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Before yesterdayWASH OFXAM Blogs

12 tips to sustain hygiene practices now and post coronavirus in emergencies

Oxfam installed Contactless Handwashing Devices which are activated with a foot peddle to avoid transmission of the virus from touching the soap. Rohingya refugee camp, Cox's Bazar, Bangladesh. Credit: Fabeha Monir/Oxfam
Oxfam installed Contactless Handwashing Devices which are activated with a foot peddle to avoid transmission of the virus from touching the soap. Rohingya refugee camp, Cox’s Bazar, Bangladesh. Credit: Fabeha Monir/Oxfam

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:

  1. Ensure access to practical attractive low cost, durable handwashing stations at household and communal levels. For example, Oxfam’s new handwashing station for rapid deployments and other locally made standardised solutions. Latest estimates by WHO/UNICEF show 2 in 5 people globally lack functioning handwashing facilities with soap and water in their home.  
  2. Instilling a sense of ownership and maintenance of WASH facilities amongst the target population.
  3. Provision of continuous access to soap or soapy water (which is cheaper and equally effective option).
  4. Provision of continuous access to safe water for personal, domestic and hand hygiene.
  5. Facilitate continuous well-planned and executed promotion and monitoring of handwashing using interactive activities to remind and reinforce handwashing practices.
  6. Community engagement to help the target population understand better the coronavirus means of transmission and how to prevent the spread. As well as how they can collectively work together to end it through:
    • dialogue
    • joint identification of key risks and debunking rumours
    • interactive age, gender and culturally appropriate communication
    • shielding most vulnerable
    • engaging in other effective action plans including physical distancing.
  7. Supporting government/local administration efforts in referrals, advising on tracing, tracking and WASH provision in treatment and isolation centres.
  8. Different stakeholders working together to ensure joined up efforts to reduce the spread and impact of the different measures introduced since the outbreak impacts on different spheres of life and all groups of people although in different ways.
  9. Sustained financing over time and investments through appropriate resources, new innovations/technologies and their scale up.
  10. Capacity building of different actors and facilitators especially on improved handwashing and hygiene promotion approaches.
  11. Government, NGO communities and others supporting different communities should also endeavour to apply key community engagement principles. These include:
    • building trust
    • collaboration
    • inclusion
    • coordination
    • context analysis
    • use of interactive information, education, communication (IEC) materials
    • accountability (including for service delivery)
    • monitoring and periodic reviews.
  12. Governments should aim to adequately pre-empt, access and address the impact of different preventive measures e.g. impact of lockdowns on access to food, health services for other non-coronavirus ailments including vaccination, gender-based violence, unemployment etc.

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.

Author
Foyeke Tolani

Foyeke Tolani

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.

Extra-ordinary faecal sludge management in Cox’s Bazar, Bangladesh

Making the Anaerobic Lagoon at Cox’s Bazar 2017 as the first step in the treatment process Photo: Andy Bastable/Oxfam GB

For the first time in the history of refugee camps there has been a concerted effort across multiple agencies to ensure proper treatment and disposal of faecal waste. Prior to 2017, there has been single unit, single technology attempts to deal with the human waste in refugee camps. This was seen in the Philippines during the cyclone Haiyan Response, and in Myanmar, Iraq and for the Syrian refugees in Jordan.  However, since the Rohingya crisis in 2017, where approximately 800,000 fled from Myanmar into camps around Cox’s Bazar in Bangladesh, there are now at least eight different types of faecal sludge treatment technologies being used in over twenty sites. These figures are unprecedented. 

 Which systems work best? 

Enlisting the support of ARUP, Oxfam saw this as an opportunity to compare the different types of faecal sludge technologies. The aim of the comparison study was to give agencies the tools to quickly decide the most appropriate technology in context and in relation to large scale emergencies. 

A range of criteria was used to compare FSM technologies such as start-up costs verses operation and maintenance costs; land requirement; technical requirements and resilience to disasters. The results show that the easiest option in terms of technical expertise, set up time and cost is Lime Treatment. However, for the long term it is not considered the best option due to the large amount of management involved. A long term, cheaper option where space is limited, is the Up-Flow filter. Where space is not an issue, anaerobic lagoons are a viable option. While there are clear indications about which technology is most suited to which environments, there is no one size fits all. Making the best decision would rely on those who understand the complexities of faecal sludge management to make the most appropriate decision based on the comparison study. Another relevant document when considering the most appropriate faecal sludge management system is The German toilet organisation’s Compendium of Sanitation Technologies in Emergencies

Going forward  

This comparison study is the first step along the way to having predictable faecal sludge treatment in every future emergency. It is only a snap shot of the technologies used at the time of the study, when many other technologies were only just beginning to be used. Therefore, we plan to conduct another faecal sludge comparison in 2020 when the technologies have been running for more than a year. This will more accurately determine the pros and cons of each unit. In addition, the Global WASH Cluster has set up a Technical Working group, led by Oxfam and Solidarite, with support from the Dutch Government and the Netherlands Red Cross. The group has identified gaps in knowledge and practice such as the lack of simple technical guidelines for the different technologies, a decision tree for technology selection and the need for a dedicated FSM Coordinator to go out to the next large emergency. 

We are clear that we do not want this Cox’s Bazar response to be a one off extra-ordinary response in faecal sludge treatment but the start of an approach that will be rolled out in all future emergencies. Thereby, ensuring the safety of people and the environment from disease and contamination.  

Read the full report: Faecal Sludge Management for Disaster Relief: Technology Comparison Study

Author
Andy Bastable

Andy Bastable

Andy took over the leadership of Oxfam GB's Public Health Engineering team in 2002, which became part of the Oxfam Global Humanitarian Team in 2016.

What really influences our behaviours?

How can civil society curb negative behaviours and practices, such as violence against women and girls, or promote positive ones such as regular handwashing habits? Thomas Dunmore Rodriguez and Ruth Mayne introduce a new infographic for understanding and influencing the range of factors that can influence our behaviours and practices. The infographic is based on learning from practical social norm influencing workshops with young people designing campaigns to end sexist violence in LAC, and from an Oxfam discussion paper. Here we apply the diagram to a practical example of handwashing.

Credit: Viridiana Montiel

Handwashing is widely considered the most effective method of preventing the spread of infectious illness, yet we’re sure all parents or guardians are tired of asking their children to wash their hands before a meal.  The photo below shows a headteacher in a school for orphans in Sierra Leone. Some of the students lost relatives to Ebola, and the school provides lessons in hygiene promotion. If you were a child at a school like this, what would make you adopt certain practices, like regular handwashing?

Oxfam is providing clean water, toilets and hygiene classes to children in Port Loko's Educaid primary school. The facilities include a solar powered water pump, tap stands and toilet blocks for both male and female students. Credit: Tommy Trenchard/ Oxfam
Oxfam is providing clean water, toilets and hygiene classes to children in Port Loko’s Educaid primary school. The facilities include a solar powered water pump, tap stands and toilet blocks for both male and female students. Credit: Tommy Trenchard/ Oxfam

No doubt the awareness-raising and information provided in the lessons are important, but what use are they if there’s no water and soap? The availability of necessary infrastructure, products and services is vital to change behaviours.  This school has built new toilet blocks with tap stands powered by solar pumps. They are now seen to be much safer and less exposed than the old ones.

There are also structural level factors that can influence individuals’ behaviours. Government policy and funding for schools to provide such lessons and infrastructure helps. Widely held cultural beliefs relating to cleanliness may also influence handwashing behaviours.  Wider information and behaviour change campaigns in the media might help influence these beliefs, but would they have a practical effect? More innovative and effective behaviour-change campaigns don’t just provide information or infrastructure, they also tap into group relationships and social norms.

People learn behaviours from others in social settings. They are also highly influenced by how they think other people will view their actions. The power of the people directly around you is therefore significant. For instance, the influence of role models like your teacher can have an impact.

In this school, the headteacher explains that, “The only ´fees´ that the children are expected to ´pay´ are excellent behaviour, excellent performance and excellent effort”. These messages help to set the unwritten rules, and no doubt they are continually reinforced by the teaching staff, but will that be enough to convince the students? The influence of your direct peers and interpersonal relationships are also vital. Do your friends wash their hands? How often? What do they expect you to do? If you don´t follow the unwritten rules set by your friends, what will their reactions be towards you?

As an example of the power of social norms, there is some evidence that gender is a significant determinant of handwashing frequency. Females reported washing their hands significantly more often than males. So if most girls around me are washing their hands regularly, they will probably influence me positively if I identify as a girl. In the same way, a perception that most boys around me don´t bother washing their hands may impact me negatively if I identify as a boy.

Creating specific messages for specific reference groups, and highlighting the positive social norm that we want to create is vital. People, including children, are more likely to adopt a certain behavior if they see their close friends, family and teachers adopting the behaviour. So getting people together in social learning groups where they can learn new behaviours from role models to get feedback and positive reinforcement can help.

Individual internal influences also play a role. It has been shown that part of the brain responds to unconscious cues which drives habitual behaviours rather than conscious decision making. Using environmental cues, nudges and reminders, can help break old habits and turn handwashing into a long-term behavior. In this school, the tap stands are visible and accessible, so they encourage handwashing by influencing the children´s environment

Similarly, our actions may be influenced by largely unconscious values and emotions, rather than rational decision making. The school encourages each child to adopt a certain attitude to handwashing, to see it as a core part of “good behaviour”, appealing to certain values at a personal level.  Successful behaviour-change can work by appealing at an emotional level. Generating emotions at an individual level, like disgust, nurture or desire to behave in a certain way, can be a powerful motivator. However, strategies that tap into certain negative emotions, like disgust, need to be carefully thought through. They could, unintentionally, lead to shaming or worse.

It is also important to consider the interaction between individual, group and structural influences, and the role power plays at each of these levels. We created this infographic to show the interconnected levels and influences which need to be considered when developing strategies that seek to influence behaviours. A lot of recent attention  has focused on the power of social norms, and these are vital, but they are not the only influence on behaviours. A social norm change strategy that recognizes that connections with changes in societal-level structures and institutions, as well as with habit-forming factors at the individual level is more likely to be successful.  Food for thought, whether for influencing and campaigning strategies or strategies employed at home with kids!!

Author
Thomas Dunmore Rodriguez

Thomas Dunmore Rodriguez

Thomas Dunmore Rodriguez the Global Adviser: Influencing & Active Citizenship at Oxfam. He supports country teams and partners to strengthen their influencing work. Most recently, his work has focused on developing country-level strategies on social norm change and the Enough campaign in Bolivia, Cuba, Honduras, Guatemala and Colombia.

Author
Ruth Mayne

Ruth Mayne

Ruth is Oxfam’s Senior Researcher on Influencing and its Effectiveness. She has an interdisciplinary background as a researcher, policy adviser and practitioner on humanitarian, development and environmental issues. Ruth previously worked at the Environmental Change Institute, University of Oxford where she is now an honorary research associate. She has also worked in the past as a Policy Advisor on some of Oxfam's major global campaigns, an independent consultant, as a country programme manager in Colombia, a socio-economist, and as a university lecturer. She is also active at local level as co-founder of Low Carbon West Oxford, an award winning charity and recent local councillor.

Improving the sustainability of water supply schemes in Nepal

This podcast focuses on the alternative models we used to boost the profitability and sustainability of rural water supply schemes in Nepal. We speak to Anjil Adhikari who is an Innovation Advisor working for Oxfam on water sanitation and hygiene, and Jessica Graf who is Managing Director of LeFil Consulting. They talk about how they worked together to demonstrate that better water service delivery is possible.

Download the report

Subscribe to the Oxfam Podcast

Soundcloud | Google Podcasts | iTunes

Three things we’ve learned about measuring quality in humanitarian WASH responses

Six months ago, we started a process for water, sanitation and hygiene (WASH) practitioners and coordination platforms to measure the quality of our responses across different contexts. James Brown reflects on what we have learned so far. 

Crowded living conditions Cox’s Bazaar, Bangladesh. Photo: James Brown
Crowded living conditions in Cox’s Bazaar, Bangladesh. Photo: James Brown

Back in January, we introduced the Quality Assurance and Accountability Project (QAAP) – a Global WASH Cluster initiative led by Oxfam, in partnership with Solidarités InternationalTufts University, and UNICEF. The project supports humanitarian WASH coordinators to go beyond simple headline indicators to understand – and ultimately improve – the quality of our work.   

Since October, our team has visited Bangladesh, Myanmar, South Sudan and Colombia. We’ve met with coordinators; programme teams; experts in WASH, protection, monitoring, and inclusion; as well as people directly affected by crisis.   

The purpose of each visit is to understand specific needs and challenges, and the approaches that have already been tried. We then work with the response team over several months to develop and test a quality assurance system that includes practical measurement tools. 

What types of challenge did WASH teams face? 

Long term sustainability of services in Cox’s Bazaar, Bangladesh 

A massive and rapid influx of Rohingya refugees from Myanmar has created the largest refugee camp in the world. With the anticipated camp lifespan running into the long-term, it is essential to make good decisions about how to invest limited resources early on. 

Restricted access and protracted displacement in Rakhine State, Myanmar 

Across the border, the work of WASH teams is constrained by ongoing restrictions on INGOs delivering services in confined camps.  Longer-term planning to support internally displaced people (IDPs), sequestered to these camps since 2012, remains difficult given the absence of a clear government strategy for durable solutions to their displacement.

Fragile peace and Ebola in South Sudan 

Decades of conflict have displaced a third of the population. Over two million people have been forced to flee the country completely. Any optimism based on the recent peace deal is tempered by the threat of Ebola from neighbouring countries. The WASH cluster is coordinating a response in both formal and open sites across the country; constantly responding to new needs.

Despite the unique challenges of each context, we found consistency in the following themes:   

1. Data needs to be used in the right way 

WASH partners and third parties conduct sophisticated monitoring that includes surveys, interviews, focus groups, user feedback systems and community engagement.  In recent years, smartphone or tablet based digital surveys, GPS mapping and aerial imagery from satellites and drones have enabled us to collect huge amounts of data.  And specialist assessment organisations such as REACH can support organisations through large scale, multi-sector data collection and analysis.  

All this data can support responses to make evidence-based decisions, and to monitor the effectiveness of our interventions. However, the right data needs to be collected, shared and analysed in the right way. We found that this is not always consistent between partners, which means joint analysis at the response level is limited. 

2. Data needs to tell us if we are meeting our objectives 

Too often, data can’t tell us whether services really are equitable, sustainable, dignified or safe.
Additionally, the data being collected often does not measure the objectives of the WASH response, or the risks faced by people it aims to serve.  Strategic response objectives often include phrases like ‘equitable and sustainable access’ or ‘safe and dignified facilities’.  

Yet too often, data used to measure these indicators can’t tell us whether the services really are equitable, sustainable, dignified or safe. Community engagement and consultation is rarely even factored into the planning of water and sanitation facilities. We measure and report from our humanitarian response point of view, rather than from the experience of people using them.  

3. We all need to work to consistent standards 

We saw many examples of WASH teams carrying out good quality programmes, designing approaches that are both effective and appropriate. The potential for other organisations in the response to learn from them, and to scale up to improve quality is great.  

However, service levels and approaches are often not consistent across organisations. And, while knowledge of key standards frameworks, such as Sphere and the Core Humanitarian Standard (CHS) is widespread, these standards are not routinely applied to programme design, or the development of monitoring frameworks. 

So, where next? 

WASH coordination platforms exist to promote joined up approaches across organisations, but in a complex response this can be extremely difficult. Teams are concerned about the growing number of WASH actors working without engaging with UN-led coordination mechanisms. We heard calls for the National Humanitarian WASH Coordination Platform (NHWCP) to be strengthened, and to ensure compliance with agreed ways of working.  

The Quality Assurance and Accountability Project will continue to work with coordination platforms to tackle these issues.  Together with country partners, we will define clear expectations and standards for each response, and design how best to monitor key performance indicators.   

By ensuring information is collected, analysed and shared in the right way, we can highlight where the quality issues arise.  Ultimately, our aim is to put quality at the top of the agenda. When partners have the right information at the right time, we will all be able to deliver continually improving, and more effective WASH services. 

Author
James Brown

James Brown

James joined Oxfam’s Global Humanitarian Team as a Public Health Engineer in 2012. In 2016, he was seconded to the Field Support Team of the Global WASH Cluster (GWC), taking on national coordination roles in both Iraq and Ukraine, working on capacity building initiatives and leading the GWC’s Technical Working Group on Cash and Markets. Before joining Oxfam, he founded a social enterprise developing household water treatment products for the development sector. His background combines humanitarian WASH programming with human-centred design and engineering.

Are Communal Tiger Worm Toilets a sustainable option for camps?

We tested Communal Tiger Worm Toilets in challenging conditions in Myanmar, and evaluated their sustainability. The ‘Tiger Team’ talk us through their findings.

CTWTs functioning during the monsoon in Myanmar. Credit: Lucy Polson/Oxfam

As increasing numbers of people are living in camp settings for longer, we need more sustainable alternatives to commonly used pit latrines. 

Tiger Worm Toilets (TWTs) are a novel sanitary solution that contain composting worms to digest faeces inside the vault. This removes the need for expensive desludging, and sludge treatment infrastructure.

With the IHE Delft Institute for Water Education, we used a grant from the Humanitarian Innovation Fund (HIF) to develop a communal version of the household TWT, appropriate for use in humanitarian camps.

We tested the Communal Tiger Worm Toilet (CTWT) in the extreme environment of an internally displaced peoples (IDP) camp in Sittwe town, Rakhine State, Myanmar. We evaluated its sustainability under three pillars, and measured results against the regular sanitation systems used in the camp: 

  1. Social. Do people use it and like it?
  2. Environmental. Does the waste get treated?
  3. Economic. How much does it cost to make and maintain?

The challenges we faced during the trial

Our first challenge was to gain permission to build the toilets in an area accommodating two displaced communities; Rohingya (Muslim) and Rakhine (Buddhist).  To comply with government regulations, we built 45 household TWT’s in Rakhine relocation villages, as well as 34 CTWTs in the Rohingya camp setting as planned.

Then, in May 2017, Cyclone Mora hit. The 10 CTWTs that had already been built withstood the cyclone – we think this was due to dedicated attention to quality control on these special toilets – but the other toilets in the camp were severely damaged. And in August 2017, political tensions started to grow, limiting our access to the camp for building and monitoring. Thankfully this eased by December 2017, and normal activity could resume.

We monitored our CTWTs for over 14 months, meaning that they survived monsoon seasons.  They were used by over 700 people, so this was a large study. Here are our findings:

Were they socially sustainable?

YES!

The CTWTs were used continuously by both men and women. Both user acceptance and satisfaction levels were extremely high. Satisfaction was linked to the lack of smell, compared to the users’ original latrines. 99% of households opted to continue using the CTWT after the trial ended.

Were they environmentally sustainable?

KIND OF!

CTWTs convert human poo into worm poo, which occupies less space. So, while this still needed to be disposed of in the same way as pit latrine waste, there was a smaller volume. And this meant a lower emptying frequency. Furthermore, less desludging means reduced use of diesel and petrol-powered tractors and pumps. The aerobic process of the CTWTs also produces less methane than traditional toilets.

Were they financially sustainable? 

YES!

We found that the CTWTs cost 47% less than traditional pit latrines over a five-year period. This broke down as a 34% reduction in construction costs, and a 90% decrease in maintenance costs – valuable savings for costly protracted camp situations.

Engineer Bagus Setyawan adding worms to the vault of a Communal Tiger Worm Toilet. Credit: Rhea Catada/Oxfam

What next?

CTWTs have proved to be sustainable within this specific context. We are now asking the humanitarian sector to consider the CTWT as an option when either retro-fitting existing communal toilets or building new ones. To help practitioners decide if this is an appropriate technology for their situation, we have developed a simple Decision Tree:

We have compiled the learning from this project in an easy-to-read manual, which is free to download. It includes the decision tree alongside all our designs.

Our next step is to develop a more general guidance manual for both the CTWT and TWT for the humanitarian sector, so watch this space. We also plan to share our findings in a journal article, to be published in the summer.

We are now asking the humanitarian sector to consider the CTWT as an option

Follow the journey of this project via blogs and video

The CTWT Team are: Andy Bastable, Jenny Lamb, and Lucy Polson in the UK; Sophie Ford, the Logistics Department, the MEAL Team, and Benedict Wood in Yangon; Bagus Setyawan, Mee Mee Htun, Pier Francesco Donati, Bo Bo Tun, Oo Shwe Than, the Logistics Team, the MEAL Team, and Sonya Milonova in Sittwe; and Researcher, Claire Furlong (WEDC, UK & IHE Delft, Netherlands).

This CTWT project was supported by Elrha’s HIF programme—a grant making facility supporting organisations and individuals to identify, nurture and share innovative and scalable solutions to the most pressing challenges facing effective humanitarian assistance. The HIF is funded by aid from the UK Government. Visit www.elrha.org for more information about Elrha’s work to improve humanitarian outcomes through research, innovation, and partnership.

Author
Dr Claire Furlong

Dr Claire Furlong

Dr Claire Furlong is Lecturer and Researcher in Non-Sewered Sanitation at the IHE Delft Institute for Water Education, Netherlands. She is an environmental engineer from the UK with over 12 years’ experience in Water, Sanitation and Hygiene in low and middle-income countries. Her research focuses on the interface between technology and people and the sanitation service chain. This includes development and trialling of disruptive technologies such as the Tiger Worm Toilet. She has collaborated with Oxfam on worm-based sanitation since 2013.

Author
Lucy Polson

Lucy Polson

Lucy Polson manages Oxfam’s Water, Sanitation & Hygiene Promotion (WaSH) Innovation Fund, which trials affordable, appropriate and sustainable solutions for fragile areas prone to natural disaster and conflict. Informed by a research and development strategy led by Oxfam’s Global Humanitarian Team, the Fund invests in new thinking to tackle the toughest challenges facing humanitarian WaSH response. Lucy has worked for Oxfam since 2013, and has experience in managing high-value philanthropic partnerships. She holds an MSc in Development Studies from SOAS.

A different approach to water management in Nepal

How a financially viable management model could work to ensure sustained safe water access for communities long after project’s end.

Anjil Adhikari, Wash and Innovation Advisor in Oxfam in Nepal, presents the new management model. Photo: Poul Due Jensen Foundation
Anjil Adhikari, Wash and Innovation Advisor in Oxfam in Nepal, presents the new management model. Photo: Poul Due Jensen Foundation

How small and regular design tweaks can make a big difference to latrine use

Communications Advisor, Tanya Glanville-Wallis, talks us through the process of developing Sani Tweaksa series of communications tools for technical staff, promoting best practices in sanitation.

The cover of our Sani Tweaks illustrated booklet, designed to make information more engaging and easy to digest.
The cover of our Sani Tweaks illustrated booklet, designed to make information more engaging and easy to digest.

Visiting the Rohingya refugee camps in Cox’s Bazar, I reflected on just how few women use emergency latrines. Having worked in the humanitarian sector for years, using camp latrines is nothing new to me. Yet I found myself starting to question whether I actually felt safe.

For me, this unease was short-lived. However, for the women and girls who call these camps home, discomfort, and sometimes terror, is a daily reality. As we recently learnt, the truth is that they often simply avoid using the latrines altogether, resorting instead to unsanitary alternatives.

Identifying our goal and how to achieve it

Our goal is behaviour change, both in the people who use the latrines, and our technical staff who build them.
To design latrines that meet the needs of the most marginalised and vulnerable groups, we need to change our approach. Users—especially women and girls—must be consulted and involved throughout the design process. Our goal is behaviour change, both in the people who use the latrines, and our technical staff who build them.

But how do we change the career-long habits of such staff, who are so often fatigued, burdened by time constraints, and bogged down by technical lingo and lengthy documents? A crucial first step is to improve the way we communicate with them; bridging the gap between theory and practice, to inspire new ways of working.

Understanding our target audience

Even with limited capacity and resources, it is essential that the materials we produce are appropriate for their target audience. Last summer, we sought to deepen our understanding of how water, sanitation and hygiene (WASH) staff like to learn. We conducted a survey, asking questions such as: how do you prefer to receive new information? What sort of communications are likely to be memorable?

The results were not surprising, identifying that technical staff learn best through human interaction—workshops, conferences, and on-the-job learning—and recognising the  greatest barriers to their learning as a lack of internet connectivity, time constraints, and an overabundance of wordy documents.

Repackaging information

Traditionally, we tend to produce academic communications that technical staff find exhausting, and struggle to engage with. We learned that we need to repackage that information to cut through the noise, and appeal to the hearts and minds of those who can make a practical difference. These three principles guided our work:

  • We can’t always provide direct interaction, but can we make our learning tools more human, relatable and engaging?
  • When time constraints and connectivity are an issue, we must simplify resources to make them catchy and bite size.
  • A combined and varied approach—with a range of products, all carrying the same core messages—is more likely to appeal to different senses, and guarantee success.

Introducing Sani Tweaks

Consult the user, regularly and repeatedly.
In January, we launched Sani Tweaks—a series of communications tools designed to promote best practices in sanitation, and encourage staff to retain one central idea: to consult the user, regularly and repeatedly.

What started as a basic checklist has grown into a range of visual resources for technical staff. Each outlines a series of design ‘tweaks’—minor adjustments based on community dialogue, that will ultimately determine whether a woman uses the latrine or not.

Sani Tweaks five-minute animation, outlining key considerations to help people feel safer using latrines.

Our aim is to overcome communication barriers. The series re-packages and presents existing best practices in a variety of new ways. This offers technical staff a range of options to choose from, according to their individual preferences.

The available tools include:

  • A checklist. Simple, practical and printable, for people who respond well to bullet points;
  • An illustrated booklet. With three central characters to bring a story-telling element for visual learners;
  • An animation. A five-minute video that brings the illustrations to life, designed for staff to watch when they are tired and have limited time;
  • Ask Andy’ videos. Short clips that provide simple solutions to practical obstacles, presented by Andy Bastable, Oxfam’s Head of Water and Sanitation.

‘Ask Andy’ episode 1, showing how to easily create durable locking mechanisms for a latrine.

Next steps

Behaviour change takes time. We are asking technical staff to consult users, regularly and repeatedly, and  as communicators, we must make the same efforts to continuously seek staff feedback, listen and adapt. Are the tools we provide engaging and user-friendly? Are they making a difference to user satisfaction, and ultimately, are they driving increased latrine use?

Whether these new tools make a difference remains to be seen. We will disseminate them throughout the humanitarian WASH sector, and closely monitor how they are used. Knowledge and awareness alone rarely bring about behaviour change. But we feel that making information more accessible is a first step in the right direction, as we strive to place women and girls at the very heart of our emergency response.

Browse and use Sani Tweaks resources

Sani Tweaks resources are available in English and French. Arabic versions to follow soon.

Author
Tanya Glanville-Wallis

Tanya Glanville-Wallis

Tanya is a communications specialist for the humanitarian sector and currently an advisor for Oxfam’s Global Humanitarian Team. Having joined the WASH team in early 2018, she has been fully focused on the production of multi-media communication tools for the Sani Tweaks series and is committed to its sector-wide dissemination.

We must do more to make emergency sanitation safer

Why do so few women and girls use emergency latrines? Rachel Hastie shares key findings that could help make sanitation safer in camps.

Sanitation facilities in a refugee camp we visited in Uganda. 92% of women and girls we spoke to said they didn’t use latrines after dark, showing the need to make sanitation safer. Photo: Rachel Hastie/ Oxfam
Sanitation facilities in a refugee camp we visited in Uganda. 92% of women and girls we spoke to said they didn’t use latrines after dark, showing the need to make sanitation safer. Photo: Rachel Hastie/ Oxfam

We looked at the latrine with dismay, as Sarah told us how her relatives had been killed in South Sudan. She had walked to the Ugandan border with her three children and nine nephews and nieces. Their latrine, rapidly constructed in a camp for refugees, was shared with five other families she didn’t know.

Stripped of its plastic sheeting, the shallow latrine was flooded from recent rains. Maggots crawled around the uneven slab set on slippery logs. It was hard not to feel thoroughly ashamed that, in the face of this woman’s courage and resilience, this was the best that humanitarians could provide for her. 

Sarah didn’t use the latrine, of course. It offered no privacy, no dignity, and was downright dangerous. Instead, each evening she dug a hole her small plot for the family to defecate into. However, space was running out and the proposed shift to household latrines was painfully slow.

Communal latrines are places of danger for women and girls

In 2017, we joined researchers from the University of Loughborough to find out whether sanitation lighting could reduce the risk of gender-based violence (GBV) in camps. We expected to find out a lot about lighting, but what surprised us was just how few people were using emergency latrines and why.

92% of women and girls said they didn’t use latrines after dark.
Like Sarah, an astonishing 92% of women and girls we spoke to said they didn’t use latrines after dark, with many using open defecation and buckets or bags in their shelters, despite there being no safe disposal method.

Similarly, 63% of women in Iraq and 44% in Nigeria said they did not use latrines after dark. Many did not use latrines during day time either, describing men spying or walking in on them, being sexually harassed, and assaulted in or around the latrines.

Who are we building latrines for?

Women and girls use latrines more than males due to menstruation, pregnancies and their long-term impact on women’s bodies. When we asked people what would make them feel safer using the sanitation facilities, we got some strong messages for the humanitarian community. 

Lighting alone cannot compensate for poor design and build

Some latrines were so far from meeting standards that no amount of lighting would ever make them safe.
Far too many latrine cubicles don’t have doors, never mind locks. They often have flimsy or damaged walls, and lack space for pregnant women, and those with children or helping a disabled relative. Some latrines we saw were just so far from meeting our existing standards that no amount of lighting would ever make them safe.

The shame and risks for women using latrines

Good quality structures in the wrong place can be dangerous too. In Iraq, women and girls were expected to use latrines less than one metre away from those for men. Having lived under strict ISIS control, any contact with a male who was not a close relative held serious consequences for them.

As one aid worker explained: “Latrines are so close together that they cause a massive risk for women. If seen coming out at the same time as a man, you can be labelled a prostitute. Then you are shamed, and can be killed or assaulted by your family, or raped by men in the community who will say that if you tell anyone, they will say you are a prostitute.”

Continuous consultation, and improvement of latrines is key

Women and girls in the Nigeria camp also experienced danger, shame and embarrassment at being seen by men going to the toilet, particularly by male elders. However, after feedback from women, the latrines were upgraded with strong walls and locking doors.  Hand-held solar lights helped everyone feel safer going to the latrines after dark, and made it easier to keep them clean.

What can the humanitarian sector learn to make sanitation safer?

We must design for the people who are most marginalised, vulnerable and scared.
Cultural and social factors affect safety around sanitation facilities. Instead of designing latrines with fit, healthy males in mind, we must design for the people who are most marginalised, vulnerable and scared.  We need to involve users – especially women and girls – in the design. And we need to make efforts to constantly listen, improve and adapt.

Women and girls in all the locations had alarmingly high levels of fear about GBV – for them, refugee and internally displaced people (IDP) camps are dangerous places, especially the sanitation facilities. None of this comes as a surprise.

Wherever we go to the toilet – Oxford, Nairobi or a refugee camp in a desert – we all want safety, privacy and dignity. By not meeting the standards we have already set for ourselves, we are putting women and girls at greater risk, and undermining our very public health rationale.

Author
Rachel Hastie

Rachel Hastie

Rachel has worked for Oxfam GB for 16 years in field and headquarter posts implementing and supporting humanitarian programmes. Since 2006 she has been the Global Protection Adviser leading Oxfam's programme strategy for protection work.

A user-centred handwashing kit for emergencies

Foyeke Tolani, Public Health Promotion Adviser and Project Coordinator, describes how a collaboration with a UK school sparked the process of developing Oxfam’s innovative new handwashing kit.

Handwashing kit in use after ten months in Nduta camp, Tanzania. Photo: Joel Trotter

Handwashing kit in use after ten months in Nduta camp, Tanzania. Photo: Oxfam

For over a decade, we had been exploring handwashing kit options to replace the Tippy Tap. The Tippy Tap requires lots of promotion for sustained use, and as a device it is not particularly durable. We wanted to create a step-change in handwashing, that would enable us to meet user’s needs, and reduce disease in emergency contexts.

The A-frame handwashing station. Photo: Joel Trotter/Oxfam

The A-frame handwashing station. Photo: Joel Trotter/Oxfam

By 2016, we felt we had exhausted our options – despite working with a range of consultants and practitioners. Then we were approached by Beech Grove Academy, UK, who wanted to work on innovation ideas. Interestingly, two female students selected the handwashing topic and surprised us all. They generated five designs based on the key attributes we had identified for a handwashing station. The Oxfam Water, Sanitation and Hygiene (WASH) Team were so impressed with their A-Frame design that we put it forward for the Elrha Handwashing Challenge.

The innovation sprint, with input from experts, helped us to map out a development path for the product. We were also working on an interactive handwashing promotion approach that uses storytelling,  jointly developed with Unilever’s Lifebuoy Soap – Mum’s Magic Hands – which we were keen to test alongside the new kit.

At the inception meeting we met with a team of designers, manufacturers and public health and behaviour specialists. We discussed the ideal handwashing station for emergency use, based on feedback from potential users. Key attributes included:  water-conserving, easy to use, simple to maintain, proper drainage, adjustable height, space for soap, spacious, and attractive.

Average rating of the PPHWK compared with the Tippy Tap during focus group discussions in Nduta camp.

Average rating of the PPHWK compared with the Tippy Tap during focus group discussions in Nduta camp.

From here, we developed the first prototype of the Promotion and Practice Handwashing Kit (PPHWK). We took this to Nduta refugee camp in Tanzania for initial trials in 2017, where it was well received. We chose Nduta because we wanted to test in a stable camp setting first. Feedback led to the improved Prototype 2, which was trialled at scale for eight weeks.

 

Further feedback informed Prototype 3, which was tested in an acute emergency setting; Kyaka refugee camp, Uganda. Again, it proved to be user-friendly, and significantly increased handwashing with soap practice. The findings in Tanzania and Uganda also showed a significant increase when we used Mum’s Magic Hands compared with traditional handwashing promotion methods such as community meetings, posters, and leaflets.

Handwashing kit prototype development from left to right: Photo: Joel Trotter/Oxfam

Handwashing kit prototype development from left to right: Photo: Joel Trotter/Oxfam

The post-evaluation of Prototype 2 in Nduta camp showed that it was still functioning after 10 months, and the coloured footsteps embedded in the ground to guide people were still intact. However, the mirrors had been stolen– an issue which we addressed in the final prototype design. The man featured in the main image at the top of this blog told us:

“I find the kit very useful … the right solution. As you see I’m a disabled person, it is difficult to use a Tippy Tap. This kit is easy to use for all … [It] uses minimal water … I advise Oxfam to install [it for] other people facing physical challenges.”

We now have Prototype 4, which was improved with feedback from the trials. It looks quite different but it retains all of the desirable features tested in Tanzania and Uganda. Every element is robust and low-cost, and it is optimized for shipping. The kit can be assembled in under seven minutes, following simple instructions.

Final handwashing kit prototype. Photo: Joel Trotter/Oxfam

Final handwashing kit prototype. Photo: Joel Trotter/Oxfam

Features:

  • 24-litre water tank (with attached lid)
  • 4.5-litre internal liquid soap dispenser (with space for bar soap as an alternative option)
  • water collection basin (to restrict splashing), drainage pipe, 3 metal legs, 2 mirrors and 4 taps (2 for water and 2 for liquid soap)

Benefits:

  • Easy to use, height-adjustable, and accessible for all
  • Bright colours and mirrors to attract people to come and use
  • Water-conserving, push up taps for handwashing only
  • Every element of the design is low cost and durable
  • Lightweight, stackable and easy to transport.

So, did we achieve what we set out to do? Yes, we did. Were there any challenges? Yes, in particular delays in manufacturing plastic components, and the unstable contexts where the trials were conducted.  It wasn’t easy to get the height right, make the design compact and theft-proof, but eventually we got there.

The project was supported by Elrha’s Humanitarian Innovation Fund (HIF), a grant-making facility that supports organisations and individuals to identify, nurture and share innovative and scalable solutions to the most pressing challenges facing effective humanitarian assistance. HIF is funded by aid from the UK Government.

It enabled field practitioners, private sector actors and designers to create a product that was tried and tested several times with potential users. Exhibiting at industry conferences allowed for feedback from WASH practitioners, donors and potential buyers, including: “It’s a very nice step forward” and “I can’t believe it’s so cheap”. Our next challenge is how to move it to scale.

Watch a video of the new handwashing kit in action

Author
Foyeke Tolani

Foyeke Tolani

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.

If you can’t measure it, you can’t improve it: Quality in WASH responses

As we launch our WASH Impact Series, Oxfam’s Quality Assurance Project Manager, James Brown introduces a new global initiative to help organisations focus on achieving quality in humanitarian WASH responses.

Aina prepares a meal at her emergency shelter outside Palu. Oxfam installed clean water facilities here after a powerful earthquake struck on September 28th, 2018. Photo: Rosa Panggabean/OxfamAUS

Aina prepares a meal at her emergency shelter outside Palu, Indonesia. Oxfam installed clean water facilities here after a powerful earthquake struck on 28 September 2018. Photo: Rosa Panggabean/OxfamAUS

What would a quality assurance system for humanitarian WASH programming look like? That’s the question being explored by the Quality Assurance and Accountability Project, a Global WASH Cluster initiative led by Oxfam, in partnership with Solidarités International, Tufts University and UNICEF.

Over the next six months we will be working to define and test a process that can be used by WASH practitioners and platforms to measure the quality of responses around the world.

Why is it important to measure quality?

WASH coordination platforms (sometimes called ‘clusters’ or ‘sectors’) are groups of WASH practitioners from NGOs and UN agencies.  An important part of their work is analysing information to provide an overview of who is doing what, where gaps exist, and whether standards are being met. Their summaries are used to inform decisions about prioritising resources across the response.

Headline figures hide a multitude of complexities, and can give a very different picture to the reality experienced by many.
Until now, coordination platforms have mainly focused on quantitative measures of output, which are then compared to the number of people in each area to give headline coverage figures (eg 20 people per latrine, 15 litres per person per day, one hygiene promoter per 250 people).  However, these headline figures hide a multitude of complexities, and can give a very different picture to the reality experienced by many.

The risks of ignoring the unseen

A recent Oxfam study of several programmes showed that, on average, 40% of women were not using the latrines provided. The needs of different users had not been sufficiently considered in latrine design. If we collect and report only numbers of latrines constructed, without quantifying actual use, we’re likely misunderstanding the problems faced by most of the people we’re committed to reaching.

If we’re not asking the right questions it’s unlikely we will have the information to make good decisions.
In a humanitarian response, when time and resources are limited, we’re biased towards prioritising visible problems and risk ignoring the unseen. If we’re not asking the right questions it’s unlikely we will have the information to make good decisions.  And this can lead to wasting scarce funding on activities that do not contribute to our objectives of providing basic services and keeping people healthy.

Practical benefits for the WASH sector

  1. A consistent definition of quality

Quality is a broad term that encompasses so many different factors and contexts it can be hard to define.  It’s often easier to identify where quality is lacking, because we have a subjective understanding of ‘good programming’.  Therefore, our first challenge is to define quality in a way that is both specific enough to measure objectively, whilst being flexible enough to apply to a broad range of contexts.  We will do this by gathering input from WASH practitioners, and carrying out a desk review of existing literature.

It is essential that our definition of quality is rooted in the experiences of communities affected by crisis.
Through this definition of quality, we will be able to shape the way humanitarian WASH responses are measured: influencing the incentives that drive programme design.  It is essential that our definition of quality is rooted in the experiences of communities affected by crisis.
  1. An adaptable framework for measuring quality

We will develop a draft framework that sets out the universal components of quality in WASH programming.  This will form the foundations for developing context-specific monitoring systems that can be set up and tested in live responses.  The framework template will be updated as we test it in each context, and then later shared with other WASH coordination platforms for wider use.

  1. Three context-specific quality monitoring systems that work

Working with WASH coordination groups in three countries, we will use the general framework to create monitoring tools and approaches that are adapted to the needs of each context.  We plan to visit each country twice, initially to gather information, and then to test each of the systems developed.  This testing process will ensure we are delivering the information that is most useful to the WASH practitioners working there, without creating additional burden. It will also provide a baseline quality measure for future assessments.

  1. Guidance and advocacy

We will write a guidance note at the end of the project to summarise our process, and what we learned.  This can inform the roll out of further quality monitoring frameworks in other countries.  We will also make recommendations for the Global WASH Cluster to systematically improve the quality of responses.

 

We hope that this project will start a more focused dialogue around quality in humanitarian WASH responses.  By demonstrating practical ways WASH coordination platforms can measure quality across different contexts we hope that this will become standard.  Once quality is routinely measured, WASH coordinators will be equipped to make better decisions about priorities and programme design, and ultimately, ensure that we deliver on our commitment to the people we aim to serve.

Author
James Brown

James Brown

James joined Oxfam’s Global Humanitarian Team as a Public Health Engineer in 2012. In 2016, he was seconded to the Field Support Team of the Global WASH Cluster (GWC), taking on national coordination roles in both Iraq and Ukraine, working on capacity building initiatives and leading the GWC’s Technical Working Group on Cash and Markets. Before joining Oxfam, he founded a social enterprise developing household water treatment products for the development sector. His background combines humanitarian WASH programming with human-centred design and engineering.

 

Can selling water and sanitation services to people living in poverty be inclusive and equitable?

Tom Wildman, Oxfam GB’s Senior Advisor on WASH Market Development, outlines the debate that took place at this year’s Water & Health Conference, and summarises the key areas where differing perspectives came together.

Clarice Akinyi demonstrates how to use a water ATM in Mathare Ward, Mashimoni Village, Nairobi, Kenya. Photo: Katie G. Nelson/Oxfam

Clarice Akinyi demonstrates how to use a water ATM in Mathare Ward, Mashimoni Village, Nairobi, Kenya. Photo: Katie G. Nelson/Oxfam

Market-based approaches to water and sanitation have grown in their scale and scope within the past decade, reflecting two glaring realities: those providing water and sanitation services must be financially viable if they want to stick around, and that there’s not enough public finance available globally to reach and maintain SDG 6 status, signalling the need for private sector investment.

The idea of viewing citizens as ‘consumers’ of essential services (e.g. drinking water, toilets, desludging services) and supporting the private sector to play a significant role in providing these services is not without its detractors; and we’ve had significant debates internally here in Oxfam about how well these approaches fit in with our larger campaigns that call on governments to provide essential services.

At this year’s Water & Health Conference at the University of North Carolina, we took that debate to a wider audience, bringing on board some of the global leaders in market-based approaches to debate the evidence – high school debate club style – around how these approaches can most effectively accelerate towards SDG 6 while remaining inclusive of the poorest.

Should subsidy models for the poorest only be included once a market-based approach has attained minimum coverage targets? 

Consumer-facing subsidies have been a point of contention within the Water and Sanitation for Health (WASH) sector for quite some time. Although there’s a dearth of evidence in terms of how far market-based approaches reach the very poorest, there’s been growing acknowledgement that well-designed subsidy models are necessary.

Safe Water Network’s Gillian Winkler and Social Finance’s Rob Mills debated this issue, specifically at what point consumer-facing subsidies should be introduced. We found synergy in these three areas:

  • Subsidies are ok, but they must be ‘smart’. No matter how affordable a service or product gets, there’s always likely to be a gap that the poorest of the poor are unable to overcome. Subsidies aim to eliminate that gap.  However, it is critical to first minimize this affordability gap through supply and demand side interventions (ensuring that-subsidies are not prematurely mispriced), and to deploy subsides in a way that doesn’t discourage payment by non-recipients.
  • Targeting is a challenge. Some of the more exciting pieces of work on subsidies, such as sanitation subsidies in Cambodia by International Development Enterprises (iDE) and East Meets West in Vietnam, have been done in countries with government-established systems for targeting the poorest.  In countries where a system isn’t already in place, creating the time and resources to develop it can be quite political and expensive.
  • Public finance for subsidies should be available as part of social safety net programs. Governments already do this with education and health, so shouldn’t water and sanitation be the same?

Should there be limits to how much the private sector benefits from selling WASH products and services to the poor?

This ties into a bigger question: should public finance be used to benefit the private sector, especially when providing essential services?  Will supporting a purely free-market approach lead to greater incentives for the private sector to enter markets with affordable and high quality services, or are limits necessary to ensure equity, affordability, and accountability? I debated this question with Population Services International’s (PSI) John Sauer. We agreed on the following points:

  • Profit cannot be ignored. There’s not a huge profit to be made selling WASH products and services to poor people.  While it’s possible to develop a viable business doing this, it often needs public sector finance to absorb some of the risk, and allow businesses to survive and invest in research and development.
  • Appropriate regulation and enforcement is critical. A tiered pricing strategy is an example of how profit can be maximized while ensuring price limits for poorer income groups.  Pricing regulation around things like water tariffs and desludging, as well as social safety net programs, are needed to ensure that the poorest are not priced out; regardless of who is delivering the service.
  • Responsible businesses are more than cheap prices. Private enterprises may not always be incentivized to sell to the poorest, as an ‘affordable’ price doesn’t provide a sufficient margin. However, in the long term, a sustainable business is one that is operating ethically within the market, looks after its employees, and creates affordable products and services.

It’s preferential to work through small and medium-sized enterprises (SMEs) in market-based approaches

Most development actors won’t flinch at the prospect of supporting a SME, but there’s trepidation once the conversation turns toward supporting a larger, profitable company to make even more money.  WaterSHED Cambodia’s Geoff Revell and iDE’s Yi Wei debated which type of partnership has more impact. Here’s where we found common ground:

  • Both SMEs and larger companies are necessary to develop sustainable WASH markets. SMEs are critical for selling toilets in remote rural areas, but they can’t buy their toilet components from each other. They need larger businesses supporting the supply chain, and bringing talent.
  • No matter the size of the business, it’s critical that we’re supporting companies that that operate in an ethical and inclusive manner if we’re serious about long-term change.

A strictly defined ‘approach’, is less important than results, impact and outcomes which include equity, inclusion and financial viability at their core.

As one of the debaters, what did I walk away with?  That the government plays a critical role in ensuring that the poorest and most marginalized are not left behind. Knowing we have a role to support the development of social safety net programs, and advocate for the inclusion of water and sanitation.  Not all service provision models will offer sufficient margins to stand on their own two feet financially; and we need to understand how best to support this shortfall in a sustainable manner.  And that a strictly defined ‘approach’, is less important than results, impact and outcomes which include equity, inclusion and financial viability at their core.

Author
Tom Wildman

Tom Wildman

Tom leads Oxfam GB's work in markets-based approaches to water and sanitation access. Tom works with programme colleagues and partners in countries around the world to establish affordable and sustainable operating systems throughout the water and sanitation value chain. The aim of his work is to ensure that water and sanitation systems are economically viable and provide affordable and inclusive services.

Handwashing innovation

Joel Trotter describes how it feels to see Oxfam’s brand-new handwashing kit tested, refined, and ready to go into action.

Oxfam handwashing kit at this year's AidEx, Brussels. Photo: Joel Trotter

Oxfam handwashing kit at this year’s AidEx, Brussels. Photo: Joel Trotter

Oxfam’s Promotion and Practice Handwashing Kit is a robust, user-friendly handwashing station that is easily assembled in the immediate aftermath of a disaster. It allows for improved, timely handwashing and reduces people’s health risks in emergency displacement camps.

It was developed by Oxfam with a variety of collaborators, and supported by Elrha’s Humanitarian Innovation Fund programme. This is a grant-making facility that supports organisations and individuals to identify, nurture and share innovative and scalable solutions to the most pressing challenges facing effective humanitarian assistance. HIF is funded by aid from the UK Government.

In November, I arrived at AidEx in Brussels to see the brand new, and final, prototype of the handwashing kit, fresh from the factory. It had been a year since I field tested the first prototype at a refugee camp in Tanzania. Another two trips followed, including Uganda, with iterated designs. To this point, I had only seen the final computer model renderings. What an amazing feeling to see the finished product looking so well-made and ready to go!

This design is much simpler than previous versions; fewer parts, easier to assemble, and extremely durable. It has a brand-new, updated tap design and a liquid soap dispenser, as well as space for soap on a rope.

We need to put the human back into humanitarian

The feedback so far has been very positive:  “It’s a very nice step forward”; “I could see this being a good update to the tippy tap system”; and “This is the first thing here that looks like it’s been designed for humans, we need to put the human back into humanitarian”.

I put a bucket at the end of the run-off water hose, so people could test it. Both the soap taps and water taps are easy to use, and people saw the mirrors as an effective way to attract people to the kit, and increase hand washing practice.

So, what’s next? The prototype will make its way back to the Design Consultant, Matt White, who will finalise the design. Then, we can move towards the first batch of production. Oxfam has so far raised half the amount we need to cover the tooling costs. We are seeking a further £50k to offer the kit for sale at the most affordable unit cost.

Watch the video to see how it looks

Author
Joel Trotter

Joel Trotter

Joel Trotter is an independent designer, innovator, researcher and film/photographer, who has been focused on field trials and development for the handwashing stand with Oxfam. Joel has a background in Innovation Design Engineering (Royal College of Art) and freelances at the Dyson School of Design Engineering at Imperial College London.

Reinventing the toilet

Brian McSorley on Oxfam’s contribution to ensuring the poorest people on the planet have access to a loo.

Dunster House’s mould of a urine diverting plastic latrine slab. Image: Dunster House

Dunster House’s mould of a urine diverting plastic latrine slab. Image: Dunster House

Earlier this month, Bill Gates stood up to address an international conference holding a jar full of human faeces.  In a sector that has been underfunded and overlooked for decades, The Gates Foundation has been a disruptive and positive force in raising awareness of the catastrophic consequences of poor sanitation. It has challenged people to think differently, and has invested millions of dollars in research, to develop new technologies and solutions to the world’s sanitation crisis.

Why is sanitation so important?

A third of people on the planet do not have access to a toilet. Consequently, up to one billion people relieve themselves in the open, behind bushes, in street gutters, or into rivers; posing a serious health risk to themselves and others around them. 

Practical, affordable and durable solutions are likely to be much more ‘low-tech’.
The WHO estimates that a child dies every two minutes from diarrhoea that could have been prevented by adequate sanitation.

Oxfam is collaborating with the Gates Foundation to explore innovative new ways of providing safe sanitation. However, practical, affordable and durable solutions for the poorest people on the planet are likely to be much more ‘low-tech’.

Alternatives to pit latrines

Across large parts of the world and in most camps for refugees and displaced people, pit latrines are the most common type of toilet. Dig a hole, cover it with a slab, walls and a lockable door for privacy and the pit will fill slowly and safely over time.  However, in flood-prone areas, and sandy or rocky ground, digging a hole to build a pit latrine toilet is often not possible or is prohibitively expensive. Therefore, alternative solutions are needed.

Over the past five years, Oxfam has both revived old toilet technologies in the humanitarian sector, and pioneered new ones.  Tiger worm toilets allow worms to feed off the faeces and break it down like compost. Urine diversion toilets that separate ‘pee’ from ‘poo’ reduces smell.  Crucially, both technologies prolong the life of a toilet as the underground pit or chamber fills more slowly.  This reduces costs to empty or rebuild the toilet when full.

Building on this success, Oxfam has been working with three different partners to develop deployable kits that meet immediate sanitation needs in the aftermath of a humanitarian disaster.

Lightweight “pop-up” septic tanks

BORDA’s design of pop-up septic tank for use in emergencies. Photo: Brian McSorley

BORDA’s pop-up septic tank design, for use in emergencies. Photo: Brian McSorley

Septic tanks were developed in the mid 19th century, and the technology hasn’t really evolved since.  In the absence of a sewer to transport waste from a toilet, it is contained, with anaerobic conditions breaking down the harmful organisms, reducing the volume of the sludge and improving the quality of effluent to a point where it can percolate safely into the ground.

This new piece of equipment has been successfully tested at a sewage treatment works by Oxfam’s partner, BORDA.  It is now ready for deployment to Bangladesh as part of Oxfam’s Rohingya response which is helping an estimated 200,000.  Each septic tank can serve 500 people and has the potential to save thousands of pounds each year in desludging costs.

Lightweight plastic squatting plates

Following the success of Oxfam’s work in refugee camps in Ethiopia, the United Nations refugee agency has adopted urine diversion toilets as a preferred technology.  To enable organisations to build these more easily and quickly, Oxfam has developed a lightweight plastic squatting plate that can be airfreighted in bulk to anywhere in the world. In partnership with Dunster House, we are also making a mould to enable local production of urine diversion toilets. These products will be sent to Uganda and Ethiopia for final field trials. If successful, we will start mass production.

Container-based toilets

Sanergy’s design of container-based toilet. Photo: : Brian McSorley.

Sanergy’s container-based toilet design. Photo: Brian McSorley

Oxfam continues to partner with Sanergy, a Nairobi based social enterprise, to explore the potential of container-based toilets in refugee contexts.  Like a camping toilet (but without the need for chemicals or additives), a container-based toilet provides an immediate “out of the box” solution. No digging or construction needed, just a private place in a home or dwelling to put it.

With recent highlighting the widespread protection risks that particularly women face in accessing shared public toilets, this could be appropriate on a much larger scale.  A critical factor to its acceptance and success is the need to establish a safe, trustworthy and cost effective collection model to get waste from the toilet to a point of disposal.  Linked with this are efforts to utilise the waste to produce products of economic value such as fuel briquettes, organic fertiliser or animal feed.

3D printed toilets

With funding from Oxfam, Sanergy has 3D printed a toilet which it is currently testing in an urban Kenyan slum.  This is the forth toilet prototype that Oxfam has supported since it started this work in 2010.  The current re-design aims to reduce the manufacturing cost, make the toilet more compact and cost effective to airfreight, and make it easier to empty and service whilst not compromising on comfort and convenience for users.

Refinement and adaption may not capture the imagination or the headlines in the same way as reinvention, but this is what’s really needed to ensure that the poorest, most marginalised people on the planet have access to this most basic necessity.

This work is being funded through grant support from the US Office of Foreign Disaster Assistance (OFDA).

Author
Brian McSorely

Brian McSorely

Brian is a Water & Sanitation Engineering Adviser for the Horn and East Africa region. He first joined Oxfam in 2003 as a Public Health Engineering Adviser in Eritrea. In 2006 he became WASH Coordinator for Oxfam in Kenya, responsible for overseeing Oxfam's water and sanitation work to pastoralist communities in Northern Kenya, as well as residents of Nairobi slums and refugees. Between 2010-2013 Brian managed Oxfam's refugee programme in Dadaab, which provided water and sanitation to over 80,000 refugees. Brian took up his current role as a technical adviser in April 2016.

Our key takeaways from Stockholm World Water Week

This year at World Water Week has always given lots of food for thought on how to manage water for productive and domestic use, as well as finding a balance with protecting the environment and managing a finite and dwindling source. Oxfam GB’s Jola Miziniak and Tom Wildman reflect on their key takeaways from the week’s events.

Oxfam has built a new solar-powered water treatment plant in the Gumbo area of Juba. Photo credit: David Lomuria/Oxfam, July 2017.

Oxfam has built a new solar-powered water treatment plant in the Gumbo area of Juba. Photo credit: David Lomuria/Oxfam, July 2017.

Jola Miziniak on accountability

An ever-challenging concept, and even more challenging perspective in practice where people, industry, livestock, agriculture all compete for the same source. The question always is “who responsibility is it?”.

Our perspective at Oxfam GB is always how do we ensure safe, clean and affordable water is provided to the poorest? And how do we ensure we preserve the environment, protect against corruption and those most vulnerable and promote good governance and management? Is it always the responsibility of government? No. It’s a collective responsibility from both formal and informal providers, as well as individual users.

It was heartening to hear this from the SIWI Water Governance Facility who looked at hydro-diplomacy and the need for multi-stakeholder partnerships on how to evoke interest and engagement from informal pathways that strengthen formal processes. GIZ also promoted greater engagement with youth in understanding the value of water and sanitation, therefore protecting the environment and public services.

To do this requires commitments from everyone as ways to measure success and bring about good practices. Durban municipality has set up a WhatsApp group and social media channels to allow people to report breakdowns and issues of water supply and provide direct (non-automated) updates. These are also measured as one of their KPI’s.

There needs to be a way in the growing world of technology to not put more distance between people and providers. We need to establish better links and communicating methods which allow people to be heard and answered, placing accountability on everyone’s shoulders. But not everyone has access to technology or a direct line to providers, especially the poorest, so we need to ensure measurements are set against social impacts that look at reaching everyone, without exception.  At this and every forum we ensure these questions keep being asked!

Tom Wildman on innovative finance

In their session on ‘innovative finance’ the World Bank Water Group highlighted that over the years, their sessions have gone from being quite small to over-subscribed. NGOs, governments, impact investors and development banks are all attempting to attract private investors into the provision of water and sanitation products and services, but as the speakers pointed out, we need to address two foundational issues before zooming in to focus on finance.

  1. Service providers need to be technically and financially viable. Nothing innovative or new here, but from small-scale systems up to large utilities, the biggest obstacle to sustainability is poor technical design, low quality components and a lack of understanding on just how much it costs to operate and run the services.
  2. Institutional and governance arrangements are critical. Providers that are not transparent in their governance structures will never attract investments.

So, how do we now address it? And for Oxfam, how do we address it in low-income and fragile contexts?

In low income and fragile contexts, it is even harder to attract investors into the water and sanitation sector because there is no return on investment. In some places an investor would lose money during an operation. Most investor financing currently goes towards a small number of creditworthy water and sanitation service providers in more stable developing countries. The belief is that if service quality increases, people will pay more for the service, which increases the potential for profit and the creditworthiness of the business. However, no one funds those risky organizations deemed not to be creditworthy, so it’s difficult for these providers to move into a positive cycle.

How are we going to find investments for building the foundations for sustainable and inclusive water services in eastern DRC, the arid lands of east Africa, and the poor, landslide-prone areas of Nepal? This is where we’re focusing our efforts. Our vision is not to design individual projects or even multi-year programs. We want to serve a long-term function in these places, building an inclusive and accountable system from the ground up and adapting our role within it. After a week in Stockholm we’re certain that that’s exactly the space we need to be working in.

Author
Jola Miziniak

Jola Miziniak

Jola is Head of Sustainable Water Development at Oxfam GB.

Author
Tom Wildman

Tom Wildman

Tom leads Oxfam GB's work in markets-based approaches to water and sanitation access. Tom works with programme colleagues and partners in countries around the world to establish affordable and sustainable operating systems throughout the water and sanitation value chain. The aim of his work is to ensure that water and sanitation systems are economically viable and provide affordable and inclusive services.

The future of humanitarian water provision is solar

For World Water Week, Oxfam Engineering Adviser Brian McSorley reflects on the achievements of the Global Solar Water Initiative and the potential of solar water pumps to transform lives and ways of working.

Joseph Ayawin taking care of the solar powered borehole in Kpatua, Ghana, part of an Oxfam initiative to help irrigate farmland. Credit: Nana Kofi Acquah/Oxfam

Joseph Ayawin taking care of the solar powered borehole in Kpatua, Ghana, part of an Oxfam initiative to help irrigate farmland. Credit: Nana Kofi Acquah/Oxfam

Solar power offers so many possibilities for development and humanitarian aid, from lighting, to internet connectivity and water provision. If you are involved in helping communities access clean water, almost anywhere where Oxfam is working, the following question is a no brainer:

Where solar radiation is a freely available natural resource in abundant supply, why rely on diesel fuel -which is expensive, difficult to source in remote areas, to power a generator, which is a complex piece of mechanics, that frequently breaks down with skilled expertise and spare parts hard to find?

Oxfam in Dadaab

Less than six years ago in 2012, Oxfam installed the first solar water pumping system in Dadaab refugee camp, Kenya. At the time Dadaab was already 20 years old and recognised as the largest refugee camp in the world with a population of nearly half a million people. The initiative was a natural progression of Oxfam’s work in arid and semi-arid regions in East Africa, where for over a decade we had been promoting solar water pumping as a more cost effective and sustainable solution to meeting the water needs of drought affected rural communities. Building on the success of this we started expanding the work to camps in neighbouring countries, but were rebuffed by one key major donor who didn’t believe that renewable energy was appropriate or cost effective for refugee camps.

Lodwar solar installation part of an Oxfam project to support the water utility company to improve water supply in Lodwar Town in Turkana, Kenya. Credit: Brian McSorley

Lodwar solar installation part of an Oxfam project to support the water utility company to improve water supply in Lodwar Town in Turkana, Kenya. Credit: Brian McSorley

The year on year drop in the price of solar “photovoltaic” panels, combined with major improvements to solar pumping components is a game changer in addressing the challenges of providing affordable and reliable water service provision. However the speed of change was such that donors, engineers and key decision makers in Government where not aware, and we had not helped by failing to gather and document a clear evidence base on the impact of our work.

The Global Solar Water Initiative

This was the basis of the formation of the Global Solar Water Initiative (GSWI) formed by Oxfam, IOM and NRC in 2016. Through training, undertaking technical field assessments, managing a technical helpline, documenting and disseminating best practice, the GSWI has improved awareness, developed and strengthened technical skills and built an evidence based to lobby Governments and donors to invest more in renewable solar energy and enable humanitarian responders to increase the number of solar pumping systems being used within humanitarian operations globally.

By analysing 140 different water schemes, we have found that switching to solar will pay for itself within four years, and in some circumstances, solar is cheaper than a diesel generator from day one.
Since then, the two person full time team that constitutes the GSWI, has visited 55 camps and communities, conducted training workshops in eight countries and addressed technical queries from 80 organizations, across five continents. By analysing 140 different water schemes, we have found that switching to solar will pay for itself within four years, and in some circumstances, solar is cheaper than a diesel generator from day one. Over the life time of these systems solar will be 40-90% cheaper.

Scaling up the solar solution

Things are changing, but not fast enough. Dadaab is no longer the largest camp in the world, many refugees have returned home and one camp has closed, but it was arguably the first of its kind in terms of seeking more cost effective and sustainable water supply services.

However, in many other countries knowledge about solar pumps and the benefits of solar power is still low. This helps to explain why there has been such a demand for the services of the GSWI and feedback from country technical visits and trainings has been so positive. As a result, by popular demand, additional funding has been secured for a second phase of the project which will enable the initiative to expand into new countries in 2018 and 2019. This is only accelerating the inevitable – solar renewable energy is the future – but the sooner it is scaled up, the more people can be reached and the better quality of service people affected by humanitarian crises will receive.

Author
Brian McSorely

Brian McSorely

Brian is a Water & Sanitation Engineering Adviser for the Horn and East Africa region. He first joined Oxfam in 2003 as a Public Health Engineering Adviser in Eritrea. In 2006 he became WASH Coordinator for Oxfam in Kenya, responsible for overseeing Oxfam's water and sanitation work to pastoralist communities in Northern Kenya, as well as residents of Nairobi slums and refugees. Between 2010-2013 Brian managed Oxfam's refugee programme in Dadaab, which provided water and sanitation to over 80,000 refugees. Brian took up his current role as a technical adviser in April 2016.

No one should be too poor to drink clean water

For World Water Week Louise Medland reflects on the stark global inequalities in access to water and sanitation, and outlines some of the Oxfam programmes which are improving services for the poorest.  

Women using a water ATM in Turkana County Kenya, James Origa/Oxfam, 2018

Women using a water ATM in Turkana County Kenya, James Origa/Oxfam, 2018

Equal access to sufficient safe and affordable water, and adequate and equitable sanitation and hygiene, can mean the difference between prosperity and poverty, well-being and ill-health, and even living and dying’

United Nations (2018). Sustainable Development Goal 6 Synthesis Report 2018 on Water and Sanitation

It’s the time of year again when professionals working on water and sanitation around the world convene in Stockholm for World Water Week. The theme this year is ‘water, ecosystems and human development’, which recognises that water is critical for human development, but at the same time we have to remember that the water resources we use and the ecosystems we’re all part of are vulnerable to many challenges like climate change, increasing pollution and over-exploitation.

Inequalities in access to water, sanitation and hygiene (WASH) are at an all-time high and affect almost every country. The richest in society have the best access to services and can in some cases actively prevent the poorest from achieving even basic levels of access. Having access to safe and affordable water and sanitation has been recognised as a human right but we’re still in the situation where less than 1% of GDP globally (Gross Domestic Product) is spent on water and sanitation services.

Leaders at the World Economic Forum have identified water crises as the top risk of global concern over the next 10 years and it’s not just about having too little water available, it’s also about having too much, like we’ve seen recently with flash floods in Spain, France, Canada, India, Indonesia and the Philippines.

Only 62 per cent of people in the least developed countries have access to a basic drinking water service compared to 89 per cent of the global population. The situation for sanitation is even worse, only 32 per cent of those in the least developed countries have access to safe sanitation facilities. Fragile countries are further behind than more politically stable countries, and rural communities lag behind urban ones. Ethnicity is also a critical factor over whether you have access to WASH services or not. Indigenous and tribal people comprise more than 15 per cent of the world’s poor, but account for less than 5 per cent of the world’s population, which means in many places they are being unfairly marginalised and denied access to even basic services. 

Only 62 per cent of people in the least developed countries have access to a basic drinking water service compared to 89 per cent of the global population.

So, what are we doing about it? Sustainability, affordability and equity of services are at the heart of all our approaches. In the Democratic Republic of Congo (DRC) we’re working on providing sustainable access to water and sanitation in some of the most difficult to reach areas. DRC has abundant water resources, but decades of conflict have led to infrastructure being destroyed and a chronic lack of investment, leaving many people without access to clean water. Oxfam is working with partners on new, more professional, ways of maintaining the infrastructure installed. We’re supporting water network users’ associations which manage water supply systems in semi-urban areas. The management teams are comprised of local people who receive a salary and the associations also employ local craftsmen for operation and maintenance of the water system.

In Kenya, through the SWIFT programme, we’ve worked with local private water utility companies to improve their services to their customers and increase their financial transparency. As a result, they were able to keep delivering safe and affordable water even during one of the most severe droughts Kenya has ever experienced. This makes a life-changing difference to people like Regina Aemun from Nakwamekwi, and the other nine members of her household, she told Oxfam:

‘We were getting water once in a while from a local water point, it wasn’t once a day – more like once a week. So we often had to go to the river to collect water. Now, we don’t have to go far’

In Myanmar, Oxfam is working with government municipalities and Ernst & Young Enterprise Growth Services to develop a tiered pricing model for faecal sludge collection and management. We’ve demonstrated that the municipalities can increase revenue collection and expand their services to the poorest using the tiered pricing model. The growth in revenue can fund improvements in health and safety.

In the year between now and the next World Water Week our key priorities are to keep developing new partnerships and pushing our work on sustainable services forwards, even in the most challenging contexts. We firmly believe that no one should be too poor to drink clean water or use a safe toilet.

Author
Lousie Medland

Lousie Medland

Louise is the WASH Resilience Advisor at Oxfam. She has a particular interest in the long term sustainability of water and sanitation programme interventions and in bridging the divide between humanitarian and development activities.

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