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• (Journal Article) Relationship between water, sanitation, hygiene, and nutrition: what do Link NCA nutrition causal analyses say?

  01.10.2017
  Defined by UNICEF as ‘the outcome of insufficient food intake and repeated infectious diseases’, undernutrition is one of the world’s most serious problems, with long-lasting harmful impacts on health and devastating consequences for social and economic development. The three main underlying causes of undernutrition, namely unsuitable or insufficient food intake, poor care practices, and infectious diseases, are directly or indirectly related to inadequate access to water, sanitation facilities, and hygiene practices (WASH). There is a growing base of evidence showing the links between poor WASH conditions, especially exposure to poor sanitation, and stunting (low height for age ratio). However, the effects of WASH interventions on wasting (low weight for height ratio) and the impact of environmental enteric dysfunction (chronic infection of small intestine caused by extended exposure to faecal pathogens) on undernutrition should be explored further. Action Against Hunger (Action Contre la Faim) promotes a participatory nutrition causal analysis, the Link NCA methodology, which is used to analyse complex, dynamic, locally specific causes of undernutrition. This article aims to assess the main findings from 12 most recent Link NCA studies, conducted from the beginning of 2014 until the end of 2016. Results show that inadequate WASH conditions are often identified as major contributors to undernutrition in the study areas. The article also provides lessons learned and a set of practical recommendations for better alignment and integration of WASH and nutrition interventions.

• (Journal Article) From new evidence to better practice: finding the sanitation sweet spot

  01.10.2017
  A growing body of evidence shows that there is a strong causal link between exposure to poor sanitation and detrimental health, human capital, and economic outcomes. At the same time a number of recent impact evaluations of specific sanitation interventions show mixed results. This heterogeneity in findings raises the questions of whether and how the demonstrated benefits of improved sanitation can be consistently achieved through regular project implementation. This paper attempts to show that the benefits of improved sanitation can be consistently achieved through investing in interventions that address the drivers of latrine use and by divesting from interventions that do not address the drivers of latrine use.

• (Journal Article) The handpump choice is yours: a pilot study in Rumphi District, Malawi

  01.10.2017
  In sub-Saharan Africa, moving towards the Sustainable Development Goals will require an approach to water and sanitation service delivery for many rural communities where handpumps still dominate infrastructure. This paper reviews a case study of allowing users (local government and communities) in Rumphi District, Malawi, to choose a handpump model based on information about the life-cycle costs. The results indicate that there is some awareness within communities and within the local government of several handpump options for the rural water supply in the study area. Given a choice of different handpump models in the treatment communities, each community chose the rope pump. Allowing communities to choose the type of handpump model, with input from both local government and donors on low cost borehole drilling, should be considered as an innovative approach to rural water service delivery.

• (Journal Article) Effects of water source accessibility and reliability improvements on water consumption in eastern Nairobi

  01.07.2017
  Under the commitments of the UN Sustainable Development targets, there is increasing pressure on water utility providers in developing countries to improve their levels of service to consumers, especially for the rapidly growing numbers of people with lower incomes who reside in urban informal settlements. However, pressure on water resources in many regions is simultaneously increasing owing to factors such as pollution, agricultural needs, and climate change. It is therefore important to assess the impacts of improving water services on city-wide water resources. This study examines consumption data from the East African city of Nairobi, collected from households of a variety of residential neighbourhoods. The study suggests that average per capita water consumption is closely related to water source choice (i.e. tap in the dwelling, yard tap, or water vendor kiosks). Within categories of water source type, variables such as household wealth, cost of water, and education do not have significant effects on per capita consumption. It is noted that increased accessibility of water causes the upper bound of consumption to rise, but not the lower. It may therefore be theorized that having a tap in a dwelling is necessary but not sufficient to increase per capita consumption. Within the sample examined, there is no statistically significant difference in per capita consumption between water source types other than a tap in a dwelling, and it is therefore suggested that providing a yard tap to those currently without any form of water connection may have negligible impact on city-wide water consumption.

• (Journal Article) Does women’s participation in water committees affect management and water system performance in rural Vanuatu?

  01.07.2017
  Greater participation of women in water management and decision-making is expected to improve outcomes for both women and the wider community. Global evidence indicates that women’s participation in Water User Committees (WUCs) has been limited; yet their involvement in management has correlated with more effective water systems. This analysis of water inventory data from Vanuatu considers how women’s participation in WUCs affects water management and system functionality. Women represent only 16 per cent of committee membership; however, their involvement in key WUC roles was associated with more effective water management, including regular meetings and revenue collection, and improved functioning of water systems. This evidence of women’s involvement is proving useful in advocacy efforts to improve the gender balance in WUCs, and targets for female membership are being considered for inclusion in water supply legislation.

• (Journal Article) Nuggets from an old book: A Practical Handbook of Water Supply by F. Dixey (1931)

  01.01.2017
  Frank Dixey’s A Practical Handbook of Water Supply, published in 1931 is briefly reviewed. The text is correlated with current knowledge and experience. It is evident from the book that some of the present challenges in the water supply sector have been around for a long time which leads to the conclusion that effecting a change takes time. Development agencies therefore need to set realistic targets and time frames. Some of the rather old texts should be consulted and reviewed periodically as they may contain very useful information.

• (Journal Article) Can and should sanitation and hygiene programmes be expected to achieve health impacts?

  01.01.2017
  Although the anticipated health benefits are not the only reason for undertaking sanitation and hygiene programmes, they do represent an important part of the justification. Studies and reviews over recent years have shown, however, that the health impacts of sanitation programmes can be quite small or even negligible. They have also provided no solid evidence that integrated (water, sanitation, hygiene) programming has any greater effect than addressing one or two of these components alone. Two questions arise: first, whether a certain level of sanitation usage and hygiene practice within a community is needed in order to achieve a measurable health impact (i.e. whether a minimum percentage of the population should be using safe sanitation); second, whether sanitation and hygiene interventions undertaken without accompanying water supply improvements are likely to have significant health benefits. In this opinion paper some plausible and practically relevant answers to these questions are extracted from the relevant literature. The conclusions are that a high level of sanitation usage (well over 65 per cent) and widespread handwashing practice are necessary to achieve significant health impact; and that in situations where water services are poor, sanitation and hygiene interventions, while valuable for other reasons, are unlikely to have significant health impacts. Sanitation and hygiene programmes may be justifiable even if they do not immediately achieve high levels of compliance and corresponding water supply improvements are not made; however, the justification should not be presented on the grounds of short-term health benefits.

• (Journal Article) Chlorination of drinking water in emergencies: a review of knowledge to develop recommendations for implementation and research needed

  01.01.2017
  Clean water provision is a critical component of emergency response, and chlorination is widely used in emergencies to treat water. To provide responders with practical, evidence-based recommendations for implementing chlorination programmes and recommend areas for future research, we conducted a literature review of chlorination in emergencies, supplemented with a literature review on chlorination in general. We identified 106 total documents, including 7 with information on technical efficacy, 26 on chlorine dosage, 22 on technical challenges, 21 on product options, 8 on user acceptability, 33 on programmes for emergencies, and 8 on monitoring. We found that: 1) international chlorine dosage recommendations in emergencies are highly inconsistent; 2) high-quality information from the general chlorination literature on challenges of chlorination can be adapted for emergencies; 3) many chlorine products are available for use in point-of-delivery, point-of-source, and point-of-use emergency-response programmes; 4) information on the effectiveness of different chlorination programmes in emergencies varies, ranging from little data available to high-quality data that can inform programming; 5) information on user acceptability of chlorination in emergencies is lacking; and 6) monitoring data on chlorine programme effectiveness in emergencies are lacking. In this manuscript, we provide a summary of knowledge on chlorination in emergencies, recommendations for programme implementation, and recommendations for future research needed to assist communities and agencies responding to the increasing number of natural disasters and outbreaks worldwide.

• (Journal Article) Urban community-led total sanitation: a potential way forward for co-producing sanitation services

  01.10.2016
  Community-led total sanitation (CLTS) has been proved to be a successful strategy for tackling the challenge of open defecation in poor rural communities across Africa and Asia. This article explores whether a similar approach can be used in peri-urban and urban areas to help co-produce sanitation facilities and services with inputs from communities, duty bearers, and other sanitation stakeholders. It is argued that an urban CLTS approach does not mean a copy and paste of tools and methods which have proved successful in the rural environment but following a set of similar principles. Based on field experiences different steps are suggested that incorporate these principles and respond to the specific urban sanitation problem. This article helps to articulate and better define urban CLTS as well as giving practical guidance for those wanting to use this kind of approach.

• (Journal Article) Taking Stock: Incompetent at incontinence – why are we ignoring the needs of incontinence sufferers?

  01.07.2016
  How would you cope if you had no control over how you urinated or defecated and regularly or constantly leaked urine or faeces? How would this make you feel? How would you deal with the smell, with the indignity? What if you were a young teenager, traumatized by very stressful events and returned to bed-wetting as a result? And what would you do if you didn’t have the money to buy spare underwear or incontinence protection products or those are simply not available to you? Could you manage if you were suddenly displaced in an emergency and did not have access to a toilet, shower or bathing facilities, or your usual materials and coping mechanisms? What if you lived in a camp and your toilet or bathing shelter was a 5 minute walk away and had a long line in front of it? Would you be able to stand in line at food distribution or water collection points, go to school, or look for or undertake work?

• (Journal Article) WASH challenges to girls’ menstrual hygiene management in Metro Manila, Masbate, and South Central Mindanao, Philippines

  01.07.2016
  This paper examines water, sanitation, and hygiene (WASH) conditions that enable and hinder Philippine schoolgirls to hygienically manage their menstruation. We collected qualitative data from 13 schools in three regions of the Philippines. Schools in both urban (Metro Manila) and rural areas (Masbate and South Central Mindanao) were included to allow for comparison across settings. Unreliable access to water, lack of disposal mechanisms for menstrual materials, unclean facilities, and insufficient number of latrines were identified as the key barriers to effective menstrual management in Masbate and Metro Manila. In South Central Mindanao, there was greater oversight of WASH hardware at schools and hardware was in better condition, which created a more enabling environment for girls to manage menstruation. Creating an enabling WASH environment for girls to manage menstruation requires sustained support and system oversight, combined with knowledge and information.

• (Journal Article) Menstrual hygiene: a ‘silent’ need during disaster recovery

  01.07.2016
  Post-disaster relief and recovery operations seldom focus on women’s priorities regarding menstrual hygiene. There is an increasing awareness to incorporate inclusive, participatory, and gender-sensitive strategies for implementation of response programmes. This article presents empirical findings related to menstrual hygiene management (MHM), demonstrating it is integral to women’s privacy and safety during recovery. Using case studies from India, the 2012 Assam floods and 2013 Cyclone Phailin in Odisha, this article explores menstrual hygiene practices in a post-disaster context. The data were collected through participatory learning and action tools such as focus group discussions, household interviews, priority ranking, and observations. It emerged that menstrual hygiene was overlooked at the household level during recovery; women and adolescent girls faced seclusion and isolation, exacerbating privacy and security concerns post-disasters. Some humanitarian agencies have an ad hoc approach towards MHM, which is limited to distribution of sanitary pads and does not address the socio-cultural practices around MHM. There is a need for strategic planning to address MHM with a gender-sensitive and inclusive approach. This article draws practical and policy inferences from the research for stronger approaches towards initiating behaviour change in MHM, and addressing attitudes and knowledge regarding menstrual hygiene.

• (Journal Article) Making pathogen hazards visible: a new heuristic to improve sanitation investment efficacy

  01.04.2016
  The public health objective of sanitation is to reduce the risk of negative health outcomes from faecal contamination. For water-based sanitation systems at the household and community scale as practised in Indonesia and perhaps elsewhere, the liquid component of the effluent comprises a significant pathogen hazard. While increasing attention is paid to managing the solid fraction, the hazard in the liquid fraction goes largely unnoticed and unmanaged. This paper proposes the means for a conceptual shift to a focus on the pathogen hazards that matter post-treatment, and where those hazards enter the environment, enabling improved local risk management. Firstly, the paper proposes exponential, rather than arithmetic, representations of pathogen number or concentration, because arithmetic representations of treatment efficacy wrongly suggest low cause for concern. Secondly, the paper introduces and applies the Pathogen Hazard Diagram, a new heuristic applicable at both the local and national scale, that requires only local knowledge and general sanitation reference knowledge to construct, but which can guide policy and action, direct monitoring, and improve the efficacy of sanitation investments.

• (Journal Article) The role of handpump corrosion in the contamination and failure of rural water supplies

  01.01.2016
  There has been much discussion over many years regarding the origin of elevated iron concentrations in rural water supplies in sub-Saharan Africa and Asia. High iron concentrations are often assumed to be naturally occurring in groundwater, despite several studies over the last 30 years which also point to the role of handpump corrosion in aggressive groundwater. Handpump standards specify that galvanized iron pump materials should not be used in groundwater due to the risk of corrosion, yet this advice is not always followed. High iron concentrations, whether naturally occurring, or present as a result of corrosion, have an impact on taste, odour, and appearance of water and can promote the growth of unpleasant iron metabolizing bacteria. These effects often result in the abandonment of boreholes, sometimes only a year old, and a return to unprotected and unsafe water sources. Where boreholes are not abandoned, the effects of corrosion can cause pump materials to degrade to the point where the pump becomes inoperable. These outcomes are clearly inconsistent with the provision of sustainable water supply services as a fundamental human right. This paper provides a synthesis of work undertaken in this area over the last 30 years and recent practical experience of WaterAid in investigating these problems in water supplies in north-eastern Uganda.

• (Journal Article) Beyond ‘functionality’ of handpump-supplied rural water services in developing countries

  01.01.2016
  Many rural point-water sources in developing countries consist of wells or boreholes equipped with handpumps. Various estimates have been made of the functionality of such water points, and functionality is now routinely monitored in national and local surveys of service performance. We argue, however, that a single binary (functional/non-functional) indicator is crude and insufficient to provide much information about service sustainability. We set out a categorization of functionality which includes three sub-categories of functional water points and five non-functional sub-categories, with well/handpump water points in mind. We use a simple model to demonstrate that reduction of high rates of early post-construction abandonment and reduction of total downtimes would greatly improve service performance. We show that functionality levels for multi-age populations of wells or boreholes equipped with handpumps would not normally be expected to exceed about 85 per cent. We recommend going beyond functionality monitoring via the collection of quantitative data on rates of abandonment, frequency and duration of breakdown, combined with descriptive narratives of actions to manage and repair water points, in order to generate more nuanced understanding of service performance.

• (Journal Article) Green microfinance strategy for entrepreneurial transformation: validating a pattern towards sustainability

  01.12.2015
  This paper illustrates a shifted microfinance modality that adopted greening principles towards sustainability. The empirical context of the research was a green microfinance programme implemented by an NGO microfinance institution at two study sites in Bangladesh. The research conceived and tested a microfinance model underpinned by ‘ecological modernization’ and ‘innovation and entrepreneurship’ theories. Field studies were carried out between January 2012 and June 2013 in order to match the ‘theoretical realm’ with the ‘observational realm’. A case study and participatory methods were the primary means of studying the modality and operations of the green microfinance strategy. The study compared the ecological outcomes of green microfinance-assisted enterprises and traditional microcredit-assisted enterprises and measured their greenhouse gas (GHG) emissions. Cool Farm Tool software was used to quantify GHGs. Comparison with a designed experiment shows that micro-enterprises employing green strategies emit less GHGs than the ones with traditional strategies. The research revealed that the microfinance-based greening interventions help to ensure ecological outcomes for micro-enterprises; thus, the combination of the embedded economic and social elements of the classic microfinance model with the new ecological elements supports sustainability.

• (Journal Article) How is microfinance being regulated in Latin America?

  01.12.2015
  Microfinance regulation is a complex and constantly evolving topic, comprising many and very diverse issues which, moreover, are treated differently by legal systems. This paper suggests a novel comprehensive analysis structure that may serve as a benchmark to analyse different regulation frameworks for microfinance, based on the international guidelines provided by the Association of Supervisors of Banks of the Americas, the Basel Committee for Banking Supervision, and the Consultative Group to Assist the Poor. This structure is then used to compare and relate the regulations of 17 Latin American and Caribbean countries.

• (Journal Article) Strengthening behaviour change communication in western Nepal: how can we do better?

  01.10.2015
  The Government of Nepal aims to achieve full water and sanitation coverage by 2017. The bilateral Rural Water Supply and Sanitation Project in Western Nepal (RWSSP-WN) works with local governments in 14 districts, aiming to declare them open defecation free. This behaviour change communications evaluation explored how to improve RWSSP-WN’s present practices to reach the diverse target population in the Terai districts, where more than 1 million people still defecate in the open. The study reviewed RWSSP-WN’s present behaviour change triggering tools and related communications strategies. Our findings suggest that availability of subsidies seems to change how people think about sanitation and tends to eliminate willingness to pay for a latrine. We recommended strong advocacy for a no-subsidy policy, and more attention paid to alternative financing options with targeted support to the poorest of the poor. The present behaviour change triggering tools do work as intended, but there is a need to develop pre-triggering and post-triggering strategies to increase the overall impact. The pre-triggering strategy would ensure that potential barriers to change are identified and addressed before the actual triggering event, and that the key stakeholders are prepared for the actual triggering event. The post-triggering strategy is needed to continue motivating households to change via messages that tap into the drivers of change, addressing also the barriers which may keep each household from changing behaviour. This paper provides a number of recommendations applicable for those working with local governments and communities to increase the scope and scale of behaviour change triggering.

• (Journal Article) Handwashing for menstrual hygiene management among primary schoolgirls in rural western Kenya

  01.10.2015
  Good hand hygiene contributes to the health and educational attainment of schoolchildren. Poor menstrual hygiene management (MHM) is recognized to impact on girls’ health, education, wellbeing and dignity, particularly in low-income countries. Identifying practical, affordable, and comfortable menstrual products to improve girls’ MHM is needed. One potential cost-effective product is the menstrual cup; however, provision of this insertable MHM product, in schools in low-income countries with challenging water, sanitation and hygiene (WASH) conditions, increases the need for assurance of good hand hygiene. This paper uses data from a randomized controlled feasibility study evaluating the acceptability, use and safety of menstrual hygiene products provided to schoolgirls in rural western Kenya. Here, we explore girls’ handwashing practices in school when using menstrual cups, sanitary pads or traditional items, examining the availability of WASH and the reported frequency of handwashing. Data generated from interviews with adults, girls’ private surveys, narratives from focus group discussions, and observational WASH surveys are explored. Reported presence of WASH was higher than that observed during random spot-checks. Overall, 10 per cent of girls never washed before, and 7 per cent never washed after, emptying or changing their menstrual item at school. Girls in cup schools were twice as likely to wash prior to emptying, compared with girls using other items. Handwashing among girls using traditional items was low, despite the same hand hygiene training across groups and a comparable WASH presence. Data highlight the need for sustained mechanisms to support schoolgirls’ handwashing practices for MHM.

• (Journal Article) Measurement of handwashing behaviour in Multiple Indicator Cluster Surveys and Demographic and Health Surveys, 1985–2008

  01.10.2015
  With this paper, we aim to describe handwashing worldwide, as measured in Multiple Indicator Cluster Surveys (MICS) and Demographic and Health Surveys (DHS) in low- and middle-income countries between 1985 and 2008, and to explain the strengths, weaknesses and evolution of this data collection to inform future survey development. We searched reports of DHS and MICS conducted before 2009 and analysed data on handwashing measurements. We examined data according to geographic region, as well as demographic characteristics such as wealth quintile, education of the household head, and rural/urban location. Before 2009, eight MICS and 40 DHS included handwashing-related measurements, using a variety of self-reports and rapid observations. Internal triangulation of findings from surveys that collected multiple types of measurement shows that self-reports to closed questions overestimate behaviour. Observation-based data suggest low handwashing rates in many low- and middle-income countries with high prevalence of water and sanitation-related diseases, and high inter- and intra-country disparities. However, due to the widely disparate nature of the pre-2009 handwashing-related measurements, much of the data cannot be compared between countries, and only an incomplete picture of global rates can be formed. Efforts to increase the prevalence of handwashing with soap and water need to be strengthened in many low- and middle-income countries, especially among poorer, rural populations and where the household head has less formal education. Closed questions asking for self-reports of handwashing behaviour should be avoided. Findings support instead the inclusion of uniform observation-based measurements, as were integrated as core modules of MICS and DHS in 2009.