. BPN asked its partners: “How can we impact multiple aspects of community poverty?” rather than “How can we increase clean water, or how can we decrease visits to the health clinic?” The answers led to H20+, an integrated approach to poverty alleviation. BPN worked with its partners to agree upon the project model, planning, implementation, and monitoring components. H2O+ partners agreed upon a common set of metrics that will be reported and analyzed on BPN’s platform.
What were the challenges, lessons learned, and positive outcomes of coordinating the different stakeholders and getting everyone on board?
Agreeing on how to operate together was the largest challenge of H2O+, given the multi-level commitment of each partner.
H20+ planning was launched with several virtual planning meetings, and followed up with a site visit in Kampala, Uganda with representatives of several H2O+ partners. The program structure, metrics, and roles were discussed virtually, while the in-country visit was essential for building trust amongst district officials and H20+ partners. As Dan Wolf, ILF’s founder and executive director explains, “The lesson always is to lay the groundwork well in advance of beginning operations.” Dan and his team realized that building collaborative relationships with local government officials was difficult without a foundation of understanding. “The problem was a lack of familiarity and trust with a new organization. We learned that we can always do a better job of explaining and leveraging our experience to show the District Water Offices the benefits of our partnership.”
H2O+ partners are now looking at economic development opportunities for women. Empowering women to make and sell clean cook stoves is a unique addition to a traditional water or health program. Carbon accreditation will generate a revenue stream that pays for equipment maintenance and community education. This multi-sector model has attracted funders because they see the opportunity to leverage partner integration for greater program outcomes.
The takeaways are:
- Detail planning and role delineation up front is key.
- Combine the virtual with the physical. Being virtual encourages creative solutions. Getting together in person builds trust that strengthens partnerships.
- Be honest about evaluating progress and results. Always be open to refining the process for greater impact and stronger partnership. Measure, measure, measure.
- Celebrate successes together, no matter how small. Partnerships are hard work, so it’s important to remind people every time you make progress toward your common goal.
Editor’s Note: This infographic illustrates the disparity of water consumption between “water rich” countries with access to clean water and “water poor” countries that lack or have limited clean water access. It was created by Seametrics, a manufacturer of water flow meter technology that measures and conserves water. It originally appeared on the Seametrics blog.
Editor’s Note: This post was authored by David Winder, chief executive of WaterAid USA. David talks about WaterAid’s work with local NGOs in Mozambique to make water and sanitation services affordable to poor, urban populations through innovative financing models. A version of this story originally appeared here.
Having just returned to New York from Maputo, the capital of Mozambique, I'm reminded how lucky we are in this city to have reliable water and sanitation services. Thanks to investment in water pipes and sewers in the 19th century, diarrheal diseases that ran rife through our city a few generations ago have all but been eliminated, and we take it for granted that safe drinking water is available at the turn of a tap.
As in many other large cities across the developing world, Maputo is facing rapid growth of low income settlements and major challenges in providing the population with access to safe water and sanitation. The latest data (UNICEF/WHO 2012) show that only 77 percent of Mozambique's urban population has access to improved water sources. The situation is even grimmer when it comes to sanitation, with only 38 percent of the urban population having access to safe sanitation.
The country has one of the highest infant mortality rates in the world with 86,000 children dying before their first birthdays every year. Diarrhea is one of the leading causes of child deaths and 44 percent of children under five are undernourished.
Increased investment in providing access to safe water and improved sanitation dramatically impacts child survival. In low-income areas of cities like Maputo, that is often a complex task. High population density, transient populations, and poor quality housing are part of the problem and present challenges to those striving to improve water and sanitation infrastructure.
Often in low-income urban neighborhoods the provision of piped water to homes is simply too expensive for ordinary families to afford. One way of tackling that problem is by helping local residents band together and negotiate affordable payment plans with water service providers with the help of local NGOs.
Last week I visited the community of Costa do Sol on the northern periphery of Maputo and found that a community water users' association, ACODECOS, established with the help of WaterAid and local partner organization ESTAMOS had achieved great success in expanding the number of household water connections over a five year period, with very positive results for the health of the community, particularly children. Data given to us by the Ministry of Health showed that the number of cholera cases had dropped from 371 in 2003/4 to only 21 in 2008/9.
One reason why this was achieved was ACODECOS' successful negotiation of a reduction in the household connection fee to $50 (from Aguas de Mozambique, a private company receiving 75 percent of its investment from government) that can be paid in installments.
Local resident Francesca Nhantos (shown in the photo at the top) told me that having piped water available in the home had transformed her life. "Before we had the standpipe, a water truck came to the village once a week and we had to pay 5-7 meticais (20 cents) for 20 liters of water and we weren't sure how clean it was so we had to boil it."
As Arminda told me, other changes, such as the installation of latrines, hygiene education, the provision of drinking water and toilets in schools and the disposal of solid waste, have also helped to dramatically improve the health of the community.
With the absence of piped sewerage in densely populated low-income urban communities, disposal of fecal sludge from latrines also poses a major challenge. Last week, I visited a pilot project managed by Water and Sanitation for the Urban Poor (WSUP), an organization working closely with WaterAid. This project shows how offering loans to small businesses can help with the development of affordable waste management services.
Paulo Biane Vaiene from the Maputo community of Maxaquene is one such entrepreneur benefiting from financial assistance. His small enterprise UGSM Vaiene started emptying small septic tanks using a small pump and tank called a "gulper" that was pulled by a donkey. With a loan from WSUP, he was able to buy a truck that has allowed him to cover more clients and expand his radius of operations. Business is thriving, more households can now take advantage of his services, which cost around $20 and are required twice a year, and public health is safeguarded by the safe disposal of the waste.
Just as Paulino has demonstrated that fecal sludge removal can be a profitable business, there are opportunities to develop small businesses selling a selection of toilet designs to families. A range of viable technologies has been developed, but business models need to be developed with finance plans to ensure that options are affordable to all families regardless of income. We found that all needed construction skills exist in the communities, so the focus needs to be on ensuring these skilled laborers are able to find employment that not only helps their families out of poverty but also helps communities stay healthy and meet their basic needs.
These experiences show how innovative financing models can impact on health in low-income urban communities. When water connection charges are not only reduced but split into installments, poor families can afford to get linked to the municipal piped water system, and the support of small private service providers ensures families have access to effective and affordable fecal sludge removal services until the sewage network can be expanded.
These examples also show the importance of linking larger systems — such as pipes for the water utility or waste management and sewage systems — with community and household-based needs and approaches. Reducing poverty and protecting people's health and well-being requires a combination of efforts, from local capacity building and small business development to larger-scale infrastructure development. I was inspired by the efforts being made by NGOs and community-based organizations to build healthy communities. The skills, the demand, and the creativity are there. We have so many opportunities now to make the most of them.
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.
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.