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☑ ☆ ✇ Globalwaters

COVID-19 and the Looming Financial Crisis for Water Utilities

By: USAID Water Team
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.

☑ ☆ ✇ Globalwaters

WASH in the Time of COVID-19

By: USAID Water Team

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


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


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


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


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.

☑ ☆ ✇ UN-Water Affiliated News

New policy and guide series to improve water productivity and water use efficiency

By: Anna Nylander

Enhancing the productivity and efficiency of agricultural water is key to increase food production and respond to the growing food demand, while at the same time preserving healthy and sustainable … Read more

The post New policy and guide series to improve water productivity and water use efficiency appeared first on UN-Water.

☑ ☆ ✇ UN-Water Affiliated News

FAO host ‘Youth Innovation in Land, Soil and Water’ webinar

By: Anna Nylander

On Thursday 23rd July, the Food and Agriculture Organization of the United Nations (FAO) Land and Water Division, will host the webinar ‘Youth Innovation in Land, Soil and Water’ at … Read more

The post FAO host ‘Youth Innovation in Land, Soil and Water’ webinar appeared first on UN-Water.

☑ ☆ ✇ WASHeconomics Blog

New paper – trial-based cost-benefit analysis of a CLTS intervention in Ethiopia

By: IanRoss


My colleague Seungman Cha has a paper out this week, which I co-authored with him and others. It’s a trial-based cost-benefit analysis (CBA) of a community-led total sanitation (CLTS) intervention in rural south-western Ethiopia. We estimated intervention delivery costs from financial records and recurrent costs from the trial’s surveys. All outcome data are from the trial (health, time savings, cost of illness) – the trial effect paper is accepted pending revisions at AJTMH, but the protocol is here. Avoided mortality comprised ~60% of benefits, and the base case benefit–cost ratio (BCR) was 3.7. In probabilistic sensitivity analysis, 95% of estimates of the BCR were within a range of 1.9–5.4.

nb. the paper was already under review at IJERPH when the recent controversy about prioritising open access waivers for high-income (!) countries came out. I won’t be submitting more papers to MDPI journals, or reviewing for them, until they report results of the apparently ongoing internal investigation and ensure nothing like that happens again.

Obviously I think you should read the paper. In case you need some persuading, here’s  three important things about it. One is a broad conclusion about the intervention, and the other two are about (the lack of) ex post and/or trial-based economic evaluations in the sanitation sector.

1. Upgrading low-quality latrines

The story of this intervention in Ethiopia is about upgrading poor-quality latrines, rather than ending OD. More detail is in the effects paper when it comes out. OD was already <5% at baseline, so not your typical setting for CLTS. About 75% of intervention group households used private latrines, of which almost all were unimproved. The other 25% used neighbours’ or communal latrines. What the intervention achieved (Figure 1 in the paper) was (i) ~100% coverage of private latrines of varying quality, and (ii) substantial upgrading from unimproved pits to improved (and “partially improved”) pits. Definitions are in the paper, but “partially” in this study essentially meets the JMP definition of improved . Achieving ~70% coverage of ~improved latrines, as opposed to the unimproved latrines typically achieved under CLTS, was probably a key factor in seeing the effect on longitudinal prevalence of child diarrhoea. High baseline usage of latrines of one type or another is also why the value of time savings comprised <30% of total benefits, which is small compared to many such studies.

2. First fully trial-based economic evaluation of a sanitation intervention

Our paper reports a “single study” economic evaluation , meaning that all key* parameter values come from the specific setting rather than being assumptions from the literature. I know of only one other sanitation study which does this: a cost-effectiveness analysis based on a case-control study of a latrine intervention in Kabul, Afghanistan, in the late 90s (Meddings et al., 2004). Our paper is therefore the only fully trial-based economic evaluation of a sanitation intervention, despite such study designs being pretty common in public health. Trial-based economic evaluations are valuable because they show the economic performance of an intervention in real conditions, with high internal validity. They are also not hard to bolt onto existing trials. In my opinion, many or most impact evaluations (RCTs or otherwise) should include an accompanying economic evaluation, if they are to influence investment decisions. It is surprising that researchers do not do them and funders do not demand them, as others have argued recently (Whittington et al., 2020). It is not enough to know whether interventions are effective – we also need to know whether their benefits justify their costs. More importantly, we need to compare the relative economic performance of competing WASH intervention options.

3. Very few ex post economic evaluations of real interventions more broadly

Our Ethiopia study presents an ex post CBA of a specific sanitation intervention – that is, the intervention actually happened. It is quite surprising just how many studies in this literature are of hypothetical interventions. There are only four other examples of ex post economic evaluations of sanitation interventions I know of, in addition to the Afghanistan study above. Two studies in India combine primary cost data from the setting with health impact estimates from secondary sources (Hutton et al (2020); Dickinson et al, 2014). The East Asian studies synthesised by Hutton et al. (2014) also combine primary cost data with secondary outcomes (and are immensely detailed in the country-level reports), though they focus primarily on technologies rather than interventions. Finally, a further Indian study by Spears (2013) combines secondary data on both costs and outcomes.

Hypothetical studies can be very informative, such as a recent one which explored how the extent of uptake (and other factors) influences the economic performance of CLTS (Radin et al., 2020). However, to be able to make investment decisions about which sanitation interventions are most efficient, we need more studies that evaluate interventions which actually happened! Interestingly, the coverage increase for improved latrines achieved by the intervention (~35%) in our Ethiopian study was the same the “high-uptake” scenario in the Radin et al., 2020 hypothetical study, and our headline result is almost identical. However, note the discussion regarding definitions above – the intervention increased coverage of “JMP-improved” latrines by ~60%. That’s quite a lot of upgrading, and a fair amount of new construction as well.


In conclusion, read our paper and reflect on toilet upgrading in rural areas! But more importantly, if you’re currently running or planning an impact evaluation, strongly consider adding a cost-effectiveness or cost-benefit analysis to the protocol. The incremental effort of collecting good-quality cost data is very low compared to the overall research cost of your study. As is the incremental effort in carrying out a cost-effectiveness or cost-benefit analysis. Effectiveness estimates only tell us so much – economic evaluations help us make decisions about investing scarce resources. If the intervention “works”, one of the first things you’ll be asked is how much it costs…


* OK, the case fatality rates come from the Global Burden of Disease study, but very few WASH trials are powered to have mortality as an outcome. Likewise the estimate for value of a statistical life (VSL) is secondary – there are precious few VSL studies in LMICs, let alone undertaken as part of a trial such as this. My point is that the key sources of data for benefits are primary (health effect, value of time, and cost of illness).



☑ ☆ ✇ Globalwaters

A Mother, A Teacher, A Trailblazer

By: USAID Water Team

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.

☑ ☆ ✇ UN-Water Affiliated News

Call for applications: Special Rapporteur on the human rights to safe drinking water and sanitation

By: Anna Nylander

The United Nations Human Rights Council announce that the call for application for the next Special Rapporteur on the human right to safe drinking water and sanitation now is open. … Read more

The post Call for applications: Special Rapporteur on the human rights to safe drinking water and sanitation appeared first on UN-Water.

☑ ☆ ✇ UN-Water Affiliated News

IWRA host online conference on groundwater and climate change

By: Anna Nylander

Visit the conference website here. Send your proposals for oral presentations by Wednesday, July 15th, 2020. More info and details here.

The post IWRA host online conference on groundwater and climate change appeared first on UN-Water.

☑ ☆ ✇ UN-Water Affiliated News

10-year anniversary of the recognition of the human rights to water and sanitation at HLPF

By: Anna Nylander

During the High-Level Political Forum, a side-event will be hosted on 7 July on the 10th Anniversary of General Assembly Resolution 64/292, which recognized human rights to water and sanitation. … Read more

The post 10-year anniversary of the recognition of the human rights to water and sanitation at HLPF appeared first on UN-Water.

☑ ☆ ✇ UN-Water Affiliated News

WHO and UNICEF launch hand hygiene for all global initiative

By: Anna Nylander

The Hand Hygiene for All is a call to action for all of society to achieve universal hand hygiene and stopping the spread of COVID-19. On Friday WHO and UNICEF … Read more

The post WHO and UNICEF launch hand hygiene for all global initiative appeared first on UN-Water.

☑ ☆ ✇ UN-Water Affiliated News

Policy brief on enhancing access to services for migrants in the context of COVID-19

By: Anna Nylander

The recommendations set out in this new policy brief emphasize the practical and principled importance of ensuring inclusive, people-centred approaches that leave no one behind. It emphasises the importance of … Read more

The post Policy brief on enhancing access to services for migrants in the context of COVID-19 appeared first on UN-Water.

☑ ☆ ✇ UN-Water Affiliated News

CDP’s Global Water Report focus on the steps companies are taking to eliminate pollution

By: Anna Nylander

The CDP Global Water Report 2019 analyses the data disclosed through CDP by 2,433 companies in 2019. It finds that companies are not doing enough to tackle water pollution – … Read more

The post CDP’s Global Water Report focus on the steps companies are taking to eliminate pollution appeared first on UN-Water.

☑ ☆ ✇ Water Integrity Network

Water-related commitments in Mexico’s Open Government Plan

By: Water Integrity Network

This blog was written by Cartocritica, as a contribution to the Community of Practice on Water and Open Government.


Access to water is a right that affects various aspects of life: environmental, social and political. It is essential for the conservation of biodiversity, to maintain hygiene, and to support health and livelihoods.

In Mexico, water is considered the property of the nation and the government is responsible for guaranteeing the right to its access, its availability in sufficient quantity and quality, and access to safe sanitation. However, what can be seen in Mexico is desiccated landscapes, polluted aquifers, and communities that lack water access. Even in cases where water is available, quantity and quality are often inadequate. Much water is lost or polluted by excessive toxic discharge, large concessions for industries, and irregular system operation.

When one tries to review official data on volumes of water available, extracted, licensed under a concession, or polluted, it becomes clear that there is little or no information available, and that most of what is available is in restricted access.

Such opacity prevents interested users, especially territory and human rights defenders, from accessing key information that would allow them to know what the state of water resources is in their localities or to promote citizen participation in water management.

This is why more transparency and accountability in the water sector are urgently needed. Incorporating water-related commitments in the Open Government Partnership (OGP) process is a means to address this and enable dialogue between government and civil society.


1. Context: the first water-related open government commitments

Introducing water in Mexico’s Open Government Partnership National Action Plans

Mexico has been a member of the OGP initiative since its creation in 2011. It has to date adopted four National Action Plans. While the second National Action Plan (2013 – 2015) included the governance of natural resources as one of its commitments, it was not until the third National Action Plan (2016-2018) that water was specifically included as a thematic focus. This has to do with the fact that this action plan was intended to address the Sustainable Development Goals (SDGs). The objective of the water-related commitment in the third National Action Plan was:

  • To measure both volume and quality of water consumption and discharges, as well as to promote water reuse, zero discharge of large-scale users and to supervise treatment, making information transparent in order to facilitate citizen participation in monitoring.

Its principal line of action was described as:

  • To promote inter-institutional coordination and the active participation of citizens in order to establish a system (public and open platform and other means of communication), to make up-to-date information available on water volumes extracted and granted in concession, as well as on discharges, based on available and newly created information.

To act on the commitment, the National Water Commission (Conagua) launched a website where documents on water quality were published, although not in line with the original objective (see evaluations on compliance with third plan here and here) and only till early 2018. Documents were then replaced by a link to a web platform featuring a real-time map of installed water meters in the country,  including information on volume extracted at each measurement point, but not on the volume of granted concessions or of discharges. However, the option for downloading open data was difficult to use and the platform ceased to be updated in March 2019.


Mistrust between stakeholders leads to the interruption of work on commitments

Unfortunately, the implementation and monitoring of the commitments made in the third Plan were interrupted in May 2017, following allegations of espionage directed at journalists and human rights defenders, some of whom were active participants in the OGP process. The Núcleo de Organizaciones de la Sociedad Civil (Nucleus of Civil Society Organisations, NOSC) then decided to withdraw from the OGP coordination board, known as the Tripartite Technical Secretariat (STT), on the grounds that there was a lack of trust and no enabling environment for the promotion of dialogue needed to continue the process. The government tried to get support from new CSOs to continue with the implementation of the third Action Plan but did not succeed.

In mid-2018, presidential elections were held in Mexico. The opposition won the election, taking power at the end of that year. In this new scenario, the OGP process was resumed in 2019, with the publication of the fourth National OGP Action Plan on December 10th, 2019.


2. A new commitment

Preparing a fourth National Action Plan with a commitment for water

Following the transition process into the new administration, the Ministry of Public Administration contacted members of civil society and academia (including UNAM, CartoCrítica, Agua para Todos) to review the most relevant issues on their agendas and consider them for future commitments. At that time, transparency and accountability in natural resources management had not shown many signs of improvement. Several civil society organisations were thus making efforts to promote access to natural resource data.

During this new round of meetings, CSOs pointed out that the situation in Mexico was characterised by over-exploitation and pollution of aquifers, vulnerable communities having little access to drinking water, a lack of transparency regarding the volume of granted concessions and of real extraction, and a lack of information on fees paid by private entities and by the real beneficiaries of those concessions.

Such a lack of access to information on the state, management, and protection of water limits the possibilities for constructive public debate and inclusive citizen participation. This lack of access to information also hinders the improvement of public policies that promote equity, efficiency, and sustainability in access to and use of water resources.

Around the time of the meetings, a group of CSOs (Causa Natura, Reforestamos Mexico, the Fund for Environmental Communication and Education, and CartoCrítica) were already working on the design of a Natural Resources Transparency Index (ITRN in Spanish), a tool to measure transparency of public information regarding the management of forests, water, and fishing resources. In this work, recommendations were made for the development of commitments on open government.

Proposals were then made to develop a commitment for water resources, to be integrated in Mexico’s fourth National Action Plan (2019 – 2021). The commitment would identify areas of opportunity to promote openness and dissemination of information in efforts to achieve SDGs (6, 14, 15 and 16), with the joint participation of three parties – government, civil society and the National Institute of Transparency, Access to Information and Personal Data Protection (INAI). An OGP Coordinating Committee replaced the STT and promoted meetings with the CSOs developing the ITRN, as well as with the government entities involved in natural resource management. In the water sector, these were Conagua and Semarnat (Ministry of the Environment).

The meetings resulted in an agreement to include the Index in the fourth OGP National Action Plan, under commitment number 10: Strengthening transparency in forest, water, and fisheries management. The commitment covers two main developments: the implementation of recommendations from the transparency assessments carried out through the ITRN, and the creation of a participatory mechanism called Transparency Monitoring Groups (Grupos de Monitoreo de la Transparencia), to follow up on the progress of this commitment.


The Natural Resources Transparency Index (ITRN): input for the OGP Action Plan Commitment

The ITRN involves an analysis of transparency in the forestry, water, and fisheries sectors, through indicators for three types of data -categorised as active (required by law), proactive (voluntary, useful and available online) and reactive (requested). The ITRN examines these in three axes, or areas, of resource management:

  1. Permits and concessions: rights to use the resource
  2. Subsidies: assistance or aid granted to the population for the use of the resource
  3. Inspection and surveillance: compliance checks on resource-related obligations



The indicators are assessed based on a set of variables (required data) according to their availability and usefulness. A set of variables (and their components) is foreseen for each data or transparency category (Active, Proactive, and Reactive), in each area of management (concessions and permits / subsidies / inspection and surveillance). In order to identify these variables, both officials and users from each sector were involved. Vulnerable groups with direct links to the resources, who are defenders of territories and the main users of the data, in particular women, indigenous peoples and small-scale producers, were also involved in this process.

To date, the variables identified are in the process of being evaluated. For example, one of the variables identified in the Active Transparency category and related to permits and concessions is: information on concessions for the exploitation and use of national surface waters. This variable is broken down into various components such as type of use, concession volume, validity period and location of the authorised point of extraction. A value of 1 is assigned to the variable if the components are available online, 0.5 if incomplete, and 0 if not available.

With the results obtained, specific recommendations will be made for each sector to improve transparency and information access. The commitment made in the OGP Action Plan is to implement these recommendations.


Moving forward with the new commitment

A roadmap was developed to ensure implementation and follow-up of the commitment. This roadmap contains key actions that make it possible to identify the state of the commitment process at any point in time. The creation of the Monitoring Groups is a milestone in this process. These groups are public, inclusive, and have an open follow-up mechanism. They include participants who are also decision makers, and who verify and ensure that recommendations are implemented. They also provide feedback for the future, including new needs, new participants, and new commitments to be monitored.

In the ongoing ITRN assessment of variables related to water resources, several issues have already been identified in terms of transparency and accountability. There is for example too little updated data on quality, extraction volumes granted and effectively withdrawn, and availability of environmental flows.

After this first assessment, it is expected that not only will the information gaps identified be filled and that data will be made available in official websites in a timely and reliable manner and in open formats, but also that this data will be usable by different stakeholders: for a researcher studying the behaviour of a basin as well as for users defending their territories, and their rights.



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☑ ☆ ✇ Water Integrity Network

WIN statement in support of Black Lives Matter

By: Water Integrity Network

The death of George Floyd under the knee of a police officer in the United States of America has thrown a spotlight on the systemic racism and discrimination that affect the lives of Black people every day, across the world.

The Water Integrity Network is not blind to the role that structural arrangements play in producing racially disparate access to adequate water and sanitation. The persisting and often invisible legacy of white supremacist institutions like slavery, apartheid, and Jim Crow segregation entail that race still serves as marker of service delivery in many countries.

WIN is committed to exposing and fighting against the ways in which Black communities and communities of colour – particularly in the Global South – bear the brunt of climate change induced environmental disasters. Now more than ever, we are committed to exposing and fighting against the corrupt forces which contribute to inadequate water and sanitation provision.

Dignified and adequate access to clean water is a matter of life and death and a human right. The Water Integrity Network is dedicated to a world in which equitable and sustainable access to clean water and decent sanitation are not threatened by corruption, greed, dishonesty and wilful malpractice. This world cannot be achieved until Black lives are given equal weight to all other lives.

Racism and injustice breed inequalities to access to water and sanitation, impacting on the health and well-being of Black communities, and on their ability to enjoy equal economic and social opportunities compared to other communities.

WIN supports the call to dismantle systemic racism,  discrimination, and stigmatization wherever it occurs. Meaningful change must challenge existing structures that privilege whiteness and deconstruct barriers facing Black people. In this, we commit to ensuring that the processes that we facilitate with governments and civil society are inclusive. We commit to ensuring diversity in our staff and governance structures, amplifying Black voices and providing a platform for contributions from the Global South.

Radical systemic social change is required for the eradication of the racial injustices Black people face. Through our work, we strive toward a world in which Black lives mattering is a lived reality.

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☑ ☆ ✇ Globalwaters

Ahead of the Curve in Nepal

By: USAID Water Team
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.

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