(English version below)

Auteur et crédits photos: Tdh Mali

Le projet SWSC mis en œuvre au Mali développe une approche holistique de l’hygiène des mains, de la qualité de l’eau dans les centres de santé. Ce projet mis en œuvre dans la région de Ségou, bénéficie des soutiens financiers de la Direction du Développement et de la Coopération Suisse. 

Le thème de la journée mondiale du lavage des mains choisi par l’OMS cette année, “S’unir pour l’hygiène des mains universelle”. Pour marquer l’évènement, Terre des hommes (Tdh), en collaboration avec le Ministère de la Santé et du Développement Social, représenté par la Direction Nationale de Santé de Ségou, a organisé une cérémonie le 15 octobre au Centre de Santé Communautaire (CScom) de Zanabougou, région de Ségou, Mali, à laquelle ont participé : le préfet, le maire, le chef de village et l’ensemble des acteurs du secteurs de la société civile.  

A travers cette journée, Tdh souhaite promouvoir et soutenir une culture universelle du lavage des mains dans la région de Ségou au Mali à travers le projet d’innovation hands4health centré sur la station de lavage des mains innovante “Gravit’eau : une solution efficace pour promouvoir l’hygiène des mains”. De manière plus spécifique, la célébration de cette journée avait pour objectifs :  

1. Plaider/ sensibiliser les communautés et les autorités sanitaires et politiques sur l’importance du lavage des mains au savon afin de susciter un effort collectif pour un changement de comportement durable en faveur du lavage des mains dans les communautés et les institutions.
2. Sensibiliser les agents de santé, les communautés et les enfants sur l’importance du lavage des mains au savon afin qu’ils soient des vecteurs de changement dans les communautés.
3. Communiquer sur le projet SWSC, notamment la méthodologie Wash FIT  comme solution pour favoriser durablement le lavage des mains, la prévention et contrôle des infections surtout dans les contextes à pénurie d’eau.  

Des jeux concours, des sketchs démonstratifs et d’autres activités ludiques et éducatives ont permis à près de 300 participants d’en apprendre davantage sur l’importance de l’hygiène des mains et de déclencher un changement de comportement durable. Par ailleurs, le projet a également sensibilisé près de 100 000 personnes à l’importance du lavage des mains au savon à travers des communications à la radio et sur les réseaux sociaux.

---

Global Handwashing Day Celebration

Author and photo credits: Tdh Mali

The SWSC project in Mali is developing a holistic approach to hand hygiene and water quality in health centres. This project, which is being implemented in the Segou region, receives financial support from the Swiss Agency for Development and Cooperation.

In 2022, the theme of Global Handwashing Day chosen by the WHO was "Unite for Universal Handwashing". To mark the event, Terre des hommes (Tdh), in collaboration with the Ministry of Health and Social Development, represented by the National Health Directorate of Segou, organised a ceremony on 15^th October at the Community Health Centre of Zanabougou, Segou region, Mali, in which the prefect, the mayor, the village chief and all the actors of the civil society sector participated. 

Through this day, Tdh wishes to promote and support a universal handwashing culture in the Segou region of Mali through the hands4health innovation project centred on the innovative handwashing station "Gravit'eau an effective solution to promote hand hygiene". More specifically, the celebration of this day had the following objectives 

1. Advocate/sensitize communities and health and political authorities on the importance of handwashing with soap in order to create a collective effort for sustainable behaviour change towards handwashing in communities and institutions.
2. Sensitise health workers, communities and children on the importance of handwashing with soap so that they can be agents of change in their communities.
3. Communicate on the SWSC project, in particular the WASH FIT methodology as a solution to promote sustainable handwashing, infection prevention and control, especially in water-scarce contexts. 

Through competitions, demonstration skits and other fun and educational activities, nearly 300 participants learned about the importance of hand hygiene and triggered sustainable behaviour change. In addition, the project also raised awareness of the importance of handwashing with soap among nearly 100,000 people through radio and social media communications.

(English text below)

Auteur : HEKS/ EPER Niger et SongES[1]
Crédits photos : Oliver Girard pour HEKS/EPER

HEKS Niger met en œuvre le projet "Amélioration de l’accès à l’eau potable et à l’assainissement et promotion des bonnes pratiques en matière d’hygiène et d’alimentation pour la réduction des maladies infantiles et de la malnutrition dans 20 villages de la commune de Tirmini (région de Zinder)". L’ONG SongES est le partenaire local de mise en œuvre du projet. Celui-ci s’articule sur les deux approches phares du consortium SWSC Ecoles Bleues et WASH-Fit et fait recours à la stratégie "Ecoles des maris" pour la mobilisation communautaire. 

Dans son volet institutionnel le projet appuie 6 écoles et 3 centres de santé à travers la mise en œuvre des approches Ecoles Bleues et WASH dans les établissements de soins de santé. Pour son volet mobilisation communautaire, il a été fait recours à la stratégie "Ecoles des maris" qui est une approche d’implication des hommes dans les questions de santé, d’hygiène et d'assainissement. 84 écoles des maris ont été mises en place, totalisant 999 membres dans 24 villages. Les écoles des maris ont pour principal rôle de sensibiliser les communautés sur les thématiques WASH et d’appuyer les écoles et centres de santé pour l’amélioration des différents services. Elles font recours au plaidoyer au niveau communautaire et local et ont reçu des formations sur les thématiques WASH, santé et communication.

De l’analyse de la situation locale du WASH, aux actions d’amélioration des services

En tant que structure d’appui à la santé et à l’éducation, les écoles des maris élaborent des plans d’actions dont la mise en œuvre permet de lever des obstacles et/ou d’améliorer la qualité des services offerts. Ces plans d’actions découlent des analyses faites des différents services WASH au cours de réunions périodiques tenues avec la facilitation des animateurs du projet et la participation des agents de santé, des enseignants, des leaders de la communauté, des membres des comités de gestion des écoles et des centres de santé.

La mise en œuvre des plans d’action se fait à travers la sensibilisation de proximité ou de masse, la réalisation de travaux communautaires, la conduite d’actions de plaidoyer, etc.

Aller au-delà des constats et convaincre par l’exemple

Les analyses faites par les écoles des maris sur les services offerts par les centres de santé révèlent des insuffisances aussi bien sur le plan de la qualité que de l’effectivité des services.

Une des insuffisances communes à tous les établissements de soins de santé est l’exiguïté des différents locaux. Devant ces constats les plans d’amélioration élaborés par les membres, ont consisté à initier des constructions de salles d’observation et de suite de couche avec des matériaux locaux comme c’est le cas au niveau du village de Toudoun Agoua.

Dans ce centre, 3 salles d’observations et 1 salle de suite de couche ont été construites à l’initiative de l'école des maris du village. En plus de la mobilisation des matériaux (argile et briques), les membres de l'école des maris ont fourni la main d’œuvre pour la construction des bâtiments.

Pour soutenir les efforts de l'école des maris, des donateurs locaux ont pris l’engagement d'apporter les matériaux nécessaires pour la couverture en tôle des bâtiments construits et l’équipement des salles en lits et matelas.

Une mobilisation communautaire pour les services de santé et le WASH

Les sensibilisations menées par les écoles des maris ont permis d’une part, i) de mobiliser les communautés pour une meilleure utilisation des services de santé notamment par les femmes et les enfants et d’autre part, ii) de contribuer à l’amélioration de la qualité des services WASH et santé. Au cours du premier semestre 2022, 5 221 hommes, femmes et enfants ont été reçus au niveau des trois centres de santé appuyés par le projet. Ces patients ont en même temps eu accès au service d’eau potable et d’hygiène grâce aux branchements d’eau, aux latrines ainsi qu'aux dispositifs de lavage des mains, installés dans les 3 établissements de santé bénéficiaires.

La mobilisation de ressources locales pour les services WASH au niveau des centres de santé et des écoles

Dans la recherche de soutiens pour l’amélioration de la qualité et de la durabilité des services WASH et de santé, les écoles des maris initient des actions de mobilisation des ressources locales. Les ressortissants des villages d’intervention établis à l’étranger et les potentiels donateurs locaux, sont approchés dans le cadre de ces initiatives. Les ressources mobilisées servent au paiement des factures d’eau des écoles et des centres de santé. Elles permettent également d’appuyer la mise en œuvre de l’approche Ecole Bleue par l’achat de matériel et d'équipements. Ainsi, dans le village de Didiari, 950 CHF ont été mobilisés par les ressortissants résidant à l’étranger. La somme a été versée dans la caisse du COGES de l’école du village et a permis d’assurer la prise en charge des factures d’eau au cours de toute l’année scolaire 2021-2022. Des travaux de réhabilitation de classes ont également été financés avec les fonds cotisés.

---

[1] Rédaction : Abdoussalami Hamani, chargé des opérations à SongES et Tidder Sadikou chargé des projets HEKS.

---

"Schools for Husbands": a Community-Based Approach to Improve Access to WASH and Health Services by Involving Men

Author: HEKS/ EPER Niger and SongES[1]
Photo credits: Oliver Girard for HEKS/EPER

HEKS Niger is implementing the project "Improvement of access to drinking water and sanitation and promotion of good hygiene and nutrition practices for the reduction of childhood diseases and malnutrition in 20 villages of the Tirmini commune (Zinder region)". The NGO SongES is the local partner for the implementation of the project. The project is based on the two main approaches of the Swiss Water and Sanitation Consortium Blue School and WASH FIT and uses the strategy of schools for husbands for community mobilisation.

In its institutional component, the project supports six schools and three health centres through the implementation of the Blue Schools and WASH approaches in health care facilities (HCF). For its community mobilisation component, the “schools for husbands” strategy was used, which is an approach to involve men in health, hygiene and sanitation issues. 84 schools for husbands were set up with a total of 999 members in 24 villages. The main role of these schools is to sensitise communities on WASH issues and to support schools and health centres to improve the various services. They use advocacy at communal and local level and have received training in WASH, health and communication.

From analysis of the local WASH situation to actions to improve services

As a health and education support structure, the schools for husbands develop action plans whose implementation helps to remove obstacles and/or improve the quality of services offered. These action plans are based on analyses of the different WASH services during regular meetings facilitated by project facilitators and involving health workers, teachers, community leaders, school and health centre management committees.

The implementation of the action plans is done through outreach or mass sensitisation, community work, advocacy, etc.

Going beyond observations and convincing by example

The analyses carried out by the schools for husbands on the services offered by the health centres reveal shortcomings in terms of both the quality and effectiveness of the services.

One of the shortcomings common to all health care establishments is the cramped conditions of the various premises. Faced with these observations, the improvement plans drawn up by the members consisted in initiating the construction of observation rooms and maternity ward with local materials, as is the case in the village of Toudoun Agoua.

In this centre, three observation rooms and one maternity ward were built on the initiative of the village's school for husbands. In addition to the mobilisation of materials (clay and bricks), the members of the schools for husbands provided the labour for the construction of the buildings.

To support the efforts of the schools for husbands, local donors have pledged to provide the materials needed to cover the buildings with sheet metal and to equip the rooms with beds and mattresses.

Community mobilisation for health services and WASH

The awareness-raising activities carried out by the schools for husbands have made it possible to (i) mobilise communities to make better use of health services, particularly for women and children, and (ii) contribute to improving the quality of WASH and health services. During the first half of 2022, 5,221 men, women and children were seen at the three health centres supported by the project. At the same time, these patients had access to drinking water and hygiene services thanks to the water connections, latrines and hand-washing facilities installed in the three beneficiary health facilities.

Mobilising local resources for WASH services in health centres and schools

In the search for support to improve the quality and sustainability of WASH and health services, the schools for husbands initiate local resource mobilisation activities. Nationals of the intervention villages living abroad, and potential local donors are approached for these initiatives. The resources mobilised are used to pay water bills for schools and health centres. They also make it possible to support the implementation of the Blue School approach by purchasing materials and equipment. In the village of Didiari, for example, CHF 950 was raised by nationals living abroad. The sum was paid into the school monitoring committee of the village school and made it possible to cover water bills for the entire 2021-2022 school year. Additionally, classroom rehabilitation works were financed with the funds contributed.

---

[1] Editors: Abdoussalami Hamani, Operations Officer at SongES and Tidder Sadikou, HEKS Project Officer.

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).

---

[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

---

[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.

Contributors: Jacques Louvat, John Brogan, Brigit Zuber
Photo Credits: Jacques Louvat

This week, the 9^th World Water Forum is taking place in Dakar, from March 21^st – 26^th, 2022, on the topic of “Water Security for Peace and Development”. The Swiss Water and Sanitation Consortium (SWSC) is also actively participating and contributing to the forum. 15 SWSC representatives came together to share their know-how and experience at the forum. The group consists of project team members and SWSC advisors from Terre des hommes, Swissaid, Helvetas, HEKS, Fastenaktion and Caritas Switzerland from 8 different countries – Mali, Burkina Faso, Niger, Ethiopia, Sudan, Cambodia, Madagascar and Switzerland.

The SWSC Supports Three Official Sesssions

On Tuesday, March 22^nd, 2022, the SWSC contributes to the action group 2C1 under the forum priority "Water for Rural Development", with the session title “Building a collective vision of more robust systems for WASH in public institutions”. The session aims to raise awareness of government stakeholders and their partners of programmatic approaches and strategies that promote WASH improvements at scale in public institutions in their countries. The exchange of knowledge and learning will catalyse increased cross-sectoral commitment (WASH, health and education), investment and policy for WASH in public institutions by governments and its partners.

On Wednesday, March 23^rd, 2022, 9am – 10:30am, the SWSC co-organises a session on WASH in Institutions – Advocacy (2C2) with the title “Water is Politics: Professionalizing WASH Advocacy” in cooperation with UNICEF, the WASH advocacy expert John Oldfield and the Water Youth Network. In the session, WASH advocates from across Africa, Asia, Latin America and the Middle East will convene to discuss and debate best, worst, and promising practices in advocating for WASH in healthcare facilities and schools. How are advocates working with political leadership in their countries and communities to accelerate progress on WASH access? What are the challenges encountered, and what are the keys to successful advocacy?

On Thursday, March 24^th, 2022, at 1:30pm – 3pm, the SWSC co-convenes a session on WASH in Institutions – Technologies (2C3) with the title “Applying the right technologies for sustainable and at-scale WASH in institutions”. The session aims to stimulate discussion about emerging technology options and considerations for WASH services in specific geographic / climate contexts in order to draft guidance on how best to support government approval and inclusion of appropriate, sustainable technologies for schools and health care facilities.

Blue School Video in the Youth Village

In the youth village in the World Water Forum, the SWSC is featuring a short introduction video to Blue Schools. The project team members of the SWSC who are active in Blue Schools in Africa and Asia have worked together to create a short introduction video to Blue Schools. The 3-minute video explains what a Blue School is in a nutshell. In the video, the Blue Schools approach becomes tangible through images from Blue Schools in Nepal, Cambodia, Madagascar, Uganda, Ethiopia, Benin, Burkina Faso and Niger.

SWSC Presentations and Exhibitions at the Swiss Pavilion

On Thursday, March 24^th, 2022, 9:30am – 10:30am, the Swiss Water and Sanitation Consortium members, Caritas Switzerland, Fastenaktion, HEKS/EPER, Helvetas, Swissaid, Swiss Red Cross and Terre des hommes, together with the Swiss Federal Institute for Aquatic Science and Technology will hold a presentation on Blue Schools – Practical, contextualized learning to inspire a generation of water and environment champions. The SWSC project teams from Africa and Asia will share stories of how Blue Schools is inspiring students, teachers and local governance actors, including a case study on the contextualization of the Blue Schools Kit in collaboration with the Ministry of Education in Cambodia.

On Friday, March 25^th, 2022, 12pm – 1:30pm, the Swiss Water and Sanitation Consortium members, HEKS/EPER, Helvetas, Swissaid and Terre des hommes, together with WATALUX and Gravit’EAU will hold a presentation on WASH in Health Care Facilities – transformative methods and technologies. In this session, SWSC members will spotlight WASH commitments and investments made by local government authorities and facility management committees to prevent health care acquired infections. Project leads from Africa and Asia will relate how the WASH in Health Facility Improvement Tool (WHO, UNICEF) is catalyzing change. They will also welcome other Swiss partners to present promising, climate-smart technologies in health care facilities. These include the Gravit’eau water recycling systems that enable handwashing without water supply and energy and WATA’s robust electro-chlorinators rolled out in 550 health facilities since 2018.

Author: Seanghak Khin, Blue Schools and Water Integrity Advisor, Caritas Switzerland in Cambodia
Photo Credits: Caritas Switzerland in Cambodia

 

The Blue Schools Kit is an open-source compilation of inspirational support materials to guide schools in their pathway to improve water and sanitation services and to integrate environmental education and practice in the curricula. The Blue School Kit was developed in 2018 by the Swiss Water and Sanitation Consortium (SWSC), Helvetas, Caritas Switzerland, Terre des hommes and Eawag.

In the project “Cambodia Goes Blue Schools” by Caritas Switzerland, the Blue Schools Kit was adapted to the Cambodian context in 2021/2022. The adapted Kit is in the Khmer language, includes locally relevant technologies as well as Cambodian pictures and illustrations. The aim of the adaptation is to give inspiration and support tailored to the context to teachers and other school stakeholders in Cambodia to improve their way of teaching with practical exercises by using the low-cost materials and technologies available at their schools.

The Cambodian Blue Schools Kit aims to give inspiration and support to teachers by complementing theoretical classes with practical exercise by using low-cost technologies and locally available resources. For each Blue Schools topic, a compilation of hands-on exercises is provided that align with the national school curriculum for different grades. The catalogue of practical exercise provides the participatory training and teaching by putting in place an enabling environment for children to practice.

The Cambodian Blue School Kit will be published in May 2022 and will be available here:

https://waterconsortium.ch/blueschool/

 

How the Cambodian Blue Schools Kit was Adapted

The Cambodian Kit, just like the general Blue Schools Kit, is structured into six main chapters:

1. My Drinking Water
2. Sanitation and Hygiene
3. Growth and Change
4. From Waste to Resource (waste management)
5. From Soil to Food (school gardens)
6. Environment

The sixth chapter on environment focuses on the sub-components My River, The Water Cycle and My Forest, underlining the importance of trees and the negative impacts of deforestation, as these are important challenges in Cambodia.

The topics were elaborated through discussions with the implementing partners of the project from different sectors – the Department of Education, Youth and Sport, local NGOs and private sector stakeholders, as well as the school staff and teachers and students practicing the exercises and activities in school. The original Blue Schools Kit was adapted to the Cambodian context by including locally available resource materials from local NGO and government partners – including their existing best practices, interpreting activities to local customs and conceptualizing new exercises with children in order for them to reach the learning objectives better. Finally, the Cambodian Blue Schools Kit was visually improved by a local graphic designer, including pictures and illustrations from the Cambodian context while keeping the overall layout and identity of the Blue Schools Kit.

The Catalogue of Practical Exercises promotes hands-on practical exercises and introduces materials for the six components of Blue Schools. It also recommends the appropriate grade for which a particular exercise is suitable.

Blue Schools practical exercise

Training of Trainers: Blue Schools training for school’s teachers 

 

The Catalogue of Technologies supports project staff, education authorities and school staff and stakeholders in selecting the appropriate technologies that can be put in place in a particular school. It provides references to low-cost technologies and points out general prices of local materials. It also includes Cambodia specific recommendations, for example Labobo [Happy Tap] or the touch-free handwashing unit. Environmentally friendly technologies are presented for students to experience them at school, learn how they work and get inspired to replicate these practices at home and in their communities.

In summary, the main features of the Cambodian Blue Schools Kit are the following:

• Inspiration for schoolteachers to engage students within the Cambodian cultural context
• Alignment of Blues School exercises to the existing national curriculum of Cambodia
• Adaptation of the exercises by aligning them with specific grades / learning levels
• All materials needed for the practical exercises are locally available
• Easy to follow layout with a nice local graphic design and pictures

Blue Schools training from teacher to students

 

The Original Blue School Kit

The Blue Schools Kit was developed in 2018 by the Swiss Water and Sanitation Consortium (SWSC) project teams and advisors from Helevtas, Caritas Switzerland and Terre des hommes, in collaboration with Eawag based on field experience in WASH in Schools and lessons from piloting the environmental components in schools.

Between 2020 and 2023, the SWSC implements Blue Schools in over 150 schools in 12 countries. In addition, several other organisations are using the Blue Schools Kit in various countries.

The Blue Schools Kit is accessible online: https://waterconsortium.ch/blueschool