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Updated: 16 min 41 sec ago

Webinar: ‘Results based financing for sanitation – do the costs outweigh the benefits?’ – 29 April 2015, Sustainable Sanitation Alliance

Thu, 2015-04-16 11:46

A webinar on ‘Results based financing for sanitation – do the costs outweigh the benefits?’ will take place on Wednesday 29th April 2015 at 13:00 (UTC/GMT). Three speakers with very different backgrounds will discuss what, from their perspectives, we know and don’t know about the questions “Do the costs outweigh the benefits of results based financing for sanitation, and what are the right conditions for it to work?”

This webinar will have ample room for discussions and inputs by the participants. Each of the speakers will only give short (5 minutes) inputs to set the scene. The panel of speakers includes:

  • Minh Chau and Per Ljung of Thrive Networks (formally East Meets West), speaking on their Community Hygiene Output Based Aid (CHOBA) Program in Vietnam. Minh Chau is now with Results for Development Institute in the U.S.
  • David Erdhart and Will Goldenberg of CASTALIA Strategic Advisors (U.S.) speaking on their review of Results Based Financing in WASH.
  • Robert Chambers, Institute of Development Studies (UK) offering his views on a wider development perspective on Results Based Financing.

This webinar, open to all, is being organised under the Bill & Melinda Gates Foundation’s Knowledge Management initiative for their Building Demand for Sanitation (BDS) program. It is supported by Stockholm Environment Institute and the Sustainable Sanitation Alliance (SuSanA) secretariat.

To find out more or to join the discussions that will take place before and after the webinar, please click here.

To register please click here.

Webinar moderation / organisation: Peter Feldmann / Pippa Scott, both with Euforic Services, UK

Webinar technical host: Arno Rosemarin (SEI, Sweden)

The webinar will be run by using Adobe Connect, hosted by Stockholm Environment Institute

Filed under: Uncategorized

Orlando Hernandez – Behavioral Challenges and Potential Solutions to Reach Universal Sanitation Coverage

Tue, 2015-04-14 18:48

Behavioral Challenges and Potential Solutions to Reach Universal Sanitation Coverage by Orlando Hernandez, USAID/WASHplus Project and Senior Monitoring and Evaluation Advisor, Global Health, Population and Nutrition (GHPN), FHI 360.

The comments below are from Dr. Hernandez’s participation at the World Water Forum 2015 and then posted to the Sanitation and Water for All website.

Behavior change specialists rely on frameworks to dissect a problem and define a strategy to address it. The Water Improvement Framework (WIF), previously named the Hygiene Improvement Framework (HIF) developed in connection to USAID WASH projects some 15 years ago, is one such framework. Given its openness and comprehensiveness, the WIF has stood the test of time. Other donors and implementation agencies are thinking along the same lines as there are other similar frameworks developed by WSP, SVN, the London School of Hygiene and Tropical Medicine, among others.

The WIF is a three-legged stool which brings together: 1) supply, 2) demand, and 3) the enabling environment. It suggests that behavior change (BC) strategies are more than mere promotion, channels and messages. They bring a human dimension to the WASH sector, and when based on the WIF’s the three elements, it guides us to design, implement and evaluate WASH activities.  

Behavior change frameworks require us to segment our audiences as social groups involved in development are not monolithic. One obvious breakdown in sanitation is a split between urban, peri-urban and rural dwellers. The needs, preferences, sanitation practices and certainly resources of urban, peri-urban and rural populations may be different. With growing urbanization throughout the developing world, coverage in peri-urban areas represent a challenge, especially when we think of tenants living in crowded quarters with no services.

Addressing appropriate sanitation practices in peri-urban areas will require appropriate sanitation options that would allow peri-urban residents to dispose safely of human feces. There are recent innovations which make us think about the importance of ‘human centered design’ for identifying effective supplies and products required to carry out an action. A first step in behavior change is to have the right enabling products as well as the needed access to such a product that a targeted population needs to have in order for a promoted practice to occur.

Sanivation in Kenya, for example, has developed the Blue Box. This is a container-based toilet that is placed in any room in someone’s home and serviced regularly by Sanivation’s Toilet Service Representatives. Sanivation then transforms the collected material in high-performing charcoal briquettes, which are resold on the market. Blue Box clients get a toilet and services to remove fecal matter from their homes for US$7/month.

This approach is based on research suggesting that 50% of Kenyans were planning to invest in improved sanitation, but that many of those living in peri-urban settings may be paid monthly salaries and could have no savings to construct a toilet, may have no space to build a latrine, or be moving away to another location in the near future and do not want to make permanent home sanitation improvements that would be forced to leave if and when they do move. The Blue Box toilet relies on a subscription service, has come to be perceived as a status symbol, and has a marketing strategy that relies heavily on word of mouth. There are other similar options to – dwellers: loowatt in Madagascar, Sanergy also in Kenya, etc.

We are probably all too familiar with the experience of easy latrine in Cambodia designed also using human centered design principles by iDE to come up with a toilet that responded to sanitation needs and preferences of rural residents. Three principles guided the design of these toilets as products that will be purchased by consumers to satisfy their needs. These principles can be referred to as those that meet the three A’s of a marketable product: aspirational, accessible and affordable. Cambodia was a country with 20% rural sanitation coverage when the work of IDE started.

Formative research conducted identified the characteristics of an attractive rural sanitation option. These rural consumers were interested in having a pour flush toilet with an off-set pit and a concrete superstructure that may constructed in due time once resources become available. Such a product was baptized as the easy latrine and ended up being the appropriate technological option for rural Cambodian households. Project implementers in Cambodia resolved production and supply chain issues and more quickly than expected sales and coverage increased considerably.

Universal coverage requires eliminating open defecation as a first step, and such a goal will not be achieved if open defecation is not eradicated in large countries, including India. The Government of India has a program that subsidizes latrines so households have no economic barriers to overcome in order to have latrines at home. Subsidies resolve an important barrier helping to increase access. However, access is a necessary but not a sufficient condition for use of an installed technology to use.

Access does not mean use or correct use. The Research Institute of Compassionate Economics (RICE) at Emory University, with Gates funding, has clearly demonstrated the multiple motivational barriers have to be overcome especially in Northeast India to get people that may have latrines constructed at home at the government’ s expense to accept having them installed, and also in using them.

The research conducted by RICE at Emory has demonstrated that family members in rural settings have morning walks, leaving home to breathe clean air in the woods as they wake up, and that at the end of their walk they defecate before returning home. In addition to enjoying a morning walk, there is a preference to leave their fecal matter away from home. We will be challenged to bring human centered design to address not only the specifications of on-site sanitation, but possible the characteristics of off-site sanitation.

Perhaps we need to think about the possibility of setting up public toilets in current open defecation sites. I know that off-site defecation may not be counted as part of meeting universal coverage, but we may forced to expand our definitions to take into account special circumstances affecting millions of people.

Rural sanitation offers other challenges that we should be prepared to address, even we have detected the appropriate technology as was the case in Cambodia. CLTS has been used in many countries, supported by donors and adopted by many public and private implementing agencies. However, it is an approach that is implemented in different phases including pre-triggering, triggering, adoption, sanitation facilities construction and certification.

It is certainly an approach that requires considerable institutional implementation capacity in addition to involvement of central and local government officials, community mobilizers, masons, lenders, etc. It is also an approach that moves at its own pace, village by village. The presence of multiple villages will require multiple implementation teams. I should add that participatory approaches are likely to be more effective than top down approaches that offer cookie cutter solutions.

A review of rural sanitation programs implemented in the past few years in Latin America has demonstrated that even when institutional capacity is in place, solutions exclusively from the desk of technicians that do not incorporate community members to the process of change may backfire.

Now, let me turn to a related topics: consistent use over time for all family members. Implementers of CLTS programs in multiple countries over time are beginning to generate data that helps to see what even when there is the right technology and the right institutional support to increase coverage, we may be confronted with the problem of recidivism.

Some of these implementing agencies are indicating that in some instances up to 30% of households with sanitation coverage may come back to open defecation . So, one challenge is how to make sure that family members continue to use available sanitation over the long run. We will also be concerned with the fact that the feces of all family members should be disposed of hygienically.

And in this regard, the disposal of child feces will emerge as a larger challenge than we think. Families that have access to sanitation facilities should use them to dispose of child feces. Some studies in which I have been involved open the door suggest that this is not necessarily done. If there is recidivism among adult family members, there may not be consistent hygienic disposal of the feces of younger family members, even when latrines are available.

Habit formation concepts are beginning to offer a new way of thinking regarding consistent use of a practice over time. They suggest that to instill sticky habits we must help construct routines that are driven by external cues and are repeated over time automatically.

Settings must be stable so that external cues remain constant. In addition, habit formation principles suggest that we must try to piggyback practices onto existing habits. Studying what sequence of events occur when we engage in cleaning up a child may help identify how the appropriate disposal of these feces can be integrated to such a sequence.

Universal coverage often means on-site sanitation for households. However, there is a homeless population of over a billion individuals in the world, data that was recently shared with be by a colleague from Bangladesh attending this forum.

But if the current proposal stands, the Sustainable Development Goals will define universal sanitation including both households and institutional settings, namely schools and health facilities. The WIF can be of use when deciding how to tackle behavioral issues in school populations and clients and staff at health facilities.

The health and nutrition and nutrition benefits of WASH investments may not be reached if we ignore handwashing with soap at critical junctures, before handling food and after potential contact with fecal matter. Future handwashing promotion programs targeting households should focus on having households set up permanent handwashing stations near toilets or places where food is handled, and ensuring that these stations are duly supplied with soap and water, if no tap are available.

The challenges presented by handwashing promotion are large, but it has been done for a long time now and we have different ways of tackling them. That, nevertheless, is a different discussion that we can pursue at another time.

I hope that these remarks help us have an eagle’s view at the behavior change challenges ahead of us and some potential ways to address them. We must be open to technological innovations but also to innovative behavior change approaches and new ways of tracking our achievements. I also hope that it stimulates your thinking and generates discussion.

Filed under: Hygiene Promotion Tagged: behavior change

SHARE – A New Training Guide on Menstrual Hygiene Management

Tue, 2015-04-14 16:24

SHARE – A New Training Guide on Menstrual Hygiene Management, 2015. | Source: SHARE website, April 13, 2015 |

An informative, new training guide which seeks to assist practitioners in integrating menstrual hygiene management (MHM) into their work and programmes has just been published by SHARE and WaterAid

SHARE has long been endeavouring to address the research gaps relating to MHM. In 2012 we published the Menstrual Hygiene Matters manual which features examples of good MHM practice and offers guidance on building competence and confidence to break the silence surrounding the issue, and in 2013 we supported a systematic review exploring the health and social effects of MHM.

Developed by WaterAid, this new training guide is our latest contribution to building the knowledge base around MHM and raising awareness of the issue globally. It builds on the Menstrual Hygiene Matters manual and presents a range of plans, handouts, presentations and films that a facilitator could use when facilitating sessions or workshops on MHM amongst development practitioners. These interactive plans and accompanying resources explore the key issues and components of MHM programmes and can be adapted depending on the context, participants and time available.

The guide in action
The training guide and its various components were tested by WaterAid in its country programmes, with local staff and (I)NGOs, and at international training forums and conferences such as the 2014 Brisbane WASH Conference.

We hope that it will be an invaluable tool to those wishing to integrate MHM into their development programming.

If you use the training the guide or the resource book to complement your programming, we’d love to hear from you. Please get in touch to tell us what you thought:

Next steps
Download the Training Guide
• View the Menstrual Hygiene Matters manual
• Check out the training tools in action at Brisbane
• Read the systematic review
• Find out more about our work on MHM

Filed under: Uncategorized Tagged: menstrual hygiene

Public Finance for WASH initiative launched

Mon, 2015-04-13 10:14

Today sees the launch of Public Finance for WASH, a research and advocacy initiative aiming to increase awareness of domestic public finance and its critical importance for water and sanitation provision in low-income countries. Check out our website

This is a collaborative initiative between IRC, Water & Sanitation for the Urban Poor (WSUP), and Trémolet Consulting. A key aim is to offer easy-to-read but rigorous information about domestic public finance solutions: our first three Finance Briefs are now available for download from our website, and over the coming year we will be building a comprehensive resource library.

And just to make sure we’re on the same page: what exactly is domestic public finance? Essentially, it’s money derived from domestic taxes, raised nationally (e.g. by the Kenyan government) or locally (e.g. by Nairobi’s municipal government). This money is going to be critical for achieving the water and sanitation SDGs: so how can we all work together to ensure that what we’re doing is supporting (not inhibiting) the development of effective public finance systems? And how can public finance be spent in ways that catalyse the development of dynamic markets for water and sanitation services?

To find out more, please check out the website. If you’d like to become involved in any way, get in touch!

Filed under: Africa, East Asia & Pacific, Europe & Central Asia, Funding, Latin America & Caribbean, Policy, Publications, Sanitation and Health, South Asia, Web sites Tagged: finance, publicfinance, rural sanitation, sanitation, urban sanitation, water

WaterAid – Healthy Start: the first month of life, 2015

Wed, 2015-04-01 15:09
WaterAid – Healthy Start: the first month of life

Bringing a new life into the world should be a time of love and hope for mother and baby, wherever they happen to live. 

But, around the world, one in every 50 births leads to heartbreak for parents, as their precious newborn son or daughter will die before they are a month old.

In 2013, over 2.7 million babies died in their first four weeks of life. This is overwhelmingly a problem of the developing world – with over 99% of neonatal deaths occurring in low and middle income countries.

In the year the world replaces the Millennium Development Goals with the Sustainable Development Goals, it is time to ensure that the next generation of children is given the best start in life – a healthy start.

Filed under: Uncategorized

Nominate now: AfricaSan Awards 2015

Thu, 2015-03-26 16:14

As part of the AfricaSan 4 conference convened by the Government of Senegal from May 25th – 27th, 2015 in Dakar, the African Ministers’ Council on Water (AMCOW) is pleased to invite entries for the 2015 AfricaSan Awards.

The awards are dedicated to recognizing outstanding efforts and achievements in sanitation and hygiene in Africa which result in large-scale, sustainable behavior changes and tangible impacts.  The aim is to raise the profile of sanitation and hygiene by drawing attention to successful approaches, promoting excellence in leadership, innovation and sanitation and hygiene improvements in Africa.

The awards are open to all individuals and institutions working in the sanitation and hygiene sector from countries of each award region.

The Technical Committee has streamlined the AfricaSan Awards to cover the critical sectors of the sanitation sector. The 2015 Awards will be in the following categories:

  • RESEARCH & TECHNICAL INNOVATION: to honour individuals and institutions who through research and development have contributed to the improvement of technical solutions for sanitation services and products to make them affordable, reliable, and sustainable.
  • YOUTH AWARD: to honour exceptional youth (under the age of 25) or agencies that promote water and sanitation that affect youth, whose work has/have made a significant impact upon children or youth.
  • LOCAL GOVERNMENT LEADERSHIP AWARD: to honour outstanding local government or utility leadership whose policies or actions have promoted innovation, enhanced capacity, mobilized resources or generally created an enabling environment for improvement in sanitation delivery.
  • HYGIENE AWARD: to be awarded to individuals or agency/business with outstanding initiatives or progress to promote good hygiene in relation to water and sanitation.
  • IMPACT AT SCALE AWARD: presented in recognition of outstanding initiatives with impact at a significant scale (i.e. city-scale; district-scale, country-scale)
  • INTEGRITY AWARD: presented to individuals or agencies that have made extraordinary progress in fighting corruption and improving governance or transparency in sanitation or hygiene service delivery.

To download the nomination forms, visit the AfricaSan website.

Filed under: Uncategorized

Global Sanitation Experts Hail Madagascar Roadmap to become Open-Defecation Free Nation by 2019

Wed, 2015-03-25 01:30

Antananarivo – March 25, 2015 — Today, a high-level delegation of global sanitation and hygiene experts arrived in Madagascar for the biannual Steering Committee meeting of the Water Supply and Sanitation Collaborative Council (WSSCC), a United Nations body devoted solely to the sanitation and hygiene needs of vulnerable and marginalized people around the world.

During the visit, the Steering Committee will see WSSCC’s Global Sanitation Fund (GSF) programme in Madagascar, locally known as the Fonds d’Appui pour l’Assainissement (FAA), in action. Developed and guided strategically by a diverse group of national stakeholders, the FAA is facilitated by Medical Care Development International (MCDI) and implemented by 30 sub-grantee organisations. It has evolved into a driving force in the national movement to end open defecation, which adversely affects the health, livelihood and educational opportunities for 10 million people in Madagascar and some 1 billion worldwide.

The five-day Steering Committee visit is dedicated to reinforcing the country’s top-level political commitment to a new “National Road Map” for the water, sanitation and hygiene sector that aims to end open defecation (ODF) in Madagascar by 2019. Madagascar’s most senior politicians, including President Hery Rajaonarimampianina, Prime Minister Jean Ravelonarivo, the President of the National Assembly, and Dr. Johanita Ndahimananjara, Minister of Water, Sanitation and Hygiene, have committed their support to achieving ODF status.

“Since 2010, Madagascar has made tremendous progress in ensuring access to basic sanitation for the rural population of the country, by introduction and scaling up of Community Led Total Sanitation (CLTS),” said Dr. Chris W. Williams, Executive Director of WSSCC. “Nearly 1.4 million people now live free of open defecation in over 10,900 communities throughout the country, one of the best examples of how individual and local initiative can lead to collective, transformative change for an entire country.”

The visit also coincides with heightened global awareness of sanitation in 2015. The United Nations Secretary General and Deputy-Secretary General have launched a Call to Action on Sanitation, encouraging global institutions, governments, households, the private sector, NGOs, and Parliamentarians, to eradicate the practice of open defecation.

“FAA has become an important catalyst for the initiation and creation of a national, regional and local movement in favour of eliminating open defecation,” said Dr. Rija Lalanirina Fanomeza, GSF Programme Manager, MCDI. “A wide spectrum of sanitation and hygiene stakeholders in Madagascar are actively collaborating to have maximum impact on the ground.”

Ever since President Rajaonarimampianina’s government came into power in January 2014, sanitation has received special attention, and the need for achieving an open-defecation free Madagascar has been considered inevitable by the highest political leadership of the nation.

During the visit, the delegation will visit villages which are now free of open defecation, and those that are not, in order to gain a firsthand understanding of the how and why people change and sustain their sanitation and hygiene behaviours.

Filed under: Uncategorized

Thursday, March 26th SuSanA will host a webinar on “Broadening the Horizon of Sanitation Monitoring : Operationalising the Sanitation Ladder in Post-2015”

Tue, 2015-03-24 09:42

On Thursday, March 26 at 15:00-15:45 CET, the Sustainable Sanitation Alliance (SuSanA) will host a webinar on the topic of “Broadening the Horizon of Sanitation Monitoring: Operationalising the Sanitation Ladder in Post-2015”. Registration for the webinar will take place here:

This webinar is a follow-up to “The Sanitation Ladder: Next Steps”, the first thematic discussion in SuSanA’s new Thematic Discussion Series. This 3-week thematic discussion (from Feb 9-27) had lively discussions on the development of the sanitation ladder and a functions-based ladder, the post-2015 agenda and monitoring challenges, and the way forward.  A synthesis of the discussion can be found here.

The 45-minute webinar will feature a short summary of the thematic discussion, then two leading questions will be provided for discussion, with input from the Thematic Leads Elisabeth Kvarnström and Ricard Gine, and the floor will then also be opened to input and questions from those in attendance.

For any questions, please post on the discussion forum or contact us at

We look forward to your input and involvement in the webinar!

Filed under: Uncategorized

The role of water, sanitation, and hygiene in reducing schistosomiasis: a review

Mon, 2015-03-23 19:39

The role of water, sanitation, and hygiene in reducing schistosomiasis: a review. Parasites & Vectors, March 2015.

Authors: Jack ET Grimes, David Croll, et al

Schistosomiasis is a disease caused by infection with blood flukes of the genus Schistosoma. Transmission of, and exposure to, the parasite result from faecal or urinary contamination of freshwater containing intermediate host snails, and dermal contact with the same water. The World Health Assembly resolution 65.21 from May 2012 urges member states to eliminate schistosomiasis through preventive chemotherapy (i.e. periodic large-scale administration of the antischistosomal drug praziquantel to school-aged children and other high-risk groups), provision of water, sanitation and hygiene (WASH) and snail control.

However, control measures focus almost exclusively on preventive chemotherapy, while only few studies made an attempt to determine the impact of upgraded access to safe water, adequate sanitation and good hygiene on schistosome transmission. We recently completed a systematic review and meta-analysis pertaining to WASH and schistosomiasis and found that people with safe water and adequate sanitation have significantly lower odds of a Schistosoma infection. Importantly though, the transmission of schistosomiasis is deeply entrenched in social-ecological systems, and hence is governed by setting-specific cultural and environmental factors that determine human behaviour and snail populations.

Here, we provide a comprehensive review of the literature, which explores the transmission routes of schistosomes, particularly focussing on how these might be disrupted with WASH-related technologies and human behaviour. Additionally, future research directions in this area are highlighted.

Filed under: Uncategorized

Water, sanitation and hygiene in health care facilities

Sat, 2015-03-21 16:48

A new report by the World Health Organization (WHO and Unicef provides an “alarming picture of the state of WASH in health care facilities”.

Drawing on limited data from 54 low- and middle-income countries the report concludes that 38% of the facilities lack access to even rudimentary levels of water, 19% lack sanitation and 35% do not have water and soap for handwashing.

In addition, “training and capacity building to ensure there are sufficient resources and personnel to operate and maintain WASH facilities and enable health care staff to deliver hygiene behaviour change messages is urgently needed”, the report says.

“While the situation appears bleak, there are a number of global initiatives for which WASH in health care facilities is a foundational element and examples of national governments taking the initiative to improve standards, implementation and monitoring”, the report concludes. Through coordinated, global action, with leadership from the health sector, WHO and Unicef believe that all health care facilities can have adequate WASH services.

Besides the full report, you can also download:

Cronk, R. & Bartram, J., 2015. Water, sanitation and hygiene in health care facilities : status in low and middle income countries and way forward, Geneva, Switzerland: World Health Organization (WHO) and Unicef. x, 38 p. : 8 boxes, 2 fig, 8 tab. Avaialable at:

Filed under: Hygiene Promotion, Publications Tagged: health care facilities, unicef, World Health Organization

Tackling the Taboo of Menstruation

Tue, 2015-03-17 08:21

In connection with last week’s WSSCC-UN Women side event on the Commission on the Status of Women, WSSCC Executive Director published a new blog on the Huffington Post. It begins:

“In 1995, global rights activists sent a powerful message about the urgent need for gender equality in political, civic, economic, cultural and social life. Two decades later, women and girls have made powerful strides in closing the gender gap.”

Read the full article at:

Filed under: Uncategorized Tagged: gender, menstrual hygiene, sanitation

UN Women and WSSCC Call for Global Action on Ending Menstruation Taboos and Reversing Neglect

Sat, 2015-03-14 08:26

New York, NY, March 13, 2015 — Today the Water Supply and Sanitation Collaborative Council (WSSCC) and UN Women revealed that women and girls in Central and West Africa lack access to clean water, private spaces for managing their menstruation, and clean, functioning toilet facilities. In a series of studies, developed within the Joint Programme on Gender, Hygiene and Sanitation in West and Central Africa, researchers drew upon the Sustainable Development Goals (SDGs) prepared by the Open Working Group and the Secretary General’s Synthesis Report on the Post-2015 development agenda.

The studies provide critical information about sociocultural taboos on menstrual hygiene and linked knowledge and practices in the region in order to highlight an area of global neglect with deleterious consequences for for the education, mobility and economic opportunity for women and girls, societies, and economies.

“Few people talk about how menstruation can be managed with dignity and safety,” said Dr. Chris Williams, Executive Director of WSSCC. “As a result of this, women and girls often choose to limit their cultural, educational, social and economic activities while menstruating, missing school, work and play.”

At an event hosted by the Permanent Missions of Singapore and Senegal to the United Nations,  Government representatives, policymakers, researchers and development practitioners articulated the need to talk about this neglected area in women’s health and education- menstrual hygiene management. Informed by evidence from Central and West Africa, South Asia and wider, the discussion took stock of the gross neglect of this issue in awareness, policy, facilities and monitoring.

“There is a general culture of silence surrounding all aspects of menstruation,” said Dr. Josephine Odera, Regional Director and Representative of the UN Women Regional Office for West and Central Africa. “This silence is exacerbated by taboos and myths that perpetuate practices that women and girls believe and how they manage their menstruation from personal hygiene to the cleaning and disposal of used materials.”

Download all key infographics

Key findings from the reports included:

  • At present, there are no public policies in West or Central Africa mentioning menstrual hygiene management. Although women manage the water, sanitation and hygiene services in their households and community and are key users as mothers and caregivers, they are not consulted in the design and maintenance elements of sanitation and water facilities. Since 2013, India’s sanitation policy and guidelines include menstrual hygiene management as a key element of the national campaign to achieve a clean India.
  • A lack of information, inadequate sanitary infrastructure and the persistence of certain beliefs have a negative impact on girls’ education, on female health and on women’s potential for economic empowerment. Half of all schools surveyed in the Kedougou region of Senegal did not even have toilets and 96% of the women surveyed said they did not regularly go to work while they were menstruating.
  • The majority of respondents in all regions surveyed said that toilets are the most common places for the disposal of used menstrual pads or cloths due to the absence of a waste management system.
  • 90% of the women and girls interviewed in Kedougou have undergone female genital mutilations. Nearly a quarter of them reported infections during their menstrual period, suggesting a link between this practice and increased vulnerability to infections.

Key policy recommendations from the event include the following:

  • Member states must break this silence, articulating menstrual needs in policies, budgets, programmes and monitoring systems and calling upon the global community to empower women and girls by guaranteeing safe menstrual hygiene management.
  • Menstruation is an indicator of female health and vitality. Sexual and reproductive health and rights advocacy and programmes must ensure knowledge, safe conditions and dignity so that the trauma at puberty is replaced by pride and confidence.
  • Citizens, the media, schools and colleges, health practitioners, mothers and fathers must talk about menstruation and enable safe, dignified management in order to replace shame with pride.
  • Safe spaces for changing, cleaning and washing and drying at home, school, the market and work must be ensured for women and girls everywhere. This means changing the design, construction and maintenance of water, sanitation and hygiene facilities to serve a human lifecycle by age, gender and physical ability.
  • Half of humanity is female. Women and girls menstruate as this enables them to have babies and reproduce humanity itself.  The silence, taboos, and stigma linked to menstruation violates a host of human rights.

Download link:

Menstrual Hygiene Management – WSSCC/UN Women Studies on Behaviour and Practice in Senegal, Niger and Cameroon

Key infographics – WSSCC/UN Women Studies on Behaviour and Practice in Senegal, Niger and Cameroon

The Water Supply and Sanitation Collaborative Council is at the heart of the global movement to improve sanitation and hygiene, so that all people can enjoy healthy and productive lives. Established in 1990, WSSCC is the only United Nations body devoted solely to the sanitation needs of the most vulnerable and marginalized people. In collaboration with our members in 150 countries, WSSCC advocates for the billions of people worldwide who lack access to good sanitation, shares solutions that empower communities, and operates the Global Sanitation Fund,   transform lives in developing countries through sustainable behaviour change.

Learn more at and follow us on Twitter @WatSanCollabCou and Facebook at

Filed under: Uncategorized

WASHplus Weekly: Focus on Community-Led Total Sanitation (CLTS)

Fri, 2015-03-06 15:06

Issue 181| March 6, 2015 | Community-Led Total Sanitation

This issue focuses on recent CLTS studies, reports, blog posts, and videos. Included is a new issue of Frontiers of CLTS on sustainability; reports on the health impacts of open defecation; videos and reports on CLTS programs in Ethiopia, Ghana, India, Indonesia, and Kenya; and other studies/resources.


Sustainability and CLTS: Taking Stock. Frontiers of CLTS: Innovations and Insights, Issue 4, Feb 2015. S Cavill. Link 
There are multiple and complex challenges associated with achieving sustainability. Habits are hard to break and so sustainability of behavior change continues to be a major preoccupation. The CLTS and WASH communities need to continue to share learning and insights and to draw practical conclusions that lead to better practice. Action learning that is grounded in field realities, open-mindedness, mutual respect, and sharing is the way forward. The accessibility of the four evaluations in the opening pages of Frontiers sets a good precedent.

Other issues covered in this series of Frontiers of CLTS are: Issue 1: Participatory Design Development for Sanitation | Issue 2: How to Trigger for Handwashing with Soap | Issue 3: Disability—Making CLTS Fully Inclusive |


Webinar on Participatory Design Development for Sanitation – March 26, 2015, 6–8 a.m. EDT. Link
Ben Cole will be discussing his experiences in applying participatory design to accompany and extend Malawi’s national CLTS program since 2012.  Participatory design is a natural extension to the processes applied in CLTS programs. Mr. Cole’s work in three rural districts of Malawi demonstrates the immense potential that participatory design can offer to CLTS programming. It offers a low-cost engagement tool that can support traditional follow-up approaches to CLTS programming.


Talking Shit: Is Community-Led Total Sanitation a Radical and Revolutionary Approach to Sanitation? Wiley Interdisciplinary Reviews: Water, Jan/Feb 2015. M Galvin.Link
In contrast to past approaches, one of CLTS’s main tenets is strictly no subsidies of finance or materials. In the absence of monitoring and evaluation systems, it is not clear whether its immediate achievements are sustainable. In addition to questioning its sustainability, it is essential to examine CLTS through the analytical lens of power dynamics and human rights.

Lessons from Pakistan’s Approach to Total Sanitation. CLTS Blog, Feb 2015. J Myers, CLTS Knowledge Hub. Link
Pakistan represents an excellent example of adaptations being made to the traditional CLTS process due to local conditions. It is due to conducting CLTS in areas recovering from the 2010 floods that some of these adaptations have been made.

Realizing the Right to Sanitation in Deprived Urban Communities: Meeting the Challenges of Collective Action, Coproduction, Affordability, and Housing Tenure.World Development, May 2015. G McGranahan, International Institute for Environment and Development (IIED). Link
Serious institutional challenges are associated with low-cost sanitation in deprived urban communities. These include a collective action challenge, a coproduction challenge, a challenge of affordability versus acceptability, and a challenge related to housing tenure. This paper examines these challenges, revealing both the importance of community-driven sanitation improvement and its difficulties. The nature of the challenges, and the means by which two successful community-driven initiatives have overcome them, suggest that while recognizing the human right to sanitation is important this should not be taken to imply that typical rights-based approaches are the appropriate means of realizing this right.

Why Do Sanitation Campaigns Fail? People, Spaces, Deliberation blog (The World Bank), Feb 2015. S Chattopadhyay. Link
This blog discusses the findings of a Lancet paper that looks at the impact of India’s Total Sanitation Campaign on the coastal Puri District in Odisha. The study found that the rural sanitation program did not reduce exposure to fecal matter. A few reasons for the failures demonstrated by the Odisha study: without total coverage, the gains from improved sanitation cannot be realized in a community. And unless all families adopt hygienic sanitation practices, a sanitation program will not make a dent in the incidence of disease prevalence.

The False Dichotomy Among Sanitation-for-All Advocates. People, Spaces, Deliberation blog (The World Bank), Feb 2015. S Chattopadhyay. Link
While sufficient evidence exists from locations using the CLTS approach that households construct latrines and start using them, little evidence is available showing that these latrines continue to be used in the long term. For instance, a study from Kenya, Uganda, Ethiopia, and Sierra Leone reveals a slippage rate of nearly 90 percent, meaning nearly 90 percent had gone back to unhygienic sanitation practices over a period of two years after the intervention. The study calls for identifying ways to help families upgrade their sanitation infrastructure alongside greater follow-up and continuous health messaging. CLTS does not address this infrastructure gap, neither does it support the poorest families in need of usable and lasting toilets.

What Explains Widespread Open Defecation in India? Links Between Widespread Open Defecation and Culture, 2015. S Vyas. Presentation
Caste, and concepts of purity and pollution, make India unique and pose particular challenges for use of simple latrines in rural north India.

The Asian Enigma: Exploring the Causal Linkages between Undernutrition and Insanitation in Children with Reference to India, 2015. F Kuriakose. Link
This paper proposes to trace the relation between undernutrition and insanitation in India and its effects on children under 5. The study is based on secondary data. Questions of nutritional sufficiency and sanitation facilities are examined in the theoretical framework of the Capabilities Approach developed by Amartya Sen and Martha Nussbaum. The paper concludes that universal access to sanitation is an integral step in eliminating nutritional deficiencies in children.

How Does Health Promotion Work? Evidence from the Dirty Business of Eliminating Dirty Defecation, 2015. P Gertler. Link
This study estimates the causal relationship between village open defecation rates and child height using experimentally induced variation in open defecation.

Triggering Five Pillars of Community Based Total Sanitation in Ende District–Indonesia, 2015. STBM Indonesia. Video
To change hygiene and sanitation behavior of the Tiwerea community in Ende District, Plan Indonesia collaborated with the district government to trigger community-based total sanitation (CBTS). This video shows the community going through each of the five pillars of the CBTS  process.

Social Network Predictors of Latrine Ownership. Social Science & Medicine, 125 (2015). H Shakya. Link
Results show that, controlling for the standard predictors of latrine ownership such as caste, education, and income, individuals are more likely to own latrines if their social contacts own latrines. Interaction models suggest that this relationship is stronger among those of the same caste, the same education, and those with stronger social ties. The results suggest that interventions designed to promote latrine ownership should consider focusing on those at the periphery of the network. The reason is that they are less likely to own latrines and more likely to exhibit the same behavior as their social contacts, possibly as a result of the spread of latrine adoption from one person to another.

Can Smartphones Solve India’s Sanitation Monitoring Conundrum? WaterAid Blog, Jan 2015. A Hueso. Link
The new sanitation campaign in India, the Swach Bharat Mission, is about to bring some changes in terms of monitoring, primarily through the use of smarter technology, which will allow the inclusion of photographs and GPS geo-tags of the latrines that are being constructed in rural areas. This is intended to improve the accuracy of the monitoring system, which has been very poor in the past. But can smartphones really solve India’s sanitation conundrum?


Urban Community-Led Total Sanitation (UCLTS), 2014. Plan India. Video
This case study is about a slum in Madanpur Khaddar in South Delhi. Plan India and its partner organization helped establish women’s groups to manage the community toilet, solid and liquid waste management, etc. Children’s groups were also created to monitor the hygiene practices and usage of facilities.

Community Led Total Sanitation in Keiyo North, Kenya, 2014. World Vision. Video
This video shows public health officers supported by World Vision Kenya conducting CLTS triggering at the Songeto/Rimoi Community Health Unit located in Keiyo North subcounty in Rift Valley Province.

Explaining Obstacles to ‘Total Sanitation’ in India with Spatial Methods: Evidence from the District Level Household Survey, 2014. G Pierce, University of California, Los Angeles. Link
Inadequate toilet use directly contributes to high rates of morbidity and mortality in India. Despite a strong research focus on sanitation solutions, understanding of the determinants of toilet use in India is remarkably poor. This paper uses spatial analysis techniques to explain variation in sanitation use at the district scale. A test of global spatial autocorrelation confirms that sanitation use is strongly clustered geographically, and spatial clustering remains robust after controlling for socioeconomic explanations. In addition to providing an empirical model of toilet use, this paper suggests that variation in regional adoption of use must be incorporated into future national program design.

Child Feces Disposal, 2014. Water and Sanitation Program; UNICEF. Link
Safe disposal of children’s feces is as essential as the safe disposal of adults’ feces. This series of country profiles provides an overview of the available data on child feces disposal in 26 locations. Each brief concludes with ideas to consider, based on emerging good practice.

Key Findings of a Sanitation Supply Chains Study in Eastern and Southern Africa, 2014. UNICEF. Link
While capacity and materials to provide sanitation services are generally available at district levels, provision of services to households at the community level remains fragmented. Prices for basic sanitation materials differ significantly between countries impacting product options and business models. Innovation in sanitation product design and availability is taking place, but there is room for more.

The Role of Local Government and Community Structures in Community Led Total Sanitation (CLTS) Monitoring, n.d. M Namwebe, Plan International. Link
Local level participatory monitoring has proven effective in tracking progress toward open defecation free (ODF) attainment and sustaining ODF status through the use of existing structures like the local government and community resource persons. Furthermore the linkage between monitoring at the local/program level and the government/national-led monitoring system has enhanced the keeping of real time data on ODF status in the country. In turn this has supported decision making and the feedback mechanism.

Filed under: Progress on Sanitation, Sanitation and Health Tagged: Community-Led Total Sanitation

Why Latrines Are Not Used: Communities’ Perceptions and Practices Regarding Latrines in a Taenia solium Endemic Rural Area in Eastern Zambia

Thu, 2015-03-05 14:57

Why Latrines Are Not Used: Communities’ Perceptions and Practices Regarding Latrines in a Taenia solium Endemic Rural Area in Eastern Zambia. PLoS Neg Trop Dis, Mar 2015.

Authors: Séverine Thys , Kabemba E. Mwape, et al.

Livestock owners from small scale farms are most vulnerable for Neglected Zoonotic Diseases (NZD) in developing countries and their risk behavior leads to more intense and complex transmission patterns. Studies in Africa have shown that the underuse of sanitary facilities and the widespread occurrence of free-roaming pigs are the major risk factors for porcine cysticercosis. However the socio-cultural determinants regarding its control remain unclear. We hypothesize that via a bottom-up culture-sensitive approach, innovative control strategies can be developed that are more adapted to the local reality and more sustainable than current interventions.

By assessing the communities’ perceptions, practices and knowledge regarding latrines in a T. solium endemic rural area in Eastern Zambia, we found that more than health, seeking privacy underlies motivation to use latrines or not. The identified taboos related to sanitation practices are in fact explained by the matri- or patrilineal descent and because men are responsible for building latrines, sanitation programs should focus more often on men’s knowledge and beliefs. In order to contribute to breaking the vicious cycle between poverty and poor health among livestock owners in developing countries, disease control strategies should always consider the socio-cultural context.

Filed under: Africa, Sanitation and Health Tagged: latrines, porcine cysticercosis, Zambia

How Bangladesh turns toilet waste into high-value compost – in pictures

Tue, 2015-03-03 16:26

How Bangladesh turns toilet waste into high-value compost – in pictures |Source: The Guardian, Feb 27 2015 |

Scientists in Bangladesh are working on ways to treat toilet waste in rural areas and use it to develop safe, nutritious compost for food crops. Led by the school of civil engineering at Leeds University, the Value at the End of the Sanitation Value-Chain (VESV) project aims to help reduce reliance on imported inorganic fertilisers and provide potential business opportunities for waste transporters and compost producers in a country where access to sanitation is now widespread but challenges of managing waste remain.

Farmers tend their cabbage crops in Manikganj district. Bangladesh has benefited from major improvements in rural sanitation with the spread of pit toilets – holes dug in the ground. 

These bypass the problem of installing sewerage infrastructure in densely populated rural areas, but the challenge is what to do with the waste when the pits are full. If treated carefully, this waste could provide a local source of organic matter and plant nutrients such as nitrogen, potassium and phosphorus. All photographs by Neil Palmer/IWMI.

Filed under: Research Tagged: Bangladesh, compost, excreta reuse

Feb/March 2015 selected studies on sanitation, hygiene & handwashing

Mon, 2015-03-02 14:53


Household-Level Risk Factors for Influenza among Young Children in Dhaka, Bangladesh: A Case-Control Study(Abstract/order)

To identify household-level factors associated with influenza among young children in a crowded community in Dhaka, Bangladesh. Case households were more likely than controls to have crowded (≥4 persons) sleeping areas and cross-ventilated cooking spaces. Case and control households had similar median 24-hour geometric mean PM2.5 concentrations in the cooking and sleeping spaces. Handwashing with soap was practiced infrequently, and was not associated with pediatric influenza in this community. Interventions aimed at crowded households may reduce influenza incidence in young children.

Getting the basic rights – the role of water, sanitation and hygiene in maternal and reproductive health: a conceptual framework. (Full text)
WASH affects the risk of adverse maternal and perinatal health outcomes; these exposures are multiple and overlapping and may be distant from the immediate health outcome. Much of the evidence is weak, based on observational studies and anecdotal evidence, with relatively few systematic reviews. New systematic reviews are required to assess the quality of existing evidence more rigorously, and primary research is required to investigate the magnitude of effects of particular WASH exposures on specific maternal and perinatal outcomes.


Editorial – Prioritising clean water and sanitation (Free full text but registration required)
Sanitation is the single greatest human achievement with regard to health, yet in much of the world it is underappreciated or inaccessible. Talha Burki investigates. “Currently, the popular approaches to sanitation place a lot of responsibility on individuals and households and not as much on governments”, adds WaterAid’s Yael Velleman. In the UK, it was legislation that led to universal access to improved sanitation. “Ultimately, it was political will and public finance that pushed that drive—I wonder whether we now expect low-income countries to do something we have never done ourselves”, said Velleman. Pollock advocates a return to a health-for-all approach, attending to the building blocks of public health, such as sanitation and nutrition, and directing major investment into infrastructure and monitoring systems. “I can’t understand why we’re prioritising clinical trials in Africa, and not prioritising clean water”, she told The Lancet Infectious Diseases.


Towards effective and socio-culturally appropriate sanitation and hygiene interventions in the Philippines: a mixed method approach. Full text

Inadequate water, sanitation and hygiene (WASH) represent an important health burden in the Philippines. The non-governmental organisation Fit for School intends to complement its handwashing programme in schools with sanitation interventions. The objectives of this mixed-method study therefore were to describe WASH practices and their impact on childhood diarrhoea in the Philippines, and to examine socio-cultural and environmental factors underlying defecation and anal cleansing practices in Northern Mindanao. When adjusting for non-modifiable factors, susceptibility and socioeconomic factors, WASH factors failed to show a statistically significant effect. Defecation and anal cleansing behaviours were constrained by the physical environment, particularly the lack of clean, safe, comfortable and private facilities. Individual determinants of behaviour were influenced by habit and motivations such as disgust, with some evidence of planned behaviour. Where available, water was the preferred material for anal cleansing. This study combines nationally-representative quantitative data with local in-depth qualitative insights, constituting critical formative research in the development of effective and appropriate interventions.


Evaluation of the impact of a simple hand-washing and water-treatment intervention in rural health facilities on hygiene knowledge and reported behaviours of health workers and their clients, Nyanza Province, Kenya, 2008. (Full text)

Many clinics in rural western Kenya lack access to safe water and hand-washing facilities. To address this problem, in 2005 a programme was initiated to install water stations for hand washing and drinking water in 109 health facilities, train health workers on water treatment and hygiene, and motivate clients to adopt these practices. In 2008, we evaluated this intervention’s impact by conducting observations at facilities, and interviewing staff and clients about water treatment and hygiene. Of 30 randomly selected facilities, 97% had water stations in use. Chlorine residuals were detectable in at least one container at 59% of facilities. Of 164 interviewed staff, 79% knew the recommended water-treatment procedure. Of 298 clients, 45% had received training on water treatment at a facility; of these, 68% knew the recommended water-treatment procedure. Use of water stations, water treatment, and client training were sustained in some facilities for up to 3 years.


Household sanitation and personal hygiene practices are associated with child stunting in rural India: a cross-sectional analysis of surveys – Full text

The prevalence of stunting ranged from 25% to 50% across the three studies. Compared with open defecation, household access to toilet facility was associated with a 16–39% reduced odds of stunting among children aged 0–23 months, after adjusting for all potential confounders. Household access to improved water supply or piped water was not in itself associated with stunting. The caregiver’s self-reported practices of washing hands with soap before meals or after defecation were inversely associated with child stunting. However, the inverse association between reported personal hygiene practices and stunting was stronger among households with access to toilet facility or piped water. Improved conditions of sanitation and hygiene practices are associated with reduced prevalence of stunting in rural India. Policies and programming aiming to address child stunting should encompass WASH interventions, thus shifting the emphasis from nutrition-specific to nutrition-sensitive programming. Future randomised trials are warranted to validate the causal association.


Assessment of a membrane drinking water filter in an emergency setting – (Abstract/order info)
The performance and acceptability of the NeroxTM membrane drinking water filter was evaluated among an internally displaced population in Pakistan. The membrane filter and a control ceramic candle filter were distributed to over 3,000 households. Following a 6 month period, 230 households were visited and filter performance and use was assessed. Only 6% of the visited households still had a functioning filter, and the removal performance ranged from 80 to 93%. High turbidity in source water (irrigation canals) together with high temperatures, and large family size were likely to have contributed to poor performance and uptake of the filters.

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Dan Campbell, Knowledge Resources Specialist
WASHplus Project

Filed under: Hygiene Promotion, Research

Frontiers of CLTS Issue 4: Sustainability and CLTS- Taking Stock

Wed, 2015-02-25 15:34

Frontiers of CLTS Issue 4: Sustainability and CLTS- Taking Stock, 2015.

Sustainability is without doubt one of the most burning subject matters that subsumes many of the issues that we are seeing in CLTS and wider WASH practice. 

There have been several useful studies on sustainability that have highlighted some of the different aspects as well as the complexities involved. However, it is unclear how much of the learning from these studies has been built into current and future programming and practice.

Based on existing research and our own understanding, this issue of Frontiers of CLTS is an attempt at an up to date synthesis of where we are at the beginning of 2015.

In the issue, we identify some priority areas for learning: How to phase in sanitation marketing; Post-ODF engagement of government, NGOS, donors and others; How to ensure equity and inclusion; How to transform social norms; Monitoring, learning, changing.

Filed under: Uncategorized Tagged: CLTS, Community-Led Total Sanitation

WASHplus Weekly: Focus on WASH & Nutrition

Fri, 2015-02-20 15:01

Issue 179| Feb 20, 2015 | Focus on WASH & Nutrition

This weekly contains recent webinars, articles, and reports on issues related to WASH and nutrition integration. Included are a policy brief on food hygiene, a handwashing and sanitation study in Tanzania, an overview of the nutrition situation in Asia, a review of the health impact of household water treatment, and other resources.


Global Maternal Newborn Health Conference, Oct. 18–21, 2015, Mexico City. Link
The year 2015 is a critical milestone in international development: the deadline for the Millennium Development Goals (MDGs) and the anticipated adoption of an ambitious new agenda, the Sustainable Development Goals. This USAID– and Government of Mexico–sponsored conference will offer the first opportunity for the global maternal and newborn health communities to discuss and strategize the new goals. The conference will have a technical focus, highlighting strategies and lessons from programs, policies, research, and advocacy for improving both maternal and newborn health.


Integrating Safe Water, Sanitation, and Hygiene into Infant and Child Nutrition Programmes: A Training and Resource Pack for Uganda, 2014. WASHplus. Link
The overall objective of this resource pack is to facilitate the training of village health teams, community knowledge workers, peer support groups, and other outreach workers on how they can help household and community members overcome, or change, the many daily obstacles to improved water, sanitation, and hygiene (WASH) practices in the home.

Webinar on Multi-Sectoral Approaches to Improve Child Growth through WASH, Nutrition, and Early Childhood Development, Jan 2015. WASHplus; CORE Group; Clean, Fed & Nurtured. Link
WASHplus collaborated with the CORE Group’s Nutrition and Social and Behavior Change working groups to host a one-hour webinar on multisectoral approaches to improve child growth and development, with a focus on improving the community knowledge of practice and sharing integration efforts for early childhood development, nutrition, and WASH integration. The Clean, Fed & Nurtured community of practice explained why WASH, nutrition, and early childhood development should be integrated.

Progress in Reducing Child Under-Nutrition: Evidence from Maharashtra. Economic & Political Weekly, Jan 2015. S Jose. Link
Assessing the progress made in reducing under-nutrition among children who are less than 2 years old in Maharashtra between 2005–2006 and 2012, this article points out that child under-nutrition, especially stunting, declined significantly in the state during this period. It holds that this decline can be associated with the interventions initiated through the Rajmata Jijau Mother-Child Health and Nutrition Mission, which began in 2005, and that this indicates the critical role the state can play in reducing child under-nutrition in India.


Policy Brief: Complementary Food Hygiene—An Overlooked Opportunity in the WASH, Nutrition and Health Sectors, 2015. SHARE. Link
This policy brief highlights the often overlooked opportunity to improve health outcomes by addressing complementary food hygiene. It outlines SHARE’s contribution to narrowing the evidence gap concerning the relationship between food hygiene and child health, indicates opportunities for future research, and offers insights that could influence policy and improve programming in the WASH, nutrition, and health sectors globally.

WASH and Nutrition Case Studies, 2014. WASHplus. Link
These 12 case studies were collected as part of putting together a joint donor document on Integrating Water, Sanitation, and Hygiene into Nutrition Policies and Programmes, which will soon be published by UNICEF, USAID, and the World Health Organization. In selecting these case studies, priority was given to activities that achieved measurable nutrition-related impact.

Benefits and Costs of the Water Sanitation and Hygiene Targets for the Post-2015 Development Agenda: Assessment Paper, 2015. G Hutton, The World Bank. Link
Within the area of water and sanitation the targets with the highest benefit-cost ratio are: basic water and basic sanitation in rural areas and eliminating open defecation in rural areas. Other valuable targets in this focus area include: basic sanitation and basic water in urban areas.

Post-2015 Consensus: Water and Sanitation Perspective, 2015. D Whittington. Link
The author reviews the Guy Hutton assessment paper (above) and argues for a carefully done cost-benefit analysis to show that many WASH interventions are economically attractive investments.

Greater Investment in Water, Sanitation and Hygiene is Key to the Fight Against Undernutrition, 2015. C Denis, Action Contre La Faim. Link
The report concludes that the WASH sector must be funded at levels that reflect its impact on under-nutrition and that strategies and programs for fighting under-nutrition must incorporate a long-term multisector component that includes WASH targets and indicators.

Water, Sanitation and Hygiene: Determining a Health Goal that Works for All, 2015. WaterAid. Link
Access to basic drinking water, sanitation, and hygiene is vital to improving health and quality of life globally. As discussions on the post-2015 framework and the Sustainable Development Goals reach their crucial final phase, WaterAid is calling for WASH to be recognized as a key influential factor to be closely integrated into any health goal and priorities taken up by governments and civil society.

Promoting Handwashing and Sanitation Evidence from a Large-Scale Randomized Trial in Rural Tanzania, 2015. B Briceño, The World Bank. Link
This paper presents the results of two large-scale, government-led handwashing and sanitation promotion campaigns in rural Tanzania. For the campaign, 181 wards were randomly assigned to receive sanitation promotion, handwashing promotion, both interventions together, or neither. One year after the end of the program, sanitation wards increased latrine construction rates from 38.6 to 51 percent and reduced regular open defecation from 23.1 to 11.1 percent. Households in handwashing wards showed marginal improvements in handwashing behavior related to food preparation, but not at other critical junctures.

Culture and the Health Transition: Understanding Sanitation Behavior in Rural North India, 2015. D Coffey. Link
This paper draws on new qualitative and quantitative data to examine the cultural meanings of latrine use and open defecation. It finds that beliefs, values, and norms about purity and pollution of private spaces and of bodies help explain widespread open defecation, and that renegotiation of caste and untouchability complicates the adoption of simple latrine technologies.

Policy Memo on Toilet Technology & Culture, 2015. RICE Institute. Link
This notes asks why rural India has uniquely high rates of open defecation. It first explains that the “usual suspects”—GDP, poverty, education, water access—are not to blame for widespread open defecation in rural India. Second, it discusses how the sanitation technology used in rural India differs from the rest of the developing world—in short, very few rural Indian households use latrines with inexpensive underground soak pits. Third, it presents qualitative and quantitative evidence that Hindu practices of purity and pollution, as well as India’s unique history and renegotiation of untouchability, complicate the adoption of the kinds of simple, inexpensive latrines that have been used to reduce open defecation in other developing countries.

Nutritional Status of Women and Children: A 2014 Update on Nutritional Status by Sociodemographic and Water, Sanitation, and Hygiene (WASH) Indicators Collected in Demographic and Health Surveys, 2014. M Kothari, PATH. Link
To provide current context, this report looks at stunting in the framework of common WASH indicators. This report provides a descriptive analysis of the status of women and children in the context of nutrition, breastfeeding, complementary feeding, anemia, dietary diversity, and micronutrient supplementation. The report also provides information on the nutritional status of women and children, with data disaggregated by selected WASH indicators.

Large Decrease in Child Stunting in Bangladesh Despite Limited Improvement in Children’s Food Intake, 2014. M Jain, HarvestPlus, International Food Policy Research Institute. Link
Bangladesh recorded one of the fastest reductions in child stunting between 1997 and 2007. The author does a descriptive decomposition analysis of this rapid decrease, focusing on the role of nutrient intake relative to other important child health inputs, such as maternal health, sanitation, maternal education, and access to health services. Among other factors, maternal health and access to sanitation were found to be the largest drivers of the growth of children across time. Maternal education and access to health services also have a positive, but non-robust, association with growth.

Overview of the Nutrition Situation in 11 Countries in Asia, 2015. FANTA III. Link
FANTA conducted a critical review of the nutrition situation in 11 countries in Asia, which is presented by region (South-Central Asia and Southeast Asia) and by country. The two nutrition overview reports and 11 country profiles provide an in-depth analysis of the key drivers of malnutrition;,current statistical nutrition data and trends for each country, and recommendations for areas to invest in to improve nutrition.

Professor Cairncross at the STOP Stunting Conference, 2014. SHARE. Video
In this video Sandy Cairncross, SHARE research director, shares his thoughts on why reducing stunting is such a priority for South Asia. Professor Cairncross attended the STOP Stunting Conference in New Delhi (November 2014) to deliver a presentation on the links between sanitation and stunting.


Household Water Treatment and Safe Storage to Prevent Diarrheal Disease in Developing Countries. Current Environmental Health Reports, Jan 2015. T Clasen. Link
Household water treatment and safe storage, such as boiling, filtering, or chlorinating water at home, have been shown to be effective in improving the microbiological quality of drinking water. However, estimates of their protective effect against diarrhea, a major killer, have varied widely. While results may be exaggerated because of reporting bias, this heterogeneity is consistent with other environmental interventions that are implemented with varying levels of coverage and uptake in settings where the source of exposure represents one of many transmission pathways.

Household Sanitation and Personal Hygiene Practices are Associated with Child Stunting in Rural India: A Cross-Sectional Analysis of Surveys. BMJ Open, Feb 2015. J Rah. Link
Improved conditions of sanitation and hygiene practices are associated with reduced prevalence of stunting in rural India. Policies and programming that aim to address child stunting should encompass WASH interventions, thus shifting the emphasis from nutrition-specific to nutrition-sensitive programming. Future randomized trials are warranted to validate the causal association.

Risk Factors Associated with Recurrent Diarrheal Illnesses among Children in Kabul, Afghanistan: A Prospective Cohort Study. PLoS One, Feb 2015. A Aluisio. Link
Maternal handwashing and improved sanitation facilities were protective, and represent important prevention points among public health endeavors. The discrepancy between soap availability and use suggests barriers to access and knowledge, and programs simultaneously addressing these aspects would likely be beneficial. Enhanced maternal education and economic status were protective in this population, and these findings support multisector interventions to combat illness.

Age-Related Factors Influencing the Occurrence of Undernutrition in Northeastern Ethiopia. BMC Public Health, Feb 2015. A Degarege. Link
The objective of the current study was to assess the prevalence of under-nutrition in different age groups and examine the relationship of the disease to parasitic and socioeconomic factors among communities in Harbu Town, northeastern Ethiopia. The odds of under-nutrition significantly decreased with an increase in the age of individuals. The odds of under-nutrition in the 5 to 19 years age group was significantly higher in those who did not wash their hands before eating than in those who did. The prevalence of under-nutrition in children younger than 5 years was significantly lower in those whose families were educated and had a family size less than five compared to those with illiterate families and a family size greater than five.

Assessing Factors that Lead to Use of Appropriate Technology: Handwashing Stations in Mali, West Africa. Journal of Water, Sanitation and Hygiene for Development, In Press 2015. C Naughton. Abstract/Order info
This study presents results of a mixed methods approach and comprehensive monitoring strategy of five use variables (use of soap, handwashing station functionality, presence of cleansing agent including soap or white ash, ground wetness, and amount of water in the jug) over two years for 42–64 appropriate technology handwashing stations located in two communities in Mali. Six factors were studied as potentially critical for lasting use of handwashing stations (gender, educational training, water proximity, seasonality, wealth, and station adoption). Statistically significant results include: a 29 percent decrease in use of soap between the dry and rainy seasons; a 35 percent decrease in stations with cleansing agent (e.g., soap or white ash) present over one year; greater station use in wealthy households; and greater use of stations built by women in one community.

The WASH Approach: Fighting Waterborne Diseases in Emergency Situations.Environmental Health Perspectives, Jan 2015. W Nicole. Link
Poor hygiene and fecal contamination were major factors in one of the world’s biggest outbreaks of hepatitis E, which began in October 2007 and persisted for a couple of years. This outbreak affected camps for internally displaced persons (IDPs) in northern Uganda’s Kitgum District, infecting more than 10,000 people and killing 160, mostly pregnant women and young children. Other recent hepatitis E outbreaks have occurred among refugees and IDPs in Kenya, South Sudan, and Chad.

The Other Asian Enigma: Explaining the Rapid Reduction of Undernutrition in Bangladesh. World Development, Feb 2015. D Headey. Link
Although South Asia has long been synonymous with persistent and unusually high rates of child under-nutrition—the so called Asian Enigma—Bangladesh has managed to sustain a surprisingly rapid reduction in the rate of child under-nutrition for at least two decades. This unheralded success is investigated through a regression and decomposition analysis of changes in child growth outcomes across five rounds of Demographic and Health Surveys from 1997 to 2011. Among the findings: rapid wealth accumulation and large gains in parental education are the two largest drivers of change, though health, sanitation, and demographic factors have played significant secondary roles.

Hand-to-Mouth Contacts Result in Greater Ingestion of Feces than Dietary Water Consumption in Tanzania: A Quantitative Fecal Exposure Assessment Model.Environmental Science & Technology, Jan 2015. M Mattioli. Link
Contaminated drinking water and hands are two important environmental transmission routes of diarrhea-causing pathogens to young children in low-income countries. The objective of this research is to evaluate the relative contribution of these two major exposure pathways in a low-income country setting. The model outcome is a distribution of a child’s daily dose of feces via each exposure route. The model results show that Tanzanian children ingest a significantly greater amount of feces each day from hand-to-mouth contacts than from drinking water, which may help elucidate why interventions focused on water without also addressing hygiene often see little to no effect on reported incidence of diarrhea.

Reducing Child Undernutrition: Past Drivers and Priorities for the Post-MDG Era.World Development, Apr 2015. L Smith. Link
As the post-MDG era approaches in 2016, reducing child under-nutrition is gaining high priority on the international development agenda, both as a maker and marker of development. Revisiting Smith and Haddad (2000), this article uses data from 1970 to 2012 for 116 countries, finding that safe water access, sanitation, women’s education, gender equality, and the quantity and quality of food available in countries have been key drivers of past reductions in stunting. Income growth and governance played essential facilitating roles. Complementary to nutrition-specific and nutrition-sensitive programs and policies, accelerating reductions in under-nutrition in the future will require increased investment in these priority areas.

Seasonal Variation of Fecal Contamination in Drinking Water Sources in Developing Countries: A Systematic Review. Science of the Total Environment, May 2015. C Kostylaa.Abstract/order info
Accounting for fecal contamination of drinking water sources is an important step in improving monitoring of global access to safe drinking water. Fecal contamination varies with time while its monitoring is often infrequent. This study sought to understand seasonal trends in fecal contamination to guide best practices to capture seasonal variation and ascertain the extent to which the results of a single sample may overestimate compliance with health guidelines. The findings from 22 studies from developing countries were analyzed. Fecal contamination in improved drinking water sources was shown to follow a statistically significant seasonal trend of greater contamination during the wet season. This trend was consistent across fecal indicator bacteria, five source types, and across both rural and urban areas. Guidance on seasonally representative water quality monitoring by the World Health Organization and national water quality agencies could lead to improved assessments of access to safe drinking water.
WASHplus Weeklies highlight topics such as Urban WASH, Household Air Pollution, Innovation, Household Water Treatment and Storage, Hand Washing, Integration, and more. If you would like to feature your organization’s materials in upcoming issues, please send them to Dan Campbell, WASHplus Knowledge Resources Specialist, at

Filed under: Sanitation and Health Tagged: WASH nutrition integration

Trémolet Consulting – Toilets on Credit, 2015 (video)

Thu, 2015-02-19 19:04
Published on Feb 3, 2015

Can microfinance help increase access to sanitation? Today, 2.5 billion people do not use proper sanitation facilities. Essential services for maintaining latrines and treating faecal sludge are also underdeveloped. In many places, toilets can cost up to one year of income for poor households. Private operators of sanitation services do not have enough capital to acquire more equipment and respond to growing demand.

Since 2010, Trémolet Consulting and research partners based in Kenya MicroSave have been exploring the potential of microfinance for helping sanitation markets to develop. The research, funded by SHARE/DFID, culminated with an action-research in Tanzania in which financial institutions were trained to provide financial services for sanitation. This film explains why microfinance should be explored further, and potentially, included in sanitation programmes.

The film also presents what has been done in Tanzania under the action-research and takes the views of households, sanitation entrepreneurs, microfinance institutions and researchers.


Filed under: Africa, Economic Benefits Tagged: credit, microfinance, Tanzania

Pakistan president to open national sanitation conference PACOSAN II

Sat, 2015-02-14 20:25

President Mamnoon Hussain will inaugurate the 2nd Pakistan Conference on Sanitation (PACOSAN II) that is being held from 17-18 February 2015 at the Sareena Hotel in Islamabad.

PACOSAN II is organised by the Ministry of Climate Change, with the support of WaterAid, UNICEF, Water and Sanitation Program – South Asia (WSP-SA), Plan Pakistan and other sector partners.

Even though Pakistan has achieved a significant reduction in open defecation, it is still practised by 41 million people.

The 1st national sanitation conference PACOSAN I took place in May 2009 – see a conference report on the WSP website.

Follow updates on Twitter at @PACOSAN_II and on Facebook.

Filed under: Campaigns and Events, Progress on Sanitation, South Asia Tagged: PACOSAN, PACOSAN II, Pakistan