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• (Article) The Bishesta campaign: a menstrual hygiene management intervention for people with intellectual impairments and their carers

  01.07.2021
  This paper describes the components of the Bishesta campaign: a behaviour change intervention for menstrual hygiene management (MHM), targeting young people with intellectual impairments, and their carers in Nepal. The campaign uses two fictitious characters: Bishesta (a young person with an intellectual impairment) and Perana (her carer), and consists of three group training modules. ‘Period packs’, designed to make MHM behaviours attractive and easy to adopt, are given to the young people. Packs include storage bags, a bin, and stories about Bishesta menstruating and learning to manage as independently as possible, with Perana’s support. Carers receive a calendar to track the young person’s menstrual cycle. A Bishesta doll, with removable clothes, underwear, and a miniature ‘period pack’ is used in training to demonstrate MHM. Evaluation findings show the intervention is feasible at small scale, so further research on how to scale up the intervention in an evidence-based way is required.

• (Article) Menstrual hygiene management in disasters: the concerns, needs, and preferences of women and girls in Vanuatu

  01.07.2021
  In disaster settings, women and girls face additional challenges in safely managing menstruation with confidence and dignity. Assessing women’s and girls’ needs and preferences at country level prior to a disaster assists Red Cross National Societies with preparedness planning and development of local menstrual hygiene management (MHM) kits for pre-positioning. This study, conducted in Vanuatu, examined the experiences, concerns, needs, and preferences of women and girls in managing menstruation in disasters. Participants trialled one of four different sanitary products included in a MHM kit. Absorbency, security of fit, and odour were the main determinants of product acceptability. Water supply and safe disposal options influenced the preference for either reusable or disposable products. Access to sanitary products, distribution processes, water supply, and privacy were key concerns. Detailed recommendations within this paper will support the Vanuatu Red Cross in decision making and programming for MHM in disaster preparedness and response.

• (Article) Impact of COVID-19 on livestock exports from Somalia and the Horn of Africa

  01.06.2021
  Somalia has a significant place in the livestock sector in the Horn of Africa; livestock trade and export is one of the key economic contributors. Most of the livestock trade happens with the Middle East, the Kingdom of Saudi Arabia being one of its biggest importers. The COVID-19 pandemic has led to both massive loss of life and huge economic losses as the result of measures to contain the virus. In June 2020, the Kingdom of Saudi Arabia took the decision to restrict the number of pilgrims for the annual Hajj. Impacts resulted in a decline in income from the seasonal Hajj of 80 per cent, though domestically prices of livestock remained stable and local markets were used for livestock sales. This paper, besides highlighting the effects, provides recommendations which could inform strategic planning, humanitarian aid, and resilience building for the livestock value chain in Somalia and the Horn of Africa

• (Article) Assessment of low-cost, non-electrically powered chlorination devices for gravity-driven membrane water kiosks in eastern Uganda

  01.04.2021
  Recontamination during transport and storage is a common challenge of water supply in low-income settings, especially if water is collected manually. Chlorination is a strategy to reduce recontamination. We assessed seven low-cost, non-electrically powered chlorination devices in gravity-driven membrane filtration (GDM) kiosks in eastern Uganda: one floater, two in-line dosers, three end-line dosers (tap-attached), and one manual dispenser. The evaluation criteria were dosing consistency, user-friendliness, ease of maintenance, local supply chain, and cost. Achieving an adequate chlorine dosage (∼2 mg/L at the tap and ≥ 0.2 mg/L after 24 h of storage in a container) was challenging. The T-chlorinator was the most promising option for GDM kiosks: it achieved correct dosage (CD, 1.5–2.5 mg/L) with a probability of 90 per cent, was easy to use and maintain, economical, and can be made from locally available materials. The other in-line option, the chlorine-dosing bucket (40 per cent CD) still needs design improvements. The end-line options AkvoTur (67 per cent CD) and AquatabsFlo® (57 per cent CD) are easy to install and operate at the tap, but can be easily damaged in the GDM set-up. The Venturi doser (52 per cent CD) did not perform satisfactorily with flow rates > 6 L/min. The chlorine dispenser (52 per cent CD) was robust and user-friendly, but can only be recommended if users comply with chlorinating the water themselves. Establishing a sustainable supply chain for chlorine products was challenging. Where solid chlorine tablets were locally rarely available, the costs of liquid chlorine options were high (27–162 per cent of the water price).

• (Article) Integrating sanitation and climate change adaptation: lessons learned from case studies of WaterAid’s work in four countries

  01.04.2021
  The links between climate change and sanitation are frequently overlooked in the WASH sector. This paper examines experiences of WaterAid in Bangladesh, Burkina Faso, India, and Madagascar where there was some consideration of the impacts of climate change on sanitation. Climate resilience was often not considered explicitly, however, with work instead framed around weather-related threats that are now increasingly frequent and severe. In these case studies, sanitation and climate integration involved adapting on-site sanitation hardware to physical impacts on infrastructure, while some social aspects of climate resilience were also considered. Integration took place primarily at the project level, while climate change consideration seemed absent from wider planning and decision-making. Aside from these case studies, most of WaterAid’s sanitation work does not seem to incorporate climate change. It is recommended that climate resilience is integrated into each stage of sanitation programming, with a more systematic consideration of its potential impacts.

• (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.

• (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.

• (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.

• (Article) Design, construction, and performance evaluation of an innovative cassava peeling machine

  01.06.2020
  Postharvest processing of cassava requires peeling as a unit operation, and it has been well documented that peeling is a major challenge of cassava processing. This study presents a recently developed cassava peeling machine made from locally available engineering materials. The machine has a capacity of 8 tonnes/day with the dual role of peeling and recycling of fruit water used in the peeling process for washing/mild pretreatment. The peeling machine utilizes an abrasive peeling surface inscribed with indented 1.2 mm stainless steel of 770 mm height with 2,450 mm diameter, a concrete based cavity, fruit water recovery tank, water pump, and the transmission system. The configuration resulted in careful removal of the tuber peels achieving > 90 per cent flesh recovery at an average rotational speed of 1,600 rpm < Nt <2,600 rpm. The average peeling efficiency of the machine was 58.6–85.75 per cent depending on the maturity, age, and variety of cassava. The cost of a single unit in Nigeria was estimated at US$1,230.

• (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.

• (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.

• (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.

• (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.

• (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.

• (Article) COVID-19, seed security and social differentiation: when it rains, it pours

  01.06.2020
  Food security and seed security are closely linked, especially for poor smallholders in developing countries. The impacts of COVID-19 highlight the vulnerability of marginalized groups, and their exposure across multiple social and economic dimensions. Employing seed interventions as part of the COVID-19 recovery requires recognizing local social dynamics, or risks worsening the situation for the most disadvantaged.

• (Article) Being realistic about the contribution of private businesses to public nutrition objectives

  01.06.2020
  This article concerns the role of the state and the private sector in addressing Sustainable Development Goal 2, which is to end hunger, achieve food security and improve nutrition, and promote sustainable agriculture. We critique the ‘food environment’ focusing on the strategies and policies of the public and private sectors which shape agri-food production and consumption. We use evidence from studies in South Asia to suggest more realism about the contribution of major businesses to public nutrition objectives. We conclude that business policies are dynamic, and for most firms and in many markets, there are genuine challenges in reaching the ‘bottom of the pyramid’ of consumers with nutritious foods. For policy-makers there should be no assumption that public and private sector objectives are aligned. Policy recommendations include stronger direct intervention such as through taxation, subsidies, regulatory incentives, and controls on advertising and distribution with appropriate monitoring and sanction mechanisms, and indirect interventions to facilitate the pro-nutrition operations of small and medium size enterprises.

• (Article) Effects of cassava peel mash on chemical composition, nutrient intake, and rumen environment parameters of West African dwarf rams supplemented with dried Ficus thonningii foliage

  01.06.2020
  The study evaluated effects of feeding cassava peel mash (CPM) supplemented with dried foliage of Ficus thonningii (DFF) on the performance of rams. Twenty rams were allotted to four dietary treatments (ad libitum CPM+2 per cent urea (control), ad libitum CPM supplemented with DFF at 0.6, 1.2 and 1.8 per cent of body weight respectively) for 90 days. From the results, crude protein content ranged from 1.99 per cent in CPM to 10.35 per cent in CPM+2 per cent urea. The total dry-matter intake ranged from 247.94 g.d−1 for rams fed with CPM+2 per cent urea to 377.00 g.d−1 for rams supplemented with DFF at 1.8 per cent BW. Higher (P < 0.05) rumen ammonia nitrogen was obtained in animals fed diets containing CPM+2 per cent urea. As the supplementation of DFF increased, total volatile fatty acids concentration as well as microbial contents increased (P < 0.05). In conclusion, supplementation of basal diet of cassava peel mash with dried Ficus thonningii foliage up to 1.8 per cent of body weight of rams is recommended for improved animal performance.

• (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.

• (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.

• (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.