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Hygiene

7 ideas on how knowledge can help us achieve universal access to safely-managed drinking water and sanitation

Guy Hutton's picture
It is vital that we better manage our knowledge, to make better use of it for delivering universal access to water and sanitation. This requires new ways of capturing, sorting, weighing, curating, and translating knowledge into practical, bite-sized chunks. The Disease Control Priorities project, now in its third edition (www.dcp-3.org), is an excellent example of what this looks like in practice. It aims to compile the best available evidence across multiple areas of health to provide a snapshot of the coverage of services, the problems resulting from lack of services, the effectiveness of interventions, and the cost-effectiveness and cost-benefit of those options.
 
Disease Control Priorities Network (DCPN), funded in 2010 by the Bill & Melinda Gates Foundation, is a multi-year project managed by
University of Washington’s Department of Global Health (UW-DGH) and the Institute for Health Metrics and Evaluation (IHME). 


As authors of the WASH chapter of DCP-3, we wanted to share some of our key takeaways below:

Chickens don't use toilets: Why managing animal feces helps children grow taller

Derek Headey's picture
Those who have tried toilet training a pet dog or cat know that it is a difficult proposition. How about toilet training a flock of 30 chickens?

“Why would I want to?” Because in poor countries, chickens are everywhere, they are pooping wherever they want, and chicken feces is dangerous for young children.

How we help countries track and report on the Sustainable Development Goals on water, sanitation and hygiene

Ana María Oviedo's picture
Enumerators in Ecuador collecting water sample
for water quality test.
Credit: World Bank team in Ecuador

Over the last few years, the international community has been busy establishing new indicators for the Sustainable Development Goals (SDGs), which officially replaced the Millennium Development Goals (MDGs) for the period 2015-2030. SDG #6: Ensure access to water and sanitation for all, seeks to reduce the incidence of malnutrition, communicable diseases, and inequities that are directly related to lack of access to improved sources of drinking water (affecting 663 million people worldwide) and sanitation (which 2.4 billion people still lack). This new goal implies a commitment by countries to monitor and report on their progress, similarly to what was done for the MDGs, but with much more detail.
 
From MDGs to SDGs: What’s New for Water and Sanitation?
 
Under the Millennium Development Goals (MDGs), countries were requested to report the coverage of water and sanitation, distinguishing between “improved” and “unimproved” coverage. The WHO/UNICEF Joint Monitoring Programme for Water Supply and Sanitation (JMP), established specific indicators for each, using definitions that could be captured with information from standard household surveys, which typically rely on self-reported questions on access to services collected from a nationally representative sample of households.

A tale of two cities: how cities can improve fecal sludge management

Isabel Blackett's picture
Photo credit: World Bank

In previous blogs on Fecal Sludge Management (FSM), we outlined the lack of appropriate attention given to FSM as a formal urban sanitation solution and we presented new tools for diagnosing fecal sludge challenges. In this blog, we provide illustrations from Indonesia and Mozambique of the challenges and opportunities of using FSM.

5 lessons to manage fecal sludge better

Peter Hawkins's picture
Desludging in Tanzania
A motorized tricycle fitted with a small tank provides
desludging services in Dar Es Salaam, Tanzania.
Photo credit: Kathy Eales / World Bank

Our last blog outlined the neglect of Fecal Sludge Management (FSM) and presented new tools for diagnosing FSM challenges and pointing the way to solutions.  
In this blog, we’ll share some lessons learned from the city-specific case studies and analysis to highlight key areas which need to be addressed if the non-networked sanitation services on which so many citizens rely are to be effectively managed.

Meaty issues on the radio

BBC Media Action's picture

Ehizogie Ohiani, a Producer/Trainer for BBC Media Action in Nigeria, discusses how radio is raising awareness about the lack of hygiene amongst the butchers of Benue State, Nigeria.

A meal without meat is as good as no meal for most people in Benue State, North Central Nigeria. Considering its importance, one would expect that hygiene surrounding the preparation and sale of meat would be held in the same high esteem. This is not the case.

A murky mix of flies, blood, water, muddy walkways, sweaty bodies and smoke combine to make the abattoirs in the marketplaces of Benue State a perfect breeding ground for disease. Lack of adequate sanitation knowledge, lack of enforcement by market associations and insufficient supervision of animal slaughter by qualified veterinary officers conspire to create major health challenges for communities.

I was at Harvest FM, a local radio station in Benue State, to train producers. We were brainstorming ways we could use their popular early morning show “Good Morning Benue” to help serve the public interest. For the producers, an obvious choice was to discuss hygiene in abattoirs.

The programme explored a number of problems in the state’s local abattoirs: an absence of toilet and handwashing facilities and the practice of washing meat with untreated water sourced direct from the River Benue.

New tactics to nudge habit change for open defecation behavior

Jacqueline Devine's picture
Open defecation remains a critical global health challenge, affecting almost 1 billion people around the world and contributing significantly to the estimated 842,000 people who die each year because of poor sanitation, hygiene practices, and unsafe water supplies [1].
 
Most behavior change approaches and frameworks for addressing open defecation have focused on relatively conscious, “reflective”  drivers of behavior, including people’s emotions (such as pride or shame), rational knowledge (e.g., of germ theory), social norms, and explicit action plans (such as commitments to change). Using the framework popularized by renowned social psychologist Daniel Kahneman [2].<, these factors can be described as “System 2” drivers of behavior i.e., relatively conscious and motivational factors. It is now well established, however, that human behavior can also be heavily influenced by “System 1” drivers i.e., relatively automatic, cue-driven factors [3].

Can we really put a price on meeting the global targets on drinking-water and sanitation?

Guy Hutton's picture

When the Millennium Development Goals (MDGs) were signed, a commitment was made to deliver improved water and sanitation to half the unserved population. This ambitious target was met for water but not for sanitation, with 2.4 billion people still lacking improved sanitation in 2015. The first part of our new study, The Costs of Meeting the 2030 Sustainable Development Goal Targets on Drinking Water, Sanitation, and Hygiene, estimates the cost of finishing what was started as part of the MDG target.

The study found that globally current levels of financing are likely to cover the capital costs of achieving universal basic WASH by 2030. The global capital costs amount to $28.4 billion per year (range: $13.8 to $46.7 billion). However, despite this good news, the current allocations need to be redirected and there will need to be significantly greater spending on sanitation (accounting for 69% of the cost of basic universal WASH) and operations and maintenance, as well as in the most off-track countries which are mainly in sub-Saharan Africa and South Asia.

But this isn’t the full story.

What happens when the playground is also the potty?

Emily C. Rand's picture

Imagine you are a busy mother scrubbing your laundry next to the public water stand near your yard. You realize your two year old — who is playing in the dirt — has to go to the toilet. What do you do? Chances are good you might just let them go on the ground somewhere nearby.

According to a recent analysis by the United Nations Children Fund (UNICEF) and the World Bank Global Water Practice's Water and Sanitation Program (WSP) in key countries, over 50 percent of households with children under age three reported that the feces of their children were unsafely disposed of the last time they defecated. What this really means is that children are literally pooping where they are and their feces are left there, in the open. Meanwhile, the feces of other children in the neighborhood are put or rinsed in a ditch or drain, or buried or thrown into solid waste streams that keep the feces near the household environment.

 

Why do sanitation campaigns fail?

Suvojit Chattopadhyay's picture

The study finds that the govt’s rural sanitation programme, implemented by NGOs, was unable to reduce exposure to faecal matter.

A recently published Lancet paper looks at the impact of the erstwhile Total Sanitation Campaign in the coastal Puri district in Odisha. The study finds that the government’s rural sanitation programme, implemented by NGOs and community-based organisations, was unable to reduce exposure to faecal matter. As a result, this sanitation programme had no impact on the incidence of diarrhoea and malnutrition. The authors of the paper conclude that in order to realise concrete and sustainable health benefits, sanitation programmes need to increase both the coverage and use of toilets, as well as improved hygienic practices.

No one denies the importance of good sanitation and the impact it has on human health. It must follow therefore that the lack of positive impact is down to poor implementation of the sanitation programme in the study area. In fact, a process evaluation of the programme concludes that the implementation was far from perfect, both in terms of the levels of coverage achieved and the levels of awareness. Over an implementation period of 13 months (January 2011—January 2012), the villages where the programme was implemented saw an increase in toilet coverage from 9% to 63%, but only 38% of the households had a functional toilet. It would have been interesting to learn more about the gap between toilet construction and usage (25 percentage points). In any case, the state of implementation, the authors point out, is typical of the prevalent Total Sanitation Campaign across the country.
 

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