Afghan Sustainable Water Supply & Sanitation (SWSS) Project, 2012. Sustainable Health Outcomes Unit, Project Final Report.
The USAID Sustainable Water Supply and Sanitation (SWSS) project, led by Tetra Tech ARD, was designed to improve the sustainability of rural infrastructure and the health of rural populations through a balanced commitment to providing water supply and sanitation facilities and improving community hygiene behaviors. It built upon the significant work done in the water supply, sanitation, and hygiene (WASH) sector in Afghanistan over the previous five years. A national policy framework was in place, engineering standards were set, and over 100 projects had provided facilities in rural communities.
Despite this high level of investment, extremely low percentages of rural Afghans used improved water supplies or sanitation facilities. Widespread utilization of water systems, sanitation facilities, and a core set of hygiene behaviors is the foundation for achieving health impacts. Without health impacts, especially among women and children under the age of five, rural water and sanitation (WatSan) projects were not reaching their goal of reducing the time and money spent by farming families on treating diarrheal diseases, allowing them more time for activities that improve their economic well-being.
The Sustainable Health Outcomes component of SWSS, implemented by Management Sciences for Health (MSH), had two sub-components; both aimed at achieving sustainability of health outcomes. The first, the Provincial Strategy, was an integrated approach to hygiene and sanitation consisting of Community-Led Total Sanitation (CLTS) and hygiene education. This would be implemented in six selected provinces. The second, the Flexible Response Strategy, aimed to provide hygiene education to beneficiaries of water supplies constructed by SWSS in many parts of the country.
In the Provincial Approach, CLTS was selected as the strategy to overcome the deficiencies in the Afghan rural sanitation and hygiene program. CLTS works by engaging whole communities in examining and acknowledging the extent and shamefulness of open defecation, its importance in the transmission of diarrheal diseases, and the costs of such diseases to well-being and household finances. This motivates the community to achieve open-defecation-free (ODF) status through ensuring that all households have access to a safe latrine and that everyone uses it. This is achieved without any subsidies and within the scope of the community’s resources. Combining the CLTS approach to sanitation with behavioral change communication approaches, which also emphasizes other aspects of home and personal hygiene, further strengthened this approach. The behavioral change approaches included Family Health Action Groups (FHAGs) for mothers of young children, training of community and religious leaders to reach men, and school programs to reach children.