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• (Journal Article) Elevating the standard: a professionalized approach to community-based rainwater harvesting systems in Uganda

  01.04.2021
  Where water resources are limited, rainwater harvesting (RWH) can provide on-site access to improved water sources. Community institutions are uniquely positioned to benefit from RWH; advocates have encouraged the installation of community-based RWH systems as a way to ameliorate water supply insufficiencies in low-income settings. However, poor quality RWH system installations and insufficient attention to management support have resulted in sustainability challenges, necessitating a commitment to higher standards for community-based RWH. Spurred on by an iterative learning cycle and commitment to innovation, the Ugandan Water Project has achieved RWH system design, installation, and management practices that are well adapted to Ugandan institutions. By investing in a professional crew, high-quality materials, and post-installation support, the Ugandan Water Project has achieved 96 per cent functionality two years after installation. The professionalized approach that the Ugandan Water Project employs can be used as a model to guide future RWH system installations in Uganda and elsewhere.

• (Journal Issue) Issue 1

  01.01.2021
  

• (Journal Article) Improving management of manually emptied pit latrine waste in Nairobi’s urban informal settlements

  01.01.2021
  Sanergy has offered reliable, non-sewered sanitation services in Nairobi, Kenya through the implementation of container-based, urine-diverting dry toilets. However, there remains a large volume of untreated faecal waste in urban informal settlements due to poorly managed pit latrines. With limited space in the settlements to bury old pits and dig new ones, management of faecal sludge requires manual pit emptying and safe discharge. Sanergy piloted the Mtaa Fresh project in the settlement of Mukuru Kwa Njenga, establishing a waste transfer station where manual pit emptiers could safely and reliably dispose of pit latrine contents. The most important factors in the successful implementation of this station were, first, the relationship established between Sanergy and the pit emptiers and, second, Sanergy’s commitment to iterating as new insights emerged. The relationship with the emptiers impacted the location, design, and adoption of the site, and aided in the formalization of a pit emptiers’ community-based organization. The commitment to iterating enabled Sanergy to respond to learnings gained from the emptiers. Additional factors that ensured the success of Mtaa Fresh included the implementation of full-time staff, security when the site is closed, support from local authorities, and an expansion to improve management of faecal sludge and trash. Improvements trialled during the expansion aim to minimize operation and maintenance costs, but sustainability will still rely on government support and external funding.

• (Journal Article) Results from implementing a cohesive strategy and standardized monitoring programme for hygiene kit distribution in Myanmar

  01.01.2021
  Hygiene kits are commonly distributed in humanitarian emergencies to interrupt disease transmission and provide dignity. Despite being commonly implemented, hygiene kit distribution interventions are under-researched, and there is a lack of knowledge on kit efficacy and effectiveness. In Myanmar, the WASH cluster developed a national hygiene kit distribution and monitoring strategy. The research was aimed at determining the effectiveness of this strategy in the context of protracted internally displaced persons camps in Myanmar. To understand programme strategy, we reviewed documents against inclusion criteria; extracted and categorized data for included documents; analysed data; and summarized results. Twenty-six documents met the inclusion criteria of describing strategy development (47 per cent), monitoring in Rakhine (47 per cent) or Kachin State (3 per cent), or monitoring menstrual health and hygiene programme (3 per cent). We identified the strategy was successfully adopted and adapted for Kachin and Rakhine states; however, limitations were identified in receiving consistent monitoring data. We found hygiene kit distributions need to consider local context, including population mobility, local markets and availability of products, and household expenses and debt. Due to these interrelated factors, the percentage of households selling kit items decreased over time; additionally, soap and sanitary pad presence was significantly associated with household income. Consistently, women reported preferring disposable pads for menstrual health and hygiene due to privacy concerns. Programmatically, it is recommended to adapt hygiene kit distributions to local contexts, continue to distribute hygiene kits in protracted contexts to identified at-risk households, distribute disposable pads, and continue revising and improving strategy and monitoring tools.

• (Journal Article) Linkage between water, sanitation, hygiene, and child health in Bugesera District, Rwanda: a cross-sectional study

  01.01.2021
  Rwanda met the Millennium Development Goal targets for access to drinking water and sanitation. However, the WASH practices of high-risk communities are undocumented. Lack of information may hide disparities that correlate with disease. The purpose of this study was to assess WASH and childhood diarrhoea in Bugesera District. A survey was administered to caregivers. Water and stool samples were collected to assess physical and biological characteristics. Focus groups provided information on community context. Analysis included descriptive statistics, Chi-square,logistic regression, and thematic analysis.Piped water and unimproved sanitation were used by 45.28 per cent and 88.38 per cent of respondents. Most respondents (51.47 per cent) travelled 30–60 minutes per trip for water and 70 per cent lacked access to hand-washing near the latrine. Diarrhoea was less prevalent in children who used a toilet facility (p = 0.009). Disposal of faeces anywhere other than the toilet increased the odds of having diarrhoea (OR = 3.1, 95 per cent CI = 1.2–8.2). Use of a narrow mouth container for storage was associated with decreased intestinal parasites (p = 0.011). The presence of a hand-washing station within 10 metres of the toilet was associated with lower odds of intestinal parasites (OR = 0.54, 95 per cent CI: 0.29–0.99). Water and sanitation access, water handling and storage, and unsanitary household environment underlie high diarrhoeal disease prevalence.

• (Journal Article) Unravelling context: a formative photovoice study of Indian youth perspectives of sanitation and hygiene practices

  01.01.2021
  Water, sanitation, and hygiene are issues of substantial public health importance. Community-based participatory research approaches such as photovoice can help explore and identify determinants that influence sanitation and hygiene-related behaviours. This study aimed to use photovoice as part of the formative research process to increase understanding of youth’s perceptions of the cultural and contextual factors that influence sanitation and hygiene-related behaviours in Thirumalaikodi, India. First, a school was recruited using convenience sampling; next, 10 participants were purposively selected to participate in an information meeting, seven photo discussion sessions, and one wrap-up session over a three-week period. In each photo discussion session, participant groups selected one ‘trigger’ photograph, and through a structured discussion using SHOWED mnemonic questions (a series of questions that ask participants to describe and reflect upon a chosen photograph), generated a new understanding of issues related to water, sanitation, and hygiene. All sessions were audio-recorded and transcribed verbatim. Conventional content analysis was used to analyse photo discussion session text. Findings revealed that factors such as social structure, education, and culture influence behaviours that determine the sanitary conditions of an individual’s private and public spaces. Furthermore, participants described how descriptive norms generated practices (e.g. littering) that were reinforced and maintained by limited access to waste management systems, attitudinal indifference, and generational beliefs. Findings yielded an in-depth understanding of youth’s perceptions of the cultural and contextual factors that influence sanitation and hygiene-related behaviours. This study also contributes to the advancement of participatory applications in formative research and intervention adaptation processes.

• (Journal Article) Between water stewardship and independent global water certification: learning from smallholder rice farmers, Karonga, Malawi

  01.01.2021
  Cooperation and locally driven water management are at the forefront of food production water management for smallholder farmers in low-income countries. The aim of this paper was to critically reflect on the experiences of 5,819 smallholder rice farmers in Karonga District, Malawi, who were members of a farmers’ organization that achieved improved water stewardship, but could not achieve Alliance for Water Stewardship certification within a three-year project. The data for this paper were obtained through farmer and stakeholder interviews. The partnership attempted to bring together four parties: academics, farmers, local government, and a non-governmental organization. The farmers were trained by combining stewardship and certification topics through a train-the-trainer approach. The farmers’ organization primarily focuses on agribusiness; therefore, they did not have any water-related data or detailed farm boundaries from the large and dispersed group of farmers and could not obtain a collective water permit. Understanding water governance was difficult for many farmers. Furthermore, moving from stewardship to certification presented some financial challenges. Critical thinking and questioning are required, along with a deeper understanding of the local context, logistical hindrances, priorities, alternatives, culture, and science, to evaluate how projects are designed and partially succeed or fail from the perspective of low-income farmers in the Global South.

• (Journal Article) Boosting financial inclusion through social assistance reform: evidence-based approach in selecting a payment system

  01.12.2020
  Digitizing social assistance for the poor has been proven to increase financial inclusion. The Indonesian Government initiated reform for non-cash social assistance disbursement in 2016. Evidence-based policy approach is an effective technique for informing the government on appropriate new regulations. A pilot project involving 4,295 participants was conducted to evaluate the following payment systems: debit card, mobile money, QR code (quick response), and NFC (near field communication). Beneficiaries utilized the funds for cash withdrawals and food purchases at bank agents. Quantitative and qualitative methods were employed in the analysis. The government decided to use debit card with multiple wallet features. A new regulation was made to support the implementation in 2017, and by the end of 2019, the government provided more than 12 million new savings accounts to the poor. Potential future improvements are proposed for the sustainability of the solution, which include a disbursement providers’ revenue model, broader financial services involvement, bank agents’ inventory system, and optimizing the latest innovations.

• (Journal Article) Assessing high-profile public messaging for sanitation behaviour change: evidence from a mobile phone survey in India

  01.10.2020
  The UN Sustainable Development Goals call for the elimination of open defecation by 2030. Assessing global progress will require learning from India’s sanitation efforts because of its ambitious program of high-profile behavior change messaging to tackle open defecation, and because open defecation is widespread in India. In 2014, the Prime Minister announced a policy called the Swachh Bharat Mission (SBM), which aimed to eliminate open defecation by 2019. However, the 2015–16 National Family Health Survey –4 found that about 55% of rural and 11% of urban Indian households lack a toilet or latrine. To assess the extent of public awareness of the SBM, we use a mobile phone survey to ask about people’s knowledge of the existence and purpose of the SBM. We report representative estimates of awareness of the SBM among adults in Delhi (2016), Uttar Pradesh (2016), Mumbai (2016–17), Rajasthan (2016–17), Bihar (2018), Jharkhand (2018), and Maharashtra (2018). While much of the SBM’s activities took place in its last two years, we find that, at the time of the survey, no more than one-third of adults in any state are aware that the SBM intends to promote toilet and latrine use. Awareness was particularly low in Uttar Pradesh, where one in eight people who defecates in the open worldwide lives. While the SBM was very active in constructing latrines, the lack of awareness we find suggests that the SBM was less successful in raising the awareness required for large-scale behavior change in promoting latrine use.

• (Journal Article) Practical experience testing aspects of market development for city-wide inclusive sanitation

  01.10.2020
  Achieving effective, city-wide inclusive sanitation service delivery requires coordination of diverse actors in the sanitation value chain as many factors constrain the efficiency and quality of faecal sludge management (FSM). In partnership with government, consumer, and private sector stakeholders in Bihar’s capital city, Patna, PSI India facilitated extensive market analysis, identified the market challenges, and co-developed a market-based urban FSM services ‘ecosystem’ which resulted in the safe collection, treatment, and disposal of over 7 million litres of faecal sludge from more than an estimated 1,500 households over two years, as part of bundled portable toilet cabins and FSM services. The FSM programme Praashadan, funded by the Bill & Melinda Gates Foundation, built trust, improved coordination, and brokered official agreements between tanker operators and government, tested a portable toilet cabin business model to subsidize operation of a faecal sludge treatment plant, and established a call centre and promotional activities to drive customers to the services of a newly formed tanker operators association. Moving forward there is a need to place the work with these market actors into a wider context of a financed, coordinated, city-wide sanitation planning to address technology, R&D, and other constraints that support better business models and allow regular quality FSM services.

• (Journal Article) A global assessment of budgeting and financing for WASH in schools

  01.10.2020
  The aim of this review is to assess the literature (published and grey) on capital and recurrent costs of water, sanitation, and hygiene (WASH) in Schools (WinS) facilities and services. The review presents life-cycle costs (e.g. consumables, repair, support, and maintenance) of WinS services and assesses the practical costing exercises and tools currently available for WinS. Furthermore, this review characterizes the typical costs and financial sources for WASH services in (primary) schools and explores the different financial mechanisms available to meet school-level WASH financing gaps.

• (Journal Article) Are ceramic water filters effective in preventing diarrhoea and acute malnutrition among under-five children in Sudan?

  01.07.2020
  Access to safe drinking-water at home is essential during the outpatient treatment of children with acute malnutrition due to their increased vulnerability to infections and disease. The study aimed to evaluate the effectiveness of ceramic water filters with safe storage in preventing diarrhoea and acute malnutrition among under-five children in Kassala state, Sudan. It was designed as an open-label randomized controlled trial, comparing two study groups. Data was collected through face-to-face interviews and direct observations, then processed and analysed using Epi Info 7.2.0.1. Use of water filters is a potential predictor of number of diarrhoea episodes per child (P < 0.001). The intervention group had a lower diarrhoea occurrence (P < 0.001), better monthly average weight gain (P = 0.012) and average mid-upper arm circumference increase (P = 0.001), and lower prevalence of acute malnutrition at the end of the study (P = 0.001) compared with the control group. Ceramic water filters with safe storage can be effective in preventing diarrhoea and acute malnutrition, and beneficial to children admitted to Community Management of Acute Malnutrition programmes in Kassala state. More research is needed to understand the pathways to achieving these outcomes. Other WASH interventions may be needed to interrupt the primary vectors of diarrhoea disease transmission in this setting.

• (Journal Article) Addressing women’s needs in water access for economic use: the case of Wukro town, Ethiopia

  01.07.2020
  In urban areas where water is not adequately supplied, women’s efforts to make a living out of water-intensive businesses face many challenges. The study examined how small-scale businesses run by women in Wukro town, Ethiopia are impacted by inadequate supply of water, and what coping strategies are employed. The lived experiences of women involved in small-scale water-intensive businesses, such as traditional beer brewing and coffee shops, were examined. In addition to these women, the perspectives and experiences of selected key informants as well as the officers at the local water utility have been assessed. Whether or not these women secure support from the social networks in their neighbourhood has also been considered. The study revealed that the unreliable supply of water in the town has impacted women involved in small business. It was indicated that some women manage to do well either by borrowing water from neighbours or purchasing from providers. In contrast, others who run businesses in rented houses with limited social networks expressed that they are struggling. Suggestions are made for the water utility to revise its working guidelines related to the provision of water services and to implement a gendered perspective in water management practices.

• (Journal Article) A call to action: organizational, professional, and personal change for gender transformative WASH programming

  01.07.2020
  The Sustainable Development Goals (SDGs) and targets aimed at improving access to water, sanitation, and hygiene (WASH) are also an opportunity for the transformation of gender norms. To facilitate this transformation, this paper makes a call to action for global and national efforts for organizational, professional, and personal change. Several NGOs are leading a process towards a more reflective and transformative approach. This paper presents a number of examples – from headquarters, and others from country offices and research institutes – of the changes under way to support a stronger connection between the ‘outer faces’ of WASH professionals in the sector and the individual, personal inner spaces. The paper concludes with a set of recommendations for personal and organizational change.

• (Journal Article) Providing municipal faecal sludge management services: lessons from Bangladesh

  01.07.2020
  Faecal sludge management (FSM) is a rising priority in the WASH sector, and governments and development agencies are increasing their investments in faecal sludge treatment plants (FSTPs). In Bangladesh there are plans to build 100 FSTPs in secondary municipalities. However, lessons from past experiences are not widely understood or considered. This article aims to fill that gap, shedding light on the drivers of success and challenges in the provision of municipal FSM services, analysing the cases of older FSTPs in four secondary towns in Bangladesh. Only one of these plants was fully operational, one was not operating, and two were partially operational. A challenge identified was that the faecal sludge treatment plants were not part of an integral and well-thought-out plan considering the whole sanitation service chain. Unbalanced partnerships between stakeholders was a crucial barrier to the long-term success of FSTPs, as it hindered the empowerment of the municipal governments to take ownership of FSM service provision. The financing and technical capacities of the municipalities were another barrier, which was covered by NGOs in the most successful plant. The study suggests that future investment in FSM services in secondary towns in Bangladesh and similar contexts should 1) put municipalities in the driving seat, 2) ensure adequate financing, 3) consider the whole sanitation service chain, and 4) strengthen the capacities of the local actors to deliver FSM services.

• (Journal Article) Global assessment of grant-funded, market-based sanitation development projects

  01.07.2020
  Evidence on the performance of market-based sanitation (MBS) interventions is needed to support renewed focus on using them to deliver sanitation services at scale. We conducted a comprehensive review of WASH grant-funding since 1980 to identify household sanitation supply projects using an MBS approach, assessed project characteristics and outcomes (population impacted), and reviewed project strategies against three key factors for scaling MBS (customer and business finance; availability and viability of local entrepreneurs; appropriate toilet product and business models). For a subset with higher outcomes, we assessed project strategies more fully against nine MBS strategies considered good practice, and the programme’s ability to leverage household investment. Of 103 sanitation supply projects in eight global databases, 49 qualified as MBS and occurred in 22 countries across sub-Saharan Africa, South/Southeast Asia, and Latin America. Cumulatively, 27.6 million people, nearly all rural, gained access to basic sanitation via markets across these projects. ‘Large-scale’ MBS projects exceeding 50,000 people gaining basic sanitation (n = 27) compared with those that did not (n = 22) were longer and significantly more likely to address all three key factors (74 per cent vs. 41 per cent; p = 0.019), but on average applied only six of nine good practice strategies. Outcomes and programme leverage were higher in South/Southeast Asia than in sub-Saharan Africa. However, African projects tended to have shorter duration, fewer reached ‘large-scale’, and rarely employed a sales and marketing strategy. We discuss implications for improving the design and performance of MBS interventions globally and particularly in sub-Saharan Africa.

• (Journal Article) Fostering smallholder investment and innovation through inclusive financial services

  01.03.2020
  This article provides a framework, with supporting examples, for addressing finance for smallholder investment for innovation. Smallholder households function in interconnected ‘systems’ radiating outwards from the household unit: livelihoods, agricultural market systems, community and society, and infrastructure and policy. An inclusive livelihoods model analyses what would need to be true for uptake of innovations by women, men, and youth, and what financial and non-financial products are needed. ‘Customer centric’ integrated value chain financing solutions are tailored to smallholder market segments along eight pathways for growth. A roadmap for facilitating innovation and change using priority pathways, yet grounded in proven financial and development principles, is recommended. Tools and approaches include: value chain facilitation and capacity development – aggregation, market linkages, and private–public partnerships; financial tools – transaction-based financing, flexible products, and risk mitigators; and innovations in service delivery – digital and ICT applications.

• (Journal Article) Dimensions of water insecurity in pastoralist households in Kenya

  01.01.2020
  Pastoralist communities in Northern Kenya face increasing water security risks attributable to disruptions in their socio-ecological environments. Sedentarized pastoralists, women, and children are most vulnerable to spatial-temporal variations in water availability. This vulnerability is exacerbated by embedded power relations within existing socio-cultural and water governance systems. A preliminary study carried out in 2016 examined pastoralist women’s disempowerment in relation to the domestic water security constraints they face. The research found anecdotal evidence that women with diversified livelihoods and social capital are more resilient to water stress. The follow-on study was carried out in 2018 and aimed to provide empirical evidence on factors behind water security and to identify factors that enhance resilience for vulnerable pastoralist communities. The study covered both urban and rural communities in Samburu County and applied a mixed-methods research methodology incorporating quantitative and qualitative research approaches. The study was also used to test a scale for measuring household water insecurity which could potentially improve the methodology for assessing shock-related stress in these high-risk communities. Results show extreme levels of water insecurity, especially in rural areas, and indicate a close relationship between water security and social capital as indicated in the earlier study. Livelihood diversity does not appear to influence water security but households with higher numbers of livestock tend to be more water insecure than households with smaller herds. This is supported by reports from women that the additional burden of watering homestead-based livestock makes them more vulnerable.

• (Journal Article) Return to learn: recommendations from revisited rural ecosan projects in Burkina Faso

  01.01.2020
  Burkina Faso has extensive experience with urine-diverting dry toilets (UDDTs) and the reuse of human excreta in agriculture in line with the ecological sanitation (ecosan) principles of containment, treatment, and reuse. Around 30 such ecosan projects have been implemented over the past 15 years, including installation of approximately 13,500 household UDDTs, accompanied by awareness-building and training on toilet use, emptying, and reuse. Recently, efforts have been made to revisit former and current project sites in the spirit of ‘return to learn’. We identified four such learning initiatives (studies/events), from which we draw recommendations to improve the sustainability of future implementation of ecosan in Burkina Faso and similar contexts. Key recommendations include increased attention to different user needs, handwashing and training on emptying/reuse as well as research and innovation on toilet design, urine collection/handling, menstrual management, and cost reduction/financing. Burkina Faso has set up the ambitious goal of 100 per cent toilet coverage and optimal reuse in the national sanitation programme by 2030, with UDDTs projected to make up 15 per cent of the 2 million toilets needed in rural areas. It is therefore timely to take stock and learn from past interventions. In addition, to enable resource recovery and reuse at scale, it will be important to develop a supportive policy and legal framework with collaboration between the WASH, agriculture, health, and environmental sectors.

• (Journal Article) Better together: improving food security and nutrition by linking market and food systems

  01.09.2019
  Market-based approaches to food security often increase agricultural productivity and income yet sometimes fail to enhance nutrition. When food security programming combines market and food systems with a specific focus on women and girls, economic and nutrition outcomes benefit. We identify distinctive and shared elements from market and food systems and highlight how they enhance nutrition outcomes when they are combined. We describe food security programming by CARE and World Vision in Bangladesh, Ethiopia, Madagascar, Zambia, and Zimbabwe, demonstrating nutrition gains in food insecure households.