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• (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) 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) 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) 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) 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) 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) 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) Options for addressing poor quality drinking water in rural Vanuatu

  01.10.2021
  Consumption of poor quality water can cause diarrhoea and waterborne disease. To determine how to support residents to consume safe water, the Vanuatu Department of Water Resources (DoWR) undertook an analysis. The analysis included reviewing 793 water quality test results, exploring treatment options with WASH sector stakeholders, surveying 689 community members in three provinces, demonstrating products to 510 people in 22 communities, and interviewing key informants. Analysis of water quality results compiled by DoWR between 2000 and mid-2019 found that Escherichia coli was detected in 60% of samples tested and total coliforms were detected in 84% of samples. Overall, 62% of individuals surveyed stated that water is in some way a daily problem. Discussion facilitators reported that most individuals had not seen or heard of water treatment options beyond boiling and most who boiled admitted they do so only occasionally. Of the water treatment options explored in this research, household water filtration systems seemed the most viable approach. However, individuals underestimated the market cost of filters and indicated a willingness to pay that is half the market price. Of the different filtration systems demonstrated, consumers stated a preference for easy-to-use units with large and transparent water storage containers.

• (Journal 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.

• (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) 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) 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) 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) Measuring progress towards sanitation and hygiene targets: a critical review of monitoring methodologies and technologies

  01.01.2022
  The Sustainable Development Goal (SDG) target for access to safe sanitation and hygiene represents a marked improvement over the target used during the Millennium Development Goal (MDG) period. The SDG target attempts to: explicitly address hygiene; eliminate inequalities within populations; evaluate sanitation services beyond the household; account for the accessibility, safety, acceptability, and affordability of service delivery; and improve the sustainability of services (WHO/UNICEF, 2015). However, the proposed indicators for monitoring progress in sanitation and hygiene still rely primarily on infrequent household surveys and census data. This paper provides a critical review of the sanitation and hygiene target and explores the potential gaps between the expanded understanding of access, the proposed monitoring strategies, and the desired impacts. A variety of innovative methodologies and technologies are reviewed, with specific attention given to their suitability for measuring and monitoring progress towards the sanitation and hygiene target.

• (Journal Article) Impacts of emergencies on water and wastewater systems in congested urban areas

  01.01.2022
  The impacts of emergencies on society and structures are often reported in the media, but the impact of these emergencies on the water and wastewater system is less publicized. The safe operation of these systems is critical during hazardous events and the recovery process to ensure safe and clean water for the public. This need is magnified in congested urban areas where the number of people affected is greatest. A critical aspect to the safe operation of these systems during emergencies is a timely response by municipal leaders. Municipalities must develop plans to prevent and/or mitigate the damage to water systems during emergencies, which will speed the recovery process when these events occur. This paper discusses the impacts of hurricanes and flood events on the water and wastewater systems of densely populated urban areas and presents measures that could be taken to prevent and mitigate the impacts of these events in the future.

• (Journal Article) Sustainability and long-term impact of community-managed water supply in rural Kyrgyzstan, Central Asia

  01.01.2022
  How can Community Managed Water Supply (CMWS) become more sustainable? Recent studies in several countries indicate that the sustainability of many CMWS is poor. As a result, their long term impact on village lives is limited. This paper presents the findings of research on the sustainability and long-term impact of a group of CMWS created by the Rural Water Supply and Sanitation Project (RWSSP) in Kyrgyzstan, Central Asia. This project adopted a Community-Based Approach to maximize the sustainability and long-term impact of its CMWS. The research assessed the sustainability of these CMWS a decade after their completion. It used six measures to assess sustainability and examined four long-term impacts. The results are compared with studies from other countries. The influence of Community-Based Approach (CBA) on the results is discussed. Recommendations are made for changes in policies and strategies to improve the sustainability and long term impact of future CMWS in Central Asia and elsewhere.

• (Journal Article) How a water trucking governance mechanism in the West Bank enhances equity and sustainability

  01.01.2022
  In the Oslo Accord-defined Area C of the West Bank, approximately 11,000 Palestinians are unserved by the water network, forced to rely on water trucking at extremely high prices. In response to this situation, Gruppo di Volontariato Civile (GVC), in partnership with UNICEF, created a programme to subsidize water trucking that alleviates water scarcity while enhancing the sustainability of water service delivery, equitability of tariffs, and predictability of demand. Established in 2014, the programme now covers all the water-vulnerable communities in the West Bank and has reached 35,000 people. The programme links humanitarian and development interventions by using a contiguum approach, where the humanitarian provision of trucked water is accompanied by the construction of water infrastructure and the creation of a multilevel water trucking governance system that defines the roles and responsibilities of all national, regional, and local actors in the water supply chain. By embedding water trucking into the Palestinian Water Authority’s normal activities, the programme is designed to escape a cycle of chronic emergency humanitarian response, in line with the national water sector reform agenda. Eventually, the international donor funding on which the programme depends should be phased out by implementing an equitable, universal water tariff schedule across the entire West Bank, with rates set high enough to subsidize the provision of reliable, safe, and affordable water to the vulnerable residents of Area C.

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

  01.01.2022
  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) The new reality: perspectives on future integrated WASH

  01.01.2022
  Over the next 10 years, the humanitarian and development fields will face significant changes as new skills, expanded technologies, and shifting funding streams prompt innovation in order to maintain impact. As the length of humanitarian crises expand relief response can no longer be viewed merely through the humanitarian lens, but current and future crisis responses increasingly require long-term development considerations. Integration across the humanitarian-development nexus will be vital to future emergency response. The interdisciplinary nature of the WASH sector makes it ideally placed to lead further integration with sectors like health, nutrition, livelihoods, child protection, and education. Integration of the WASH sector is not only possible but essential to face the challenges of future crises. COVID-19 is a wake-up call showing how quickly global humanitarian needs can change and the need for a more integrated response to emergencies. Tomorrow’s WASH practitioners will need to be proactive in developing new hard and soft skills and have broader multi-sectoral experience to succeed. Future integration will require stronger relationships between multi-mandated organizations, governments, and the private sector as well as new innovative funding sources, including impact investing, blended finance, and development impact bonds. We argue that there is a unique window of opportunity to bridge these gaps as COVID-19 brings the value of effective WASH programming forward as a foundational part of long-term resilience building. To indeed provide life-saving interventions as humanitarian works claim to do, we must start with a clear focus on the long-term developmental ends in mind.