Editor’s Note: This guest blog post is authored by Hanna Woodburn, Deputy Secretariat Director for the Global Public-Private Partnership for Handwashing. In her post, Hanna discusses the importance of incorporating targets and indicators on hygiene, a critical but often overlooked area, into the post-2015 development agenda under the Sustainable Development Goals (SDGs). She points out that, while the proposed goal for water under the SDGs is a step in the right direction, there is a need to develop global level indicators that more accurately assess progress on hygiene.
Some of the world’s greatest development challenges have the simplest solutions. If you are reading this blog, you likely know the facts about water, sanitation, and hygiene (WASH). You probably know that diarrhea and pneumonia are the top killers of children under the age of five, and that WASH can make a big difference in saving these lives. You might be able to cite statistics about how many days of school children miss due to diarrhea (272 million per year, in case you were wondering), or be able to describe the impact that a lack of facilities have on menstruating girls’ education.
However, did you know that you can and should be involved in ensuring that WASH is an integral component of the Post-2015 development agenda?
The Millennium Development Goals (MDGs), established in 2000, represented a major shift in the way in which the global community rallied against some of the world’s greatest economic and development challenges. Many successes born out of the MDGs are hard to ignore. Sources of improved drinking water became available for 2.3 billion people. Major progress was made in the fight against child mortality, with the mortality rate for children under the age of five dropping from 90 deaths per 1,000 live births in 1990 to 48 in 2012. Between 2000 and 2012, primary school enrollment increased from 83 percent to 90 percent in developing regions.
And yet, critical goals remain off-target, particularly that of sanitation. The Sustainable Development Goals (SDGs), which the global community is currently debating, represent an opportunity to continue the work that began under the MDGs, but the SDGs must also be used to address gaps in the goals, and a major oversight in terms of WASH was the absence of hygiene.
This must not occur again. Hygiene undergirds success in a myriad of areas, including reducing under five mortality, education, nutrition, gender equity, and more. And of course it is an essential counterpart to water and sanitation.
Despite its importance, hygiene is far too often overlooked, as we saw in the MDG era. And, as the 2014 Global Analysis and Assessment of Sanitation and Drinking Water (GLAAS) Report found, hygiene is also largely ignored at the country level, with only 19 of the 93 countries surveyed having an approved, funded, implemented, and reviewed national hygiene policy. Likewise, only 18 countries had national hygiene policies in schools and healthcare centers that fulfilled the same requirements.
The GLAAS report confirms that lack of investment in hygiene is a serious barrier to progress in international development, and that there are inequities in access to proper handwashing facilities. Knowing these shortcomings exist, however, is very different than taking action to address them, but with the United Nations’ work on developing global SDGs, the international community faces a valuable juncture wherein water, sanitation, and hygiene can be prioritized.
The proposed Water Goal (Goal 6) is a step in the right direction, and an indicator addressing water, sanitation, and hygiene is included under the goal, presently. However, this is not enough to guarantee that WASH under the SDGs will be adequately measured and prioritized. Rather, water, sanitation, and hygiene must be included as mandatory, global level indicators. These indicators should address not just the availability of the critical hardware and behavioural promotion to encourage their use at the household level, but also at important public locations, such as schools and healthcare centers.
Given the importance of hygiene, the Global Public-Private Partnership for Handwashing has taken a leading role in advocating for hygiene at the global level. We encourage you to download our hygiene advocacy toolkit and join us in our advocacy efforts.
Without proper investment, measurement, and prioritization of WASH, the global community is missing an important opportunity to improve the health and lives of billions of babies, children, and adults around the world. The global community has an opportunity to change this. Everyone, young or old, rich or poor, should have access to these life-saving resources by the year 2030.
In celebration of Global Handwashing Day, learn more about enabling handwashing technologies through the World Bank’s Water and Sanitation Program searchable online database. The database features over 40 simple designs used to facilitate the practice of handwashing in areas of the world where running water is not accessible for sanitation or hygiene.
Innovative designs include the bobotap, a technology that improves on traditional water storage in clay jars by both storing and regulating the flow of water for handwashing. The database also features several versions of the tippy-tap, a hands-free technology that has gained traction in development circles for its use of locally available materials and simple but effective design.
The database —aimed at practitioners and funders interested in evaluating the benefits of different handwashing station designs —includes pictures and information on key product features, as well as contact details to allow for follow up. Users are encouraged to submit their own designs to add to the database.
To learn more about Global Handwashing Day and to get involved, visit the Global Public-Private Partnership for Handwashing.
Editor’s Note: This guest post was authored by Catarina Fonseca, director of WASHCost and economist and Senior Programme Officer at the IRC International Water and Sanitation Centre. A five-year initiative ending this year, WASHCost has worked with countries to identify the long-term costs of sustaining rural and peri-urban water and sanitation services. This initiative has embedded the concept of life-cycle costing with donors, national and local governments and NGOs, so that services continue to meet national standards reliably for generations. Catarina discusses the challenges of the team’s recent work in Bangladesh.
Over the last year, there have been many requests to the WASHCost team to adapt the life-cycle cost approach to other sub-sectors. One of them is WASH in schools. Programme managers and funders want to know the costs for the provision of WASH in schools and how to fund the desired outcomes over at least a 10 year period.
IRC-International Water and Sanitation Centre has been providing support to the BRAC WASH programme in Bangladesh. BRAC is interested in the life-cycle cost approach to seek improvements in the long-term sustainability of their programmes and in this context, we have taken up the challenge: we have started by searching, discussing and defining what is considered a basic service level for WASH in schools.
These questions become even more pertinent in the context of the proposals for the global goals in the post-2015 agenda. It has been recognised that future global water, sanitation and hygiene targets must extend beyond household level and include a wide range of settings including schools, workplaces, markets, transit hubs, health centres, etc. Schools and health centres are at the top of the priority list because of the potential health benefits to a large number of children and people. Specifically, handwashing and menstrual hygiene management are considered to be universal priorities to be reached by 2030 so that girls are given the same opportunities and access to education.
For the work in Bangladesh, our starting point was the WASHCost life-cycle cost methodology, which was developed specifically for rural water and sanitation services in developing countries. Together, with a BRAC team of 15 project and programme officers, over a period of three weeks in June 2013, we developed and tested a service ladder, criteria and indicators for WASH in schools.
The first step was the development of a draft service ladder for WASH in schools with the key criteria that define a basic level of service. The draft service ladder was developed by the team and based on the international literature, Bangladesh and BRAC standards. The ladder included the following key indicators of services for WASH in schools: access (number of latrines per student), safe use and maintenance, reliability of water for drinking, flushing and handwashing, environmental protection and menstrual hygiene management.
To get all the information required for the proposed criteria, we ended up with a 16-page questionnaire, which was tested twice in six schools and covered every indicator and sub-indicator required in national and international norms, including questions about how water is collected and accessed, as well as access to facilities by those with disabilities.
The first challenge started with establishing the benchmark for the most obvious indicator: the number of latrines per student. What is good enough? International experts were consulted and the answers were far from consistent. Therefore we focused on the written literature.
The international standard was developed by WHO in 2009 for schools in low-income settings. The standard recommends one toilet per 25 girls and one toilet plus one urinal for 50 boys. The most important recommendation is that boys’ and girls’ facilities should be in separate toilet blocks or be separated by solid walls and separate entrances. In short, toilets need to provide privacy and security if they are going to be used. This is a very high standard for many developing and developed countries. Even my secondary school in (not so low-income) Lisbon, Portugal would not meet these standards, which one might think of as “aspirational” instead of “good enough”.
Looking further, we found out that Bangladesh has actually adopted a national standard in 2011 for WASH in schools. The national standards are “more realistic” and include “1 toilet for 50 children and, when possible, girls’ and boys’ toilets must be completely separated”. Interestingly, “when possible” is not adequate wording for a standard and BRAC took the national norm a step further, closer to the international norm, and adopted “that toilets for boys and girls MUST be separate”. Additionally, a recent innovative study done in Kenya has found considerable difference in the required student to toilet ratios between boys and girls because the time they need to use the toilet also differs.
From testing the methodology in six primary and secondary schools (both government- and BRAC-supported), we found that the toilet ratio was one toilet for anywhere from 71 to 150 students — all well above the national standard and therefore not considered “a basic level of service”, but closer to “below-standard”. However, all of the toilets were clean; some had excellent menstrual hygiene management facilities available, as well as washing basins, soap and safe drinking water.
It would seem unfair to label some of these schools as “below standard” especially when interviews with school girls noted that they were happy and using their toilets. However, a monitoring tool is about measuring whether a standard is met. For all schools, it might appear that the standard is not met, but the takeaway for the team is that both the international and the Bangladesh access benchmark for WASH in schools is at the aspirational level.
The testing has confirmed some other challenges mentioned in a 2012 UNICEF state-of-the-art report of WASH in schools in Bangladesh: that on average there is a toilet for every 130 students and that the majority of facilities is in extensive need of repair (see graph below), making it urgent to deliberate how and who can cover maintenance costs. Interestingly, collecting information about the cost of constructing, maintaining and repairing the latrines, was a rather simple task. Most of the schools track all expenses in their account books, including who funded which component — a topic for another blog.
Over the next six months BRAC will roll out the methodology in about 100 schools covering a diverse range of settings. We expect the data to inform the final “service ladder” and the methodology will be available early next year. To read the draft methodology and questionnaires, please contact WASHCost@irc.nl.
The University of Toronto has announced a $2.2 million grant from the Bill & Melinda Gates Foundation in support of ongoing efforts to design a waterless hygienic toilet that is safe and affordable for people in the developing world.
Engineering professor Yu-Ling Cheng, director of the Centre for Global Engineering in the Faculty of Applied Science & Engineering, and her team, which includes researchers from Western University and the University of Queensland, placed third in the Gates Foundation's Reinvent the Toilet Challenge last August. Working with partners in Bangladesh, Cheng's team hopes to build an operational prototype by December 2013 that uses readily available materials and equipment that can be maintained locally.
The team's solution uses a sand filter and UV disinfection to process liquid waste and a smolder chamber — similar to a charcoal barbeque — to incinerate solid waste that has been flattened and dried in a roller/belt assembly. The team will work to further simplify the process, reduce mechanical complexity of the device, and minimize odor.
"I am very proud of our entire team and the work we have done up to now," said Cheng. "We have proven that our concept works technically; now we are going to get busy to make sure it will work for the users — some of the 2.6 billion people in the world who do not have access to basic sanitation."
Source: “U of T Engineers Awarded $2.2 Million Grant for Toilet Research.” University of Toronto Press Release 11/28/12.
For additional WASH-related philanthropy news, see the news feed on WASHfunders.org.
Editor’s Note: PSI and Unilever announced a new initiative with local governments in Kenya, Vietnam, and Zimbabwe to improve hand-washing behaviors in schools. A version of this story originally appeared here.
Although many people around the world wash their hands with water, very few wash their hands with soap at critical moments — such as after using the toilet, while cleaning a child, and before handling food. If hand-washing with soap became a standard practice, health experts estimate that deaths from diarrhea could be reduced by one half and that one in four deaths from acute respiratory infections would be averted.
This year, a new initiative launched between Lifebuoy (Unilever’s leading soap brand), PSI (one of the Unilever Foundation's global partners), and local governments is focusing on establishing behavior change programs in schools and communities across Kenya, Vietnam, and Zimbabwe — three countries where hand-washing with soap practices are low. In Kenya, for example, 28 percent of school children report washing their hands with water at key times during the day, yet only 1 percent report using soap.
The new Unilever-PSI initiative will help children get into a habit of correctly and consistently washing their hands with soap at critical times of the day. Using Lifebuoy soap products and communication materials, teachers and community health workers will work to change behaviors among school-aged kids through hand-washing programs and activities, such as song writing, comic books, and even hand-washing pledges. When children learn and understand healthy behaviors, they help pass life-saving information to their families at home and to future generations — setting off a powerful ripple effect.
Together PSI and Unilever aim to reach more than 250,000 school-aged children and their families in Kenya, Vietnam, and Zimbabwe over the next year. Through these three pilot programs, Lifebuoy, the Unilever Foundation, and PSI hope to prove the efficacy of this approach, and replicate the program at scale across a number of countries.
PSI joined Unilever and CSRWire for a Twitter chat to discuss the importance of hand-washing. Check out the highlights from the conversation, including questions and discussion from the audience. Continue the conversation with Unilever, PSI, and its partners at #IWashMyHands and become part of a worldwide dialogue to push hand-washing up the global health agenda.