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Editor's Note: In this post, Ammar Fawzi, Global WASH Advisor with GOAL, discusses the prospect of using smell-cancelling technology to combat global sanitation challenges in the future.

I recently attended the Global Toilet Business Innovation Summit hosted by The Toilet Board Coalition in Mumbai, India. The summit brought together key players from across the sanitation sector, but what was especially refreshing to see was the significant presence of the private sector – a sector often spoken of as the key to achieving success at scale, yet rarely actually in attendance at such summits. The range of the private sector attendees was broad, including large multi-nationals such as Unilever, Kimberly Clark Corporation, LIXIL and Firmenich, and over 75 small- and medium-scale entrepreneurs and businesses.

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Undoubtedly, one of the highlights of the three days was a talk from Firmenich on Eliminating the “yuck factor” with smell science. You might have already seen the video that they premiered at the event, or read about it on Bill Gates’ Blog. Essentially, Firmenich is working with the Bill and Melinda Gates Foundation to tackle latrine malodour with “smell-cancelling” technology. The argument is that too often toilets don’t get used because they smell bad, and to combat this, Firmenich researchers are working on developing fragrances that block certain receptors in our noses, making us unable to register certain malodours. Think of noise cancelling headphones for example, but using your nose instead of your ears. As Bill Gates himself puts it, “The question now is whether this technology is good enough to make a difference in communities with poor sanitation.”

Innovative solutions to tackling global water access, sanitation, and hygiene (WASH) issues are often a cause of much excitement, especially when a large multi-national company is seen to be working on something as exciting as this and is backed by the Gates Foundation. There is, after all, plenty of depressing statistics and indicators on access to sanitation in our sector, so why not afford ourselves the opportunity to get excited by something as pioneering and potentially as game changing as this? I would agree, however, perhaps the question that needs to be asked is not whether this technology is good enough to make a difference, but instead how can it make a positive difference?

Although smell-cancelling technology is still a long way from being usable and available, let’s just assume that it is ready to roll out and let me play devil’s advocate for a moment to pose some key questions about the potential impacts of this innovation:

  • Would you still be keen on using a latrine if there was poop all around the toilet even if there was no smell? This technology could be seen as a substitute for Operation and Maintenance (O&M) which will be required, perhaps more than ever, if a latrine has more users. Caretakers might feel that they no longer need to keep up hygiene standards - there is no smell, so it must be clean! Effective O&M from caretakers is often needed (but not always) to manage the emptying of pits, ensure there is access to water and soap, maintain hygiene, and collect user fees where relevant. Can we expect them to do all of this if they can’t keep a latrine clean and smelling decent without the use of this technology? Are we addressing a simple problem with a complex technical solution? Should we also be concentrating on behaviour change (people are embarrassed to be seen going to a latrine), increasing capacity, and promoting adequate monitoring with suitable incentives?
  • How will this technology be rolled out and integrated into existing supply chains so that it is accessible in hard-to-reach places in sub-Saharan Africa?
  • Public latrines aren’t always used as latrines. I’ve seen them used as homes, storage, and even a pigeon breeding home. What will happen if we make them smell too nice?
     
  • Flies are attracted to strong smells and there is a direct correlation between smell and presence of flies. I wonder, would this technology also work on pathogen vectors? It would be fantastic if it did, but if it didn’t, people might think their toilet is lovely when really there are many vectors spreading disease. Our overall target as professionals is to improve public health – not to increase latrine use. There is a case to be made that there is a logical and evolutionary reason for smell. In 2003, researchers at the London School of Tropical Hygiene and Medicine carried out a study on smell and our association with disease. One of the researchers on the team, Val Curtis, echoes a suggestion that goes back as far as Charles Darwin: that we think poop stinks for our own good. Our disgust towards certain sights and smells, said Curtis, is a “behavioural immune system”: an adaptation—biologically rooted, but tweaked by culture and social conditioning—that evolved to keep us from coming into contact with infection and disease. Perhaps we shouldn’t be playing with this formula.

I don’t mean to be all doom and gloom. One area where this technology could really have an impact is in container-based sanitation. Many of the enterprises like Clean Team, Sanivation, SOIL or Mosan working in and pioneering this approach, rely on business models where the collection of waste from households is every two or three days. This is how long it takes it starts to smell and it doesn’t become something you want in your house. But what if this technology could be used here? Collection time could be increased to perhaps five days or more and this could be a successful method for scaling up access to sanitation by making business models more attractive and cost neutral.

Refugee camps and those for internally displaced people might also provide a great opportunity to trial this technology. The O&M works differently in this setting, there is a reliable supply of international products making their way to the camp from the implementing partners, and the focus here is less on behaviour change and more on public health impact.

I congratulate Firmenich and the Gates Foundation on this project and their early results. Let’s hope that if the opportunity comes, we as a sector can utilise it in the most beneficial way possible.

Editor's Note: This post discusses the method of Community Led Total Sanitation (CLTS) and how we can ensure that sanitation is both sustainable and inclusive. This post originally appeared on the website of Institute of Development Studies, to view the original post please click here

Great strides have been made in improving sanitation in many developing countries, not least through Community Led Total Sanitation (CLTS), an innovative method developed to address the behaviours behind ongoing open defecation. CLTS has spread rapidly over the last 16 years and is now present in over 60 different countries. However recent research shows that more thinking and action is needed to ensure that sanitation efforts are sustainable and inclusive. A new book, entitled Sustainable Sanitation for All, examines how CLTS and the WASH sector more generally has and needs to continue to evolve to meet these challenges.

Creating an Enabling Environment for CLTS Sustainability drawing - credit: Barney Haward

Creating an Enabling Environment for CLTS Sustainability drawing - credit: Barney Haward

The urgency of the sanitation crisis cannot be underestimated. An estimated 2.4 billion people worldwide still lack access to adequate facilities, of whom 1 billion defecate outdoors. Faecally transmitted infections, poverty, and undernutrition reinforce each other.

In December 2015, a UN General Assembly resolution defined water and sanitation as two separate rights for the first time while the Sustainable Development Goals (SDGs) include the ambitious aim of universal access to improved sanitation by 2030, with targets that include the elimination of open defecation.

The achievement of open defecation free (ODF) status is increasingly being recognised as only the first stage in a long process of change towards Total Sanitation.

“Open defecation free is just a start, we need to maintain the gains, deal with the faecal sludge, resolve problems of menstrual and hand hygiene, and see sanitation businesses spread around the world.” Professor Val Curtis, Director of Environment Health Group at the London School of Hygiene & Tropical Medicine.

New book “Sustainable Sanitation for All” looks beyond open defecation free

With a particular focus on sustainability of behaviour change as well as physical infrastructure, post-ODF follow up and monitoring, and ensuring equity and inclusion, Sustainable Sanitation for All includes 18 contributions which look at cases from Asia and sub-Saharan Africa. Edited by Petra BongartzNaomi Vernon and John Fox, the book was produced by the CLTS Knowledge Hub, based at IDS and published by Practical Action.

Exploring current experiences, innovations and insights, the book addresses two key questions:

  • How do we reach the poorest and most marginalized, with toilets that are suitable to their needs?
  • How can we embed hygienic habits and create new social norms around sanitation behaviour?

In his foreword to the book, Robert Chambers writes, “The empirical evidence and analysis in the eighteen contributions made in this book show just how much has been learned. We have learned that without losing its core essence, CLTS must be adapted and evolved to fit national and local conditions.”

One-day meeting brings water and sanitation experts together on how to take forward and expand on CLTS

On 23 November, the CLTS Knowledge Hub brought together over 20 experts on sanitation (CLTS and WASH) to discuss the challenges and opportunities for making sanitation sustainable and inclusive and to elicit views on how to better meet the needs of the sector through its activities.

participants at the CLTS workshop - credit: E.Wilson - IDS

participants at the CLTS workshop - credit: E.Wilson - IDS

Diversity of contexts requires adaptable and pluralistic approaches

The huge diversity in contexts within which CLTS has been used suggests that the traditional approach needs to be adaptable to respond to different needs. The range of different experiences to learn from is much wider than it was just 5 years ago. There are now opportunities for pluralism and with that more openness and learning.

Inclusion needs to remain at the forefront of efforts to sustain ODF communities When done badly, CLTS has been known to exacerbate existing inequalities. Whilst in an ideal case scenario, the poor or less able are helped by the better off, in practice, this is often not the case. Since the poor and less able people find it the most challenging to access and sustain adequate sanitation facilities and bear the highest burden of disease it is imperative that better ways of reaching them and meeting their specific needs are found.

Do subsidies need to be revisited?

Whilst CLTS has always maintained a strong position against individual household hardware subsidies, it may now be time to look at how smart financing mechanisms could support efforts to make sanitation more inclusive.

In many cases, maintaining a position against subsidies is the right thing to do, in order to achieve the behaviour changes needed to achieve ODF. However, many present at the meeting agreed that a more nuanced and targeted approach to subsidies, for example through a voucher or rebate systems as described by Andy Robinson's book chapter, may add value.

Sanitation Marketing

We have come a long way since some of the early meetings and discussions when CLTS and sanitation marketing were presented as opposing approaches with practitioners aligning themselves to the different camps. Now there is a far more nuanced understanding and discussions are evolving around ways CLTS and sanitation marketing can complement each other and be phased together to ensure sustainable ODF communities.

Handwashing CLTS must be better linked together with other sanitation and hygiene concerns. One crucial area that was identified as a frontier we have yet to crack was handwashing. It is clear that more innovation is needed in order to influence handwashing behaviour in communities.

Editor's Note: This post explores ACTED's efforts to encourage good hygiene practices among Syrian refugees in the Dohuk governate in Iraq. This post originally appeared on ACTED's website, to view the original post please click here.

ACTED case workers conducting hygiene education activities with children in Syrian refugee camp - ACTED Iraq, 2016

ACTED case workers conducting hygiene education activities with children in Syrian refugee camp - ACTED Iraq, 2016

Today, 2.4 billion people in the world are struggling to stay well and keep their children alive due to the lack of access to hygiene and sanitation services. In recognition of the importance of addressing this global challenge, ensuring access to water and sanitation was listed as Sustainable Development Goal #6 in 2015.

Poor sanitation and children’s vulnerability

Inadequate provision of water and sanitation, and poor hygiene education affect people of all ages, but particularly compromise the well-being of children, who tend to be more sensitive to preventable diseases than adults. The integration of simple practices, such as hand washing and correct oral hygiene, in children’s day-to-day life can prevent the occurrence of a variety of conditions – from infections to tooth decay – that have both short and long-term impacts on their physical development. Keeping this in account, ACTED’s programme teams in Iraq have adopted a mainstreamed and multi-sectoral approach to target the water, sanitation and hygiene (WASH) needs of children and youth.

Hygiene promotion for young ages

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A clear example of this approach is the integration of hygiene promotion in ACTED’s child protection programmes. In ACTED’s child and youth friendly spaces in Domiz 1 and Domiz 2 Syrian refugee camps in Dohuk governorate in Iraq, hygiene promotion is a daily activity, implemented through awareness-raising sessions with children and youth. In order to get even the youngest ones involved, ACTED staff utilises participative methods for teaching good hygiene practices, including dramatizations, cartoon drawing, singing, peer-to-peer sessions, and short films. In recent activities, conducted in partnership with Medical Corps and Doctors Without Borders, awareness-raising campaigns were complemented by the distribution of toothpaste, toothbrushes and anti-lice shampoos to refugee families living in camps.

A multi-sectoral approach to water, sanitation and hygiene

ACTED’s comprehensive approach to providing water, sanitation, and hygiene does not only focus on encouraging good hygiene practices among the youngsters. Child Protection teams operating in Domiz 1 and Domiz 2 also conduct hygiene promotion campaigns with parents, caregivers, and volunteer committees with the focus on providing support to children and youth. These hygiene messages are shared with the community through providing information leaflets, ensuring that counselling sessions are available, and having dedicated awareness-raising activities on health and hygiene, such as the one organised in Domiz 1 refugee camp for parents whose children have been affected by lice.

Integrating hygiene promotion activities into child protection programmes allows ACTED not only to reach vulnerable children while most in need, but also to promote their physical well-being in the long-term.

Editor's Note: In this post, Guang Z. Chen, Senior Director of Water Global Practice at World Bank Group, discusses the role of World Bank and its partners in meeting the water-related challenges facing our world. This post originally appeared on The Water Blog of the World Bank Group, to view the original post please click here

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To many people, it is a surprise to learn that in an age of such advanced technology, at least 663 million people still lack access to basic needs, like safe drinking water, or that 2.5 billion people lack access to sanitation, such as a toilet or latrine. And while much progress has been made, receiving safe drinking water 24 hours a day, seven days a week simply by turning a tap is still a dream for many in the developing world.
 
Even fewer realize this is not just a problem for families, but also for those on which families rely and that also need water: the farmers who grow the families’ food, the environment that protects and sustains their homes and communities, the businesses that employ them, the cities that house them, the schools that educate their children, the clinics and hospitals that treat them, and even the power plants that generate their electricity.
 
Why does this challenge persist? How can this challenge be met? And an increasingly urgent question: is there enough water to go around?

Water is becoming increasingly scarce, including in places where it was once considered plentiful. Meanwhile, extreme water events, such as floods and droughts, are increasing in frequency and intensity because of climate change. Further, cities are growing faster than ever, which means more demand coming up against a decreasing supply.
 
This is an urgent challenge. Business as usual will see some areas lose up to an additional 6 percent off of their GDP growth by 2050. Something has to change.
 
I recently assumed the role as head of the World Bank Group’s Water Global Practice (GP)to help countries do just that. With a portfolio of roughly $35 billion in 170 water related projects globally, the World Bank Group is the largest external financier of water related development projects. In response to demand from countries for support in implementing these changes — in the form of Sustainable Development Goals (SDGs) related to water — we will leverage this portfolio and draw on a team of over 300 experts from 78 nationalities based in nearly 60 countries around the world to help our clients identify options for economically, environmentally and socially sustainable solutions tailored to their context. Success will require a focus on institutions, information, and infrastructure.
 
We will do this working with the United Nations, civil society organizations, the High Level Panel on Water, and other sectors like agriculture, environment, energy, urban development, and the climate policy community to help countries bring about that change in a way that acknowledges the right to water and sanitation for all, the value of water and water-related services, in behavioral, cultural, and economic terms, and the role of water in climate change adaptation and mitigation.
 
Today, many people have the false perception that freshwater resources are infinitely available and therefore of lesser value. This leads to behaviors like overconsumption and poor services. Given this, it is important to recognize the call to action by the High Level Panel on Water (HLPW), which met for the second time a few weeks ago at the UN General Assembly in New York. At that meeting led by World Bank President Jim Yong Kim and UN Secretary-General Ban Ki-moon, the HLPW launched an action plan to mobilize the global community around SDG 6 and related targets. I echo their call for a fundamental shift in the way the world thinks about and values water, with the vision of a future where individuals and societies automatically make better decisions with respect to water and how it is used and allocated.
 
However, I also believe donor support is one piece of a larger puzzle. Countries need support from their leaders, citizens, and neighbors to bring about this kind of change in mindset towards water stewardship.
 
At the World Bank Group, with an eye towards ending poverty by 2030 and promoting shared prosperity, we will do our part working with partners to drive towards the water related SDGs and continue building support for this change to encourage the political will and financial resources needed to help countries meet their targets with home grown, scalable, and sustainable solutions.
 
I am glad to see the Water GP has advanced in an area for which I have advocated for some time: connecting the water supply and sanitation subsector to broader water resources management. I also believe it is increasingly impossible to separate the Water agenda from the urban agenda, just as we cannot separate the climate and Water agendas. There is much we can do on Integrated Urban Water Management to help countries tackle these challenges.
 
Similarly, it is increasingly difficult for countries to separate water from agriculture, environment, energy, health, and others, which all rely on water. We’ll work closely with our colleagues in other GPs at the World Bank Group to help identify cross-sector solutions that could help our country clients leapfrog ahead.
 
We must also work hard to ensure focus on global trends does not take focus away from trends like slow progress in ending the practice of open defecation. Sanitation was the most off track of the MDGs, so we must continue the focus on the SDG targets for water supply and sanitation. In addition to our work on rural sanitation, we are intensifying our efforts on urban sanitation and fecal sludge management.
 
Thanks to support from bilateral donors, we will continue to supplement Bank operations with thoughtful analysis, cultivated partnerships, and advocating for high level support on issues like sanitation and climate change, which we hope will help us continue to be a reliable, effective partner for our clients.
 
Looking ahead, I do believe it is possible to achieve much together with our eyes set on the World Bank's twin goals of ending extreme poverty and boosting shared prosperity and the SDGs related to water. I look forward to hearing feedback from you during this journey together. 

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, Georges Mikhael, Head of Sanitation at Water & Sanitation for the Urban Poor (WSUP), explores the importance of government buy-in for improving sanitation.

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I think I may have recently witnessed a real toilet revolution! As Water & Sanitation for the Urban Poor’s (WSUP’s) Head of Sanitation, a general poop enthusiast, and having been born on World Toilet Day, I hope you can understand how exciting this is for me.

I recently visited Visakhapatnam (‘Vizag’ for short) for the second time to support the WSUP Advisory India team in their implementation of a USAID project supporting the Greater Visakhapatnam Municipal Corporation (GVMC). Vizag is the largest city in Andhra Pradesh state, found on India’s eastern coast.

The project aims to improve sanitation across the whole city – eliminating open defecation and making sure that all residents have access to a toilet.

Since my first visit, I found an unmistakable urgency and energy in the way sanitation is being tackled in India by different institutions as a result of Prime Minister Modi’s commitment to Swachh Bharat Abhiyan, a national campaign to clean up India in time for Mahatma Gandhi’s 150th birthday on  October 2, 2019.

I had heard reports from my Indian colleagues about the speed at which authorities are making decisions on sanitation issues, and I had seen maps showing the rapid progress being made on the ground - a lot of toilet building!

But this urgency only really hit me once I got out to the Bnr Nagar community in Vizag. Everywhere I looked, literally every few steps I took, there was a toilet at a different stage of construction. I wasn’t taken to this community because it represented a standout example of progress on construction of toilets – there are plenty of other communities just like it around the city.

Of course, constructing toilets is just one part of improving sanitation, but GVMC, supported by WSUP, is already looking at the next steps, including how to deal with the challenge of emptying toilets on the hillsides around Vizag.

At WSUP, we always talk about this so called ‘enabling environment’, and how important it is to making progress in sanitation. It is core to our theory of change; it’s in all of our national business plans. But it can be hard to grasp what it actually is, and how to make it more effective.

It was obvious to me during this trip that an important part of the enabling environment is without a doubt government spending: the Government of India’s 2016 budget for the Swachh Bharat was US$ 1.3 billion. That’s about $1 per person across the country in just one year. As WaterAid’s recent study of East Asian countries has shown, it is obvious that commitment by political leadership is a major factor for improving access to safe sanitation.  

What could be done in Maputo if $1 per resident per year were spent on sanitation by the municipal authority? Lusaka? Freetown? Without a doubt, we could make much more rapid progress on Sustainable Development Goal 6 if this level of government buy-in were replicated around the world.

So if you’re curious what a real toilet revolution looks like, if you want some inspiration, consider a trip to Vizag. Maybe bring an aspiring politician with you.

Editor's Note: In this post, David Kreamer, Professor of Geoscience, a Graduate Faculty member in Civil and Environmental Engineering, and past Director of the interdisciplinary Water Resources Management Graduate Program at the University of Nevada, Las Vegas, offers suggestions for the hydrophilanthropist wanting to make a positive impact on communities and ecosystems.

Northern Ghana. Photo Credit: David K. Kreamer

The Challenge

Say you wanted to put in a well in a small community that needed water, in an economically depressed part of the world. You did your homework on how a well could be built for sustainable, good quality water. You gathered the resources, knew the well would not dry up nearby springs because you understood the local hydrogeology, and had a pump design that could be supported by the community and repaired if broken in the future. You set up a system for the community to periodically test the water quality, ensuring it would remain safe.  Sounds perfect, right?

But what if that well was placed in the backyard of someone in the community that everyone disliked? You may have just started a local water war that could last generations. 

There are a multitude of ways that a well-meaning hydrophilanthropic person or group, with clear objectives and an eagerness to improve the human condition, can make things worse. Rather than alleviate suffering, imprudent actions can reduce the quality of community life, and individual health and safety. Plunging unawares in one of countless pitfalls is surprisingly easy, particularly for those lacking a holistic view and having little background in water projects.

Perspectives and Strategies for Getting It Right – Some Suggestions

Water can help both communities and ecosystems by propelling agriculture and economic growth, ensuring improvements in health, reducing work absenteeism,  increasing opportunities for childhood education (which is sometimes gender-biased against girls who gather water), and  combating the effects of drought and climate change. 

As many readers know, statistics suggest that the water and sanitation crisis will expand.  Estimates related to water scarcity indicate that approximately 3.4 million people, over half of which are children, die from lack of clean drinking water each year, and 748 million people do not have access to clean water. In addition to direct mortality from thirst and waterborne disease, mortality could be even greater because of cascading effects, such as death from malnutrition caused by water shortages to agriculture and herd animals. Sanitation statistics are even worse with the World Bank (2014) estimating 2.5 billion people don’t have access to improved sanitation and 1 billion practicing open defecation.

Here are a few suggestions for the hydrophilanthropist wanting to make a positive impact on communities and ecosystems:

  • Take a long term view. Studies support the idea that fewer, sustainable water and sanitation developments are more beneficial than numerous, short-lived developments which can be neglected and fall into disrepair.  
  • Ensure follow up and sustainability. Make sure there are local resources, expertise, and educational programs for continued project viability. Consider regular sustainability audits.
  • Plan a post-project monitoring program, with community-based stewardship. Try to anticipate multiple outcomes for your project, and think about future, mid-course corrections (create Plan B, and maybe C and D).
  • Ensure that those who use water or sanitation facilities will be physically safe and secure. This may involve carefully planning the location of and access to facilities.
  • Also when considering location, make sure the science and engineering are right. Get experts and/or facilitators involved.  Wells that are too close to pit privies can cause disease. Wells that are hydrologically connected to springs or other wells could dry them up. A borehole in the wrong geologic media could have an adverse water quality that could poison people, domestic animals, and wildlife.
  • Seek engineering designs for wells and other facilities that are the appropriate technology for the community.  Sometimes low-tech is the right tech.
  • Include community education for two reasons. First, so outside people wishing to help a village can be educated by the community to understand local needs, cultural wealth and values, existing local resources, economic goals, religious appreciations, and identify gaps in human and physical resources. Second, outside people can work with locals to bring in additional educational resources, help establish  household education and action plans, and  explore possible connections and collaborations with nearby schools and universities.
  • Work with the local community to understand the social and moral norms. Research culture and traditions prior to your arrival, and ensure language translation accurately communicates ideas. It is not advantageous to impose pre-conceived values on a community. Pre-planning and pre-construction site visits can be key to establishing trust, understanding, and rapport.
  • Be aware of the political landscape. Be cognizant of the impacts of any local policies and laws, note any corruption and unrest, appreciate positive community resources, and determine how hydrophilanthropic work might best fit in. 
  • Know the impacted population’s goals for economic development and specifically how a water or sanitation development can strategically help boost economic growth. Think about how your project fits into a livelihoods-based approach to community development.
  • Seek experienced project leadership for hydrophilanthropic efforts. Water and sanitation efforts with strong leadership, mentoring, technical expertise, and continuing communication among practitioners and stakeholders typically have built-in resilience, underlying confidence, and the perspective provided by that experience.

Keeping some of these principles in mind can direct hydrophilanthropy in a positive way and increase the efficacy of water and sanitation projects. 

More information can be found at: http://specialpapers.gsapubs.org/content/early/2016/03/07/2016.2520_19.abstract

Editor's Note: In this post, Anita Zaidi, Director of the Enteric and Diarrheal Diseases (EDD) program at the Bill and Melinda Gates Foundation, discusses how we can use data-driven approaches to defeat diarrheal diseases. This post originally appeared on Huffington Post, to view the original article please click here

When I was a young girl in Pakistan, my mother would remind me daily to only drink boiled water. We almost lost my sister to severe diarrhea and my mother was determined to make sure this didn’t happen to our family again.

Back then, I didn’t fully understand her. It wasn’t until years later, when I became a pediatrician and a child health researcher, that I realized how deadly watery stools can be.

Unlike for adults, the rapid loss of liquids caused by severe diarrhea can bring children and babies to the brink of death in a matter of hours. Last year alone, over half a million children under five died from diarrheal diseases - that’s more than one every minute. And for those that survive, the resulting rapid dehydration and metabolic disturbances can lead to long-term damage to the gut and increased risk of malnutrition.

The sad truth is that the ripple effects of something as seemingly simple as a case of childhood diarrhea often extend far beyond health: children miss out on school, treatment costs can drive their families into poverty and in many countries, nursing a sick kid back to health can use up resources that are needed for other essentials like food or education.

Shockingly, although the illness touches almost every family on the planet at one time or another, the primary bugs that cause diarrhea remained obscure until recent years.

In the early 1900s, many members of the scientific community accredited causes as varied as changes in seasons, feelings of panic, teething or capillary restriction. And while we’ve known for decades that water, sanitation, hygiene, bacteria, viruses and parasites play a role in diarrhea, it wasn’t until 2013 - when the Global Enteric Multicenter Study (GEMS) released - that we were able to identify the top four culprits.

The study, which looked at 22,000 kids across seven countries in sub-Saharan Africa and South Asia, was game-changing. Not only did it identify the pathogens that cause half of all cases of diarrhea in developing countries, it also singled out the biggest offender: rotavirus.

Based on the study, the global health community rallied behind prioritizing the need to get children life-saving rotavirus vaccines. But even so, we still had an imprecise understanding of these bugs.

That changed a few days ago.

The Lancet just published a reanalysis of samples from GEMS. The updated study looked at the same samples as before, but used more sensitive and advanced diagnostic methods that were able to identify the cause of diarrhea for approximately 90% of all the cases. For the first time in human history, we can identify almost all of the bugs that cause diarrhea - and what you can identify, you can prevent.

While the updated study confirmed that rotavirus remains one of the top causes of diarrheal diseases, we also learned that a bacteria unrecognizable by most, Shigella, is responsible for more illness than we previously thought.

In a world where cholera, typhoid and dysentery are well known as common diseases, it turns out that the greatest killers of children have almost no name recognition amongst parents or policymakers.

So what can we do?

For starters, most children can be saved with the solutions we have today and raising awareness of these is key. My mom was right, boiling drinking water is essential in many parts of the world. But we can also prevent diarrheal disease by improving immunization rates, community sanitation practices and encouraging moms to exclusively breastfeed throughout early infancy to build babies’ immune systems.

Furthermore, increasing access to prevention and treatment tools is critical to give all children the chance they deserve. It is essential to make sure that life-saving oral rehydration solutions and zinc therapy are quickly available.

Vaccines for Shigella don’t yet exist but are being studied and developed by scientists, and we need to support and speed up that research. However, vaccines for rotavirus are available now, and we need to make sure every child in the world gets them. Since 2013, the number of countries that have introduced rotavirus vaccines into their national immunization programs has increased from 17 to 81. Despite this, only 15% of the children in the world’s poorest countries have access to it.

There is much to do, and scientists, while mighty, cannot do it alone. Governments have a pivotal role to play to ensure children everywhere have access to these lifesaving tools. This will require increased political will including increased financial commitments and policies that prioritize child health.

Every child should have the opportunity to live a long, healthy and productive life - and it’s up to us to make sure they have that chance.

Editor's Note: In this post, Vincent Masterson, an International Education & Training Advisor at CAWST, discusses the importance of training people how to be effective WASH promoters in order to achieve real behavior change in communities. This post originally appeared on CAWST's blog, to view the original post please click here

Community-WASH-Promotion-in-Action

When designing training, program managers often include only technical knowledge. Subject matter knowledge is essential, but developing skills to present and communicate information, relate to target audiences, and disseminate complex information for the purpose of learning are equally important.

Take the case of Community WASH Promoters. They certainly need to know how to treat water, how to collect rainwater safely, how to build a basic latrine, and to understand the importance of handwashing. To be effective in their role’s objective of achieving behaviour change in their communities, however, it is also crucial for them to have interpersonal and observational skills. They need to identify WASH issues in a household, effectively deliver key messages using education materials, actively listen, ask questions, and fill out forms.

We have spent 15 years listening to our clients who work with Community WASH Promoters and collected learnings from program managers about what has worked and what has failed in the implementation of their programs. Across continents and cultures, one of the top challenges they have shared is getting people to change their behaviours. Although WASH organizations clearly see the link between improved WASH and improved health, this is not always the case for community members.

We have listened to our clients’ challenges and designed a new Community WASH Promotion workshop. In addition to WASH technical knowledge, it teaches participants how to be effective WASH promoters, and provides them the forum to practice that role in a safe simulation setting.

Only one-third of our Community WASH Promotion workshop covers technical knowledge of WASH. The rest of the time is allocated to preparing participants to perform their role effectively. The entire first day of the training is used to prepare Community WASH Promoters to think critically about the reasons why community members may have difficulty, or may not want, to change their behaviour and adopt healthy WASH practices. They learn how to actively listen to understand the needs of community members, and then practice on-the-spot modifying their key messages to meet those reasons.

Two important traits of being an effective trainer are: 1) Delivering the information in such a way that it is relevant to the experience of the learner; and 2) Creating the opportunity for the learner to use the newly acquired knowledge and skills in real life. We use the Kirkpatrick framework in our instructional design process, which gives us the ability to focus on the behavioural outcomes of how the learner will use the information in real life. Community WASH Promoters will be much more effective in their role if they are given the opportunity to practice and receive feedback on their performance in that role.

The implications of this instructional design approach are profound. As program managers, we need to assess not the knowledge of the Community WASH Promoter, but their ability to create positive behaviour change and impact in their communities; and the way this workshop was designed, does exactly that. This workshop focuses on the result of their work, rather than their knowledge.

CAWST’s new Community WASH Promotion workshop will be piloted in Kenya in October.

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