Sanitation Updates

Sanitation in Guatemala. Photo: LatinoSan 2013

Delegates attending LatinoSan 2013 have agreed to set up a Latin-American and Caribbean Observatory on Sanitation. The observatory will monitor progress on sanitation in those countries that have signed up to the LatinoSan initiative. Sub-regional and national sanitation scorecards are already available online.

There will also be a Regional Meeting of Ministries of Sanitation every 2 years.

These are two of  the commitments written up in the Panama Declaration at the conclusion of  the 3rd Latin American and Caribbean Sanitation Conference, LatinoSan 2013. The conference took place in Panama City from 29 to 31 May 2013.

The declaration was signed by government representatives from Bolivia, Brazil, Costa Rica, Dominican Republic, Ecuador, El Salvador, Guatemala, Guyana, Haiti, Honduras, Mexico, Nicaragua, Panama, Paraguay, Peru, Sint Maarten, Trinidad & Tobago and Uruguay.

Subregional and country sanitation profiles are available at: www.latinosanpanama2013.info.

Except for Jamaica’s profile, all information is only available in Spanish.

The country profiles include sanitation scorecards with 7 main indicators: access, policy, institutionalization, planning, budget, monitoring and capacities. Each main indicator has several sub-indicators.

The access indicator for example includes sub-indicators for wastewater treatment, sludge management and access in schools and health facilities.

Exploring changes in open defecation prevalence in sub-Saharan Africa based on national level indices

• Link to study

About 215 million people in sub-Saharan Africa still defecate in fields, forests or out in the open, a practice that puts people and especially children at risk of diarrheal diseases. Public health experts are calling for an end to such practices by the year 2015 in order to protect the public health.

A new analysis by researchers at the George Washington University School of Public Health and Health Services (SPHHS) looks at how well countries in sub-Saharan Africa are doing when it comes to putting in basic sanitation facilities that would reduce this risky practice.

Jay Graham, PhD, MBA, MPH, an assistant professor of global environmental health at SPHHS and his co-authors looked at data on open defecation in 34 sub-Saharan African countries and estimated any changes in prevalence from 2005 through 2010. Deise Galan, MPH, was the lead author of the study and conducted much of the data analysis as part of her MPH thesis.

The authors found that only three countries were successful in reducing open defecation by 10 percent or more during the study’s time frame. And only one country, Angola, is on track to end the practice by the target date of 2015, according to the authors.

The authors also examined factors that might speed progress, finding that overseas development assistance might help low income sub-Saharan countries defray the cost of putting in place improved sanitation such as pit latrines or basic toilets. Additional research must be done to find other factors that might assist countries in meeting the public health goal of reducing open defecation, Graham and his colleagues said.

Community-Led Total Sanitation in East Asia and Pacific: Progress, Lessons and Directions, 2013. 

• Full text, pdf

UNICEF, Plan, WaterAid and Water and Sanitation Program (WSP).

Community-Led Total Sanitation (CLTS) is a community-wide behaviour change approach to stop open defecation which has been practiced by an estimated 100 million people in this region. Various organizations (i.e. Plan International, UNICEF, WaterAid, Water and Sanitation Program (WSP), Institute of Development Studies (IDS) and the CLTS Foundation, are supporting implementation across 12 countries in the East Asia and Pacific region; more then 50 UNICEF Country Offices across Asia, Africa and Latin America are now supporting implementation of Community Approaches to Total Sanitation.

The publication provides an up-to-date summary of CLTS status, lessons and experiences from the region, and highlights some of the key areas that require further attention and better quality uptake of CLTS at country level, and as such guide in accelerating efforts for reaching open defecation free (ODF) status and overall sanitation and hygiene improvements at scale.

Evaluating the potential of microfinance for sanitation in India, 2013.

• Full text, pdf

Sophie Trémolet, T V S Ravi Kumar. SHARE. 

This case study investigates how household financing for sanitation can be mobilised via microfinance institutions and commercial banks in order to accelerate sustainable access to sanitation facilities and/or services. The research (conducted in India between May and June 2011) sought to document existing experiences in providing microfinance services to households to allow them to invest in sanitation solutions that meet their needs. The objective of the research was to map out the existing provision of microfinance for sanitation, identify where opportunities for future market development lie and identify how the development of such a market could be fostered (through the targeted use of public funds or regulatory changes for example).

This research has identified that there is potentially high demand for sanitation microfinance in India, due to a combination of factors. Coverage rates remain low (particularly in rural areas) and national policies emphasise household investments (combined with subsidies in some cases, such as in the Total Sanitation Campaign which provide ex-post subsidies once the household has made the investment, hence the need for pre-financing). By 2010, only 31% of India’s population had access to improved sanitation facilities (WHO/UNICEF, 2010).

Evaluating the potential of microfinance for sanitation in Tanzania, 2013.

• Full text, pdf

Sophie Trémolet, George Muruka. SHARE.

The objectives of the case study are to investigate how household financing for sanitation can be mobilised via microfinance institutions, community banks and mass market commercial banks in order to accelerate sustainable access to sanitation facilities and/or services. 

The research conducted in Tanzania is exploratory in nature. It seeks to map out the existing provision of microfinance for sanitation, to identify where opportunities for future market development lie and to identify how the development of such a market could be fostered (through the targeted use of public funds or regulatory changes for example). The case  study in Tanzania will feed into broader research about how donors can channel financing
for water and sanitation to small-scale actors.

Reliably assessing the cost of different sanitation solutions is a key urban planning challenge. This Practice Note describes an Excel-based financial analysis tool which generates reliable costings of different options for achieving 100% sanitation access across low-income and non-low-income areas.

For a more in-depth look at the development of the prototype tool, how it works, its practical application in two wards of Dhaka and the results it produced, see our accompanying Topic Brief ‘Financial analysis for sanitation planning’. The Brief also addresses ways in which the tool could be improved and a discussion of the tool’s potential wider applications.

WSSCC is pleased to announce publication of Celebrating Womanhood: How better menstrual hygiene management is the path to better health, dignity and business, the final report from the International Women’s Day event arranged in Geneva in March 2013 by WSSCC.  

In addition, if you are participating in the 28-30 May “Women Deliver” conference in Kuala Lumpur, Malaysia, you are cordially invited to attend our events, including the Menstrual Hygiene Management Lab, and a 29 May side meeting on menstrual hygiene management featuring the following speakers:

• Lucinda O’Hanlon, Human Rights Officer, Women’s Rights and Gender Section, OHCHR
• Venkatraman Chandra-Mouli, Scientist, Adolescent Sexual and Reproductive Health, Department of Reproductive Health and Research, World Health Organisation (WHO)
• Racheal Meiers, Director, HERproject, BSR
• Beth Outterson, Advisor, Adolescent Reproductive Health, Save the Children
• Lisa Schechtman, Head of Policy and Advocacy, WaterAid in America
• Archana Patkar, Programme Manager, WSSCC

For more information on how to Break the Silence around menstrual hygiene management, visit http://www.wsscc.org/topics/hygiene/menstrual-hygiene-management.

This issue contains recent studies and resources on several WASH-related diseases: cholera, dengue, diarrhea, leptospirosis, neglected tropical diseases, malnutrition, and typhoid. Included are a just-published UNICEF cholera toolkit, an updated review of WASH-related diseases from DfID, typhoid case studies from Bangladesh and Fiji, and other resources. 

The Centers for Disease Control and Prevention suggested the topic for this issue, and we welcome other suggestions for topics. Future issues will focus on menstrual hygiene management, innovation, water point mapping, mobile applications, and WASH in schools; more than 100 past issues of the Weekly are archived on the WASHplus website.

• Link to Weekly

WaterSHED’s Vietnamese HappyTap. Photo: WaterSHED

The HappyTap, a low-cost handwashing device for the Vietnamese market, is one of seven innovations to receive a grant from the WASH for Life Partnership. This US$ 17 million initiative is co-funded by the Bill & Melinda Gates Foundation and USAID’s Development Innovation Ventures (DIV).

In 2010, with USAID support, the WaterSHED program teamed with the Water and Sanitation Program (WSP) to develop and market a new handwashing device. The design came from IDEO.org, which itself has received a WASH for Life grant for Clean Kumasi, an digitally-supported approach to Community-Led Total Sanitation (CLTS). Together with Water and Sanitation for the Urban Poor (WSUP), IDEO.org is working to combat open defecation in Kumasi, Ghana using mobile phones and open-source mapping.

Examples of signs posted to prompt residents to flash Clean Kumasi. Photo: IDEO.org

A third grant went to Bear Valley Ventures Ltd. to test new anti-microbial hand cleaning products, based on ByotrolTM,  for poor urban families in India who have limited access to water. For this purpose Bear Valley has set up Clean Hands Inc, a joint venture with Val Curtis of  the London School of Hygiene and Tropical Medicine and Helen Trevaskis, an innovation and behaviour change consultant.

Social enterprise Sanergy has won a second (Stage Two) DIV grant to expand its ecosan approach in Kenya’s slums, which involves building household toilets and converting the waste into fertilizers for sale to farmers. With their Stage Two funding, Sanergy will scale to 700 latrines and provide hygienic sanitation to 70,000 slum residents.

The sixth grantee and another Stage Two recipient, KickStart International, tests new innovations in microfinancing to increase technology adoption of its “MoneyMaker” irrigation pumps.

The seventh project and recipent of the first Stage Three grant in the WASH for Life Partnership is Innovations for Poverty Action for its Dispensers for Safe Water programme . The programme installs point-source chlorine dispensers in East Africa, which are proven to increase uptake rates of treated drinking water and prevent its recontamination. The grant will allow scaling-up of the programme from 632,000 people with access to clean water to more than 5 million people at a cost of only about US$ 0.50 per person per year.

Source: Maura O’Neill, Impatient Optimists, 23 May 2013 ; USAID, 22 May 2013

Dr. Peter Morgan has been named the 2013 Stockholm Water Prize Laureate for his work to protect the health and lives of millions of people through improved sanitation and water technologies. | Source: Stockholm International Water Institute |

H.M. King Carl XVI Gustaf of Sweden will present the prize to Dr. Morgan at a Royal Award Ceremony during the 2013 World Water Week in Stockholm on September 5.

Over the past four decades, Dr. Morgan has invented and advanced low-cost practical solutions to provide access to safe sanitation and clean water that are being used by millions of people worldwide.

“Many currently existing solutions to provide clean water and sanitation are unaffordable, impractical and out of reach for the world’s poorest people,” said the Stockholm Water Prize Committee in its citation. “As a result of Dr. Morgan’s pioneering work to develop practical water and sanitation technologies for those most in need, countless communities now enjoy safer water, a cleaner environment and quality of life.”

More than 780 million people live without access to safe water and 2.5 billion people lack access to adequate sanitation. Diseases caused by unsafe water, sanitation, and hygiene kill more than 5,000 people each day.

Upon receiving the news, Dr. Morgan said: “Great strides have been made to bring safe water and sanitation to people around the world, yet countless millions are currently still denied access. This prestigious award encourages me to carry on to play my part to improve the conservation and supply of this most precious resource – water – and provide more people with access to clean sanitation.”

A world class inventor and problem solver
Dr. Morgan has invented a wide range of simple, smart and low-cost water and sanitation technologies. Several of his most prominent innovations, including the Bush Pump and the Blair Ventilated Improved Pit (VIP) Latrine, have been adapted as the national standard by the government of Zimbabwe. Over 500,000 Blair VIP latrines have been built and serve 3 million people in Zimbabwe alone, and many more have been built worldwide. Dr. Morgan also created the ‘Upgraded Family Well’, which now help half a million people improve the quality of water obtained from traditional wells.

Dr. Morgan has an unwavering commitment to creating solutions that local communities can build and sustain themselves. For each of his technologies he also developed a wide range of training and educational materials that enable local practitioners to install, maintain and improve them. The Blair VIP latrines, for example, are designed so that they can be upgraded as the need or opportunity arises. The ‘Bush Pump’ was specifically designed so that local ‘pump minders’ can provide maintenance using tools that they can carry on their bicycles.

Dr. Morgan is also renowned as the leading creator and proponent of ecological sanitation solutions, which enable the safe reuse of human waste to enhance soil quality and crop production. His ‘eco-san’ toilets are now in use in countries across the globe, centred on converting a sanitary problem into a productive resource.

About Dr. Peter Morgan
Dr. Morgan currently serves as Director of Aquamor, a not-for-profit company working in the rural water supply and sanitation sector in Zimbabwe. He has previously served as Director of the Blair Research Laboratory and as Advisor to the Ministry of Health in Zimbabwe. Throughout his career, Dr. Morgan has shared his designs and innovations freely and ensured that they can be implemented and improved by the local communities where they are used.

A prolific and highly respected scientist, Dr. Morgan is the author of over 100 published articles and previously served as President of the Zimbabwe Scientific Organization and editor of Zimbabwe Science News. He frequently acts as an advisor and consultant on rural water supply and sanitation programmes in countries throughout Africa, such as Botswana, Ethiopia, Kenya, Malawi, Mozambique, Namibia, Tanzania, South Africa, Sudan, Uganda, and Zambia. Dr. Morgan has been the recipient of multiple awards and distinctions, including the International Inventors Award, The AMCOW AfricaSan Award for Technical Innovation in Sanitation, and the Rural Water Supply Network Award for Lifetime Services to Rural Water Supply.

Born in 1943 in Wellingborough, United Kingdom, Dr. Morgan is a naturalized citizen of Zimbabwe. He holds a PhD in Marine Biology from the University of Hull.

About the Stockholm Water Prize
The Stockholm Water Prize is a global award founded in 1991 and presented annually by the Stockholm International Water Institute (SIWI) to an individual, organisation or institution for outstanding water-related achievements. The Stockholm Water Prize Laureate receives USD 150,000 and a crystal sculpture specially designed and created by Orrefors. H.M. King Carl XVI Gustaf of Sweden is patron of the prize.

Initially founded by the Stockholm Water Foundation to encourage research and development of the world’s water environment, the Stockholm Water Prize is additionally supported by the Royal Swedish Academy of Sciences, International Water Association, Water Environment Federation and the City of Stockholm. The Founders of the Stockholm Water Prize are companies united in their strong conviction to push sustainability in the water sector. They are: Bacardi, Borealis & Borouge, DuPont, ERV, Fujitsu, Grundfos, HP, Kemira, KPMG Sweden, Ragn-Sells, Scandic, Scandinavian Airlines (SAS), Siemens AG, SJ (Swedish Railways), Snecma/Safran, Uponor, Xylem and Ålandsbanken.

New Global Study Pinpoints Main Causes of Childhood Diarrheal Diseases, Suggests Effective Solutions

A new international study published today in The Lancet provides the clearest picture yet of the impact and most common causes of diarrheal diseases, the second leading killer of young children globally, after pneumonia. The Global Enteric Multicenter Study (GEMS) is the largest study ever conducted on diarrheal diseases in developing countries, enrolling more than 20,000 children from seven sites across Asia and Africa.

GEMS, coordinated by the University of Maryland School of Medicine’s Center for Vaccine Development, confirmed rotavirus – for which a vaccine already exists – as the leading cause of diarrheal diseases among infants and identified other top causes for which additional research is urgently needed. GEMS found that approximately one in five children under the age of two suffer from moderate-to-severe diarrhea (MSD) each year, which increased children’s risk of death 8.5-fold and led to stunted growth over a two-month follow-up period.

“Until now, comprehensive data on the burden of diarrheal diseases in Asia and sub-Saharan Africa has been limited,” said Dr. Myron M. Levine, GEMS Principal Investigator and Professor at the University of Maryland School of Medicine. “By filling critical gaps in knowledge, we hope GEMS will help countries across these two highest-burden regions focus their efforts to improve child health.” Despite many causes, GEMS found that targeting just four pathogens could prevent the majority of MSD cases. Expanding access to vaccines for rotavirus, the leading cause of MSD among infants at every site, could save hundreds of thousands of lives. Likewise, GEMS data suggests that accelerating research on vaccines, treatments and diagnostics for the three other leading pathogens – Shigella, Cryptosporidium and ST-ETEC, a type of E. coli – could have a similar impact.

Prior to GEMS, Cryptosporidium was not considered a major cause of diarrheal disease and as a result there is currently little research on this pathogen underway. “The GEMS findings help set priorities for investments that could greatly reduce the burden of childhood diarrheal diseases,” said Dr. Thomas Brewer, deputy director of the Enteric & Diarrheal Diseases team at the Bill & Melinda Gates Foundation, which funded the study. “Vaccines and treatments available today can save thousands of children right now but targeted research to develop new tools to combat severe diarrhea could save many more lives in the future.”

The GEMS findings also suggest that longer-term monitoring and care of children with diarrheal diseases could reduce mortality and developmental delays. Children with MSD grew significantly less in height in the two months following the diarrheal episode when compared with control children without diarrhea, and were 8.5 times more likely to die over the course of the two-month follow-up period. Notably, 61 percent of deaths occurred more than a week after the initial diarrheal episode, with 56 percent of deaths happening after families had returned home from a healthcare facility.

“GEMS strongly indicates that follow-up care after the initial diarrheal episode is critical to protect the health and wellbeing of children,” said Professor George Griffin, Senior Co-Chair of the GEMS International Strategic Advisory Committee and Professor at St. George’s, University of London. “By focusing only on the acute diarrhea that brings children to hospitals, we overlook a significant portion of diarrheal diseases’ burden.” Expanding access to existing interventions that protect against or treat all diarrheal diseases, including oral rehydration solutions, zinc supplements, clean water and sanitation, can save lives and improve the health of children immediately.

“GEMS is a landmark study for the child health community,” said Professor Fred Binka, Co-Chair of the GEMS International Strategic Advisory Committee and Vice-Chancellor at the University of Health and Allied Sciences, Ghana. “By using consistent methods across countries, GEMS sites generated data that can guide evidence-based decision making at both the local and global levels.” Release of the GEMS findings follows last month’s announcement by the World Health Organization and UNICEF of the first-ever Integrated Global Action Plan for the Prevention and Control of Pneumonia and Diarrhea (GAPPD). The GEMS findings add to the scientific evidence cited in the GAPPD strategy for effectively controlling pneumonia and diarrhea, which together are the two leading causes of death among young children globally. ### About GEMS GEMS, coordinated by the University of Maryland School of Medicine’s Center for Vaccine Development, was a case-control study conducted at seven diverse, high-burden sites in Asia and Africa: the Gambia, Kenya, Mali, Mozambique, Bangladesh, India and Pakistan. The study enrolled 22,568 children under five years of age, a sample size that is large enough to provide comprehensive data on the causes, incidence and impact of the range of diarrheal diseases affecting children around the world. GEMS established a network of well-equipped laboratories in the study countries that can be used to accelerate future research on diarrhea and other child health priorities. Investigators have provided open access to their data, which can provide baselines for further studies. Supplemental materials on GEMS methods and sub-studies can be found in Clinical Infectious Diseases (volume 55, supplement 4, and December 2012) and the American Journal of Tropical Medicine and Hygiene. Additional analyses of GEMS data are ongoing. For further information, please visit http://medschool.umaryland.edu/GEMS/. About the Center for Vaccine Development The Center for Vaccine Development (CVD) at the University of Maryland School of Medicine in Baltimore has earned an international reputation as an academic vaccine development enterprise. Since its inception in 1974, the Center is known for creating and testing vaccines against cholera, typhoid fever, paratyphoid fever, non-typhoidal Salmonella disease, shigellosis (bacillary dysentery), Escherichia coli diarrhea, malaria, and other infectious diseases, including influenza. Its global staff includes molecular biologists, microbiologists, immunologists, internists, pediatricians, epidemiologists, malariologists, biostatisticians and informaticians. The CVD is engaged in the full range of vaccinology, from basic laboratory science research through vaccine development, early clinical evaluation, large-scale pre-licensure field studies and post-licensure assessments. In addition to its research and outpatient facilities in Baltimore, Maryland, the CVD has facilities to conduct clinical studies in Mali, West Africa, Malawi, Southern Africa and Santiago, Chile and undertakes time-limited field studies in many other countries in Africa, Asia and Latin America.

Source: University of Maryland, May 13, 2013.

Developing and Monitoring Protocol for the Elimination of Open Defecation in Sub-Saharan Africa, 2013.  UNICEF.

• Link to full text, pdf

Eliminating open defecation is increasingly seen as a key health outcome, with links to reduced stunting, improved educational and positive health outcomes for children. In Sub Saharan Africa, over 35 countries are implementing some form of CLTS, ranging from TATS in Tanzania to CLTSH in Ethiopia. Since the introduction of CLTS in 2005 in the region, rapid scale-up has been achieved with suggested numbers of ODF communities in the range of 30,000 affecting over 15 million people in SubSaharan Africa. Several countries have set aggressive targets for elimination of Open Defecation in rural areas for the next five years which often include not only safe disposal of faeces but handwashing facilities, cleanliness and solid waste management.

Sustaining the progress made through the application of the CLTS process is emerging as a challenge with experience suggesting that sustainability is determined by the process followed to achieve ODF. Rapid scale up in SSA is arguably linked to the fact that CLTS is based on the concept of triggering community-wide behaviour change, requires no subsidies and integrates easily into existing health programming structures. Current focus is on ‘triggering’ communities into action; while considerably less resources and emphasis on following up and mentoring of communities ‘post-triggering’.

This paper reviews process and protocol for defining, reporting, declaring, certifying ODF and sustaining ODF, highlighting where the process varies between countries and potential determinants of sustainability within the process itself. Critical questions include what elements (should) constitute an ODF protocol, what are the determinants of sustainability and what impact does target-setting have on achievement of ODF goals in country?

Water Sanitation for Africa (WSA) has signed a memorandum of understanding with Malaysian firm Indah Water Konsortium Sdn Bhd for technical know-how and consultancy services in sewerage management in African countries.

WSA selected Indah Water “to be in a technical committee formed by the Bill and Melinda Gates Foundation to propose immediate, medium- and long-term solutions for sanitation services in WSA member countries”. In 2011-2012 WSA received three Gates Foundation grants totalling US$ 7.2 million, one of which to develop sanitation financing models for urban poor and another to set an African Sanitation Think Tank.

Chief Executive Officer Datuk Abdul Kadir Mohd Din said that the Gates Foundation “had sent a team of wastewater experts from the United States to visit Indah Water after visiting the African continent and Asean countries”.

Indah Water is Malaysia’s national sewerage company. In 1994, the Federal Government awarded the company the concession for nationwide sewerage services which before were the responsibility of local authorities.

Water and Sanitation for Africa (WSA) is a Pan African Inter-governmental Agency based in Burkina Faso, previously known as the African Regional Centre for Water and Sanitation (CREPA). WSA has a presence in 32 African countries.

Source: Bernama, 16 May 2013

Cholera Toolkit 2013. UNICEF.

• Toolkit website

The UNICEF Cholera Toolkit aims to provide UNICEF Offices, counterparts and partners with one source of information for prevention (or risk reduction) and control of cholera outbreaks, preparedness, response and recovery – including integration with regular/development programmes. 

The Toolkit provides guidance primarily for the Health and WASH sectors; nevertheless guidelines are presented in an integrated manner, to avoid the continuation of ‘silo’ approaches for cholera prevention, preparedness and response. In addition, the Toolkit includes specific content linked to Education, Nutrition, C4D, Child Protection and other relevant sectors.

The Toolkit comprises this ‘Main Document’, a series of ‘Annexes’ (templates, checklists, spread sheets and more detailed reference information available only in electronic copy) and a selection of ‘Additional Resources’ (an electronic library including published papers, IEC materials, cholera guidelines, training packages, examples of mapping and a range of other practical information, available in the companion USB). Links to web-based resources are included throughout the electronic version of the Main Document.

The Water Supply and Sanitation Collaborative Council (WSSCC) has specified in its Medium Term Strategic Plan 2012-2016 that all programmes funded by WSSCC’s Global Sanitation Fund (GSF) are subject to independent mid-term and five-year evaluations. These evaluations are aligned with the overall GSF financing mechanism, which is based on a five-year programme cycle.

Therefore, WSSCC is now calling for proposals by 7 June 2013 for “GSF Mid-Term Evaluation Consulting Services”. For more information about the consultancy, please click on this link:

http://www.wsscc.org/about-us/jobs

The mid-term evaluations of GSF programmes in ten countries will be clustered in two batches of five countries in 2013 and 2014/2015 respectively. The assignment covers design and implementation of the mid-term evaluations as well as analysis, consolidation and dissemination of findings as per the Terms of Reference.

As of 31 March 2013, the GSF programmes are implemented in ten countries: Cambodia, Ethiopia, India, Madagascar, Malawi, Nepal, Nigeria, Senegal, Tanzania and Uganda. In addition, programme preparation is on-going in another six countries; Bangladesh, Benin, Burkina Faso, Kenya, Pakistan and Togo. Sanitation and hygiene awareness-raising and promotion activities in the first ten countries with GSF programmes has resulted in 1.4 million people having improved toilets, and more than 1 million people in nearly 4,000 communities who are now living in open defecation free environments.

Everyone on North Tarawa now has access to improved sanitation. Photo: ABC Radio Australia / UNICEF Pacific.

North Tarawa in Kiribati is the first island in the Pacific to be declared open defecation free, thanks to the “Kiriwatsan I Project”. The Ministry of Public Works is implementing this project with technical support from UNICEF and funding from the European Union.

North Tarawa is made up of a string of islets with a combined population of 6,102 (2010) and a land area of 15.26 sq.km.  Previously about 64 per cent of people used the beaches and mangroves for defecation and dumping their rubbish.

UNICEF spokeswoman Nuzhat Shahzadi says that diarrhoeal diseases cause 15 per cent of the deaths of children under five in Kiribati.

In March 2013, North Tarawa adopted the Community-Led Total Sanitation (CLTS) approach following a training of trainers course conducted by Dr Kamal Kar. The CLTS pioneer wrote that he had convinced Kiribati President Anote Tong to set December 2015 as the target date for the whole nation to become open defecation free.

The villagers of North Tarawa dig shallow pits and use local materials like brick and coconut leaves to build the toilet superstructure. They keep water and soap in one corner. After using the toilet, the villagers sprinkle ash to stop the smell and flies getting in, and then keep it covered.

Ms Shahzadi said that the women and girls were very happy that no longer have to go out on the beach in the middle of the night if they need to use the toilet.

Source: UNICEF, 11 May 2013 ; Radio New Zealand International, 13 May 2013 ; ABC Radio Australia, 14 May 2013

To tackle the alarming resurgence of cholera, UNICEF has launched a new comprehensive Cholera Toolkit on 15 May 2013.

The toolkit launch [...] will be the culmination of a thorough review of existing guidance and global consultation with UNICEF at all levels and from all divisions in Africa, along with main partners in the fight against cholera, such as the World Health Organization as the lead agency.

There are 3-5 million cholera cases each year, killing 100,000 to 120,000 people, half of whom are children under 5 years old. Only 5-10% of cases are reported. In Western and Central Africa, there were more than 80,000 cases of cholera in 2012 resulting in nearly 1,500 deaths.

The Toolkit provides the health and WASH sectors an integrated approach to cholera prevention, preparedness and response. In addition it includes specific content linked to education, nutrition, communication for development (C4D), child protection and other relevant sectors.

UNICEF Cholera Kit, p. 41

“What the toolkit does is harvest the best and most up-to-date knowledge in the field and brings it together in one location,” said UNICEF Chief of Water, Sanitation and Hygiene Sanjay Wijesekera. “It looks at the evidence. It looks at practices that have produced results.”

Download the Toolkit at: www.unicef.org/cholera

Related websites:

• WHO – Cholera
• CDC – Cholera
• MSF Field Research – Cholera

Source: UNICEF, 15 May 2013

“If women can have moustaches we can all talk about menstruation”. With this message WASH United kicked off May MENSTRAVAGANZA, a 28-day campaign to raise awareness and break the silence around menstruation and menstrual hygiene.

Messages are posted on the campaign website:
wash-united-may-menstravaganza.tumblr.com and
on Twitter using hashtag #MENSTRAVAGANZA

Map showing frequency & severity of violence against
women in Bhalswa slum, Delhi. Shirley Lennon/SHARE.

The lack of safe toilets for women and girls is often linked to an increased risk of sexual harassment and rape. Earlier studies [1] from Kenya, Uganda and India, and now a recent BBC news item are some of the few sources to actually quantify this risk.

Senior police official Arvind Pandey from the Indian state of Bihar told the BBC that 400 women would have “escaped” rape in 2012 if they had toilets in their homes. The rapes take place when women go outside to defecate early in the morning and late evening. These “sanitation-related” rapes make up nearly half of the more than 870 cases of rape in Bihar in 2012.

The BBC news item lists three specific cases:

• On 5 May, an 11-year-old girl was raped in Mai village in Jehanabad district when she was going to the field at night
• On 28 April, a young girl was abducted and raped when she had gone out to defecate in an open field in Kalapur village in Naubatpur, 35km (21 miles) from the state capital, Patna
• On 24 April, another girl was raped in similar circumstances on a farm in Chaunniya village in Sheikhpura district. She told the police that two villagers had followed and raped her. One of them has been arrested

In Bihar , 75.8% of homes have no toilet facilities (Census 2011). Some 49% of the households without a toilet wanted one for “safety and security” for women and children, according to a study by Population Service International (PSI),   Monitor Deloitte and Water for People.

[1] Heise, L., 2013. Danger, disgust and indignity : women’s perception of sanitation in informal settlements. Powerpoint presented at “Making connections: Women, sanitation and health”, 29 April 2013, London School of Hygiene and Tropical Medicine (LSHTM). Video version available at:  http://www.youtube.com/watch?v=AS9ulpJqh7s

Related news:

• Request for Proposals: The effects of poor sanitation on women and girls in India, Sanitation Updates, 07 Mar 2013
• India, Delhi: how sexual violence against women is linked to water and sanitation, E-Source, 27 Mar 2012

Source: Amarnath Tewary, BBC, 09 May 2013

Septage disposal. Sri Lanka/Nuwara Eliya sanitation project, 2008, Photo: Flickr/USAID.

An international research institute is helping the government of Sri Lanka to improve septage management in the country.

On 8 May 2013, the Colombo-based International Water Management Institute (IWMI) and the Ministry of Water Supply and Drainage signed a Memorandum of Understanding that provides a collaborative framework for sustainable septage management in Sri Lanka.

IWMI will contribute research data for the drafting of a septage management component of the national sanitation policy. The Ministry will lead implementation of the policy through an advisory committee headed by Minister Dinesh Gunawardena.

Only about 3% of Sri Lankans have a sewerage connection while the rest rely on latrines and septic tanks for sanitation. Safe disposal of septage (fecal sludge) is a problem because of a lack of treatment facilities in large parts of the country.

IWMI is studying a new approach in cities around the world, which treats the sludge so that it can be safely reused as agricultural fertiliser. With the rising costs of imported fertiliser, such an approach would not only benefit farmers but also allow better sanitation and environmental protection for all.

Related news:

• The business of the honey-suckers in Bengaluru (India), E-Source, 27 Sep 2012
• WASHplus Weekly: Focus on Fecal Sludge Management, Sanitation Updates, 30 Nov 2012

Related web sites:

• IWMI - Resource Recovery and Re-use
• Ministry of Water Supply and Drainage
• SuSanA - WG 5 – Food security and productive sanitation systems and Library – Fecal sludge management

 Source: IWMI, 8 May 2013