Community case management of diarrhea, malaria and pneumonia: Tracking science to policy and practice in sub-Saharan Africa, 2012.
Community case management (CCM) increases access to treatment to those beyond the reach of health facilities and has the potential to more equitably address the three largest causes of child mortality in sub-Saharan Africa: diarrhea, malaria and pneumonia.
Based on data from UNICEF country offices, we provide a profile of government policies and implementation of CCM diarrhea, pneumonia, and malaria for sick children aged 2 months-5 years across sub-Saharan Africa in 2010. This offers an aggregated analysis and disaggregated tables for subSaharan Africa and where possible we explain the status of outliers based on correspondence with UNICEF country offices. We also compare our findings with previous data collected by Countdown 2015 to describe trends in CCM pneumonia policy and implementation for sub-Saharan Africa. The following bullet points represent key findings.
- The majority of governments in sub-Saharan Africa have policies supporting CCM of diarrhea, malaria or pneumonia, yet important exceptions remain. Moreover, even when supportive CCM policies exist, CCM programs are not always implemented, and far fewer are implemented at scale.
- Even as CCM pneumonia lags the furthest behind, significant change has occurred. The number of countries in sub-Saharan Africa with supportive CCM pneumonia policies has more than doubled since 2005.
The study presented in October through the blog post: “Fecal Sludge Management: A smelly but fruitful business”, is now available.
The study was funded by the Bill & Melinda Gates Foundation and is entitled “Business analysis of fecal sludge management: emptying and transportation services in Africa and Asia”. The purpose of the study is to analyse the fecal sludge management (FSM) sector and its operating models in 30 cities across 10 countries. 2.1 billion people in urban centres use non-piped sanitation facilities and unavoidably require the emptying of fecal sludge (see picture below). Mismanagement of FSM represents a serious threat to public health and the environment.
The study also aims at filling the important information gaps on this business sector, which is often unregulated and leads to situations where households pay excessive fees for these services or are compelled to undertake emptying manually exposing themselves to serious health hazards.
Chowdhry, S. and Kone, D., 2012. Business analysis of fecal sludge management : emptying and transportation services in Africa and Asia. Seattle, WA, USA: Bill and Melinda Gates Foundation. 116 p.; 47 fig.; 22 tab. With bibliography p. 115-116
Available at: <http://www.washdoc.info/docsearch/title/179741>
By Pascal B. Garde, Consultant, WASH Policy and Governance, @GardePascal
To mark World Toilet Day, the London School of Hygiene & Tropical Medicine in collaboration with Domestos has produced “Toilets for health”, a comprehensive report on toilets and sanitation.
The report, rich in infographics, provides overview of the sanitation crisis and the related burden of disease in developing countries. While it shows that interventions in the water, sanitation and hygiene sector are the most effective ways to address morbidity and mortality, the report concludes that the importance of these interventions in developing countries is not acknowledged.
Roma, E. and Pugh, I., 2012. Toilets for health. London, UK: London School of Hygiene & Tropical Medicine. 28 p. Available at: <www.lshtm.ac.uk/newsevents/multimedia/features/toilets_for_health.pdf>
Source: London School of Hygiene & Tropical Medicine, 19 Nov 2012
Mass media campaign with loudspeaker rickshaw, Bangladesh. Photo: Eawag
Evidenced-based methods are more cost effective than traditional NGO awareness raising approaches to ensure sustained behaviour change in the WASH sector, says environmental psychologist Prof. Hans-Joachim Mosler.
Two of his presentations on evidence-based behaviour change are now available online. An accompanying guideline for behaviour change  was published in June 2012.
Mosler begins his first presentation with examples of failed sanitation and water projects. What they have in common is that they focus on hardware and neglect behaviour change. In one striking study, the construction of new school latrines actually increased health risks among girls because hygiene behaviour did not improve .
Posted in Africa, Hygiene Promotion, Latin America & Caribbean, Multimedia, Publications, Research, South Asia
Tagged behaviour change, EAWAG, evidence-based behaviour change, fluoride removal, handwashing, Hans-Joachim Mosler, RANAS model, shared toilets, videos
Sustaining sanitation is much more expensive than building latrines. The 20-year cost of sustaining a basic level sanitation service per person in certain countries is anywhere from 5-20 times the cost per person of building the latrine in the first place.
This is one of the key findings on costing sustainable sanitation services, which are being highlighted in the first month of the WASHCost campaign. The campaign was launched on 24 October, and every month until March 2013, it brings a roundup of fast facts from the WASHCost research project, experiences from several organisations which are using the life-cycle cost approach and ways to get involved.
“Some very basic elements of human development related to water, sanitation and hygiene that were accepted in the 19th and early 20th centuries are still unavailable to a large proportion of pregnant women in the 21st century”, write the authors of a new Simavi study .
Each year 290,000 women die from complications during pregnancy, birth and the neonatal period; and, an estimated 10 to 20 million women suffer from related health complications. Almost 90% of the maternal deaths occur in Sub-Saharan Africa and South Asia. Much of this is preventable through practices that have long been established.
The Simavi study reviews published literature describing the impact of water, sanitation and hygiene on maternal health and mortality.
One of the most quoted WASH statistics was recently “downgraded”. For every $1 invested in water and sanitation, not $8 but “only” $4 is returned in economic returns through increased productivity. This recalculation , says the World Health Organization, is mainly a result of higher investment cost estimates and the more complete inclusion of operation and maintenance (O&M) costs.
Providing a better insight into O&M costs has been one of the achievements of the WASHCost project of the IRC International Water and Sanitation Centre. WASHCost has published minimum benchmarks for costing sustainable basic WASH services in developing countries . The project collected data from Burkina Faso, Ghana, Andhra Pradesh (India) and Mozambique.
The main message is that spending less than the minimum benchmarks will result in a higher risk of reduced service levels or long-term failure. NGOs claiming that “US$20 can provide clean water for one person for 20 years” have clearly forgotten to include annual recurrent costs for operation and maintenance, capital maintenance and direct support.
The real cost for 20 years of basic water supply from a borehole and handpump would be, per person, between US$ 20 and US$ 61 for construction plus US$ 3-6 every year to keep it working. In total for the 20 years this would amount to US$ 80 to US$ 181 per person.
Similarly, for the most basic sanitation service, a traditional pit latrine, the combined costs would be US$ 37 – 106 per person over 20 years.
Posted in Economic Benefits, Publications
Tagged cost-benefit analysis, Economics of Sanitation Initiative, handwashing, IRC International Water and Sanitation Centre, life-cycle costs, sanitation costs, statistics, WASHCost, Water and Sanitation Program, World Health Organization