Category Archives: Sanitation and Health

Bringing Design Thinking To Social Problems, Focuses On The People In Need

Bringing Design Thinking To Social Problems, Focuses On The People In Need | Complete article: FastCoexist, Dec 2013 |

The nonprofit spin-off of the huge design firm takes on issues like sanitation and clean cook stoves from the unique perspective of the design world.

Excerpts – Jocelyn Wyatt and Patrice Martin are the co-leads and executive directors of, the unique nonprofit wing of innovative design firm Ideo. Their mission: apply human-centered design to poverty-related challenges … and in the process, change the way that a for-profit business can use their resources to create social good.

Patrice Martin

Exactly what is human-centered design? Whether working with low income parents in the U.S. on how to engage in their children’s education, or creating a sanitation business in Ghana, Wyatt and Martin say their goal is to focus first on the people being served, enabling them to find a solution that’s better. “Instead of just looking at the problem from a technical perspective, we always make sure to integrate what’s desirable to people,” says Martin. “Almost all of our work begins with the actual end user, or the target market, or the person that we ultimately want to impact. We’ve found that that lens was in many cases missing from work in the social sector. We want to make something and find out if it works–and if it doesn’t, how we can change it?”

One example is the Uniloo/Clean Team toilet developed by alongside Unilever and Water & Sanitation for the Urban Poor, using Kumasi, the second-largest city in Ghana, as a test market. “Public pay toilets were prevalent in Kumasi, and they were used quite a bit of the time,” reports Wyatt. “They were dirty, and sometimes inconvenient, but, you know, it was still kind of the best option.” And yet there continued to be open defecation in the city. In talking to Kumasi residents, Wyatt says, they soon learned about the problem of, um, emergencies. “People would say, ‘Yes, I use the public toilet,’” Wyatt says. “And we would say ‘Always?’ And they would say ‘Yes.’ Finally they would admit that, ‘Well, yes, sometimes in the middle of the night there’s an emergency, and I dump the bucket outside my home in the gutter.’”

That led the team to realize that instead of bringing the people to the toilets, they needed to bring the toilets to the people. Clean Team now has 330 Uniloo toilets in operation on a rental service model–waste is picked up three times a week and delivered to a treatment facility–and they’re hoping to scale that to 10,000 by the end of next year.

Launch of Cochrane Review on WASH and Chilhood Undernutrition

Launch of Cochrane Review on WASH and Chilhood Undernutrition – Nov 6, 2013. | Source: SHARE

The UK Launch of the Cochrane Review on WASH and Childhood Undernutrition was held yesterday at the London School of Hygiene and Tropical Medicine (LSHTM). Lead author Dr Alan Dangour, Senior Nutrition Lecturer at LSHTM, presented the findings, followed by comments from a distinguished panel including Ms Anna Taylor, Senior Nutrition Advisor at the UK Department for International Development (DFID), Mr Girish Menon, Director or International Programmes and Deputy Chief Executive at WaterAid and Professor Sandy Cairncross OBE of LSHTM.

This study was funded by DFID through the SHARE Research Consortium and provides a definitive synthesis of the current evidence relating improvements in drinking water, sanitation and hygiene (WASH) to childhood undernutrition. The study has attracted much interest in the scientific community as well as in the media, including stories in the BBC and in the Independent. UK-Launch-Cochrane-Review-201317

The full Cochrane Review can be accessed here. In brief, the evidence suggests that WASH interventions confer a benefit on growth in children under five years of age. These findings make an invaluable contribution to the area of child health. Almost 220 million children under the age of five years in low income countries suffer from chronic or acute undernutrition, which increases the risks of illness and death in childhood. Research and experience have shown that food-based interventions to tackle this problem cannot alone provide the solution, pointing to the importance of environmental factors. By consolidating and synthesising available research on the links between WASH and under nutrition this review provides an initial evidence base in favour of putting greater emphasis on WASH in nutrition interventions and lays the groundwork additional research in this area.

Anna Taylor spoke on the strength of this evidence base in relation to similar evidence on comparative nutrition interventions. She also highlighted the challenge that lies ahead, of applying these findings to create meaningful integration of programmes aimed at improving nutritional outcomes in children under the age of five. One important step forward, she said, would be to use this new evidence to make a compelling case for including WASH as a nutrition specific intervention to add to the existing ten interventions recommended in the Lancet Series on Maternal and Child Nutrition published in June this year.

Sandy Cairncross remarked on how this work on the linkages between WASH contributes to a long tradition of such thinking. Some of the earliest studies of the health impact of water and sanitation were by nutritionists: Leonardo Mata in Central America and Andrew Tomkins in Nigeria.

Girish Menon’s comments helped set the context for discussion on how to bring the research findings to life at a programmatic level, with examples of how WaterAid is taking this agenda forward through piloting of integrated WASH/nutrition interventions.

WASHplus Weekly-Focus on the health impacts of WASH interventions

Issue 121 November 1, 2013 | Focus on the Health Impacts of WASH Interventions

This issue updates the May 2013 Weekly on WASH-related diseases. Included are links to four reports, seven journal articles plus 14 Weeklies on WASH and various health issues. Studies in this issue review the health impacts of drought, WASH and nutrition, behavior change frameworks, and WASH and HIV/AIDS.


Considerations for Policy Development and Scaling-Up Household Water Treatment and Safe Storage with Communicable Disease Prevention Efforts, 2013. World Health Organization. (Full text, pdf)
The overall consensus from a group of technical experts was that existing meta-analyses, individual research reports, and WHO guidelines provide sufficient support for scaling-up household water treatment and safe storage (HWTS). More can and should be done to integrate HWTS into HIV, child and maternal health, dengue and vector control, and other targeted efforts. Some of the report’s recommendations are: link HWTS with efforts to rapidly expand HIV testing in order to reach the global HIV target of treating 15 million by 2015; increase implementation of HWTS to end preventable child deaths from pneumonia and diarrhea by 2025; and develop and implement preventive interventions that jointly address fecal contamination and vector breeding in household water storage containers.

Effects of Early-Life Exposure to Sanitation on Childhood Cognitive Skills: Evidence from India’s Total Sanitation Campaign, 2013. D Spears. (Full text, pdf)
This study focuses on the effects on childhood cognitive achievement of early life exposure to India’s Total Sanitation Campaign (TSC), a large government program that encouraged local governments to build and promote use of inexpensive pit latrines. The researchers concluded that six-year-olds exposed to TSC in their first year of life were more likely to recognize letters and simple numbers. Results suggest that open defecation is an important threat to the human capital of the Indian labor force, and a program that is feasible to low capacity governments in developing countries could improve average cognitive skills.

Integrating Water, Sanitation, and Hygiene into Nutrition Programming, 2013. WASHplus. (Link, pdf)
Diarrhea, pneumonia, and birth complications are the top three killers of children under age 5 worldwide. Diarrhea is also a leading cause of undernutrition in this age group, and one-third to one-half of all child mortality cases are linked to undernutrition. If mothers and other caregivers used basic hygiene practices and had better access to safe water and adequate sanitation this could greatly reduce under-5 deaths and improve child nutrition.

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Undoing Inequity – Investigating the Cost of Inclusive Water, Sanitation and Hygiene Service Delivery

This video investigates the cost of having in place inclusive water, sanitation and hygiene services in Uganda. A team of WaterAid and partner staff carried out an accessibility audit on water and sanitation facilities constructed by the community in the districts of Amuria and Katakwi north east Uganda after being trained on making water, sanitation and hygiene services accessible to the disabled , the elderly and people with chronic sicknesses.

This research project aims at understanding barriers faced by persons with disability, chronically ill and elderly when attempting to use standard water, sanitation and hygiene facilities.

It is interesting to see how local communities are using the knowledge acquired to make innovations using locally available materials to put in place inclusive water and sanitation facilities. This is a clear indication that when local communities are given the right information, they can drive their own change and priorities.

WASHplus Weekly: Focus on WASH & Nutrition

Issue 117 – September 20, 2013 | Focus on WASH and Nutrition

This issue contains some of the most recent studies and resources that discuss the integration of WASH (water, sanitation, and hygiene) with nutrition. Included are a recent webinar on environmental enteropathy, an online tutorial about nutrition programming that has a WASH component, and studies on child height and open defecation. Another resource is the WASHplus online library of WASH and nutrition, which is still under development but contains the resources listed below as well as other recent studies and reports. washplusweekly


USAID Webinar on Environmental Enteropathy (EE) and WASH, Sept 11, 2013. (Link)
This webinar discussed the latest EE findings, including how WASH can be integrated into USAID nutrition and other programs.  The webinar was sponsored by the USAID Community of Practice: The Nexus between WASH, Nutrition and Food Security with support from the USAID-funded TOPS program and the WASHplus project. The presenters were Laura Smith, Cornell University and Helen Petach from USAID; Tom Davis of the TOPS Program/Food for the Hungry moderated the program.


Programming for Nutrition Outcomes. London School of Hygiene & Tropical Medicine/DFID. (Link)
Programming for Nutrition Outcomes is a free open-access educational resource, supported by the UK’s Department for International Development. This Master’s-level module has been designed to explore the complicated problem of undernutrition, highlight its multisectoral causes, and identify potential programmatic solutions.

REPORTS (Alphabetical by Title)

Clean, Fed & Nurtured: Joining Forces to Promote Child Growth and Development: A Report on a Consultative Meeting, 2013. (Link, pdf)
This report presents the results of a consultative meeting held on May 2–3, 2013, at FHI 360 in Washington, DC, on the topic Clean, Fed & Nurtured: Joining Forces to Promote Child Growth and Development. Forty-eight practitioners, researchers, and academicians attended the meeting to begin creating linkages across their disciplines of WASH, including hand washing; nutrition, infant and young child feeding in particular; and early childhood development.

Growing Taller Among Toilets: Evidence from Changes in Sanitation and Child Height in Cambodia, 2005–2010. 2013. P Kov, et al. Rice Institute. (Link, pdf)
Child height is an important indicator of human capital and human development, in large part because early life health and net nutrition shape both height and adult economic productivity and health. Recent medical evidence suggests that exposure to poor sanitation and specifically to widespread open defecation can pose a critical threat to child growth. Cambodia saw a significant decline in open defecation and increase in child height between its 2005 and 2010 Demographic and Health Surveys. Results suggest that reduction in children’s exposure to open defecation statistically accounted for much or all of the increase in average child height during this period.

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Making hygiene the central issue

I’ve just had the luxury of sitting down and reading a pile of reports that have been accumulating over the last few months.   A group of these relates to the clear links between sanitation and under-nutrition, especially, how the prevalence of open defecation (OD) in India is clearly correlated with stunting in children in that country. The relevant documents, being a report by Dean Spears (How much international variation in child height can sanitation explain) and an article by Robert Chambers and Gregor von Medeazza (Sanitation and stunting in India: undernutrition’s blind spot) are a must-read for all WASH practitioners and child health specialists, and provide ammunition by the bucket load for advocates of better sanitation and hygiene.

One comment in the Chambers/von Medeazza paper, however, stirred up a problem that has been gnawing away at me for a while: “OD is particularly harmful where population density is high”. There is nothing surprising there, we would all agree. So, here is the troubling thought: you might think that the converse applies: perhaps OD is not especially harmful where population density is not particularly high? The situation where someone defecates in a remote field, in a very dry location, and buries the faeces under a desiccating sun is one that has probably occurred to all of us as being not hugely problematic, especially if that person has and uses an effective method of washing his/her hands quickly afterwards.

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USAID Webinar on Environmental Enteropathy and WASH!

Thank you to all who attended the USAID Webinar on Environmental Enteropathy and WASH!

You can find a recording of the webinar and materials from our presenters, Laura Smith from Cornell University and Helen Petach from USAID, at www.fsnnetwork.orgusaid2

Are you interested in opportunities to continue the discussion on integrated programming opportunities for WASH, nutrition and food security? Then consider joining the Community of Practice: The Nexus between WASH, Nutrition and Feed the Future. Contact Dan Campbell (

This event was sponsored by the USAID Community of Practice: The Nexus between WASH, Nutrition and Feed the Future with support from the USAID-funded TOPS program and WASHplus project.

Big business pledge for access to WASH @ workplace

Investing in employee WASH = healthy and more productive employees.

This simple business logic inspired  WBCSD, the World Business Council for Sustainable Development, to  launch a “Pledge for Access to Safe Water, Sanitation and Hygiene at the Workplace”.

Big names like Nestlé, Greif, Borealis AG, EDF, Deloitte LLP, Roche Group, Unilever and the Hindustan Construction Company (HCC)  have already signed up. These companies pledge to provide access to WASH at the workplace for employees in all locations under their control within three years.

The longer term vision is to “go beyond the fence to advocate for access for all employees along the value chain and ultimately employee homes and communities where employees live”.

More information can be found in two documents:

The guiding principles document includes two cost-benefit calculation examples for investments in urban WASH (piped water + septic tanks) and rural WASH (wells + pit latrines).

The WBCSD has been active on water issues for over 15 years. Around 60 companies and 18 regional network partners are members of the WBCSD Water Working Group, of which 28 member companies, representing 11 business sectors, constitute the Water Leadership Group.

Within the WBCSD  Water Working Group, Borealis AG leads the WASH “pathway” group promoting “business action for access to safe water and sanitation at scale”.

Source: WBCSD, 04 Sep 2013

WASHplus Weekly: Cholera Prevention and Control

Issue 111 August 9, 2013 | Cholera Prevention and Control

This issue updates the August 2012 Weekly with studies and resources published in 2013 on cholera prevention and control. Included are the latest statistics from WHO on the number of cholera cases and deaths. WHO states that annual figures in this report exclude the estimated 500,000–700,000 annual cases labeled “acute watery diarrhea” occurring in southeastern and central Asia. The actual numbers of cholera cases are known to be much higher than those reported. Other resources in this issue are the 2013 Cholera Toolkit by UNICEF, studies on socioeconomic and environmental factors that affect cholera outbreaks, country studies from Bangladesh, Cameroon, Haiti, and other studies.


August 1, 2013 – Subcommittee Hearing: The Impact of U.S. Water Programs on Global Health. (Video)
Witnesses: Panel I - Christian Holmes, Global Water Coordinator, USAID | Aaron A. Salzberg, Special Coordinator for Water Resources, U.S. Department of State. Panel II- John Oldfield, Chief Executive Officer, WASH Advocates | Malcolm Morris, Chairman, Millennium Water Alliance | Buey Ray Tut, Executive Director, Aqua Africa

June 2013 – USAID and World Vision Join Coalition to Eliminate Cholera from Haiti and the Dominican Republic. Pan American Health Organization, June 2013.(Link)
USAID and World Vision recently became the newest members of the Regional Coalition on Water and Sanitation to Eliminate Cholera in Hispaniola, an alliance of more than 20 agencies and associations that are supporting efforts by the governments of Haiti and the Dominican Republic to eliminate the transmission of cholera.


Cholera in 2012Weekly Epidem Rec, Aug 2013. WHO. (Full text)
After several years of steady increases in the number of cholera cases reported to WHO as well as the number of countries that reported cholera cases, there was an important decrease in cases in 2012. Of the 30 countries that reported deaths from cholera, 23 were from the African continent, accounting for 2042 deaths or 67% of the global total, while in the Americas, the Dominican Republic and Haiti reported 962 deaths or 31% of the global total.

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Toxic waste’s health impact in Asia similar to malaria’s

Toxic waste’s health impact in Asia similar to malaria’s |Source: Prime Sarmiento, SciDev Net, Aug 7, 2013|

Toxic waste is an under-recognised major global health burden comparable to outdoor air pollution and malaria, according to a study.

The paper says that people’s exposure to industrial pollutants such as lead, asbestos and chromium from toxic waste sites in India, Indonesia, and the Philippines in 2010 resulted in the loss of 829,000 years of good health due to serious diseases or early death.

Waste collector Dinesh Mukherjee, 11, watches his friend jump over a puddle of toxic liquid at the Ghazipur landfill in New Delhi November 10, 2011. REUTERS/Parivartan Sharma

Waste collector Dinesh Mukherjee, 11, watches his friend jump over a puddle of toxic liquid at the Ghazipur landfill in New Delhi November 10, 2011. REUTERS/Parivartan Sharma

Such a health burden, the researchers say, is comparable to that caused by outdoor air pollution and malaria — both serious problems in developing countries in Asia. The WHO estimates that people living in India, Indonesia and the Philippines lose a total 1.45 million healthy years per year because of outdoor air pollution and 725,000 healthy years due to malaria.

The researchers sampled 373 sites in the three countries. They found that these sites endanger more than eight million people as their daily exposure to industrial pollutants puts them at risk of developing heart disease, cancer and anaemia. The toxic wastes mainly come from tanneries, mining firms and battery recycling plants.

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