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✇Sanitation Updates

COVID-19 & Sanitation: Water Currents, August 11, 2020

By: usaidwaterckm

Below is an excerpt from the August 11, 2020 issue of Water Currents and the complete issue is on the Globalwaters.org website :

Water Supply, Sanitation, and Hygiene (WASH) and COVID-19: Critical WASH Interventions for Effective COVID-19 Pandemic Response . World Bank, April 2020. Good and consistently applied WASH and waste management practices serve as essential barriers to human-to-human transmission of COVID-19 in communities, homes, health care facilities, schools, and other public spaces.

Policy and Legislation Linked to COVID-19 and Pandemics . UN Environment Program (UNEP), June 2020. This policy and legislation guidance is intended  to help countries better respond to future waste emergencies such as COVID-19 and includes information on the types of measures that could be put in place, the coverage and scope of the measures, and how to monitor compliance and enforce the measures.

Coronavirus Disease 2019 (COVID-19) Outbreak: Some Serious Consequences with Urban and Rural Water Cycle . NPJ Clean Water, July 2020. Conventional sewage treatment methods with disinfection are expected to eradicate COVID-19. However, for densely populated countries like India that lack adequate sewage treatment facilities, chances of contamination are extremely high.

Waste Management: An Essential Public Service in the Fight to Beat COVID-19 . UNEP, March 2020. With COVID-19 continuing to spread and its impacts on human health and the economy intensifying day by day, governments are urged to treat waste management, including medical, household, and other hazardous waste, as an urgent and essential public service.

Water, Sanitation, Hygiene, and Waste Management for the COVID-19 Virus: Interim Guidance . WHO, April 2020. This interim guidance summarizes WHO guidance on water, sanitation, and health care waste relevant to viruses, including coronaviruses and supplements previous infection prevention and control documents.

Exploring the Correlation Between COVID-19 Fatalities and Poor WASH (Water, Sanitation and Hygiene) Services . Medrxiv, June 2020. In this study, researchers analyzed the latest data on COVID-19 fatality rates in sub-Saharan Africa with indicators of safe water and sanitation governance and found a strong correlation between a higher case fatality rate and poorer access to safe drinking water and safe sanitation.

Global Socio-Economic Losses and Environmental Gains from the Coronavirus Pandemic . PLoS One, July 2020. Using a global model, the authors of this study captured the direct and indirect spillover effects of COVID-19 in terms of social losses, economic losses, and environmental effects.

Wastewater/Wastewater Surveillance
Wastewater Surveillance for COVID-19: An African Perspective . Science of the Total Environment, November 2020. During the COVID-19 pandemic, early warning wastewater systems have been proposed as a platform for surveillance and a potentially important public health strategy to combat the disease. This short communication on wastewater surveillance in sub-Saharan Africa highlights challenges, opportunities, and alternatives taking into account local context.

Wastewater Surveillance for Population-Wide COVID-19: The Present and Future . Science of the Total Environment, September 2020. This article explores wastewater-based epidemiology (WBE), which the authors believe holds the potential as a key tool in containing and mitigating COVID-19 outbreaks while also minimizing domino effects, such as long stay-at-home policies that stress humans and economies alike.

Computational Analysis of SARS-CoV-2/COVID-19 Surveillance by Wastewater-Based Epidemiology Locally and Globally: Feasibility, Economy, Opportunities and Challenges . Science of the Total Environment, August 2020. In this study, researchers computationally examined wastewater as a matrix for detection of COVID-19 and found that combined use of WBE followed by clinical testing could save billions of U.S. dollars.

Read the complete issue .


✇Sanitation Updates

eCompendium of Sanitation Technologies 2020

By: usaidwaterckm

eCompendium of Sanitation Technologies

Reliable planning of sanitation service chain solutions in emergencies
The eCompendium is a comprehensive and well-structured online capacity development and decision support tool that allows real time filtering and configuration of entire sanitation service chain solutions in emergency settings.

It provides detailed information on key decision criteria for all tried and tested emergency sanitation technologies, information on cross-cutting issues and available case studies, relevant to come up with informed sanitation technology decisions in emergencies.

The eCompendium is a systematic compilation of all relevant emergency sanitation technologies. It disaggregates the sanitation service chain into their functional components, defines key terminology and provides concise information on key decision criteria for a wide range of emergency sanitation technologies and related cross-cutting issues.

It facilitates informed decision-making by providing the necessary framework for identifying appropriate technology combinations in a given context and for configuring entire sanitation service chain solutions: from the toilet via collection, transport, treatment to safe disposal and reuse.


✇GHP Blog

Incorporating nudges into COVID-19 Communication and Prevention Strategies

By: apalomares

By: Julia Rosenbaum, USAID WASHPaLS Project (FHI 360)

Nudges are physical cues that influence people to behave in a certain way, without particular messaging or promotion of any behavior. Nudges avoid direct instruction, mandates or enforcement. The term “nudge” became popularized starting in 2008, after publication of Thaler and Sunstein’s book by that name. Nudges engage audiences at a subliminal level and work ‘reflexively’, rather than providing information to audiences to ‘reflect’ upon and then act. Nudges are reflexive not reflective.

Nudge theory operates by designing elements or ‘architecture’ in the environment which encourage positive or improved behaviors. Nudge principles have been applied for social good as well as in commercial marketing. For example, when searching for a hotel room on priceline.com, the pop-up saying, 5 people are looking at this hotel right now! nudges browsers to not lose the opportunity and book now! At an airport or food court, bakeries intentionally emit sweet cinnamon scents to spur you to buy donuts or cinnamon buns. Nudging has also been successfully used for traffic safety, recycling and toilet etiquette.

In what has now become the iconic handwashing nudge example, cheerful footsteps in demarcated pathways led Bangladeshi school children from school latrines to handwashing stations brightly decorated with handprints. These nudges were found to be an effective way to nudge children to wash their hands after the toilet. Without additional handwashing education or motivational messages, handwashing with soap among school children increased from 4% at baseline to 68% the day after nudges were completed, and 74% at both 2 weeks and 6 weeks post intervention. (Dreibelbis et al, 2016). A second, larger trial showed nudges to be as effective as intensive health education without the intensive or expensive effort. (Grover, Hossain, Uddin, Venkatesh, Ram & Dreibelbis, 2018). The findings generated high interest in integrating nudges into behavior change programs; including, handwashing in health facilities (INudgeyou, 2016), schools (Thrive Networks, 2017), and communities.

While not explicit to nudge theory, easy access to any required supplies or equipment (called ‘enabling technologies’ because they remove obstacles to action) also facilitates the practice of behaviors. Linking nudges with access to flowing water and soap further facilitates behavior change, which is why nudges are often placed near handwashing stations with soap and water.

As we scramble to respond to the COVID-19 crisis, we suggest one effective approach, which is to incorporate nudges into COVID-19 communication and prevention strategies.

Key COVID-19 prevention strategies include:

  • Frequent handwashing, including when returning home from trips outside;
  • Avoid touching your nose, mouth, or eyes; and
  • Social distancing by maintaining two meters or six feet apart.

Handwashing nudges have been elaborated and evaluated, primarily in school contexts. Footpaths, footprints, hands, and ‘watching eyes’ successfully nudge handwashing, as do mirrors (calling audiences to check their appearance in the glass). Again, placement of the nudges matters.

Nudges for other COVID-related prevention behaviors have not yet been defined, but collective brainstorming will help to develop possible nudges for different contexts.

As a start, we suggest nudges to spur social distancing might include painting six-foot rulers at the entrances to parks and markets. When walking or waiting in small groups, a two-meter (six foot) string or bright ribbon kept taut to assure the ideal distance is maintained. Others seeing the string — whether taut or flaccid — will be reminded to keep the safe distance from others.

There is some debate as to the effectiveness of various types of facemasks, particularly home-crafted masks, at protecting against aerosols that transmit coronavirus. Nonetheless, in addition to any partial protection offered by masks, the use of masks may nudge AWAY from bringing hands to your mouth or nose. Wearing one at the supermarket the other day, I stopped myself from wetting my finger to open a plastic produce bags (commonly used in US supermarkets). Gloves might also nudge ‘hands off’, however the effect could wear off as the wearer becomes more accustomed to the feel of the gloves.

As we enter into an unprecedented time, it is important to consider the use of nudges in our response strategies to assure swift and sustained preventive action.

✇Sanitation Updates

WASH & COVID-19 – Water Currents, March 2020

By: usaidwaterckm

This special issue contains links to key websites as well as studies and reports that discuss the water, sanitation, and hygiene (WASH)–related aspects of COVID-19. With the release of additional funding, to date USAID has committed up to $100 million in financing from the Emergency Reserve Fund for Contagious Infectious-Disease Outbreaks for 25 countries affected by novel coronavirus (COVID-19) or at high risk of its spread.

The COVID-19 virus is transmitted through two main routes: respiratory and contact. No evidence to date suggests that the virus is present in surface or groundwater sources or transmitted through contaminated drinking water. And no evidence to date suggests that the COVID-19 virus has been transmitted via sewerage systems, either with or without treatment.

The provision of safe WASH conditions is essential to protecting human health during all infectious disease outbreaks, including the COVID-19 outbreak. Below are some WASH–related infectious disease prevention and control measures. 

  • Ensuring good and consistently applied WASH and waste management practices in communities, homes, schools, marketplaces, and health care facilities will further help to prevent human-to-human transmission of the COVID-19 virus.
  • Frequent and proper handwashing with soap is one of the most important measures that can be used to prevent infection with the COVID-19 virus. WASH activities aiming to respond to COVID-19 should work to enable handwashing by improving services and facilities and using proven behavior change techniques. 
  • Reliable water services in health facilities and households are critical to ensuring both sufficient quantities of safe drinking water and the ability to maintain hygiene (including hand hygiene, laundering, cleaning, and disinfection). 

Read the complete issue.


✇IRC Sanitation

Water, sanitation, hygiene and waste management for COVID-19

By: Anonymous

Technical brief on providing guidance on water, sanitation and health care waste that is relevant to viruses, including coronaviruses.


This technical brief supplements existing World Health Organization (WHO) documents on infection prevention and control (IPC) by referencing and summarising the WHO guidance on water, sanitation and health care waste that is relevant to viruses, including
coronaviruses. This technical brief is written, in particular, for water and sanitation practitioners and providers. It is also for health care providers who want to know more about water, sanitation and hygiene (WASH) risks and practices.

✇Sanitation Updates

New WHO Guidelines on Sanitation and Health

By: usaidwaterckm

Guidelines on sanitation and health. WHO, October 1, 2018.

Safe sanitation is essential for health, from preventing infection to improving and maintaining mental and social well-being. who

Developed in accordance with the processes set out in the WHO Handbook for Guideline Development, these guidelines provide comprehensive advice on maximizing the health impact of sanitation interventions.

The guidelines summarize the evidence on the links between sanitation and health, provide evidence-informed recommendations, and offer guidance for international, national and local sanitation policies and programme actions.

The guidelines also articulate and support the role of health authorities in sanitation policy and programming to help ensure that health risks are identified and managed effectively.

The audience for the guidelines is national and local authorities responsible for the safety of sanitation systems and services, including policy makers, planners, implementers within and outside the health sector and those responsible for the development, implementation and monitoring of sanitation standards and regulations.



✇WASHeconomics Blog

Water supply & diarrhoea – latest systematic review and economic implications

By: IanRoss

An update to the WHO-led systematic review of the ‘Impact of drinking water, sanitation and handwashing with soap on childhood diarrhoeal disease’ by Wolf et al. (2018) was published in TMIH in May.

I re-read it last week with a water supply hat on, and was interested to see how they’ve improved on the 2014 version. The main difference, apart from including studies recently completed, is that they’ve updated the structure of the meta-regression to allow for separate results for “piped water, higher quality” and “continuous piped water”. This means there’s additional comparisons to be made (with more relevance for SDG6 “safely managed” definitions).

As background, their meta-regression approach allows estimation of service level transitions that have not been directly observed in studies. This builds on ‘network meta-analysis’, a technique increasingly being used in economic evaluations of health interventions where there are no head-to-head trials between options.

Below is my visualisation of the key results (building on the diagrams of the 2014 review’s results in this WHO publication). The numbers are percentage reductions in diarrhoea morbidity risk associated with each transition – explanation below the figure.

wolf et al* / ** see note at bottom of post

I made this based on table 3 of Wolf et al. 2018, calculating % reduction = 1 – risk ratio. In my view, the transitions most likely to happen in practice, as a result of investments, are the incremental ones. Therefore, I have put these in bold blue. Those transitions less likely are in bold back, and those fairly unlikely are in italics. By “unlikely”, I mean that those people remaining with unimproved water are now predominantly in rural areas, where the direct transition to a safely managed water supply (meeting SDG criteria for both quality and continuity) is unlikely to be affordable in many settings. This reduction (75%), which the authors estimated indirectly, would appear to be the reduction maximally achievable with water supply. Some more notes are at the bottom of this post.

What should we make of these results? I would make two observations, and then two arguments based on the economic implications.

  1. There is good evidence that improving people’s water supplies can reduce diarrhoea, which is among the top three contributors to the all-age disease burden amongst the two quintiles of countries with the lowest human development. For the transitions in the figure previously reported in the 2014 review, the only change is that the point estimate for improved off-plot to piped on-plot has fallen from 14% to 13%.
  2. The reduction varies by level of service attained. Piped water reduces diarrhoeal morbidity more than off-plot supplies, when provided at high quality and continuity. The continuity effect most likely happens via a direct increase in quality, though also via the fact that people are less likely to use secondary sources and improper storage.

What does this mean for the economics of water supply provision, specifically the comparison of investment options?

  1. There is an equity/efficiency trade-off to be made in investment prioritisation. Improving water quality in existing piped supplies has the largest single incremental effect (68%), and there are hundreds of millions of people in urban areas of developing countries using piped services which are not safely managed. Investments in this area are therefore important. However, any improvement in service level for populations using unimproved supplies should arguably be the highest priority on equity grounds, even if to an improved off-plot supply which has only an 11% reduction. Firstly, these populations are most likely to concentrated in rural areas where mortality risk from diarrhoea is highest. Furthermore, in such populations the 11% reduction is likely to be applied to a number of annual diarrhoea cases per capita which is higher than in most urban areas, where people also live closer to health services. Decisions obviously also take place not only on the effects side of the equation, but the cost side too.
  2. Broader benefits should also be taken into consideration. Time savings are often associated with a move from unimproved to off-plot improved supplies (and again in a move from there to on-plot piped). These have an economic value. Water quantity increases associated with a move to on-plot supplies decrease the opportunity cost of using water for handwashing, meaning it is more likely to happen. While improved continuity has a much smaller incremental impact (17%) than improved water quality (68%), improvements in continuity reduce wasted time and money invested in coping strategies and the use of secondary sources. These results are also based on a small number of studies (see below). In short, any decision should be based on a lot more than relative risk reductions.

Decision-makers are rarely faced with simple choices of ‘urban versus rural’, ‘pipes versus handpumps’, or ‘quality versus continuity’. The factors above are all built into the calculus of local government agencies and Ministries of Water when they make their investment plans. I would argue that the principle of “first a basic service for all” should be factored into any such decisions.


  • The bold blue figures are the ones for which we have studies with a direct comparison (though studies also exist comparing unimproved and piped) – see table 2 in the paper.
  • The asterisks denote that transitions to “piped, higher quality” rely on one study, and to “continuous supply” on two studies (against 6, 7 and 11 studies for other key transitions). So, these should be interpreted with caution.
  • I left out the results for point-of-use filters with safe storage to avoid cluttering the diagram, but the reductions for these are 48% (on an unimproved source). POU chlorination has limited impact after blinding is accounted for.
  • These are point estimates. Some of the upper bound 95% confidence intervals for risk ratios in table 3 are higher than 1, i.e. the result is not statistically significant.


wolf et al

✇Sanitation Updates

Recent WASH research on handwashing, latrine use, CLTS, water quality

By: usaidwaterckm


Acceptability and Feasibility of Sharing a Soapy Water System for Handwashing in a Low-Income Urban Community in Dhaka, Bangladesh: A Qualitative Study. AJTMH, June 2018.

Washing with hope: evidence of improved handwashing among children in South Africa from a pilot study of a novel soap technology. BMC Public Health, June 2018.

Small town water services sustainability checks: development and application in Ethiopia. Water Policy, June 2018.

Water Sector Reforms, Commercialization and Financial Sustainability of Public Water Utilities in Kenya: The Case of Homa Bay Water and Sewerage Company Limited. International Journal of Business and Management, June 2018.

Quantifying Averted Disability-Adjusted Life Years as a Performance Indicator for Water Quality Interventions: A Review of Current Methodologies and Challenges, Water, http://www.mdpi.com/2073-4441/10/6/744

A Review of In-Situ and Remote Sensing Technologies to Monitor Water and Sanitation Interventions, Water, http://www.mdpi.com/2073-4441/10/6/756

Health, livelihood, and environmental impacts of the distribution of a carbon-credit-financed, large-scale water filter and improved cookstove programme in Rwanda, Lancet Planetary Health, https://www.thelancet.com/journals/lanplh/article/PIIS2542-5196(18)30116-5/fulltext

Effect of precipitation on clinic-diagnosed enteric infections in children in Rwanda: an observational study, Lancet Planetary Health, https://www.thelancet.com/journals/lanplh/article/PIIS2542-5196(18)30099-8/abstract


Using behavioral science to promote latrine use in rural India. 3ie, May 2018. This video captures insights on the barriers to latrine use in different states in India and reinforces the need for high-quality evidence on effective behaviour change interventions for informing sanitation programmes and policies.

Lessons learned from the Safe Water Phase 2 initiative (2015-2018): a WASH Talk podcast. IRC, June 2018. CEO of the Cambodian social enterprise Hydrologic, Rachel Pringle, and Managing Director of the Netherlands-based non-profit Aqua for All, Sjef Ernes, talk to host, Andy Narracott, about their lessons learned in developing viable BoP business models.

Menstrual Hygiene Webinar Series. WASH United.


Does CLTS target the right psychosocial factors to succeed in triggering households to build latrines? RANASMosler, June 2018. Two articles on a study in Mozambique analyzed whether CLTS is connected to the RANAS psychosocial factors that influence latrine building and latrine rebuilding after collapse.



✇Sanitation Updates

Recent WASH research on water quality, sanitation and gender, community management and other topics

By: usaidwaterckm


Adherence to Point-of-Use Water Treatment over Short-Term Implementation: Parallel Crossover Trials of Flocculation–Disinfection Sachets in Pakistan and Zambia. Environ. Sci. Technol., May 2018.

Access to Household Water Quality Information Leads to Safer Water: A Cluster Randomized Controlled Trial in India. Environ. Sci. Technol., April 2018.

Access to water and sanitation among people with disabilities: results from cross-sectional surveys in Bangladesh, Cameroon, India and Malawi. BMJ Open, June 4.

The evolution and importance of ‘rules-in-use’ and low-level penalties in village-level collective action. Water Alternatives, 2018.

Community management or coproduction? The role of state and citizens in rural water service delivery in India. Water Alternatives, 2018.

A Community-Designed Play-Yard Intervention to Prevent Microbial Ingestion: A Baby Water, Sanitation, and Hygiene Pilot Study in Rural Zambia. AJTMH, June 4.

Mealworms as an environmentally sustainable solution to malnutrition and food insecurity. The Lancet, May 28.


Strengthening participatory irrigation management in Tajikistan. IWMI; USAID, June 2018.

Maintaining Water Security in Peru Through Green Infrastructure: An Ecosystem-based Adaptation Approach. USAID, May 2018.

A global overview of national regulations and standards for drinking-water quality. WHO, 2018.


The Other Side of Gender: Sanitation, Men and Boys. IDS CLTS,  May 17, 2018. How can men and boys can be more meaningfully engaged in the sanitation and hygiene process to achieve sustainable behaviour change and a new social norms?

Webinar summary: Systems approaches to hygiene behavior change – lessons across WASH, health, and education. GHP; IRC, June 1, 2018.

Water Governance, Training and Gender in Agriculture: A New Evidence Base. Agrilinks, May 24, 2018.


Taps and toilets aren’t enough: designing WASH programmes that strengthen the system. WaterAid, June 19.

Can we regulate small and rural water supply and sanitation operators in Latin America? Water Blog, June 18.

Gaining new insights into CLTS and rural WASH from field visits to Babati and Karatu districts, Tanzania. IDS CLTS, June 11.


In USAID Redesign, Water Is Grouped with Food and Climate. Circle of Blue, June 1.


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