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

Sanitation promotion: experiences from government-led initiative in southern Ethiopia

In Ethiopia’s Southern Nations Nationalities and People’s Region (SNNPR) an innovative programme has promoted latrine construction and use, hand washing and safe water storage and handling. The intervention is an example of how visionary government leadership can create the political momentum for low-cost sanitation and hygiene (S&H) and reach out to rural communities.

Papers from the Overseas Development Institute, in the UK, and the IRC International Water and Sanitation Centre, in the Netherlands investigate the SNNPR approach. The research was undertaken by Ethiopian researchers on behalf of the Research-inspired Policy and Practice Learning in Ethiopia and the Nile Region (RiPPLE) project.

[...] In 2003 the SNNPR Bureau of Health (BoH) began a new community health strategy, including S&H [which aimed] to reach households through paid health extension workers (HEWs) and volunteer community health promoters (CHWs) [and which] promoted latrine construction without any form of subsidy.

A combination of political promotion and institutional mobilisation was successful in launching and expanding the regional government’s strategy as a ‘movement’. [...] The key elements of the S&H strategy were designed to be politically attractive and administratively feasible, and were written in non-technical language.

The researchers found after the project:

• The proportion of households having latrines increased by a factor of eight.
• There was less acceptance of open defecation.
• Questionnaire results indicated better knowledge on hand washing, although actual practice remained poor.
• There were hand washing facilities in 82 percent of households, but only 6 percent were near the household latrine and few people used soap or detergents.
• Water storage and handling practices also remained poor.
• Men mostly decided latrine design, siting and construction, although women were involved in providing materials and plastering.

Despite these positive developments, doubts remain about sustainability and some latrines have collapsed [and] many are infested with flies. As CHWs are unpaid and receive little follow-up support or training, many have lost motivation. Higher levels of government have not provided enough technical support or monitored changes in household S&H behaviour.

[...] Aspects of the SNNPR experience which might help improve [sanitation elsewhere] include:

• promoting local, rather than donor-driven, S&H programmes and technology designs
• using community promotional change agents coordinated by local authorities in command and facilitation roles
• reviewing local S&H progress within wider health sector review processes
• ensuring that strategising, political positioning and communication are based on solid evidence
• realising that sanitation workers cannot make their case to high-level politicians without understanding the political dynamics around S&H.

Source: id21, 01 Apr 2009

Post-conflict approaches: evaluation of Water for Recovery and Peace Program (WRAPP), Southern Sudan

The Water for Recovery and Peace Program (WRAPP) has been operating in Southern Sudan under PACT since 2005 with the aim to:

1. increase access to protected water supply and enhance awareness about sanitation and hygiene;
2. enhance capacity for community management of water schemes;
3. contribute to the reduction of conflict and the promotion of stability and peace; and
4. be gender and environmentally sensitive.

The main funding agency of WRAPP is USAID/OFDA. By November 2007, WRAPP had implemented 707 (boreholes) rural water supply schemes, rehabilitated 505 (boreholes) schemes, 13 semi-urban water distribution schemes, public toilet blocks in 10 towns and one hafir, a major rainwater harvesting facility. The total number of beneficiaries reached under WRAPP reach an estimated 1,4 million.

An evaluation of WRAPP carried out by the Overseas Development Institute (ODI) formulated the following lessons learned that are relevant for the WSS sector:

Working through local partners: Contrary to most other I-NGOs and donors, WRAPP works through local partners. WRAPP’s support to local drillers (e.g. AMA, PARAD, SUPRAID) contributed to vitalising the S Sudanese drilling market and is an activity that should be fostered in the future. Local drillers are able to mobilise faster, equire less logistical support and can provide better quality work in Southern Sudan.

WRAPP’s experience of supporting local CBOs to act as ToTs for water supply management is a viable approach but requires a high level of back stopping support from WRAPP to ensure quality.

Working with and through sector structures: A Water policy and related strategies are underway and government structures are being established to implement these with implications for the way in which NGOs and donors operate in the sector.

Operation and Maintenance: Field work has shown that rural user committees are able to organise themselves for repairs of hand pumps, particularly if there are no alternatives, government support structures are strong and training is done well. For semi-urban water distribution systems, current levels of training and management models are not sufficient.

The lack of spare parts and tools is probably the most important challenge for the sector. Without addressing this problem, investments in water supply schemes remain largely futile. Developing a sustainable supply chain for repairing rural water supply schemes is therefore an urgent priority for all sector stakeholders.

Sanitation and hygiene promotion: Sanitation and hygiene have been neglected at the detriment of providing hardware water supply services in Southern Sudan. The alarmingly high incidence of under-five diarrhoea of over 40% as well as repeated outbreaks of cholera in some urban settings highlight the need for action.

Reducing Conflict: Focusing water interventions on conflict reduction is very relevant in the context of Southern Sudan. Hafirs have a strong potential to reduce conflict but are difficult to implement and manage. The actual contribution to conflict reduction of the first hafir implemented in Yuai still needs to be supported with evidence.

“Do no harm” is an often neglected yet important aspect of conflict mitigation and highly relevant for WRAPP interventions in water supply and water resources management.

Welle, K. … [et al.] (2008). Water for Recovery and Peace Programme PACT Sudan : external evaluation : final report. London, UK, Overseas Development Institute. 45 p. Read full report

Nepal: engaging the media for sanitation awareness and advocacy

“The Nepal WASH Coalition is able to leverage media coverage and establish the ties needed to bring lasting change in the sanitation and water supply situation in Nepal. It has successfully increased coverage of sanitation issues in the media, educated communities and villages on the benefits of good hygiene practices, and has been able to convince the Government to endorse the Sanitation Model District Approach programme. The Nepal WASH Coalition also encourages sector stakeholders to come together as a group, in order to voice needs and suggest changes. As it grows in influence, the Nepal WASH Coalition brings much needed attention to a sector that is often shrouded in stigma.”

This is the conclusion of the May 2008 WASH case study on Nepal, one of a series published by the Water Supply and Sanitation Collaborative Council (WSSCC).

Sanitation and hygiene: responding to challenges, lessons from Burkina Faso

Safe hygiene practices and access to sanitation are crucial for combating the main health threats to children. However, nearly twice as many people lack access to sanitation compared with water supply. Is it time to stop aligning sanitation and health (S&H) policies so closely with water management policy?

A paper from Tearfund, researched and written by ACCEDES, one of Tearfund’s local partners, together with the Overseas Development Institute, in the UK, investigates barriers to sanitation and hygiene promotion in five villages in Burkina Faso.

Read more: id21, 14 Mar 2008