In Focus

Taking Health into Their Own Hands

Simple WASH Solutions Save Lives

Children in Madagascar use the low cost, low tech, water-conserving tippy tap to wash their hands.
Children in Madagascar use the low cost, low tech, water-conserving tippy tap to wash their hands.
Shahbaz Fawbush

Every day, we take hundreds of small, simple actions for granted—things like going to a public restroom, using a flush toilet, and washing our hands with soap. However, these basic parts of our daily routines are out of reach for over 2 billion people in the developing world. Diarrhea and acute respiratory infections, which kill millions of children under age five each year, are the consequence.

USAID’s WASHplus project set out to fight these two killers. The project, operated by FHI 360 and its partners CARE and Winrock International, is a follow-on program that builds on the efforts of its predecessor, the Hygiene Improvement Project (HIP). HIP ended in 2010 and worked to improve water quality and hygiene behaviors in homes, schools, health centers, markets, and religious centers, with populations including schoolchildren, the urban poor, and those living with HIV. WASHplus takes into account lessons learned from HIP and builds on its successes while trying to avoid its pitfalls. It works in areas such as creative financing, innovation, and public-private partnerships and taps into a network of partners on the ground in Madagascar, Kenya, and Zambia. “WASHplus’ ability to draw on the expertise of a group of resource partners working worldwide, with their country and sector specific knowledge, allows us to be more responsive and flexible to support new activities or integrate a WASH component into an already existing program,” said Sandra Callier, Project Director for WASHplus.

Traditionally, WASH stands for water, sanitation and hygiene. But the “WASH” in WASHplus refers to the project’s twin goals of increasing access to and lowering the costs of water and sanitation services and improving personal hygiene habits. The “plus” represents the project’s efforts to combat pneumonia and other respiratory illnesses caused by indoor air pollution from inefficient or misused cooking stoves.

Making a SPLASH

“WASHplus achieves its goals by engaging different sectors and organizations in various communities for lasting change,” Ms. Callier said. One WASHplus program focuses its efforts on boosting child education in Zambia. Many students are forced to stay home from school due to diarrheal diseases caused by poor sanitation and unsafe water, and girls also face menstrual hygiene challenges as they grow older, making it even harder for them keep up with their studies. When girls reach puberty, they often stop going to school because private, secure, and gender-segregated toilets and access to water for personal hygiene are not available. Not only is the health of these girls and boys at risk, but so is their education and their prospects for future employment.

In June 2012, WASHplus launched Schools Promoting Learning Achievement through Sanitation and Hygiene (SPLASH) through the Zambian Ministry of Education. The project increases attendance by improving access to safe drinking water and sanitation and promoting hygiene education. It has done so by repairing or constructing school boreholes and latrines and introducing child-friendly handwashing stations suitable for group handwashing in schools. In addition, the program is launching a media campaign that targets children and promotes healthy habits such as treating drinking water and washing hands with soap.

SPLASH has learned from and taken steps to address the challenges faced by HIP. HIP found in Madagascar that bringing safe water to schools was challenging because of the large amount of water that needed to be disinfected to serve schools with an average size of 300 students, and the fact that not all schools could obtain water treatment products on the market.

To address this challenge, HIP introduced alternatives such as solar disinfection (SODIS). By learning from HIP’s experience, WASHplus has been able to introduce technology such as biosand filters, chlorination, and SODIS to ensure the schools have safe water.

SPLASH is also building upon HIP’s successes in schools, especially with regard to women and girls. The program worked to lower girls’ dropout rates and boost female teacher retention by introducing improved water and sanitation facilities. Female school teachers who benefited from HIP’s water and sanitation activities say this made all the difference. “Before we had WASH instruction, students were often sick with diarrhea,” said Madame Brigitte, a teacher at the Isorana School in southcentral Madagascar. “Now the students aren’t sick and can study regularly,” she said. Many more girls will soon benefit, as SPLASH will work in more than 641 primary schools in four districts of two provinces in Zambia.

Small Doable Actions

People living with HIV and AIDS also have a great need for easy access to safe water and sanitation. Because of weakened immune systems, diarrhea and other infectious diseases can have severe health consequences.

In Kenya, WASHplus is building on the work started by HIP and C-Change, a communication project based at FHI 360, to reduce the impact of diarrhea on HIV-affected patients and families. Using the curriculum established by these projects, WASHplus is training partners on the ground to then train community health workers on ways that people living with HIV and their families can improve WASH practices. Topics include how to safely treat and store drinking water in homes, when and how to effectively wash hands, and how to dispose of feces safely. Behavior change is negotiated through the “small doable actions” approach developed by HIP.

“Families are encouraged to try simple, easy-to-do steps to improve their health,” said Merri Weinger, USAID’s Agreement Officer for WASHplus. These actions might be to use a tippy tap to wash hands when no running water is available or making bedpans or a portable potty for people living with HIV who are too weak to get up and use a latrine. And adding a pole or bars inside a latrine for support can also make life easier for someone weakened by disease. "This approach is especially effective in settings where resources are limited, and making improvements one step at a time can increase the likelihood that a family will stick to these new practices over time,” Ms. Weinger said.

Communities Take the Lead

While diarrhea and other infectious diseases pose a particular threat to HIV/AIDS patients, they threaten everyone, so HIP’s and WASHplus’ partners encourage communities to take a bigger role in fostering public health.

In Madagascar, WASHplus is building on HIP’s efforts to renovate public sanitation facilities, known as sanitary blocks, which include showers, toilets, and laundry areas.

In a growing number of urban communities, these blocks are being placed in strategic locations, including markets and transportation hubs. These efforts have been most successful when community members stepped up. In the town of Mahitsy, for example, the block was poorly managed, dirty, and did not generate revenue for the municipality. When it was renovated by HIP, the municipality invited community groups to bid on managing it. The winning bid came from a local scout troop. Students from a local Scouts organization took over managing the block and generated considerable income for their troop and for the municipality, who reinvested the funds in refurbishing other blocks. “This is a win-win for us. We are students in management, and managing the block is an opportunity to serve the community and to do a management project for our studies,” one of the scouts, Tsilavina, said.

Based on these sanitation successes, WASHplus is pioneering new approaches untested by HIP. The program is now exploring new public-private options for emptying community toilets when they fill up with human waste, a serious challenge in urban areas. They found that the day laborers tasked with emptying the toilets face serious health hazards, engage in questionable disposal practices, and lack the capacity to improve the quality of their services. Pilot projects will test low-cost options for integrated hygienic fecal sludge management, including sludge removal, transfer, transportation, disposal, and treatment.

WASHplus is currently expanding to Bangladesh, Benin, Uganda, and Kenya. Soon many more will be able to do those little things we take for granted, but that do make all the difference.

P. Mantey with C. Wixted

More Information

WASHplus on Twitter

USAID Every Child Deserves a Fifth Birthday Campaign

WASHplus Newsletter

Last updated: September 17, 2013

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