(Version française ci-dessous)

Authors: Aboubacar BALLO, WASH Coordinator, Terre des hommes in Mali; Bruno PASCUAL, Head of Wash expertise, Terre des hommes
Photo Credits: Terre des hommes

 

The Swiss Water and Sanitation Consortium (SWSC) and its member organisations are contributing to the improvement of water and sanitation services worldwide – this is particularly crucial during the current COVID-19 pandemic. Thanks to the intervention of Terre des hommes in Mali, several health care facilities offer improved water services, including the health care facility in Kodougouni.

 

Assessing the WASH Situation using FACET

At the start of the project in 2020, Terre des hommes and the health authorities carried out an assessment of access to water, sanitation and hygiene (WASH) in ten health care facilities (HCF) in the Segou region of Mali, using the consortium's FACET tool. The tool compiles standard questions on WASH, based on the standardised JMP indicators (WHO/UNICEF). The findings of the survey were worrying because while 70% of the HCFs offered basic water service, service was limited or non-existent in the areas of sanitation, medical waste management, hand hygiene and environmental cleaning. Furthermore, WASH issues were not prioritised in the budget plans of health facility managers.

Photo: Traditional well in the HCF of Kodougouni (before the project intervention)

 

Capacity Building: The WASH FIT Approach

In response to these findings, Terre des hommes, within the framework of the Swiss Water and Sanitation Consortium and with the financial support of the Swiss Agency for Development and Cooperation (SDC), supported the ten HCFs in implementing the WASH FIT approach.[1] In collaboration with the Ségou Regional Health Directorate, the capacities of the HCF managers (technical agents, town hall, community health associations) were strengthened using the WASH FIT tool. A participatory improvement and monitoring plan for water, hygiene and sanitation services was developed by each HCF.

[1] WASH FIT is a tool for improving water, sanitation and hygiene services in health facilities, developed by WHO and UNICEF.

Photo: Training health staff on WASH FIT

 

Infrastructure Improvements: Construction of Water Supply Systems

Before the project’s intervention, the Kodougouni HCF did not have a suitable water supply system. It only had a traditional well with unsafe water – it was polluted with faecal coliforms. In accordance with the improvement plan put in place by the WASH FIT committee, Terre des hommes supported the construction of a water supply system, which was the HCF’s highest priority need.

Photo: New water supply system

 

Mechanisms for the Sustainable Management of the Water System

Two local technicians were trained and equipped to maintain the water supply system. The Health Centre Committee (ASACO) has included a lump sum of 10,000 CFA francs in its monthly budget planning for the maintenance of the structure.

Photo: The water tower

 

As a result of these interventions, the HCF of Kodougouni, once one of the poorest in the Segou region, now provides basic water service to over 5000 people who rely on the HCF.

Following a national assessment by the Ministry of Health, the facility was furthermore selected to host a telemedicine unit, as part of a programme to improve the technical health platform targeting 15 HCFs in Mali. Progress in WASH services was one of the determining criteria for the selection process.

Photo: A doctor examines a child in a health centre in Mali

 

"Before, women used to fetch water outside for deliveries. We had to go out into the yard to get water from the polluted traditional well. Now we have access to quality water right under our noses, in the delivery room, in all the other units and in the courtyard. This makes our work much easier. Deliveries are much safer!”

Korotimi Tangara, midwife of the Kodougouni health centre.

Photo: A midwife washing her hands at the sink

 

For more information, please visit:

• Swiss Water and Sanitation Consortium (SWSC) website on WASH in HCF: https://waterconsortium.ch/wash-in-health-care-facilities/
• Article on lessons learned and best practices from WASH activities in health care facilities: "Improved Sanitation and Hygiene in Health Care Facilities in Mali through WASH FIT and Community Mobilization"

Contact:

Aboubacar BALLO, WASH Coordinator, Terre des hommes Lausanne in Mali
aboubacar.ballo@tdh.ch
+223 91 57 96 08

 

______________________________________________________________________________

 

Terre des hommes favorise l'amélioration durable du système WASH dans les centres de santé au Mali

 

Auteurs : Aboubacar BALLO, Coordinateur WASH, Terre des hommes au Mali ; Bruno PASCUAL, Responsable de l'expertise WASH, Terre des hommes
Crédits photos : Terre des hommes

 

Le Consortium suisse pour l'eau et l'assainissement (SWSC) et ses organisations membres contribuent à l'amélioration des services d'eau et d'assainissement dans le monde entier, ce qui est particulièrement crucial pendant la pandémie actuelle de COVID-19. Grâce à l'intervention de Terre des hommes (Tdh) au Mali, plusieurs établissements de santé offrent des services d'eau améliorés, notamment l'établissement de santé de Kodougouni.

 

Évaluation de la situation EHA à l'aide de FACET

Au début du projet en 2020, Tdh et les autorités sanitaires ont réalisé une évaluation de l'accès à l'eau, à l'assainissement et à l'hygiène (EHA) dans dix établissements de soins de santé (ESS) de la région de Ségou au Mali, en utilisant l'outil FACET du consortium. Cet outil compile des questions standard sur le EHA, basées sur les indicateurs du JMP (OMS/UNICEF). Les résultats de l'enquête étaient inquiétants car si 70% des ESS offraient un service d'eau de base, le service était limité ou inexistant dans les domaines de l'assainissement, de la gestion des déchets médicaux, de l'hygiène des mains et du nettoyage de l'environnement. Les questions relatives à l'eau, à l'assainissement et à l'hygiène n'étaient pas prioritaires dans les plans budgétaires des gestionnaires des établissements de santé.

Photo : Puits traditionnel dans le ESS de Kodougouni

 

Renforcement des capacités : L'approche WASH FIT

Face à ces constats, Terre des hommes, dans le cadre du Consortium Suisse pour l'Eau et l'Assainissement et avec le soutien financier de la Direction du Développement et de la Coopération (DDC), a appuyé les dix ESS dans la mise en œuvre de l'approche WASH FIT.[2]  En collaboration avec la Direction Régionale de la Santé de Ségou, les capacités des gestionnaires des ESS (agents techniques, mairie, associations de santé communautaire) ont été renforcées en utilisant l'outil WASH FIT. Un plan participatif d'amélioration et de suivi des services d'eau, d'hygiène et d'assainissement a été élaboré par chaque ESS.

[2] WASH FIT est un outil destiné à améliorer les services d'eau, d'assainissement et d'hygiène dans les établissements de santé, mis au point par l'OMS et l'UNICEF.

Photo : Formation du personnel de santé sur le WASH FIT

 

Amélioration des infrastructures : Construction de systèmes d'approvisionnement en eau

Avant l'intervention du projet, le ESS de Kodougouni ne disposait pas d'un système d'approvisionnement en eau adapté. Il ne disposait que d'un puits traditionnel dont l'eau était insalubre - elle était polluée par des coliformes fécaux. Conformément au plan d'amélioration mis en place par le comité WASH FIT, Terre des hommes a soutenu la construction d'un système d'approvisionnement en eau, qui était le besoin le plus prioritaire du ESS.

Photo : Nouveau système d'approvisionnement en eau

 

Mécanismes pour la gestion durable du système d'eau

Deux techniciens locaux ont été formés et équipés pour entretenir le système d'approvisionnement en eau. Le Comité du Centre de Santé (ASACO) a inclus une somme forfaitaire de 10.000 francs CFA dans sa planification budgétaire mensuelle pour l'entretien de la structure.

Photo : Le château d'eau

 

Grâce à ces interventions, le ESS de Kodougouni, autrefois l'un des plus pauvres de la région de Ségou, fournit désormais un service d'eau de base à plus de 5000 personnes qui dépendent du ESS.

Suite à une évaluation nationale du Ministère de la Santé, la structure a en outre été sélectionnée pour accueillir une unité de télémédecine, dans le cadre d'un programme d'amélioration du plateau technique sanitaire ciblant 15 ESS au Mali. Les progrès en matière de services EHA ont été l'un des critères déterminants du processus de sélection.

Photo : Un médecin examine un enfant dans un centre de santé, Mali

 

« Avant, les femmes effectuaient la corvée d’eau pour les accouchements. Il nous fallait sortir dans la cour pour nous approvisionner en eau à partir du puits traditionnel pollué. A présent, nous avons accès à de l’eau de qualité sous nos nez, dans la salle d’accouchement, dans toutes les autres unités et dans la cour. Cela nous facilite beaucoup la tâche. Les accouchements se font dans des conditions plus sûres ! »

Korotimi Tangara, matrone du centre de santé de Kodougouni.

Photo : Une sage-femme se lave les mains au lavabo

 

Pour plus d'informations, veuillez consulter le site :

• Site web du Consortium suisse pour l'eau et l'assainissement (SWSC) sur le EHA dans les ESS : https://waterconsortium.ch/wash-in-health-care-facilities
• Article sur les leçons apprises et les meilleures pratiques des activités EHA dans les établissements de soins de santé : "Improved Sanitation and Hygiene in Health Care Facilities in Mali through WASH FIT and Community Mobilization"

Contact :

Aboubacar BALLO, coordinateur WASH, Terre des hommes au Mali
aboubacar.ballo@tdh.ch
+223 91 57 96 08

(Version française ci-dessous)

Author: Arsène Raveloson, Coordinator, Taratra
Photo Credits: Luc Ratsimiah et Rahantanirina Esperance, Taratra

Fastenaktion, in cooperation with their local partner Taratra, implements the project “Rano Aina 3” in the south of Madagascar. In their twelve Blue Schools in the districts of Betioky and Ampanihy, students learn about water and hygiene as well as environmental conservation and reforestation. For this purpose, the “One Student One Tree” approach is applied – a way to inspire students to take care of trees and the environment.

In the current project, 52,000 tree seedlings have been planted since 2017. At the beginning, only four schools participated, namely the schools of Ankopia, Vohipotsy, Amborompotsy and Agnaramaika. The trees do not only serve for the embellishment of the school surrounding and shade, but they also help the soil to store more water and to reduce rainwater runoff as well as soil erosion. This is key in order to maintain the groundwater levels in the region, as the south of Madagascar is a semi-arid region with an average rainfall of only 350 mm/year.

The Rano Aina 3 project has fostered the environmental awareness of the school community through information sessions. The knowledge about the interlinkages in the water cycle has inspired teachers, students and parents to protect the groundwater tables through reforestation. Through the collaboration with the water and forestry service in the area, forest and fruit tree seedlings were supplied, such as orange, eucalyptus and other native trees.

The Reforestation Initiative is Gaining Traction Beyond the Project

This year (2022), the chiefs of CISCO (Circonscription Scolaire) of the two districts of Betioky and Ampanihy have planned with the twelve Blue Schools and other schools under their administration to plant 2'400 trees per school per year. In parallel, this initiative is also taken up by families in the communities where the schools are located: The communities have committed to planting two trees per family.

 

« Nous avons été particulièrement ravi d’avoir été parmi les Écoles Bleues parce que c’est une approche transformatrice, c’est une approche qui intègre à la fois la dimension environnementale mais aussi la dimension sociale, éducative et même économique. »

Harena, student CM2, Andranomena Mahasoa

 

____________________________________

Fastenaktion et Taratra à Madagascar promeut la reforestation grâce aux écoles bleues

 (English Version above)

Auteur : Arsène Raveloson, Coordinateur, Taratra
Crédits photos : Luc Ratsimiah et Rahantanirina Esperance, Taratra

Fastenaktion, en coopération avec son partenaire local Taratra, met en œuvre le projet "Rano Aina 3" dans le sud de Madagascar. Dans leurs douze écoles bleues situées dans les districts de Betioky et d'Ampanihy, les élèves apprennent des notions d'eau et d'hygiène ainsi que de conservation de l'environnement. À cette fin, l'approche "Un élève, un arbre" est appliquée – un moyen d'inciter les élèves à prendre soin des arbres et de l'environnement.

Dans le cadre du projet actuel, 52 000 plants d'arbres ont été plantés depuis 2017. Au début, seules quatre écoles ont participé, à savoir les écoles d'Ankopia, Vohipotsy, Amborompotsy et Agnaramaika. Les arbres ne servent pas seulement à l'embellissement des environs de l'école et à l'ombrage, mais ils aident aussi le sol à stocker plus d'eau et à réduire le ruissellement des eaux de pluie ainsi que l'érosion. Il s'agit d'un élément essentiel pour maintenir le niveau des eaux souterraines dans la région, car le sud de Madagascar est une région semi-aride où les précipitations moyennes ne sont que de 350 mm par an.

Le projet Rano Aina 3 a favorisé la prise de conscience environnementale de la communauté scolaire par le biais de séances d'information. La connaissance de ces liens dans le cycle de l'eau a incité les enseignants, les élèves et les parents à protéger les nappes phréatiques par la reforestation. Grâce à la collaboration avec le service des eaux et forêts de la région, des plants d'arbres forestiers et fruitiers ont été fournis, tels que des orangers, des eucalyptus et d'autres arbres indigènes.

L'initiative de reboisement gagne en popularité au-delà du projet

Cette année (2022), les chefs de CISCO (Circonscription Scolaire) des deux districts de Betioky et Ampanihy ont prévu avec les douze écoles bleues et les autres écoles sous leur administration de planter 2'400 arbres par école et par an. En parallèle, cette initiative est également reprise par les familles des communautés où se trouvent les écoles : Elles se sont engagées à planter deux arbres par famille.

« Nous avons été particulièrement ravi d’avoir été parmi les Écoles Bleues parce que c’est une approche transformatrice, c’est une approche qui intègre à la fois la dimension environnementale mais aussi la dimension sociale, éducative et même économique. »

Harena, élève CM2, Andranomena Mahasoa

 

 

 

 

 

 

 

 

Author: Debi Nabukeera
Photo Credits: Rogers Musiitwa

Community Initiative to Construct Latrines in the Bidibidi Refugee Settlement

Uganda hosts many refugees from neighboring countries, especially from South Sudan. The Bidibidi refugee settlement (in the Yumbe district) is one of the biggest refugee camps in the North of Uganda. In the settlement, many refugee families do not have access to proper water and sanitation services: A third of the population in the Bidibidi settlement does not have access to a toilet (UNHCR, June 2021). Having no access to sanitation facilities leads to cycles of disease and poor health outcomes among the families and communities.

To change this and to improve access to sanitation services, the Agency for Cooperation Research and Development (ACORD) Uganda with support from HEKS/EPER and the Swiss Water and Sanitation Consortium (SWSC) work with the families in the Bidibidi settlement. With the help of the Participatory Hygiene and Sanitation Transformation approach (PHAST, see more information below), families are sensitized about hygiene and health. The hygiene promoters of ACORD Uganda work with the communities in weekly sessions to promote improved WASH practices. An important part of their work is also to encourage families to construct pit latrines for their own use.

Below are two success stories of families who build their own latrines at home:

---

Elida Ajonye, a 30-year-old South Sudanese refugee, who lives in the Bidibidi refugee settlement, also attended a PHAST awareness session in her village, carried out by ACORD Uganda. Elida became aware of the benefits of having her own latrine and was determined to construct one in her home. Her determination was also anchored on her prior experience of sharing a latrine with her neighbors, which came with a lot of restrictions.

Elida recalls digging the latrine pit herself using the digging tools given to the community by ACORD Uganda. This is hard work, due to the rocky nature of the soil in the village. Elida also collected other materials, including logs and grass from the bush. She hired a mason from the community to support her with the construction work and the roofing of the latrine. She also installed a hand-washing facility, using a recycled five-liter jerry can.

Having a latrine in my home has come with tremendous benefits including reduced cases of open defecation in and around my home and reduced diarrheal cases. Now I have more respect in the community and – best of all – I am living in harmony with the neighbors, which was not the case before. I feel confident to have visitors in my home because there is no need to worry about where they will go in case they need to use a latrine.

Elida Ajonye

---

Anite Scovia is a 35-year-old single mother, a South Sudanese refugee, and lives in the Bidibidi refugee settlement in Uganda. Also Anite’s family now owns a latrine, thanks to ACORD Uganda and their sensitization campaigns on sanitation and hygiene in the communities.

Anite explains that before having an own latrine, the family had to ask neighbors to use their latrines. This was inconvenient and caused stress as some neigbours did not allow the family to use the latrines, other neighbors would ask Anite to first sweep their latrine before using it. At times, the neighbors would also lock their latrine. And, especially at night, it was difficult for Anite’s family to find a latrine to use. Anite recounts that her family was not respected in the community and that family members constantly suffered from diseases related to poor sanitation.

After attending a hygiene and sanitation awareness session in our village, I became motivated to build a latrine in my home to improve the health of my household. I bought nails, collected logs and grass from the bush and paid UGX 20,000 (approx. $5.50) to the mason for the construction work. I’m very happy that I no longer have to go through the experience of asking permission to use the latrine from my neighbors. I can use my own latrine at any time and live peacefully with my neighbors. I am also not so worried about diarrhea anymore which has disturbed my family for so long.

Anite Scovia

The Project in the Bidibidi Refugee Settlement

The Agency for Cooperation Research and Development (ACORD) Uganda with support from HEKS/EPER and the Swiss Water and Sanitation Consortium (SWSC) implements the project “Improving Sustainable Services and Schools in Bidibidi Settlement”. The overall objective of the project is to improve sustainable access to safe water, sanitation and hygiene services for 12,542 South Sudanese refugees and 1,680 host community members in Bidibidi. The project builds on past phases, which promoted Community Led Total Sanitation (CLTS), improved Water Supply and WASH infrastructure development.

In the current project phase, ACORD uses the PHAST approach (“Participatory Hygiene and Sanitation Transformation”, WHO) at household level. The aim of the approach is to further a community’s understanding of how improved WASH services prevent diarrhea and other gastrointestinal diseases. With specific participatory activities, community groups discover for themselves the faecal-oral contamination routes of disease, analyse their own hygiene behaviours and plan how to block the contamination routes.

The hygiene promoters of ACORD Uganda work with the communities in weekly sensitization sessions to promote improved WASH practices. The hygiene promotion sessions include the following topics:  

• Safe excreta disposal (identification of pit latrines)
• Improved hand washing practice (tippy tap installations at households)
• Safe water chains at household level and at water points
• Community health, hygiene and sanitation awareness meetings (advocacy meetings and focus group discussions)
• COVID-19 prevention messages
• Jerry can clean up campaign
• Monitoring functionality of water points (tap stands and hand pumps)

Contributors: Abdias Bio Sika, Jacques Louvat, Thijs van der Velden, Brigit Zuber
Photo Credits: Brigit Zuber, Abdias Bio Sika

The project teams of the Swiss Water and Sanitation Consortium (SWSC) from Mali, Burkina Faso, Niger, Madagascar and Benin met in Benin for an experience exchange. The regional Workshop took place from November 15^th – 18^th 2021. Twenty-three participants working in seven different projects and six organizations met to exchange, discuss and learn from each other. The workshop focused on the two signature approaches of the SWSC: Blue Schools and WASH in Health Care Facilities (WASH FIT).

Focus on Menstrual Health and Hygiene

The project teams exchanged their diverse experiences and extracted lessons learned in order to improve their project implementation. An important cross-cutting issue that the workshop focused on was Menstrual Health and Hygiene (MHH). By using the RANAS approach (Risks, Attitudes, Norms, Abilities and Self-regulation), the project teams worked on effective messages and ways of communication to fight the tabus and the misconceptions around MHH.

Spotlight on the Helvetas Project “Nim’Dora” in Benin

On Wednesday 17 November 2021, participants of the SWSC regional workshop visited the project sites of the Helvetas Benin project "Nim'Dora". The project operates in the north of Benin in the department of Alibori. The overall objective of the project is to improve the living conditions of vulnerable people through access to safe water, improved hygiene and sanitation services. It targets twelve schools and five health facilities in the communes of Banikoara and Segbana.

During the field trip, the participants visited a school and a health centre in the commune of Banikoara:

The Public Primary School of Founougo is one of the schools where Helvetas Benin is supporting the implementation of the "Blue School" concept. A Blue School is a school that provides a healthy learning environment and introduces students to environmentally friendly technologies and practices that can be replicated in their community.

The visit to the school provided an opportunity to observe the implementation progress of the project and to discuss with the various actors in the school system, including teachers, pedagogical advisors, representatives of parents and local officials, such as the community responsibles for water and sanitation, the village chief and the district chief.

Furthermore, the team was able to visit a demonstration model of an MHH-friendly toilet. This toilet provides a safe environment for menstruating girls to wash and change inside the toilet building in the school with sufficient space, running water, soap and disposal facilities. The project also builds a borehole with a solar powered pump in the school which will provide the children with water.  

At the health care facility (HCF) in Gama, which is a target HCF of the project, the workshop participants visited the centre and met the responsible staff. Before the project intervention, the health centre did not have a water point, and water had to be fetched from far away. The WASH FIT process, which was recently started, enabled the HCF to develop a WASH improvement plan. The improvement plan includes among others the instalment of a solar-powered water supply system with taps inside the HCF in all key locations, such as the treatment rooms and the maternity ward, as well as improved waste management practices. The workshop participants discussed the implementation of the WASH FIT improvement plan with the local WASH FIT committee and exchanged experiences.

Moreover, a meeting with the municipal authorities of Banikoara was held to discuss the governance of the WASH services in the area. The meeting showed how the collaboration between the project team of Helvetas Benin and the local officials evolved and was strengthened over the past five years. The project teams also exchanged their regional experiences and perspectives as well as discussed best practices with the municipal team.     

Authors: Tigist Gebremedhin (WASH Coordinator at HEKS/EPER in Ethiopia); Zelalem Mitiku (Program Manager at Enhanced Rural Self Help Association ERSHA)

Photo: Woret Shewangezaw, a 6^th grade student at Hedase Primary school in Ethiopia, carrying her daily water supply for drinking and handwashing
Photo Credits: ERSHA

 

The Amhara Region in Ethiopia: Background

The Amhara region is the second most populous region in Ethiopia. Nearly 84% of the population reside in rural areas and are engaged in agriculture. Although, technically, there is enough water available in the Amhara region,  the population and institutions, such as schools, lack access to clean and safe drinking water. The sources of water for drinking for the majority of the people are unprotected springs and manual hand dug wells. Major WASH related challenges in the region include: lack of access to safe water, poor sanitation and hygiene practices, high workload on women and children to fetch water leading to school dropout, high incidences of water borne diseases and low community awareness on the relationship between water sanitation and health.

 

The “Angolelana Tera WaSH Project” of HEKS in Ethiopia

To complement the government’s effort of increasing access to improved WASH services, Swiss Church Aid (HEKS) in collaboration with a local NGO partner, Ethiopian Rural Self-Help Association (ERSHA), is implementing the “Angolelana Tera WaSH Project” in the North Showa Zone of the Amhara Region. The project involves the construction of a multi village water scheme that will create access to safe water supply for more than 8,600 people and 2,200 students in 3 primary schools. It also creates safe water access for 2 health care facilities. The project is in progress and the construction of the water scheme is ongoing.

Photo: Hedase Primary School, Amhara Region, Ethiopia
Photo Credits: ERSHA

 

Strenuous Everyday Routine at Hedase Primary School: Children Carry Water to School for Drinking and Handwashing

Woret Shewangezaw is a 6^th grade student at Hedase Primary school. She is 14 years old and lives in Tsigereda Kebele (North Shoa Zone, Amhara Region). Hedase Primary school is one among the three target schools of the HEKS’ Angolelana Tera WaSH Project.

Woret said the school is far from her village, and she walks one hour (one way) every day to her school. When Woret talks about her school days, she says:

“My parents are farmers and only have a low income. I have four brothers and one sister. Since we don’t have access to clean water at our school, every school day, I have to bring 2-3 liters of water from my home to school. The water that I take to school is not safe since it is collected from an unprotected spring. At the same spring, also our cattle drinks water. Usually, I share the water that I take to school with my younger brother, Abreham, who is a 5^th grade student. Since we use this water both for drinking and hand washing, it is not sufficient, and we always have to use it with great care. Before we take our lunch, we use a very small amount of water to wash our hands.”

Woret also mentions the increased challengers for girls regarding menstrual health and hygiene (MHH) and she adds:

“The lack of water in the school has a profound negative impact on girls’ education. Due to lack of water in our school, we girls have a hard time in getting water for hand washing and keeping our hygiene, especially during our menstruation. Girls like me carry water not only to ourselves but also to our little brothers and sisters.”

Swiss Church Aid/HEKS and ERSHA will extend the water scheme, which is under construction, for 3 km, so that it can reach the Hedase School and create access to safe water for the students and teachers there. Woret said that she and the school students are happy and are looking forward to the water scheme to reach their school compound. In the meantime, the  parents and teachers encourage the children to take water to their schools for drinking and hand washing. The parents and the teachers said although the amount of water they bring to the school is very small, it is important that the children wash their hands, specially in this time of the COVID-19 pandemic.

 

 

Authors: Mithila Rahman Soshy, Intern, HEKS/EPER; Noor Kutubul Alam Siddique, Project manager-Health, HEKS/EPER; Shahid Kamal, Regional Humanitarian Aid Delegate-ASIA, HEKS/EPER.

 

The WASH Interventions of HEKS in Bangladesh

HEKS/EPER, a member of the Swiss Water and Sanitation Consortium, has been implementing the Water and Sanitation for Health Facility Improvement Tool (WASH FIT) in Bangladesh since 2018. WASH FIT is a risk-based, participative continuous quality improvement process for health care facilities (HCF) launched by WHO and UNICEF in 2018. Until 2020, the HEKS interventions in HCF in Bangladesh focused on Rohingya refugee communities and adjacent host communities. The current phase is focused on infection prevention and control and maintenance of facility infrastructure to protect staff, patients and carers in the government HCF in all the eight sub-districts of Cox’s Bazar.

Photo: People from the local community entering and waiting outside to receive healthcare from the Natun Mahal Community Clinic, Chowfaldandi, Cox’s Bazar Sadar Upazila, Cox’s Bazar
Photo Credits: HEKS/EPER

 

Natun Mahal Community Clinic

The Natun Mahal Community Clinic is a government primary healthcare facility situated in Chowfaldandi Union in Cox’s Bazar Sadar Upazila. For over 20 years, this community clinic (CC) has been providing health services to a population of over 12,000. Seven HCF staff members provide comprehensive primary healthcare services including the Community Health Care Provider (CHCP), currently Mr. Harun Ar-Rashid. Since 2013, he has supported community members with services regarding immunization, family planning, sexual and reproductive health, maternal neonatal and child health. Despite being a significant part of the local health-care system, Natun Mahal had received minimal maintenance support over the years, particularly in the area of water, sanitation, hygiene (WASH) infrastructure.

HEKS and its local partners use WASH FIT. The project worked with the management staff and the Upazila Health and Family Planning Office to form and train a team to participate in the WASH FIT process and develop a facility improvement plan to undertake comprehensive repair and reconstruction activities. The WASH FIT assessment completed in October 2020 identified several risks owing to the absence of WASH facilities and inadequate infrastructures. There were broken floors, damaged roofs, two unusable toilets, open dumping of waste, absence of hand washing stations with water and soap and no functional water source.

Photo: The Community Healthcare Provider at the Natun Mahal Community Clinic is providing healthcare services to a local woman
Photo Credits: HEKS/EPER

 

After the repair and reconstruction activities, the overall accessibility and utilization of WASH services in Notun Mahal CC have significantly improved, as have capacities of the CHCP to manage facility infrastructure maintenance. Mr. Ar-Rashid states that this coincided with an increase in health care seeking behaviour and that the number of patient visits rose. Mr. Ar-Rashid concludes:

”The improvements in our clinic are unprecedented in my years of service. I will always be grateful for such support, especially the recasting of the roof to prevent leakage of rainwater.”

The testimony of the CHCP and the patient registers draw a correlation between the improvement of WASH infrastructures and quality of care provided by the clinic.

Authors: Lucie Leclert (SWSC Regional Advisor East Africa), Adeline Mertenat (project officer, EAWAG-Sandec)

The Swiss Water and Sanitation Consortium (SWSC) is proud to announce that the Blue Schools Kit (available here) is listed as an example of good practices for waste education by UN-Habitat under the Waste Wise Cities Campaign. In 2020, UN-Habitat called for innovative educational practices on waste management at school and 19 best practices were selected worldwide and summarized in factsheets.

• The UN-Habitat factsheet on Blue Schools is available here.
• All the UN-Habitat factsheets are available here.

 

Collaboration between SWSC and EAWAG

The SWSC collaborates with EAWAG, the Swiss Federal Institute of Aquatic Science and Technology, on monitoring for Blue Schools and on the topic of solid waste management. Thanks to this collaboration for the development of the Blue Schools Kit, solid waste management is one of the core components of Blue Schools. Furthermore, EAWAG and the SWSC co-designed the monitoring framework for the waste management component of Blue Schools based the Joint Monitoring Programme (JMP; WHO/UNICEF) service laddered approach for WASH. Currently, EAWAG supports the SWSC with a resource person on waste management issues who helped to organize two Community of Practice meetings dedicated to the exchange of experience on solid waste management. The fruitful exchanges with project teams in both English and French have inspired the SWSC teams to replicate good practices in Blue Schools around the globe, such as waste segregation and other initiatives for reducing, reusing and recycling waste.

Photo: Print screen from the Blue Schools Facilitator’s Guide: Topic 8 on Solid Waste
Source: Blue Schools Kit 

 

The SWSC Blue Schools

The SWSC promotes the innovative approach called Blue Schools (more information available here). The projects of Phase III of the SWSC (2020 – 2023) target more than 150 schools in ten countries around the globe, benefitting more than 50’000 students and teachers.

Becoming a Blue School is a step by step process. The starting point is to ensure that children drink safe water, use well-maintained latrines and maintain good hygiene practices. Among others, the SWSC project teams rehabilitated or constructed a total of 130 drinking water supply systems and 1044 handwashing facilities in schools until mid-2021. The Blue Schools projects also promote menstrual hygiene and health, gardening activities, safe management of solid waste and environmentally friendly practices. It is the aim that children learn about these topics through practice and experiments.

Photo: A teacher in a Blue School in Cambodia demonstrating to students how to reuse pet bottles as plastic cups (project of Caritas Switzerland)
Photo Credits: Lucie Leclert

 

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.