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• (Article) Menstrual hygiene management: education and empowerment for girls?

  01.01.2015
  This paper discusses the recent attention of the water, sanitation, and hygiene (WASH) sector to resolving the menstrual hygiene crisis for young girls in developing countries. Menstrual hygiene management (MHM) interventions, including the use of sanitary pads, education, and awareness, and where possible separate, sanitary toilets, are identified to have far-reaching impacts on the education and empowerment of girls. Field research conducted in Ghana's Northern Region indicates a pronounced socialized, sexualized understanding and experience of menstruation among young girls and their families, school teachers, and local NGOs. Unfortunately WASH initiatives only allow interventions to manage menstrual hygiene, leaving the young girls and others in their social settings to deal with the larger subset of sexuality issues. We argue that opening the dominant discourse of a medicalized concept of menstruation to other meanings and experiences will have significant implications for the education and empowerment of young adolescent girls.

• (Article) Mainstreaming menstrual hygiene management in schools through the play-based approach: lessons learned from Ghana

  01.01.2015
  The study objective was to identify and document the effectiveness of the play-based approach in promoting menstrual hygiene management (MHM) in schools and share lessons learned. The study used a mix of study approaches including qualitative and quantitative techniques. The writer carried out an exploratory evaluation on the promotion of MHM activities as part of WASH in Schools programmes in 120 public schools in Ghana. Comparison was drawn between 60 schools currently using the play-based approach in promoting MHM, and 60 other schools which are not using the play-based approach. Data were gathered through interview, focus group discussions, observation, and from field level reports over a six month period. The study showed that there is much potential in play-based approaches, which could accelerate and sustain the implementation of MHM in schools. More teachers and school children participate in and demonstrated considerable knowledge and were confident discussing MHM. The play-based activities also served as point of attraction for the primary school children. The study indicated positive attitudes in boys towards menstruating girls and improved personal hygiene among adolescent girls.

• (Article) Uncovering the challenges to menstrual hygiene management in schools in Mali

  01.01.2015
  There is limited information on girls' menstrual hygiene practices and experiences at school in francophone sub-Saharan Africa. We conducted qualitative research to determine the challenges faced by school-aged girls in Mali, a culturally diverse and largely Muslim country. Research activities were conducted in eight urban and rural schools across the Sikasso and Koulikoro regions, including in-depth interviews with 26 girls and key informant interviews with 14 teachers and school directors. Results describe girls' practices for managing menstruation at school, their support systems and information channels, and their voiced recommendations for school WASH and education improvements.

• (Article) Adolescent schoolgirls' experiences of menstrual cups and pads in rural western Kenya: a qualitative study

  01.01.2015
  Poor menstrual hygiene management (MHM) among schoolgirls in low income countries affects girls' dignity, self-esteem, and schooling. Hygienic, effective, and sustainable menstrual products are required. A randomized controlled feasibility study was conducted among 14-16-year-old girls, in 30 primary schools in rural western Kenya, to examine acceptability, use, and safety of menstrual cups or sanitary pads. Focus group discussions (FGDs) were conducted to evaluate girls' perceptions and experiences six months after product introduction. Narratives from 10 girls' and 6 parents’ FGDs were analysed thematically. Comparison, fear, and confidence were emergent themes. Initial use of cups was slow. Once comfortable, girls using cups or pads reported being free of embarrassing leakage, odour, and dislodged items compared with girls using traditional materials. School absenteeism and impaired concentration were only reported by girls using traditional materials. Girls using cups preferred them to pads. Advantages of cups and pads over traditional items provide optimism for MHM programmes

• (Article) Putting the men into menstruation: the role of men and boys in community menstrual hygiene management

  01.01.2015
  This paper examines how men and boys have an essential role in effective menstrual hygiene programmes and describes an initiative to engage men and boys in Uttar Pradesh, India. Cultural norms around menstruation are rooted in gender inequality and compromise women's ability to manage menstruation hygienically and with dignity. While there has been significant progress in developing comprehensive approaches to menstrual hygiene management (MHM), the role of men and boys in supporting menstrual hygiene has been lacking. In India, WaterAid and Vatsalya have targeted men and boys to address this gap in a programme that started in December 2011. Groups of men and boys were established and sensitized. Male teachers and masons were also trained to provide MHM services in school. Regular monitoring of software and hardware components, focus group discussions with male and female community members, and analysis of attendance registers has been undertaken to assess the emerging outcomes of the programme. As a result of the initiative, men and boys have begun to talk about menstruation more freely and are better able to support the MHM needs of women and girls within the household, community, and school.

• (Article) Guest editorial: tackling the stigma and gender marginalization related to menstruation via WASH in schools programmes

  01.01.2015
  

• (Article) Identification of the potential opportunities, barriers, and threats within the sector in taking up sanitation as a business: rural sanitation in Nkhata Bay District (Malawi)

  01.07.2014
  Private sector participation in sanitation marketing provides a great opportunity to improve rural sanitation access. Although a number of opportunities for private sector participation within the sanitation sector exist, there are numerous barriers and threats to taking up sanitation as a business. This Note from the Field identifies these opportunities, barriers, and threats in Nkhata Bay District, a rural area of Malawi. These insights emerge from a wider research project entitled ‘Private sector participation in the delivery of sanitation and hygiene services’. This note provides background information on the research project on private sector participation and the project location. It goes on to describe the data collection process and present two examples of business activities in the district sanitation sector, before listing the opportunities, barriers, and threats identified and the recommendations that emerge from them.

• (Article) Roads for water: the unused potential

  01.04.2014
  Roads are generally perceived as infrastructure to deliver transport services, but they are more than that. They are major interventions in the hydrology of areas where they are constructed - concentrating runoff and altering subsurface flows. At present, water-related damage constitutes a major cost factor in road maintenance. Using ongoing research from Ethiopia, this article argues to reverse this and turn water from a foe into a friend and integrate water harvesting with road development. Optimized road designs are required - better planning of alignments, making use of road drainage, road surfaces, and river crossings, but also capturing freshly opened springs and systematically including developing storage and enhanced recharge facilities in road-building programmes. Equally important are inclusive planning processes that are sensitive to the multi-functionality of roads but also to the potentially uneven distribution of benefits and the diverse livelihood impacts. There is a need for closer integration of watershed and road-building programmes. With 5.5 million kilometres of roads in sub-Saharan Africa alone, and road building continuing to be one of the largest public investments, the potential of roads for water harvesting is great.

• (Article) Menstrual hygiene management in humanitarian emergencies: Gaps and recommendations

  01.01.2012
  Over the last 15 years there has been increasing attention to adolescent girls' and women's menstrual hygiene management (MHM) needs in humanitarian response contexts. A growing number of donors, non-governmental organizations, and governments are calling attention to the importance of addressing girls' and women's MHM-related needs in post-disaster and post-conflict settings. However consensus on the most effective and culturally appropriate responses to provide for girls and women remains insufficiently documented for widespread sharing of lessons learned. This article is an effort to begin to document the recommendation of key multi-disciplinary experts working in humanitarian response on effective approaches to MHM in emergency contexts, along with a summarizing of the existing literature, and the identification of remaining gaps in MHM practice, research and policy in humanitarian contexts.

• (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.

• (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.

• (Article) Financing and design innovation in rural domestic rainwater harvesting in Madagascar

  01.04.2019
  Rural water supply interventions in low-resource settings often suffer from poor functionality. The use of technologies and financing approaches, that are out of step with the communities that they target, are primary drivers of this breakdown in supply. This paper describes a pilot study from south-east Madagascar that provides rural households with access to a water source at the home through the sale of rainwater harvesting systems. Results from the pilot show that households were prepared to pay a significant contribution towards establishing a household water supply despite being located in a low-resource, water-abundant region. Over a payback period of six months, zero households defaulted on loans that covered 57 per cent of the costs for materials and transport. Water quality tests demonstrated that the systems were capable of providing water with low levels of microbial contamination (median CFU/100 ml = 7). High levels of adherence to operation and maintenance schedules suggest that people were capable and motivated to maintain and use their systems.

• (Article) Menstrual hygiene management and reproductive tract infections: a comparison between rural and urban India

  01.04.2019
  The objective of the research was to compare factors associated with menstrual hygiene management (MHM) between urban and rural ever-married women in India, and its effect on reproductive tract infections (RTIs). A cross-sectional study was performed analysing data from the Indian District Level Household and Facility Survey 2007–08 (DLHS-3). The respondents were ever-married women between 15 and 49 years of age (N = 577,768). A quarter of women from urban areas use improved methods compared with only 4.3 per cent in rural areas. Cloth had the highest prevalence of usage in both areas. Socio-demographic factors associated with the usage of improved methods were almost the same between localities. Women using improved methods were less likely to suffer from RTIs across localities, except for urinary tract infections (UTIs) in rural areas; UTIs (adjusted odds ratio (AOR) = 0.95 – 1.03 in rural areas and AOR = 0.80 – 0.88 in urban areas). Findings reiterate the complexity of MHM and the need for immediate attention from the government and other agencies to ensure that girls and women have hygienic practices during their menstrual periods which will help prevent RTIs related to poor MHM.

• (Article) Evaluating the viability of establishing container-based sanitation in low-income settlements

  01.07.2019
  Container-based sanitation (CBS) services operate in a number of low-income urban settlements across the globe, providing sanitation services where other on-site and off-site sanitation systems face logistical and environmental restrictions. The viability of each CBS service is influenced by a number of location-specific factors. Drawing on an initial review of existing CBS services, this paper identifies and evaluates these factors in relation to establishing CBS in a new service location. By applying a weighted scoring matrix to these factors, the potential viability of CBS services has been assessed for urban informal settlements in Kathmandu Valley, Nepal. The viability of CBS services in these settlements was found to be most influenced by the current availability of basic sanitation facilities, the unfamiliarity with paying for sanitation services, and the universally adopted practice of anal cleansing with water. The process and scoring matrix developed and subsequently applied in Nepal are recommended as part of the pre-feasibility stage assessment where a CBS service is being considered as a sanitation option in new locations.

• (Article) Experiences from East Africa and lessons in addressing the menstrual hygiene needs of women and girls

  01.07.2019
  This practice paper outlines key results from research conducted by the International Federation of Red Cross and Red Crescent Societies (IFRC) in East Africa from 2012 to 2016. Implemented in Burundi, Uganda, Somaliland, and Madagascar, the work aimed to better understand the menstrual hygiene management (MHM) needs of women and girls and the challenges they face with menstruation in humanitarian contexts. Based on a participatory consultation with women and girls, three types of ‘MHM kit’ were designed and tested to generate evidence on the appropriateness, acceptability, and value of the kits as a relief item. Results showed improvements in dignity, health, and knowledge after the distribution of MHM kits and promotion of menstrual hygiene. Findings highlighted the importance of appropriate facilities, including safe, private spaces for washing, changing, and drying pads. Key lessons and recommendations for future MHM programming include: distribute sanitary items together with supportive items (for washing, drying, and disposal); distribution must come with information and a demonstration on use and care; involve men and boys from the beginning; build confidence and capacity of male and female staff and volunteers; and link with sexual and reproductive health service providers.

• (Article) Process learning on partnerships: building functioning research and practice organizational relationships

  01.01.2019
  Implementers and researchers are responding to increasingly strong incentives to work together closely. Donors are placing a higher value on data, rigour, and evidence of impact from development assistance projects. This is seen in policy debates emphasizing value for money, and funding contingent on results and performance. In response, implementing organizations are increasingly collaborating with researchers. Such arrangements incur costs (financial and other), but the return on investment is high. Investments in relationship building, open and frequent communications, a clear understanding of partners’ objectives and non-negotiable requirements, and a mind-set of problem solving are important priorities in setting productive implementation science partnerships. We document process learning from developing a partnership between an implementing organization, Plan International, and a research institute, the Water Institute at the University of North Carolina. We make the case that: effective partnerships have preconditions for success; building institutional respect takes time and incremental changes to business as usual; establishing a partnership early with a long start-up period is advisable; accountability and research relevancy increase through shared roles during project design and results interpretation; and research message development requires regular review meetings with increasing frequency toward the end of a project.

• (Article) Incontinence in Zambia: initial investigation into the coping strategies of sufferers and carers

  01.07.2018
  There is little information on the management of incontinence in low-income settings. This article provides some initial insights, of particular relevance to water, sanitation, and hygiene (WASH) and health practitioners, into the coping strategies used by sufferers and carers in Zambia. Incontinence is rarely reported to medical professionals in Zambia, possibly due to a reluctance to disclose as a result of the stigma associated with the condition. Management and treatment of incontinence is subsequently limited, and both coping strategies and treatment received are determined by affordability and accessibility. If the global community is to achieve the Sustainable Development Goals of universal sanitation (Goal 6) and well-being (Goal 3), future studies and programmes on incontinence in Zambia will need to involve collaborations between WASH and health practitioners that investigate how to reduce the stigma associated with the condition and increase awareness, and how to improve the availability and affordability of management and treatment, considering the potential preference for traditional medicine in rural communities.

• (Article) Efficiency of additives and internal physical chemical factors for pit latrine lifetime extension

  01.07.2018
  Pit latrines are the most common form of on-site sanitation, but are blighted by the problem of pit fill-up. Little is known about what factors and conditions affect decomposition of pit content and thus govern pit filling, but the liquid–mass balance is the key factor. Under laboratory conditions the effect of inorganic and biological additives and the effect of physical chemical factors on solids hydrolysis of black water and human faeces were investigated to establish the potential of these to extend pit latrine lifetime. Additives did little or nothing to enhance net solids hydrolysis in batch tests or to reduce pit fill height in miniature simulated pit latrines. Physical chemical factors such as redox condition and initial pH increased solids hydrolysis, whereas temperature and substrate moisture did little. Since additives need contact with the substrate to act, measurements on faeces crust formation speed and strength were performed and showed that crusts formed within three hours and persisted after covering with fresh faeces or water.

• (Article) Transgender-inclusive sanitation: insights from South Asia

  01.04.2018
  This paper provides insights from initiatives to include transgender people in sanitation programming in South Asia. Three case studies of recent actions to make sanitation inclusive for transgender people (in India and Nepal) are presented, accompanied by reflections and recommendations to guide future practice. Practitioners are recommended to: engage with transgender people as partners at all stages of an initiative; recognize that the language of gender identity is not fixed, varying across cultures and between generations; and acknowledge that transgender people are not a single homogeneous group but rather have diverse identities, histories, and priorities. The case studies aim to raise awareness of the diversity of transgender identities, exploring the needs and aspirations of transgender women, transgender men, and third gender people in South Asia.

• (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.