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Integrating, collaborating and building capacity for menstrual hygiene management

By: Mirembe

What can Uganda and other sub-Saharan African countries learn from Kenya's successful approach to improve menstrual health management?

Kenya is recognised as one of the countries that have made progress in policy, processes and practice relating to menstrual health management (MHM). It provides key lessons to other sub-Saharan countries that would like to improve MHM as a crucial aspect of SDGs and related efforts to leave no one behind.

Against that background, the Water Supply and Sanitation Collaborative Council (WSSCC), through International Water and Sanitation Centre - Uganda (IRC Uganda) organized a three-day learning visit to Kenya (April 23rd-25th), which attracted ten WASH professionals from the Ministry of Education, Ministry of Health and Ministry of Water and Environment, Water for People and Uganda Water and Sanitation NGO Network (UWASNET).

Hosted by the Kenyan Ministry of Health, the ten-strong delegation from Uganda was led by Julian Kyomuhangi, Commissioner Environmental Health, Ministry of Health. The delegation engaged in a wide range of activities which mainly involved meetings with Kenya Ministry of Education and Ministry of Health; meeting with the Kenya Hygiene Technical Working Group; meetings with key officials and CSOs in Kwale County; and visiting MHM intervention sites in Samburu Ward. The visit was crowned with a reflection on key lessons learnt, and proposed actions for the Uganda MHM coalition.

Key lessons from Kenya

Coordination and Collaboration: The MHM programme in Kenya is government led, with the Ministries of Health, Education and Gender working closely through an MHM working group. A joint annual plan exists, which makes it easier to mobilise resources. The Ministry of Health plays a crucial coordination role bringing together all key stakeholders in MHM including Community Based Organisations, Faith Based Organisations, NGOs, UN-agencies, private Sector and social enterprises. This is done through the Inter Agency Coordination Committee (ICC) and Hygiene Promotion Technical Working group. The Hygiene Promotion Technical Working group and the supporting MHM taskforce coordinate all activities related to the development of the MHM Policy & strategy, capacity building of key stakeholders and addressing standards of menstrual products.

Integration: The realisation that MHM is not a standalone and it relates with other issues like food security, poverty, reproductive health. MHM proponents are using existing structures to push the agenda of MHM. Integration was also observed beyond just institutions but also in terms of activities implementation – integrated in activity budgets. Integration was also observed at household level where MHM has been integrated with Community Led Total Sanitation (CLTS). Integration and joint planning have made it possible to accelerate resource mobilisation and fill the funding gap for MHM.

Capacity building: Kenya has invested in MHM capacity building at national, county and community level. With support from WSSC, the Ministry of Health undertook capacity building for six (6) master trainers on MHM in India. The six have since conducted a series of trainings across the country at national and county level – Training of Trainers (TOT) at national level and training of MHM champions at county level, starting with county first ladies who create an entry point for MHM advocacy. In Kwale county alone, a total of 77 people from the four sub counties were trained in MHM. Several MHM training tools have been developed. These include but are not limited to; the National MHM Training Manual; menstrual wheel; booklet titled "As We Grow Up", conveners manual and WASH infrastructure handbook.

Policy and guidelines: Kenya has clear policies and guidelines on MHM and sanitation, which guide action planning and implementation. MHM interventions and progammes are anchored in a strong legal and policy framework, staring with the Kenyan constitution which recognises MHM as a human right. Basic education Act amendment 2017 provides for free sanitary pads for menstruating girls in primary school. Other legal instruments are: Draft Environmental Health and Sanitation Bill; National Environmental Management and Coordination Act (Waste management regulations 2006); Adolescent Sexual and Reproductive Health Policy 2015; National School Health Policy; Kenya Environmental Sanitation and Hygiene Policy 2016-2030; Draft National Reproductive Health Policy; Draft Neonatal Child and Adolescent Health Policy; Draft Menstrual Hygiene Management Policy and Strategy awaiting endorsement from the PS-MOH Kenya and the Ministers of Education, Health and Gender

Involvement of prominent personalities at national and county level: Working with prominent people as MHM champions is a good approach e.g the first lady of Kwale and other first ladies.

Innovative approaches like the MHM lab are key for information sharing

Work through the school management committee at school level since they are the decision makers who support the head teacher

The disposal of MHM waste products is still a challenge

Action points for Uganda

• Develop an MHM policy and strategy, anchored in an Act of Parliament.
• Promote multi-sectoral approach while integrating and mainstreaming MHM. Bring on board line ministries, private sector, etc
• Jointly plan and develop a five-year MHM plan for the country, under the coordination of the National Sanitation Working Group
• Strengthen the school health programme
• Undertake an MHM stakeholders mapping exercise
• Need to develop and M&E frame work for monitoring and Evaluating MHM interventions
• Documentation and sharing of MHM interventions with the wider audience
• Identify and continuously engage MHM champions. This has to be done strategically through well packaged information and tools for the Champions. Delegates in this learning visit should be champions themselves. Also involve other prominent personalities like the First Lady and Minister of Education
• Innovate around menstrual waste disposal management-conduct informative research on what works and what does not
• Build capacity of the stakeholders on MHM; starting with a National level TOT in MHM
• Integrate MHM in the Country Engagement Plan (CEP) and the USF
Organise a media breakfast meeting on MHM and a stakeholders' meeting to share the lessons from this learning visit.

Tips from Kenyans to Ugandans

• Policy processes may be delayed but that should not discourage actors. Start on the work and it continuously enriches the draft policy
• Don't create cliques. Open MHM for everybody. Anyone who wants entry, bring them in, build their capacity and move together
• Don't use one piece of research to make conclusions. Don't make assumptions. There's a lot of research and data, only that they have not yet been streamlined. Acknowledge that you're not starting from scratch and build on what others have done.
• Integrate MHM into as many programmes as possible, it speaks to many aspects of life. Also consider the ways in which MHM will help accelerate other agendas e.g Uganda Sanitation Fund
• Train and support champions to adopt a common message to avoid mixed messages. Standardizing peoples understanding will require some financial and human resources .
• Government should be the leader and don't create exclusive clubs for partners who only have big budgets. Small NGOs are just as important.

Read the full report below under Resources.

Integrating, collaborating and building capacity for menstrual hygiene management

By: Mirembe

What can Uganda and other sub-Saharan African countries learn from Kenya's successful approach to improve menstrual health management?

Kenya is recognised as one of the countries that have made progress in policy, processes and practice relating to menstrual health management (MHM). It provides key lessons to other sub-Saharan countries that would like to improve MHM as a crucial aspect of SDGs and related efforts to leave no one behind.

Against that background, the Water Supply and Sanitation Collaborative Council (WSSCC), through International Water and Sanitation Centre - Uganda (IRC Uganda) organized a three-day learning visit to Kenya (April 23rd-25th), which attracted ten WASH professionals from the Ministry of Education, Ministry of Health and Ministry of Water and Environment, Water for People and Uganda Water and Sanitation NGO Network (UWASNET).

Hosted by the Kenyan Ministry of Health, the ten-strong delegation from Uganda was led by Julian Kyomuhangi, Commissioner Environmental Health, Ministry of Health. The delegation engaged in a wide range of activities which mainly involved meetings with Kenya Ministry of Education and Ministry of Health; meeting with the Kenya Hygiene Technical Working Group; meetings with key officials and CSOs in Kwale County; and visiting MHM intervention sites in Samburu Ward. The visit was crowned with a reflection on key lessons learnt, and proposed actions for the Uganda MHM coalition.

Key lessons from Kenya

Coordination and Collaboration: The MHM programme in Kenya is government led, with the Ministries of Health, Education and Gender working closely through an MHM working group. A joint annual plan exists, which makes it easier to mobilise resources. The Ministry of Health plays a crucial coordination role bringing together all key stakeholders in MHM including Community Based Organisations, Faith Based Organisations, NGOs, UN-agencies, private Sector and social enterprises. This is done through the Inter Agency Coordination Committee (ICC) and Hygiene Promotion Technical Working group. The Hygiene Promotion Technical Working group and the supporting MHM taskforce coordinate all activities related to the development of the MHM Policy & strategy, capacity building of key stakeholders and addressing standards of menstrual products.

Integration: The realisation that MHM is not a standalone and it relates with other issues like food security, poverty, reproductive health. MHM proponents are using existing structures to push the agenda of MHM. Integration was also observed beyond just institutions but also in terms of activities implementation – integrated in activity budgets. Integration was also observed at household level where MHM has been integrated with Community Led Total Sanitation (CLTS). Integration and joint planning have made it possible to accelerate resource mobilisation and fill the funding gap for MHM.

Capacity building: Kenya has invested in MHM capacity building at national, county and community level. With support from WSSC, the Ministry of Health undertook capacity building for six (6) master trainers on MHM in India. The six have since conducted a series of trainings across the country at national and county level – Training of Trainers (TOT) at national level and training of MHM champions at county level, starting with county first ladies who create an entry point for MHM advocacy. In Kwale county alone, a total of 77 people from the four sub counties were trained in MHM. Several MHM training tools have been developed. These include but are not limited to; the National MHM Training Manual; menstrual wheel; booklet titled "As We Grow Up", conveners manual and WASH infrastructure handbook.

Policy and guidelines: Kenya has clear policies and guidelines on MHM and sanitation, which guide action planning and implementation. MHM interventions and progammes are anchored in a strong legal and policy framework, staring with the Kenyan constitution which recognises MHM as a human right. Basic education Act amendment 2017 provides for free sanitary pads for menstruating girls in primary school. Other legal instruments are: Draft Environmental Health and Sanitation Bill; National Environmental Management and Coordination Act (Waste management regulations 2006); Adolescent Sexual and Reproductive Health Policy 2015; National School Health Policy; Kenya Environmental Sanitation and Hygiene Policy 2016-2030; Draft National Reproductive Health Policy; Draft Neonatal Child and Adolescent Health Policy; Draft Menstrual Hygiene Management Policy and Strategy awaiting endorsement from the PS-MOH Kenya and the Ministers of Education, Health and Gender

Involvement of prominent personalities at national and county level: Working with prominent people as MHM champions is a good approach e.g the first lady of Kwale and other first ladies.

Innovative approaches like the MHM lab are key for information sharing

Work through the school management committee at school level since they are the decision makers who support the head teacher

The disposal of MHM waste products is still a challenge

Action points for Uganda

• Develop an MHM policy and strategy, anchored in an Act of Parliament.
• Promote multi-sectoral approach while integrating and mainstreaming MHM. Bring on board line ministries, private sector, etc
• Jointly plan and develop a five-year MHM plan for the country, under the coordination of the National Sanitation Working Group
• Strengthen the school health programme
• Undertake an MHM stakeholders mapping exercise
• Need to develop and M&E frame work for monitoring and Evaluating MHM interventions
• Documentation and sharing of MHM interventions with the wider audience
• Identify and continuously engage MHM champions. This has to be done strategically through well packaged information and tools for the Champions. Delegates in this learning visit should be champions themselves. Also involve other prominent personalities like the First Lady and Minister of Education
• Innovate around menstrual waste disposal management-conduct informative research on what works and what does not
• Build capacity of the stakeholders on MHM; starting with a National level TOT in MHM
• Integrate MHM in the Country Engagement Plan (CEP) and the USF
Organise a media breakfast meeting on MHM and a stakeholders' meeting to share the lessons from this learning visit.

Tips from Kenyans to Ugandans

• Policy processes may be delayed but that should not discourage actors. Start on the work and it continuously enriches the draft policy
• Don't create cliques. Open MHM for everybody. Anyone who wants entry, bring them in, build their capacity and move together
• Don't use one piece of research to make conclusions. Don't make assumptions. There's a lot of research and data, only that they have not yet been streamlined. Acknowledge that you're not starting from scratch and build on what others have done.
• Integrate MHM into as many programmes as possible, it speaks to many aspects of life. Also consider the ways in which MHM will help accelerate other agendas e.g Uganda Sanitation Fund
• Train and support champions to adopt a common message to avoid mixed messages. Standardizing peoples understanding will require some financial and human resources .
• Government should be the leader and don't create exclusive clubs for partners who only have big budgets. Small NGOs are just as important.

Read the full report below under Resources.

Managing Menstruation Delivers Dignity and Opportunity

In some remote parts of Ghana, girls are told that crossing a river during their menstrual period will offend the river deity — so some…

Continue reading on Global Waters »

Menstrual hygiene management in humanitarian situations

May 28, 2019 is Menstrual Hygiene Day and below are excerpts from the May 23, 2019 issue of Water Currents: Menstrual Hygiene Day 2019 on menstrual hygiene management in humanitarian situations.

Events
Menstrual Hygiene Day 2019 – This global advocacy platform for MH Day brings together the voices and actions of nonprofits, government agencies, individuals, the private sector, and the media to promote MHM for all women and girls. This website contains campaign materials for this year’s theme—It’s Time for Action—and a list of events and resources. mhday2019

WASH Innovation Challenge on Menstrual Hygiene Management (MHM) and Incontinence – Elrha’s Humanitarian Innovation Fund is launching a challenge May 23, 2019, and will be seeking innovative projects exploring how to design safe and dignified MHM spaces in emergency camp settings and how to better engage with and understand the needs of people with incontinence in emergencies. We will especially welcome applications from broad partnerships that include NGOs as well as designers, academic institutions and local organisations, and we expect that any approach would take a participatory and user-centred approach to developing the innovation. Additional information will soon be posted on the Elrha’s website. You can also get in touch with Cecilie Hestbaek, c.hestbaek@elrha.org, and Sophie Van Eetvelt, s.vaneetvelt@elrha.org, for more information and advice on how to prepare for the call.

MHM and Humanitarian Situations
Pilot Study Findings on the Provision of Hygiene Kits with Reusable Sanitary PadsUnited Nations Refugee Agency (UNHCR), December 2018. In collaboration with AFRIpads, UNHCR Sub-Office Mbarara implemented a three-month pilot intervention to test the acceptability of introducing reusable sanitary pads to schoolgirls in the refugee context.

Periods Don’t Stop in Emergencies: Addressing the Menstrual Hygiene Needs of Women and GirlsHumanitarian Innovation Fund, August 2018. This article discusses the challenges that women and girls face around menstrual hygiene in emergencies.

Exploring Menstrual Practices and Potential Acceptability of Reusable Menstrual Underwear among a Middle Eastern Population Living in a Refugee SettingInternational Journal of Women’s Health, July 2018. Primary data analysis of narratives around the beliefs, behaviors, and practices of menstrual hygiene in this population revealed key themes related to the physical environment; the social environment; cleanliness, comfort, and health; and adaptation and coping.

Pilot Testing and Evaluation of a Toolkit for Menstrual Hygiene Management in Emergencies in Three Refugee Camps in Northwest TanzaniaJournal for International Humanitarian Action, June 2018.  This paper describes the development and pilot testing of the Menstrual Hygiene Management in Emergencies Toolkit in three camps hosting Burundian and Congolese refugees in northwest Tanzania.

Improving Menstrual Hygiene Management in Emergency Contexts: Literature Review of Current PerspectivesInternational Journal of Women’s Health, April 2018. The objective of this review was to collate, summarize, and appraise existing peer-reviewed and gray literature that describes the current scenario of MHM in emergency contexts to understand the breadth and depth of current policies, guidelines, empirical research, and humanitarian aid activities addressing populations’ menstrual needs.

Menstrual Hygiene Management in Emergencies ToolkitColumbia University Mailman School of Public HealthInternational Rescue Committee, 2017. The toolkit provides streamlined guidance to support organizations and agencies seeking to rapidly integrate MHM into existing programming across sectors and phases.

MHM and Waste Disposal
Menstrual Hygiene Management and Waste Disposal in Low and Middle Income Countries—A Review of the LiteratureInternational Journal of Environmental Research and Public Health, November 2018. A literature review showed that MHM and sanitation value chains often neglect the disposal of menstrual waste, leading to improper disposal and negative impacts on users, sanitation systems, and the environment.

Menstrual Hygiene, Management, and Waste Disposal: Practices and Challenges Faced by Girls/Women of Developing Countries. Journal of Environmental and Public Health, February 2018. At home, women dispose of menstrual products with other domestic waste. Outside of the home, they often flush them in public toilets without knowing the consequences of choking sewer pipelines.

Menstrual Waste Management: A Simple GuideMinistry of Drinking Water and Sanitation, Government of India, 2019. This guide discusses composting and small-scale incineration of disposed menstrual hygiene products.

Others

Women’s and girls’ experiences of menstruation in low- and middle-income countries: A systematic review and qualitative metasynthesisPLoS Medicine, May 2019. This model hypothesizes directional pathways that could be tested by future studies and may serve as a framework for program and policy development by highlighting critical antecedents and pathways through which interventions could improve women’s and girls’ health and well-being.

A cross-sectional mixed-methods study of sexual and reproductive health knowledge, experiences and access to services among refugee adolescent girls in the Nakivale refugee settlement, UgandaReprod Health, March 2019. Humanitarian crises and migration make girls and women more vulnerable to poor sexual and reproductive health (SRH) outcomes. Nevertheless, there is still a dearth of information on SRH outcomes and access to SRH services among refugee girls and young women in Africa. This study discusses SRH experiences, knowledge and access to services of refugee girls in the Nakivale settlement, Uganda.

Pilot study findings on the provision of hygiene kits with reusable sanitary padsUNHCR, 2019. Testing the appropriateness and acceptability of AFRIpads reusable sanitary pads in southwestern (Ugandan) refugee context among schoolgirls.

Protecting women and girls in refugee camps: States’ obligations under international law. LSE Centre for Women, Peace and Security, 2019. This report examines the core international human rights obligations of States toward non-citizen refugee women and girls who live in camps within the State’s territory and/or jurisdiction.

Female-friendly public and community toilets: a guide for planners and decision makers. WaterAid, 2018. The guide can help improve understanding of the requirements of women and girls using public and community toilets.

usaidwaterckm

mhday2019

Water Currents: Menstrual Hygiene Day 2019

Menstrual Hygiene Day 2019. Water Currents, May 23, 2019.

Every May 28, Menstrual Hygiene Day (MH Day) raises awareness and combats taboos associated with menstrual hygiene with the goal of enabling women and girls to achieve their full potential. mhday2019

The theme of Menstrual Hygiene Day 2019—It’s Time for Action—not only emphasizes the urgency of this public health issue, but also highlights the transformative power of improved menstrual hygiene to unlock economic and educational opportunities for women and girls.

Empowering women and girls and promoting gender equality are core operating principles of the U.S. Government Global Water Strategy and USAID Water and Development Plan. To alleviate a major constraint to women’s and girls’ participation in education and public life, USAID seeks to integrate menstrual hygiene management (MHM) interventions where practical and improve MHM in key settings, including schools.

As a contribution to MH Day 2019, this issue contains links to recent studies on “period poverty,” MHM and its impact on schooling/education, MHM in humanitarian situations, and other MHM–related topics.

Events
Menstrual Hygiene Day 2019 – This global advocacy platform for MH Day brings together the voices and actions of nonprofits, government agencies, individuals, the private sector, and the media to promote MHM for all women and girls. This website contains campaign materials for this year’s theme—It’s Time for Action—and a list of events and resources.

WASH Innovation Challenge on Menstrual Hygiene Management (MHM) and Incontinence – Elrha’s Humanitarian Innovation Fund is launching a challenge May 23, 2019, and will be seeking innovative projects exploring how to design safe and dignified MHM spaces in emergency camp settings and how to better engage with and understand the needs of people with incontinence in emergencies. Additional information will soon be posted on the Elrha’s website.

MHM Overviews
What Is the Point of a Period? Scientific American, May 2019. Age-old taboos against menstruation have led to a lack of research on how women’s menstrual cycles work, with serious consequences for their health.

Period Poverty Impact on the Economic Empowerment of WomenKnowledge, Learning and Evidence for Knowledge, January 2019. Period poverty refers to a lack of access to sanitary products due to financial constraints. The problem exists in high as well as low- and middle-income countries.

Read the complete issue.

usaidwaterckm

mhday2019

Innovations in Combating the Hand Hygiene Crisis: A Lesson in Getting Creative

By: Lindsay Denny

This post was originally posted on the WASH in Health Care Facilities website.

What do you do when there aren’t enough working sinks in the hospital and the infrastructure situation won’t be improved anytime soon? Sometimes, you need to get creative.

Walking through a packed hospital in rural Cambodia, I saw the same problem yet again: this facility cared for more than 100 patients per day, but the building that housed the pediatric and post-surgery wards had no water access. Standing between rows of beds, I observed the patients and their caregivers and wondered how the staff could possibly do their job well without a sink to wash their hands.

Simply washing hands with soap has been shown to prevent nearly 40 percent of neonatal deaths. It is fundamental to patient care and worker safety. The importance of handwashing cannot be overestimated, and soap and water and the ability to dry hands are imperative for infection prevention and control.

Staff at this hospital cared for patients who had just had major surgery; yet they needed to walk to the building next door to access a functioning sink and soap. One of the nurses told me she and her colleagues sometimes used hand sanitizer, but because they had to purchase it themselves, it was used sparingly. In addition to being cost-prohibitive, hand sanitizer isn’t always the best option to decontaminate hands. For example, the WHO says hands need to be washed with soap and water when covered with blood, a common occurrence in a health facility. Neither walking 100 meters nor using hand sanitizer intermittently was ideal for ensuring proper hand hygiene for every patient.

This absence of handwashing facilities inside healthcare facilities puts entire communities at risk of health epidemics and the spread of infectious diseases; and it is by no means unique to Cambodia. A series of recent reports have confirmed what should be incomprehensible: billions of people are served by healthcare facilities that lack adequate hygiene facilities. Forty-three percent of hospitals and health centers globally do not have materials for handwashing at points of care. That’s the conclusion of the first global report on water, sanitation and hygiene (WASH), based on data from over 560,000 healthcare facilities in 125 countries, recently released by WHO/UNICEF. These findings follow a landmark 2018 report that analyzed data from 129,000 healthcare facilities in 78 low- and middle-income countries: 50 percent of healthcare facilities lacked piped water, 33 percent lacked basic toilets, and 39 percent lacked soap.

What then do you do when there aren’t enough working sinks in the hospital and the infrastructure situation won’t be improved anytime soon? Sometimes, you need to get creative. WaterSHED, a local Cambodian NGO, is no novice when it comes to finding innovative, yet simple solutions. They started by looking at ways to improve hygiene in rural communities across the Mekong, focusing on households and how to motivate families to consistently wash their hands. With insights from Vietnamese and Cambodian mothers, they designed a portable sink and tested it in rural homes with young children. The end product: the “HappyTap”, an affordable, mobile, and easy-to-use way to encourage everyone to stay healthier by maintaining better hand hygiene.

Photo Credit: HappyTap Asia

It may sound like an obvious solution, yet there were no low-tech, low-cost alternatives to sinks on the market in Cambodia. But could it function in the more demanding healthcare setting as an acceptable alternative where water infrastructure is not available? Through funding from the General Electric Foundation, Emory University partnered with the team at WaterSHED to bring Happy Taps to GE project hospitals where Emory was working. While hospital staff were keen to try it out, they made it clear that they wanted their own designated sinks, separate from patients and caregivers. Four portable taps were placed in critical handwashing areas that lacked water access, on carts so they’d be mobile. A mirror and a poster about handwashing were hung on the wall above and staff members were assigned to refill the water.

Our initial visits were encouraging. The Happy Taps were intact, functional and most important, in regular use thanks to their proximity to points of care. But we know sustainability notoriously plagues water solutions. With the best of intentions, equipment and infrastructure is installed, but with no funding, training and plans for on-going maintenance, faucets crack, pipes snap, and far too many sinks gather dust. Even with this low-tech innovation, we didn’t know what we’d find.

The real test was what we’d find when we returned a year and a half later. Not only were all the taps fully functioning and being used, they’d been placed in preferred locations and staff had rigged them with add-ons, like attachments for liquid soap purchases. During staff training on infection prevention, the portable sink in the middle of the training room was perfectly suited to demonstrate proper handwashing technique. Several staff even inquired about purchasing handwashing stations for their homes.

Is a portable tap a long-term solution? Probably not, because they require a staff member to fill up them with water and empty the discharge. When discussing their ideal handwashing situation, the hospital directors in Cambodia described a normal sink, piped in from outside.

But providing healthcare workers with the ability to clean their hands is absolutely vital. Until hospitals have access to piped water and permanent sinks in critical locations, particularly the point of care, and are kept operable with on-going maintenance, our experience in Cambodia demonstrates that portable handwashing stations may be one acceptable, cost-effective way to help close the global gap in the hand hygiene crisis within healthcare facilities. And that is the definition of one very happy tap. do you do when there aren’t enough working sinks in the hospital and the infrastructure situation won’t be improved anytime soon? Sometimes, you need to get creative.

 

Private Sector Partnerships for a Water-Secure Iloilo City

Students attend a Metro Iloilo Water District (MIWD) educational tour. Photo credit: MIWD

With a rapidly increasing population, Iloilo City, a highly urbanized city in western Philippines has grown to just under 1 million residents. In recent years, the city experienced an economic growth spurt. Commercial and residential buildings are springing up around the city, services and retail businesses are thriving, and tourists are flocking to the city’s landmarks. A potential economic powerhouse, Iloilo City is one of the eight partner cities of the USAID/Philippines through its Cities Development Initiative. Through this initiative, USAID partners with regional growth hubs outside of Metro Manila to be engines of inclusive, sustainable growth.

Despite Iloilo City’s fast-paced growth, water systems have not kept up with the developments. As of 2016, only about 23 percent of the population was connected to piped water service through the government-owned Metro Iloilo Water District (MIWD), and those who were connected experienced rationing and low water pressure. For years, MIWD struggled to meet Iloilo City’s growing water needs, but with limited resources. “MIWD has no internal funding [to upgrade and expand its services],” says Imelda Magsuci, MIWD general manager.

An important policy shift occurred in 2013 when the Philippine government actively began to encourage public-private partnerships to spur sustainable development across the country. Municipal water boards, like MIWD, looked to these opportunities with interest. In December 2014, MIWD received an unsolicited proposal from Metro Pacific Water Investments Corporation (MPIC), part of a leading Philippine-based, private infrastructure firm, to rehabilitate, expand, operate, and maintain MIWD’s water systems.

Workers conduct pipeline repairs in Iloilo City’s Megaworld business district. Photo credit: MIWD

Meanwhile, USAID was continuing to respond to U.S. policy priorities to partner with the private sector in advancing development. USAID, through its Water Security for Resilient Economic Growth and Stability, or Be Secure, project helped facilitate the partnership between MIWD and MPIC. “USAID enabled MIWD to evaluate and negotiate the technical, legal, economic, and financial aspects of the proposal, ensuring that consumers will benefit in the best possible way from the partnership,” says Joanne Dulce, USAID/Philippines project manager for water, sanitation, and hygiene.

USAID’s Be Secure project operated for four years (2013–2017) in six target cities, including Iloilo, to expand access to improved water and sanitation to approximately 1.8 million people across the Philippines.

In July 2015, Be Secure began working with MIWD, providing a team of experts to help review an evaluation of the proposal and then, starting in March 2016, with the negotiation process. It would take several more steps to finish the entire process until the contract was awarded, but the project provided the necessary assistance during the critical and arduous stage of the negotiations.

USAID’s Be Secure project ended before final negotiations concluded, but the two parties were far along at that point in successful negotiations, and MIWD was confident to carry out the process on its own. In December 2018, the final agreement was signed. “With expert support from the U.S. Government, MIWD’s joint venture agreement is now in order and has a high degree of integrity and credibility,” says Magsuci.

A technician inspects for water leaks in Iloilo City’s Jaro district. Photo credit: MIWD

Under the joint venture, MPIC will invest nearly $250 million to rehabilitate, upgrade, expand, operate and maintain MIWD’s water distribution facilities. The partnership will provide septage and wastewater treatment services as well as address MIWD’s high rates of non-revenue water or water lost through old and leaky pipes and theft. The partnership aims to expand the water district’s current service coverage and provide access to safe and potable water for the growing population of Metro Iloilo in the next 25 years.

“The U.S. Government believes that the private sector plays a crucial role in the Philippines’ development journey,” says Mission Director of USAID/Philippines Lawrence Hardy II. “USAID is proud to have facilitated this partnership between the Metro Iloilo Water District and the Metro Pacific Water Investment Corporation. This collaboration is a concrete example of how businesses can play a significant role in offering developmental solutions such as advancing water security.”

By Christine Chumbler

This article appears in Global Waters, Vol. 10, Issue 3; for past issues of the magazine, visit Global Waters’ homepage on Globalwaters.org.


Private Sector Partnerships for a Water-Secure Iloilo City was originally published in Global Waters on Medium, where people are continuing the conversation by highlighting and responding to this story.

Water and Youth: StandUp4Water

By: kiana
Water and Youth: StandUp4Water kiana 20 May 2019 - 11:57

Download the webinar videos of the 2019 SMM

 

In May 2019, SWA organized four webinar sessions in English, French and Spanish which focused on the outcomes and follow-up actions for the Sector Ministers Meeting which was held in Costa Rica on 4-5 April 2019.  Part of the webinar featured reflections by ministers who attended the SMM including:

  • Minister of State in Environment, Mr Ahmed Mujthaba, Maldives, stressed on their focus on regulation and monitoring framework and requested SWA to support for that.
  • Honorable Jonathan Tengbeh, Minister of Water Resources and Irrigation of Sierra Leone, took Ethiopia and Ghana as key learning points and mentioned that they are planning to learn more from them and move forward to have a better WASH programme. 
  • M. Vonjy ANDRIAMANGA, Minister of Energy, Water and Hydrocarbons, Madagascar, shared his pre and post experience of the 2019 SMM, and the country’s visibility gained, in WASH.
  • M. Hugo Ruiz, Director of Drinking Water and Sanitation of MOPC Paraguay stated that Leave No One Behind is a very meaningful and necessary expression to be consolidated.
    He also mentioned that there should be adequate governance for the review of laws, financing of investments, information for the accountability and data transparency.

 

View videos here

 

 

The post Download the webinar videos of the 2019 SMM appeared first on SWA.

Typhoid, Water and Buried Pipelines: A Call for Better Health-WASH Integration

By: Laura Kallen, Scientific Communications Officer, PATH

Handwashing with soap and clean water prevents diseases from spreading from the hands to the mouth. Vaccines save lives by preventing pathogens from causing illness.
For a disease such as typhoid, where bacteria from hands can contaminate food and water and cause illness, we need both water, sanitation, and hygiene (WASH) and vaccines to control it successfully. But to ensure these tools reach all communities and effectively control disease transmission, we need more coordination.

Children drinking from well pipe. Photo: PATH/ Monique Berlier

Typhoid: A disease of sanitation

Spread via the fecal-oral route through contaminated water and food, typhoid is estimated to have caused nearly 11 million cases and more than 116,000 deaths worldwide in 2017. It used to be a global disease, but after improvements in water and sanitation infrastructure in high-income countries during the last few centuries, the typhoid burden is now mostly found in low- and middle-income countries in Asia and sub-Saharan Africa. Typhoid thrives in settings where water and sanitation infrastructure—e.g., sewer systems, water treatment facilities, and well maintained pipelines—are in disrepair or lacking completely. Typhoid continues to spread when communities struggle with a lack of access to clean water and sanitation facilities, which makes handwashing and other hygiene behaviors difficult to employ consistently. Eroded, insufficient, and overused pipes, wells, toilets, and sewage systems allow contaminated fecal matter to seep into pipelines and water supplies, forcing families to use unsafe water for drinking, cooking, and bathing.

Vaccines work

Improving WASH infrastructure is a complicated and expensive. This problem has led many typhoid control experts to support a readily available and effective solution: typhoid vaccines. During the last two years, momentum for typhoid vaccination has accelerated with the availability of a new WHO-prequalified typhoid conjugate vaccine(TCV), a huge step forward for the protection of young children against the disease.
Vaccines offer a necessary near-term solution for typhoid control while governments and communities continue to work on WASH improvements. But the opportunity to introduce TCV doesn’t mean we can forget about WASH. Typhoid will continue to lurk in the pipes.

Merging sectors

In order to take on typhoid, diarrheal disease, and other waterborne pathogens, we need both vaccines AND improvements in WASH. While vaccination can save and improve lives now, long-term investments in WASH infrastructure will create a future where typhoid and other diseases are removed from the water altogether, effectively ending the risk of falling ill.
That future needs to start now. The momentum for new typhoid vaccines provides an opportunity to start building a more integrated approach for typhoid control. By integrating WASH behaviors into vaccination programs, encouraging diverse sectors and government ministries to collaborate, and advocating for integrated solutions, we can start to change the paradigm—not just for typhoid, but for diarrheal disease, cholera, and other waterborne diseases. Health is comprehensive and multifactorial, and health solutions need to be, too.

A pipeline of promise

By identifying opportunities to strengthen the coordination between the health and WASH communities, we can develop new, innovative solutions to tackle diseases of poverty. One imminent example is the current initiative for WASH in health care facilities, which is the subject of a resolution at this year’s World Health Assembly. The resolution will encourage all countries to assess and develop plans to improve the availability of clean water and sanitation in health care facilities—a goal that will require coordination between the health and WASH sectors.
Yes, we need to improve actual water and sewer pipelines. We also need to continue to strengthen the development and introduction pipeline of vaccines for waterborne diseases. But to start building a more integrated approach to health, we need to create, strengthen, and reconnect the figurative pipeline of collaboration between the health and WASH communities. It has remained fractured and buried for far too long.

How an Indian village learned about its rights and reduced the water burden on women

Introduction

In the fishing village of Mangamaripeta, in India’s coastal state of Andhra Pradesh, it used to take five to six hours for the women to get water. There were very few taps and the water quality in the wells that the taps were pulling from was getting salty.

Around 2.4 billion people across the world live within 100 kilometres of the coast, according to a report by the United Nations. As climate change causes sea levels to rise, these communities aren’t just facing the threat of their homes being washed away, the salty ocean water is contaminating freshwater sources further and further inland. Globally, water shortages already affect 1.2 billion people — one fifth of the world’s population — and could affect half of the world’s population by 2030 with climate change making it worse. Women face the brunt of it.

Drinking Salt

Around 70 percent of people in Mangamaripeta rely on water from borewells that often are contaminated with salt water, according to Arjilli Dasu, of the District Fishermen’s Youth Welfare Association (DFYWA).

Studies show that drinking water with above-average levels of salt water can have dangerous health effects, especially for pregnant women. Researchers in Bangladesh found pregnant women in areas where most sources of water are salty have problems with high blood pressure and are at higher risk of diseases like pre-eclampsia and eclampsia, which can be fatal.


The switch for the electric water pump, and often the water that the pump gives is salty. Photo by: Manon Verchot ;

“Drinking water salinity problems are expected to be exacerbated in the future, putting millions of coastal people—including pregnant women—at increased risk of hypertension and associated diseases” the study found.

“There is an urgent need to further explore the health risks associated to this understudied environmental health problem and feasibility of possible adaptation strategies.”

Villagers in Mangamaripeta also say they’ve faced health problems related to salt water. Some say using salt-contaminated water for day-to-day activities like washing clothes and dishes results in skin irritation. The community faces more water problems in summer. During the rainy season, freshwater replenishes the groundwater where the village gets its water from. In summer there’s no inflow to replenish the wells and the water pressure drops while the quality becomes saltier.

Two years ago, many villagers in Mangamaripeta turned to bottled water for cooking and drinking, but not all families could afford it. Most families depend on fishing, and in the last years fish shoals have become sparse. Experts attribute the worsening fishing conditions to pollution and climate change. This is hurting the community’s ability to sustain itself and pay for clean water.

 

The Water Burden

 Water-related tasks like cleaning and fetching water fall to women and girls in Mangamaripeta. Children are also asked to help fetch water. And that can affect their schooling, according to G Ratna, one of the women in Mangamaripeta.

“When women are going to collect water, in some areas, men are sitting there. It makes women uncomfortable,” says Ratna. “When we are filling water, some are wearing saris, others may go in nightgowns. We have to carry pots of water across the road, so what do we pay attention to, the traffic or the men staring at us?”

Every year, women are caught in 10 to 15 road accidents because they have to cross a four-lane highway to reach one of the main taps, according to Dasu. No one has died, but three or four of the accidents resulted in bone fractures, and minor injuries.
 

A bumpy road ahead

DFYWA started working with Mangamaripeta 15 years ago, according to Dasu. The association encouraged the community to begin voicing their problems to local government representatives by teaching the community what rights they had. Over time, village representatives began to listen, and started looking for solutions for the community, Dasu says. Five to six years ago, this wasn’t the case. According to Dasu, any time the community wanted the panchayat to release water, they thought they had to give the panchayat some money. The panchayat enforced this belief by sometimes refusing to release water unless they were paid. Now things have changed, thanks to the help from Dasu and his team. The community is now aware that they don’t have to pay to get the water they’re entitled to. So they no longer fold under pressure. Dasu says cases where the community pays to get water have dropped significantly.

Inhabitant of the village interviewed by the author. Photo by Manon Verchot ;

With the help of Dasu’s District Fishermen’s Youth Welfare Association (DFYWA), things have gotten better for women and children.

DFYWA has encouraged the community, especially the women, to advocate for their rights. Now the women know that they can approach their village representatives, and the representatives are obligated to relay the information to the concerned authority.

In the last five to six years, this has worked well for Mangamaripeta. The village council however does not have any women representatives.
“We used to spend all our time water towards water,” says Ratna. “Now it’s not that bad. One, one and a half hours we spend now.” “They [village representatives] fear that if they don’t [help us], then the people won’t support them in elections,” she adds. Across the globe, eight out of ten households that collect water rely on women to take care of the work, according to the the Tata-Cornell Institute. Despite the gender imbalance in the labour, policies on water and land management are usually not made with women in mind. In the last few years the village council in Mangamaripeta has managed to set up more taps so for every 10 households there are two to three taps available. It’s a lot easier for women now. The water doesn’t run all day, but it comes at times set by the local village council known as the panchayat. The panchayat has two women representatives.

“Some women also request the panchayat (village council) not to give water at certain times, says Ratna. “So that they can fill it before they leave for work. Because everyone has work to go to these days.” Children are also asked to help fetch water. And that can affect their schooling, according to Ratna. “Kids get late [to school sometimes], so they tell the teacher,” she says. “If the water supply comes during school time, some kids go to school without getting water, others who need it first fill water, then go to school.”

Working Towards A More Stable Future

Dasu and his team have focused on empowering women in the community. Because fishing is becoming a bigger challenge, many of the men migrate for work, leaving the women to take care of things at home. In many cases, Dasu says, this means the women have to take on additional financial burdens.
So DFYWA is working on projects to help bolster employment for the community, with a focus on women, according to Dasu. One of those projects was to get the community a truck that transports fish with support from the District Administration through Department Of Fisheries. In the future, they want to create a solar fish drying unit, seafood curry points and tuna processing unit to create more jobs in Mangamaripeta. DFYWA also helped the community develop proposals for a Reverse Osmosis (RO) plant to filter water.

Women say though the water situation is still tough, it’s better since they started putting pressure on the government. Photo by Manon Verchot

If the plan for an RO plant is successful, Dasu says they will create a committee of women to oversee water distribution to the village. He says women are better at ensuring equal water distribution across the community than men. But even with this plan in mind, it’s difficult to say if it will materialise anytime soon, adds Dasu.

At the state level, the government also made promises to help villages get water. In January 2018, the chief minister promised that by 2021, all households would get drinking water.

When women are forced to carry the burden of fetching water, they’re prevented from working on other avenues of generating revenue for their family, according to Water.org. A study from the Institute of Home Economics at the University of Delhi further found that women push aside education and skill development opportunities because of water-related issues.

“If there are RO plants, it’ll make it easier for people,” says Dasu. “It can even be provided for free. The government can provide it.”

The post How an Indian village learned about its rights and reduced the water burden on women appeared first on WIN - Water Integrity Network.

BEYOND THE SECTOR MINISTERS’ MEETING: Suggestions for follow-up actions

 

SWA Secretariat has put together Beyond the Sector Ministers’ Meeting document which includes recommendations on actions that stakeholders in the water, sanitation and hygiene sector can include in their ongoing national or organizational approaches after the Sector Ministers’ Meeting. Among others, the recommendations focus on efforts to maintain and raise political attention to the sector and to “Leave No One Behind”; improve the use of the mutual accountability mechanism; identify and share experiences in the use of the SWA framework to achieve the SDGs.

The document also provides a list of available resources and tools from the Secretariat and partners.

Who is this document for?

SWA partners at national, regional and global levels; all governments and agencies which participated or were invited to the SMM in Costa Rica.

Download here

The post BEYOND THE SECTOR MINISTERS’ MEETING: Suggestions for follow-up actions appeared first on SWA.

Burden of disease from inadequate WASH for selected adverse health outcomes: An updated analysis

Burden of disease from inadequate water, sanitation and hygiene for selected adverse health outcomes: An updated analysis with a focus on low- and middle-income countries. International Journal of Hygiene and Environmental Health, 12 May 2019.

Authors: Annette Prüss-Ustün; Jennyfer Wolf; Jamie Bartram; Thomas Clasen; OliverCumming; Matthew C. Freeman; Bruce Gordon; Paul R.Hunter; Kate Medlicott; Richard Johnston wateraid

Background – To develop updated estimates in response to new exposure and exposure-response data of the burden of diarrhoea, respiratory infections, malnutrition, schistosomiasis, malaria, soil-transmitted helminth infections and trachoma from exposure to inadequate drinking-water, sanitation and hygiene behaviours (WASH) with a focus on low- and middle-income countries.

Methods – For each of the analysed diseases, exposure levels with both sufficient global exposure data for 2016 and a matching exposure-response relationship were combined into population-attributable fractions. Attributable deaths and disability-adjusted life years (DALYs) were estimated for each disease and, for most of the diseases, by country, age and sex group separately for inadequate water, sanitation and hygiene behaviours and for the cluster of risk factors. Uncertainty estimates were computed on the basis of uncertainty surrounding exposure estimates and relative risks.

Findings – An estimated 829,000 WASH-attributable deaths and 49.8 million DALYs occurred from diarrhoeal diseases in 2016, equivalent to 60% of all diarrhoeal deaths. In children under 5 years, 297,000 WASH-attributable diarrhoea deaths occurred, representing 5.3% of all deaths in this age group. If the global disease burden from different diseases and several counterfactual exposure distributions was combined it would amount to 1.6 million deaths, representing 2.8% of all deaths, and 104.6 million DALYs in 2016.

Conclusions – Despite recent declines in attributable mortality, inadequate WASH remains an important determinant of global disease burden, especially among young children. These estimates contribute to global monitoring such as for the Sustainable Development Goal indicator on mortality from inadequate WASH.

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What is WASH finance?

By: IanRoss
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A 2017 GLAAS report graphic on the WASH finance mix in a set of countries

In a previous post, I proposed a working definition of WASH finance as “the study of how WASH services are paid for, including who pays, how and when”. There is also the huge question of what is paid for (i.e. level of service, technology, paying to cover capital or recurrent costs, how equitable it is, etc.). To simplify, let’s take that investment option as given. We could be thinking about a shared pit latrine, a gravity-fed network of rural standposts or a sewer network.

The “who, how and when” are important in the following ways:

  1. Who pays: It matters who is fronting the money, not least because it will give them a say in what is done. Service providers should be accountable to users paying tariffs. Banks offering loans will set conditions. Money might come from the public sector, private firms, individuals/households, donors/NGOs, etc. Some or all of that money might be borrowed (i.e. repayable), so there are effectively multiple payers sharing risk.
  2. How: There are many ways to provide money, whether through cash, debt, equity, etc. Money can be “cheap” or “expensive” if it is borrowed, or “free” if it is not. In-kind payment and unpaid labour can be important but would technically not cover a financial cost (see this post).
  3. When: Timing is everything. Spreading costs can make things more affordable to those without deep pockets, but sometimes interest payments can be crippling. Possible scenarios include immediate payment in full, instalments spaced over time periods (with or without interest), instalments on delivery of contracted outputs etc. Capital itself has an opportunity cost, i.e. it could make a return if invested in something else, like government bonds.

In summary, finance is about how financial costs are covered. The above three dimensions are just an intuitive way I like to think about it – comprehensive frameworks exist for conceptualising WASH finance, discussed below. This post aims to scratch the surface of those in fairly simple terms.

Categorising different types and sources

“Finance” is a useful catch-all term, but it should really be split into funding and financing, as I mentioned via a quote in this post. In short:

  • Funding means providing money which is not expected to be repaid.
  • Financing means providing money on expectation that it will be returned in full, plus interest or dividends, so perhaps better framed as repayable financing.

More on the sub-categories underlying these are as follows. In the WASH context, funding usually comes from three “sources”, together known as the “3Ts” framework popularised by the OECD (2009).

  1. Tariffs, meant in the usual sense as ‘fee for service’ but, conceptually, this bucket also includes self-supply expenditure (e.g. household-funded toilet construction) or user charges such as connection fees.
  2. Tax revenue, which might be collected by different levels of government (local, municipal, state, national)
  3. Transfers, e.g. from donors, NGOs, foundations or remittances

The best explanation I’ve seen of this is the table in the TrackFin guidance doc p.49, which shows how an accounting perspective (“types”) overlays with the 3Ts perspective (“sources”).

Repayable financing fits broadly within two categories:

  1. Debt, which could be a concessional or non-concessional loan, bonds or loan guarantees, etc. – on which the principal must be repaid and interest can be paid
  2. Equity, which could be a formal stake (or share) in a company, a PPP-based “contribution” to capital costs, etc. – on which dividends may be paid and the stake can be withdrawn.

The GLAAS 2017 report graphic at the top of this post shows how different countries use different mixes of funding and financing sources in their sectors. However, only the countries asterisked in the figure have done full TrackFin studies. I would take data for other countries with a pinch of salt (i.e. they are likely ‘best guesses’ by someone),  because detailed information on flows is rarely available at the sector level. That is the whole reason why TrackFin was originated by WHO and is so important (but I’m biased as I was involved in the Tunisia TrackFin study and am fully bought into the approach ).

When is WASH finance cheap or expensive?

Funding is “free” in the sense that it has no cost of capital (though capital may be allocated an opportunity cost in economic analysis). Repayable financing, meanwhile, comes at a price. That price can be “cheap” or “expensive” depending on the terms and implied interest rate. Concessional loans from development banks (such as the African Development Bank or World Bank) are generally the “cheapest” type of repayable financing for WASH services. They allow borrowing at below-market rates but come with various conditions. Non-concessional loans can be secured from commercial banks which probably comes with fewer strings, but at full capital market rates.

In practice in low-income countries, service providers are unlikely to be able to secure repayable financing beyond these options. Most will simply not have the track record of revenue generation and loan repayment (and subsequent credit rating) to be able to issue bonds, for example. A graphic from IRC shows how this can work. With equity meanwhile, allowing private stakes in service providers may not be legally straightforward in many low-income countries.

There is increasing interest in the idea of “blended finance”, whereby public funds (or concessional loans) and commercial repayable financing are combined in a synergistic way. The objective is usually to make an overall package cheaper than the commercial market could provide, but still crowding in private capital rather than crowding it out. Sophie Trémolet gives a clear explanation in this episode of WASH Talk or there’s this World Bank report.

Conclusion

All sources of funding and repayable financing have a role to play in expanding and sustaining WASH services. However, some are more appropriate than others for (i) different purposes, (ii) different providers, and (iii) at different stages of a WASH sector’s development.

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An Emergency WASH Update – May 15, 2019

NEWS

OFDA Meet Our Experts – Trevor White. OFDA, May 7, 2019. Trevor White is a Water, Sanitation, and Hygiene (WASH) Advisor at USAID/OFDA. As part of the USAID/OFDA WASH team, Trevor provides support at the country level during natural disasters and conflicts, but also at a global level to support efforts to improve the quality of future WASH responses. emergencies

BLOG POSTS

Cash transfers can help Yemen’s conflict-affected children. IFPRI Blog, May 6, 2019. As a result, the transfers helped preserve children’s dietary diversity in critical early developmental stages 6-23 months. The program also led to improved breastfeeding and water treatment practices, which further enhanced the nutritional environment.

JOURNAL ARTICLES

Efficacy of the SuperTowel: An Alternative Hand-washing Product for Humanitarian Emergencies. The American Journal of Tropical Medicine and Hygiene, May 2019. Given that the ST is more lightweight than soap and longer lasting, we envisage that the ST would also be beneficial to humanitarian actors working in areas where logistical and security issues make regular hygiene product distribution challenging. We recommend that further testing should be carried out to assess the efficacy of the ST under conditions that more closely mirror real-world hand-washing practices.

REPORTS

Urban WASH programming in Protracted Conflict Contexts: Aleppo’s Experience, Syria. UNICEF, March 2019. The focus of this Field Note is Syria’s urban WASH programme, documenting the experience in implementing WASH in a city which has endured years of protracted conflict, and is designed as a learning note for the organization as it strengthens its role in urban areas.

Private Sector & Refugees—Pathways to Scale. IFC, 2019. Multinational corporations like Mastercard, regional and national businesses such as Equity Bank and PowerGen, social enterprises like NaTakallam and Sanivation, and a range of others across industries, are demonstrating the potential roles of the private sector in supporting refugees and host communities.

Global Report on Internal Displacement 2019. GRID, 2019. This year’s GRID focuses on urban internal displacement and presents new evidence on the humanitarian and development challenges presented by displacement to, between and within towns and cities.

User-Centred Design and Humanitarian Adaptiveness: A Case Study. ODI/ALNAP, 2019. To conserve water, Hygiene Promoters also came up with an idea for a ‘smart’ sink made out of a large plastic bottle to which all households in the settlements have access. The design of the sink allows users to collect soap water left over from handwashing and use it to clean and flush the latrines after use.

SHORING UP STABLITY: Addressing Climate & Fragility Risks in the Lake Chad Region. SUS, 2019. Lake Chad is caught in a conflict trap. Violence between armed opposition groups – including the so-called ‘Islamic State West Africa Province’ and ‘Boko Haram’ – and state security forces has left 10.7 million people in need of humanitarian assistance. Climate change is compounding these challenges. This report identifies key risks and proposes pragmatic solutions to shore up stability in the region.

We’re Listening: An evaluation of user-centred community engagement in emergency sanitation. OXFAM, 2019. The staff of all four teams liked and valued the user-centred approaches, and all plan to use them in future projects. It seems that with a focused commitment to engaging users, several common organizational barriers could be surmounted.

Water Supply in a War Zone: A Preliminary Analysis of Two Urban Water Tanker Supply Systems in the Republic of Yemen. World Bank, 2018. The study described in this discussion paper accordingly presents one of the only detailed, survey-based assessments of water supply and sanitation in an active war zone.

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Shaping the Sanitation Market with Product Innovations in Ghana

Over 10 million urban Ghanaians live with unimproved sanitation services or are openly defecating causing a severe public health concern according to WHO/UNICEF. The World Bank estimates that poor sanitation and hygiene in Ghana leads to $290 million in economic losses each year. While businesses are trying to address the sanitation crisis, they face several…

Water Works

How Access to Clean Water Transforms Lives in Madagascar

Photo credit: Anne Daugherty/USAID

In the village of Sabotsy Anjiro in Madagascar, a simple water tap installed outside Voahangy Rasoanantenaina’s door has changed her life.

“Before the fountain, I had to get water from the public pump, a half-hour walk away,” said Voahangy, who has four children. “Having to do that twice a day meant that I lost two hours trying to access water and carry it home.”

“Now, the fountain is right in front of my home, and I can get as much water as I need, whenever I need it,” she said.

Click here to read the full article on Exposure.

Photo credit: Anne Daugherty and Amy Fowler, USAID

Water Works was originally published in Global Waters on Medium, where people are continuing the conversation by highlighting and responding to this story.

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