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News, Opinions and Resources for Sanitation for All
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Measuring the Safety of Excreta Disposal Behavior in India with the New Safe San Index: Reliability, Validity and Utility

Wed, 2014-08-27 14:01

Measuring the Safety of Excreta Disposal Behavior in India with the New Safe San Index: Reliability, Validity and Utility. Int. J. Environ. Res. Public Health 2014, 11(8), 8319-8346.

Marion W. Jenkins 1,2,*, Matthew C. Freeman 3 and Parimita Routray 2
1 Department of Civil and Environmental Engineering, University of California Davis, One Shields Ave., Davis, CA 95616, USA
2 Environmental Health Group, Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, Keppel Street, London WC1E 7HT, UK
3 Department of Environmental Health, Rollings School of Public Health, Emory University, Atlanta, GA 30322, USA
* Author to whom correspondence should be addressed.

Abstract: Methods to assess household excreta disposal practices are critical for informing public health outcomes of efforts to improve sanitation in developing countries. We present a new metric, the Safe San Index (SSI), to quantify the hygienic safety of a household’s defecation and human feces disposal practices in India, where behavioral outcomes from on-going public expenditures to construct household sanitation facilities and eliminate open defecation are poorly measured. We define hygienic safety of feces disposal as capture in a hygienic sanitation facility.

The SSI consists of 15 self-report items and two sub-scales, Latrine Use Frequency and Seven-Day Open Defecation Rate. Households are scored on a standardized scale from 0 (no defecation safely captured) to 100 (all defecation safely captured). We present results of a pilot study in Odisha, India to apply the Index to assess excreta disposal behaviors among rural households and evaluate the reliability and validity of the Index for estimating the rate of correct and consistent sanitation facility usage of household with an improved latrine.

Filed under: Research, South Asia Tagged: excreta disposal behaviors, India, Safe San Index

Uganda – 1st National Conference on Menstrual Hygiene Management, 2014

Wed, 2014-08-20 17:20

The theme of the conference was Break the Silence on Menstruation, Keep the Girls in School. 

Author: Netwas Uganda

The conference had 4 objectives; a) to raise awareness on the impact of poor menstrual management, b) advocate for policy review, c) develop strategies for operationalizing existing policy, d) demonstrate sustainable good practices on menstrual management. The overall aim was to explore how best the School Health Policy can ensure girls get all the support they need to complete school and reach their full potential.

Filed under: Africa, Dignity and Social Development Tagged: menstrual hygiene management, Uganda

An update from Sanivation in Kenya

Tue, 2014-08-19 18:09

Below are updates from Sanivation, check out the latest newsletter for more information on Sanivation projects and activities. 

One thing we believe in our bones is the customer is king. Over the past couple months, we have been sharing meals, asking questions, and collecting feedback from customers on both toilets and fuel. We have captured some inspiring quotes and wanted to share them with you. This month we will be introducing each short update in this newsletter with a quote from one of our customers.

Learnings from Kakuma: “Two people came and commented positively on my new latrine. One person came, a Somali lady, and asked me if I could sell it to her.” 

We’re currently processing (and soon to be publishing!) all of our learnings from Kakuma. From initial glances, the refugees were not only were satisfied but became promoters of the approach.After an initial review of feedback, we found that the refugees were not only satisfied but also became promoters of the approach. Already, one of our big lessons has been in the power of instituting quick feedback loops and a customer service approach to toilets. We feel honored to have worked with such great partners and are looking forward to continuing work with UNHCR, NRC, and CDC on how to bring this approach to even more refugees. The US Embassy Nairobi made an awesome video of our work. Check it out!

Introducing MakaaDumu: the next generation of household fuel. Made from human waste. “I have seen this charcoal before. I can try it too because I have heard that this charcoal burns for a long time.

In collaboration with a fellow briquette maker, we have created a compact, pillow-shaped briquette. These briquettes are akin to those used in 4th of July barbecues and each one is dense enough to hold its shape.  They also burn longer than wood or charcoal, which are already in short supply in areas that we have worked.

But don’t take our word for it! We had our briquettes tested by the Kenya Industrial Research and Development Institute (KIRDI), and were excited to see that MakaaDumu (our fuel from waste) has comparable energy to oven-dried wood. We are beginning to look for funding to help finance the production of MakaaDumu. See the full results from KIRDI and more reactions in the post Introducing MakaaDumu: The Next Generation of Household Fuel  authored by Benjamin Kramer-Roach our new Director of Energy Production.

Filed under: Progress on Sanitation, Sanitary Facilities Tagged: Kenya, Sanivation

Composting latrine vs. flush toilet: A crowd-funded study

Tue, 2014-08-19 17:50

Composting latrine vs. flush toilet: A crowd-funded study | Source: by Rob Goodier, EngineeringForChange, Aug 2014 |

Excerpt: What we know is that composting toilets have clear ecological and economical advantages over flush toilets. They turn waste into compost, and the compost can fertilize crops, completing a circle of nutrients that saves soils and saves money. They save money in the costs of sewage and in fertilizer. Importantly, they also require much less water.

In this composting pit latrine design, when waste has filled the first pit, the latrine is moved over the second pit. The first pit converts to compost and can be emptied to fertilize fields. Credit: E4C Solutions Library

Those arguments for composting latrines are well documented and have been made for years, but how do they compare in hygiene and how do they fare within the cultures of the different people who use them? Do they limit the spread of disease as well as a flush system with a septic tank or a sewer might? And do they feel as comfortable for families to use? Are they as accessible? And are they really the most sustainable solution in global sanitation?

To answer these questions, Jeff Deal the director of health studies at the water and sanitation engineering non-profit Water Missions International, is raising money through the site that crowdfunds scientific research, The goal is $22,000, which Water Missions International will match to pay for the study.

Filed under: Sanitary Facilities Tagged: composting latrines, latrines

Kenya – Ministry alarmed by ‘long calls’ along highways, to build toilets along Nairobi-Nakuru highway

Mon, 2014-08-18 17:24

Kenya – Ministry alarmed by ‘long calls’ along highways, to build toilets along Nairobi-Nakuru highway | Source: by Antony Gitonga, Standard Digital, Aug 8, 2014 |

NAKURU COUNTY: The ministry of health has expressed its concern over the high number of people who defecate in the open mainly along the main highways in the country. Following the revelation, Nakuru County has announced plans in major centres along the Nairobi-Nakuru and Naivasha-Mai Mahiu road to construct public toilets. According to the department of health, the open defecation was one of the leading causes in the increase in the number of typhoid and diarrhoea cases in the county.

Nakuru County director of health Dr Benedict Osore with county public health officer Samuel King’ori and USAID’s WASHplus project manager Evelyn Makena examine some chairs used for defecation for the disabled at Longonot village in Naivasha. He said that around 300 of the 1,949 villages in the county had been declared open defecation free. [PHOTO: ANTONY GITONGA/STANDARD]

This emerged during celebrations in Longonot Primary school in Naivasha where Longonot was declared as the first Open Defecation Free (ODF) village in Nakuru County. According to Nakuru County director of health Dr Benedict Osore, open defecation on the highways was a major problem which needed to be addressed urgently.

He said that the county in conjunction with other partners was planning to construct public toilets along the highway which would come in handy for motorists and passengers. “The centres will also offer other services like HIV testing and counselling and the public toilets will help deal in containing cases of diarrhoea and typhoid,” he said. He said that the county was committed to eradicating communicable diseases in the next five years and was working on how to dispose pampers which had turned out to be public nuisance.

On his part, Nakuru county public health officer Samuel King’ori said that around 300 of the 1,949 villages in the county had been declared open defecation free. King’ori said the campaign aimed at sensitizing residents on proper hygiene and had seen the number of sanitation related diseases drop significantly. “So far we have trained 235 public health officers who are tasked with training residents on the use of sanitation as one way of eradication communicable diseases,” he said. “Through ODF we have been able to reduce diarrhoea and typhoid cases by 75 percent and we seek to have them eliminated in the county,” said King’ori.

The campaign which is targeting various villages in the county as one way of reducing disease burden has been funded by USAID Washplus and FHI360. During the celebrations a natural leader Pauline Nduta expressed her concern over the number of passengers defecating along the highways while traveling to their destinations. Nduta said they had formed a group of villagers who were monitoring the situation and sensitizing the passengers on the need to use latrines instead of defecating in the open. “We have seen a drop in the number of typhoid cases amongst our school going children thanks to this campaign against open defecation,” she said.

Filed under: Africa, Progress on Sanitation Tagged: Kenya, open defecation eradication, USAID, WASHplus

Making a stink: creating social media platforms to end #opendefecation

Mon, 2014-08-18 09:34

The UNICEF India WASH section is hosting a side event at the Stockholm World Water that builds on their poo2loo campign to promote the use of social nedia iniatives aimed at ending open defecation.

Journalist and author of The Big Necessity Rose George will moderate the event. Panel members Include: Stephen Brown (Global Poverty Project and Global Citizen, UK), Sanjay Wijesekera (UNICEF New York), Thorsten Kiefer (WASH United) and Sue Coates and Maria Fernandez (both from UNICEF India).

Make the Stink will be held from 12.30-14.00 on 3 September.

Register for the event

More information at:

Filed under: Campaigns and Events, South Asia Tagged: India, open defecation, Poo2Loo, Rose George, social media, Stockholm World Water Week, unicef

AMCOW AfricaSan Awards 2014: call for nominations

Sat, 2014-08-16 09:29

The African Ministers’ Council on Water (AMCOW) is pleased to invite entries for the AMCOW AfricaSan Awards to be announced on the 10th October 2014 at AfricaSan 4.

The AMCOW AfricaSan 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.

Nominations for awards are being called for in 6 categories for the 2014 Awards.  These are:

1.      RESEARCH & TECHNICAL INNOVATION: to honor 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.

2.      YOUTH AWARD: to honor exceptional youth (under the age of 35) or agencies that promote water and sanitation that affect youth, whose work has/have made a significant impact upon children or youth.

3.      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.

4.      HYGIENE AWARD: to be awarded to individuals or agencies/businesses that have undertaken outstanding initiatives or progress to promote good hygiene in relation to water and sanitation

5.      IMPACT AT SCALE AWARD: presented in recognition of outstanding initiatives that have had impact at a significant scale (i.e. city-scale; district-scale, country-scale)

6.      INTEGRITY AWARD: presented to individuals or agencies that have made extraordinary progress in fighting corruption and improving governance or transparency in sanitation service delivery  or hygiene promotion

Nomination guidelines

The AMCOW AfricaSan Awards are open to all individuals and institutions working in the sanitation and hygiene sector throughout the African continent. Nominations will be accepted from individuals or organizations based within or outside Africa. However, the nominees must be involved in sanitation and hygiene-related activities within Africa.

All nominations should be made on prescribed Nomination Forms provided by the African Ministers’ Council on Water (AMCOW). The forms are available online at  and on the website of all AMCOW partner institutions.  Completed Nomination Forms (in English or French) should be sent to  not later than 6 pm (Abuja time) on Wednesday September 10th, 2014.

Selection of Winners
Entries will be reviewed by a technical committee of experts and judged by a panel of independent and eminent sector leaders. The judges’ decisions will be final. Winners will be announced at the end of September while the awards will be presented at a ceremony to be to be held as part of the AfricaSan 4 Conference holding in Dakar, Senegal on the 10th of October 2014.
For more information contact Thompson Abu at:  or call: (+234(0)803 311 9493)

Filed under: Africa Tagged: AfricaSan 4, AfricaSan Awards 2014, AMCOW

#CleanUpIndia: #Sanitation “All Stars” discuss plans to make India #opendefecation free

Sat, 2014-08-16 07:16

Prime Minister Narendra Modi has taken up sanitation as a special cause. He would like to celebrate Mahatma Gandhi’s 150th birth anniversary in 2019 by declaring India open defecation free. A noble goal, but is it realistic? The political will and financial commitment is there but can the shift in mindset from building infrastructure to behaviour change and ensuring toilet use and safe disposal be made?

As part of its #CleanUpIndia initiative, TV channel CNN – Indian Broadcasting Network (CNN – IBN) invited an “all star” cast of sanitation celebrities to discuss the Swach Bharat or Clean India campaign that Modi intends to launch in October 2014. What do they think needs to be done to clean up India for good?

In the line up are:

and invited guests:

Filed under: Campaigns and Events, Dignity and Social Development, Sanitary Facilities, South Asia, Wastewater Management Tagged: #CleanUpIndia, Bindeshwar Pathak, CNN-IBN, Girindre Beeharry, India, Jairam Ramesh, open defecation, Sunita Narain, Swach Bharat, Vimlendhu Jha

Free online course on urban sanitation starts 13 October

Fri, 2014-08-15 07:17

A team of instructors led by Christoph Lüthi from the École Polytechnique Fédérale de Lausanne (EPFL) are eager to teach you how to plan urban sanitation systems.

Together with Sandec/Eawag, EPFL has designed a 5 week online course introducing sector planning tools and frameworks such as Sanitation 21, Community-Led Urban Environmental Sanitation (CLUES) and the Sanitation Systems Approach.

The course consists of lecture videos (English, with French subtitles), practical exercises, a homework quiz and a final exam. The questions and explanations for the practical exercises, the homework quiz and the final exam are offered in English and French. Watch the introduction video.

The course “Planning & Design of Sanitation Systems and Technologies” runs from 13 October to 16 November 2014.

It is the 2nd MOOC (massive open online course) of the series on “WASH in developing countries”. The first MOOC was on “Household Water Treatment and Safe Storage“.

Filed under: Education & training, Sanitary Facilities, Wastewater Management Tagged: EPFL, MOOC, online courses, Sandec, training courses, urban sanitation

Rose George – What is life like when your period means you are shunned by society?

Wed, 2014-08-13 15:22

What is life like when your period means you are shunned by society? by Rose George, WaterAid Blog, July 2014 |

Journalist Rose George reports on her visit to WaterAid Nepal, where she saw the impact of menstrual taboos on women and girls.

Excerpts – For Radha dinner is served at 7. She crouches down behind a shed, a good distance from her house, then waits.

She knows what the menu will be: boiled rice, the same as yesterday and the day before. She knows that it will be her little sister who serves it, throwing the rice onto her plate from a height, the way you would feed a dog.

Radha Bishwa Karma serving food behind the toilet.
Credit: WaterAid/Poulomi Basu

In Jamu, Radha’s village in western Nepal, her status is lower than a dog’s, because she is menstruating.

She is only 16, yet, for the length of her period, Radha can’t enter her house or eat anything but boiled rice. She can’t touch other women – not even her grandmother or sister – because her touch will pollute them. If she touches a man or a boy, he will start shivering and sicken.

If she eats butter or buffalo milk, the buffalo will sicken too and stop milking. If she enters a temple or worships at all, her gods will be furious and take their revenge, by sending snakes or some other calamity.

Here, menstruation is dirty, and a menstruating girl is a powerful, polluting thing. A thing to be feared and shunned.


Filed under: Dignity and Social Development, Sanitation and Health, South Asia Tagged: menstrual hygiene

WEDC – Menstruation hygiene management for schoolgirls

Wed, 2014-08-13 14:12

Menstruation hygiene management for schoolgirls, 2014.

Author: Tracey Crofts, WEDC.

This guide outlines the problems experienced by menstruating schoolgirls in low-income countries. Although its focus is predominantly sub-Saharan Africa, many of the issues raised are relevant to girls in most low-income countries, although there may be differences in popular practice and beliefs. 

The guide also evaluates simple solutions to these problems including the use of low-cost sanitary pads, and suggests ways in which menstruation hygiene management (MHM) can be included in water, sanitation and hygiene (WASH) programmes.

Filed under: Dignity and Social Development, Hygiene Promotion Tagged: menstrual hygiene, WEDC

One day CLTS sharing and learning workshops

Tue, 2014-08-12 18:23

Conference goers in Asia and Africa can get updated on Community-Led Total Sanitation (CLTS) during two one day sharing and learning workshops.

The CLTS Knowledge Hub at IDS will host the first workshop on Sunday 14 September in conjunction with the annual WEDC Conference that takes place in Hanoi, Viet Nam from 15-19 September 2014.

The second workshop is on 7 October 2014 in Dakar, Senegal. This is one day before the start of AfricaSan 4 conference that is being held in Dakar, Senegal from 8-10 October 2014.

For full details go to:

Filed under: Education & training Tagged: Community-Led Total Sanitation

Registration open for AfricaSan 4

Mon, 2014-08-11 13:09

AfricaSan 4 is being held on October 8-10 2014 in Dakar, Senegal. The website is now up and running and registration is open:

AfricaSan 4 continues the AfricaSan tradition, building on approaches that have worked. It is essentially a political meeting seeking to raise the priority of sanitation amongst the new generation of san leaders. The timing is AfricaSan 4 is fortuitous both as the last AfricaSan meeting to assess progress against the MDGs; as well as being well-positioned to build momentum on sanitation and hygiene for the SDGs.

The theme of AfricaSan 4 “Making Sanitation for All a Reality in Africa” responds to the visionary ideals of a new generation of Africa’s sanitation ministers. It sets the bar high so that the highly successful eThekwini commitment process can consider a new set of targets and indicators to help accelerate progress towards universal coverage.

The AfricaSan 4 theme not only concerns itself with sanitation access. It seeks to address the full sanitation value chain (containment, emptying, transport, treatment, disposal and reuse). Moreover it also focuses on a full sanitation ladder of access, including making Africa open-defecation free. By sanitation is also implied hygiene: AfricaSan 4 will host a specific discussion on how to accelerate good hygiene behaviour change.

AfricaSan 4 has also had a strong regional and country process leading up to the Dakar meeting. Led by the chair of AMCOW’s AfricaSan Task Force Subcommittee, WSP, countries have engaged in three substantial sub-regional meetings in which countries have been involved in a peer-to-peer exchange on progress and sector bottlenecks in country action plans. Progress on country action plans and against the eThekwini commitments have been mapped and the results will be presented at AfricaSan 4. A feature of this preparatory process was the conscious effort to align the different sanitation sector monitoring processes in Africa.

Get in engaged with this important opportunity for sanitation in Africa, share this post with your colleagues who may be interested and come to Dakar!

Best wishes,

Piers Cross
AMCOW Lead Advisor on AfricaSan

Filed under: Africa, Campaigns and Events, Dignity and Social Development Tagged: AfricaSan, AfricaSan 4

Deprived of water and sanitation in Gaza

Sat, 2014-08-09 06:44

We don’t want another catastrophe besides the one we already have. Fatma (43) mother of 9 children

Since the start of the Israeli assault on Gaza on 7 July 2014, codenamed “Protective Edge”, the water and wastewater infrastructure in Gaza has been heavily affected by Israeli airstrikes and shelling.

Main water supply and wastewater as well as electricity infrastructure has been hit. As a result services have been cut or severely disrupted, affecting the entire population in Gaza.

Up to 25 per cent of Gaza’s population were displaced. The 1.8 million people in Gaza, living in homes and shelters have extremely restricted access to water and sanitation.

Fatma, 45, was displaced with her family and sought shelter at a school in Ash Shuja’iyeh. She speaks about the problems with water, sanitation and hygiene that her family faces amongst the many other displaced.

Filed under: Emergency Sanitation, Middle East & North Africa, Sanitary Facilities, Sanitation and Health Tagged: EWASH, Thirsting for Justice

Dutch WASH Alliance – The Diamond Business Approach in Sanitation: a Malawi Case

Fri, 2014-08-08 18:27

The Dutch WASH Alliance aims to establish sustainable Water, Sanitation and Hygiene systems that can easily be replicated and scaled up. Within the domain of sanitation, we are creating a functioning WASH market and WASH public sector aiming to increase access to improved sanitation facilities. We support partner organisations that work on demand creation (amongst users); involve WASH entrepreneurs and financial institutions (a working private sector); and support the development of a working public sector. As an Alliance, this is what we refer to as “system change”. To realise system change, WASH Alliance partner WASTE has developed a unique approach called the Diamond Business Approach.

Filed under: Dignity and Social Development, Economic Benefits Tagged: demand creation, Dutch WASH Alliance, entrepreneurs

WASHplus Weekly: Focus on Cholera and Ebola Outbreaks

Fri, 2014-08-08 13:36

Issue 157 | August 8, 2014 | Focus on Disease Outbreaks

This issue highlights recent alerts, news and publications on cholera and Ebola outbreaks. On August 1, 2014, WHO published its latest statistics on the number of cholera cases and cholera-related deaths in 2013. In 2013, there was a 47% decrease in the number of cases reported compared to 2012 and this is the second consecutive year in which reported cholera era cases declined. Resources on the Ebola outbreaks include WHO alerts, a WHO fact sheet, recent newspaper articles and reports on the One Health approach, which investigates human, animal, and environmental interconnectedness and its impact on health.


Recent Newspaper Articles on Outbreaks – Cameroon – Aug 6, 2014 | Ghana – Aug 4, 2014 | South Sudan – July 30, 2014 | Vietnam – Aug 6 2014 |


Cholera Fact Sheet, 2014. World Health Organization. (Link)
Cholera is an acute diarrhoeal infection caused by ingestion of food or water contaminated with the bacterium Vibrio cholerae. Every year, there are an estimated 3–5 million cholera cases and 100,000–120,000 deaths due to cholera. The short incubation period of two hours to five days enhances the potentially explosive pattern of outbreaks.

Cholera in 2013. Weekly Epidem Rec, Aug 2014. WHO. (Link)
In 2013, 47 countries reported a total of 129,064 cases of cholera including 2102 deaths, giving a case-fatality rate of 1.63%. This represents a decrease of 47% in the number of cases reported compared to 2012 and this is the second consecutive year in which reported cholera era cases declined.


Epidemic Cholera Spreads Like Wildfire. Nature, Jan 4, 2014. M Roy. (Link)
Cholera is on the rise globally, especially epidemic cholera, which is characterized by intermittent and unpredictable outbreaks that punctuate periods of regional disease fade-out. These epidemic dynamics remain however poorly understood.  This article examines records for epidemic cholera over both contemporary and historical timelines, from Africa (1990–2006) and former British India (1882–1939). The authors found that the frequency distribution of outbreak size is fat-tailed, scaling approximately as a power-law. This pattern, which shows strong parallels with wildfires, is incompatible with existing cholera models developed for endemic regions, as it implies a fundamental role for stochastic transmission and local depletion of susceptible hosts.

Epidemic Risk from Cholera Introductions into Mexico. PLoS Curr. 2014 Feb.  S Moore.(Link)
Stemming from the 2010 cholera outbreak in Haiti, cholera transmission in Hispaniola continues with over 40,000 cases in 2013. The presence of an ongoing cholera outbreak in the region poses substantial risks to countries throughout the Americas, particularly in areas with poor infrastructure.

Cholera Outbreaks in Malawi in 1998-2012: Social and Cultural Challenges in Prevention and Control. J Infect Dev Ctries. 2014 Jun. K Msyamboza. (Link)
Despite improvements in safe drinking water and sanitation, cholera is still a major public health problem. Introduction of a community-led total sanitation approach, use of social and cultural information in community mobilization strategies, and introduction of an oral cholera vaccine could help to eliminate cholera in Malawi.

Risk Factors for Cholera Transmission in Haiti During Inter-Peak Periods: Insights to Improve Current Control Strategies from Two Case-Control Studies. Epidemiol Infect. 2014 Aug.  F Grandesso. (Abstract)
Two community-based density case-control studies were performed to assess risk factors for cholera transmission during inter-peak periods of the ongoing epidemic in two Haitian urban settings, Gonaives and Carrefour. The strongest associations were: close contact with cholera patients (sharing latrines, visiting cholera patients, helping someone with diarrhoea), eating food from street vendors and washing dishes with untreated water. Protective factors were: drinking chlorinated water, receiving prevention messages via television, church or training sessions, and high household socioeconomic level.

Water Sources As Reservoirs of Vibrio cholerae O1 and Non-O1 strains in Bepanda, Douala (Cameroon): Relationship Between Isolation and Physico-Chemical Factors.BMC Infectious Dis, July 2014. J Akoachere. (Link)
Cholera has been endemic in Douala since 1971. Most outbreaks start from Bepanda, an overcrowded neighbourhood with poor hygiene and sanitary conditions. We investigated water sources in Bepanda as reservoirs of Vibrio cholerae, the causative agent of cholera, determined its antibiotic susceptibility and some physico-chemical characteristics that could maintain the endemicity of this organism in Bepanda.


Strategies & Challenges to Handwashing Promotion in Humanitarian Emergencies, 2014.  J Vujcic. (Link)
Handwashing promotion is deemed important by experts in WASH in emergencies.  However, there are a number of constraints to the success of programs to promote handwashing among emergency-affected persons. These include a lack of targets for prevalence of handwashing practice among the target population, lack of attention to and capacity for developing and implementing effective behavior change communication approaches, lack of understanding of best practices and use or acceptability of different types of handwashing hardware, and limitations in improving programs based on existing knowledge derived from the development context.



Frequently Asked Questions on Ebola Virus Disease, 2014, World Health Organization.(Link)
When visiting patients in the hospital or caring for someone at home, hand washing with soap and water is recommended after touching a patient, being in contact with their bodily fluids, touching his/her surroundings.

WHO Ebola Virus West Africa UpdateAug 6, 2014
Between August 2-4, 2014, a total of 108 new cases of Ebola virus disease (laboratory-confirmed, probable, and suspect cases) as well as 45 deaths were reported from Guinea, Liberia, Nigeria, and Sierra Leone.

Ebola Virus Disease:  Alerts, Publications, Resources. World Health Organization. (Link)
Technical information on infection control, response plans, etc.

USAID PREDICT Project. (Link)
PREDICT has been conducting global surveillance to detect and prevent spillover of pathogens of pandemic potential that can move between wildlife and people.


Ebola Can Be Killed by Soap and Water. CBN News, Aug 2014. L Johnson. (Link)
This article describes how the Ebola virus can be killed by washing hands using soap and water and with education, this practice can help stop the spread of the virus.

Liberia: ‘Practice Good Hand Hygiene’ – U.S. Monitoring Ebola Situation. AllAfrica, June 2014. (Link)
Transmission among humans is almost exclusively among caregiver, family members or health care workers tending to the very ill or preparation of the body of a deceased case for burial. The virus is easily killed by contact with soap, bleach, sunlight, or drying. A washing machine will kill the virus in clothing saturated with infected body fluids.

How Deforestation Shares the Blame for the Ebola Epidemic. Washington Post, July 2014. T McCoy. (Link)
The commonality between numerous outbreaks of Ebola, scientists say, is growing human activity and deforestation in previously untouched forests, bringing humans into closer contact with rare disease strains viral enough to precipitate an epidemic.


The 2014 Ebola Virus Disease Outbreak in West Africa. J Gen Virol,  Aug 2014. D Gatherer. (Link)
On March 23, 2014, the World Health Organization issued its first communiqué on a new outbreak of Ebola virus disease (EVD), which began in December 2013 in Guinée Forestière (Forested Guinea), the eastern sector of the Republic of Guinea.  The appearance of cases in the Guinean capital, Conakry, and the transit of another case through the Liberian capital, Monrovia, presents the first large urban setting for EVD transmission.

The Ebola Threat: A “New Normal”? World Bank Blog, July 2014. P Marquez. (Link)
“As recently described by Laurie Garrett of the Council of Foreign Relations, the Ebola virus in West Africa should be tackled the same way it was done in 1976:  with soap, clean water, protective gear, safe medical practices, and quarantine; technology and vaccines are of no use. Also community engagement and involvement, effective contact tracing, cross-border collaboration and effective coordination would be critical.  But I also add that in pursuing a broader development agenda to end poverty and enhance shared prosperity over the medium term, countries and the international community have the responsibility to act on the recognition that environmental factors can impact human health and support the development of sustainable ‘One Health’ platforms to deal with the emergence of new viruses or the reemergence of known pathogens that risk affecting all of us across the world.”

Outbreak of Ebola Virus Disease in Guinea: Where Ecology Meets Economy. PLoS Neglected Tropical Diseases, July 2014. D Bausch. (Link)
As best as can be determined, the first case of Ebola virus disease in Guinea occurred in December 2013, at the beginning of the dry season, a finding consistent with observations from other countries that outbreaks often begin during the transition from the rainy to dry seasons.

Effects of Environmental Change on Zoonotic Disease Risk: An Ecological Primer.Trends in Parasitology, Apr 2014. A Estrada-Pena. (Link)
Impacts of environmental changes on zoonotic disease risk are the subject of speculation, but lack a coherent framework for understanding environmental drivers of pathogen transmission from animal hosts to humans.  This article reviews how environmental factors affect the distribution of zoonotic agents and their transmission to humans, exploring the roles they play in zoonotic systems.

Zoonoses and One Health: A Review of the Literature. Journal of Parasitology Research, Jan 2014. S Bidaisee. (Link)
One health is a concept that was officially adopted by international organizations and scholarly bodies in 1984. It is the notion of combining human, animal, and environmental components to address global health challenges that have an ecological interconnectedness.

Seeing the Forest for the Trees: How “One Health” Connects Humans, Animals, and Ecosystems. Environmental Health Perspectives, May 2014. W Nicole. (Link)
With West Nile encephalitis, SARS, Ebola hemorrhagic fever, swine flu, and other zoonotic diseases popping up regularly in recent decades, scientists and medical practitioners have taken notice. In 2004 the Wildlife Conservation Society held the One World, One Health conference to bring together leaders from various disciplines; it culminated in the 12 Manhattan Principles, which urged world leaders, scientists, and society to more holistically consider the interelationship between zoonotic diseases and ecosystems.

Filed under: Sanitation and Health Tagged: cholera, Ebola, One Health

The Bangladesh Paradox: exceptional health and sanitation advances despite poverty

Mon, 2014-08-04 20:28

Dr. Mushtaque Chowdhury from BRAC on the Bangladesh public health miracle, aid or trade, arsenic, floating latrines and the post-2015 development agenda.

Dr. Mushtaque Chowdhury from BRAC presents the “Bangladesh Paradox”, International Water House, The Hague, The Netherlands, 30 July 2014

By Cor Dietvorst and Vera van der Grift, IRC
Originally posted on the IRC web site, 01 August 2014

Bangladesh has made tremendous progress in the fields of health and sanitation. With a population of 149 million, it now has the highest life expectancy; the lowest fertility rate and the lowest mortality rate of children under five in South Asia (excepting Sri Lanka), although it spends less on health care than most neighbouring countries. Only 10% of the population in Bangladesh practices Open Defecation (OD) compared to 50% in India.

It is one of only six countries that are on track to achieve Millennium Development Goals 4 and 5 on reducing child mortality and improving maternal health.

Emerging from the war of liberation in 1971, Bangladesh embraced a new more liberal identity, which manifested itself in a change in societal attitudes towards women, and girls’ education in particular.


How did Bangladesh pull this off? During a recent lunch meeting organised by IRC and the Netherlands Water Partnership at the International Water House in The Hague, Dr. Mushtaque Chowdhury gave a presentation on the Bangladesh health paradox, drawing from his article [1] published last year in The Lancet. His organisation, BRAC, of which he is Non-Executive Vice Chair and Interim Chief Executive Officer, has played an important role in transforming Bangladesh from a  “basket case” 42 years ago to an exceptional health performer now.

BRAC’s relationship with the government is more a love than hate relationship

Government commitment to social welfare and health, donor support and pluralism in health care, allowed NGOs like BRAC to flourish. Unlike many countries that are increasing restrictions on NGOs, Bangladesh has created a more NGO-friendly climate for instance by creating an NGO affairs bureau to fast track the proposal approval process.

World’s largest NGO

BRAC is one of the organisations that has contributed to and benefitted from this burgeoning NGO sector. With 120,000 employees in 12 countries and an annual expenditure of US$ 718 million in 2013, BRAC is the largest NGO in the world, reaching an estimated 135 million people. Since 2006, The Netherlands supports a large water and sanitation programme (BRAC WASH) that covers more than half of Bangladesh and in which IRC acts as a knowledge partner.

What makes BRAC attractive and successful is its business model, based on 70% own funding while the remaining 30% is provided by donors. Some 50% of the profits BRAC derives from its microfinance service and 18 other social enterprises go towards development projects. The other 50% is reinvested in the enterprise themselves.

Aid or trade?

When asked if BRAC will ever become 100% self-reliant, Dr. Chowdhury replied with an emphatic “no”!  Soliciting for funds from donors creates a competitive environment, which boosts/breeds innovation. BRAC will continue soliciting for the 30% or so funding from donors.

Dr. Chowdhury also does not believe that trade can completely replace development aid. Micro-loans only work if they are linked to the market, he said and the ultra-poor will never be able to pay market prices.

Donors make a mistake if they pull out of countries like Viet Nam when they reach a middle-income status. These countries still harbour huge numbers of the very poor. Continued investment is needed.

Arsenic, the forgotten story

BRAC has a strong research culture with links to programme implementation, focusing on solving problems and testing the effectiveness of its interventions. In collaboration with the University of Toronto  and social enterprise PurifAid, BRAC, for example, is trying to address the arsenic poisoning problem by testing appropriate filters. In the 1990s, arsenic contamination of groundwater attracted a lot of media attention but now it has become a “forgotten story” that still affects 30% of the population. A BRAC WASH II action research project, ASTRA, is developing a decision-support tool to help deliver arsenic- and salt-free drinking water in Bangladesh.

Floating latrines

Floating latrine. Copyright BRAC

Providing sanitation for marginalised communities in wetlands is a daunting problem. There is little space for latrines and frequent flash floods wash them away. The BRAC WASH programme is experimenting with an innovative solution: the floating latrine. Sludge management remains a challenge.

Moving forward: changing roles in the South and North

BRAC’s role is shifting from implementing services to quality assurance. As government takes over the responsibility of service provision, NGOs like BRAC can help support that transition.

If southern NGOs like BRAC start expanding their operations to other countries is there still a role for NGOs from the North? Dr. Chowdhury believes there is. He still values the technical support BRAC receives from organisations like IRC.

Advocacy efforts can benefit a lot if southern NGOs team up with their northern partners, Dr.Chowdhury believes.

“It is easy to reach service coverage rates up to 60-70%”, Dr. Chowdhury said, when asked how he thought BRAC could contribute to the post-215 Sustainable Development Goals (SDGs). “We can’t use the same approach to reach the remaining 10-30%. We have to think differently”.

[1] Mushtaque, A … [et al.], 2013. The Bangladesh paradox: exceptional health achievement despite economic poverty. The Lancet, 23 November 2013. doi:10.1016/S0140-6736(13)62148-0


Filed under: Sanitation and Health, South Asia Tagged: arsenic, Bangladesh, BRAC, development aid, floating toilets, NGOs, public health, social entrepreneurs

India: Big push for small cities

Mon, 2014-08-04 16:08

By Prakhar Jain

The run-up to elect a new government brought sanitation to the fore of public conversation in India. Last month, Prime Minister Modi declared sanitation as a national priority, announcing ‘Swachh Bharat Abhiyan’, a sanitation programme dedicated to creating clean India by 2019 as a tribute to Mahatma Gandhi’s 150th birth anniversary. Whether or not this plan succeeds may depend on whether it is simply a repackaged programme such as the ‘Nirmal Bharat Abhiyan’ that was focused entirely on building toilets in rural India, or a renewed commitment to improve sanitation in both the rural and urban areas.  As India urbanizes, demand for effective and sustainable sanitation services will increase. India, with 11% of the world’s urban population currently, accounts for 46% of global urban open defecation [i]. While other developing countries like China, Vietnam, and Peru have already achieved open defecation free (ODF) status in urban areas, India still lags behind. The situation is particularly abysmal in small cities (population below a million) where close to 17% of the population defecates in the open as compared to 4% in large cities (population greater than a million) [ii]. The 2011 national census has shown that these small cities represent more than 91% of total urban open defecation in the country. If we are to catch up, the key is to immediately turn our attention towards small and medium-sized cities.

While access to toilets remains a big issue, improving sanitation services in urban areas requires an integrated approach that includes treatment and disposal of human waste. This integrated infrastructure is particularly lacking in smaller cities. According to a report published in 2009 by the Central Pollution Control Board (CPCB) on wastewater treatment in India, large cities have about 51% of required wastewater treatment capacity as compared to only 17% in small cities [iii]. The untreated wastewater pollutes the environment particularly drinking water sources such as lakes and rivers, resulting in health hazards. Lack of access to adequate public health facilities and resources in small cities further aggravates the problem.

Government investments in the sector through national programmes and schemes have favoured large cities. One such example is of the Jawaharlal Nehru National Urban Renewal Mission (JNNURM) that was initiated by the Government of India in 2005 to create infrastructure in cities. Out of the total INR 240 billion (US$ 3.9 billion) approved for sanitation projects so far, less than one-third has been allocated to small cities [iv]. It’s time to spread the investment span of these schemes more evenly.

In addition to targeted projects, capacity must be built in the smaller cities. Urban local government bodies in large cities usually have dedicated engineering wings with qualified engineers and technicians. Apart from enjoying easier access to central government and state government funds, they have the capacity and experience to approach donor agencies or raise money from the market. Sadly, sanitation as a sector is relatively low on their agenda when compared with other sectors; infrastructure projects such as flyovers, metro systems and bus rapid transport systems usually take precedence. On the other hand, local governments in small cities are likely to prioritise sanitation as a key development objective over other sectors. Despite lack of technical and institutional capacities and a serious dearth of funds, they are likely to have a greater appetite and lesser inertia for using innovative and alternative models when compared to large cities. With some national and state government assistance and effective local leadership, some of them can hope to create implementable, successful, and scalable models of sanitation service delivery which other cities can emulate.

There is a simple economic argument, one that the new government should not overlook: based on estimates by the World Bank and our research, India could be losing close to 2.6% of its national GDP every year due to inadequate sanitation in urban areas [v]. These economic impacts include direct monetary losses incurred from healthcare expenditure, money spent on accessing toilets and indirect imputed productivity losses which include access time costs, mortality losses and so on. Our analysis further show that share of small cities is between 53%-69% of the total urban losses. Moreover, with a high number of villages transforming into towns over time, the economic costs due to inadequate sanitation from urban areas shall continue their steady ascent.

All the aforementioned factors including insufficient treatment capacity, big city bias of central funding programmes, lack of technical and institutional capacities, high appetite for non-conventional systems and high economic losses signal the need for greater policy focus on small and medium-sized cities. Small cities across India need to create better infrastructure, improve service quality, and strengthen the institutions responsible for achieving and sustaining these goals. As the new government makes sanitation a priority, it should take note to correct the relative ignorance of achieving sanitation in small cities. The time has come to bring the resources and commitment it has shown to improve systems in the Delhis and Mumbais to bear on the Kochis and Cuttacks.

Prakhar Jain is researcher with the SCI-FI: Sanitation initiative of the Centre for Policy Research, New Delhi.

[i] World Health Organization and UNICEF 2014. WHO/UNICEF Joint Monitoring Programme (JMP) for Water Supply and Sanitation. Database. URL

[ii] Census of India 2011

[iii] Central Pollution Control Board, Government of India 2009. Status of Water Supply, Waste water generation and treatment in Class I Cities and Class II Towns of India. New Delhi.

[iv] Ministry of Urban Development, Government of India 2014. JNNURM Database. URL

[v] Aditya Bhol 2014, Economic impacts of sanitation across city-sizes , Working paper, Centre for Policy Research

Filed under: Policy, Sanitary Facilities, South Asia, Wastewater Management Tagged: economic impacts, India, small cities, urban sanitation

August 15 is World Portable Sanitation Day

Sun, 2014-08-03 15:51

We already had World Toilet Day on 19 November. Now, starting in 2014, we have World Portable Sanitation Day (WPSD), initiated by the Portable Sanitation Association International (PSAI), on August 15.

The aim of the celebration is to raise awareness about the need to expand access to sustainable sanitation. The PSAI estimates that portable sanitation can save 125 million gallons (470 million litres) of fresh water daily, as well as have a significant impact on productivity and fuel savings at construction sites.


The PSAI has over 550 portable restroom organisations in 34 countries around the world as members. The majority of members are from the USA, where the PSAI is based.

Web site:

Filed under: Campaigns and Events, Sanitary Facilities Tagged: Portable Sanitation Association International, portable toilets, World Portable Sanitation Day

Innovative communal sanitation models for the urban poor: Lessons from Uganda

Fri, 2014-08-01 15:44

Innovative communal sanitation models for the urban poor: Lessons from Uganda, 2014.

Authors: Greg Bachmayer, Noah Shermbrucker. SHARE.

This paper describes the construction and management processes related to two toilet blocks in Uganda, one in Jinja and one in Kampala. Designs, financial models and insights into the process and challenges faced are presented and reflected on. Discussions about scaling up sanitation provision through these models are also tabled. To strengthen their planning processes, the Ugandan federation sought to draw on other community driven processes in India and Malawi. With divergent contexts, especially in terms of density, lessons were adapted to local conditions. 

Through unpacking these experiences the paper draws attention to a number of key points. Firstly it argues that organised communities have the potential to develop functional and sustainable systems for the planning, construction and management of communal toilet blocks. Secondly, how shared learning, practical experience and exchanges driven by communities assisted in refining the sanitation systems and technologies piloted and thirdly the value, especially in terms of scale and leverage of including City Authorities in the provision of communal sanitation. A fourth key point, interwoven across discussions, relates to the financial planning, costing and affordability of the sanitation options piloted. Understanding the seed capital investments needed and various options for cost recovery is vital in assessing the affordability and scalability of pilots.

The paper mixes one of the co-author’s reflections (written in first person) with descriptions and analysis of the sanitation projects supported. This narrative method is deployed to emphasise the collegiate manner in which learning takes place across a country-spanning network of urban poor communities.

Filed under: Africa, Progress on Sanitation, Sanitary Facilities Tagged: communal sanitation, Uganda