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Before yesterdayGlobalwaters

COVID-19 and the Looming Financial Crisis for Water Utilities

A water service provider marketer gets customer feedback from a residential caretaker. Photo credit: Rose Odengo, WASH-FIN

Water, sanitation, and hygiene (WASH) is the first line of defense against the spread of COVID-19. Safe WASH practices can help stop human-to-human transfer of the virus at the household- and community-level. Recognizing the crucial role of WASH services during a pandemic, national and county governments, especially in low- and middle-income countries, have deemed WASH as essential services and have directed water utilities to ensure uninterrupted supply to all consumers, regardless of their ability to pay. While important for public health, this directive can compromise the financial health of utilities over the long-term.

Averting Financial Crisis for Water Utilities During the COVID-19 Pandemic

As a result of the COVID-19 pandemic, water utilities are caught in a perfect storm of declining revenue coupled with rising costs. In Kenya, the government’s directive to water service providers (WSPs) includes the following requirements: water should be provided for free in informal settlements and public places, disconnected customers should be reconnected, and no disconnections for nonpayment of bills should be carried out during the pandemic. In addition, WSPs also have to comply with social distancing guidelines and use personal protective equipment (PPE) and other infection control measures. While these directives serve important public health needs, they also amplify the economic effects of the COVID-19 pandemic on water utilities. WSPs, which rely on fees from customer tariffs, new connections, and reconnections to cover their operations and maintenance costs, stand to incur huge losses in revenue from these directives. This sharp decline in revenue collection, combined with the cost of COVID-19–related compliance, increases the financial stress on utilities.

The Nzoia Water Services Company Limited (NZOWASCO), a Kenyan utility organization providing water and sewerage services within the County Governments of Bungoma and Trans Nzoia, is one such utility that is facing a looming financial crisis due to the pandemic. “Our revenue collection is low, and customers are not paying for water. Following the directives given by the government, we cannot disconnect them. We have not paid our power bill for the last month as a result of this,” notes Mathew Wakhungu Maruti, Managing Director of NZOWASCO.

NZOWASCO’s experience is not unique. The Kenya Water Service Providers Association estimates that water utilities’ revenue collection has dropped from 94 percent to 30 percent since March. Based on Kenyan Water Services Regulatory Board projections of the primary financial impact of COVID-19 on two large WSPs, USAID estimates that collection efficiency will fall to 50 percent in a best-case scenario. The worst-case projection sees this number falling to 20 percent. When expenditure changes are required to meet the directive of providing free water, the worst-case scenario predicts a two-fold increase compared to pre-COVID-19 monthly expenditures. (For more details, see Water Service Provider COVID-19 Financial Stress Testing and Mitigation.)

“Immediate financial support is very much needed and will be critical for sustaining water and sanitation service provision that underpin public health measures in responding to the pandemic,” notes Barbara Kazimbaya-Senkwe, USAID WASH-FIN’s senior WASH governance advisor.

A MAWASCO customer shares an SMS notification about an outstanding balance. Photo credit: Rose Odengo, WASH-FIN

How USAID and Partners are Helping Water Utilities Keep the Lights On

Providing support to WSPs to ensure continuity of services enables communities to maintain access to WASH — a crucial pillar of USAID’s response to COVID-19, and a part of the Agency’s larger framework of short- and long-term recovery and resilience.

Financial Stress Testing of WSPs in Kenya

USAID’s Water, Sanitation, and Hygiene Finance (WASH-FIN) project is conducting financial stress testing of large WSPs in Kenya using the World Bank’s COVID-19 Financial Impact Assessment Tool for Water and Sanitation Providers. Through assessments of revenue, debt, operational expenditures (such as wages and rent), and additional costs associated with the crisis (such as chemicals, PPE, additional water points, and tanker services), the tool allows WSPs to quantify the financial impact of the pandemic on their operations and helps prioritize potential response options. For its first cohort, USAID WASH-FIN selected two large WSPs that had previously been relatively well-performing, financially stable, and among those best-positioned to weather a financial crisis. The third WSP is smaller and representative of WSPs that despite not being financially creditworthy, had still procured commercial loans through an output-based aid approach. Such WSPs are likely to experience significant pandemic impact.

The results of the analyses are stark. The three selected WSPs will require around KES 155 million (US$1.4 million) to sustain their operations through the next six months. If no action is taken, all three WSPs assessed are expected to run out of cash by September 2020 and, in some cases, even earlier. To continue to serve the public, the WSPs must, at a minimum, have enough cash to cover their most basic operational and maintenance costs. Given that they are presently unable to fully collect revenue from most of their customers, additional financial resources will be required to close the gap and ensure they can continue to provide essential services and support the government’s public health objectives.

To help mitigate financial stress, USAID is working closely with these WSPs to consider a mix of actions, such as increase in collection efficiency, internal cash preservation, liquidation of assets, and debt restructuring. Even with all of these mitigating factors, however, it will be critical to provide financial support to these WSPs. “Due to reduced revenue from water sale, we have accumulated debt to our suppliers, including those supplying water treatment chemicals,” notes David Ndumo, Corporate Manager of NYEWASCO.

USAID WASH-FIN is also performing a crucial coordination role for the Council of Governors (COG) concerning national-level dialogue and action following the onset of the COVID-19 pandemic in the WASH sector. Following the facilitation of a high-level meeting by USAID between COG and WASH development partners, UNICEF committed US$100,000 for the provision of water treatment chemicals for WSPs in 13 counties.

All of these efforts will be extremely beneficial to companies like NYEWASCO, which must meet their obligations not just for chemicals but also other inputs, including electricity and labor costs required to keep water and sanitation services flowing.

Financial Stress Testing of WSPs in Indonesia

As in the case of Kenya, the Government of Indonesia required that local WSPs provide free or discounted water to customers, free connections for new customers from low-income households, and greater flexibility on payments to ensure residents’ uninterrupted access to water. This mandate has severely impacted the financial situation of local water utilities.

Customers of the Surakarta water utility struggled to pay their water bills on time due to the COVID-19 pandemic. The Mayor of Surakarta, however, directed the utility to not charge any penalties for late payment. Photo credit: IUWASH PLUS

Using the World Bank’s financial assessment tool, USAID’s IUWASH PLUS (Indonesia Urban Water, Sanitation, and Hygiene Penyehatan Lingkungan Untuk Semua) project is conducting financial stress testing for its 25 local partner utilities. The results, which are expected by the end of July, will help to better focus the needed assistance, including getting reduced tax for the year of 2020. In the next quarter, USAID IUWASH PLUS will continue the analysis for all of the 32 assisted water utilities, while continuing to help them improve performance, reduce operational cost, and adjust their business plans to get operations going while expanding coverage. Additional data collection is ongoing to assess COVID-19’s impact on the operational activities of WSPs, which will in turn inform the local government’s planned investment in their utilities.

Three months’ worth of data from the Bogor District’s water utility are already projecting a 12.5 percent decrease in the utility’s revenue this year, which is largely attributed to commercial entities’ reduced water use. The billing collection rate is also down from 98 percent to 85 percent, and capital expenditure has been reduced by 70 percent.

Building on efforts in Kenya and Indonesia, USAID plans to further roll out the stress testing tool in Mozambique and Zambia, with the possibility of expanding to other countries.

Rapid Assessment of the Impacts of COVID-19 on WSPs and Business Continuity Planning in the Philippines

To assist WSPs in the Philippines with their emergency response and recovery planning, USAID, through its Strengthening Urban Resilience with Growth and Equity (SURGE) project, conducted online surveys from April 23 to May 12, 2020, to identify the impact of COVID-19 on WSPs. USAID and its partners used the findings from the rapid assessment to identify appropriate assistance and interventions for WSPs, such as providing training and mentoring to develop business continuity and recovery plans (BCRP). The purpose of the BCRP is to ensure continuity of water services during the pandemic while maintaining the safety of the WSP employees and consumers. The project is also working with its partner WSPs to identify their interest in electronic billing and payments following the findings on low collection efficiency. SURGE is also advocating and promoting the institutionalization of proper handwashing with soap by completing concept designs of handwashing stations.

Legazpi City Water District (LCWD) staff join the information education communication campaign on handwashing. Photo credit: LCWD, Philippines

Short-Term Operating Cost Subsidies to Private Water Providers in Mozambique

As part of a coordinated response to the COVID-19 pandemic, many governments have issued decrees suspending water tariff charges for low-income households. While these decrees may be beneficial and are a form of targeted subsidies for at-risk households, they will also lead to lowered revenues for water utilities. This will result in the WSPs having reduced ability to pay for the energy and water treatment chemicals, in effect compromising the ability to provide quality water services over the long-term. USAID is partnering with UNICEF and key government partners in Mozambique to provide short-term operating cost subsidies to private water providers in peri-urban areas and small towns. This initiative will help ensure they are able to balance the need to meet short-term public health mandates with the risk of financial insolvency over the long-term.

Intervening at a Critical Juncture

The COVID-19 pandemic has already shown in just a few months the devastating impact it has had on water utilities globally. If these shocks are not addressed urgently, the consequences of utility deficits will be felt immediately and long after the virus subsides. We are also at a critical juncture in the progress toward universal access to water and sanitation by 2030. Falling utility revenues and ballooning national budget deficits in many countries could set back the advances in universal access that have been made in recent years.

Mobilizing resources to counter falling revenues and rising costs will require a concerted effort from governments, development partners, and water utilities themselves. “It’s clear that water is critical to mitigating the impact of COVID-19. As importantly, we also recognize that many of our service providers weren’t operating in a technically and financially viable manner, even before the crisis,” notes Joel Kolker, program manager for the World Bank’s Global Water Security and Sanitation Partnership. “Therefore, we must enhance our efforts to deal with the crisis and improve the long-term viability of the service providers.”

USAID is committed to using the results of financial stress tests and other approaches to not only keeping vital water supplies flowing but also ensuring water utilities remain operational now and well into the future. By supporting water utilities, USAID can ensure that the WASH sector not only maintains its critical role in fighting COVID-19, but is also on course to help countries achieve universal access in WASH by 2030.

By Ella Lazarte, USAID, and Farah Siddique, USAID WASH-FIN

Special thanks to Amanda Robertson (USAID/Kenya), Marian Cruz Navata (USAID/Philippines), and Trigeany Linggoatmodjo (USAID/Indonesia) for contributing to this story.

Additional Resources:

This article appears in Global Waters, Vol. 11, Issue 3; for past issues of the magazine, visit Global Waters’ homepage on Globalwaters.org.


COVID-19 and the Looming Financial Crisis for Water Utilities was originally published in Global Waters on Medium, where people are continuing the conversation by highlighting and responding to this story.

WASH in the Time of COVID-19

To control further spread of a deadly disease, USAID and its partners are pivoting to improve access to safe water, sanitation, and hygiene, bolstering public health at a critical moment as the worst pandemic in 100 years sweeps the globe.

Regular handwashing with soap is a key behavior for reducing infection and transmission risk for COVID-19. Photo credit: Water and Development Alliance

Since it emerged in late 2019, COVID-19 has gained a foothold in more than 185 countries, claimed more than 645,000 lives, sickened more than 16 million people, and become the world’s worst public health crisis in a century.

Joining a fight that is at once global and local, USAID is marshaling its considerable expertise and resources in the field of water, sanitation, and hygiene (WASH) to help stabilize public health at a time of great uncertainty. The Agency is working in close coordination with communities, governments, development partners, and the private sector to help contain the spread of the disease. This all-hands-on-deck approach is working to flatten the infection curve, buying crucial time for local and national health care systems to increase testing capacity, improve contact tracing, and develop surge capacity at hospitals to treat serious cases.

USAID’s Approach

USAID’s Water Leadership Council developed and released the “USAID Water, Sanitation and Hygiene: Strategic Approach to COVID-19 Response” in mid-April to shape the Agency’s global response to the pandemic and emphasize the vital roles WASH infrastructure and services play in reducing transmission risk.

In the absence of a treatment or vaccine for COVID-19, the strategic approach emphasizes that one of the greatest tools in the battle against COVID-19 is also one of the simplest — handwashing with soap — shown to be one the most effective behaviors for reducing the risk of infection and transmission.

In addition to promoting this vital hygiene behavior, USAID’s contribution to the global fight against COVID-19 includes facilitation of public education campaigns to improve personal hygiene habits, decrease transmission risk, and build communities’ resilience in the face of the ongoing pandemic.

Water service providers are also facing a perfect storm of declining revenues and sharply rising costs as a result of this pandemic. Sustaining water services is critical for public health and handwashing, and provides a foundation for safely reopening schools, businesses, and public spaces. USAID is leveraging its expertise in WASH to help service providers continue operations, secure critical supplies, and avoid financial collapse.

USAID missions around the world are putting the Agency’s new strategic approach into action every day in the fight to more quickly contain and control COVID-19. Read how in the stories below.

USAID/Indonesia has supported the installation of more than 5,000 handwashing stations in recent months. Photo credit: IUWASH PLUS

INDONESIA

With more than 100,000 positive confirmed cases as of late July, Indonesia is grappling with an escalating crisis as increased testing reveals the extent of COVID-19’s spread across the country. Improving access to reliable water and sanitation services and championing regular handwashing with soap are two ways USAID’s IUWASH PLUS (Indonesia Urban Water, Sanitation, and Hygiene Penyehatan Lingkungan Untuk Semua) project is contributing to critical actions that will reduce the spread of the virus.

Working in 120 communities spread across 35 municipalities, USAID IUWASH PLUS and its partners supported the installation of 5,000 handwashing stations, more than 900 soap dispensers, and nearly 700 water taps. In March 2020, IUWASH PLUS began collaborating with puskesmas (community health clinics) to educate the public about handwashing with soap, using a variety of channels to reach residents including radio jingles and social media posts. These efforts are supplemented with strategic messaging emphasizing the importance of either remaining at home or physical distancing when in public.

Meanwhile, to ensure residents’ uninterrupted access to water, the government has mandated that local water utilities must provide customers with free water for the next three months. To support the 25 partner utilities affected by this new mandate and the resulting decrease in revenue, USAID IUWASH PLUS is assisting them to plan their capital needs and strategize how to meet those needs while providing more free water. This support is maintaining continuity of water supply and keeping faucets from running dry.

Improving access to hygiene-related infrastructure continues: IUWASH PLUS is setting up handwashing stations equipped with soap not only outside puskesmas, but also near other centers of community life, such as the local mosque.

“I hope the community understands the importance of clean and healthy behaviors,” says Wheny Susianti of Surakarta city in Central Java. “Hopefully, the handwashing-with-soap facilities will remind people to wash their hands with soap,” a key behavior for stopping the transmission of COVID-19.

In South Sudan, strengthening handwashing habits is an emerging priority to help stem the spread of COVID-19. Photo credit: USAID OFDA

SOUTH SUDAN

In South Sudan, the world’s youngest country, COVID-19 threatens to overwhelm a fragile health care system. To curb transmission of the disease, USAID is helping distribute hygiene kits and soap while improving water and sanitation access in at-risk communities — as well as sending personal protective equipment to health care workers as hospitals prepare for a potential surge of patients.

Efforts to educate the public on best practices for avoiding COVID-19 infection target particularly high-risk communities, such as the densely populated sites hosting people displaced by the conflict that began in 2013. In these settlements, where donors provide safe water and sanitation, USAID support enabled UNICEF to recently reach nearly 30,000 residents in Juba with emergency WASH infrastructure and services.

USAID funding is also helping ramp up additional infection prevention and control measures such as routine cleaning and disinfection of sanitation facilities and water points. “USAID’s continuing support,” says Tina Yu, head of the USAID Disaster Assistance Response Team in South Sudan, “will allow frontline workers to continue combating COVID-19 in the places at greatest risk of infection.”

USAID support is empowering other development partners to make a substantial impact, such as Action Against Hunger International, which now provides handwashing demonstrations to community members visiting its health and nutrition centers. Meanwhile, USAID partner International Organization for Migration installed handwashing stations in high-traffic areas such as transportation hubs and marketplaces. This USAID implementer also focuses on building leadership capacity and holding training sessions with local community leaders so that they may educate their neighbors and spread the word about healthy hand hygiene.

Temperature checks have become a way of life in India, which now has the world’s third highest number of confirmed COVID-19 infections. Photo credit: Gwydion Williams

INDIA

After a months-long national lockdown extending from late March through the end of May, India continues to grapple with the rapidly intensifying spread of COVID-19. Currently, India is experiencing the world’s third highest number of confirmed COVID-19 infections with more than 1.4 million cases nationwide as of late July.

To help reduce the risk of unchecked disease transmission, USAID/India and local partners are working to improve conditions in the country’s densely populated urban informal settlements. Through its Moving India Towards Sanitation for All (MISAAL) activity, USAID/India empowers sanitation committees to improve access to vital hygiene and sanitation services. In addition to promoting healthy sanitation and hygiene habits among residents of slum settlements, these committees serve as intermediaries between residents and local government bodies, facilitating the installation of in-home toilets and improving upon existing sewer infrastructure.

Beyond its push to strengthen WASH in urban settlements, USAID/India teamed up with the Ministry of Health and Family Welfare to facilitate a government public education campaign to help protect frontline health care staff and quarantined households from prejudice. Since March 2020, USAID has trained close to 40,000 health workers on COVID-19 prevention and response in the 12 states where it implements programs, directly benefiting 2.5 million people in India.

Oshodi, Lagos. Photo credit: Adedotun Ajibade

NIGERIA

Africa’s most populous country, Nigeria, confirmed more than 41,000 cases of COVID-19 as of late July. In a country where one in three people is without access to safe water and more than half of residents are without access to basic sanitation, the potential for transmission of the virus is widespread, as reliable water access is a key ingredient for creating sustainable changes in handwashing habits.

“The importance of water, sanitation, and hygiene has been emphasized by the COVID-19 pandemic,” noted USAID/Nigeria Mission Director Stephen Haykin in May, as the outbreak spread.

Ever since the earliest known confirmed COVID-19 infections in Nigeria, USAID’s Effective Water, Sanitation, and Hygiene Services (E-WASH) program, which partners with utilities in six Nigerian states to improve water access, intensified efforts to improve WASH services. For example, Nosa Okoh, general manager of the Delta State Urban Water Corporation, pledged to provide a “constant safe water supply” in his jurisdiction, to decrease transmission risk. E-WASH is also supporting the digitization of payment services; e-billing enables customers to reduce unnecessary visits to the utility to pay their bills to better promote social distancing.

The state water utilities that E-WASH partners with are shaping other aspects of Nigeria’s evolving response to the pandemic as well. USAID and the Taraba Water and Sewage Corporation recently helped convene Nigerian media professionals, who exchanged ideas on how to combat COVID-19 misinformation and shared best practices for responsibly informing the public about the nature of the disease. Apart from its support to water utilities, USAID/Nigeria also collaborated with telecommunications firms to deliver messaging about safe hygiene habits to millions of Nigerian cell phone users and provided direct technical support to the National WASH Response on COVID-19, including implementing risk communication interventions such as signs and pictorial guidance on the proper use of masks and information resources for hand hygiene.

The Path Forward

As the pandemic continues to evolve, USAID and its many partners across the U.S. Government collectively pledged more than $1 billion to the effort to combat COVID-19 as of late June 2020. Whether it involves installing soap-equipped handwashing stations, refurbishing water and sanitation infrastructure, or delivering ventilators to overburdened hospitals, USAID stands committed to helping protect the communities it serves as they endure some of their most uncertain hours. Thanks to the transformative power of improved WASH, the Agency and its partners are already helping some of the world’s most at-risk populations stay one step ahead of the disease.

By Russell Sticklor

Additional Resources:

This article appears in Global Waters, Vol. 11, Issue 3; for past issues of the magazine, visit Global Waters’ homepage on Globalwaters.org.


WASH in the Time of COVID-19 was originally published in Global Waters on Medium, where people are continuing the conversation by highlighting and responding to this story.

A Mother, A Teacher, A Trailblazer

Raising the Status of Water Issues and Women in Turkmenistan

Lyale Orazova in Mary, Turkmenistan, June 2019. Photo credit: Petro Kotzé

“In many cases, women here are homemakers,” says Lyale Orazova, talking about her homeland, Turkmenistan. “Since a woman gives birth to her children, she is responsible for teaching them the ways of our people. It’s the women who teach children that water is special, that it must be valued, and that they need to take care of it. My mother taught me that and I am teaching it to my daughter,” she says.

Lyale is an expert in the processing and cleaning of industrial drainage water and the Head of the Mary branch of the Union of Women of Turkmenistan, which promotes the role of women in social, political and cultural life. Lyale was also elected a member of the recently established Small Basin Council for the Murgab River, as part of USAID’s Smart Waters project.

The Small Basin Council is the first platform in the country that enables representatives from different agencies, ministries and community members like farmers and business people to discuss water management issues together. The aim of the Small Basin Council is to foster collaboration to find the best solutions to water-related problems.

Click here to read the full story.


A Mother, A Teacher, A Trailblazer was originally published in Global Waters on Medium, where people are continuing the conversation by highlighting and responding to this story.

Ahead of the Curve in Nepal

At the Lekhpokhara health post, patients are required to wash their hands before entering to help cut down on the spread of infections, including COVID-19. Photo credit: DevWorks International

Safe water, improved sanitation, waste management, and electricity are prerequisites for infection prevention in health care facilities. However, the dire state of water, sanitation, and hygiene (WASH) in health care facilities globally, both rural and urban, is a neglected problem — and never more critical than now as COVID-19 tears its way around the world.

Swachchhata, which means cleanliness in Nepali, is a $4.9 million, five-year USAID WASH project (2016–2021) in rural Nepal. In light of COVID-19, the importance of cleanliness is clear. Nepal is a USAID priority country for water, and this project’s goal is to get sustainable WASH into health care facilities where there is little to none.

I had the opportunity to travel with SNV USA, now known as DevWorks International and the prime implementing partner for Swachchhata, into the rugged middle mountains of Nepal to see the activity’s innovative improvements and community engagement firsthand. As it would turn out, this trip took place at the exact time COVID-19 was silently brewing next door in China.

Onsite training and mentoring of health workers and Health Facility Quality Improvement Committee members to use infection prevention and hygiene messaging is taking place in 147 health facilities in two rural provinces. Photo credit: DevWorks International

In Nepal, USAID is funding groundbreaking work to improve the foundation of safe health care, at a cost of just $11 per person. USAID is building and renovating small-scale drinking water, sanitation and waste management systems, as well as solar-powered electrical systems in 80 health care facilities in Provinces 5 and 6. Now, 57 health posts have fully functioning water supply systems, separate female latrine facilities that are accessible to people with disabilities, and solar electrification. Now with COVID-19, a number of local committees are installing 500-liter drums and handwashing stations at the entrances of their health posts for patients to wash hands with soap and water before entering. Swachchhata has also provided critical infection prevention and control (IPC) commodities for 140 facilities, and trained health care workers on IPC in 147 facilities. When the project is completed, 147 health care facilities and the nearly 430,000 people they serve are going to have far more effective IPC, and dramatically improved safe, dignified, and sustainable health care now and for years to come.

Not only is this USAID activity creatively solving urgent infrastructure challenges in 147 health care facilities, Swachchhata is also providing essential technical assistance and training to community-based health care facility management committees. Nepal’s national government mandates these local oversight committees to create a sense of local pride, ownership, and financial buy-in. It’s an innovative approach to the Achilles heel of WASH the world-over: sustainability.

Swachchhata designed and constructed new waste management and sanitation infrastructure at the Sankh health point, one of many rural health facilities that will now have onsite sanitation facilities and the ability to safely manage its medical waste. Photo credit: DevWorks International

Around the globe, WASH suffers from a lack of funding, coordination, preventive maintenance and repairs, and training. The result is a global graveyard of busted pipes, pumps, wells, faucets, sinks, toilets, and more that plague health facilities by the hundreds of thousands across low- and middle-income countries (Joint Monitoring Programme 2019). It is in these dilapidated facilities that women give birth, emergencies are treated, and diseases need to be prevented and contained, including COVID-19.

In Nepal, though, these community management committees are comprised of local people — businessmen, elected leaders, health workers, health volunteers, and others — who, while dedicated and passionate, are by no means experts in how to meet the special needs of running a health care facility. Swachchhata is working with each committee to create long-term capacity and training in finance, funding needs, record keeping, supply chain, self-assessment, preventive maintenance, repair capabilities, and IPC, so they’ll have the resources and know-how they need to support safe — and sustainable — health care.

Part of Swachchhata’s outreach is to train community health volunteers to mentor mothers’ groups to improve household sanitation and hygiene practices. Photo credit: DevWorks International

USAID is also working with health facility staff on effective hygiene inside facilities, and how to influence hygiene behavior in patients’ homes. Effective hygiene also includes training cleaners, who often go unseen and unacknowledged. Which brings me to an unexpected, heated discussion I witnessed.

I found myself standing between a cleaner and the ward chairman who also chairs the facility management committee (akin to a town mayor). Though I don’t speak Nepali, this cleaner made it abundantly (and loudly) clear that she wanted specific changes to the facility so that she can clean to the best of her ability. In a rural society that maintains strict social hierarchy, and men dominate, she was not to be deterred. I’d put my money on her getting what she wants, and the patients and staff will be better for it.

For far too long, getting WASH into health care facilities has been neglected around the world. Swachchhata was in place well before the COVID-19 pandemic and WASH is vital to global health security and safety. We must continue to increase prioritization of WASH in global health. Getting sustainable water and sanitation into health care facilities requires cross-sector coordination. Swatchchhata’s innovative approach of combining specialized WASH design and construction with the provision of equipment, training, and local-level sustainability and governance interventions illustrates the potential, power, and impact of USAID WASH programming.

Susan K. Barnett is a part of the Global Water 2020 initiative that focuses on issues of global water security. She is a former journalist with ABC News and NBC News networks and is founder of Cause Communications.

Additional Resources:

This article appears in Global Waters, Vol. 11, Issue 3; for past issues of the magazine, visit Global Waters’ homepage on Globalwaters.org.

To subscribe to Global Waters magazine, click here.

Follow us on Twitter @USAIDWater.


Ahead of the Curve in Nepal was originally published in Global Waters on Medium, where people are continuing the conversation by highlighting and responding to this story.

Reflecting on Changing Perceptions around Menstrual Hygiene Management

Every May 28, Menstrual Hygiene Day is celebrated around the world to combat stigma and raise awareness about the vital role MHM plays in…

Continue reading on Global Waters »

Water Brings Communities Together in Post-Earthquake Nepal

Local communities participate in construction of a USAID–supported public tap in Indrawati Rural Municipaltiy-7, Sindhupalchowk District. Photo credit: USAID/Nepal

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.”

A Restored Water Supply Brings New Hope

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.

A drinking water reservoir tank, constructed through a USAID–supported WASH recovery activity in Bhimeshwor Municipality, Dolakha, Nepal, is one component of infrastructure helping boost resiliency in Nepali communities. Photo credit: USAID/Nepal

Unlocking Villages’ Economic Potential

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.”

Nin Maya Thapa Magar, 32, of Balephi, Sindhupalchowk, is the first woman from her ethnic community to work as a trained village maintenance worker for a water scheme supported by USAID, which enables her to repair and maintain drinking water supply schemes set up in her locality. Photo credit: USAID/Nepal

Creating Healthier, More Resilient Communities

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.

Girls and women participate in a sanitary pad-making training event that Safaa Paani organized in Chautara, Sangachowkgadhi Municipality-2, Sindhupalchowk District. Photo credit: USAID/Nepal

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.

Where the Road to Recovery Merges with the Path to Sustainability

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.

Members of community-led water user groups observe Safaa Paani technicians conducting a water quality test. Photo credit: USAID/Nepal

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.

Looking Back, Looking Forward

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

Additional Resources:

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.

Just Add Water

Water metering and billing mobile technology contribute to the journey to self-reliance.

Photo credit: Benjamin Ilka/USAID

Located in the foothills of the Sierra Madre Mountains, San Rafael Pie de la Cuesta is one of six municipalities in the Western Highlands of Guatemala that benefits from USAID’s work in adapting communications technology to improve public service delivery. USAID’s Nexos Locales project partnered with the Guatemalan Ministry of Finance on an innovative water metering and billing application to provide citizens with a transparent and effective means to pay their water bills.

Prior to USAID’s involvement, San Rafael Pie de la Cuesta was not unlike many other municipalities, where Municipal Water and Sanitation workers must hand write thousands of meter readings in a notebook every month and then enter all the data into a national billing system. This time and resource intensive system means that citizens wait up to five hours in line in just to pay their water bills, often discouraging them from paying at all.

Click here to read the full story.

Photo credit: Benjamin Ilka/USAID

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

Just Add Water

Water metering and billing mobile technology contribute to the journey to self-reliance.

Photo credit: Benjamin Ilka/USAID

Located in the foothills of the Sierra Madre Mountains, San Rafael Pie de la Cuesta is one of six municipalities in the Western Highlands of Guatemala that benefits from USAID’s work in adapting communications technology to improve public service delivery. USAID’s Nexos Locales project partnered with the Guatemalan Ministry of Finance on an innovative water metering and billing application to provide citizens with a transparent and effective means to pay their water bills.

Prior to USAID’s involvement, San Rafael Pie de la Cuesta was not unlike many other municipalities, where Municipal Water and Sanitation workers must hand write thousands of meter readings in a notebook every month and then enter all the data into a national billing system. This time and resource intensive system means that citizens wait up to five hours in line in just to pay their water bills, often discouraging them from paying at all.

Click here to read the full story.

Photo credit: Benjamin Ilka/USAID

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

Kenyan County Sets Sights on Lofty WASH Goals

A meter reader with the Kakamega County Water and Sanitation Company checks a
consumer’s water point. KIWASH supported the water utility to streamline this process by
making sure supporting photos are collected, which eliminates the opportunity to tamper with
readings. Photo credit: Euphresia Luseka/KIWASH.

The government in Kakamega County — Kenya’s second-most populated county (after the capital, Nairobi), with nearly 2 million residents — has set a goal to supply piped water to 80 percent of its residents by 2022. While 61 percent of residents currently have access to improved water sources, the county in Kenya’s far west is largely rural, so connecting more customers to the water utility is no small task.

“With the capacity development and infrastructure support we have received from Kenya Integrated Water, Sanitation and Hygiene (KIWASH) project, we are ready for take off,” explains the county’s Chief Officer for Water Joseck Maloba.

Two plumbers with the Butere Water Scheme create a new water connection. Photo credit: Euphresia Luseka/KIWASH.

KIWASH is a five-year USAID program with the goal of improving the lives and health of Kenyan citizens in nine counties through the development and management of sustainable water, sanitation, and hygiene (WASH) services. It was developed to take on nearly all aspects of WASH from water catchment protection, to policy and legislation development, and services provision management.

“KIWASH was meant to try to holistically and comprehensively address the WASH needs in specific counties in Kenya,” says Amanda Robertson, Senior WASH Advisor with USAID/Kenya and East Africa. “Through KIWASH, we’ve really been able to be ambitious and to say ‘here is a wide set of problems and we’re going to try to tackle those in an exhaustive way.’”

Through KIWASH’s support, a water operator at Tindinyo Water Scheme helps ensure water supplied to consumers meets the minimum standard for potable water. Photo credit: Euphresia Luseka/KIWASH/2017.

To make the government more accountable for service delivery to citizens, Kenya devolved many of its governance functions from national to county level as enshrined in the country’s 2010 Constitution. As a result, the counties are now responsible for providing water and sanitation services, rather than the central government. Thus much of KIWASH’s work is with county governments. “We have staff from KIWASH that are embedded at the county level, so that means they are able to do their planning together,” explains Nicholas Owuor, USAID/Kenya and East Africa Program Management Specialist for WASH.

As a KIWASH WASH Governance Specialist, Euphresia Luseka is that point of contact in Kakamega County. “I sit in the office where the Minister of Water, the Chief Officer of Water, and the Directors of Water sit,” she says. “In terms of activity design, implementation, monitoring, participating in each other activities, mentoring and coaching, and being available all the time, it really helps in creating ownership and accountability of processes.”

“Local ownership is really what allows all the work to happen.”

KIWASH’s emphasis on a close relationship with local government means that gains made through the program are likely to be sustainable. “It’s truly viewed as USAID having a partnership with the county government, and that local ownership is really what allows all the work to happen,” explains Robertson. “It’s very much owned by them.”

The billing and revenue clerk at Mumias Water Scheme, under Kakamega County
Urban Water and Sewerage Company, helps the utility curb non-revenue water
losses through effective billing, handling of customer complaints, and metering. Photo credit:
Euphresia Luseka/KIWASH

In Kakamega County, KIWASH has helped the local government develop policies that will guide their water services priorities, and the county has increased the budget allocation for WASH services and related capital investments by more than 100 percent as a result.

“KIWASH has really helped us improve water services through projects that are aligned to the government’s agenda. We now plan to create a rural water company to operate community water utilities for uniformity of service and sustainability of the water services in [all] the rural towns and villages,” says John Baraza, Kakamega County Minister for Water, Environment, and Natural Resources.

The program has also focused on strengthening corporate governance and operational efficiency at Kakamega County Urban Water and Sewerage Company (KACWASCO). As a result, the utility adopted automated metering and billing processes and data management, developed company policies, overhauled customer services, and introduced staff performance agreements. This led to improved overall performance and expanded water coverage for 87 percent of residents in the area (up from 68 percent before 2016). Annual revenues increased by 36 percent, from US$19.2 million to $30 million. KACWASCO is now one of the top-ten performing water utilities in Kenya, and its credit rating has increased from a B to a BB.

Students from Glory High School enjoy a newly connected water served by Butere Water
Scheme. KIWASH supported the scheme through an eight kilometer pipeline extension reaching
underserved areas and institutions. Photo credit: Euphresia Luseka/KIWASH

KACWASCO’s customers have noticed the improvements. A customer survey conducted in December 2019 indicated an 81 percent approval rating, up from 65 percent in 2017. “Customers are now willing to pay for water,” says Luseka. “They are now feeling like KACWASCO is more reliable and they can depend on their services.” Water quality is also critically important for consumers, and Luseka says that reported rates of waterborne disease have been cut in half.

“We have a huge potential in terms of resources in the private sector that we’ll be able to tap.”

KIWASH also emphasizes partnerships with the private sector to try to expand WASH coverage. “We have a huge potential in terms of resources in the private sector that we’ll be able to tap,” says Owuor. “We have raised close to $25 million from various commercial banks going into water companies.” Additional investments in WASH in Kakamega have come from KIWASH recoverable grants and growth in revenue from the 24 small enterprises working with the project.

Luseka feels that the future is bright for Kakamega County’s water services. “Even if another management team comes in place or another county government leadership comes in place, they will find this precedence, so it will be so tough for them to fall back. They will now be aiming higher and higher.”

By Christine Chumbler

Additional Resources:

This article appears in Global Waters, Vol. 11, Issue 2; for past issues of the magazine, visit Global Waters’ homepage on Globalwaters.org.

To subscribe to Global Waters magazine, click here.

Follow us on Twitter @USAIDWater.


Kenyan County Sets Sights on Lofty WASH Goals was originally published in Global Waters on Medium, where people are continuing the conversation by highlighting and responding to this story.

World Water Day 2020: Five Ways USAID is Helping Thirsty Cities

This World Water Day, March 22, we spotlight USAID’s efforts to help partner cities and towns around the globe avoid their own “day zero” scenarios, when taps run dry, and improve sustainable water access for the neediest.

Waiting in line for water should be a thing of the past, not a portent of the future. Photo credit: Shutterstock

Our world is becoming more urban, and USAID is helping partner countries adapt to this rapid change. By 2030, 68 percent of the world’s population will be living in cities, with the majority of that growth happening in the developing world. The infrastructure of these cities, peri-urban areas, and market towns is under great strain as their populations grow. Access to safe drinking water in many urban areas is actually declining in response to demographic shifts, while water insecurity is growing, particularly among the urban poor, as city planners struggle to adapt to changing water supply and demand.

With severe water shortages in major cities such as Cape Town, Mexico City, and Chennai recently grabbing headlines, USAID is helping partner cities and towns avoid their own “day zero” scenarios — when taps run dry — and improving sustainable water access for the most needy.

To commemorate World Water Day, here are five ways USAID is helping thirsty cities become more resilient in the face of a growing water crisis:

Increased revenues from CRM reform will be invested in augmenting and diversifying Cape Town’s water supplies to reduce the impact of future droughts. Photo credit: USAID WASH-FIN

1. Providing Professionalized Customer Service

USAID’s Water, Sanitation, and Hygiene–Finance (WASH-FIN) project is leading a program to transform customer relationship management in Cape Town, a component of the city’s new water strategy that aims to not only conserve water but also bring in tens of millions of dollars in additional revenue. When reservoirs are drying up and citizens are urged to severely curtail their water use, why would customer relationship management be a priority? In addition to improving goodwill among customers, and thus willingness to pay and to conserve water, it improves cash flow by resolving inaccurate metering, billing errors, and collection backlogs. All of this delivers outsized payback to water service providers — and not only in times of crisis — enabling them to adapt to future droughts and other shocks. Read more.

Newly recruited younger staff members work in a water laboratory in Nigeria. Reforms in the country’s water sector are prioritizing youth engagement to improve service delivery. Photo credit: USAID E-WASH

2. Fostering a New Culture in the Water Service Sector

Close to half of Nigeria’s 183 million citizens reside in urban centers. Decades of domestic migration have put a significant strain on the country’s water and sanitation services, with residential access to piped water dropping from 32 percent in 1990 to just 7 percent in 2015. Water service remains generally unreliable due to ineffective governance, lack of regulatory mechanisms, and inefficient financial structures. USAID’s Effective Water and Sanitation Hygiene Services (E-WASH) project has embedded technical experts into six Nigerian state water board offices to work alongside decision-makers and local employees to help create a corporate culture in the water service sector. The goal is for these state water boards to become more autonomous in managing services and financially sound. Changing the management structure to a corporate model will not only lay the groundwork for increased efficiency and expanded services, but will ultimately spark job creation in the sector. Read more.

In Jordan, USAID helped launch an incentive-based program called Maana, meaning “with us,” which employs female plumbers to install a water-saving devices in customers’ homes. Photo credit: USAID Water Management Initiative

3. Conserving Water in an Era of Scarcity

Although Jordan is among the most water-scarce countries on Earth, its people lack awareness about the extent of the challenges and the role they can play in stemming the crisis. USAID’s Water Management Initiative partnered with a local water utility in the capital city of Amman to implement a social marketing campaign to raise awareness about the looming water crisis and encourage residents to take practical action to conserve water. The campaign’s slogan, “Don’t underestimate the value of a drop,” not only went viral, but also proved to be effective. A post-campaign survey found people’s knowledge of Jordan’s water crisis increased 19 percent and that 24 percent of the targeted population checked their roof tank valves for leaks in the first three days of the campaign. Calls to the utility’s customer service number also increased 70 percent. The final phase of the initiative shared practical actions people can take to conserve water, including participating in a USAID-supported program that incentivizes families to retrofit water fixtures and roof tanks with water-saving devices. Read more.

The Haiti Water and Sanitation Project trained all the country’s semi-private municipal water utilities to use the mWater cloud-based data collection platform. Photo credit: Maxcy Ceant

4. Building the Capacity of Service Providers

A decade after the devastating 2010 earthquake, Haiti’s decentralized water sector is still struggling to serve its customers. USAID’s Water and Sanitation Project works in five cities, including Cap Haïtien, Haiti’s second-largest city, to help its semi-private municipal water utilities expand their customer base and improve operations. USAID is helping these utilities restore basic functions, such as understanding who their customers are; providing clean, reliable water; billing regularly; and finding and repairing leaks. An “mWater” cloud-based system provides real-time monitoring of the utilities’ financial and operational systems, helping the businesses to increase their self-reliance. With operations, maintenance, and monitoring systems in place and supported with their own revenue streams, more resilient utilities can be independent of donors and the central government. Read more.

Luciano Tapa, TCWS meter reader, delivers a computer-generated billing statement to a customer in Tagbilaran. Photo credit: USAID/Philippines

5. Partnering for Sustainable Solutions

Tagbilaran is a growing city in the central Philippines with great economic potential. But the city’s inability to deliver reliable and safe water has limited economic growth. Water rationing is common for its 100,000 residents. In response, USAID’s Strengthening Urban Resilience for Growth with Equity project facilitated a partnership between the Tagbilaran City Waterworks System (TCWS) and Maynilad, a Philippine private water and waste services company, to extend the government-run water utility’s service hours, improve its revenue generation, and update its accounting. The partnership’s first priority was improving billing and district metering. From 2015 to 2018, TCWS recorded a 144 percent increase in revenue collection, enabling it to acquire additional water pumping units and improve its service hours. Then Maynilad and USAID technical experts worked with TCWS to shift perceptions on the importance of reducing leaks in the water system. Called non-revenue water, or simply water loss, these leaks can drain funding for cities if left unchecked. With improvements in place, Tagbiliaran residents now have access to water nearly 24 hours a day, seven days a week and more revenue is available to upgrade the system and address ongoing challenges like water loss. Read more.

This work to promote local utility reform, improve water quality management, and reduce non-revenue water is critical to ensure the reliability and sustainability of water services in growing urban areas. USAID is also committed to advancing rural water access, particularly for underserved poor and vulnerable households.

By Wendy Putnam, USAID’s Water Communications and Knowledge Management Project

This article appears in Global Waters, Vol. 11, Issue 1; for past issues of the magazine, visit Global Waters’ homepage on Globalwaters.org.


World Water Day 2020: Five Ways USAID is Helping Thirsty Cities was originally published in Global Waters on Medium, where people are continuing the conversation by highlighting and responding to this story.

Can Mobile Tech Lower the Cost of Household Water in Rural Ethiopia?

An innovative pilot project seeks to transform lives through improved rural water supply access.

Residents of Wita, a small rural community three hours south of Addis Ababa, Ethiopia’s capital, examine infrastructure that will be used to improve the reliability of their water supply. Photo credit: Triple Bottom Line (3BL) Enterprises

The wait for water sometimes felt endless. “When the water point, pump, and generator faced difficulty, it took a long time to fix,” recalls Feleke Abera, a resident of Wita, a rural kebele (village) in south-central Ethiopia. “Sometimes it took up to three months.”

During these stretches, obtaining enough water to meet daily needs for Feleke’s household became an endurance contest. “We queued up two to three hours to get water,” he recalls — and even that wasn’t enough. “We were getting water by shift, so the supply of water was not compatible with our demand.”

Today, the situation is much improved, and access to safe water has become more reliable. For the past few years, Feleke and his neighbors have been quietly experimenting with a water supply improvement effort that may one day become a revolutionary solution for water-stressed rural communities across Ethiopia and beyond.

The concept driving this innovative pilot project is relatively straightforward: Harness the power of community engagement and mobile technology to guide the construction, operation, and maintenance of water supply infrastructure to lower costs for consumers and bring safe, piped water directly into their homes. Sound ambitious? Well, it is. But the reduced water anxiety Wita residents have been experiencing these days suggests the creative minds and software designers behind this water-supply model, known as Flowius, may be on to something. Already, thanks to support from USAID’s Development Innovation Ventures (DIV), Flowius has facilitated the installation of about 25 kilometers of water pipes throughout the community, connecting some 500 households to a water distribution system, with each home paying about $50 to connect to the system.

In Wita, 600 community households have become active participants and partners in the implementation of Flowius to reduce the time and effort required to obtain water. Created by Triple Bottom Line (3BL) Enterprises with support from USAID DIV, which seeks to invest in evidence-based innovations with the potential to make an impact at scale, Flowius relies upon robust community engagement, as well as proactive infrastructure maintenance and wireless technology.

Can mobile apps like Flowius Manage (shown above) help improve rural water supply delivery to homes? Residents of Wita, Ethiopia, think so. Photo credit: Triple Bottom Line (3BL) Enterprises

Rural Areas Face Unique Water Challenges

Rural areas often face different water-supply challenges than cities. Funding, constructing, and maintaining water infrastructure is more difficult to achieve in areas that are sparsely populated, and therefore, clean water piped directly into the home becomes a luxury available only to those with financial means. Too often, rural households must rely on unsafe surface water sources, such as lakes or rivers or polluted wells to meet their daily needs.

“In most rural areas, women typically spend a lot of time and energy fetching and carrying water for their household needs,” points out Kathrin Tegenfeldt, USAID/Ethiopia’s Climate and Water Advisor. “By having water available at the household, when the family needs it, we would expect an increase in positive hygiene behaviors as well as to see the impact time savings has on women and girls.”

Rural communities in the Gurage Zone of south-central Ethiopia often struggle to ensure a reliable water supply. Photo credit: Daniel Zolli

The mind behind Flowius is 3BL Cofounder Chris Turnbull-Grimes, who moved to Ethiopia in 2015 to focus on rural water supply improvements. The country, he says, provides an excellent testing ground for the Flowius concept and model because not only do nearly 80 percent of Ethiopia’s more than 100 million people live in rural areas, the government also has the geographic reach and ambition to aggressively combat rural water insecurity. “Since we are building micro-utilities, we need to partner with governments wherever we go,” he says. “Since Ethiopia has a much stronger government presence across the country than most others in the region, it will allow us to build our reputation through existing government linkages.”

The Government of Ethiopia’s long-term strategic objectives for improving water, sanitation, and hygiene (WASH) access under the OneWASH National Program, launched in 2013, also help create a political environment at the national and local levels conducive to Flowius’ implementation. This “allows us to have the security of a standard to which we can operate by as we aim to grow,” Turnbull-Grimes says.

“We only work in communities with existing infrastructure,” says Turnbull-Grimes, which might ideally include either an existing borehole, or a spring with a storage tank that can facilitate distribution of water to nearby public taps. Wita met those criteria, and the community’s homes are also located close enough to facilitate one of the core components of the Flowius model — linking existing infrastructure to area homes via newly laid pipes.

Credit: Triple Bottom Line (3BL) Enterprises

A Community Affair: In Pursuit of “Radically Affordable” Water

The resulting hybrid system, which combines pre-existing infrastructure with new infrastructure, is community-owned. “Since the communities we work with end up owning the water systems we build, we avoid a question of ownership between our systems and theirs,” says Turnbull-Grimes. Training the community to operate and fix the system as needed fuels further community buy-in.

“By developing locally managed, affordable solutions that include a focus on operations and maintenance, we are supporting communities to take ownership over managing their water supply needs,” says Tegenfeldt.

“People just want water in their homes — and they are willing to pay to get it there.”

Beyond piping water into homes, the Flowius model appeals to cash-strapped households because it significantly reduces water costs. “The biggest issue for most community infrastructure projects is the often overwhelming cost,” says Turnbull-Grimes. After earlier stints working on rural water supply projects in El Salvador and Kenya, he “began to understand that people just want water in their homes — and they are willing to pay to get it there.”

Once implemented, the Flowius model supports a “medium level” of water service delivery that is not necessarily as convenient as the “unlimited level of water supply seen in most cities and towns,” he says, but far more convenient than the only option that exists today for many — walking to a distant surface water source or well. To ensure supply meets demand, “we work with communities to determine the amount of water that they’ll typically need, and limit the amount of daily supply that each home gets, allowing for a certain amount of flexibility between homes and the inevitable need for variations in demand over time. This allows us to drastically reduce the size of our infrastructure and pass those cost savings along to the customer.”

Harnessing the Power of Mobile Technology

3BL’s four interconnected mobile apps have helped lay the groundwork for Flowius’ success and set the project apart from other rural water supply initiatives. Customized for use in Ethiopia, the apps are accessed via mobile phone and “provide a dramatic improvement on existing methodologies and tools,” Turnbull-Grimes says. But with the exception of smartphone-equipped members of the local WASH committee, community households do not typically use the apps, since smartphones remain relatively rare. Instead, he says, “our rurally-based franchises will be provided smartphones and trained on using our full suite of mobile tools.”

First an easy to use mapping platform helps build communities’ capacity for data collection and management. “We built our own GIS mapping tool called Flowius Maps, which allows us to gather data about houses and existing infrastructure locations, while also helping communities begin to manage their own data,” he says. Previously a data-scarce community, Wita utilized Flowius Maps to map every household, compiling names and contact information in the process; beyond its relevance to Flowius, this information can now be linked to other initiatives related to education and health.

Second, an app called Flowius Connect helps local partners manage infrastructure construction, allowing the implementation team to “input our system design, including material components and labor expectations, and develop a construction schedule with it. Flowius Connect also serves as a significant organizational tool, keeping tabs on inventory, facilitating coordination of material drop-offs at work sites, and establishing a timeline for the completion of key project deliverables,” he adds.

Once the infrastructure has been installed, the locations of that infrastructure are added to Flowius Maps, and two other apps, Flowius Manage and Flowius Pay, enable community members to more effectively operate and manage the infrastructure and collect revenue. Flowius Manage gives users technical tools for maintaining water supply infrastructure and uses instructional videos to promote proactive maintenance, while Flowius Pay assists customers in managing the financial aspects of their water service by facilitating invoicing, for example.

The overarching goal of these apps is to increase community engagement with — and ownership of — its new water infrastructure and incentivize regular maintenance of the system.

Water supply infrastructure is prepared for installation in Wita, Ethiopia. Photo credit: Triple Bottom Line (3BL) Enterprises

Partners Help Manage Challenges and Expectations

Seifu Saide is a team leader with the Meskan Woreda (district) Water, Mining, and Energy Office and has been actively involved with the Flowius pilot project since its inception.

The project’s initial implementation has not been without its challenges, Saide concedes, but the Flowius model has proven resilient and durable in the face of logistical and bureaucratic headwinds. It took time to raise awareness about the model and to collect the money and labor required to initiate construction for water pipes. “We addressed these challenges by creating community awareness and by working with our partners from the region to kebele administrators.” To that end, community meetings organized throughout the planning process helped glean information about residents’ water demands and concerns, and help manage their expectations for the project. Subsequently, community residents were hired to help build the system to familiarize themselves with its operations and maintenance. Residents also helped test out the mobile apps vital to Flowius’ success.

“For us, the biggest issue for expansion is the density of the communities that we’re working with,” says Turnbull-Grimes. “If a community doesn’t have enough homes in a small enough area, the capital costs become so high that they are not affordable to the members there.”

Making a Difference

For Feleke, gone are the days of long waits or walks for water. He has taken on a leadership role as a member of the seven-person WASH committee for his kebele. In that role, he helps the community manage its water supply by overseeing and maintaining infrastructure, collecting monthly fees, coordinating with the regional water office in nearby Butajira, and rallying his neighbors to be good stewards of their kebele’s most vital intrastructure and equipment — its water point, pump, and generator. Since Flowius’ implementation, the WASH committee has seen its water management responsibilities increase, and members have either directly participated in building the system or helping manage revenue collection using the Flowius Pay app.

“Accessing safe water in our home is improving our health.”

Feleke recognizes that Flowius has played an important role in recent years in elevating the public’s shared understanding of the importance of a well-maintained water supply. And it has made quite a difference in his family’s life. “My wife,” he says, “now gets relief instead of carrying water on her back. Previously, we lined up for a couple of hours to get water, but now accessing safe water in our home saves us time and energy for other tasks.” Most importantly, he said, the next generation of his family is benefitting: “In the past our child faced diarrhea because of unsafe water, but now accessing safe water in our home is improving our health.”

Residents of Wita, Ethiopia, come together to help lay new water pipes for their community to improve household water access. Photo credit: Triple Bottom Line (3BL) Enterprises

Beyond Borders

The pilot is projected to build on its successes to date. “Flowius’ model is expected to demonstrate how a private sector approach can address some of the challenges rural communities face when it comes to sustained water supply,” says Tegenfeldt. “I particularly hope that by modeling a successful private sector approach for water service delivery, the project will generate opportunities for replication throughout Ethiopia. I am excited to learn how this pilot project will help inform and shape the dialogue around household water supply and what that can look like in rural areas.”

“Most countries across the globe will have enough densely populated communities that we can go anywhere.”

There are millions of rural Ethiopians who face water challenges similar to those that Feleke and his neighbors have been tackling. While Turnbull-Grimes acknowledges capital financing remains a significant hurdle, he adds “we have received requests from people across the continent and world to establish a franchise of Flowius in their countries. While we’re not ready for this step yet, it has shown us the global demand for water piped into homes.”

As Flowius matures and works out some of the kinks in its initial implementation, the sky may be the limit in terms of demand for safe water piped directly into rural homes. “We have a product and service that people want,” he says. “Most countries across the globe will have enough densely populated communities that we can go anywhere.”

By Russell Sticklor

Additional Resources:

This article appears in Global Waters, Vol. 11, Issue 1; for past issues of the magazine, visit Global Waters’ homepage on Globalwaters.org.


Can Mobile Tech Lower the Cost of Household Water in Rural Ethiopia? was originally published in Global Waters on Medium, where people are continuing the conversation by highlighting and responding to this story.

In Senegal, Sanitation Means Dignity

USAID and Sagal representatives meet with a women’s group. Photo credit: Oliver Subasinghe/USAID

Like many of us, Fatou Badji balances a hectic schedule. She is the chairlady of a women’s group that sells onions and other essentials. She is also on the frontlines of addressing the global sanitation crisis.

Today, six in 10 people lack proper sanitation, costing economies $260 billion annually. Poor sanitation leads to the deaths of more than a quarter-million children annually, and affects the safety of women and girls.

On my recent trip to Senegal, I had the privilege to meet Fatou and her group members who are working to increase access to sanitation services in the region of Ziguinchor. Despite significant progress made on drinking water access, Senegal still faces sanitation challenges. To address the lack of affordable and appropriate sanitation options, USAID/Senegal is promoting market-based approaches to create viable and local sanitation businesses that harness global innovations and engage the private sector. This promising approach has the potential to reach the billions of people who are not connected to centralized sewer systems worldwide.

Fatou Badji, a Sagal sales agent, demonstrates her pitch to potential latrine customers. Photo credit: Oliver Subasinghe/USAID

Building Up Senegal’s Sanitation Entrepreneurs

In 2018, USAID/Senegal’s ACCES project [Senegal’s Assainissement — Changement de Comportement et Eau pour le Sénégal] launched a branded sanitation solution called Sagal. In the Wolof language, the word Sagal translates as a “a sense of pride in one’s dignity.” This model connects customers to sales agents, masons, and financing for improved household latrines.

Fatou, a Sagal sales agent trained by the project, is a crucial partner in this supply chain. She was initially attracted to Sagal as a way to diversify her income.

Her pitch to potential customers focuses on Sagal’s health and cost benefits with the overarching goal of providing quality latrines for everyone, so that everyone will be healthier. Prior to Sagal, Fatou’s customers relied upon poorly constructed open pit latrines that attracted flies and smelled, or they practiced open defecation. She markets her improved latrines as a preventative health measure akin to an “inoculation.” For those harder-to-convince customers, she shows a photo of a woman bitten by a snake while trying to find a spot to relieve herself in an open field.

After Fatou wins over a new client, she makes a follow-up housecall with a trained mason to scope out the installation of the latrine, sign the purchase order, and collect a downpayment. Sometimes the latrine is purchased through a microloan from a local financial provider. Then the mason returns to install the family’s new latrine. ACCES has trained masons on properly installing the Sagal latrines, including developing a detailed handbook that ensures quality standards are met. In some cases, 10 percent of the final payment is withheld until the client is satisfied and a technical specialist confirms that the latrine meets construction standards.

Fatou sees a growing market for Sagal. Her goal is to expand the brand to her entire commune and ensure everyone has access to affordable sanitation services.

A SATO Pan installed with ventilation and a covered pit. Photo credit: Oliver Subasinghe/USAID

Local Needs, Global Innovation

A key component to Sagal’s brand centers on Lixil’s SATO Pan, a line of affordable, hygienic, and odor-free latrines for lower income households. A tiny self-closing flap at the bottom of the SATO Pan blocks odors and keeps away flies. This gives users peace of mind that their latrine is hygienic, and it makes using a latrine a more dignified experience.

The SATO Pan’s maker, Lixil, is a home products and building multinational company that sees addressing the global sanitation crisis as both a business opportunity and a social good. The company sees the low-cost latrine as the first rung of its global sanitation product line of latrines and toilets, having integrated the SATO fully into its business model. Based on ACCES’s customer research, the SATO was the right product for the right market to build Sagal’s brand.

Sanitation Solutions that Last

In Senegal, the Sagal brand has shown promising early results. Since its launch in March 2018, more than 3,600 Sagal latrines have been installed — with 40,500 people gaining basic sanitation access. Early success is largely thanks to both product quality and a concerted marketing campaign that combined a road show with radio and TV spots.

The success we have seen in Senegal to date is impressive, but there is more to be done. Less than half of the country’s population has access to at least a basic sanitation facility, which makes scaling the market for sanitation products and services critically important, and that takes patience and adaptability. In particular, financing and supply-chain constraints need to be addressed for sanitation businesses to be viable. Equally important are sound public policies that create incentives that both grow sanitation markets and reach low-income households.

From Ghana to Indonesia, USAID’s market-based sanitation approaches take different forms. Each country has its own context and business environment. But in all contexts, we recognize the tremendous value of engaging with the private sector — whether it is a global multinational company, local firm, or entrepreneur like Fatou. They help test and scale solutions that can continue long after USAID’s assistance has ended.

By Jennifer Mack, USAID Deputy Assistant Administrator in the Bureau for Food Security and Global Water Coordinator

Jennifer Mack, USAID’s Global Water Coordinator (center) visits the home of a Sagal customer with sales agents and ACCES project team members. Photo credit: Oliver Subasinghe/USAID

Additional Resources:

This article appears in Global Waters, Vol. 11, Issue 1; for past issues of the magazine, visit Global Waters’ homepage on Globalwaters.org.


In Senegal, Sanitation Means Dignity was originally published in Global Waters on Medium, where people are continuing the conversation by highlighting and responding to this story.

Creating a Roadmap for Sustainable Water Service Delivery in Haiti

All 27 semi-private municipal water utilities have participated in Water and Sanitation Project trainings on the mWater cloud-based data collection platform. Photo credit: Maxcy Ceant

When the 2010 earthquake hit Haiti, the country had just undertaken a massive reform of its water sector. The recovery from the initial disaster and subsequent cholera outbreak shifted the focus from structural reform to disaster response. An outpouring of international assistance helped Haiti dig itself out of these disasters and rebuild its infrastructure. However, the country still struggles to deliver adequate and reliable water at the household level, and the 2009 effort to decentralize its water service has made little progress in improving services or creating self-sustaining local water utilities.

The USAID Water and Sanitation Project stepped in to address this gap in 2017 with the goal of sustainably providing water to 250,000 people and sanitation services to 75,000. In doing so, USAID partners with other donors and the Government of Haiti to leverage infrastructure and cholera-related funding to fill a significant capacity gap that is essential to improving service delivery in the country. At the beginning of the project, only 6,300 households had paid connections to the public water utility systems in the five targeted project areas, includings Cap Haïtien, Haiti’s second largest city. The previously dysfunctional billing and collections have been insufficient to cover salaries, let alone utility operations or service expansion.

When utility employees are seen repairing leaks in Jérémie, Haiti, requests for new household connections increase. Photo credit: Marc Germain

Breaking the Cycle: From Dependent to Dependable

Through in-depth assessments of each of its five targeted urban areas — Canaan, Cap Haïtien, Jérémie, Les Cayes, and Mirebalais — the USAID Water and Sanitation Project identified unique circumstances in each area that constrain water service delivery as well as many shared challenges, including: poorly trained and under-resourced staff; flat tariffs for water service that encourage clandestine connections over legal ones; non-revenue water loss; poor record-keeping and customer service; no routine preventative maintenance to ensure sustained functionality of infrastructure; and lack of equipment to make repairs. Using these detailed assessments, USAID facilitated stakeholder meetings to develop roadmaps and action plans that are focused on tackling the barriers to improving water service.

Toward that end, the project is now strengthening the semi-private municipal water utilities, known as Centres Techniques d’Exploitation or CTEs, in its target communes to build their management and revenue-generating capacity to improve sustainability and self-reliance. Project Director Daniel O’Neil calls this getting back to basics: “figuring out who their customers are, how to manage the system, to get the invoices out, and how to keep the water flowing so that customers learn to go back and rely on them.” The project works closely with the central hub of Haiti’s water system, the National Directorate for Water and Sanitation (DINEPA), and the regional water authorities, known as OREPAs, to develop and implement effective models for managing and overseeing the CTEs.

A nine-month collaboration among these institutions led to the development and customization of an “mWater” cloud-based system that is being used to upload data on the water production, operating costs, and sales revenues of the CTEs. All of the 27 CTEs in the country have been trained on the system, which enables real-time monitoring of the utilities’ financial and operational systems and helps increase their self-reliance as businesses.

“mWater has helped us update and keep track of our internal data on leaks occurring within the system, and it allows us to share this information with multiple actors — OREPA, DINEPA and WATSAN [Water and Sanitation Project],” says Jocelyn Laurent, CTE Jérémie’s technical director.We’re also able to identify and catalog leaks on the spot and create plans to address them at a later date. While we still have more work to do, the local population is happier with our service and efforts.” Laurent is looking forward to using the platform to monitor water quality, capture customer concerns, and respond to their needs, including sending relevant water-related text messages to customers.

Jérémie’s water comes from a spring-fed system in the mountains, but little of that ample supply had been reaching customers because of poor management. The CTE currently has only 900 paying customers, but that is beginning to change. The goal is to have the CTE serve 25,000 people and receive enough revenue to cover staff salaries and basic operating costs. A three-month pilot in the commune tested a series of interventions to help the CTE break out of its cycle of dependence and decline and expand its customer base. The interventions included mapping the water system, identifying unlicensed connections, providing the CTE with the materials to make repairs, and establishing metered connections.

“Providing the CTE with the tools to manage its network has worked beautifully,” says O’Neil. “It allows the CTE to get out working to fix the pipes and for the community to see the water utility fixing leaks. Each time we’ve repaired leaks in an area, they get a handful of people who come in and register for new connections. They realize that the CTE is serious about providing water.” The pilot is now being replicated in Mirebalais.

“If people can afford a connection, they’ll pay for it because it’s so much more convenient to have a faucet in your house than to walk even 20 meters down the street to get water.”

Reestablishing that credibility with the customer is the critical first step toward growing household connections. And it is those paid household connections that will in turn support the entire system. “CTEs have done such a poor job of providing safe water for so long,” says O’Neil, “people have stopped relying on them. No amount of outreach is going to do any good because you can’t market a bad product.” Once leaks are repaired and distribution improves, the CTEs can focus on changing the billing from fixed price to metered connections. This cuts down on clandestine connections and enables the utility to accurately gauge who is using what and bill accordingly. “If people can afford a connection, they’ll pay for it because it’s so much more convenient to have a faucet in your house than to walk even 20 meters down the street to get water,” O’Neil adds.

Local Ownership and Lasting Solutions

The private sector currently plays a strong role in the water service market and is likely to continue to do so in the near future as piped networks managing to provide water still do not deliver a reliably potable product. This means people with household connections use the piped water for cooking and cleaning but purchase treated water for drinking. Private firms also truck treated water into underserved neighborhoods. The goal is to strengthen public utilities in a way that complements what the private sector is doing.

The Water and Sanitation Project is helping rehabilitate water kiosks that serve as a critical water source for poor households that cannot afford piped water to their homes. Photo credit: Dan O’Neil

CTEs also manage water kiosks that provide water for residents in mostly informal settlements who cannot pay for their own household connections. Many of these kiosks suffer from neglect and do not function at all. Recently, the Water and Sanitation Project awarded the first grant under its Enterprise Acceleration Fund to the faith-based organization Living Water to improve the safety and reliability of water sold in downtown Cap Haïtien. This is an interim step in a community that hasn’t had a functioning water distribution network in a decade. Working with eight private water providers, Living Water will transform 12 different kiosks from manual to solar-powered systems to reduce energy costs, establish a water treatment system to ensure safer water, and provide management training to grow their businesses.

The goal is to provide “water entrepreneurs exactly what they need to improve their business and serve a larger number of clients, with lower cost,” says Jameson Salomon, Living Water’s country director. “Our initiative will show to DINEPA a different and sustainable way to serve the population through entrepreneurship.”

More Enterprise Acceleration Funds are expected to be awarded in the near future to other innovators tackling entrenched water and sanitation issues in Haiti — to expand water quality testing, develop interlocking blocks for latrines, and test different types of fecal management approaches.

While USAID is ensuring that any new or improved infrastructure is built to withstand the shocks and stresses of future natural disasters, the key to sustainability of Haiti’s water and sanitation sector is the work USAID is doing to make each utility more resilient, according to O’Neil. With operations, maintenance, and monitoring systems in place and supported with their own revenue streams, CTEs will no longer need to rely on donors or the central government to support them, even in the face of disasters.

The USAID Water and Sanitation Project is addressing the unique challenges identified in each of its five targeted urban areas. In Les Cayes, the project is working to make bill payment easier through a mobile money app and upgrading its generators from diesel to solar power. On the other end of the spectrum, Cannon needs its entire water distribution system rebuilt.

“The common theme is we’re trying to develop sustainable water utilities,” says O’Neil. “Although our focus is on our five target areas, by working through the four OREPAs we’re actually having an impact on all 27 existing CTEs.”

And he concludes, “if we pull this off, by the end of our two and a half years, Haiti will have clear models for how all the CTEs should be functioning.”

By Wendy Putnam

Additional Resources:

This article appears in Global Waters, Vol. 11, Issue 1; for past issues of the magazine, visit Global Waters’ homepage on Globalwaters.org.


Creating a Roadmap for Sustainable Water Service Delivery in Haiti was originally published in Global Waters on Medium, where people are continuing the conversation by highlighting and responding to this story.

Social Media for Social Good: Raising Awareness of Jordan’s Water Crisis

In Jordan, USAID’s Water Management Initiative is working to ensure water conservation practices continue to expand and are sustainable. The project is helping launch an incentive-based program called Maana, meaning “with us,” immediately on the heels of a summer conservation campaign. As part of the Maana program, a female plumber (above) installs a water-saving device at a customer’s home. Photo credit: USAID Water Management Initiative

Hanan Ahyad is a resident of Jordan’s capital and largest city Amman. She is a domestic customer of the local water utility company, Miyahuna, and has always been aware of her country’s limited water resources. However, she did not understand the extent of the water crisis and how she could help until she came across a mysterious and innovative water conservation campaign in the summer of 2019. The campaign was trending in a matter of days, eventually reaching 3.5 million Jordanians (approximately one-third of the population), garnering nearly 60 million social media impressions, and extending far beyond Jordan’s borders. “In my neighborhood, we receive water once a week,” Ahyad explained. “My previous perception was that water resources in Jordan were little, but it never appeared to me that we are in the middle of a critical and worrying situation.”

Jordan is among the most water scarce countries on Earth. The recent influx of refugees and changing weather patterns are adding strain to the already shrinking water supply. The USAID Water Management Initiative is supporting the Government of Jordan to address the Kingdom’s most pressing water challenges and avoid a looming crisis by developing critical capacity and improving sector performance. Behavior change and strategic communications are a pivotal component of efforts to foster sustainable change.

Ahyad was not alone in her perceptions. In 2018, the Water Management Initiative conducted a comprehensive survey of Jordanians’ knowledge, attitudes, and practices regarding water. The study found that while most residents were aware of the Kingdom’s water challenges, 40 percent did not believe that their country was facing a crisis.

The Campaign to Address a Looming Crisis

The initiative’s social marketing and behavior change experts understood that residents needed awareness as well as tools and incentives to adopt and sustain water conservation behaviors. With this in mind and survey results in hand, the Water Management Initiative and Miyahuna set about devising a summer water conservation campaign based on a state-of-the-art social marketing model to increase knowledge of the looming water crisis and encourage residents to take practical action to conserve water.

“A successful, large-scale water conservation campaign requires broad public understanding, buy-in, and action,” said Michael Jones, director of the Water Resources and Environment Office at USAID/Jordan. “Miyahuna identified water-saving behaviors that we need customers to adopt. We aligned those behaviors with the findings of the study to create the framework for the water conservation campaign.”

The Water Management Initiative and Miyahuna developed core messaging and detailed plans for a multistage campaign. They enlisted the marketing firm, Ogilvy, to produce creative final designs and leverage its extensive networks in the private sector and with online influencers. The campaign design included three phases: an initial “Teaser” phase, a “Reveal and Information” phase, and a “Call to Action” phase.

An Attention-Grabbing Strategy

The first phase needed a creative angle to create awareness of the campaign and break through the clutter of advertising in Amman. “We took our brief to the advertising giant, Ogilvy, to create a campaign that would stand out and attract the attention of citizens who are flooded daily with countless messages,” Jones added. Ogilvy digested the campaign brief and translated it into what would become one of the most successful media campaigns in Jordan’s history.

The campaign’s simple slogan, “Don’t underestimate the value of a drop, ” employed a play on words in Arabic where the word “drop” is the same as the word for the Arabic diacritic marks (dots) used with certain Arabic letters. By omitting diacritic marks from the campaign’s Arabic slogan, it rendered the phrase challenging to read and interpret, which clearly illustrated “the value of a drop.”

The teaser phase (left) omitted the Arabic diacritic “drops” from the slogan, making it difficult to read. The reveal (right) clearly demonstrated the “value of a drop.” Credit: USAID Water Management Initiative

On July 28, 2019, this simple, cryptic slogan without “drops” was posted on billboards throughout Amman and social media without any explanation of its meaning or the source. This generated extensive buzz throughout Jordan and beyond, as people tried to decipher its meaning and who was behind it. The campaign’s intriguing twist resonated broadly, and the campaign hashtag #لا_تستهين_بالنقطة was soon trending on social media. It was featured on local television programs and other local, regional, and international media. In addition, more than 800 organizations, including Royal Jordanian Airlines, Arab Bank, Orange, McDonald’s, Ford, and the Crown Prince Foundation, showed their support for water conservation by dropping the Arabic diacritic marks (the “dots”) from their names and slogans and sharing the campaign hashtag.

The campaign followed an integrated marketing communications approach, reaching the target audience via multiple platforms including billboards, print, and online media. This local newspaper also dropped the diacritic marks from its logo in support of the campaign. Photo credit: USAID Water Management Initiative

After allowing the teaser message to be absorbed and discussed for three days, the campaign moved to the Reveal and Information phase. Adding the diacritic marks to the teaser message made the slogan readable, and the message also revealed who was behind it (Miyahuna, the City of Amman, and USAID). New billboards included the diacritic marks, and posts online showed animated water drops falling onto the page. The revised messages also directed people to Miyahuna’s website, which had been transformed for the campaign to specifically target knowledge gaps and misperceptions identified in the survey. For example, while recent rainfall has helped refill reservoirs, the underground water upon which Jordan heavily depends is continuing to be depleted.

The campaign slogan was placed in prominent locations around the city of Amman, including billboards and pedestrian bridges such as this one. Photo credit: USAID Water Management Initiative

Finally, on August 18, the campaign transitioned to the Call for Action phase. This phase provided information on practical actions people can take to conserve water, including linking to a new USAID–supported program to incentivize households to retrofit water fixtures and roof tanks with water-saving devices. It also included information on how homeowners can report water leakage and inspect their roof tank valves to ensure they are not a source of water losses.

Miyahuna’s vehicles bore the campaign’s slogan and remind citizens to call the company’s toll-free customer service number to report any observed water leakage. Photo credit: USAID Water Management Initiative

Immediate Impact Exceeds Expectations

Upon the campaign’s completion, the Water Management Initiative conducted a survey to measure the campaign’s effectiveness in raising awareness and promoting action. It found that people’s knowledge of Jordan’s water crisis increased to 79 percent compared to 60 percent reported in the initial survey. The survey also indicated that 24 percent of the targeted population checked their roof tank valves in the first three days of the campaign. The water company’s customer service number, which was promoted during the campaign, received nearly 190,000 additional calls in August and September of 2019 compared to the same period in 2018, representing an increase of more than 70 percent.

“The campaign was overwhelmingly successful in highlighting the significance of preserving water resources in Jordan. We are aiming to create awareness and encourage citizens to conserve water through adopting simple behaviors,” said Orwa Al Falayleh, Communications and Water Awareness Unit head at Miyahuna Company.

From Overnight Success to Long-Term Behavior Change

The USAID Water Management Initiative is now implementing its plan to ensure that water conservation practices continue to expand and are sustainable. The project is supporting Miyahuna to launch an incentive-based program called Maana, meaning “with us,” immediately on the heels of the summer conservation campaign. The program leverages the Water Management Initiative’s outreach and study findings — notably the fact that people are more likely to carry out new water-saving behaviors when they are relatively inexpensive, easy to perform, and result in a tangible benefit. Maana incorporates these considerations to deliver an innovative experience to Miyahuna’s customers. This voluntary program allows participants to obtain low-cost, water-saving retrofit technologies and access free support services including water audits and roof tank cleaning.

“The campaign was powerful in communicating critical facts about the water shortage in addition to encouraging us to adopt simple, yet valuable, behaviors to preserve water. We are now more than ever conscientious with our water usage.”

Maana will use recently trained female plumbers to carry out home visits for water conservation support services. The choice of female plumbers is helping women to earn additional income while overcoming cultural challenges — female plumbers are permitted to enter homes without a male present.

Hanan Ahyad, like thousands of other Miyahuna customers, now has a clear understanding of the urgency of Jordan’s water situation. She concluded, “Today, my family and I have fully realized the stressful dilemma Jordan is facing. The campaign was powerful in communicating critical facts about the water shortage in addition to encouraging us to adopt simple, yet valuable, behaviors to preserve water. We are now more than ever conscientious with our water usage. Drop over drop, we believe that we can positively contribute to preserving water in the country.”

By Maha Dergham, Sofian Qurashi, and David Favazza

Additional Resources:

This article appears in Global Waters, Vol. 11, Issue 1; for past issues of the magazine, visit Global Waters’ homepage on Globalwaters.org.


Social Media for Social Good: Raising Awareness of Jordan’s Water Crisis was originally published in Global Waters on Medium, where people are continuing the conversation by highlighting and responding to this story.

The Year in Review

USAID Water Security and Sanitation Highlights from 2019

USAID is working to improve the lives of millions of people around the globe by addressing the most basic of human needs — access to water and sanitation. And toward that end we made some news this year: introducing a new Global Water Coordinator, developing new indicators for water and sanitation, designating eight new priority countries, and sharing key results made during implementation of the U.S. Government Global Water Strategy.

In 2019, through stories, photo essays, and podcasts we also brought you face-to-face with the organizations, governments, and individuals working to deliver improved drinking water and sanitation services. We shared our learnings along the way through blogs, webinars, and evaluations. Take a look at some of the highlights of the year to see how USAID is making an impact.

Click here to view “Year in Review” in Adobe Spark.

By Wendy Putnam and Russell Sticklor of the USAID Water Communications and Knowledge Management Project


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

World Toilet Day 2019: These Countries are Making Sanitation Gains with USAID’s Help

Photo Essay: These Countries Are Making Sanitation Gains with USAID’s Help

As we celebrate World Toilet Day and the transformative health and economic impacts of access to improved sanitation this November 19, USAID takes you from Ethiopia to Indonesia in this photo essay to showcase how innovative thinking, government action, and private sector participation are collectively improving sanitation around the world. Learn how USAID is helping contribute to our partner countries’ progress toward safe sanitation for all.

In a Delhi slum, USAID, CURE India, and the New Delhi Municipal Council have renovated community toilets with solar light, giving women safe toilet access at night, and promoted behavior change messages to end open defecation. Photo credit: USAID/India

INDIA

“Sanitation is more important than political independence,” Mahatma Gandhi once remarked, revealing the former Indian leader’s keen awareness of sanitation’s crucial role in uplifting communities. But more than 70 years later, India — today home to more than 1.3 billion people — still struggles with considerable sanitation challenges.

In recent years, a new generation of leaders has elevated the importance of improved sanitation at the local and national levels, stepping up efforts to eliminate open defecation and facilitate access to latrines and toilets in rural and urban areas alike. In 2014, the Government of India launched the multi-year Swachh Bharat (“Clean India”) campaign, which has received support from a diverse group of partners — ranging from USAID to India’s private sector. On October 2, 2019, India held nationwide celebrations with an announcement befitting Gandhi’s 150th birthday: The construction of some 110 million toilets nationwide to help lay the foundation for a cleaner and healthier future. Moving forward, the Swachh Bharat campaign will focus on sustaining India’s open defecation free status by maintaining toilets and improving the responsible treatment of sewage.

USAID’s support of India’s sanitation improvement efforts includes a partnership with the country’s Ministry of Housing and Urban Affairs and the Bill and Melinda Gates Foundation. To provide technical assistance to the Swachh Bharat campaign, USAID/India and the Gates Foundation support a project management unit within the ministry to provide online training for municipal officials, monitor the country’s sanitation progress, facilitate access to new funding sources, and make it easier to identify promising sanitation projects that could be rapidly developed and implemented at scale. Mirroring the Government of India’s robust efforts to foster greater private sector engagement to improve the country’s sanitation outlook, USAID also helped enlist Google to track usage rates of public sanitation infrastructure. According to the most recent data available, India’s progress is evident on a global scale: As of 2017, the country boasted the world’s fifth highest annual rate of change in basic sanitation access (2.54 percent), as well as the third largest decrease in open defecation rates (-2.76 percent).

Participants at the Sanitation Co-Design Summit in Hawassa, Ethiopia, develop toilet prototypes using local materials. Photo credit: Kathrin Tegenfeldt

ETHIOPIA

It is no secret that Africa’s second most-populous nation has long struggled with open defecation, a practice that heightens the transmission risk of waterborne illnesses and jeopardizes public health. But thanks to a sustained effort to curb open defecation as part of its One Water, Sanitation, and Hygiene (WASH) National Programme, Ethiopia has emerged as one of East Africa’s greatest sanitation success stories in recent years, earning the coveted title of world’s top performer in terms of annual rate of change in open defecation (-3.34 percent) in 2017.

What has driven such significant changes? A multi-faceted approach — including public education and behavior change campaigns — deserves much of the credit. USAID is supporting the Government of Ethiopia’s efforts in this regard through initiatives such as the USAID Transform WASH program (2017–21), which is developing and promoting market-based sanitation solutions to increase business interest in the sector and speed communities’ progress on the path to open-defecation-free status. Last year, for example, USAID/Ethiopia sponsored a WASH summit that brought together the Massachusetts Institute of Technology’s Design Lab and Ethiopian health workers, government officials, and interested community members. Together, they brainstormed and created sanitation and hygiene products geared toward the Ethiopian market to spark innovation in the sanitation sector, attract interest from Ethiopia’s private sector, and grow the market for affordable sanitation products and services to help build upon the country’s recent sanitation momentum.

By 2021, Transform WASH seeks to help more than 1 million Ethiopian households gain access to an improved toilet facility. Further fueling progress in the sanitation sector, the Government of Ethiopia is also preparing to launch a national campaign against open defecation to build on the country’s recent momentum in eliminating that practice.

Two men install a new toilet in their house in Nawalpur, Sindupalchok District, Nepal. Photo credit: Kj Borja, USAID/Nepal

NEPAL

Though relatively small in stature compared to its giant neighbors, Nepal has been making big strides in improving its sanitation outlook in recent decades. According to the latest data, the country ranks fourth in the world in terms of annual rate of change in open defecation (-2.67 percent) and third in the world in terms of annual rate of change in basic sanitation access (2.76 percent). These improvements have not only helped create healthier communities, they have also helped erode long-held stigmas surrounding menstrual health in rural Nepal.

USAID supports Nepal’s sanitation and hygiene improvements with initiatives like the Safe Practices on Water, Sanitation, and Hygiene (SAFE-WASH) II project. Since 2014, SAFE-WASH II has partnered with communities in rural western Nepal, where a lack of adequate water and sanitation services and facilities had long hampered economic development and even contributed to cholera outbreaks, such as a 2009 episode that claimed the lives of several hundred people. In support of the country’s ongoing efforts to eliminate open defecation, the project has aligned itself with the Government of Nepal’s 2011 National Sanitation and Hygiene Master Plan and has been working with WASH committees in rural villages to build latrines and improve water supply access. To further local accountability, each committee has been urged to create an action plan revolving around the slogan “Sanitation and hygiene for every person, every day.” By the time SAFE-WASH II concludes operations, USAID and local partners are aiming to help three districts in western Nepal achieve open defecation free status, and empower more than 80,000 households with access to improved sanitation.

Community members learn about SATO latrine pans during a product demonstration hosted by the USAID-supported Water Resources Integration Development Initiative. Photo credit: USAID/Tanzania

TANZANIA

Fewer than one in three of Tanzania’s nearly 60 million people have access to safely managed or basic sanitation services. With such a daunting level of unmet need for improved sanitation, it comes as little surprise that open defecation remains a major public health concern, drawing the attention of public and private sectors alike. Slowly but surely, however, Tanzania is beginning to turn the tide and take charge of its sanitation challenge: In 2017, the country emerged as one of Africa’s top performers in terms of annual rate of change in basic sanitation access (1.51 percent), outpacing Botswana and Mali and falling behind only to Lesotho, Cabo Verde, and Mauritania in the most recent global top 20 rankings.

Today, projects like the USAID-supported Water Resources Integration Development Initiative (WARIDI) are further driving progress in the country’s WASH sector, as USAID teams up with local partners in both the public and private sectors to help improve access to better sanitation facilities as well as safe water services. Launched in 2016, WARIDI aims to help 1 million Tanzanians gain access to basic sanitation facilities by 2021 in a bid to curb open defecation. To that end, WARIDI and its partners are facilitating collaboration between local government authorities and businesses to improve the effectiveness and sustainability of sanitation interventions, helping communities access business development services for the WASH sector, and strengthening the supply chain of sanitation-related products and services to better serve the growing Tanzanian market. One particularly promising technology is the “SATO pan,” an inexpensive low-flow toilet geared for use in pit latrines where even rudimentary sewer infrastructure might not be available. Developed by LIXIL with support from the Bill and Melinda Gates Foundation, SATO pans are easy to clean and maintain and can require just 200 milliliters to rinse. As part of a global campaign to deploy this affordable sanitation technology, SATO now has a manufacturing license for Tanzania with hopes to scale-up deployment of this promising sanitation solution in the coming years.

A mason builds a septic tank at the house of a Bank Muamalat Indonesia Cooperative microcredit beneficiary in Indonesia’s Tangerang district. Photo credit: USAID IUWASH PLUS

INDONESIA

Home to more than half of the country’s 260 million residents, Indonesia’s cities have grown in population by more than four percent annually — the fastest urban growth rate in Asia. By 2025, more than two out of every three Indonesians will live in an urban area, meaning that municipal authorities will have to think creatively about how to best deploy technology and financing to get sanitation services and infrastructure to the crowded urban areas that need it.

Thanks to the efforts of sanitation advocates at all levels of government and within local communities, Indonesia appears well-positioned to further build the capacity of its sanitation sector. According to the most recent available data, the country ranked eighth in the world in 2017 for annual rate of change in expanding access to basic sanitation (1.88 percent) while simultaneously reducing its annual rate of change for open defecation by 1.34 percent. Nevertheless, unregulated wastewater disposal and underfunded sanitation services are still prevalent in many cities, putting families and communities at constant risk of contracting waterborne diseases. These challenges also stand in the way of Indonesia realizing its vision for self-reliance in providing universal access to safe water and sanitation for its citizens.

To improve the country’s sanitation outlook, the USAID Indonesia Urban Water, Sanitation and Hygiene Penyehatan Lingkungan untuk Semua (IUWASH PLUS) project has expanded the reach of sanitation services, strengthened wastewater utilities’ financial footing, and implemented public awareness initiatives and behavior change campaigns by working with the private sector, donors, non-governmental organizations, utilities, and 35 local governments in eight provinces since 2016. Growing Indonesia’s urban sanitation market has been a primary focus of these efforts. To that end, IUWASH PLUS engages the private sector to facilitate microfinance loans, assists the government to target subsidies for the poor so that more families and neighborhoods can stay healthy, and promotes community savings arrangements so that interested residents can construct more toilets and septic tanks. Local private sector firms contribute corporate social responsibility funds so that sanitation improvements are even more affordable. This heightened private sector engagement enhances quality of life for urban neighborhoods by allowing families to spend savings on their childrens’ education and other essential needs, while improving the financial bottom line of firms and utilities in the sanitation sector.

Today, nearly three out of four Indonesians can access basic and safely managed sanitation services. Keeping its focus on meeting the needs of the country’s most vulnerable communities, IUWASH PLUS aims to increase access to safely managed sanitation to more than 500,000 Indonesians by 2021.

Follow @airsanitasi on Twitter, Facebook, and Instagram for the latest IUWASH PLUS updates.

Click to view this photo essay in full-screen interactive Story Map format.

Sanitation Definitions

Basic sanitation: An improved facility that is not shared with any other household. Improved sanitation facilities include flush toilets to sewer system or septic tank, pit latrines with slab, or composting toilets, which provide the largest health benefits by safely separating excreta from human contact.
Safely managed sanitation: The use of improved facilities that are not shared with other households and where excreta are safely disposed in situ or transported and treated off-site. Improved sanitation facilities are facilities that provide the largest health benefits by safely separating excreta from human contact. Such facilities can include flush toilets to sewer system or septic tank, pit latrines with slab, or composting toilets.

By Chris Holt and Russell Sticklor

Additional Resources:

This photo essay appears in Global Waters, Vol. 10, Issue 6; for past issues of the magazine, visit Global Waters’ homepage on Globalwaters.org.


World Toilet Day 2019: These Countries are Making Sanitation Gains with USAID’s Help was originally published in Global Waters on Medium, where people are continuing the conversation by highlighting and responding to this story.

Strengthening Urban Indonesia’s Water and Sanitation Systems: Geser si Jahat (Out with the Bad)…

Strengthening Urban Indonesia’s Water and Sanitation Systems: Geser si Jahat (Out with the Bad) and the 1,000 Rupiah Healthy Toilets Movement

The municipal government in Surakarta, in Indonesia’s Central Java province, engages the private sector to deliver desludging services to the wider community. Photo credit: USAID IUWASH PLUS

In Indonesia, safe sanitation is a big challenge that goes beyond just access to a toilet. The vast majority of the country’s human waste is released untreated into the environment with devastating consequences — approximately 100,000 children across Indonesia die every year from diarrheal diseases. In fact, approximately 90 percent of groundwater in Jakarta, the country’s massive capital city, is contaminated with E. coli bacteria.

Some communities are still learning about the dangers of unsafe sanitation and the high rate of water contamination. “People in urban areas say, ‘But we do have a toilet, so we’re okay,’” says Lina Damayanti, advocacy and communication advisor with USAID’s Indonesia Urban Water, Sanitation and Hygiene Penyehatan Lingkungan untuk Semua (IUWASH PLUS) project. The problem is that most of these toilets empty raw sewage directly into the environment, not into a septic tank or municipal sewage system. The Government of Indonesia has committed to changing this and achieving the Sustainable Development Goal of universal access to safely managed water and sanitation by 2030. Through the five-year (2016–2021), $48.4 million IUWASH PLUS project, USAID is building the Government of Indonesia’s capacity to reduce barriers to safely managed water and sanitation services and improve hygiene practices. One of the main barriers is that the poor can not afford the cost to connect to the improved services and the utilities lack access to alternative financing.

IUWASH PLUS works with governmental and donor agencies, the private sector, NGOs, service utilities, and communities to strengthen the overall WASH ecosystem in urban Indonesia. The project, which has recently received additional funding from the Swiss Government State Secretariat for Economic Affairs, supports water and sanitation service providers to ensure that improved access is maintained over the long term.

Financing and Sanitation Expansion

“USAID IUWASH PLUS focuses on technical assistance, not physical construction,” explains Alifah Lestari, the project’s deputy director. An example of this is its partnership with 35 local governments in the provinces of North Sumatra, West Java, Central Java, East Java, South Sulawesi, Maluku, North Maluku, and Papua as well as Jakarta and Tangerang districts to improve household services, such as the availability of piped water and toilets with septic tanks. The project facilitates microfinance loans from financial institutions and subsidies from the government so that more households can connect to piping and vacuum truck operators. At the local level, IUWASH PLUS boosts local governments’ ability to better manage septage and improve operational and financial performance of sanitation utilities. The project also conducts formative research on the realities of sanitation conditions for low-income families so that utilities can make better management and programming decisions.

Veli, a sanitarian from Margahayu urban village in West Java province’s Bekasi City, initiated a community savings scheme called GESER SI JAHAT to help low-income residents build toilets with septic tanks. Photo credit: Siti Ngaisah, USAID IUWASH PLUS

To help households finance septic tanks, IUWASH PLUS is helping community health workers, also called Sanitarians, spread the word about GESER SI JAHAT, an acronym for Gerakan Seribu Rupiah Siapkan Jamban Sehat, which means “The 1,000 Rupiah Healthy Toilets Movement.” It is a locally developed program which promotes incremental savings — like 1,000 Rupiah, or less than $0.10 — for toilets and safe septic systems. In Indonesian, “Geser si Jahat” is equivalent to the English expression “Out with the bad.”

“The idea of GESER SI JAHAT came up when I met some community members who are motivated to have their own toilet with a septic tank but had limited financial capacity to build the facility,” said Muliastuti. “USAID IUWASH PLUS helped me to implement the idea by facilitating the discussion with communities to agree on the monthly saving scheme and establish the sanitation forum, [which] collected and managed the community saving,” said Veli Muliastuti, a sanitarian in Margahayu, Bekasi, West Java. “As a sanitarian, I am called to end this habit.”

Through the program, households contribute 1,000 Rupiah per month for five months toward the cost of a toilet and septic tank. Through their corporate social responsibility funding, local businesses including Mitra Keluarga Hospital and Bank Jabar also contribute.

Sludge Control

In many urban areas, entrepreneurs have stepped up to remove fecal sludge for a fee. Unfortunately, these companies often dispose of the sludge by dumping it, untreated, in local waterways. IUWASH PLUS helps local governments to develop regulations to curb these practices and ensure septage treatment plants for safe sludge disposal.

In East Java province, a private desludging operator signs a cooperation agreement with Malang city’s UPTD PALD, a municipal wastewater agency. Photo credit: Ristina Aprillia, USAID IUWASH PLUS

In Malang, East Java, for example, the project facilitated a series of discussions between the municipal wastewater agency known as UPTD PALD and 11 private desludging operators. These discussions resulted in a March 2019 cooperative agreement that will allow the private operators to connect with customers via the UPTD PALD, which will develop a customer database and promote desludging services to the wider community.

Both local government and the private operators expect to benefit from the agreement. “Private desludging operators have long been operating in Malang City and have served thousands of customers,” said Ari Kuswandari Yushinta, head of UPTD PALD. “It is necessary for UPTD PALD to establish a partnership with them to ensure that they meet environmental health and safety requirements when delivering their services, including disposing of the septage in the treatment plant.”

“Being a partner of UPTD PALD, I hope we can serve more customers in the future. UPTD PALD will also train the operators to improve service quality,” said Johan Setiawan from CV Prayogo, a private desludging service operator.

“Together with the Government of Indonesia, USAID is creating a market for sanitation products and services to make sure that activities like desludging is self-sustaining beyond the project period because they are creating a market for those services.”

“Together with the Government of Indonesia, USAID is creating a market for sanitation products and services to make sure that activities like desludging is self-sustaining beyond the project period because they are creating a market for those services,” explains Trigeany Linggoatmodjo, senior WASH program specialist with USAID/Indonesia.

Creating this market demand for sanitation begins at the community level with people like Veli Muliastuti, the sanitarian. “We want to build the legacy for the future,” says Lestari. “People like Veli will continue to help after IUWASH PLUS is finished.”

“We are not working alone,” says Damayanti. “If it’s not done hand-in-hand with people who are living there, it will not be sustained.”

By Christine Chumbler

Additional Resources:

This article appears in Global Waters, Vol. 10, Issue 6; for past issues of the magazine, visit Global Waters’ homepage on Globalwaters.org.


Strengthening Urban Indonesia’s Water and Sanitation Systems: Geser si Jahat (Out with the Bad)… was originally published in Global Waters on Medium, where people are continuing the conversation by highlighting and responding to this story.

Out with the Bad: Strengthening Urban Indonesia’s Water, Sanitation, and Hygiene Systems

The municipal government in Surakarta, in Indonesia’s Central Java province, engages the private sector to deliver desludging services to the wider community. Photo credit: USAID IUWASH PLUS

In Indonesia, safe sanitation is a big challenge that goes way beyond just access to a toilet. The vast majority of the country’s human waste is released untreated into the environment with devastating consequences — approximately 100,000 children across Indonesia die every year from waterborne diarrheal diseases. In fact, approximately 90 percent of groundwater in Jakarta, the country’s massive capital city, is contaminated with E. coli bacteria

Some communities are still learning about the dangers of insufficient sanitation and the high rate of water contamination. “People in urban areas say, ‘But we do have a toilet, so we’re okay,’” says Lina Damayanti, advocacy and communication advisor with USAID’s Indonesia Urban Water, Sanitation and Hygiene Penyehatan Lingkungan untuk Semua (IUWASH PLUS) project. The problem is that most of these toilets empty raw sewage directly into the environment, not into a septic tank or municipal sewage system. The Government of Indonesia has committed to changing this and achieving the Sustainable Development Goal of universal access to safely managed water and sanitation by 2030. Through the five-year (2016–2021), $48.4 million IUWASH PLUS project, USAID is building the Government of Indonesia’s capacity to reduce barriers to safely managed water, sanitation and hygiene services.

IUWASH PLUS works with governmental and donor agencies, the private sector, NGOs, service utilities, and communities to strengthen the overall WASH ecosystem in urban Indonesia. The project, which is funded in part by the Swiss Government State Secretariat for Economic Affairs, supports water and sanitation service providers to ensure that improved access is maintained over the long term.

Financial issues and capacity building of local institutions are the biggest technical assistance challenges. As a result, “USAID IUWASH PLUS focuses on technical assistance, not physical construction,” explains Alifah Lestari, the project’s deputy director.

Financing and Sanitation Expansion

USAID works in partnership with 35 local governments in the provinces of North Sumatra, West Java, Central Java, East Java, South Sulawesi, Maluku, North Maluku, and Papua as well as Jakarta and Tangerang districts to improve household services, such as the availability of piped water and toilets with septic tanks. The project facilitates microfinance loans from financial institutions and subsidies from the government so that more communities can connect to piping and septage hauler systems. At the local level, IUWASH PLUS boosts local governments’ ability to better manage septage and improve operational and financial performance of sanitation utilities. The project also conducts formative research on the realities of sanitation conditions for low-income families so that utilities can make better management and programming decisions.

Veli, a sanitarian from Margahayu urban village in West Java province’s Bekasi City, initiated a community savings scheme called GESER SI JAHAT to help low-income residents build toilets with septic tanks. Photo credit: Siti Ngaisah, USAID IUWASH PLUS

On the microfinance side, IUWASH PLUS is helping community health workers, also called sanitarians, spread the word about GESER SI JAHAT, a locally developed program using community savings schemes to build toilets and safe septic systems. “It is sad to see some people dispose human waste directly to the environment,” said Veli Muliastuti, a sanitarian in Margahayu, Bekasi, West Java. “As a sanitarian, I am called to end this habit.”

GESER SI JAHAT is an acronym for Gerakan Seribu Rupiah Siapkan Jamban Sehat, meaning “The 1,000 Rupiah Healthy Toilets Movement,” which signifies that incremental savings — like 1,000 Rupiah, or less than $0.10 — can add up to big benefits. In Indonesian, “Geser si Jahat” is equivalent to the English expression “Out with the bad.”

“The idea of GESER SI JAHAT came up when I met some community members who are motivated to have their own toilet with a septic tank but had limited financial capacity to build the facility,” said Muliastuti. “USAID IUWASH PLUS helped me to implement the idea by facilitating the discussion with communities to agree on the monthly saving scheme and establish the sanitation forum, [which] collected and managed the community saving.”

Through the program, households contribute 1,000 Rupiah per month for five months toward the cost of a toilet and septic tank. Through their corporate social responsibility funding, local businesses including Mitra Keluarga Hospital and Bank Jabar also contribute.

Sludge Control

In many urban areas, entrepreneurs have stepped in to supplement the provision of services, specifically around removal of fecal sludge. Unfortunately, often these companies dispose of the sludge by dumping it, untreated, in local waterways. IUWASH PLUS helps local governments to develop regulations to curb these practices and ensure septage treatment plants for safe sludge disposal.

In East Java province, a private desludging operator signs a cooperation agreement with Malang city’s UPTD PALD, a municipal wastewater agency. Photo credit: Ristina Aprillia, USAID IUWASH PLUS

In Malang, East Java, for example, the project facilitated a series of discussions between the municipal wastewater agency known as UPTD PALD and 11 private desludging operators. These discussions resulted in a March 2019 cooperative agreement that will allow the private operators to connect with customers via the UPTD PALD, which will develop a customer database and promote desludging services to the wider community.

Both local government and the private operators expect to benefit from the agreement. “Private desludging operators have long been operating in Malang City and have served thousands of customers,” said Ari Kuswandari Yushinta, head of UPTD PALD. “It is necessary for UPTD PALD to establish a partnership with them to ensure that they meet environmental health and safety requirements when delivering their services, including disposing of the septage in the treatment plant.”

“Being a partner of UPTD PALD, I hope we can serve more customers in the future. UPTD PALD will also train the operators to improve service quality,” said Johan Setiawan from CV Prayogo, a private desludging service operator.

“Together with the Government of Indonesia, USAID is creating a market for sanitation products and services to make sure that activities like desludging is self-sustaining beyond the project period because they are creating a market for those services.”

IUWASH PLUS activities promote sustainability, both at the community and national government level, so that the impacts will last long after the project ends. “Together with the Government of Indonesia, USAID is creating a market for sanitation products and services to make sure that activities like desludging is self-sustaining beyond the project period because they are creating a market for those services,” explains Trigeany Linggoatmodjo, senior WASH program specialist with USAID/Indonesia.

Creating this market demand for sanitation begins at the community level with people like Veli Muliastuti, the sanitarian. “We want to build the legacy for the future,” says Lestari. “People like Veli will continue to help after IUWASH PLUS is finished.”

“We are not working alone,” says Damayanti. “If it’s not done hand-in-hand with people who are living there, it will not be sustained.”

By Christine Chumbler

Additional Resources:

This article appears in Global Waters, Vol. 10, Issue 6; for past issues of the magazine, visit Global Waters’ homepage on Globalwaters.org.


Out with the Bad: Strengthening Urban Indonesia’s Water, Sanitation, and Hygiene Systems was originally published in Global Waters on Medium, where people are continuing the conversation by highlighting and responding to this story.

Averting a Cholera Epidemic in the Wake of Dual Natural Disasters

An overhead view of Buzi, Mozambique, shows the devastation caused by Cyclone Idai. Photo credit: Adrien Barbier, AFP

When Tropical Cyclone Idai made landfall March 15, 2019, it pummeled Mozambique’s fourth-largest city Beira and three neighboring provinces, leaving only 10 percent of the port city intact. An unprecedented cyclone in scope and scale, the storm’s flooding and devastation affected nearly 2 million people in three countries (including Zimbabwe and Malawi) and led to the deaths of approximately 960 people. Images of families being rescued from trees in helicopters, flattened homes along the coastline, and inland roads and bridges shorn in two — cutting off access to thousands in need — triggered an outpouring of international response.

Six weeks later, with the region still in the throes of recovery, Tropical Cyclone Kenneth hit the northern section of Mozambique and dealt a glancing blow to the Comoros Islands. The resulting wind and rain damage affected close to 500,000 Mozambicans, killing an additional 45 people.

Back-to-back natural disasters of this scale could have taxed the donors, local governments, and NGOs on the ground, but the catastrophic nature of the disasters prompted a high-level of response and cooperation that put Mozambique and its neighbors in a better position to respond to the second cyclone and help avert a cholera epidemic.

JUST ANNOUNCED: @USAID deployed a Disaster Assistance Response Team to Mozambique in response to massive flooding caused by #CycloneIdai. Working closely with our partners, the team will provide critical lifesaving assistance to the people of #Mozambique, #Malawi & #Zimbabwe

 — @theOFDA

Within days of Idai’s landfall, USAID’s Office of U.S. Foreign Disaster Assistance (OFDA) deployed a 17-person Disaster Assistance Response Team (DART) team comprised of USAID personnel and a Centers for Disease Control and Prevention (CDC) epidemiologist to lead the U.S. Government response. In close coordination with representatives from the Government of Mozambique (GRM) and humanitarian partners, the DART team assessed the situation on the ground and identified the restoration of water, sanitation, and hygiene (WASH) as one of the top priorities.

USAID/OFDA staff assess the needs of Beira and Chimoio cities. Photo credit: USAID/OFDA

Home to the downstream portions of several major southern African rivers, including the Zambezi and Limpopo, central Mozambique’s lowland, coastal geography and topography exacerbated the extent and duration of the flooding, the storm’s death toll, and the subsequent concerns about water contamination. When the rivers began swelling from weeks of rain before and after the cyclone, people could not escape, crops and homes were destroyed, water supplies became contaminated, latrines washed away, electricity and communications were damaged, roads were cut, and bridges collapsed. “The heavy rain up-basin had a great impact downstream,” explains Albert Reichert, WASH technical advisor for OFDA and a member of the DART team.

In response, USAID flew in food and WASH supplies, including jerry cans, water dispensers, emergency water treatment systems, and latrine kits. The DART team met early on and regularly with the key personnel coordinating the overall emergency response — a cholera task force and WASH cluster coordinator — to launch a multi-tiered effort to get clean, chlorinated water to people in need. “When there’s flooding you want a big water supply effort and you want to chlorinate,” says Reichert.

To help prevent the spread of Cholera, USAID airlifted supplies like these water containers to help families store safe drinking water. Photo credit: USAID/OFDA

UNICEF had been working with the local water utility prior to the cyclone and could leverage that relationship early on after Idai to restart municipal water supply systems with USAID support. Meanwhile the response team set in motion emergency water treatment protocols — such as bucket chlorination and household distribution of point-of-use water products — and a massive hygiene education campaign. Though the flood waters receded and access became easier, finding safe water continued to be a problem.

On high alert for cases of acute watery diarrhea and cholera, Mozambique’s Institute of Public Health (INS) requested that humanitarian agencies prioritize the distribution of hygiene kits and hygiene promotion activities to prevent the spread of disease. That community-level effort included mass distribution of Certeza, a local water disinfection product approved for household use. With the knowledge that cholera is endemic to the region, “huge efforts were put into chlorinating the water because of the flooding to prevent disease transmission,” says Reichert.

Staff from USAID and the International Organization for Migration inspect a water point in Dondo District. USAID and other WASH actors rehabilitated water networks in Matua and Mandruzi, two towns in Dondo designated as resettlement areas. Photo credit: USAID/OFDA

Furthermore, Idai displaced more than 200,000 people and flooded or destroyed most household latrines. Accommodation centers for thousands of displaced people lacked toilets, forcing temporary residents to rely upon what remaining sanitation facilities they could find in the neighborhood or defecate in the open, until USAID and other responders established communal facilities. The lack of sanitation in the storm’s aftermath exacerbated the spread of waterborne disease, with the first case of cholera appearing just two weeks after the cyclone.

CDC field workers screen for diarrhea and malaria in Beira, Mozambique. Photo credit: Erika Rosetto/Mozambique FELTP

Mounting a Multi-Tiered Cholera Response

Within 48 hours of the storm, six CDC-trained graduates of the Field Epidemiology and Laboratory Training Program in Mozambique deployed to the affected area to establish surveillance of emerging diseases and investigate and control possible outbreaks. These on-the-ground health experts worked with WHO to verify and confirm reported cholera, however, responders had difficulty initially pinpointing the location of the outbreak due to gaps in information sharing. Reichert, with fellow DART team members and CDC Epidemiologist Dr. Tom Handzel, provided input into the cholera surveillance strategy early on and worked with INS to strengthen existing surveillance efforts. “One of the challenges was how to identify the key locations to focus the WASH resources,” says Handzel.

With support from OFDA and CDC field workers, WHO established an early warning and surveillance system known as “EWARS in a box” to facilitate the reporting of cholera cases and other outbreak-prone diseases in the hardest-hit areas. Handzel explains, “It’s basically a way of helping staff at peripheral health facilities report on a daily basis, using cell phones to send information very quickly.” Relief actors were also on the lookout for outbreaks in Zimbabwe and Malawi, particularly in camps for internally displaced people. Cases that began in Beira’s poorest neighborhood eventually peaked two weeks later at 6,600 with eight deaths before leveling off and dropping.

The story of how Mozambique averted a significant health crisis in the midst of cyclone recovery is one of vigilance, coordination, planning, some luck, and rapid response. The INS requested cholera vaccine within a week of Idai hitting. The international stockpile of vaccine is limited and only available in response to a large outbreak. The GRM already had a plan in place to execute a campaign to blanket vaccinate 90 percent of the most affected areas, a campaign Reichert describes as “very effective.” The vaccines arrived quickly, and 80 percent of the public received their vaccine within the first week, and overall coverage eventually extended to more than 90 percent. Members of the DART team describe passing by five vaccination posts within a 20-minute walk. With immunity beginning to develop within a week of vaccination, the number of new cases started to fall.

With support from USAID and the international community, Mozambique’s Institute of Public Health vaccinated 80 percent of the public in affected areas within a week. Photo credit: USAID/OFDA

Beyond the prevention of new cases, the other critical piece of emergency response involved treatment of existing cases. To that end, NGOs that had responded to Idai with the intention of dealing with trauma victims shifted gears to establish cholera treatment centers. Community-level response of hygiene education and mass distribution of Certeza and hygiene kits continued through the peak of the outbreak. As case numbers started to go down, CDC-trained rapid response teams followed up at the household level to address clusters of remaining cases.

Applying Lessons Learned to the Kenneth Response

WASH and cholera emergency response efforts in the aftermath of Idai set the stage for what was to come after Kenneth, which hit Mozambique six weeks later. Rather than overwhelming the system, the back-to-back cyclones meant that responders had worked out the kinks and hit the ground running. The port city of Pemba in Mozambique’s Cabo Delgado Province became the focal point of emergency response after the second cyclone; staff involved in Idai’s WASH and cholera responses traveled to Pemba to put similar systems in place.

“My impression was that things probably were implemented more quickly and more strategically because lessons learned from one location were easily applied to Pemba,” says Handzel. “The issue we had with getting good quality data where [cholera] cases were coming from in Beira went much faster in Pemba.” The GRM replicated the successful cholera vaccination campaign in Kenneth-affected areas, and OFDA provided support for rapid response teams. While emergency response in the aftermath of Kenneth had some unique challenges, including unrest in some of the affected areas, the number of cholera cases peaked in the low hundreds with no reported deaths.

On the Road to Recovery

Months after enduring these dual disasters, Mozambique and its neighbors continue the arduous task of rebuilding, reestablishing household sanitation, and replanting crops. One effort put in place during the emergency phase with USAID and CDC technical support and funding continues — strengthening water quality monitoring of both piped water systems and household chlorination. INS is now responsible for the monitoring taking place, and UNICEF and the GRM have expressed interest in expanding monitoring to other urban areas.

“I think it helped the utility identify some gaps where they can improve the treatment of water to ensure a more adequate chlorination process throughout the piped network,” says Handzel. “It doesn’t have to be in response to an outbreak, it can be a preventative measure. How can we set up a monitoring system to ensure the quality of water is safe before cholera comes? That is something that we would really like to see.”

Despite suffering through a series of devastating storms, Mozambique and neighboring countries have proven resilient in the face of disaster, equipped with the knowledge and experience that rapid response and smart resource deployment can help emergency responders stave off the worst impacts of future storms.

By Wendy Putnam

Additional Resources:

5 Ways the U.S. is Responding to Cyclone Idai

This article appears in Global Waters, Vol. 10, Issue 5; for past issues of the magazine, visit Global Waters’ homepage on Globalwaters.org.


Averting a Cholera Epidemic in the Wake of Dual Natural Disasters was originally published in Global Waters on Medium, where people are continuing the conversation by highlighting and responding to this story.

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