On the Waterfront

It Starts with Sustainability

A Winning WASH Formula in Afghanistan

Children in Nawa, Afghanistan fill their containers with fresh running water.
Children in Nawa, Afghanistan fill their containers with fresh running water.
USAID/LGCD

Afghanistan has weathered decades of conflict, but the biggest threats facing its children are unsafe water and sanitation. Just 27 percent of rural households have access to improved drinking water, and only 10 percent of the population has access to improved sanitation facilities. Young girls and boys often miss school because they have to walk long distances to collect drinking water from unclean sources. Consequently, six Afghan children die every hour from diarrheal diseases.

Since 2009, Afghan villagers have mobilized to improve water and sanitation with the help of USAID’s Sustainable Water Supply and Sanitation (SWSS) project. The project (pronounced “swiss”) has increased access to sanitation by working with community members to build or renovate 38,388 latrines and has increased access to safe drinking water by constructing over 2,674 wells. But, most importantly, SWSS started by focusing on sustainability.

From Hardware to “Software”

While constructing latrines and wells is essential for improved public health in rural Afghanistan, it is not enough to create a lasting impact. Generations of life without proper access to latrines or clean water had ingrained unhealthy habits in many villagers, and 89 percent of rural Afghans defecated out in the open. For the program to be sustainable, villagers would have to make fundamental changes to their behavior, and real change takes time.

SWSS engaged with national and provincial departments of Afghan ministries, community leaders, and local villagers to promote key behavior changes that, together with new and improved facilities, would reduce the incidence of diarrheal diseases and boost public health. This is the kind of investment in development that lasts.

The fulcrum of this strategy was community-led total sanitation (CLTS). CLTS is a collective behavior change methodology that invokes feelings of shame and disgust to improve the overall health of a community by visually demonstrating the proximity of fecal matter to water resources. The goal of CLTS programs is to certify villages as “open defecation free.”

At the heart of CLTS lies the recognition that merely providing toilets does not guarantee their use, nor result in improved sanitation and hygiene. Earlier approaches to sanitation had prescribed high initial standards and offered subsidies as an incentive. But this often led to uneven adoption, problems with long-term sustainability, and only partial use. Open defecation and the cycle of fecal-oral contamination continued to spread disease.

SWSS invested in community mobilization instead of hardware and shifted the focus from toilet construction for individual households to the creation of open defecation free villages. By raising awareness of the reality that everyone is at risk of disease if even a minority continues to defecate in the open, CLTS triggers the community’s desire for change, propels them into action, and encourages innovation, mutual support, and appropriate local solutions. This leads to greater ownership and sustainability.

It Takes a Village

To foster this feeling of ownership, CLTS requires the involvement of the communities. “You have to first establish trust and an understanding of the community and how it functions,” said Dr. Christopher McGahey, senior associate at SWSS implementing partner Tetra Tech ARD. This level of trust can take months, even years to establish, which is time that the project did not have. To address this challenge, SWSS turned to one of its USAID health program partners, Management Sciences for health, which already had a decade-long track record of success working with Afghan communities and had established a network of NGOs.

By working through this network, SWSS engaged community members in the planning, design, and implementation of the CLTS approach. SWSS trained 682 Afghan facilitators to bring clTS to communities and 3,960 community leaders to promote hygiene. “We were ensuring ownership and sustainability at the community level,” said Dr. Gul Afghan Saleh, senior program manager for energy and water at USAID/Afghanistan. Involving the Afghans every step of the way, SWSS ensured that clTS lessons appealed to local customs, attitudes, and values and resonated with villagers. Shahla, a student from laghman province, said that her religion helped her see the value of clTS, “Islam is a complete religion that advises all humans to wash hands with clean water and soap, as long as there are millions of germs living in the environment.”

To ensure that communities become open defecation free, women were brought into the forefront and trained in health and hygiene promotion. “hygiene and sanitation without the involvement of women cannot be achieved in any society,” said Bimal chapagain, former director of sustainable health outcomes for the SWSS project. They participated in what Dr. McGahey called “mother-to-mother peer education programs” through the creation of Family health Action Groups of local women, selected by their communities to be trained. They then taught other women in the community about health and hygiene practices. These women would in turn educate their families, leading to community-wide behavior changes. “My husband gathered other men to support their ladies and bring a healthy environment to the village,” said Fatima, one of the participating women from Badakhshan province. A cycle of good hygiene was set into motion. Already, 394 communities have been certified open defecation free.

Tools for Change

Providing the infrastructure and tools to change behaviors related to sanitation was just half the formula for decreasing instances of diarrheal disease. There was still work to be done to ensure continuous access to safe drinking water across Afghanistan’s rural countryside. The new water infrastructure brought clean water to 511,150 Afghans, but SWSS had to ensure the sustainability of these gains. Since an estimated 30 to 50 percent of all water points in Afghanistan are not functional after two years due to maintenance or construction issues, communities would have to be equipped with new tools to ensure maintenance of the wells over the long term.

SWSS addressed this by training locals selected by their communities to repair broken hand-pump wells. local councils oversaw the compensation of the hand-pump mechanics based on community standards, thus creating a livelihood for dozens of previously unemployed people. Each mechanic is now responsible for maintaining specific wells. One mechanic from Kandahar province, Mohammed, expressed a desire to keep building upon his newfound knowledge. “I’m hoping to gain all the knowledge and expertise needed for the proper maintenance of wells,” he said. Malak, a mechanic from Parwan province, said he was so happy with his new profession that he wanted to spread the wealth, “I trained my two brothers in this same field, and now each of them can make enough money to support their families.”

As an added assurance that the wells remain operational, SWSS empowered citizens with a well-monitoring tool called Watertracker. The project trained select community members to report on each well’s functionality by calling a hotline using a unique identification number for each water point. To report a problem, a villager enters the well's number and follows two simple prompts. callers are able to leave longer, more detailed messages about the problem that they are facing.

Once a community member concludes his or her report, the information is transferred to the Watertracker website with all new data and changes instantaneously reflected. The website was developed using the Ushahidi platform, an open source information management software that facilitates data crowd sourcing and mapping. each water point is color-coded to indicate its functioning status. Detailed well information, such as the technical specifications, project history, community contact information, and the recorded voice messages left by community members are stored on dedicated, searchable pages for each water point constructed during the project. According to Nicola Armacost, managing director of SWSS partner Arc Finance, the data available on Watertracker tells “the story of the well from both an engineering and community perspective.”

Using the regular phones that community members already own, Watertracker enables SWSS to track the status of its wells, while also providing further assistance to communities. After a call comes in, a technical associate for Watertracker follows up with the communities to get more information and help facilitate a resolution. This could require activating the contractor’s warranty so that the design and construction of the well can be tweaked, finding a replacement for an absent well caretaker, or assisting communities in working out financing mechanisms to pay for part replacements.

Soon, Watertracker will be entirely in the hands of Afghans. Ownership of Watertracker will be transitioned to the Afghanistan Ministry of rural rehabilitation and Development, and so far, 1,131 Afghans have been trained to support the Watertracker system, including 994 well caretakers and 137 mechanics.

Lasting Change

In Afghanistan, villagers have begun to experience the fruits of their labor. “clean water has decreased the level of diarrheal diseases and enhanced the economic status of local residents,” said Sayed Wali of Nangarhar province. One of his neighbors, qari Atiqulla, agreed and said, “This project was the dream of local residents, which has turned into a reality.”

While SWSS ends in September 2012, the work of the villagers has only just begun. It won’t be easy, but they have proven that they are up for the challenge. Families have mobilized to build themselves latrines. community members are working hard to keep their wells functioning. Jamaluddin from laghman province echoed the sentiments of many with newfound purpose when he said, “Now, this is our responsibility.”

Global Waters Editors

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Last updated: September 18, 2013

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