Hygiene promotion: lessons from Save the Children’s programme in Malawi

When Save the Children launched its School Health and Nutrition (SHN) program in Mangochi, Malawi in 1998, only 42 percent of schools had access to clean water and none had hand-washing facilities. [...] Only 54 percent of schools had separate facilities for girls. In 2003, when Save the Children expanded its SHN program in Malawi to Balaka district, the situation was a marginally better than it had been in Mangochi five years before [and] as in Mangochi, no schools in Balaka had hand-washing facilities.

Qualitative surveys conducted in both districts also showed that before Save the Children’s SHN program:

• Students traveled long distances to fetch water, which often made them late [to class or] miss class altogether;
• Girls who traveled to collect water faced harassment from boys and men;
• Girls missed school when they were menstruating due to the lack of privacy in school latrines;
• Students drank from unprotected shallow wells and rivers;
• Students did not wash their hands after using the toilet because there were no hand-washing facilities; and
• Despite the availability of facilities, many children did not use them because they were locked or unhygienic

To increase access to and use of safe water and sanitation facilities, Save the Children worked with communities, schools, and water and sanitation experts to construct and rehabilitate boreholes, latrines, and hand-washing facilities and to train teachers and communities on hygiene.

Separate, ventilated latrines with doors and handwashing facilities nearby not only promote good hygiene but also enable girls to consistently attend school. Photo. Save the Children

[...] Quantitative and qualitative end line surveys conducted in Balaka and Mangochi district in 2006 and 2007 respectively showed that the presence of adequate water and sanitation facilities have had a tremendous impact on children’s lives and communities.

Despite these important achievements, the project encountered a number of challenges:

• Only 33 percent of the handwashing facilities in schools were functional and none had soap or ash. [...] When communities provide soap, it usually gets stolen. Just 41 percent of children report hand-washing after visiting the toilet and only 28 percent of children said that they used soap and water the last time they washed their hands.
• Community resource efforts were not consistent. In less active communities that did not provide sand, bricks and labor, latrines and hand-washing facilities were not constructed. However, among most communities that did provide resources, community participation helped create a sense of ownership and ensured the facilities were well-maintained.
• Community members sometimes vandalized handwashing facilities [and] school committees could not always afford to [...] fix facilities quickly. To minimize these incidents, Save the Children directed communities to report all instances of vandalism to the police.
• Rural shop owners did not regularly keep borehole parts in stock, so community members had to travel long distances to buy them.
• Water monitoring assistants conducted frequent supervision of the water point committees to ensure the committees and the boreholes functioned properly.
• Monitoring of hygiene education in schools was infrequent, as primary education advisors rarely monitored the teaching of hygiene. [...] Some teachers said they were not comfortable with the topic due to its sensitive nature and the use of words such as “defecation.”

While Save the Children’s SHN program saw tremendous progress in improving access to safe water and adequate latrines, hand-washing remained a low priority for schools and communities. Hand-washing facilities are not maintained and children rarely wash their hands with soap or ash. A targeted campaign around the importance of hand-washing is needed. Save the Children’s experience in Mangochi and Balaka districts illustrate the importance of community participation and ownership along with regular supervision.

[...] After approximately 20 years of programming and ten years supporting School Health and Nutrition in the district, Save the Children is phasing its programs out of Mangochi. Malawi’s Ministry of Education adopted most of Save the Children’s School Health and Nutrition activities when it began a nation SHN program in 2007. Unfortunately, the provision of water and sanitation facilities is expensive and the government will probably not be able to bare the full cost to equip all schools with adequate facilities.

Source: Save the Children (2008). Improving water, sanitation, and hygiene behaviors in schools : successes and lessons learned from Mangochi District, Malawi. 4 p. Download here

Transparency: public accountability through “Citizens’ Voice” initiative, Cape Town, South Africa

The “Raising Citizens’ Voice in the Regulation of Water Services” is a public education initiative driven by the National Regulator (currently within the Department of Water Affairs and Forestry [DWAF]). It supports a bottom-up approach to water services regulation by actively involving citizens in the local monitoring of water and sanitation services.

It aims to empower citizens to hold local government accountable through:

• Training citizens about their rights and responsibilities, and then
• Setting up “User Platforms” which serve as monthly meetings between the municipality and the community for ongoing civil society water services monitoring and problem solving.

The initiative aims to build partnerships between the three spheres of government (national, provincial and municipal levels) and civil society.

Important lessons learned so far are:

• the need to secure political support, through getting endorsement and providing training to local government officials;
• after citizens are trained, User Platforms should be established as soon as possible to keep them engaged;
• ensure citizen ownbership of User Platforms and not let them become a public relations vehicle for local government.

Read the full story in the WIN-SA lesson series no. 20 “Public accountability through “Citizen’s Voive”: City of Cape Town shares good practice (March 2009).

Urban sanitation: putting people at the centre of informal settlement upgrading in Pakistan

The Orangi Pilot Project (OPP) has transformed sewage systems in low income, informal settlements (‘katchi abadi’), where 60 percent of Karachi’s population lives. OPP has challenged development approaches, which are very technical and overly-dependent on government and donor support. Such approaches treat poor communities as objects, rather than drivers, of development.

A report for the International Institute for Environment and Development, in the UK, explores how OPP has expanded from a focus on the ‘katchi abadi’ of Orangi to become an important voice on issues related to sewerage, drainage sanitation and informal settlement upgrading across Karachi.

[...] OPP has achieved credibility over years of rigorous mapping and documentation. [...]. OPP’s model of low-cost sanitation gives residents the responsibility of building household and lane-level sanitation infrastructure. Municipal authorities are responsible for building and maintaining secondary infrastructure. [...] Infant mortality rates have declined dramatically.

[...] In order to ensure individuals are driven by ideals, not [...] financial reward, OPP salaries are lower than those of other NGOs.  [...] OPP does not seek large-scale funding from donors. High standards of openness and financial transparency are central to building relationships. Staff numbers are kept low by training community members as activists and mappers, and encouraging them to work themselves.

OPP rejects all form of subsidy, believing it inevitably leads to dependence [and] increases costs and causes waste. When the community contributes towards a project – [..] costs are immediately cut: designs are simplified, methods of construction are cost-efficient, and profiteering, kickbacks and professional fees for contractors, engineers and supervisors are eliminated.

OPP’s experience shows that:

• It important to work on a single issue – or only a small number of issues – comprehensively before taking on related issues.
• In order to influence government it is vital not to be confrontational: it is necessary to work patiently over a period of time with department staff and build trusting relationships with civil servants.
• Meticulous documentation of findings, observations and processes, leading to the preparation of alternatives is critical to being taken seriously by decision-makers.

Source: id21, 01 March 2009

Corruption prevention: lessons from a community management sanitation programme in Kerala, India

An estimated 20-30% of funds and materials are diverted from sanitation programmes in South India due to corruption, experts have estimated. The Socio-Economic Unit Foundation (SEUF) has successfully employed a number of anti-corruption strategies in a participatory and community-based household sanitation programme, serving more than 200.000 families in 200 Panchayats (communities). It has become a model for many other regions in India.

Learning from experience, using different strategies, including all stakeholders, using preventative measures, reserving enough time and resources for participation and capacity building and focusing on quality assurance rather than anti-corruption are among the lessons SEUF has learned from the programme.

Read more in the Water Integrity Network (WIN) best practice information sheet on the project written by Kochurani Mathew.

See also the project case study and corresponding list of tools used in the project here.

Laos: evaluation of small towns water and sanitation project

In October 1999, the Asian Development Bank (ADB) approved the Water Supply and Sanitation Sector Project to sustain improvements in environmental health and the quality of life for the urban communities in small towns. The Executing Agency was the Department of Housing and Urban Planning (DHUP) of the Ministry of Public Works and Transport.

The purpose of the Project, , which ended in July 2008, was to provide 24-hour, potable water at affordable tariffs to 12 of the highest-priority small towns and to parts of the capital, Vientiane.

The Project is considered relevant though less effective, less efficient, and less likely to be sustainable. Its overall performance is therefore rated only partly successful. Sustainability will require (i) increased support and commitment from the Government and the PNPs ([provincial nam papa (provincial water supply company)];  (ii) continued training of operational and management staff, especially in minimizing non-revenue water and improving asset management, to improve operating performance and technical sustainability; and (iii) higher revenues, through the sale of more water and an increase in water tariffs.

Lessons Learned

Noncompliance with Financial Loan Covenants. The Loan Agreement included covenants on water tariff increases, sufficient to cover O&M, depreciation, and debt service. These covenants and the WASA [Water Supply Authority] recommendations on tariff increases were not followed, contributing substantially to the poor financial position of the PNPs and the Project’s low ratings for efficiency and sustainability. If the water tariffs had been increased before investments were made in water supply facilities, the Project would have been financially viable and sustainable.

Low Connection Rates Caused by High Connection Charges Up-front. Distribution mains, but not service mains, were part of the Project at the start. The PNPs were to provide the service connections and charge consumers in advance at marked-up rates. These rates made the connections less attractive. Moreover, given the low tariffs, the PNPs could not generate enough revenues to lay service mains and facilitate the connections. The project towns have low connection rates as a result.

Low Awareness of Loan Obligations, Leading to Low Project Ratings. The PNPs and provincial governors were apparently unaware of their obligations under the Loan Agreement between ADB and the Government, particularly with respect to tariffs, financial sustainability, and outputs to be achieved. This led to low achievement of the outputs and noncompliance with financial covenants.

Continuous Support Needed for Effective Community Participation. The CAPP [community awareness and participation program] appeared to be less effective, considering the low level of disbursements from the revolving fund and the slow implementation of the sanitation works. This was because the consultants were not based in the project area and could not provide continuous support to the newly formed WSS user groups.

Read full completion report (Aug 2008) here.

Output-based aid: community water project in Andhra Pradesh, India

A project supported by the Global Partnership on Output-Based Aid (GPOBA) is piloting a project providing safe drinking water to 12,500 poor households in 25 villages in three coastal districts of Andhra Pradesh: Guntur, Krishna, and West Godavari.

Each village will have a water treatment plant connected to a water distribution point from which users will purchase water in jerry cans.

The scheme involves a public-private partnership between the Naandi Foundation, a local Indian NGO, Water Health International, a water purification technology provider, and the village councils.

As of September 2008, four Community Safe Water Schemes (CSWSs) have been constructed and verified, three in Krishna and one in West Godavari. The remaining 21 villages have been selected and 10 are in the process of making their community financial contributions. The GPOBA subsidy has made it easier for Naandi to borrow funds from commercial banks. The OBA approach is also promoting participatory community involvement and building capacity in the villages for managing and delivering efficient services. The grassroots fee-for-service model coupled
with a sense of community engagement and ownership will help ensure the long-term sustainability of the water supply schemes.

It is anticipated that the lessons learned and methodology developed for each CSWS can readily be applied to other villages in the State of Andhra Pradesh and ultimately in other parts of India. GPOBA, Naandi, and WHI believe that scaling up is possible, as the demonstration effects of each pilot will motivate adjoining villages to engage in similar projects, accelerating demand and willingness to pay for clean water through user fees. Lessons from this project may also assist in the design of national programs aimed at achieving the Millennium Development Goals for water
and sanitation.

Project web site: GPOBA – India: Safe water shouldn’t be a luxury (includes slideshow)

Source: Mandri-Perrott, C. (2008). Output-based aid in India : community water project in Andhra Pradesh. (OBApproaches note ; no. 21). Washington, DC, USA, Global Partnership on Output-Based Aid (GPOBA), World Bank. 4 p. Download here

The policy implications of accountability in municipal service delivery in Sudan

Musch, A. (2008). The policy implications of accountability in municipal service delivery in Sudan. The Hague, The Netherlands, Ministry of Foreign Affairs. 11 p. Download here.

This paper highlights the importance of issues of local government accountability to citizens, analyses how changes in accountability mechanisms have been accomplished in a specific case, and examines the policy implications. The analysis is based on the case of the city of Gedaref, in Sudan. Over a period of about eight years, many channels were created in the city through which citizens could express their concerns and demands. This compelled the local government to improve the quality of its services (drinking water, waste, health and education), issue rules that were seen to be fair, and allow the leaders of a great many citizens’ associations and participatory platforms access to decision-making procedures. Key elements in the process were increased public awareness of rights and standards, changed civic attitudes, the involvement of a critical mass of citizens, and recognition by the city authorities that they are dependent on these associations and platforms. Outside help was provided by Eindhoven, a twin city in the Netherlands through hands-on municipal service projects. Much of the funding came from VNG International’s LOGO South programme. This paper looks at how results were achieved in Gedaref and where the external actors had the greatest influence in bringing about change. It concludes with lessons and advice for donors who may wish to facilitate similar processes.

The paper recommends that donor officials:

• accept that effecting changes in accountability takes between five and ten years;
• spend less time on designing the best aid distribution channels and more time on finding trusted implementers;
• reward approaches that create choice for citizens and reach a critical mass of participation, and discourage approaches based on ‘the best accountability mechanism under the circumstances’, which are only open to a small group;
• accept approaches based on general principles that involve many civic organisations and multiple ways to reorient accountability downwards, but insist on details when it comes to the incentives.

Strengthening accountability for improved service delivery: SNV’s local capacity development approach

Todd, B. (2008). Strengthening accountability for improved service delivery :  SNV’s local capacity development approach. The Hague, The Netherlands, Ministry of Foreign Affairs. 15 p. Download here

Better accountability improves service delivery performance. Based on more than twenty-five case studies in over twelve countries, this paper describes the attempts of SNV Netherlands Development Organisation to strengthen the accountability capacity of citizens, government and service providers. Breaking accountability down into five actions, it examines a number of strategies that have produced good results. It finds multi-stakeholder approaches particularly valid and highlights the critical need to empower citizens, especially marginalised groups. Greater investment in developing the accountability capacity of local actors to delegate, finance, perform, inform and enforce, can produce significant improvements in service delivery.

While accountability is not a silver bullet, it is a powerful driver of change and improved performance. To really improve service delivery, it needs to be accompanied by other elements (such as increased resources, improved infrastructure and equipment, better technical capacity and internal reforms), which all are complementary to building capacity for greater accountability.

Examples of SNV”s work in the water sector mentioned in the paper are:

• Capacity building support for the Public Health Engineering Division of the Bhutanese Ministry of Health has resulted in an increase in drinking water coverage from 45% in 1990 to 85% in 2005. The service provider has adopted and institutionalised participatory approaches to community operation and maintenance, and to hygiene education, which communities have enthusiastically supported.

• In collaboration with the Water Resources Development Bureau in southern Ethiopia, SNV designed and supported a comprehensive governance and service delivery assessment of household access to safe water. The survey motivated the Bureau to rehabilitate 16 water schemes in two months and improve water access for 1,600 households. It also generated long-term, institutional momentum for continuous improvement.

• SNV has been working with municipal water companies in Ecuador, Honduras and Nicaragua to enhance efficiency, quality of services and sustainability through organisational development, integrated management and improved local water governance. This has helped to establish the conditions for sustainable and improved service delivery for about 355,000 people in urban areas and has created opportunities for improved livelihoods for about 210,000 rural dwellers.

• Service providers in Ghana are delegated huge responsibilities which can only be fulfilled through better coordination and collaboration with all stakeholders. In the northern capital of Tamale, the service provider can only guarantee water supply for two to three days a week. A multi-stakeholder consultation process facilitated by SNV agreed that the key to improvement lies in a new water governance system. This will involve delegating some of the service provider’s responsibilities to decentralised and non-state local providers. [...] The lesson learned is that, even within a weak institutional environment at national level, it is possible to improve performance at local level through better leadership, partnership and coordination.

Sector reforms: lessons and challenges from Kenya, Tanzania, Uganda and Zambia

A paper [1] commissioned by the German Federal Ministry of Economic Cooperation and Development, summarises critical water and sanitation sector reform implementation issues by drawing from recent experience in Kenya, Tanzania, Uganda and Zambia. It was written by a group of policy advisors of the German Technical Cooperation (GTZ), who, as long term advisors, have supported these reforms.

The experiences examined in the four case study countries clearly demonstrate that the reform process is unique to the specific institutional, historical, socio-economic and other conditions prevailing in each country, as well as the existence of individuals who champion a reform process, or strong interest groups who try to prevent change. As a result, the authors said it was not possible to develop overall guidelines that would precisely match the reform needs in other countries. However, they did draw a number of lessons learned from the experiences that may help other countries to design and implement sector reforms, on the following issues:

• Reform history and timing
• Policy and strategy development
• Reform management set up
• Reform communication
• Role of development partners (including Sector Wide Approaches [SWAp])
• Establishing effective regulatory institutions
• Commercialisation and clustering
• Private sector involvement
• Community participation
• Addressing the staffing challenge
• Information management
• Resources management
• Pro-poor approaches

[1] Richards, T. … [et al.] (2008). Water supply and sanitation sector reforms in Kenya, Tanzania, Uganda and Zambia : challenges and lessons. Dar es Salaam, Tanzania, Deutsche Gesellschaft fuer Technische Zusammenarbeit (GTZ). 33 p. Download here

Community-managed toilets: Tiruchirappalli, India, shows the way

The city of Tiruchirappalli in Tamil Nadu, India shows a way out of the sanitation crisis. The Tiruchirappalli model of community-managed toilets with bathing and washing facilities is an example of a partnership between sensitive city authorities, communities and NGOs, working together to address these problems. The work undertaken by these partners over the last six years has demonstrated how this can be taken to scale at the city-level. Within the next two years, it is expected that all slum communities in the city will be covered by community-managed toilets (CMTs).