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Editor's Note: In this post, Eve Mackinnon, a researcher working on innovative responses and evidence-based solutions to the sanitation crisis, discusses how WASH programs in nurseries or child care centers could protect child health. Eve is a water, sanitation and hygiene practitioner with over five years of hands–on emergency humanitarian response experience across Asia and Africa. Her current research focuses on more effective, sustainable and safer sanitation management, across the entire sanitation service chain to deliver positive changes to the way that human waste is managed. 

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Although global death rates of children under five resulting from diarrheal disease has fallen from a global high of 1.2 million in 2000 to 500,000 in 2015, it still represents the second leading cause of morbidity for this age group. These deaths are mainly preventable; 88% of them are attributed to a lack of access to water, sanitation and hygiene (WASH). The significant decrease in the last 15 years is a major achievement largely due to improvements in access to better quality drinking water, toilets, and better hygiene and care practices. These changes prevent young children being infected with harmful microbes that come from drinking dirty water and living in dirty environments, and contracting severe diarrheal diseases, which without sufficient treatment or in vulnerable children ultimately leads to death. 

Of course diarrhea is not the only threat to infant and young children. Ongoing research indicates that the same WASH factors that lead to diarrhea, also lead to stunting and malnutrition in young children. This is because low level of exposure to harmful microbes damages the intestinal tract and prevents proper absorption of nutrients in children. Infants and children under five are more vulnerable to being infected by microbes and get ill far quicker. From a health perspective, the targeting of effective WASH infrastructure is crucial to reach the most vulnerable groups.

Provision of WASH programs for vulnerable children whilst at nurseries or child care centers could be the most efficient way to protect their health. In Naivasha whilst researching risks of diarrheal disease for my PhD case study, I was shown Vision Nursery. The nursery cares for on average around 40 children in one small room. There is no drinking water provision, only water stored in containers from a tap stand. The nursery has access to a child adapted toilet (a container based toilet, provided by Sanivation), a positive step in WASH provision, however, without handwashing or regular cleaning the use of the toilet carries its own risks. Moreover, the nursery is also host to resident chickens, which are major carriers of harmful bacteria and co-habitation with people is linked to malnutrition and stunting in children according to recent research. The mud and rough concrete floor means cleaning and hygiene is difficult to maintain. There is inadequate space and utensils to safely prepare the childrens’ meals, and food cannot be re-heated or stored in secure containers.

Despite all of these shortcomings, the nursery provides an essential service. The female entrepreneur who started Vision Nursery has been running it for almost seven years and rents the small space. She is constrained by small margins, high rents, and lack of borrowing power. Her operation is linked to the Kenyan flower industry- a global success story of export growth. Naivasha is an epicenter of this booming export center for flowers, and it is driven overwhelmingly by a female workforce.  The associated employment opportunities allow women to gain a regular income with positive consequences of independence, empowerment, and rising equality for women in Kenyan society. An unintended consequence of female empowerment is the growth in a secondary industry of local nurseries and childcare. There are little to no regulations for nurseries in Kenya, and if they do exist,  they are not enforced. This allows for poor standards to exist, particularly in regard to WASH provision.

Potential baby WASH strategies to combat infection at the nursery level focus on robust barriers to specific exposure pathways that are specific for infant behaviours. For example, ingestion of pathogens occurs indirectly when children place contaminated objects in their mouths. Termed ‘mouthing’ it is responsible for almost 90% of a child’s exposure in one study.

Other direct exposure pathways include placing of hands directly into mouths and touching dirty floors. It’s important to regularly disinfect toys and maintain hygienic floor surfaces—possibly through use of mats or plastic, washable floor covers. Informed WASH strategies should be developed which can identify a broad range of baby-specific exposure routes. Indeed these indirect routes may be far more of consequence for children than direct routes of drinking contaminated water and food, which are traditionally the focus of WASH household campaigns.

The safe disposal of faeces remains the primary barrier to prevent dispersal of pathogenic bacteria in the environment and subsequent exposure routes. Despite a recent systematic review of health impact from sanitation intervention that concludes there is a lack of robust evidence, provision of safe sanitation is ultimately necessary to reduce contaminated environments that occurs as a result of open defecation.

In addition to focusing on specific prevention strategies at the nursery level, it is also crucial to increase integration between WASH, early childhood development (ECD), nutrition, and maternal newborn and child health (MNCH) programming. In addition, it’s important that outcome and impact monitoring is not uniquely focused on reduction in diarrheal disease. Impact monitoring and value for money evaluations should also explore targets that are linked with nutrition, undernutrition, and height and weight. It is notoriously difficult to link specific WASH interventions with impacts, without radnomised controlled trials, due to the huge variety of exposure pathways and variables that exist.

The WASH and sanitation sector might consider moving its focus from mostly household WASH and school sanitation to specialist WASH needs during infant care. If children survive the first year they are less vulnerable to further infection or severe outcomes. Therefore, intentionally focusing on activities at this juncture, as well as better integrating our efforts with other sectors—as the new babywashcoalition.org does—could have an enormous impact on child health.

Editor’s Note: In this post, Amy Pickering (Stanford University) and Clair Null (Mathematica Policy Research), co-principal investigators of the Povu Poa Project in Kenya, describe how with funding from the USAID Global Development Lab’s Development Innovation Ventures program, they teamed up with Innovations for Poverty Action, and using a human-centered design process developed a new handwashing station for settings that lack piped water. In this article, the authors describe its methods and preliminary findings. This article was cross-posted with permission, to view the original article please click here.

A member of a focus group in Kisumu, Kenya, provides user preference input for a handwashing station customized for areas without access to piped water. Photo Credit: Noel Wilson

A member of a focus group in Kisumu, Kenya, provides user preference input for a handwashing station customized for areas without access to piped water. Photo Credit: Noel Wilson

The theme of this year’s Global Handwashing Day on October 15, 2016, was “Make Handwashing a Habit!” In places without access to piped water, new products and technologies are needed to make handwashing with soap convenient enough to become a habit. Handwashing with soap is a powerful weapon against diarrhea and respiratory illness, the leading causes of death among children under 5. It is estimated that handwashing with soap could save 1 million lives annually. Unfortunately, only 19 percent of the global population wash their hands with soap after contact with feces.

raditional handwashing with a basin. Photo Credit: Amy Pickering

raditional handwashing with a basin. Photo Credit: Amy Pickering

Without access to water on tap in the home, handwashing is inconvenient — using one hand to pour water over the other is awkward and requires more water than washing two hands together. Moreover, if everyone followed the standard recommendations about how often to wash their hands (after defecation, before cooking, before eating), women and children would likely have to spend more time fetching water from sources outside the home. Soap is another challenge — if left at locations where handwashing would ideally occur (near latrines, cooking areas, and eating areas), it is vulnerable to being wasted by children or stolen.

We set out to design a water- and soap-conserving handwashing system that could address the barriers faced by millions of people who don’t have access to piped water in their homes. We wanted it to be adaptable for a variety of contexts, ranging from space-constrained urban dwellings to schools with hundreds of students. For plastics manufacturers to produce it, the system needed to be a desirable product that consumers would want to buy. Our goal was to seed the market with a good idea and then let the private sector take over.

From Boring Bar Soap to “Cool Foam”

With funding from the USAID Global Development Lab’s Development Innovation Ventures program, our team of researchers from Innovations for Poverty Action partnered with engineers from Catapult Design to invent an innovative, appealing, and practical new handwashing station in Kenya. Using a human-centered design process, we started by holding focus groups and tinkering around with available handwashing products — buckets, pitchers, and tanks with taps — trying to locate features that would create value for a handwashing product. We watched people wash their hands using different types of handwashing stations and soap, interviewed them about their experiences, and engaged them in games and activities to reveal preferences that they might not have thought to explain.

Testing prototype handwashing stations in Kisumu, Kenya. Photo Credit: Noel Wilson

Testing prototype handwashing stations in Kisumu, Kenya. Photo Credit: Noel Wilson

We then brainstormed a large number of new concepts for handwashing products. We focused on water-frugal devices and soapy foam dispensers rather than regular soap or soapy water. We invited households to test out our models, lining up multiple options of water and soap dispensers side by side so we could see how users interacted with them and hear their opinions.

After several months of this exploratory and iterative design phase, we honed in on several key user design preferences: soap security, affordability, and adaptability. Ultimately we developed what is now branded as the Povu Poa, or “cool foam” in Swahili. The product comes in a pipe model, which can be hung from a tree or nail in a wall and is very portable. There is also a bucket model, which captures the runoff and has a larger capacity but is more cumbersome to move around. Both models incorporate a water-frugal swing tap that allows only a small amount of water to flow and a foaming soap dispenser. The dispenser transforms 5 grams of powdered soap and 250 milliliters of water into 100 handwashes, and both systems can be locked into place to reduce theft.

Povu Poa handwashing stations, as bucket (left) and pipe (right) models. Image Credit: Noel Wilson

Povu Poa handwashing stations, as bucket (left) and pipe (right) models. Image Credit: Noel Wilson

Importantly, the Povu Poa reduces the everyday cost of handwashing by more than half compared to conventional systems because of its exceptional soap and water efficiency. In Kenya, the cost of soap and water is only $0.10 per 100 handwashes using widely available powdered laundry detergent to make the foam. The Povu Poa is also adaptable to institutional settings; for example, the pipe model can be connected to large tanks for higher water storage capacity.

Prospects for Scale-Up

To understand the price that Kenyan households are willing and able to pay for the Povu Poa, we marketed and offered the products for sale to 200 households at varying price points. We also contracted a local Kenyan firm to create a logo and messaging for marketing the Povu Poa. We found that 78 percent of households bought the product at a price of $4, while approximately one-third (35 percent) bought it at $8. When offered side-by-side, the bucket model was more popular than the pipe, perhaps because it has a more familiar appearance or because it has a larger capacity.

Interestingly, among consumers who were only offered the pipe model, sales were almost identical to the bucket model and there is evidence that suggests some consumers would purchase the soap foamer alone. Even though the current estimated price point of a mass-produced Povu Poa is slightly higher at $12, we were very encouraged to see this real demand for a convenient and efficient handwashing system in Kenya. Notably, the Povu Poa could pay for itself with soap and water savings in 2.5 years for a family of five.

Currently, the Povu Poa is being field tested in 30 schools and health clinics in peri-urban Kenya to see if the product can increase handwashing rates among students, teachers, doctors, and nurses. We will use these longer-term evaluations to refine the product design and continue mass production discussions with plastic manufacturers in Africa.

“Foam is exciting,” said one head teacher, capturing a typical user reaction to the Povu Poa system. “It won’t be wasted.”

Editor's Note: In this post, Dylan Lunney, Director of Communications for OHorizons, discusses the Low Tech, High Thinking approach to creating affordable, simple solutions that can have a meaningful impact on WASH issues.

Bangladeshi_Women_Stand_Next_to_an_OHorizons_BioSand_Filter

Bangladeshi Women. Photo credit: ohorizons.org

Low-tech, scalable, local solutions present an exciting opportunity to address the water, sanitation, and hygiene (WASH) objectives laid out in goal number six of the United Nation’s Sustainable Development Goals (SDGs).

There is no one-size-fits-all solution to tackling WASH issues, but in order for development projects to be successful and sustainable, communities should not be bystanders in projects that are designed to help them. This belief is underscored within SDG 6 section 6.6b

In addition, solutions addressing the challenges of people living in poverty should be designed by carefully examining and accounting for the needs, practices, and available resources of the end-user. This seems like a basic, self-evident concept, however the history of water development projects demonstrates otherwise.

Take for instance that the cumulative cost of failed water systems in sub-Saharan Africa alone was estimated to be $1.2 billion to $1.5 billion from 1987-2007. The poster child of this development design failure is the PlayPump, an initially highly-touted safe drinking water ‘solution’ that quickly failed when it turned out that kids would have to ‘play’ for 27 hours a day to filter the intended amount of water. Development projects that fail to incorporate the needs, skills, habits, and resources of the end-user don’t produce their intended result—in this instance providing safe drinking water—and they are an enormous waste of money, time, and resources. Instead, beneficiaries should be involved in identifying the technology and approach that will benefit them most and the community should be directly involved in the building and maintaining of their local infrastructure.

OHorizons, where I work, is part of this appropriate design movement in WASH global development. We call our design process Low-Tech, High-Thinking.

A lot of attention is given to the newest app or high-tech gadget. You’ve probably heard of Bill Gate’s highly celebrated machine that turns human waste into water. It’s impressive. It’s also impractical for most poor, rural communities, where the water and sanitation crisis is particularly dire, who likely don’t have the infrastructure or funds to build or maintain this $1.5 million dollar facility that is roughly the size of two school buses.

The core belief behind the Low-Tech, High-Thinking movement is that it takes just as much creativity and ingenuity to create affordable, simple solutions that can have a meaningful impact on a global scale. Understanding the systemic underlying causes along with listening to and learning from the end- user, is a vital part of this design process. Adhering to the following principles can also help guide this process and ensure a solution is truly centered around the beneficiaries and the environment in which they live:

Low-Tech Principles

Simple: Anyone, regardless of education level or expertise, should be able to develop and implement a solution with minimal instruction.

Low-cost: The solution should be affordable to the end-user.

Locally-sourced: 100% of the materials, tools, and labor should be available locally.

Flexible: Every community is different and has different resources available to them; solutions should be flexible enough to adapt to varying local conditions.

Open-source: Solutions should be freely available to anyone who would like to utilize them.

OHorizons has used this approach to engineer a Wood Mold for the production of concrete BioSand Filters (BSFs). BioSand Filters (BSFs) are a low-tech, household appliance that use sand, gravel, and natural biological processes to filter pathogens out of water, making it safe for drinking. We’ve made our step-by-step construction manual open-source so that local organizations can manufacture BSFs for a fraction of the upfront costs of the traditional steel mold. Our Molds make more than 50 concrete filters without an issue due to the use of our patented collapsible inner core and 2” x 2” supports that hold the outer walls of the Mold together with bolts rather than screws, which strip the wood. This innovation allows more people to get safe drinking water at an exponentially faster rate. 

There exist many other fantastic household level solutions that follow similar design parameters. Two of my favorites are the Tippy Tap for hand-washing and the C.R.A.P.P.E.R. for toilets.

TippyTap

The Tippy Tap is a hands free way to wash your hands and is especially appropriate for rural areas where there is no running water. It is operated by a foot lever and thus reduces the chance for bacteria transmission as the user touches only the soap. They’re also very easy to build and can be made with basic, low-cost materials.

The organization Toilets for People (TFP) has designed a high-quality composting toilet that they’ve appropriately named the C.R.A.P.P.E.R. (compact, rotating, aerobic, pollution-prevention, excreta reducer). It’s user-friendly and easy to maintain, can be made from locally available materials for about $100, and is being built around the world by NGOs serving their communities.

Here’s a video of TFP in Peru with their NGO partner Amazon Promise, building 17 CRAPPERS:

 

Toilets for People’s founder Jason Kass, is a passionate ambassador for bridging the gap between the appropriate technologies already out there and creative implementation on the ground.

As we continue to develop solutions for water, sanitation, and hygiene, one area to think seriously about investing in is low-tech, human-centered design projects that transform beneficiaries into local change makers. Harnessing the power of people through Low-Tech, High-Thinking Design can and should play an important role in helping ensure availability and sustainable management of water and sanitation for all by 2030!

Editor's Note: In this post, Caitlin Gruer, Program Associate for WASH & Health at PLAN International USA, discusses the issues surrounding menstruation around the world and how we might address those issues. This post originally appeared on Huffington Post, to view the original post please click here

Even in the best circumstances having your period can be an unpleasant experience, but for many women and girls around the world, it presents a serious problem.

In low income countries, many women and girls don’t have access to affordable and hygienic feminine products; instead they are forced to use improvised materials like rags or leaves, which are not only uncomfortable but can also lead to infection or embarrassing leaks.

This isn’t just a “third world problem.” Many women and girls in the USA also struggle to access the hygiene products that they need. Homeless women in particular struggle to obtain these products, which despite high demand, are frequently unavailable at shelters and food banks.

And, it’s not just homeless women and girls who face these problems. Feminine hygiene products are expensive—the estimated cost of a year’s supply is $70—and they are not covered by food stamps. Periods are a significant expense, made even more expensive by the fact that in 40 states nationwide, tampons are considered a “luxury” and so are taxed.

Women and girls also need access to safe, private, clean bathrooms or latrines with a place for washing up so that they can manage their periods and keep themselves clean. However, for homeless women in the US, and women and girls in low income countries, this is often difficult to find, if not impossible. One in three people worldwide don’t have access to a toilet—that’s a lot of women left searching for a private place to go.

Compounding these issues, is the fact that menstruation is an incredibly stigmatized topic worldwide. In most cultures, including our own, menstruation is not openly discussed. If girls are lucky, they may learn about the menstrual cycle as part of their school curriculum, but in many places worldwide not even that happens.

Harsh social taboos also limit the roles and actions of women and girls while they are menstruating. For example, in some parts of India, women and girls may be excluded from eating with their families or bathing when they have their periods.

It’s difficult to imagine that in 2016, a simple biological process experienced by 800 million women and girls every single day can be such a problem, but it is.

It’s an education problem: When girls don’t have access to the supplies and facilities they need, they may miss school during their periods. Even if they do attend school, they may be distracted, anxious and uncomfortable. This can have a serious impact because educated girls are more likely to earn a good income, are less likely to be married as a child, and are more likely to raise healthy babies.

It’s an economic problem: When women have to miss work because they are unable to manage their periods in the work environment, they lose out on potential income. When feminine hygiene products are expensive (due to taxes, limited supply, etc.), many women and girls have to make critical choices between buying these products and other necessities.

It’s a dignity problem: Women and girls shouldn’t have to suffer from anxiety, embarrassment and discomfort because of a natural process, but in almost every country they still do.

There is hope though. Recently, the issue of menstruation has been gaining attention, and an increasing number of organizations are working to combat this issue. To address all aspects of this problem, approaches must be comprehensive:

Improve access to supplies: Women and girls need access to affordable, safe feminine hygiene products. That’s why child rights organization Plan International has partnered with social enterprise BeGirl in Ethiopia to provide girls with access to their reusable panty-pads. And why, Camions of Care—founded by Nadya Okamoto, a member of Plan’s Youth Advisory Board—works to collect and distribute hygiene care packages to nonprofit partners across 10 states in the US.

Improve access to facilities: Women and girls also need proper sanitation facilities, which is why Plan engages in a human centered design process to create girl-friendly facilities in schools, health clinics and communities.

Improve knowledge and reduce stigma: But providing facilities and supplies isn’t sufficient—the stigma of menstruation must also be addressed through large-scale behavior change. Internationally, Plan is working to break the silence surrounding this topic by providing women and girls with education and information on menstruation and options for managing their periods. In addition, Plan engages men and boys in discussions about menstruation because they have a critical role to play in changing societal attitudes and creating a positive environment. On the domestic front, Camions of Care is also working to raise awareness about menstruation, and to reduce the stigma.

2016-05-17-1463521161-8015176-201305UGA91-thumb

Photo credit: Plan International/Richard Wainright

Through the work of these organizations and others like them, a lot of progress has been made, and we’re just get started. Menstruation is still an uncomfortable topic for most people to talk about, and it remains underfunded, under researched, and underrepresented in global policy. However, by breaking the silence that surrounds this issue, raising awareness and combatting taboos, and ensuring access to supplies and facilities, we are changing the way this issue is addressed.

So this Menstrual Hygiene Day (May 28), I challenge you to join the conversation, because #MenstruationMatters, period.

Hanna Woodburn, Deputy Secretariat Director for the Global Public-Private Partnership for Handwashing

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. 

Global Handwashing Day

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.

Catarina testing questionnaires with BRAC team in Mymensing, North Bangladesh. Credit: Catarina Fonseca

Catarina testing questionnaires with BRAC team in Mymensing, North Bangladesh. Credit: Catarina Fonseca

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”. 

Secondary school girl in Meymensing, Bangladesh. Credit: Catarina Fonseca

Secondary school girl in Meymensing, Bangladesh. Credit: Catarina Fonseca

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. 

WASH in schools Bangladesh, 2012 UNICEF. Source: UNICEF WASH for School Children South Asia Report

WASH in schools Bangladesh, 2012 UNICEF. Source: UNICEF WASH for School Children South Asia Report

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

University of Toronto

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.

A mother washing her child’s hands in Benin. Credit: Ollivier Girard

A mother washing her child’s hands in Benin. Credit: Ollivier Girard

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. 

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