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sanitation

Reading ICAI’s review of DFID WASH results

Suvojit Chattopadhyay's picture

The Independent Commission for Aid Impact (ICAI), UK’s aid watch dog, today, released its review of DFID’s programming and results in water sanitation and hygiene (WASH). In this impact review, they take a close look at the results DFID reported in its 2015 Annual Report; results that cost £ 713 million between 2010 – 2014. 

Do read the full report here.

Some thoughts on the areas of concern in the report:

  • The focus on ‘leaving no one behind’ is spot on. It is easy to stack up impressive WASH numbers if one ignores the poorest and the most vulnerable in communities. Safe sanitation and hygiene need to be universal for health benefits to accrue to communities. Within WASH, sanitation is specifically complex, sometimes also called a ‘wicked problem’ – a challenge foremost, of inducing lasting behaviour change. The very nature of careful social engineering required to bring about this behaviour change seems to run contrary to some of the factors that make an intervention scalable – an ability to standardise inputs and break programme components down to easily replicable bits.
  • Within the broad basket of ‘service delivery’ interventions, WASH is one of the trickier sectors when it comes to measuring sustained impact, especially at scale. Naturally then, ICAI find that while DFID’s claims of having reached 62.9 million people are broadly correct, it is very hard to establish if the benefits are sustained. Therefore, the results reported remain at the ‘output’ level and that is what ICAI ends up assessing, even though what they set out to do is an ‘impact’ review. While the report speculates on sustaining benefits beyond the 2011-15 period, I wonder whether those that accessed the programme in 2011-12 continued to experience any benefits in 2015.
  • The link with government systems, in terms of implementation, monitoring and sustenance remains unclear: another typical WASH issue. Barring say, India, (and this is true especially in sub-Saharan countries, government WASH budgets are highly inadequate. A lot of the work that happens is funded by donors and this implies that monitoring and maintenance happens outside the official system. Achieving local ownership in such a context is a challenge.
  • ICAI finds it difficult to assess value for money (VfM) in DFID’s WASH programmes. On one hand, it finds that there isn’t enough competitive procurement, but also there is a lack of established metrics and benchmarks to analyse VfM. Following DFID’s own 3Es framework, an Economy and Efficiency analysis should be possile across the portfolio, and as far as I can tell, is rapidly being developed in the sector, and within DFID. However, partly as a consequence of the lack of ‘outcome/impact’ data, cost-effectiveness studies are likely to remain a challenge. This work by an OPM-led consortium should be particularly relevant in improving VfM analysis across the sector.

Meaty issues on the radio

BBC Media Action's picture

Ehizogie Ohiani, a Producer/Trainer for BBC Media Action in Nigeria, discusses how radio is raising awareness about the lack of hygiene amongst the butchers of Benue State, Nigeria.

A meal without meat is as good as no meal for most people in Benue State, North Central Nigeria. Considering its importance, one would expect that hygiene surrounding the preparation and sale of meat would be held in the same high esteem. This is not the case.

A murky mix of flies, blood, water, muddy walkways, sweaty bodies and smoke combine to make the abattoirs in the marketplaces of Benue State a perfect breeding ground for disease. Lack of adequate sanitation knowledge, lack of enforcement by market associations and insufficient supervision of animal slaughter by qualified veterinary officers conspire to create major health challenges for communities.

I was at Harvest FM, a local radio station in Benue State, to train producers. We were brainstorming ways we could use their popular early morning show “Good Morning Benue” to help serve the public interest. For the producers, an obvious choice was to discuss hygiene in abattoirs.

The programme explored a number of problems in the state’s local abattoirs: an absence of toilet and handwashing facilities and the practice of washing meat with untreated water sourced direct from the River Benue.

Tackling cholera through radio in Kenya

BBC Media Action's picture

David Njuguna, a mentor for BBC Media Action Kenya, looks at how a volunteer-run local radio station is helping prevent cholera in Kenya.

Kamadi, presenter at Mtaani Radio in Nairobi, Kenya
Kamadi, presenter at Mtaani Radio in
Nairobi, Kenya

Last year Kenya was facing a devastating cholera outbreak. It started in the capital, Nairobi and by June 2015, a total of 4,937 cases and 97 deaths had been reported nationally.

According to public health officials, the spread of cholera in Nairobi particularly affected people living in slums. Frequent bursting of sewer lines, poor sanitation facilities and heavy rains played a major role in the outbreak. Poor hygiene practices – such as not washing hands before eating or preparing food – also contributed to the spread of disease. The outbreak eventually petered out, but the environment and practices that contributed to the spread of cholera continue to pose a threat.

In a quiet courtyard, away from the hustle and bustle of Nairobi’s Kawangware slum, a community radio station was planning a response.

Local radio

Mtaani Radio, run by a team of volunteers, was a hive of activity when I walked into their studio last week. They were recording content for ‘WASH Wednesdays’, a show looking at ways listeners can improve their health and hygiene. The show, reaching over 100,000 people in the Kawangware community, was just about to start.

What can historical success teach us about tackling sanitation and hygiene?

Duncan Green's picture

Ooh good, another ‘lessons of history’ research piece. Check out the excellent new WaterAid report: Achieving total sanitation and hygiene coverage within a generation – lessons from East Asia.

The paper summarizes the findings of four country case studies: Singapore, South Korea, Malaysia and Thailand, all of which produced ‘rapid and remarkable results in delivering total sanitation coverage in their formative stages as nation states’. I can certainly vouch for Singapore – I spent 3 years there as a child in the late 60s. Whenever the rains came, the main roads flooded, turning the city into an insanitary swamp. Not any longer.

The paper concludes: ‘Although their initial conditions were very different from those currently found in ‘fragile’ and ‘least-developed’ countries in Africa and South Asia, some useful conclusions can be used to inform discussions on development of strategic approaches to delivering sanitation for all:

Campaign art: Want to be a hero? First, go wash your hands.

Roxanne Bauer's picture

People, Spaces, Deliberation bloggers present exceptional campaign art from all over the world. These examples are meant to inspire.

Hand-washing is one of the single best habits any individual can adopt to lead a healthier, happier life. Hand-washing with soap is an extremely effective and inexpensive way to prevent diarrhea and acute respiratory infections, including pneumonia, which is the number one cause of mortality among children under five years old, according to the World Health Organization. Over 2 million children die from pneumonia each year, and diarrhea and pneumonia together account for almost 3.5 million child deaths annually. Simply hand-washing with soap could, though, could reduce the number of deaths due to diarrhea by almost half and deaths from acute respiratory infections by one-quarter, saving more lives than any single vaccine or medical intervention.

These are some of the many reasons that Global Handwashing Day was established. It is observed on October 15 with the aim of increasing awareness and knowledge about the importance of hand-washing with soap to prevent diseases and save lives.

The following video, produced by Help Nepal.today, encourages people in Nepal to wash their hands with soap. The lyrics ask, “How can Sabunman fly? Why is his body so strong?" and answer “Because before eating a meal he washes his hands with soap and water.”  Composed and performed by Almoda Rana Uprety, "Kina Udcha Sabunman," cheers kids to defeat the dirt monsters by washing their hands before they eat and after they play or use the bathroom.
 
VIDEO: Kina Udcha Sabunman (How can Sabunman Fly?)


Six steps to a successful sanitation campaign

Suvojit Chattopadhyay's picture

new latrineInadequate sanitation costs India $54 billion a year. To that, add the challenge of juggling our nationalistic aspirations of superpowerdom with the ignominy of housing the largest share of human population that defecates in the open.  In light of this, here are six steps to a success sanitation campaign.

Amid many reports that the Swachh Bharat Abhiyan (SBA) is failing, we need a dose of optimism. While SBA might be failing, it certainly isn’t the first, nor will it be the last state-led sanitation programme to fail in India. Our large schemes to tackle this challenge have, more often than not, ended up as models of just what one should avoid doing if they are serious about bringing about total sanitation.
 
It is now widely acknowledged that conventional approaches are not working: those that set up a false dichotomy between construction and behaviour change; those that are content with pit latrines as opposed to functional toilets; those that use reductionist conceptions such as communities being open defecation free rather than focusing on personal and environmental sanitation and hygiene as a whole; and those that settle for incremental coverage instead of full coverage from the start.
 
However, it’s not that there are no success stories within India or in our immediate neighbourhood. For one, the experiences of locally-embedded NGOs that have taken their interventions to scale can be highly instructive. There have also been state-led successes in Maharashtra and Himachal Pradesh that can offer valuable lessons. So what could some key design elements in a sanitation programme be?
 

Why do sanitation campaigns fail?

Suvojit Chattopadhyay's picture

The study finds that the govt’s rural sanitation programme, implemented by NGOs, was unable to reduce exposure to faecal matter.

A recently published Lancet paper looks at the impact of the erstwhile Total Sanitation Campaign in the coastal Puri district in Odisha. The study finds that the government’s rural sanitation programme, implemented by NGOs and community-based organisations, was unable to reduce exposure to faecal matter. As a result, this sanitation programme had no impact on the incidence of diarrhoea and malnutrition. The authors of the paper conclude that in order to realise concrete and sustainable health benefits, sanitation programmes need to increase both the coverage and use of toilets, as well as improved hygienic practices.

No one denies the importance of good sanitation and the impact it has on human health. It must follow therefore that the lack of positive impact is down to poor implementation of the sanitation programme in the study area. In fact, a process evaluation of the programme concludes that the implementation was far from perfect, both in terms of the levels of coverage achieved and the levels of awareness. Over an implementation period of 13 months (January 2011—January 2012), the villages where the programme was implemented saw an increase in toilet coverage from 9% to 63%, but only 38% of the households had a functional toilet. It would have been interesting to learn more about the gap between toilet construction and usage (25 percentage points). In any case, the state of implementation, the authors point out, is typical of the prevalent Total Sanitation Campaign across the country.
 

The false dichotomy among sanitation-for-all advocates

Suvojit Chattopadhyay's picture

The sanitation debate has suffered from a seemingly irreconcilable dichotomy when it comes to identifying the best approach towards sanitation for all.

A good way of blocking progress in an argument is to present two aspects of a whole as a dichotomy. The sanitation debate, in recent years, has suffered from a seemingly irreconcilable dichotomy when it comes to identifying the best approach towards sanitation for all. This is the one that pits subsidies against motivation and correspondingly, construction against behaviour change communication. And yet, in a comprehensive and prudent programme design, there is no need for these ideas to be opposed to each other. I call this then, the false dichotomy in the world of sanitation advocates.

The current sanitation programme in India has at its centre a subsidy and incentive for individual households constructing toilets. This is a programme that has clearly not worked, irrespective of the minister or bureaucrat at the helm of affairs. India holds the ignominious record of having the largest number of people defecating in the open. At the same time, the popularity of the community-led total sanitation (CLTS) approach has risen. This approach depends on using shame and motivate as a call to action to build basic pit latrines (rejecting subsidies completely) and has worked in multiple countries around the world, as well as in certain states in India.
 

Technology Alone Will Not Save the World: Lessons from the 2015 Gates Letter

Suvojit Chattopadhyay's picture

Melinda and Bill Gates have made an annual tradition of publishing their thoughts on international development and its key challenges. Given the substance, I assume these letters reflect an annual manifesto for the organisation they head, the Bill and Melinda Gates Foundation (BMGF). Last year, I wrote about how the Gates Annual Letter was disappointing, perhaps not in the context of what the BMGF itself does, but what it ought to be doing, given its $42 bn muscle and its influential promoter, Bill Gates.

This year, the letter makes four “big bets” for 2030: child deaths will go down by half, and more diseases will be eradicated than ever before; Africa will be able to feed itself; mobile banking will help the poor radically transform their lives; and better software will revolutionise learning. In short, fast-tracking the identification ­technological fixes and expanding their reach over the next fifteen years will deliver a better world.

Unfortunately, these bets seem to me to be wildly optimistic. I may be quibbling, but from what we have learnt from research, there seem to be many reasons to suggest that we should be cautious with our optimism regarding what we can achieve with technology. The complexities of working on power, politics and implementation find no mention in the letter. Let us look a little more closely at each one of the bets to find out why that matters so much.

The Things We Do: Shame is a Powerful Thing

Roxanne Bauer's picture

Billions of dollars are spent each year on sanitation, healthcare, and good governance, but the results vary quite a bit from place to place.  What separates successful programs from the unsuccessful?
 
Those that achieve their goals try to change behavior alongside introducing new methods or making investments. One way to change behavior is to use shame— an overwhelmingly negative emotion —to emotionally link individuals to the communities in which they live.
 
Shame and Sanitation

Shame was, in fact, a central ingredient to a program in Bangladesh that reduced the percentage of Bangladeshis defecating out in the open from 19% in 2000 to only 3% in 2012.

The program utilized the Community-Led Total Sanitation (CLTS) method, which “focuses on instigating a change in sanitation behaviour rather than constructing sanitation infrastructure.” Changes in sanitation behaviors are accomplished through a process of deliberation and discussion within communities to build consensus on the need to end open defecation and clarify the hazards that open defecation poses.

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