IHE Delft hosted the 2020 Capacity Development Symposium from 27 – 29 May. Due to the COVID-19 measures an online platform was created using webinars and poster presentations.
Henk Holtslag and Reinier Veldman both presented on behalf of the SMART Centre Group on SMART Centres. A promising approach to reach SDG6 and water related SDGs in rural areas and Faith and Water – Accelerating WASH knowledge sharing and capacity building through the use of Faith Groups.
Their presentations and webinar recordings can be accessed through the resources page.
The report, entitled Referee! Responsibilities, regulations and regulating for urban sanitation, has four key findings:
As part of this research we spoke to staff from regulators in Kenya, Zambia and Mozambique about the importance of active regulating in promoting access to quality, affordable sanitation.
Safe sanitation is not just about toilets – it’s about the effective systems that underpin strong services. Regulators are a crucial, but often undervalued part of that.
WSUP and ESAWAS have analysed the role of regulators in four countries to assess their importance in the broader system of sanitation services, and understand how their roles are being made more impactful. The report identifies a range of different regulatory instruments and demonstrates how their introduction is leading to improved sanitation services in traditionally under-served urban communities.
The national case studies are as follows:
Bangladesh: national institutional and regulatory framework for un-sewered sanitation
Kenya: standard operating procedures in the city of Kisumu
Kenya: introducing cross-subsidies to finance sanitation
Mozambique: adopting new regulatory responsibilities
Zambia: a new national framework for regulating un-sewered sanitation
Kenya: incentives to encourage utilities to serve the poorest communities
The report also assesses the contribution being made by ESAWAS to drive change through at pan-African level.
The U.S. Centers for Disease Control and Prevention (CDC) is launching a new weekly webinar series for IPC in healthcare settings. Speakers from CDC, WHO, and IPC professional societies around the world will focus on practical advice and implementation considerations for IPC for COVID-19. These 90-minute sessions will give equal time for presentations and for answering questions.
IPC professionals, Ministry of Health staff, partner organizations, and any interested healthcare workers are encouraged to participate. Simultaneous translation is available in Arabic, French, Portuguese, Russian, and Spanish. CME credit is also available.
Webinars will be held every Thursday, May 14 – July 30, 2020 | 8:00-9:30am EDT │ 12:00-1:30 UTC
Registration link – https://echo.zoom.us/webinar/register/WN_tY840l7cQFiaPnoxXEdTZg
Webinar Series Topics:
• June 4: WASH in healthcare settings in the context of COVID-19
• June 11: Assessing SARS-CoV-2 infection among healthcare workers and inpatients
• June 18: Post-mortem considerations in the context of COVID-19
• June 25: Cleaning and disinfection in the context of COVID-19
• July 2: Limiting the introduction of COVID-19 in healthcare settings
• July 9: Rational use of personal protective equipment and emergency strategies
• July 16: Advice on the use of medical and non-medical masks
• July 23: Considerations for SARI treatment centers
• July 30: IPC in nursing homes and long-term care settings
Over 20 years ago when I stopped seeking medicinal remedies to prevent and treat diarrhoea and other infectious diseases and moved to population enabling solutions, I have not had cause to look back. Today the coronavirus is having a huge impact, so now more than ever we have better hygiene practices in emergency that not only tackle it now but put in place long term solutions.
Handwashing practice with soap and water is a significant solution for reduction of diarrhoea related diseases and respiratory infections. In recent years these solutions have received increased attention globally. Oxfam and partners have made substantial investments in handwashing research to identify enhanced and innovative approaches which facilitate handwashing, especially among vulnerable population groups affected by crisis (women, girls, men, boys, elderly and persons with different mobilities).
Today, we have a collection of robust handwashing options and a novel low-cost station with over 20 features to increase handwashing practice. There is also a novel promotion approach – “Mums Magic Hands”, which was co-created with Unilever to help increase and reinforce handwashing practice, not just amongst carers, but also with their immediate family and entire community.
Working with different partners, we have harnessed Oxfam’s people centred, gender and vulnerability sensitive experiences with a strong emphasis in different emergencies to develop products which are now needed in one of the biggest disasters of the century.
Since the onset of the outbreak, Oxfam has been working to prepare for the pandemic. In February 2020, the organization formed a taskforce, who pulled together lessons learnt from previous outbreaks (e.g. Ebola, Cholera, Zika) and developed guidelines to help ensure staff safety and implementation of quality responses.
Many countries are now responding to the outbreak with a focus on preventing and reducing the infection risks related to coronavirus. This entails the promotion of handwashing practice with soap and water alongside the training of community-based volunteers to motivate and support their peers in adapting safe behaviours and practices.
So how do we ensure that handwashing and other related hygiene practices are maintained and sustained when the coronavirus may continue for many years? To address the most vulnerable, more efforts will be needed to tackle inequalities. In particular prioritization of programme and policy which look at erasing disparities.
For sustained behaviour change, the following intersectoral recommendations will be crucial:
The above is all encompassing, however, to make handwashing and hygiene a lifestyle, the right enabling environment and adequate resources to fund it will be needed. Globally, only 9% of counties with costed hygiene plans reported are having enough financial resources to achieve national hygiene targets. Ultimately if we are all able to make proper frequent handwashing and always practice good hygiene (including respiratory and surface hygiene) a way of life, some of the losses to coronavirus may turn to gains through significant reduction in some of the other infectious diseases.
Dr Foyeke Tolani has over 20 years of Public Health humanitarian and development experience, in more than 20 countries in the world. She is a Public Health Adviser and lead in handwashing research and innovation in Oxfam. She has been involved in six different multi-agency Water, Sanitation and Hygiene (WASH) projects, and is passionate about supporting women and different vulnerable groups in disaster-affected and vulnerable communities.
By Kariuki Mugo, Director of WASH Sector Support
There has also been a great deal of investment in ensuring that water is available to all, especially the most vulnerable in cities, where lockdowns have been enforced. The poor have a different level of vulnerability in the sense that majority, if not all of them, depend on daily wages. The moment human movement is restricted, it immediately curtails their cash flow and as a result, denies them the opportunity to afford basic needs such as water supplied by vendors and pay-per-use public sanitation.
Despite these praiseworthy responses by WASH service institutions, this epidemic has made us realise that we do not have the right mechanisms for any form of emergencies in the sector. Traditionally, our systems are designed for normal conditions and not to respond to emergencies such as flooding, hunger, and war. These situations are usually localised and responded to by independent state and global bodies and not service providers.
However, there has been no known humanity crisis like Covid-19 in our generation, one that permeates nearly every facet of our existence. It is therefore not a surprise that the WASH sector, just like many others, was caught flat-footed by this pandemic. The situation has been of helplessness, the same case like everywhere else in terms of response.
Now that we seem to have somehow figured out the immediate actions to save lives and sustain a basic level of access to services, we need to envision what could have been done to better prepare for such circumstances. This becomes the immediate area of attention for the WASH sector to focus on, and the following are some suggestions.
Institutional overlaps in the hygiene and sanitation sectors is a common occurrence in developing nations. Lack of clarity in mandates lead to either duplication or lapse of service provision. There is usually a level of unseen competition, especially in areas deemed to be well resourced by governments and donors, and abandonment of others that are difficult and less lucrative. The latter is usually the case for provision of services to the poor, and more so, onsite sanitation and basic hygiene services.
One of the evident and significant struggles in our programme countries is how various governmental bodies have struggled to respond on their own, as well as to rally support from stakeholders. This situation has clearly shown that it is the high time governments figured out how WASH institutions can effectively and efficiently work together not only to respond to humanitarian crises, but also in the day-to-day provision of services.
There is need for policymakers to rethink how institutions are structured and coordinated to enable clarity of responsibilities and allocation of resources, and as a result, reducing overlap and competition, and enhancing efficiency and collaboration in service provision at all times.
There is no doubt that the WASH sector lacks the relevant policies, laws, and regulations to govern response to crisis. The fact that the sector is designed to provide services to the population under normal economic conditions, any change in circumstances exerts undue stress to the systems, structures, and available resources. Besides, new, improved ways of working can only work if the existing policies and laws are repealed and this can often be challenging to implement.
Proper policies, laws and regulations will, for sure, enable WASH institutions to be in a better place to respond to emergencies and sustain services to a reasonable level. It is therefore imperative that governments draft statutes to better harmonize sanitation and hygiene institutions. This structured coordination is critical in such emergencies and is lacking in most countries.
Besides, hygiene has been a silent component in WASH service provision. Historically, most hygiene interventions have been mainly short-term campaigns without any meaningful infrastructure investment and sustainability mechanisms. This failure to position hygiene as a critical public health driver emanates from the fact that WASH sector policies do not consider the need for its investment and as a crucial responsibility of service providers. Now that Covid-19 pandemic has demonstrated the value of hygiene in saving lives, policies and regulations must be reviewed to reposition its place in the sector.
Utilities’ response to the crisis, in countries such as Ghana and Kenya, has mainly been the provision of free water in the short-term. This act of benevolence is commendable. But without any doubt, non-reimbursement by governments will usher in a more severe crisis of operational sustainability in the medium and long terms.
To begin with, low-income people living in unserved areas cannot afford to pay for services when directly provided by utilities during emergencies. Since they lack daily income and primarily depend on informal vendors and on-demand payments. The utilities, on the other hand, lack mechanisms for deferring non-customer payments and subsequent collection of revenues for services provided during the lockdowns. This situation, in addition to undue political pressure, has forced them to extensively provide free water during this pandemic.
The low levels of financial cost recovery mean that the service providers will soon experience a struggle to meet their fundamental recurrent obligations, thus further leading to a deterioration of services.
There is, therefore, a need to develop frameworks for enabling full cost-recovery support mechanisms for WASH service provision institutions while undertaking acts of emergency response for vulnerable populations. This is what is done for other sectors that typically intervene during humanitarian crises.
The curtailment of movement during lockdowns means that people are confined in spaces that generate a high level of service provision demand that is never experienced in regular periods. The need for water in low incomes areas is never high through days and nights, and as a result, utilities are finding it difficult to respond to this unusual condition.
Most importantly, this crisis has brought out the need for having arrangements to provide basic services to all those living in urban areas. The fact that the poor cannot access basic goods and services has made it impossible for most developing world governments to enforce lockdowns in low income urban and peri-urban areas.
This not only demonstrates how inequality inhibits the response to a public health emergency but also clearly tells that governments cannot respond to any other form of disasters in cities by way of broadly restricting human movement in low-income areas. It is a clear indication that inequality in access to basic urban goods and services leads to administrative incapability. Needless to say, inability to enforce a total lockdown in a segment of the population during Covid-19 outbreak indicates powerlessness to fully govern citizens in crisis situations.
This security red flag should serve as a serious wake-up call all governments to focus on providing services and ensuring economic empowerment of all their city populations, particularly the poor. If they do, it will improve the likelihood that in times of emergencies, people’s basic needs are met. In turn, this will make it easier to implement the necessary disaster responses across all of their people, speeding up recovery and a return to normality.
Every May 28, Menstrual Hygiene Day is celebrated around the world to combat stigma and raise awareness about the vital role MHM plays in…
Under the umbrella of the EERN (Evangelical Church in the Republic of Niger (EERN)) a new SMART Centre recently started. Jim McGill, who was also involved in the setting up of the SMART Centre in Malawi is now working in both Niger and South Sudan.
As one of the responses for the COVID-pandemic and the SMART Centre in Niamey recently held a training for female community leaders in the construction of dip taps and other handwashing stations. These simple, but effective technologies can be made at no cost, using locally available materials.
For more info on Smart Hygiene Solutions, check the recently published brochure.
Dharapani Village in Sindhupalchowk District is one of hundreds of communities devastated by the April 2015 earthquake in Nepal, which killed nearly 9,000 people and impacted hundreds of thousands more. The earthquake destroyed all 53 homes in the village and ruined crucial water and sanitation infrastructure, resulting in months of water scarcity.
Phurten Sherpa, a 53-year-old man from Dharapani, had hoped to build an earthquake-resistant house in the immediate aftermath of the disaster to replace his demolished home. Like most rural Nepalis, he planned to use locally available materials to do so, such as mud bricks or stone. But in order to bind these materials into a durable home, he would need large amounts of water — something that Dharapani severely lacked at the time. The village barely even had a dedicated drinking water supply, let alone any extra water to use for agriculture or housing reconstruction.
“The Government of Nepal provided grants to rebuild our houses,” Sherpa recalls. “But we still lacked water to aid with the construction. Buying water and bringing it up all the way to our village was costly as well as unmanageable.”
“The water problem persisted in our village and ruled out our dream of building a new house any time soon.”
“It was a tough time,” he adds. “We traveled half an hour and waited for an hour to fetch a bucket of water from a pond…. Even this 30-minute journey was painful for me because I have a bad back. The water problem persisted in our village and ruled out our dream of building a new house any time soon.”
In December 2015, less than eight months after the earthquake, USAID launched the Safaa Paani (“Clean Water”) program to help disaster-stricken communities like Dharapani restore access to safe water. To date, the program has improved water access and public health outcomes for more than 45,000 of the most vulnerable and earthquake-impacted Nepalis, increasing their self-reliance while assisting them on the long road to recovery. This included Sherpa and his neighbors who were able to complete the construction of their new, earthquake-safe homes thanks to an accessible water source.
To maximize the program’s effectiveness, upon launching, USAID used geographic information system technology to map water sources and determine where its assistance was most urgently needed. “We prioritized at-risk populations and people who are underserved, especially those located in difficult geographic locations,” says Pragya Shrestha, environmental health specialist at USAID/Nepal.
With this knowledge in hand, the program supported 200 villages to construct gravity-flow water systems outfitted with taps in villages throughout Sindhupalchowk and Dolakha districts in Nepal, including Dharapani. In each of the 200 communities that received a water system, USAID worked closely with residents to ensure they had the knowledge, skills, resources, and will to safeguard and maintain the infrastructure.
These water systems not only improved communities’ economic prospects, they strengthened their social fabric and eased the burden of women and children who are typically tasked with fetching water in rural Nepal. In the immediate aftermath of the earthquake, for example, women and children had to travel longer distances than usual to obtain water, and fights would frequently erupt once they arrived at their destination. “We had to travel in the early morning to fetch water,” remembers Binda Giri, a 42-year-old woman from Pathlehola Pokhare. “And if we reached it late…it was impossible to get water and the quarrels and conflicts would start at water points.”
“Before, it was difficult for me to manage water for my kitchen garden. Now, I am happy to see green vegetables growing on my own land. It’s a dream come true.”
Today, however, with water available locally once again, women have been able to make more productive use of the time once spent retrieving water. While the Safaa Paani water systems are mainly designed for supplying drinking water, they also provide water for productive uses such as growing vegetables. “Before, it was difficult for me to manage water for my kitchen garden,” says Ramila Thapa, a 32-year-old woman from Kupri village. “Now, I am happy to see green vegetables growing on my own land. It’s a dream come true.”
Others have taken advantage of the improved water supply to engage in promising new livelihoods to help support their families. One man, 29-year-old Raju Kharel from Sware Khani Gau Village, experienced a significant change in outlook since he began to use the newly available water to start up a lucrative vegetable trade. “Before I didn’t have any money to spend on my kids,” he remembers. “I barely had enough for household expenses and nothing to save. But now, I earn by selling vegetables and save for future investment.”
Safaa Paani’s water supply improvements also play a key role in safeguarding community health, since more than three-quarters of diarrheal diseases, including cholera, are linked to unsafe water supply, or poor sanitation and hygiene. To that end, the program focuses on implementing a range of water, sanitation, and hygiene (WASH) improvements to help keep communities healthy.
The results have been cause for celebration. Sathimuri, a small village in Sindhupalchowk District that is home to the indigenous Majhi community, is experiencing both health benefits and improved educational access. “We have seen a reduction in waterborne diseases such as jaundice and diarrhea in our community,” says Sita Majhi, secretary of the local water user committee. “Children fall sick less frequently as a result of waterborne diseases. Most of them are seen attending school regularly.”
To improve WASH at the village level, USAID works with a number of public and private-sector partners. Safaa Paani successfully advocated for the Government of Nepal to include toilets in its post-earthquake reconstruction plans. USAID also engaged communities directly with the help of trained community mobilizers, who went door to door to educate families about proper handwashing, toilet use and cleanliness, point-of-use water treatment, and other key WASH topics. Safaa Paani’s robust public outreach also manifested itself in organized rallies, handwashing demonstrations, and dozens of other events to educate communities about how to safeguard their health.
Beyond its general hygiene campaign, USAID tackled the issue of menstrual hygiene management. Even today, religious and social stigma against menstruating women continue to pose serious threats to women’s health in Nepal. In many cases, menstruating women are barred from religious or socio-cultural engagement, and in some regions, they are even still forced to quarantine in isolated “chhaupadi huts” during their monthly periods.
To address such stigma, Safaa Paani trained school principals and staff from district education offices on menstrual hygiene and then provided classroom orientations to girls and boys with the aim of increasing their knowledge of menstruation and reducing stigma. “Now, girls can talk about menstruation and its management without hesitation,” said Nirmala Timalsena, a teacher at Ram Devi Secondary School in Sindhupalchowk District. Teachers also praise USAID’s approach of focusing on both boys and girls. Educators report that including boys has led to increased acceptance and understanding. As a result, boys have grown more sensitive and offer to help and provide moral support to female classmates rather than teasing them, as they did before.
Although USAID’s WASH interventions in rural Nepal have had a significant positive impact in many communities in the years since the earthquake, ensuring that water supply improvements remain viable over time is challenging. Nepal is prone to natural disasters, such as frequent landslides, that can strike with little to no warning and wreak havoc on infrastructure.
Sound construction, while important, is simply not enough — if the water systems are to truly stand the test of time, communities need to know how to maintain them and, if necessary, restore them if they incur significant damage.
USAID consulted extensively with local governments to select where the water systems would be built, recognizing that gaining local public officials’ trust early on in the process is an important determinant of whether or not infrastructure would remain viable in the future. Once the stakeholders weighed in on where to build each water system, USAID began working with community members to establish water user committees — associations of community members tasked with maintaining the local infrastructure. Safaa Paani involved each village’s committee in everything from pre-construction planning to post-construction maintenance, and provided training on topics such as financing the water systems, construction and maintenance, and water quality testing. “Strengthening governance is essential to ensuring infrastructure investments are sustainable,” explains USAID/Nepal’s Shrestha.
Thanks to this training, water user committees in each of the villages are now better equipped to fix problems that arise, and maintain the water systems. The training also gave community members marketable skills — such as financial management and revenue collection — and contributed to empowering women and members of diverse ethnic groups and castes. In fact, about half of all water user committee members are women, and women or members of diverse ethnic groups and castes hold more than two-thirds of leadership positions on the committees.
Beyond good governance, financing is an essential component of water system sustainability, as it helps facilitate community buy-in. When communities contribute financially to development initiatives such as water supply infrastructure, residents become more invested in the maintenance of those systems. For that reason, Safaa Paani required local governments and communities to co-fund their water schemes.
With many residents unaccustomed to paying for water, fee collection proved challenging at first. To combat this reluctance, Safaa Paani empowered the water user committees to educate community members about the need for pooling resources to cover the costs of maintaining local water schemes. The committees successfully mobilized families to donate an up-front fee to fund operations and maintenance of the water infrastructure. As a result, the project exceeded its cost-share target by more than 150 percent, collecting over 50 million Nepalese rupees, or more than USD $425,000 — providing extra funds for communities to maintain their water systems over the long term.
As a result of improved water security, many of the communities most impacted by the April 2015 earthquake are today looking toward the future with optimism rather than anxiety, thanks to the efforts of Safaa Paani. As the program prepares to come to an end later this year, it does so having made significant strides towards improving the quality of life in villages recovering from that devastating event.
While earthquakes, landslides, and other natural disasters may always lurk in Nepal’s future, hundreds of rural communities are now equipped with the WASH infrastructure, technical knowledge, and tools needed to remain resilient in the face of future threats. With this newfound self-reliance comes the confidence that no challenge will ever be too great for rural Nepalis to cope with and, eventually, overcome.
By Celia Zeilberger
This article appears in Global Waters, Vol. 11, Issue 2; for past issues of the magazine, visit Global Waters’ homepage on Globalwaters.org.
Water Brings Communities Together in Post-Earthquake Nepal was originally published in Global Waters on Medium, where people are continuing the conversation by highlighting and responding to this story.
Thursday, May 28 is Menstrual Hygiene (MH) Day and to mark the occasion, this special issue brings together the voices and actions of nonprofits, government agencies, individuals, the private sector, and the media to advocate for all menstruators.
The inability to manage menstruation prevents millions of women and girls from reaching their full potential.
Lack of education and accurate information on menstrual hygiene management (MHM) issues, persisting taboos and stigma, limited access to hygienic menstrual products, and poor sanitation infrastructure are some of the factors that undermine the educational opportunities, health, dignity, and social status of women and girls around the world.
USAID works to address these factors by developing design standards for female-friendly facilities, creating educational resources, promoting the availability of MH supplies, and destigmatizing menstruation. USAID also works with host governments to draft national MHM strategies.
The USAID Water, Sanitation and Hygiene Partnerships and Learning for Sustainability (WASHPaLS) project and the Columbia University Mailman School of Public Health provided content suggestions for this issue.
May 28, 2020, Menstrual Hygiene Day 2020 – MH Day helps raise awareness and change negative social norms around MHM and engage decision-makers to increase the political priority and catalyze action for MHM, at global, national, and local levels. Content on the website includes Campaign Materials, MHM Resources, News, and additional information.
May 28, 2020, Webinar. Dignity, Agency, Power: Exploring the Linkages Between Women’s Economic Empowerment and Workplace MHM – In this webinar, the USAID WASHPaLS project will present the current body of evidence related to MHM and women’s opportunities for economic empowerment and growth worldwide, as well as early efforts of an action research initiative to further understand this relationship. Here is the link for registration and additional information.
Improving the Impact of Menstrual Health Innovations in Low- and Middle-Income Countries: A Theory of Change and Measurement Framework. Journal of Global Health Reports, March 2020. This paper seeks to introduce the Theory of Change and Monitoring and Evaluation (M&E) framework as supportive resources that provide a common framework for the global community as both investors and social entrepreneurs seek to develop more scalable menstrual solutions globally.
Read the complete issue.
By: Rebecca Root
Salimata Dagnogo, matron at a health center in Mali, washes a piece of equipment in the delivery room. Photo by: Guilhem Alandry / WaterAid
BELFAST, Northern Ireland — Hand-washing is the first line of defense against COVID-19 and many other diseases. Yet 1 in 4 health care centers around the world has no hand-washing facilities, and in the lowest-income countries, almost half have no clean water.
A lack of facilities means over 2 billion people are forced to seek care in a place where there is no clean water and 1.5 billion people visit health care facilities with no sanitation services at all.
Advocates say that needs to be understood in order to help low- and middle-income countries control the virus.
“The vital role of good hygiene in preventing hospitals [from] becoming breeding grounds for disease is being woefully overlooked as part of the global response to COVID-19,” said Tim Wainwright, chief executive of WaterAid.
In a statement for WaterAid, Rhoda Phandama, a nurse and midwife in Malawi, added that the Katimbira Health Centre in Nkhotakota, where she works, doesn’t have enough soap.
“We need to have enough supplies so that we are protected and that the clients who come here with issues like injuries and other diseases do not end up catching coronavirus,” she said.
Aside from hand-washing, soap and water are needed to clean floors, operate some medical devices, and deliver babies, said Lindsay Denny, health advisor at Global Water 2020, an initiative focused on water access and security. Over 1 million deaths annually are associated with unclean births.
“We’ve heard stories of people using swamp water because it’s the only water available and that causes infection in the lungs of newborns,” Denny added. “And can you imagine being told ‘oh there’s an outbreak but you can’t wash your hands?’ If anyone needs to have access it’s nurses and doctors,” she said.
As well as patients, the lack of hygiene puts health care workers themselves at risk.
“We know of midwives who don’t go to the toilet on a 12-hour shift because the toilets are on the other side of the freeway from the health center or because it’s not safe,” Denny said, which can lead to infections.
Salimata Dagnogo, matron at a health center in Mali, collects dirty water from an open well. Photo by: Guilhem Alandry / WaterAid
At last year’s World Health Assembly — the annual governance forum for the World Health Organization — ministers of health signed a water, sanitation, and hygiene in health care facilities resolution. The agreement committed to developing national roadmaps, setting targets, increasing investments, and strengthening systems around the issue. In 2018, United Nations Secretary-General António Guterres also made a global call to action for achieving WASH in all health care facilities.
But in many places, this is yet to happen.
Ahead of this year’s World Health Assembly — which is taking place online due to the pandemic, on May 18 — WaterAid issued a call for change.
“As leaders meet virtually at the World Health Assembly we want to see rapid commitments that will mean that no nurse, midwife, or doctor has to work without somewhere to wash their hands,” Wainwright said.
In the Democratic Republic of the Congo, health care workers in rural areas often have to travel long distances to collect water from the nearest well or river, which means less time providing care, according to Amuda Baba Dieu-Merci, a former community health worker and director of the Panafrican Institute of Community Health.
Dieu-Merci blamed an absence of water companies focused on rural areas and the costs being higher than many facilities can afford.
For Denny, the siloed approach to global health and WASH is the main culprit. “When you have a breakdown of water in your health care facility you don’t necessarily have the expertise there to solve these problems. Similarly, the people working in the health system have a health perspective and they may not see water as important to the work they’re doing,” she said.
Zoe Pacciani, country director for Uganda at Freshwater Project International — an organization that provides WASH to villages, schools, and health centers — said many rural health centers were built years ago when building hand-washing facilities outside of the operating rooms wasn’t thought of.
Of the facilities that once had a water supply, many have deteriorated due to a lack of operation and maintenance, Pacciani explained, “rehabilitation on its own is not enough.” Mechanisms to enable district governments to maintain new water systems and local operators to perform routine operations and minor maintenance are needed alongside more funding, she said.
Just 3% of Uganda’s national budget is allocated to water and environment, and that figure drops to 1.5% in Malawi. Pacciani hopes the pandemic will highlight the need to prioritize water supply and hand-washing facilities in health centers.
“It’s shining a light that we’ve ignored this issue for so long. It’s been such a neglected crisis,” Denny agreed. “The outbreak will help countries and major organizations reprioritize and think about how we really focus on what the key elements of a health care facility are.”
In the meantime, Dieu-Merci hopes NGOs will step in, especially in places like DRC where conflict and displacement remain higher priorities for the government.
WaterAid constructs water tanks, towers, and toilets for health centers in several countries including Malawi, Ghana, Zambia, and Mali, while also working to put plans in place for their maintenance. In partnership with Engineers Without Borders, Freshwater Project International is also upgrading and replacing pumps, tanks, sinks, and taps in health care facilities in Malawi.
But this is not something that the WASH sector can solve alone, Denny said. “It’s about coming together, prioritizing, and budgeting. If we don’t have the money for it, it’s never going to be something that’s prioritized,” she said.
Visit the Duty of Care series for more coverage on how health systems can function better so that health care workers are supported and protected. You can join the conversation using the hashtag #DutyOfCare.
WASH & COVID-19
Summary report on doing community engagement at a distance. COVID-19 Hygiene Hub, May 2020.
Summary report on COVID-19 transmission via faecal-oral routes. COVID-19 Hygiene Hub, May 2020.
Summary report on considering gender in COVID-19 hygiene promotion programmes. COVID-19 Hygiene Hub, May 2020.
Water for the urban poor and Covid-19. IDS Help Desk, May 2020.
Handwashing Stations and Supplies for the COVID-19 Response. UNICEF, May 2020.
COVID-19: The environmental implications of shedding SARS-CoV-2 in human faeces. Environment International, July 2020.
Climate-smart cassava gets new use in Zambia: hand sanitizer. Reuters, May 1, 2020.
Some short-term measures are important, but equally important is a renewed focus on long-term availability of water supplies, particularly for the poorest in cities.
Universal water coverage is not a luxury: it is an essential part of keeping people safe. Many governments in the Global South have responded impressively to the threats caused by Covid-19. They now need to use this momentum to look to the long term and create water access in informal settlements that will be sustainable for years to come, protecting against future pandemics or a second wave of Covid-19.
Water & Sanitation for the Urban Poor (WSUP) has identified four steps to creating long-term water solutions that will last:
Utilities are the solution to comprehensive, safe water access in cities, with a remit to manage water supply from source right through to settlement. To have any chance of achieving access, cities need bring piped, treated water to households, and increase the number of people connecting to this water supply.
Investing in utilities and helping them improve services for the people who need them most is one of the most important steps that we can take to tackle the water crisis.
A key element to this is investing in continuous water supply. Intermittent water supply – where water supply is switched on and off – weakens infrastructure, can allow contamination into the water network, and crucially, means that water is not available when residents need it. Utilities have to be able to provide water 24 hours a day, seven days a week for all their customers.
Great customer service means customers are happy, bills are paid promptly and leads to more customers, which leads to more revenue – which in turn results in better, and expanded, services. It is a crucial, and often neglected, part of tackling the water crisis.
The current guidance from many governments that customers cannot be disconnected has meant some water providers fearing that poor customers will stop paying their bills. Utilities are concerned that their long-term financial viability may be threatened if this happens.
But our experience is that customers will keep paying if they receive a quality service. To create more water access, therefore, utilities need to visibly improve services for existing residents, building a more loyal customer base which will provide the launchpad for growth.
Regulation is often over-looked but a crucial part of incentivising utilities to provide water to the poorest segments of society. If servicing the poorest becomes a matter of regulatory compliance, rather than an optional add-on, then it changes the focus for senior management of those water utilities.
In Kenya, for example, this is starting to happen, with the introduction of a metric that utilities must report to the regulator showing how well it is serving low-income areas. The better a utility does serve these communities, the better it does on the annual league tables.
Poor relations between urban communities and publicly owned utilities are a significant reason for slow uptake of water services. When communities take matters into their own hands to source and distribute water to residents, this actually hampers the availability and quality of water across a city.
Community-led water services can result in poorly treated water, a lack of fairness in pricing, a proliferation of informal water vendors and often, different communities in effect competing to draw water from underground sources. Uncoordinated water abstraction is a major threat to water availability in urban areas.
To solve these challenges, water providers have to be much more proactive about showing how they can meet the needs of residents and winning communities over, so that residents can benefit from safely treated, piped water from the central water network.
Brighton Kaniki is the owner of Zaluso Plumbing and Engineering Works in Kasungu, Malawi and one of the welders trained through the CCAP SMART Centre in Malawi in the production of Rope Pumps. Brighton was recently interviewed for The Times, one of the main newspapers in Malawi.