Category Archives: Sanitation and Health

A Community Approach to Better Public Health in Rural Liberia

A Community Approach to Better Public Health in Rural Liberia. Global Waters, June 2016

Liberia is no stranger to difficult times, having weathered a devastating Ebola outbreak and now struggling through a slow economic recovery. Lost amid the headlines from these events is the story of Liberia’s quiet public health victories.

liberia

Residents of Lofa County’s Vahun district in Liberia gather to discuss strategy for sustaining recent local sanitation improvements. Photo Credit: Global Communities

Half of Liberia’s 4.5 million people live in the countryside and roughly the same amount practice open defecation.

This practice has jeopardized public health by facilitating the spread of diseases that cause diarrhea, Liberia’s sixth leading cause of death and the primary cause of childhood morbidity and mortality.

However, thanks to two programs that championed community-led sanitation improvements, USAID has now helped 1,500 Liberian communities achieve open defecation-free (ODF) status — fueling optimism about continued public health improvements in the near term

Read the complete article.

The Knowledge Base for Achieving the Sustainable Development Goal Targets on Water Supply, Sanitation and Hygiene

The Knowledge Base for Achieving the Sustainable Development Goal Targets on Water Supply, Sanitation and Hygiene. Int. J. Environ. Res. Public Health 2016, 13(6), 536; doi:10.3390/ijerph13060536

Authors: Guy Hutton and Claire Chase

Safe drinking water, sanitation, and hygiene (WASH) are fundamental to an improved standard of living. Globally, 91% of households used improved drinking water sources in 2015, while for improved sanitation it is 68%. Wealth disparities are stark, with rural populations, slum dwellers and marginalized groups lagging significantly behind. Service coverage is significantly lower when considering the new water and sanitation targets under the sustainable development goals (SDGs) which aspire to a higher standard of ‘safely managed’ water and sanitation.

Lack of access to WASH can have an economic impact as much as 7% of Gross Domestic Product, not including the social and environmental consequences. Research points to significant health and socio-economic consequences of poor nutritional status, child growth and school performance caused by inadequate WASH. Groundwater over-extraction and pollution of surface water bodies have serious impacts on water resource availability and biodiversity, while climate change exacerbates the health risks of water insecurity.

A significant literature documents the beneficial impacts of WASH interventions, and a growing number of impact evaluation studies assess how interventions are optimally financed, implemented and sustained. Many innovations in behavior change and service delivery offer potential for scaling up services to meet the SDGs.

 

The Developing World Urgently Needs Phages to Combat Pathogenic Bacteria

The Developing World Urgently Needs Phages to Combat Pathogenic BacteriaFront. Microbiol., 08 June 2016. Authors: Tobi E. Nagel,  Benjamin K. Chan, et. al.

With the growing global antimicrobial resistance crisis, there is a critical need for alternatives to conventional antibiotics, especially in developing countries. Virulent bacteriophages (phages) represent a viable antibacterial technology that could be particularly beneficial, since phages are active against antimicrobial-resistant bacteria, easy to isolate from contaminated environments, and relatively inexpensive to produce.

We discuss here examples of infectious diseases that significantly affect developing countries, phage applications that could be especially impactful in those settings, and special considerations for implementing phages in the developing world.

Impact of Community-led Total Sanitation on Women’s Health in Urban Slums: A Case Study from Kalyani Municipality

Impact of Community-led Total Sanitation on Women’s Health in Urban Slums: A Case Study from Kalyani Municipality, 2016.

Authors: Prabhakaran, P., Kar, K., Mehta, L. and Chowdhury, S.R. Institute of Development Studies.

This Evidence Report seeks to understand the health and other impacts of slum women’s access to sanitation through the Community-led Total Sanitation (CLTS) approach. It also examines the process through which open defecation free (ODF) status was attained in two different slum colonies, the resulting health impacts and the collective action that took place around both sanitation and other development benefits.

The study was conducted in the slums of Kalyani, a Municipality town located 55km north of Kolkata, the capital city of West Bengal state in India. From an area plagued with rampant open defecation, the slums of Kalyani were transformed into the first ODF town in India in 2009. This was achieved through the CLTS model that focused on motivating the community to undertake collective behaviour change to achieve ‘total’ sanitation and an ODF environment. This was in sharp contrast to earlier, top-down approaches to the provision of toilets, which had failed to ensure ownership or usage by the community.

The benefits of CLTS to the community were not limited to changed sanitation behaviour and an end of open defecation – there were significant development and health gains beyond sanitation. Women’s health in this study has been viewed not just in terms of the presence or absence of disease burden on the physical health of women but also in terms of their socio-psychological wellbeing resulting from reduced risks and a wide range of benefits accruing from better sanitation and hygiene practices and facilities.

The study also focused on exploring the extent to which the CLTS process can be said to have empowered women. As experiences of good health and wellbeing are affected by factors in the external environment, namely the role of the local government, women’s access to health services and the involvement of multiple sectors, these issues were also considered, in order to understand the overall health status and experiences of women in Kalyani slums.

WASH & stunting: an annotated bibliography

Below is a bibliography that we are compiling on WASH and stunting so please email USAID Water CKM if you have other recent studies or reports that should be added.

JUST PUBLISHED

The NOURISH Evaluation: Can WASH and Nutrition Boost Kids’ Growth? Global Waters, May 2016. Link
To better understand the possible benefits of improved water, sanitation, hygiene and nutrition on reducing childhood stunting, USAID is undertaking an impact evaluation in Cambodia as part of its anti-stunting intervention under the U.S. Government’s Feed the Future initiative, the NOURISH project. The evaluation’s principal investigator shares what is hoped to be learned from the Agency’s first randomized control trial for WASH programs.

Can Water, Sanitation and Hygiene Help Eliminate Stunting? Current Evidence and Policy Implications. Maternal & Child Nutrition, May 2016. Authors: Oliver Cumming and Sandy Cairncross. Link
This review article considers two broad questions: (1) can WASH interventions make a significant contribution to reducing the global prevalence of childhood stunting, and (2) how can WASH interventions be delivered to optimize their effect on stunting and accelerate progress? The evidence reviewed suggests that poor WASH conditions have a significant detrimental effect on child growth and development resulting from sustained exposure to enteric pathogens but also due to wider social and economic mechanisms. Realizing the potential of WASH to reduce stunting requires a redoubling of efforts to achieve universal access to these services as envisaged under the Sustainable Development Goals. It may also require new or modified WASH strategies that go beyond the scope of traditional interventions to specifically address exposure pathways in the first 2 years of life when the process of stunting is concentrated.

Preventing Environmental Enteric Dysfunction through Improved Water, Sanitation and Hygiene: An Opportunity for Stunting Reduction in Developing Countries. Maternal & Child Nutrition, May 2016. Authors: Mduduzi N.N. Mbuya and Jean H. Humphrey. Link
The unhygienic environments in which infants and young children live and grow must contribute to, if not be the overriding cause of environmental enteric dysfunction. We suggest that a package of baby-WASH interventions (sanitation and water improvement, handwashing with soap, ensuring a clean play and infant feeding environment and food hygiene) that interrupt specific pathways through which feco-oral transmission occurs in the first two years of a child’s life may be central to global stunting reduction efforts.

USAID RESOURCES

Improving Nutrition Outcomes with Better Water, Sanitation, and Hygiene: Practical Solutions for Policies and Program, 2015. World Health Organization (WHO), UNICEF, and USAID. Link.
This publication summarizes the current evidence on the benefits of WASH for improving nutrition outcomes and describes how WASH interventions can be integrated into nutrition programs. It provides practical suggestions, targeted at nutrition program managers and implementers, on what WASH interventions should be included in nutrition programs and how to include them. It also seeks to help the WASH community to better understand its role, both as providers of technical expertise in WASH interventions and in prioritizing longer-term improvements to WASH infrastructure, in areas where undernutrition is a concern.

WASH and Nutrition Implementation Brief, 2015. USAID. Link
Positive nutritional outcomes are dependent upon WASH interventions and nutrition actions. Poor WASH conditions create an additional burden of undernutrition. Opportunities for co-programming WASH in nutrition programs exist and are discussed in this brief.

USAID WASH and Nutrition Webinar, 2015. Link
Elizabeth Jordan and Katherine Dennison of USAID discuss the connection between undernutrition and lack of access to water, sanitation, and hygiene (WASH) services and highlight opportunities for integrated programming to achieve better health outcomes.

Learning Brief on WASH and Nutrition, 2016. WASHplus. Link
When an integrated program is designed at the outset with related project indicators for both WASH and nutrition equally emphasized, then results can be clearly targeted and measured. Despite the best intentions of sector and program managers, a primary challenge is that in most nutrition programs, WASH is considered after the project’s initial design, so projects improvise by identifying strategic opportunities as they arise and incorporating one or two WASH components into an established nutrition program, often without the accompanying indicators appropriate to those interventions

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WASH Innovation Award Winners

Congratulations to the winners and finalists of the inaugural DFAT-sponsored Civil Society Innovation Award 2016, which was announced at the WASH Futures Conference Dinner 2016.  | Source: Civil Society WASH Fund, May 2016 |

First place went to Save the Children – Nudging handwashing among primary school students in BangladeshKamal Hossain from Save the Children Bangladesh was excited to receive the award in person from Anne Joselin, DFAT. Save the Children’s innovation to improve hand-washing in schools uses environmental cues and nudges. handwashing.pngIt is more cost effective than hygiene communication programs and has shown positive results in changing and sustaining behaviour change amongst school children. Watch the winning video here

Second place was awarded to Water for People! in Uganda for their submission, Low cost solutions for Faecal Sludge Management. Water for People! have shown their work innovating at many stages of the sanitation chain, from low cost modular toilet design, pit emptying and faecal sludge treatment and reuse. Their holistic approach to sanitation and faecal sludge management (FSM) are impacting many peoples’ lives, particularly in the slums of Kampala. Watch the video here

Third runner up was Wetlands Work! 
Cambodia for the HandyPod – Sanitation solutions for floating communities in CambodiaThe Handy Pod is a floating toilet design suitable for the communities of the Tonle Sap lake area and uses wetlands treatment technology. Watch the video here.  

Read the complete article.

 

WASHplus – A Surprise Inoculation Against Cholera

A Surprise Inoculation Against Cholera, 2016. WASHplus.

Communities that embraced the WASHplus and Kenya Ministry of Health community-led total sanitation-plus approach appear to have protected themselves against cholera during a recent epidemic.