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• (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) 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) 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) 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.

• (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.

• (Article) The practice of contract farming in India: making it inclusive and effective

  01.10.2013
  Agricultural marketing reforms are central to changing the agricultural/agribusiness sector. The Amended APMC Act in India, which permitted contract farming, direct purchase from farmers, and setting up of private wholesale markets, was seen as the way forward to kick start the process of modernizing markets and giving better market access and choice to primary producers. The practice of contract farming, which is one of the new institutions as a result of the policy reforms, leaves much to be desired in India's smallholder context as there is exclusion of small farmers who make up most of the farming population. In this context, this paper examines the extent and nature of small producer exclusion, reasons thereof, and various policy options to encourage more inclusive and effective contract farming so that these mechanisms could be leveraged for inclusive and market-oriented sustainable agricultural development.

• (Article) Nuggets from an old book: A Practical Handbook of Water Supply by F. Dixey (1931)

  01.01.2017
  Frank Dixey’s A Practical Handbook of Water Supply, published in 1931 is briefly reviewed. The text is correlated with current knowledge and experience. It is evident from the book that some of the present challenges in the water supply sector have been around for a long time which leads to the conclusion that effecting a change takes time. Development agencies therefore need to set realistic targets and time frames. Some of the rather old texts should be consulted and reviewed periodically as they may contain very useful information.

• (Article) Can and should sanitation and hygiene programmes be expected to achieve health impacts?

  01.01.2017
  Although the anticipated health benefits are not the only reason for undertaking sanitation and hygiene programmes, they do represent an important part of the justification. Studies and reviews over recent years have shown, however, that the health impacts of sanitation programmes can be quite small or even negligible. They have also provided no solid evidence that integrated (water, sanitation, hygiene) programming has any greater effect than addressing one or two of these components alone. Two questions arise: first, whether a certain level of sanitation usage and hygiene practice within a community is needed in order to achieve a measurable health impact (i.e. whether a minimum percentage of the population should be using safe sanitation); second, whether sanitation and hygiene interventions undertaken without accompanying water supply improvements are likely to have significant health benefits. In this opinion paper some plausible and practically relevant answers to these questions are extracted from the relevant literature. The conclusions are that a high level of sanitation usage (well over 65 per cent) and widespread handwashing practice are necessary to achieve significant health impact; and that in situations where water services are poor, sanitation and hygiene interventions, while valuable for other reasons, are unlikely to have significant health impacts. Sanitation and hygiene programmes may be justifiable even if they do not immediately achieve high levels of compliance and corresponding water supply improvements are not made; however, the justification should not be presented on the grounds of short-term health benefits.

• (Article) Chlorination of drinking water in emergencies: a review of knowledge to develop recommendations for implementation and research needed

  01.01.2017
  Clean water provision is a critical component of emergency response, and chlorination is widely used in emergencies to treat water. To provide responders with practical, evidence-based recommendations for implementing chlorination programmes and recommend areas for future research, we conducted a literature review of chlorination in emergencies, supplemented with a literature review on chlorination in general. We identified 106 total documents, including 7 with information on technical efficacy, 26 on chlorine dosage, 22 on technical challenges, 21 on product options, 8 on user acceptability, 33 on programmes for emergencies, and 8 on monitoring. We found that: 1) international chlorine dosage recommendations in emergencies are highly inconsistent; 2) high-quality information from the general chlorination literature on challenges of chlorination can be adapted for emergencies; 3) many chlorine products are available for use in point-of-delivery, point-of-source, and point-of-use emergency-response programmes; 4) information on the effectiveness of different chlorination programmes in emergencies varies, ranging from little data available to high-quality data that can inform programming; 5) information on user acceptability of chlorination in emergencies is lacking; and 6) monitoring data on chlorine programme effectiveness in emergencies are lacking. In this manuscript, we provide a summary of knowledge on chlorination in emergencies, recommendations for programme implementation, and recommendations for future research needed to assist communities and agencies responding to the increasing number of natural disasters and outbreaks worldwide.

• (Article) Urban community-led total sanitation: a potential way forward for co-producing sanitation services

  01.10.2016
  Community-led total sanitation (CLTS) has been proved to be a successful strategy for tackling the challenge of open defecation in poor rural communities across Africa and Asia. This article explores whether a similar approach can be used in peri-urban and urban areas to help co-produce sanitation facilities and services with inputs from communities, duty bearers, and other sanitation stakeholders. It is argued that an urban CLTS approach does not mean a copy and paste of tools and methods which have proved successful in the rural environment but following a set of similar principles. Based on field experiences different steps are suggested that incorporate these principles and respond to the specific urban sanitation problem. This article helps to articulate and better define urban CLTS as well as giving practical guidance for those wanting to use this kind of approach.

• (Article) WASH challenges to girls’ menstrual hygiene management in Metro Manila, Masbate, and South Central Mindanao, Philippines

  01.07.2016
  This paper examines water, sanitation, and hygiene (WASH) conditions that enable and hinder Philippine schoolgirls to hygienically manage their menstruation. We collected qualitative data from 13 schools in three regions of the Philippines. Schools in both urban (Metro Manila) and rural areas (Masbate and South Central Mindanao) were included to allow for comparison across settings. Unreliable access to water, lack of disposal mechanisms for menstrual materials, unclean facilities, and insufficient number of latrines were identified as the key barriers to effective menstrual management in Masbate and Metro Manila. In South Central Mindanao, there was greater oversight of WASH hardware at schools and hardware was in better condition, which created a more enabling environment for girls to manage menstruation. Creating an enabling WASH environment for girls to manage menstruation requires sustained support and system oversight, combined with knowledge and information.

• (Article) Menstrual hygiene: a ‘silent’ need during disaster recovery

  01.07.2016
  Post-disaster relief and recovery operations seldom focus on women’s priorities regarding menstrual hygiene. There is an increasing awareness to incorporate inclusive, participatory, and gender-sensitive strategies for implementation of response programmes. This article presents empirical findings related to menstrual hygiene management (MHM), demonstrating it is integral to women’s privacy and safety during recovery. Using case studies from India, the 2012 Assam floods and 2013 Cyclone Phailin in Odisha, this article explores menstrual hygiene practices in a post-disaster context. The data were collected through participatory learning and action tools such as focus group discussions, household interviews, priority ranking, and observations. It emerged that menstrual hygiene was overlooked at the household level during recovery; women and adolescent girls faced seclusion and isolation, exacerbating privacy and security concerns post-disasters. Some humanitarian agencies have an ad hoc approach towards MHM, which is limited to distribution of sanitary pads and does not address the socio-cultural practices around MHM. There is a need for strategic planning to address MHM with a gender-sensitive and inclusive approach. This article draws practical and policy inferences from the research for stronger approaches towards initiating behaviour change in MHM, and addressing attitudes and knowledge regarding menstrual hygiene.

• (Article) Making pathogen hazards visible: a new heuristic to improve sanitation investment efficacy

  01.04.2016
  The public health objective of sanitation is to reduce the risk of negative health outcomes from faecal contamination. For water-based sanitation systems at the household and community scale as practised in Indonesia and perhaps elsewhere, the liquid component of the effluent comprises a significant pathogen hazard. While increasing attention is paid to managing the solid fraction, the hazard in the liquid fraction goes largely unnoticed and unmanaged. This paper proposes the means for a conceptual shift to a focus on the pathogen hazards that matter post-treatment, and where those hazards enter the environment, enabling improved local risk management. Firstly, the paper proposes exponential, rather than arithmetic, representations of pathogen number or concentration, because arithmetic representations of treatment efficacy wrongly suggest low cause for concern. Secondly, the paper introduces and applies the Pathogen Hazard Diagram, a new heuristic applicable at both the local and national scale, that requires only local knowledge and general sanitation reference knowledge to construct, but which can guide policy and action, direct monitoring, and improve the efficacy of sanitation investments.

• (Article) Beyond ‘functionality’ of handpump-supplied rural water services in developing countries

  01.01.2016
  Many rural point-water sources in developing countries consist of wells or boreholes equipped with handpumps. Various estimates have been made of the functionality of such water points, and functionality is now routinely monitored in national and local surveys of service performance. We argue, however, that a single binary (functional/non-functional) indicator is crude and insufficient to provide much information about service sustainability. We set out a categorization of functionality which includes three sub-categories of functional water points and five non-functional sub-categories, with well/handpump water points in mind. We use a simple model to demonstrate that reduction of high rates of early post-construction abandonment and reduction of total downtimes would greatly improve service performance. We show that functionality levels for multi-age populations of wells or boreholes equipped with handpumps would not normally be expected to exceed about 85 per cent. We recommend going beyond functionality monitoring via the collection of quantitative data on rates of abandonment, frequency and duration of breakdown, combined with descriptive narratives of actions to manage and repair water points, in order to generate more nuanced understanding of service performance.

• (Article) The role of handpump corrosion in the contamination and failure of rural water supplies

  01.01.2016
  There has been much discussion over many years regarding the origin of elevated iron concentrations in rural water supplies in sub-Saharan Africa and Asia. High iron concentrations are often assumed to be naturally occurring in groundwater, despite several studies over the last 30 years which also point to the role of handpump corrosion in aggressive groundwater. Handpump standards specify that galvanized iron pump materials should not be used in groundwater due to the risk of corrosion, yet this advice is not always followed. High iron concentrations, whether naturally occurring, or present as a result of corrosion, have an impact on taste, odour, and appearance of water and can promote the growth of unpleasant iron metabolizing bacteria. These effects often result in the abandonment of boreholes, sometimes only a year old, and a return to unprotected and unsafe water sources. Where boreholes are not abandoned, the effects of corrosion can cause pump materials to degrade to the point where the pump becomes inoperable. These outcomes are clearly inconsistent with the provision of sustainable water supply services as a fundamental human right. This paper provides a synthesis of work undertaken in this area over the last 30 years and recent practical experience of WaterAid in investigating these problems in water supplies in north-eastern Uganda.