Contributors: Amna Shaddad, Amélie Courcaud, Lucie Leclert
Photo Credits: Mugtaba Elkhalil – SRCS WASH Officer North Kordofan, April 2021

In the North Kordofan State of Sudan, the Swiss Red Cross (SRC) supports 19 schools to become Blue Schools.

School gardens and environmentally friendly activities require a reliable access to water. However, in this part of the word, there is not even enough water for children to drink and for hygiene purpose. Out of the 19 schools, only five have existing water infrastructure (hand pump boreholes), all of which need some form of rehabilitation. The 14 other schools will be equipped with new water hand pumps, which will be built during the last quarter of 2021 (after the rainy season).

The starting point of the SRC Blue Schools interventions has therefore been on ensuring a reliable access to water through the rehabilitation of existing water supply systems.

To build local capacity on operation and management (O&M), SRC organized trainings for two hand pump mechanics per village (10 in total), ensuring that women also get the opportunity to be trained. Hand-pumps mechanics were selected by the communities themselves. The repairs of the pumps in the five schools were done as part of this training. The training also focused on introducing the basics of regular maintenance.

In Albirika Al Medina boys school for example, the SRC team, along with technicians from the Water Cooperation of the State Authority, carried out repairs for the school’s hand pump and trained two community members, a man named Ahmad Mohamad and a woman named Abeer Alsideg, as hand pump mechanics. Abeer is 26 years old and lives with her family. She is unmarried and this is the first time that she participates in a technical training. She is glad to have volunteered and to have been selected by the community for this role. She states:

“Having done the training, now I have a good theoretical knowledge of how to diagnose hand pump problems. But a one-day training is not quite enough to be able to put everything into practice.”

Ahmad is 31 years old and lives in the village with his family. He works as a miller and already has some mechanical experience. Ahmed explains:

“I have some mechanical know-how, but I am happy to have received this training which has increased my skills.”

Both Abeer and Ahmed will be supported by the project team in their roles as handpump mechanics through regular supervision and with a hand pump tool kit.

 

In another village, the trained hand-pump mechanisms are a woman named Daffa Allah Ahmad and a man named Adil Foda Ali. Daffa Allah says:

“I am happy to be one of the trained hand-pump mechanics so that I can support my village with hand pump maintenance when it is broken.”

Adil states:

“I have always tried to assist in hand pumps repairs in the past, but I did not know all the parts nor how to diagnose the faults. This training has clarified a lot for me.”

The hand pump rehabilitations in North Kordofan are only the first steps of a long-term project. With the tireless dedication of the Sudanese Red Crescent Society (SRCS) team, the schools expressed a desire for WASH support: “The schools were grateful, they asked for support as many of them are lacking latrines and hand washing facilities. They also asked if we could help provide sensitization on handwashing for the teachers and students’’, said Bashir Shouyeb, a member of the SRCS’ local unit. Support to initiate school gardens is also always welcome, as it is fully part of the Sudan educational habits.

At El Obeid, on April 26^th, 2021

Contributors: Tigist Gebremedhin, Zekarias Fekade, Lucie Leclert
Photo Credits: Ali Said From – Ethiopian Rural Self Help Association (ERSHA)

HEKS is implementing two projects in the framework of the Swiss Water and Sanitation Consortium (SWSC) in different regions of Ethiopia. In the Amhara region (North Showa Zone), they work with their local partner ERSHA in two kebeles (lowest administrative units). Together, they build a multi-village rural piped water supply scheme and promote proper sanitation and hygiene facilities and services. These activities reach 25’000 persons in the rural community and includes three schools and two Health Care Facilities (HCF).

In order to assess the situation, the project teams used the SWSC baseline data collection and analysis tools, which are aligned with the JMP core indicators for WASH in institutions. In this way, the project teams got an overview of the baseline situation beyond the usual WASH aspects, and collected information about environmental sanitation, including waste management.

In terms of access to safe drinking water, the two HCF use rainwater from rainwater storage structures as their main source of water. During the baseline survey, medical personnel reported seasonal and daily shortages of water due to leakages, limited storage capacity and lack of a dedicated budget for operation and maintenance. Regarding sanitation, both HCF have pit latrines with concrete slabs; However, there are no hand washing facilities near the toilets. For waste management, one HCF has a basic level of service as defined by JMP: a system to separate the different waste fractions into three labelled bins and an incinerator for infectious waste, while the other uses only a protected pit to openly burn the waste.

Being part of the SWSC community of practice on WASH in HCF, HEKS has proactively consulted with SWSC colleagues in other countries to initiate the Water and Sanitation for Health Facility Improvement Tool (WASH FIT; WHO, UNICEF, 2018). The project team has taken promising steps to start the WASH FIT process of participatory risk assessment and continuous quality improvement of WASH services.

Photo: WASH FIT team members making an assessment of the WASH situation in Tsegereda Health Center

In March 2021, to get the buy-in and political commitment from the local government, HEKS teams organised a series of meetings with relevant local government offices to discuss the results of the baseline survey, present the WASH FIT approach, and highlight how a collaborative process can help improve WASH services including preparedness and response to pandemics such as COVID-19. As a result, the local health office led the process of revision and adaptation of WASH FIT indicators in line with the national and regional health policies.

The next step was to review of the local health plan, including the specific plans concerning the two target HCF. This was the starting point to establish the WASH FIT team. Building on existing kebele (village) level health related committees, the WASH FIT team in each HCF includes 9 to 10 members: the kebele administrator, the head and three technical experts of the HCF, a cleaner from the HCF, a community representative, a member of the water management committees (WASHCO) from the nearby water point, the health extension worker and a woman who recently gave birth at the HCF (as per the WASH FIT guidelines). Since women are the key responsible for the health of their household as well as for maternity and childcare, the gender balance of the WASH FIT team has to be given special consideration. Ensuring the participation of a woman who recently experienced the maternal services from the HCF is a way to safeguard that women’s needs are considered and that women get a voice in decision making.

On April 16^th, HEKS and ERSHA, together with the local health office representatives, guided the WASH FIT team in each HCF through the WASH FIT assessment steps, using the locally adapted WASH FIT indicators and the WHO recommended sanitation inspection form. Based on this, the WASH FIT teams identified the main hazards and gaps. They are currently summarizing the findings and are preparing a health improvement plan.

The commitment and motivation of the local health office has opened a window of opportunity to advocate for budget allocation for the anticipated healthcare improvement plans at the local administration.

(version française ci-dessous)

Contributors: Laafia Project Team, Idrissa Moussa, Jacques Louvat, Lucie Leclert, Ramesh Bohara
Photo Credits: Abdoul Konaté

Over 800 million women and girls menstruate every day; Yet across the globe, they face barriers to properly manage their periods in dignity. Without doubt, the COVID-19 pandemic has further worsened these barriers. Annually on 28 May, the world observes Menstrual Hygiene Day (MHDay) to highlight the importance of and advocate for good menstrual health and hygiene (MHH). The theme of this year’s Menstrual Hygiene Day is: “Action and Investment in Menstrual Health and Hygiene.”

The Swiss Water and Sanitation Consortium (SWSC) member organizations are promoting Menstrual Health and Hygiene in schools as part of the “Blue Schools” approach in projects in seven countries, with co-funding from the Swiss Agency for Development and Cooperation (SDC). The approach includes training for girls, boys and teachers towards breaking the taboo on menstruation and addressing stigma, ensuring access to basic sanitation to provide a safe space for MHH, sustainable sanitary pad supply in schools as well as safe waste management and disposal. The SWSC members also engage in advocacy with the relevant local and national authorities for prioritizing MHH interventions in schools and in health care facilities as part of WASH interventions, with a focus on unlocking targeted and sustainable investments to ensure institutionalization of MHH.

The SWSC aims to enhance the learning experience for 65’000 girls and boys in 175 schools in seven countries in Africa and Asia by improving WASH, menstrual health and hygiene, and waste management services while promoting school gardening and environmental activities.

With the third phase of the SWSC (2020-2023) in full implementation mode, projects are now rolling out activities, with encouraging stories emerging from the field.

Breaking the taboo in Burkina Faso

LAAFIA is a rural sanitation and hygiene project in the Gnagna province in eastern Burkina Faso, implemented by Helvetas under the SWSC. The "Blue Schools" approach is implemented in six schools in the communes of Manni and Coalla. The project team, in collaboration with the provincial technical services of basic education, organise information events on MHH. The objective is to contribute to the improvement of hygiene practices in schools by reinforcing the knowledge of girls and boys in school on this subject, which has long been considered a taboo. About 1,500 students in six schools were informed and sensitised on MHH. In each school, girls who already have their period are provided with reusable MHH kits and guidance on how to safely use them.

Positive Feedbacks

During visits of the project teams in the schools, girl leaders did not hide their enthusiasm about the usefulness of the reusable pads provided in the MHH kits. The testimony of Fadima, a pupil in the 2^nd class at Néiba School speaks for itself:

"Before, I used to double up my skirts and underwear and hope that it would cover up. But unfortunately, I was obliged to stay at home because if I came to school there was a good chance that it would overflow. And very often when I tried to go to school, I had to go home at recess and come back later. With the pads provided in the kit, I don't have this problem anymore. Even if I wear a pad, people don't know it.”

For education staff, the approach offers hands-on tools to address MHH and opportunities for linking it with the regular life skills curriculum in schools and further project activities. According to the teachers in Neiba School, the distribution of the pads and the MHH kits has considerably reduced girls' absences from school.

Celebrating MHDay in Niger

Several of the SWSC members organize outreach activities on the occasion of MHDay, including Swissaid Niger, which is teaming up with a network of WASH journalists to prepare the celebrations for MHDay in the country.

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(English version above)

Action et investissement dans l'hygiène et la santé menstruelles

Contributors: Laafia Project Team, Idrissa Moussa, Jacques Louvat, Lucie Leclerc, Ramesh Bohara
Photo Credits: Abdoul Konaté

Plus de 800 millions de femmes et de filles ont leurs règles chaque jour, et pourtant, à travers le monde, elles se heurtent à des obstacles pour gérer correctement leurs menstruations dans la dignité. Sans aucun doute, la pandémie de COVID-19 a encore aggravé ces contraintes. Chaque année, le 28 mai, le monde célèbre la Journée de l'hygiène menstruelle (MHDay) afin de souligner l'importance d'une bonne hygiène et santé menstruelles et de plaider en leur faveur. Cette année, le thème de la Journée de l'hygiène menstruelle est : "Action et investissement dans l'hygiène et la santé menstruelles".

Les organisations membres du Consortium Suisse pour l’Eau et l'Assainissement (SWSC) font la promotion de la gestion de l'hygiène menstruelle (GHM). Elles interviennent dans les écoles de sept pays, dans le cadre de l'approche "Écoles bleues", avec un cofinancement de la Coopération Suisse au Développement (DDC). L'approche comprend une formation pour les filles, les garçons et les enseignants visant à briser le tabou de la menstruation et à lutter contre la stigmatisation, à garantir l'accès à des installations sanitaires de base afin de fournir un espace sûr pour la GHM, la fourniture de serviettes hygiéniques dans les écoles, ainsi que la gestion et l'élimination sûres des déchets. Les partenaires du SWSC s'engagent également dans des actions de plaidoyer auprès des autorités locales et nationales compétentes. L'objectif est de donner la priorité aux interventions de la GHM dans les écoles et les établissements de soins de santé, dans le but de débloquer des investissements ciblés et durables pour assurer l'institutionnalisation de la GHM.

Le SWSC vise à améliorer l'expérience d'apprentissage de 65 000 filles et garçons dans 175 écoles de sept pays d'Afrique et d'Asie en améliorant les services WASH, la santé et l'hygiène menstruelle et la gestion des déchets tout en promouvant le jardinage scolaire et les activités environnementales.

Avec la troisième phase du SWSC (2020-2023) en pleine mise en œuvre, les projets déploient maintenant leurs activités, avec des témoignages encourageants émergeant du terrain.

Briser le tabou au Burkina Faso

LAAFIA est un projet d'assainissement et d'hygiène en milieu rural dans la province de la Gnagna, dans l'est du Burkina Faso, mis en œuvre par l'ONG Helvetas, dans le cadre du SWSC. L'approche "Écoles bleues" est réalisée dans six écoles des communes de Manni et Coalla. L'équipe du projet, en collaboration avec les services techniques provinciaux de l'éducation de base, organise des événements d'information sur la GHM. L'objectif est de contribuer à l'amélioration des pratiques d'hygiène dans les écoles en renforçant les connaissances des filles et des garçons scolarisés, sur ce sujet longtemps considéré comme un tabou. Environ 1 500 élèves ont été informés et sensibilisés sur la GHM. Dans chaque école, les filles qui ont déjà leurs règles reçoivent des kits de GHM réutilisables et des conseils sur la manière de les utiliser en toute sécurité.

Des réactions positives

Lors des visites des équipes de projet dans les écoles, les filles leaders n'ont pas caché leur enthousiasme quant à l'utilité des serviettes réutilisables fournies dans les kits de GHM. Le témoignage de Fadima, une élève de seconde à l'école Néiba, est éloquent :

"Avant, j'avais l'habitude de doubler mes jupes et mes sous-vêtements en espérant que cela me couvre. Mais malheureusement, j'étais obligée de rester à la maison parce que si je venais à l'école, il y avait de fortes chances que ça déborde. Et très souvent, quand j'essayais d'aller à l'école, je devais rentrer à la maison à la récréation et revenir plus tard. Avec les serviettes fournies dans le kit, je n'ai plus ce problème. Même si je porte une protection, les gens ne le savent pas".

Pour le personnel de l'éducation, l'approche offre des outils pratiques pour aborder la GHM, et des possibilités de la relier au programme scolaire habituel sur l'apprentissage de la vie, ainsi qu'à d'autres activités du projet. Selon les enseignants de l'école de Neiba, la distribution de serviettes et de kits de GHM a considérablement réduit les absences des filles de l'école.

Célébration du MHDay au Niger

Plusieurs membres du SWSC organisent des activités de sensibilisation à l'occasion du MHDay, notamment Swissaid au Niger, qui fait équipe avec un réseau de journalistes WASH pour préparer les célébrations du MHDay dans le pays.

Authors: Girum Girma, Lisa Fry
Photo Credits: Alexander Niguse

Blue Schools of Caritas Switzerland in Ethiopia

13-year-old Fatiya attends a Blue School of Caritas Switzerland in Ethiopia. In the school garden, she has learned how to grow fruits and vegetables. Now, she has a garden of her own. She knows the rules of hygiene and has even built a latrine at home. Since then, she and the whole family get sick less often.

"I have a small garden at home with fruits and vegetables," says 13-year-old Fatiya proudly. "At school I learned how to do it. In my garden I grow chillies, sweet potatoes, mangoes, avocados, tomatoes and a neem tree with its bittersweet fruits. My garden is small but very beautiful."

"I am very economical with water," the girl continues. "In our school we take plastic bottles, fill them with water and make a small hole in it. That way, the plants are watered drop by drop. With this system, I can grow plants even during the dry season."

 

Transferring the Knowledge from Blue Schools to Communities

Fatiya learned all this in a Blue School of Caritas Switzerland. Caritas Switzerland works with the children to plant vegetable gardens, improve water systems and teach children and teachers about the connections between health, nutrition and climate.

Fatiya's parents are small-scale farmers. They live with Fatiya and her eight siblings in a small house in Kerjul, in the Oromia region of Ethopia. Fatiya is proud to pass on her knowledge to the family. "My father always waits for the rain when growing the plants. At school, we water the plants ourselves and don't wait for it to rain. This way we can harvest more. We plant onions, cabbage, chillies, sweet potatoes and papaya. My father grows maize, runner beans and teff. From the teff plant, we get the flour for our national dish 'Injera', the flat bread we love so much."

 

Latrines at Home

At the Blue School, Fatiya also learned how important hygiene is. "At our school, we have good latrines and the teacher showed us how to use them properly. He said we should also build latrines at home. My mother immediately agreed. My father dug a hole together with my brothers and we collected wood for the wall and grass for the roof. After a week, the latrine was ready and I was very happy." she says. "Since then, me and my family suffer less from diarrhoea and feel healthier."

Fatiya makes sure that there is always soap in the latrine so that everyone can wash their hands properly. She also sprinkles ash in the latrine. She takes her duties very seriously: "I want to help my family and my community. I don't want them to get sick. That's why I want to be a doctor when I grow up."

Covid-19: The Virus Demands Patience

Due to Covid-19, schools in Ethiopia had been closed since March 2020. Fatiya had to practice patience: "I missed school a lot. I see my friends there and we talk and play together." To Fatiya's great joy, the Ministry of Education decided to reopen the schools in September 2020. Fatiya hopes that it will stay that way.

Blue Schools of Caritas Switzerland in Ethiopia

In the rural regions of Ethiopia, water and sanitation services are often lacking. As a result, children get sick and cannot attend school regularly. With the current SWSC project, Caritas Switzerland provides access to clean drinking water and improved sanitation facilities in ten Blue Schools in the Southern Oromia region of Ethiopia. In these schools, Caritas Switzerland also promotes school gardens which are taken care of together with the children and teachers. In the Blue Schools, children and teachers learn about improved hygiene behaviour, climate-smart agricultural techniques as well as environmentally friendly waste management.

 

 

 

Authors: Seanghak Khin, Brigit Zuber
Video Credits: Deadbeat Productions

Caritas Switzerland in Cambodia implements the Blue Schools approach in 45 public schools in the current SWSC project. Since 2018, the approach was successfully piloted in eight schools within the context of a community-based disaster risk reduction (DDR) project in Banteay Meanchey.

In the following video, three school principals and their students share their Blue Schools experiences. The children explain what they have learned about water quality and show how to properly clean water filters. The school principals explain how good personal hygiene is practiced at the schools in groups where the children wash their hands and brush their teeth at least twice a day.

 

Children as Change Agents

In the video, the school principals also share how the activities in the Blue School project have changed their teaching methods to be more practice-oriented and participatory, for instance, by letting the senior students instruct the junior students. Through hands-on practice of good hygiene, climate-smart agriculture and sustainable waste management, children are much more likely to remember the good practices and to mobilize their parents and their community.

“I practice the things I’ve learned also at home, such as washing my hands or cleaning and maintaining water filters.”

Female student at a public Blue School of Caritas Switzerland in Cambodia

Student Enrolment in Public Blue Schools on the Rise

The successful implementation of these eight pilot Blue Schools has led to a significant increase in the number of students enrolling every year. Some students even change from private schools to these “blue” public schools supported by Caritas Switzerland.

 

Terre des hommes’ experience in Segou, Mali

Authors: Aboubacar Ballo and Brigit Zuber
Photo Credits: Terre des hommes / Amadou Maïga

Mali recorded its first case of Covid-19 on 25^th March 2020. The challenges of facing the pandemic coincided with the aggravation of a chronic security crisis in an unstable socio-political context. This multidimensional crisis further weakened Mali’s health system and impedes an adequate response to the pandemic.

Emergency WASH and Covid-19 Intervention of Terre des hommes

On the request of the Ministry of Health in Mali, Terre des hommes, in the framework of the Swiss Water and Sanitation Consortium (SWSC), has proposed an emergency WASH and Covid-19 intervention in the Segou Region. The activities are aligned with Mali’s Covid-19 Response Plan, with the overall objective of limiting the spread of Covid-19 infections in the eight health districts of Segou.

 

The intervention comprises the following activities:

• Coordination and planning of the Covid-19 response at national level and monitoring of the activities;
• Implementation of Water and Sanitation for Health Facility Improvement Tool (WASH FIT, WHO/UNICEF) in health care facilities to prevent and control infections;
• Rapid provision of low-cost WASH services responding to the needs of the health care facilities and the communities;
• Implementation of a hygiene campaign to promote good handwashing practices with the innovative, water-recycling handwashing stations “Gravit’eau”.

WASH FIT to Prevent Infections

WASH FIT is a practical guide developed by WHO and UNICEF for improving quality of care through water, sanitation and hygiene in health care facilities. During the Covid-19 intervention of Terre des hommes, the capacities of health centre managers were strengthened using the WASH FIT tool, adapted to the Covid-19 context. A participatory service improvement and monitoring plan was developed in each targeted health centre.

 

Supporting Communities to Fight the Pandemic

Terre des hommes also provided new water and sanitation infrastructure and rehabilitated infrastructure in need of renewal. In line with the priorities of Mali’s Covid-19 action plan and specific needs of health care facilities and vulnerable communities, access to basic services has been improved through the provision of water points, hand-washing stations, sanitation facilities adapted for people with reduced mobility and equipped for menstrual hygiene management.

As a result of these interventions, the ten most under-resourced health centres in the Segou Region now provide “basic” WASH services to 24,000 people per nationally and internationally recognised standards.

Left: Latrine of the Health Centre Zanabougou before the intervention

Below: Latrine of the Health Centre Zanabougou after the intervention

Moreover, Terre des hommes provided capacity building activities in health care facilities on infection prevention and control. The national level is now using updated WASH tools for Infection Prevention and Control. Furthermore, a Covid-19 prevention and case management system has been established in all health centres in the Segou Region in accordance with WHO guidelines and the national protocol. Thus, all health centre in the region now have a clinical referral system to manage Covid-19 cases.

 

Providing Reliable Information About Covid-19

Terre des hommes collaborated with the National Centre for Information, Education and Communication for Health (CNIECS) to produce posters and banners to raise awareness about Covid-19. These materials were used to relay the official messages and combat rumours and stigma surrounding the pandemic. The information campaign was carried out with the intervention of the local media as well as mixed mobile teams, consisting of health workers, Terre des hommes staff and community members.

More than 100,000 people have been reached by official messages on the prevention of risks related to Covid-19, including 25,000 vulnerable people in sites for internally displaced persons.

"We do not have access to television or radio. This awareness campaign "sono mobile" helped us to realise the existence of Covid-19 thanks to official information, to know the symptoms and the measures for prevention. We were very worried and anxious but access to information prevented us from being infected.”

Aminata DEMBELE, Bousin, Region of Segou

 

Terre des hommes Shared their Learnings in the AGUASAN Community of Practice

Terre des hommes also presented these achievements and best practices at the quarterly AGUASAN meeting in March 2021. AGUASAN, the most longstanding community of practice in the water sector based in Switzerland, contributes to knowledge sharing among water professionals and wider development specialists.

 

 

The recently published Global Progress Report on WASH in Health Care Facilities (HCF) features contributions of several members of the Swiss Water and Sanitation Consortium (SWSC).

These include the adaptation of the WASH Facility Improvement Tool (WASH FIT) for COVID-19 in Mali by Terre des hommes as well as Helvetas’ role in supporting the Ministry of Health in Benin to join 46 other countries in sharing progress on country level commitments taken in the 2019 World Health Assembly.

 

WASH FIT Learnings from Terre des hommes in Myanmar on WHO/UNICEF Knowledge Portal

Furthermore, a learning paper on piloting WASH FIT in the Myanmar health system  by Terre des hommes is now available for download on the WHO/UNICEF knowledge management platform.

Among the main learnings from the first six months of the WASH FIT project implementation by Terre des hommes in Myanmar, the following stand out:

• WASH in HCF is a new topic for many HCF Management Committees and local authorities: Include orientation on infection prevention and control, the WASH FIT process and contextualized indicators. Time invested in stakeholder understanding WASH FIT processes is paramount.
• While technical expertise is important, WASH FIT requires skills in community mobilization: Plan time and resources to train local authorities/partners on facilitation techniques. An expert in community mobilization should coach the process – s/he need not have a WASH background.
• Monitor signs that WASH FIT team and HCF Management Committee are becoming risk aware: After the first WASH FIT exercise, community members and HCF personnel demonstrated risk awareness (e.g. citing inadequate space between toilets and tube wells).

 

Global Progress Report – Gaps and Responses

Since 1990, WHO and UNICEF have been jointly producing regular updates on water, sanitation and hygiene. They are further responsible for monitoring the 2030 Sustainable Development Goal targets 6.1 and 6.2 and support global monitoring of other WASH-related SDG targets and indicators.

The report identifies major global gaps in WASH services:

• one third of HCF do not have what is needed to clean hands where care is provided,
• one in four facilities has no water services,
• 10% of HCF have no sanitation services.

This means that 1.8 billion people use facilities that lack basic water services and 800 million use facilities with no toilets.

Across the world’s 47 least-developed countries, the challenges are even greater:

• half of HCF lack basic water services,
• one in four HCF has no hand hygiene facilities at points of care,
• three in five HCF lack basic sanitation services.

The major gaps in water, sanitation and hygiene services in health care facilities are putting people that work at or use these facilities at heightened risk of COVID-19 and other diseases.

The Global Progress report also describes the global and national responses to the 2019 World Health Assembly resolution on WASH in HCF. More than 70% of countries have conducted related situation analyses, 86% have updated and are implementing standards and 60% are working to incrementally improve infrastructure and operation and maintenance of WASH services. The report includes four recommendations to all countries and partners, particularly health and community leaders to accelerate investments and improvements in WASH services in HCF. These are:

1. Implement costed national roadmaps with appropriate financing.

Costed national roadmaps on WASH in health care facilities provide the blueprint for action, a mechanism for coordination, and, when appropriately financed, enable comprehensive and sustainable incremental improvements. Such roadmaps should either be embedded in or directly coordinated with broader health and infrastructure planning and processes.

2. Monitor and regularly review progress in improving WASH services, practices and the enabling environment.

While the global database is substantial, with 154 country files, gaps remain. Data on environmental cleaning, higher levels of WASH services and aspects of sanitation are especially lacking. Global WASH indicators should be incorporated into facility surveys and regular health monitoring and data should be regularly collected, analysed and used to direct resources and prioritize action.

3. Develop capacities of the health workforce to sustain WASH services and promote and practice good hygiene.

Sustaining WASH services, particularly cleaning and safe management of health care waste, requires dedicated, trained and supported staff. These non-health care providing staff, who are often overlooked and undercompensated, need to be recognized and elevated within health workforce policies, programming and budgeting.

4. Integrate WASH into regular health sector planning, budgeting and programming to deliver quality services, including COVID-19 response and recovery efforts.

The COVID-19 pandemic has exposed stark inequities in public services across a range of sectors, including for health and WASH. Government and external donors need to prioritize investments in core health system functions that are fundamental to protecting and promoting health and well-being. WASH and waste are “common goods for health” that must be financed if any other health objectives, including the primary goal of universal health coverage, are to be achieved

written by Aboubacar Ballo – Terre des hommes
Note: The original story is available in French here.

WASH FIT is a participatory and continuous approach to introduce water, sanitation and hygiene improvements in health care facilities. Terre des hommes has piloted the approach in four health care facilities in Mali between 2018 and 2019 and is now integrating these lessons learned into the project activities of phase three of the Swiss Water and Sanitation Consortium. Aboubacar Ballo, WASH expert at Terre des hommes in Mali, has put together a case study on the experiences and learnings from piloting WASH FIT in the districts of Macina and Markala.

Context

In the area of Segou in Mali, the lack of access to water, hygiene and sanitation in health care facilities (HCF) is particularly acute. An evaluation conducted in 2018 found that none of the 21 assessed health care facilities offered basic sanitation services in accordance with the standards of the Joint Monitoring Program developed by WHO, UNICEF and the Malian Ministry of Health.

For a sanitation facility in a health care center to comply with the sanitation standards of the Joint Monitoring Program the following criteria must be met:

1. Provide improved toilets within the health care facility;
2. Provide separated functioning toilets for staff, for women as well as for disabled persons with menstrual hygiene facilities.

The actual situation in the health care facilities presented a completely different pictures when Terre des hommes started its work in the districts of Macina and Markala. Open defecation was a common practice within some health care facilities.

Terre des hommes gained experience from working in 35 health care facilities in the framework of the second phase of the Swiss Water and Sanitation Consortium. These experiences were used for a WASH FIT pilot phase between 2018 and 2019 in 4 health care facilities in Macina and Markala districts. The WASH FIT approach is a participatory method for the continuous improvement of access to basic water, hygiene and sanitation. One of the pilot centers was the community health center of Kokry, which had a sanitation facility with improved but not functioning toilets resulting in bad sanitation practices.

With the support from Terre des hommes, the community health center of Kokry implemented the WASH FIT approach. The sanitation component received particular focus in Kokry, given that it represented the biggest challenge for the health center.

Strategy and Approach

During Mali’s decentralization process, public water, sanitation and health services have been transferred to local authorities. Thus, the local authorities have the administrative authority; however, they have transferred the management responsibilities for public water, sanitation and health services to community health associations. Community health associations are voluntary groups comprised by villagers of a neighborhood or a village and ensure the functioning of a community health care center. For the project these associations represent a key partner for planning and implementation.

In the piloting phase, Terre des hommes started with awareness raising campaigns in the target districts of Markala and Macina. Communities were sensitized to the risks associated with lacking water, hygiene and sanitation services at the health care facilities and learned about the advantages and opportunities of the WASH FIT approach. WASH FIT is a practical and participatory tool aiming to improve water, hygiene and sanitation services of health care facilities– for staff, patients and visitors. WASH FIT also helps health care facilities to be prepared to face epidemics such as COVID-19 or climate-induced disasters.

Key Steps in the Project Implementation

1. Active Engagement in Mali’s WASH FIT Community

Terre des hommes has invested time and resources to establish a network within the local WASH community and became an active member of the ‘WASH in Health Care Task Force’ co-led by WHO and the Ministry of Health.

2. Facilitation of an Inter-District Learning Visit on WASH FIT

Thanks to the established network, Terre des hommes has been able to initiate inter-project learning exchanges with projects led by WaterAid, WHO and the Ministry of Health. One exchange was organized jointly with the regional health and sanitation directors in July 2018 between the WASH FIT pilot districts Macina and Marka. The learning visit enabled health personnel, technical directors, the public officials and the community health associations to get a better understanding of the WASH Fit methodology. The peers actively exchanged on advantages, challenges and the contextual factors to be taken into account for the replication of best practices.

3. The Implementation of the WASH FIT Approach

The WASH FIT approach was implemented step-by-step according to the following order:

• Establishing the WASH Fit team: This team was composed of the community health associations, health personnel, community leaders, youth and women's associations, the mayor's office, and other interested parties.
• Conducting an initial assessment of the WASH conditions in the community health centers;
• Identifying and prioritizing measures and actions for improvement;
• Developing and implementing a progressive improvement plan;
• continuously monitoring the effectiveness of the plan and revising it periodically.

During the practical phase of the WASH FIT training, a session was conducted on the consequences of open defecation around health centers. A simulation (inspired by the WASH approach “Assainissement Total Piloté par la Communauté”) was carried out in order to create disgust and motivate the WASH FIT committee to abandon unsafe sanitation practices.

4. Community Mobilization for Improved Toilets

In the community health center of Kokry, a community mobilization campaign was initiated with the support of the village religious leader. The campaign was able to raise funds and to collect construction materials (concrete and reinforcing iron) from village merchants, which were used to start the local construction work on the toilet block of three latrines. Terre des hommes technically supported the construction work and made sure that the infrastructure met the technical requirements of the Ministry of Health. These requirements included an access ramp for people with reduced mobility as well as installations for menstrual health management. The Regional Departments of Health and Sanitation strongly welcomed the initiative and participated in the official inauguration of the facilities.

5. Strengthening Community Capacities for Safe Management and Dispoal of Excreta

Prior to the project implementation, the community health center of Kokry was not safely disposing excreta, even though the health center is located in a flood-prone area. Terre des hommes, in collaboration with the local department for sanitation and pollution as well as the regional sanitation director, raised awareness among the community health associations and the health personnel about the interlinkages between sanitation, health, environmental pollution as well as climate change. They were also informed about the correct use of the double pit latrine as well as the toilet maintenance protocol. The community health association decided to contract a local business for the regular emptying of the single pit latrines.

Results

The main results that have been achieved by November 2020 are as follows:

• Thanks to the hard work of the community, the Kokry community health center offers safely managed basic sanitation facilities consisting of three latrines that include access to electricity and water supply. The latrines are visibly separated for gender and people with disabilities and accommodate menstrual hygiene needs.
• The community health association has introduced sustainable measures for the safe management of excreta.
• The community health association has earmarked a budget line for the improvement of WASH services in health care facilities.

Success Factors

• Peer Exchanges Through Learning Visits
  The facilitation of the peer learning visit by Terre des hommes between the districts of Macina and Markala allowed the community health associations to learn from concrete experiences in the other regions, in particular with regard to community mobilization.

"If all health care facilities in the area drew inspiration from the health care center of Kokry, WASH problems in the health care centers would be soon solved. This demonstrates the success of the community health associations and the effectiveness of the new WASH FIT approach. The strong position of the community health association is an unusual and new situation because the associations generally have limited resources and can generally only cover the costs related to maintenance and consumables.”
Danséni Synayogo, Chief Medical Officer of the Health District of Macina

• Influential and Motivated Community Members as Part of Community Health Associations
  The selection of influential and motivated people as leaders and members of the community health association has helped build trust and solidarity in the service of the community health centers. This was the key to mobilizing local resources for the realization of the improved sanitation facilities. Since 2019, the community health associations have made sanitation one of the priorities in their budgeting.

"We have seen that the community health association is on the right track and has decided to take its destiny into its own hands. This is why the local authorities decided to support the community health association in their work and offered to cover the plumbing costs for the installation of the toilet seats in the sanitation cabins. A plumber from Ségou, 130 km away, was recruited.”
Zoumana Diassana, Mayor of Kokry

Recommendations

The main challenges that have been encountered in project implementation are the following:

• The construction of the latrine took longer than expected because of the strong increase in the price of sanitary equipment and inputs related to logistical constraints and the health emergency measures put in place by the government due to COVID-19.
• Initially, the community health association used local masons without involving the governmental technical services. As a result, the toilets did not meet the minimum WASH standards defined by the Ministry of Health and the WASH in Health Care Task Force. Particularly bothersome was the fact that the constructed pit lacking the technical standards was constructed in a flood-prone area and was thus at risk of being damaged during rainy season. With the technical support of Terre des hommes, the pit was well fortified and plastered on the inside to ensure safe waste disposal.
• The WASH FIT approach should be included and integrated in municipal planning. This strengthens the commitment of the communal councils in the financing of WASH activities in the health care facilities.

Going to Scale

The experiences from the Kokry health center and the three other health care facilities where the WASH FIT approach was piloted will be used for phase three of the Swiss Water and Sanitation Consortium. In phase three, Terre des hommes continues to support the four health care facilities of the piloting phase and extends its outreach to six additional health care facilities, supporting in total ten health care facilities in three districts in Mali.

Terre des hommes will continue to facilitate inter-district learning from the experience to create favorable conditions for replication. Lessons learned from the experience can be used by other consortium members as part of the inter-project learning process.

 

References

WHO / UNICEF. 2018. Water and sanitation for health facility improvement tool (WASH FIT): A practical guide for improving quality of care through water, sanitation and hygiene in health care facilities.