Authors and photo credits: Miada Azrag

Background

In the schools of West and Nord Kordofan in Sudan, many children do not wash their hands due to the lack of water, or only rinse them without a detergent and/or often with dirty water. Yet they use their hands to eat the meals which are provided by the school feeding programme of the world food programme (WFP).

The Swiss Red Cross and the Sudanese Red Crescent Society are implementing a project co-funded by the Swiss Water and Sanitation Consortium in these schools. To tackle this acute danger to the health of children, the Blue School project (BSP) is addressing the issues by providing access to water, teaching proper handwashing techniques, and mounting suitable handwashing stations. Whereas the latter is seemingly a simple task, it was in fact not. Finding the right solution for handwashing infrastructure at the schools has come a long way.

Development of handwashing stations

Children first started to learn handwashing practices with tippy taps which are hands-free devices for handwashing that are especially designed for rural areas where there is no running water. However, its success was unfortunately rather limited in the project area due to several sustainability challenges such as water scarcity, frequently needed replenishment of the used containers, as well as the lack of funds for soap. After trying out different technology adaptations (bigger containers, etc.) did not lead to the wished success either, the BSP team together with the schools came up with a sustainable and innovative handwashing station that is adapted to the restrictive conditions. The schools were provided with user-friendly handwashing facilities consisting of movable and bigger containers that are fitted with “the Drop” taps.

The Drop is an eco-sanitarian tap which was designed in Switzerland. It has two major advantages: Firstly, it is more hygienic than usual taps and valves as the back of the hand is used to start the flow of water and is thus limiting potential contamination. It is estimated that it accumulates 40% fewer microbes than a regular tap. Secondly, it saves up to 70% of water compared to a conventional tap due to the cleverly designed motion of water and its self-cleaning nature. This saves valuable resources in an environment of severe water scarcity. Moreover, the robust design promises to be long-lasting.

Instead of using soap, the water is now chlorinated with locally generated chlorine using a simple technology which results in a chlorine-based handwashing solution. This only requires salt available in the market and a device which can either use a battery, a solar panel or a plug to an electricity grid if available. After being trained by the BSP staff, the students produce the chlorine-based handwashing solution themselves under the supervision of teachers as well as PTA (Parent Teacher Association) members. Moreover, the students are also responsible to fill up the handwashing stations with the produced solution.

The same technology can be used to produce chlorine solutions for multiple other purposes such as for cleaning the classrooms and latrines (for which the schools were lacking appropriate products so far), and even to treat drinking water by simply adjusting the dosage of chlorine.

The used water from the handwashing stations is filtered through a locally made recycling system using charcoal, sand and gravel in different compartments and then reused for irrigation of the gardens and/ or cleaning of latrines.

Handwashing becomes easy

The installation of the handwashing stations has been accompanied by hygiene promotion spearheaded by the trained school clubs. Two schools used the community event approach whereby the students prepared a sketch and demonstrated the proper handwashing practice to the community.

Students are part of the school feeding program but with unclean water many will just eat without washing their hands and we could not afford buying soaps all the time. How we wish we had known these simple technologies and types of taps that you brought, we would not have had such a great number of sick school children. I am sure it was partially due to dirty hands.

reports Mrs. Kawther, one of the teachers in Shushai Girls Primary school

Now handwashing has become fun and easy for the school children and the small mirrors which were attached on the sides of the handwashing facilities played a big role in attracting the girls. The handwashing facilities had been placed in the area near to the eating area which also serves as a hygiene measure for different waterborne diseases like cholera or Covid-19 prevention.

Now we can wash our hands as soon as we come to school. We had known that dirty hands can make us sick and worms could get in our stomachs if we eat food without washing our hands, but this is the first time to have handwashing facilities in our school

says Zianab Hamza (12), while she is washing her hands with chlorinated water before a school meal provided by WFP at Shushai Primary School.

Authors: Deborah Nabukeera, David Ogwang
Photo credits: HEKS / EPER Uganda and ACORD Uganda

In Uganda, HEKS/EPER and its partner organization ACORD-U are taking a holistic approach to improve the water, sanitation and hygiene (WASH) services for their target population. The WASH project is co-founded by the Swiss Water and Sanitation Consortium (SWSC). To ensure protection and preservation of ground water, the project not only focuses on conventional WASH activities but also on agroforestry, rehabilitation of degraded range land and tree planting in watersheds.

The growing host community population as well as the influx of refugees in the district of the Bidibidi refugee settlement has increased pressure on natural resources, such as land, water, range land, and fuel wood. This settlement is the second largest refugee settlement in the world and is home to over 240,000 South Sudanese refugees (UNHCR 2022). Anthropogenic activities, such as the creation of housing areas, agriculture, the need for raw materials for infrastructure development, use of fuel wood, etc., have immensely contributed to the depletion of vegetation and ecosystems in the area. As a result, the Bidibidi area experiences ground water depletion resulting in the reduction of the water quantity available and at worst the drying of water sources (bore holes & spring wells). Furthermore, other degradation effects are visible, such as soil erosion by wind and water, soil compaction, soil contamination by oil due to poor disposal, loss of habitats and waterlogging[1].

A WASH project with integrated environmental protection activities, such as promotion of agroforestry and rehabilitation of degraded range land, is implemented by ACORD Uganda with the support of HEKS/EPER and the SWSC. The project strongly benefited from the engagement of the Yumbe District Natural Resources and Environment Office who organized formal engagement meetings with local leaders and community members and offered technical guidance on tree planting. This led to an awareness creation about causes, effects and impacts of environment degradation as well as the importance of preservation and restoration of the environment and their impact on water supply in communities and schools. Furthermore, it triggered community members to offer land for tree planting to restore and conserve the degraded environment.

As a result of successful community engagement, the project has established two woodlots (estimated area of 11 acres) in the host community of Tokulu village in zone 5 of the Bidibidi settlement and supported seven schools (Nipata SS, Abiriamajo, Moli, Nyoko, Knowledge land, Ariwa and Ayivu primary schools) with a total of 6,000 tree seedlings of different species. The trees were of the following kinds: Giant Lira, Gravellia, Maesopsis (musizi), Mvule, Melina, Calliandra as well as grafted mangoes and guavas fruit trees. The established woodlots are owned and operated by the landlords. Mansur Aviola, one of the landlords says:

As a landlord and one of the beneficiaries, I am so grateful to the project for supporting us with tree seedlings. I had land which was unutilized until we established a woodlot. Now I’m considering introducing leguminous crops (e.g. beans) and staple foods (e.g. cassava) in the woodlot for more ecosystem and dietary diversity.

Mansur Aviola is optimistic that the woodlot will contribute to reducing the effects of climate change and benefit the preservation of ground water.

A cash for work approach was adopted by the project to pay community groups for land preparation and woodlot planting. Thanks to the initiative and leadership of women, the community group formed the Tokulu Youth Village Savings and Loan Association (VSLA) which started with 8 members and daily contributions. Currently, 30 individual members (5 men and 25 women) meet once a week and each weekly contribute 10,000 UGX (2.7 USD).

Mansur explains:

The purpose of the community group is to improve the environment and at the same time to support the livelihoods of the community members. Because of the VSLA, some of us now bought goats and some have started poultry farms as income generating activities.

In addition, the district environment department provided technical guidance and supervision of planting during the set-up of the woodlots. Mr. Solo Andama, a Senior Environmental Officer of the Yumbe District Local Government states:

The planted trees are vital to increase the vegetation cover and will contribute to mitigate climate change impacts. The fruit trees planted in schools are anticipated to supplement nutrition and act as learning central points for children in schools.

Consultations between the Yumbe Local Government and the International Union for Conservation of Nature (IUCN) are ongoing to ensure the sustainability of such initiatives by developing action plans and reforming ordinances on Environmental and Natural resource. The District Natural Resources and Environment department with support from Sub counties already reinstated ordinance and byelaws to discourage tree cutting and charcoal trading. The ordinance stipulates that, two trees must be planted when a person cuts one tree and non-compliance results in a fine of UGX 100,000-UGX 250,000 (27-68 USD).

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[1] Waterlogging refers to temporary or permanent saturation of soil in the root zone of a plant which constrains plant growth.

Authors and Photo Credits: Health and WASH Team, Terre des hommes, India[1]

Context

Terre des hommes (Tdh) in the framework of the Swiss Water and Sanitation Consortium (SWSC) has been improving the access to water, sanitation and hygiene (WASH) and the associated infrastructure in the flood-prone Canning-II Block in West Bengal since 2020. Tdh embedded the project into a community-based integrated health and WASH program which ensures the ownership of the project by the communities and authorities. The percentage of population with access to an improved water source during floods, i.e. a water source constructed above the maximum flood level, significantely increased from 4% to 75% since the project’s start.

In India, the local self-government institutions known as the Panchayati Raj Institutions (PRIs) are responsible for the construction of drinking water facilities in rural areas. Canning II Block is a disaster-prone and low-lying area in the Sundarbans region and is waterlogged during the monsoon season every year. The handpumps constructed by the PRIs often get flooded and are not maintained. As a result the groundwater is commonly contaminated which in turn leads to health hazards in the community.

Flood Resilient Plinth Raised Handpumps – Using Participatory Learning and Action

To ensure uninterrupted access to safe drinking water – even during floods – and to address community demand across 20 villages, Tdh supported the construction of 10 flood resilient plinth raised handpumps. To create ownership of the handpumps, users committees were mobilized to generate a community contribution which amounted to 5000 INR or 63 CHF for each handpump (5% of the total capital cost).

Local Government’s Involvement and Scale-up of the Model

When cyclone Amphan made landfall in the project area in 2020, the existing handpumps were submerged while the raised plinth handpumps that were installed by the project remained intact and in use. This generated a local demand in the community for flood resilient raised handpumps. After the cyclone, key members of the local self-government (PRIs) visited the handpump sites interacting with the water user committees and the project team members. They conducted meetings with the government representatives to discuss how the approach could be replicated. As a result of extensive discussions and repeated meetings, the local government officials were convinced and agreed to support 85% of the total cost for the construction of an additional 20 handpumps in the form of drilling and material costs which amounted to 32,000 CHF. The community contribution which was initiated to ensure the ownership of the model remained consistent for the construction of all the handpumps.

Strengthening Community Capacities for Operation and Maintenance

A total of 30 water user committees were formed, trained, provided with tools and linked with the local self-government institutions to ensure routine operation and maintenance of the handpumps. The experience in Sundarbans has shown that this model can play an effective role in providing safe drinking water in flood-prone areas.

Earlier, we had only one handpump in our village of 150 households. It was built by the local self-government institutions but within six months, the platform completely broke and the water became contaminated. With no alternative, we were forced to continue using that water. In those days, we had increased cases of diarrhoea and vomiting in the village. Now we have raised handpumps and we have access to safe drinking water even during heavy monsoon rains. As a member of the water user committee, it is important for me to make sure that our handpump is maintained well and functional.”

Swagata Sardar, Secretary of Jharna Water Users Committee at Hediya village, Canning II, South 24 Parganas

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[1] Involved team members:
Runa Nath, Program Manager Health and WASH
Tanmoy Das, Program Officer Health
Sabyasachi Mitra, Program Officer WASH
Deepali Savyasachi, MCD Fundraising & Communications Manager

Author and Photo Credits: Tigist Gebremedhin, WASH Coordinator, HEKS Ethiopia

Abdurahman, Shemsia, Tahir and Rehima attend a Blue School of HEKS in Ethiopia. A Blue School is a school where children learn about environmentally friendly technologies and practices for their everyday life. Due to the trainings on vegetable gardening in their school, the four students became interested to start a vegetable garden at home. On a 125 square meter plot, they now started to grow beet roots and carrots.

Abdurahman Abdela, his sister Shemsia Abdela, their father Ato Abdela Suleiman and two of their cousins, Tahir Kedir and Rehima Kedir, live in Welensuna Kebele in the Oromia region of Ethiopia. The two girls, Rehima and Shemsia are 6^th graders, while the boys, Tahir and Abdurahman, are 5^th graders. They all attend the Welensu Chatimana primary school. In this school, HEKS in collaboration with Dorcas Aid Ethiopia is implementing a school WASH project and is promoting the Blue School Approach.

Transferring the Knowledge from Blue Schools to Communities

Abdurahman is a member of his school agriculture club. In this club, Abdurahman learns about climate-smart agricultural, for instance how to grow food sustainably and to use water economically. He, his sister and his cousins told their family about the training they attended at their school on vegetable gardening. They explained the practical steps and exercises they did at their school. The father, Ato Abdela, recounts:

Our children requested us to provide them a piece of land from the family farmland to apply their knowledge.

The four students justified their request for land by telling their parents that vegetables are one of the most important food categories for a balanced nutrition. They also told them that when sold, vegetables generate more income than cereals.

Ato Abdela and his family cultivate cereals, such as barley and wheat, on the family farmland. Everyone who has land in the neighborhood cultivates barley too. As there is a lot of produce, prices of the cereals are usually very low during harvest season. At the same time, the prices of vegetables are high, and families need to buy vegetables from the market. Therefore, the family liked the idea of the children to grow their own vegetables and provided them with a piece of land to practice gardening and vegetable growing. Ato Abdela gave the four students approximately 125 square meters of land which was already ploughed and prepared to plant barely. They further prepared the land and planted beet roots and carrots. The students are very excited to see their vegetables grow and are taking good care of the seedlings. Ato Abdela says:

We are happy that they wanted to experiment and try what they learned in their school.

Authors: Prakash Bohara, Health & WASH Programme Manager, Terre des hommes Nepal; Sudarshan Neupane, Head of Country Office, Terre des hommes Nepal
Contributors : This study was commissioned under the technical guidance from Laxman Kharel, Terre des hommes' Regional Advisor for WASH, and valuable support from Nabin Rana, WASH Project Manager, as well as our partner Geruwa.

Background

Globally, safe management of healthcare waste is a big concern, especially in developing countries. The latest available data (from 2019) indicates that 1 in 3 Health Care Facilities (HCF) globally does not manage healthcare waste safely (WHO 2022). COVID-19 has contributed to a massive increase in healthcare waste, straining already under-resourced HCFs and exacerbating environmental impacts from solid waste.

In Nepal, waste from HCFs has become a matter of major public health concern as most of it is fed into municipal waste management systems, is dumped, burnt in open pits, or incinerated improperly at the site of the HCFs. There are very limited studies that provide an opportunity for local authorities to choose appropriate waste management technologies for primary HCFs.

In this context, Terre des hommes (Tdh) under its WASH in HCF project co-financed through the Swiss Water and Sanitation Consortium conducted a study with the objective to explore methodologies for the characterization and quantification of HCF waste. The study was carried out from 23 to 31 May 2021 in three HCFs in Bardiya district of Nepal – Khairapur, Mohammadpur, and Khairichandanpur. These are rural HCFs with delivery rooms and outpatient consultation services.

Methodology

In this study, the medical waste wascategorised in line with WHO’s Healthcare Waste Management Rapid Assessment Tool (RAT) and its 2011 updates. The categories are the following: (1) infectious waste, (2) sharps waste, (3) Medicinal/ Pharmaceutical waste, (4) Anatomic waste, (5) Radioactive waste, (6) Chemical waste, (7) Other medical waste. General waste was categorised into: biodegradable and non-biodegradable.

Waste collection and weighing were done as follows:Wastes produced from (i) delivery room, (ii) outpatient service, and the (iii) HCF staff were collected separately in plastic bags and then segregated as per the above classifications. Waste generated within 24 hours was transferred for digital weighing and a new plastic bag was replaced at the point of collection to collect the waste for the next 24 hours. This was continued for seven consecutive days. The number of people that produced the waste each day was also recorded.  During the study period, the HCFs helped with 6 deliveries, provided consultation to 256 outpatients and had 7 residential staff members. 

Key Findings

The type of waste and their quantities were found to be as follows:

Comments:

• Regarding personal protection equipment (PPE) in the HCFs used by facility staff and cleaners: apron, gown, and utility gloves are reusable and thus used after reprocessing; surgical gloves and masks are disposed and included here under infectious waste. 
• Radioactive wastes are not generated in these HCFs
• Chemical waste, though not generated during the study period, can be produced in the three HCFs e.g. in the labs. However, the labs were closed during the time of the study because of COVID-19 induced lockdown.

The whole process of collecting, segregating, weighing, and recording the wastes generated was conducted by the support staff under the guidance of the Health Facility in-charge. This procedure is simple, cost-effective, and relevant as the team had time and easy access to the HCFs to conduct the study. Remote support from the project staff due to COVID-related travel restrictions was not always very effective compared to communicating with health facility staff on the ground.

Discussion and Recommendations  

The categorization of medical waste into seven types – infectious, sharps, medicinal / pharmaceutical, anatomic, radioactive, chemical, and other wastes – and their definition used is based on the WHO (2001/2011) and are found to be relevant by the HCF personnel.

Each waste category can be further categorised by its constituents, which could be taken up in a more in-depth future study of this kind, by segregating and weighing separately the constituents. For example, it is a practice to segregate general waste into the following categories: food, inert (soil, sand, etc), plastics (non-saleable), plastics (saleable), paper, wood-and-leaves, glass, metal, textile, and miscellaneous.

Data on the quantity of waste types generated at a HCF are rarely collected, which makes planning for waste management more difficult. Even though the data collection requires time, the tracking efforts allow facilities to identify where waste separation could be improved and to plan practically how to achieve this. As a result, the amount of waste that needs treatment will be reduced significantly which also reduces costs for safe disposal. In other words, treatment becomes more affordable.

Future Aspirations

Having tested the methodology, the future intension of Terre des hommes is to conduct a more in-depth and scaled-up version of this study, whereby a larger number of HCFs would be targeted which would provide a larger volume of waste to have more representative outcomes. Further general waste would be segregated into ‘recyclable’ and ‘non-recyclable’ in addition to biodegradable and non-biodegradable. To inform programming decisions concerning waste management at national and local levels, as well as to inspire adaptation and piloting of similar methodologies in other countries, Tdh will share a guidance note and tools for waste data collection with the Nepali Government and national and global partners at the end of the project.