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• (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) 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) 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) 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) 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) 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) Why do some behaviours change more easily than others? Water-use behaviour interventions in rural Nepal

  01.10.2015
  Water-sector development is inevitably based on changes in people’s behaviour. We analyse why some types of domestic water-use behaviours change more easily than others. Our case study is a water supply and sanitation intervention in remote and rural Nepal. We found that collective opportunities, degree of individual freedom, and individual incentives influenced the ease of the promoted behaviour changes. The enhanced individual opportunities, incentives, and collective tolerance enabled behaviour changes that were regarded as beneficial by the people themselves, whereas the existing social traditions in our case-study context often restricted those changes. Often, the individual agency and the collective traditions confronted one another. We suggest that this study can provide a design for predicting possible opportunities and challenges regarding behaviour changes in field operations, and for enhancing joint operation of individual and collective capabilities at local levels in the development intervention context.

• (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.

• (Journal Article) Schoolgirls’ experiences of changing and disposal of menstrual hygiene items and inferences for WASH in schools

  01.10.2015
  Menstrual hygiene management (MHM) challenges during changing and disposal of menstrual items are important in low-income countries (LICs) where schools lack sufficient water and sanitation. Changing in poorly maintained latrines may expose girls to excrement and infection. We examine the frequency of dropping menstrual items and disposal of waste by schoolgirls in a menstrual solutions feasibility study in western Kenya. Drops when changing were reported in 17 per cent (20 per cent <16 years; 16.5 per cent 16 years plus; p=0.04) of girls’ reports overall. Differences by socio-economic status were not evident. Fifty-four per cent of girls dropped at least once. A quarter of girls using pads and cups reported drops in the first few months, reducing to 10 per cent over time, compared with ~30 per cent among traditional item users. One in four accidental drops occurred at school during the study. When dropped at school, most girls swapped the dropped item for a new one, but 24 per cent brushed/washed the item and reused it. While no clinical events occurred during this study, data suggest dropping within latrines could place girls at potential risk of exposure to infection. Disposal of items, or emptying cups, was mostly into the latrine. We conclude that accidental dropping of menstrual items while changing is common, including at school. Prevention will be helped by improving poorly constructed sanitation facilities, shelving, privacy, and staggering/increasing break time for girls to change. Provision of special garbage bins to prevent clogging and overflow of latrines is recommended.

• (Journal Article) Microfinance for sanitation: what is needed to move to scale?

  01.07.2015
  The sanitation sector is gradually realizing that the effectiveness of approaches such as Community-Led Total Sanitation (CLTS) is limited by inadequate access to finance. Households are not able to construct durable facilities and sanitation services are unable to develop so as to respond to demand. At the same time, there is fierce competition among microfinance services providers that is pushing institutions towards more remote customers and to offer innovative products. In addition, the rise of mobile banking and digital finance has lifted many poor people out of financial exclusion. These factors have created a nexus between microfinance and sanitation with high growth potential. However, the sanitation microfinance market remains small to date. Since 2010, the SHARE research consortium has investigated global experiences and lessons for using microfinance to develop sanitation services. A SHARE action-research in Tanzania triggered selected financial institutions to offer financial products for sanitation and generated lessons for scaling up sanitation microfinance. This article presents the findings from the SHARE research, in the context of broader developments in the microfinance markets and key findings from other donor-led initiatives.

• (Journal Article) Are burial or disposal with garbage safe forms of child faeces disposal? An expert consultation

  01.07.2015
  The importance of safe handling and disposal of child faeces given its potential role in disease transmission are increasingly recognized. Household surveys demonstrate that the burying of child faeces (‘dig-and-bury’) is common in several countries, especially in sub-Saharan Africa and South-east Asia. Disposal with garbage is widely practised in middle- and high-income countries and is becoming increasingly common in urban areas of low-income countries. The safety of these two approaches is difficult to assess given the limited evidence available and we therefore sought the opinion of experts in the field of sanitation to support advocacy around the topic. We report the findings of an anonymous expert (Delphi) consultation on the safety of these two child faeces disposal methods. There was almost unanimous agreement these should be considered neither safe nor improved. A range of arguments was provided to support this position, including proximity of solid waste and burial sites to the home and children’s play areas and that neither practice would be acceptable for adults. The consultation also highlighted gaps in the current evidence base that should be addressed to gain a fuller insight into the risks involved in these two forms of sanitation with a view to providing both programmatic and normative guidance. In particular further work is needed to assess the potential for exposure to faecal matter in solid waste in low- and middle-income countries and to elucidate the predominant practices of child faeces burial including proximity to the home or infant play areas as well as depth of burial.

• (Journal Article) Fostering economic opportunities for youth in Africa: a comprehensive approach

  01.06.2015
  Youth unemployment and working poverty are large and growing development challenges. The barriers faced by young women and men in accessing sustainable livelihoods are many, so supporting their successful transition into employment and entrepreneurship requires a comprehensive and holistic approach. This article reflects on the evolving approach of The MasterCard Foundation-supported programmes in sub-Saharan Africa, within the broader context of wider research and evidence. It suggests that combining training in a range of market-relevant skills, with access to job and business opportunities and appropriate financial services, can foster economic opportunities for youth. It emphasizes the importance of recognizing the role of mixed livelihoods in contexts where formal jobs are lacking, and of supporting youth engagement in agriculture and agribusiness as viable livelihood opportunities. And it highlights that the challenge can only be adequately addressed via the meaningful engagement of a range of stakeholders, including the private sector, government and civil society, and, especially, youth themselves.

• (Journal Article) Empowerment in action: savings groups improving community water, sanitation, and hygiene services

  01.03.2015
  With 748 million people worldwide lacking adequate water, sanitation, and hygiene (WASH) services (WHO/UNICEF, 2014), increased access to these services is a significant global challenge. Savings groups (SGs) combined with social empowerment strategies can be used to engage communities meaningfully in addressing development challenges such as access to clean water and a functioning latrine. As participants in PCI's SG initiative entitled Women Empowered (WE), women have independently identified WASH needs in their communities and have organized and carried out collective actions to improve their situation. This paper highlights results from a qualitative study in which PCI looked at SGs within two international development programmes in urban and rural Guatemala. The paper explores key opportunities in implementing an integrated, social and economic empowerment strategy and how changes in self-efficacy and leadership can lead to positive community impact. PCI found that participation by women in rural and urban Women Empowered SGs contributes to increased decision-making abilities and leadership, as well as increases in collaborative, collective actions at the community-level. Moreover, when one integrates SGs as a component of larger, multi-intervention development programmes, one can create a facilitative environment which encourages SGs to participate as active development partners rather than passive development recipients.

• (Journal Article) Making markets work for women: how push and pull strategies can support women's economic empowerment

  01.03.2015
  In many countries, the inability of women to negotiate pervasive social, legal, and cultural barriers inhibits their participation in the productive sphere, particularly their entry into market systems as producers and entrepreneurs. The paper draws on case studies from projects implemented by the Mennonite Economic Development Associates (MEDA) in Ghana, the Entrepreneurship and Community Development Institute (ECDI) in Pakistan, and Zardozi in Afghanistan to show how practitioners can maximize ‘push’ and ‘pull’ strategies to increase the scale, impact, and sustainability of women's economic empowerment programming. Despite differences in country contexts, value chains, and sectors, the authors illustrate the importance of ‘push’ strategies in helping women to overcome the persistent gender-based discrimination that undermines women's understanding of markets, access to networks, self-confidence, and business success. They also show how deliberate ‘pull’ strategies that use commercially based incentives can increase women's incomes and business sustainability. The authors conclude that a blend of push and pull strategies will provide the most reach and impact for women's economic empowerment projects, ensuring income growth and gender equality dividends for families and communities.

• (Journal Article) Bringing together push and pull through local entrepreneurs

  01.03.2015
  Despite significant efforts in agriculture market development, millions of smallholder farmers remain isolated from markets, due to remoteness and low farm productivity. Push/pull approaches to market development suggest a dual strategy for bringing smallholders into agricultural markets: 1) reduce producer vulnerability and build capacities, based on market requirements; and 2) facilitate relationships for producers to deal in consistent, growing markets. While simple in concept and effective as an approach, the execution of push/pull is complex. In particular, it is difficult to connect push (producer capacity) and pull (market) elements, resulting in unsustainable market linkages. When applying a push/pull approach in areas where the Aga Khan Foundation (AKF) works, AKF has noted that local entrepreneurs can link push and pull effectively and for the long term. This case study reviews how entrepreneurs link push and pull in AKF's market development programme in southern Tanzania. It outlines learning on how local entrepreneurs bridge gaps between producers and firms, taking the case of remote farmers accessing inputs (seed, fertilizer, implements, and pesticide) from larger suppliers. The paper describes the challenge of linking push and pull, outlines AKF's experience in southern Tanzania, and follows with points for discussion on incorporating local entrepreneurs into push/pull programmes.

• (Journal Article) Improving the food security of the extremely poor by linking them to markets

  01.03.2015
  This article draws lessons from ACDI/VOCA, CARE, and World Vision-implemented food security programmes to answer three questions: how can push/pull activities better integrate the extremely poor into 1) output and 2) input markets? And 3) how can push/pull programme activities help improve intra-household gender dynamics and financial decision-making to improve the food and nutrition security of household members? In output markets the lessons include: 1) that market development and savings group interventions can be implemented by the same officer; and 2) projects should move early to have a private sector provider take over the village savings and loan associations. While there are constraints in the input markets, there are also push strategies for increasing production, including direct delivery of inputs to farmers, vouchers to increase demand, and Farmer Business Group development to increase collective input buying and pull strategies such as linkages with buyers for the selling of products and tapering down subsidies. Intrahousehold gender equitable decision-making can positively impact the food security of the household members. Mixed gender Village Economic and Social Associations are efficient in tackling intra-household decision-making. This allows the provision of flexible and efficient financial services as well as an opportunity to engage husbands and wives in gender-related dialogues.

• (Journal Article) Microcredit: from hope to scepticism to modest hope

  01.03.2015
  After its introduction in the late 1980s and its fast expansion thereafter modern microfinance, and specifically microcredit, raised the hope that it could combine access to (semi-) formal credit for the poor with financial sustainability of the new microfinance institutions, and that it would contribute to increased micro-entrepreneurial activity, consumer welfare, and the empowerment of women. More recently scepticism about the operation of microfinance institutions and their impact has arisen. Based on the literature, we discuss the possibility of combining outreach to the poor with financial sustainability, microfinance crises, and the findings of recent impact studies. Our conclusion is that microfinance is not a panacea for development, but that it is a tool poor households can use in their fight for survival.