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Updated: 40 min 24 sec ago

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

WASHplus Weekly: Focus on Handwashing

Fri, 2014-08-01 13:15

Issue 156 | August 1, 2014 | Focus on Hand Washing

This issue contains journal articles and reports published to date in 2014 on hand washing. Journal articles include an updated review of hand washing’s health effects, an evaluation on the use of soapy water, a new Community Handwashing Guide, and an article on the Super Amma campaign in India.

Reports include a review of hand washing in the perinatal period, a social media toolkit from the Global Public-Private Partnership for Handwashing, a report from the Institute of Development Studies on developing hand washing campaigns as part of community-led total sanitation programs, and others.


What Does Sustainability Mean for Handwashing and Hygiene? Handwashing & Hygiene Track, Sustainability Forum, July 2014. Overview by J Rosenbaum, USAID/WASHplus. (Link)
The literature on improving hand washing practice and then sustaining or maintaining the practice suggests determinants such as social norms, policy, and presence of “enabling technologies” (like tippy taps and water treatment products) are the primary factors required to sustain behaviors rather than issues around functioning hardware, community maintenance, and local governance. These technology and systems issues lie within the household domain rather than with community or government. Availability of  key supplies and spare parts, and willingness to pay also factor into the equation, as does sustained maintenance of hand washing stations and water filters.


Periodic Overview of Handwashing Literature: Summary of Selected Peer-Reviewed and Grey Literature Published July – December 2013. The Global Public-Private Partnership for Handwashing (PPPHW). (Link)
Twice a year, PPPHW publishes overviews of handwashing literature that provide practical guidance for implementers. This is a compilation of peer-reviewed and grey literature that were published between July through December 2013.


Hygiene and Health: Systematic Review of Handwashing Practices Worldwide and Update of Health Effects. Trop Med Int Health, Aug 2014. M Freeman. (Link)
From the 42 studies reporting hand washing prevalence the authors estimate that approximately 19 percent of the world’s population washes hands with soap after contact with excreta (i.e., use of a sanitation facility or contact with children’s excreta). Meta-regression of risk estimates suggests that hand washing reduces the risk of diarrheal disease by 40 percent; however, when they included an adjustment for unblinded studies, the effect estimate was reduced to 23 percent. Results show that hand washing after contact with excreta is poorly practiced globally, despite the likely positive health benefits.

Association between Moderate-to-Severe Diarrhea in Young Children in the Global Enteric Multicenter Study (GEMS) and Types of Handwashing Materials Used by Caretakers in Mirzapur, Bangladesh. Am Jnl Trop Med Hyg, July 2014. K Baker. (Link)
Hand washing practices among caretakers of children under 5 years of age enrolled in the Global Enteric Multicenter Study in Mirzapur, Bangladesh, were characterized and analyzed for association with moderate-to-severe diarrhea. Soap or detergent ownership was common, yet 48 percent of case and 47.7 percent of control caretakers also used ashes for hand washing, including 36.8 percent of the wealthiest households. Contact with ash and water reduced concentrations of bacterial enteropathogens, without mechanical scrubbing. Thus, washing hands with ash is a prevalent behavior in Mirzapur and may help diminish transmission of diarrheal pathogens to children.

Microbiological Evaluation of the Efficacy of Soapy Water to Clean Hands: A Randomized, Non-Inferiority Field Trial. Am Jnl Trop Med Hyg, June 2014. N Amin.(Abstract)
Researchers conducted a randomized, non-inferiority field trial in urban Dhaka, Bangladesh, among mothers to compare microbial efficacy of soapy water with bar soap and water alone. Scrubbing hands with water alone reduced thermotolerant coliforms but was less efficacious than scrubbing hands with soapy water. Soapy water is an inexpensive and microbiologically effective cleansing agent to improve hand washing among households with vulnerable children.

Hand Contamination with Human Rhinovirus in Bangladesh. Jnl Med Virol, Apr 2014. S Luby. (Abstract)
As one step in developing a measure of hand contamination with respiratory viruses, this study assessed if human rhinovirus (HRV) was detectable on hands in a low income, non-temperate community where respiratory disease is a leading cause of child death. This study demonstrates in the natural setting that, at least after sneezing or nasal cleaning, hands were contaminated commonly with potentially infectious HRV. Future research could explore if HRV RNA is present consistently and is associated sufficiently with the incidence of respiratory illness in communities that it may provide a proxy measure of respiratory viral hand contamination.

Associations Between Presence of Handwashing Stations and Soap in the Home and Diarrhoea and Respiratory Illness in Children Less than Five Years Old in Rural Western Kenya. Trop Med Int Health, Apr 2014. K Kamm. (Abstract)
Researchers tested whether soap presence in the home or a designated hand washing station was associated with diarrhea and acute respiratory illness in Kenya. Soap presence in the home was significantly associated with reduced diarrhea, but not ARI, in children in rural western Kenya. Whereas most households had soap in the home, almost none had a designated hand washing station, which may prevent hand washing at key times of hand contamination.

Community Handwashing Guide: Utilizing Available Resources to Initiate a Handwashing Intervention. World Medical & Health Policy, Mar 2014. MP Sandhu. (Link)
In this article, the current hand washing recommendations and their applicability to hygiene interventions in developing nations were examined. The results of this review suggested that a new hand washing paradigm is needed to address the varying resources available for hand hygiene. Thus, a novel community hand washing guide was developed. This guide emphasizes the importance of increasing access to physical hand washing resources in developing communities, and can be applied to communities regardless of their socio-economic status. The community hand washing guide promotes sustainable, incremental improvements in hygiene within a community, and is a more feasible approach than previous recommendations.

Effect of a Behaviour-Change Intervention on Handwashing with Soap in India (SuperAmma): A Cluster-Randomised Trial. Lancet Global Health, Mar 2014. A Biran.(Link)
The authors tested whether a scalable village-level intervention based on emotional drivers of behavior, rather than knowledge, could improve hand washing behavior in rural India. Hand washing with soap at key events was rare at baseline in both the intervention and control groups. At six weeks’ follow-up, hand washing with soap at key events was more common in the intervention group than in the control group. This study shows that substantial increases in hand washing with soap can be achieved using a scalable intervention based on emotional drivers.

Increasing Handwashing with Soap: Emotional Drivers or Social Norms? Lancet Global Health, Mar 2014. E Leontsin. (Link)
The authors state that although the argument for disgust as a key motivator for hand washing is intriguing, further research is needed to provide definitive evidence of its effectiveness.

Efficacy of Moringa Oleifera Leaf Powder as a Handwashing Product: A Crossover Controlled Study Among Healthy Volunteers. BMC Complementary and Alternative Medicine, 14:57 2014. B Torondel. (Link)
Four grams of Moringa oleifera powder in dried and wet application had the same effect as nonmedicated soap when used for hand washing. Efficacious and available hand washing products could be useful in developing countries in controlling pathogenic organisms that are transmitted through contaminated hands.

An Investigation of the Effects of a Hand Washing Intervention on Health Outcomes and School Absence Using a Randomised Trial in Indian Urban Communities. Trop Med Int Health, Mar 2014. J Nicholson. (Link)
Direct-contact hand washing interventions aimed at younger school-aged children can affect the health of the whole family. These may be scalable through public-private partnerships and classroom-based campaigns. Further work is required to understand the conditions under which health benefits are transferred and the mechanisms for transference.

The Impact of School Water, Sanitation, and Hygiene Interventions on the Health of Younger Siblings of Pupils: A Cluster-Randomized Trial in Kenya. Am Jnl Public Health. Mar 2014. R Dreibelbis. (Link)
Authors examined the impact of school water, sanitation, and hygiene (WASH) interventions on diarrhea-related outcomes among younger siblings of school-going children. In water-scarce areas, school WASH interventions that include robust water supply improvements can reduce diarrheal diseases among this group.

Increased Hand Washing Reduces Influenza Virus Surface Contamination in Bangkok Households, 2009–2010. Influenza and Other Respiratory Viruses, Jan 2014. J Levy.(Link)
Within a hand-washing clinical trial, we evaluated factors associated with fomite contamination in households with an influenza-infected child. Influenza virus RNA contamination was higher in households with low absolute humidity and in control households, suggesting that hand washing reduces surface contamination.


Handwashing in the Perinatal Period: Literature Review and Synthesis of Qualitative Research Studies from Bangladesh, Indonesia, and Kenya, 2014. P Ram. (Link)
The purpose of this USAID-sponsored report is threefold: to report on a systematic review of the biomedical literature regarding hand washing in the perinatal period in low- and middle-income country contexts; to synthesize the information available from the MCHIP- and USAID-funded qualitative research studies on the motivators, barriers, and current practices of maternal hand washing behavior in the perinatal period; and to provide recommendations to practitioners seeking to develop and implement programs to promote hand washing to reduce neonatal mortality.

Global Handwashing Day 2014: Social Media Toolkit, 2014. Global Public-Private Partnership for Handwashing. (Link)
The Global Handwashing Day social media campaign aims to create a global buzz about hand washing and to inspire increased investment in hand washing efforts globally. This toolkit provides resources for spreading the word about Global Handwashing Day on Twitter, Facebook, and blogs.

How to Trigger for Handwashing with Soap, 2014. J Maulit, Institute of Development Studies. (English version) | (French version)
Community-led total sanitation (CLTS) provides an excellent opportunity to facilitate hand washing behavior change. The purpose of this document is to outline several practical tools that can be used as a part of CLTS to trigger realization among communities of the importance of hand washing with soap as well as eliminating open defecation.

Disgust and Shame: Motivating Contributions to Public Goods, 2014. R Guiteras. (Link)
While inexpensive and effective practices such as chlorination and hand washing exist, interventions appealing to health benefits to motivate their use have seen only limited success. This paper measures the effect of messages appealing to negative emotions (disgust at consumption of human feces) and social pressure (shame at being seen consuming human feces) on hand washing behavior and use of and willingness to pay for water chlorination among residents of slum compounds in Dhaka, Bangladesh.

Hygiene Under the Microscope: Microbiology in the Domestic Laundry Settings in Developed and Developing Settings: Challenges and Solutions, 2014. C Amberg.(Presentation)
Washing clothes by hand is the most common way of doing laundry in developing countries. In Asia, hand washing laundry is still common, even if people own a washing machine (to protect clothes, washing machine is considered a status symbol, etc). In developing countries powder detergent is more common than in developed countries, though liquids are a rising market. Other trends noted in this presentation are the rise of environmental concerns associated with the growing markets of developing countries.


Filed under: Hygiene Promotion Tagged: handwashing

WaterAid – Assessing the water, sanitation and hygiene needs of people living with HIV and AIDS in Papua New Guinea

Wed, 2014-07-30 16:25

Assessing the water, sanitation and hygiene needs of people living with HIV and AIDS in Papua New Guinea, 2014. WaterAid.

The research revealed that people living with HIV in PNG have increased needs for WASH, and that these needs are not being adequately met. Stigma and discrimination were found to be barriers to access to WASH for respondents and their families. In addition, this study identified priority areas for service providers to direct future activities and best integrate WASH into programming for people living with HIV. Priority areas include hygiene education, safe treatment and storage of water, self-treatment for diarrhoea, latrine construction, and education around the transmission of HIV.

Filed under: East Asia & Pacific, Sanitation and Health Tagged: Papua New Guinea, WASH and HIV/AIDS

UNESCO-IHE – Smart eSOS toilet for emergencies

Tue, 2014-07-29 18:09

UNESCO-IHE – Smart eSOS toilet for emergencies | SOURCE: UNESCO-IHE, July 2014 |

The emergency Sanitation Operation System (eSOS) concept provides a sustainable, holistic and affordable sanitation solution during the aftermath of a disaster. The eSOS reinvents (emergency) toilet and treatment facilities, and uses ICT to bring cost savings to the entire sanitation management chain. The toilet will improve the quality of life of people in need during emergency situations – from natural to anthropological disasters – and minimizes the threat to public health of the most vulnerable members of society.  

The eSOS concept was developed by UNESCO-IHE Institute for Water Education. The experimental prototype of the smart toilet was developed in collaboration with FLEX/The INNOVATIONLAB and SYSTECH and is funded by the Bill and Melinda Gates Foundation-funded project SaniUP – Stimulating local innovation on sanitation for the urban poor in Sub-Saharan Africa and South East Asia.

Smart features
The eSOS emergency toilets are easily deployable in disaster areas because of their robust and light-weight specifications. The smart eSOS toilet includes some unique features in the prototype that will shed new light on how the toilets are used in emergencies. This includes remote-sensing monitoring, an energy supply unit, GSM/GPS sensor/card, occupancy sensors, urine/faeces accumulation sensor, an S.O.S. button, and a communication system that allows for data collection by remote sensing and their transfer to an on or off-site emergency coordination center. The data resulting from the use of the toilets will allow the toilets as well as the entire sanitation management chain to be improved.

Field testing
The eSOS toilet will be tested further in a refugee camp in the Philippines in September with support of the Bill and Melinda Gates Foundation and the Asian Development Bank. UNESCO-IHE PhD fellow Fiona Zakaria from Indonesia will carry out further experimental testing in cooperation with relief agencies on the ground. The eSOS smart toilet design prototype will be manufactured based on the results and feedback obtained from the experimental application.

Filed under: Emergency Sanitation

Compendium of Sanitation Systems and Technologies, 2nd Edition

Mon, 2014-07-28 17:33

Compendium of Sanitation Systems and Technologies 2nd Edition, 2014. IWA; EAWAG.

Authors: E. Tilley, et al.

This second, revised edition of the Compendium presents a huge range of information on sanitation systems and technologies in one volume. By ordering and structuring tried and tested technologies into once concise document, the reader is provided with a useful planning tool for making more informed decisions.

  • Part 1 describes different system configurations for a variety of contexts.
  • Part 2 consists of 57 different technology information sheets, which describe the main advantages, disadvantages, applications and the appropriateness of the technologies required to build a comprehensive sanitation system. Each technology information sheet is complemented by a descriptive illustration.
Download the English 2nd Edition Download the 1st Edition


Filed under: Progress on Sanitation, Publications, Sanitary Facilities, Sanitation and Health

How and Why Countries are Changing to Reach Universal Access in Rural Sanitation by 2030

Fri, 2014-07-25 18:28

How and Why Countries are Changing to Reach Universal Access in Rural Sanitation by 2030 | SOURCE: Eddy Perez, The Water Blog, July 2014.

In this article Eddy Perez discusses how many countries have started working to achieve the goal of universal access to improved sanitation by taking steps to make the transformational changes needed to stop doing “business as usual” in their sanitation programs. 

He provides several examples of what countries are doing to achieve this. One method is that governments are establishing a shared vision and strategy for rural sanitation among key government and development partner stakeholders by building on evidence from at-scale pilots that serve as policy learning laboratories.

Governments are  also partnering with the private sector to increase the availability of sanitation products and services that respond to consumer preferences and their willingness and ability to pay for them and are also working to improve the adequacy of arrangements for financing the programmatic costs.


He then writes about specific sanitation progress in Indonesia, Kenya and Tanzania. In Tanzania, one of the key interventions through which the government of Tanzania is expected to achieve its sanitation vision and targets is the National Sanitation Campaign (NSC).  The Ministry of Health and Social Welfare coordinates the implementation of the National Sanitation Campaign with funding from the Water Sector Development Program.  There have also been efforts to further strengthen and sustain the NSC structure by establishing linkages to other sectors experts and also getting the Ministry of Health to dedicate a budget line for community sanitation. The Water Basket is the main financing mechanism for community sanitation and hygiene in Tanzania. In the Water Basket, there is a clear budget line for sanitation.


Filed under: Africa, East Asia & Pacific, Progress on Sanitation Tagged: Indonesia, Kenya, Tanzania

FSM services in Lusaka: moving up the excreta management ladder

Tue, 2014-07-22 10:29

Despite most residents of African and Asian cities depending on non-sewered sanitation, only a handful of sanitation authorities have addressed the management of faecal sludge from these systems. This Practice Note describes the launch of a faecal sludge management (FSM) service in the peri-urban area of Kanyama, in Zambia.

Click on the image below for a free download.

Filed under: Africa, Progress on Sanitation Tagged: faecal sludge management, FSM, Lusaka, sanitation, Zambia

Water, sanitation, hygiene, and nutrition: successes, challenges, and implications for integration

Fri, 2014-07-18 17:48

Water, sanitation, hygiene, and nutrition: successes, challenges, and implications for integration. Int J Public Health, 2014 Jul 11.

Authors: Teague J, Johnston EA, P Graham J.
Author email:

OBJECTIVES: This study explores the integration of water, sanitation, and hygiene (WASH) and nutrition programming for improved child health outcomes and aims to identify barriers to and necessary steps for successful integration.

METHODS: Sixteen semi-structured in-depth interviews were conducted with key stakeholders from both the WASH and nutrition sectors, exploring barriers to integration and potential steps to more effectively integrate programs.

RESULTS: Key barriers included insufficient and siloed funding, staff capacity and interest, knowledge of the two sectors, coordination, and limited evidence on the impact of integrated programs. To achieve more effective integration, respondents highlighted the need for more holistic strategies that consider both sectors, improved coordination, donor support and funding, a stronger evidence base for integration, and leadership at all levels.

CONCLUSIONS: Organizations desiring to integrate programs can use these results to prepare for challenges and to know what conditions are necessary for successfully integrated programs. Donors should encourage integration and fund operational research to improve the efficiency of integration efforts. Knowledge among sectors should be shared and incentives should be designed to facilitate better coordination, especially where both sectors are working toward common goals.

Filed under: Sanitation and Health Tagged: Nutrition

Multi-level sanitation governance: Understanding and overcoming the challenges in the sanitation sector in Sub-Saharan Africa

Thu, 2014-07-17 13:56

Multi-level sanitation governance: Understanding and overcoming the challenges in the sanitation sector in Sub-Saharan Africa, 2014.

Nelson Ekane, Björn Nykvist, Marianne Kjellén, Stacey Noel and Nina Weitz. Stockholm Environment Institute.

This paper shows how analysis of multi-level governance, path dependency, and institutional inertia can be used to improve understanding of some of the challenges in the sanitation sector in SSA, and discusses approaches that can contribute to improving the sanitation situation in a sustainable way. In addition, the paper asserts that demand-driven strategies and private sector involvement in the sanitation sector is paramount for establishing new sanitation paradigms and socio-technical regimes. We conclude that a good understanding of actors at all levels – that is, their various roles as well as interactions and the way they interpret and respond to policies – is key to accelerating progress in sustainable sanitation coverage in SSA.

Filed under: Uncategorized Tagged: governance

Webinar! The power of creative thinking: working within and around challenging institutional frameworks

Tue, 2014-07-15 14:31

Join WSUP and the WASHplus project for this interactive webinar.

Date: Wednesday, July 23, 2014
Time: 10:00-11:00 EDT (New York) / 15.00–16:00 BST (London)

Reserve your place now at:

Filed under: Africa, Campaigns and Events Tagged: institutional frameworks, Madagascar, sanitation, USAID, WASHplus, water, webinar, WSUP

Poor Sanitation in India May Afflict Well-Fed Children With Malnutrition

Mon, 2014-07-14 13:24

Poor Sanitation in India May Afflict Well-Fed Children With Malnutrition | Source: by Gardiner Harris, New York Times, July 13, 2014.

Excerpts: A long economic boom in India has done little to reduce the vast number of children who are malnourished and stunted, leaving them with mental and physical deficits that will haunt them their entire lives. Now, an emerging body of scientific studies suggest that many of the 162 million children under the age of 5 in the world who are malnourished are suffering less a lack of food than poor sanitation. 

Two years ago, Unicef, the World Health Organization and the World Bank released a major report on child malnutrition that focused entirely on a lack of food. Sanitation was not mentioned. Now, Unicef officials and those from other major charitable organizations said in interviews that they believe that poor sanitation may cause more than half of the world’s stunting problem.

“Our realization about the connection between stunting and sanitation is just emerging,” said Sue Coates, chief of water, sanitation and hygiene at Unicef India. “At this point, it is still just an hypothesis, but it is an incredibly exciting and important one because of its potential impact.”

This research has quietly swept through many of the world’s nutrition and donor organizations in part because it resolves a great mystery: Why are Indian children so much more malnourished than their poorer counterparts in sub-Saharan Africa?

Filed under: Sanitation and Health, South Asia Tagged: India, malnutrition, stunting

You too can become a poo!

Sat, 2014-07-12 06:49

You can dress up as a poo and get flushed down a gigantic toilet in Tokyo’s Miraikan science museum. The toilet is the centre piece of an exhibition on human excrement and the search for the ideal toilet. At the end of the exhibition, visitors are thanked by a choir of toilets.

The exhibition runs from 2 July until 5 October 2014 and costs 1200 yen (around US$ 11 ).

Web site: Miraikan - Special Exhibition “Toilet!? – Human Waste & Earth’s Future” English | Japanese


Filed under: Campaigns and Events, Dignity and Social Development, East Asia & Pacific, Sanitary Facilities Tagged: Miraikan, museums, toilets

AfricaSan 4 dates and venue confirmed!

Fri, 2014-07-11 16:08

The African Ministers’ Council on Water (AMCOW) and the Government of Senegal are pleased to announce the dates and venue of the fourth AfricaSan conference, AfricaSan 4.
Date: 8 – 10 October 2014
Location: Dakar, Senegal (King Fahd Hotel)

Registration website: coming soon, watch this space!

Filed under: Africa, Campaigns and Events, Progress on Sanitation Tagged: AfricaSan 4, AMCOW