On the Waterfront

Water For Health

A family in Khan Younis, Gaza, where USAID built a wastewater network that eliminated disease-causing raw sewage.
A family in Khan Younis, Gaza, where USAID built a wastewater network that eliminated disease-causing raw sewage.
Rania El-Helou

Hana, a Palestinian mother of eight, lives in Khan Younis, a city in Gaza with mostly dirt roads that wind around small family homes and shops. For the past 30 years, the town has lacked an operational sewage system. When rain fell heavily in the winter, homemade cesspits overflowed and sewage streamed down the dirt roads.

“The situ­ation was bad,” Hana said, “It hurt us a lot when the cesspits flooded; they caused a huge problem. I was always worried about my children. I was afraid that they would walk in the sewage and get infected by parasites.”

Hana and her children, along with 26,316 other residents of the Al- Amal neighborhood in western Khan Younis, no longer have to be concerned about their children being infected from raw sewage in the mud. Thanks to the Emergency Water and Sanitation and Other In­frastructure (EWAS) II Program, which is funded by USAID and im­plemented by American Near East Refugee Aid (ANERA) and provides essential water and sanitation infra­structure throughout the West Bank and Gaza Strip, Hana and her neigh­bors now have a wastewater network. With more than 5,230 linear meters of pipes that connect the area to a new drainage system, Khan Younis’ homes are now linked to a sewage treatment plant. 

Borne in the Water

Interventions like these target­ing water, sanitation, and hygiene (WASH) are the best hope for creating a n d sustaining healthy, thriving societies. Drinking dirty water leads to waterborne diseases such as diarrhea, typhoid, intestinal worms, and cholera. And when feces are improperly disposed of, they can contaminate streams, aquifers, and other water sources that people rely on for cooking, drinking, and bathing. Diarrheal diseases are the second leading cause of death among children under 5.

Approximately 88 percent of diar­rheal diseases are caused by drinking unsafe water, using inadequate sani­tation, and practicing poor hygiene. With over a third of the world’s population still lacking access to im­proved sanitation, open defecation and use of inadequate latrines and toilets are pervasive.

USAID released its first-ever Water and Development Strategy to more effectively reach the millions without improved access to water and sanita­tion. One of the strategy’s two stra­tegic objectives is to “improve health outcomes through the provision of sustain­able WASH.” The strategy sets a goal to provide a minimum of 10 million people with sustain­able access to improved water and a minimum of 6 million people with sustainable access to improved sanita­tion by 2018. It sets out to achieve these goals by simultaneously target­ing water and sanitation infrastruc­ture, promoting behavior change, and supporting an enabling policy and institutional environment. 

The principles in the Strategy build upon the United Nations Millennium Development Goals. The Millennium Development Goals pledged to halve the proportion of the world with­out sustainable access to improved drinking water and basic sanitation by 2015.  While the water target has been met, the sanitation target re­mains elusive. Furthermore, in cer­tain areas, like rural parts of Africa, communities are far from meeting  these targets. USAID’s work focuses on transformative change and puts special emphasis on targeting the lack of access to sanitation. 

The impacts of improved WASH reverberate throughout communi­ties. Insufficient WASH affects education and hampers livelihoods. Adults suffering from diarrhea and other waterborne diseases are unable to work productively and provide for their children. And children often miss school because they have to walk long distances to collect water or because they are stuck at home with diarrhea.  Lack of sanitation in schools is particularly harmful to girls as they begin to menstruate and often feel the need to skip school because of the lack of private toilets. “We are learning more and more about how cross-cutting WASH programs are and how dependent other sectors are on successful WASH programs to reach their outcomes,” said Jesse Shapiro, WASH Advisor and Sanita­tion Focal Point for USAID. 

Marketing Among Neighbors

In rural Cambodia, one USAID part­nership, the Water, Sanitation, and Hygiene Enterprise Development program, or WaterSHED, is improv­ing health and increasing the demand for sanitation while enlivening rural economies and supporting local en­terprise.

Over three quarters of people in rural Cambodia do not own toilets so open defecation is common. USAID’s WaterSHED program is success­fully using a “hands-off ” marketing approach to enable Cambodians to change their sanitation behaviors for improved health. 

“We learned from experience that people are more likely to embrace something new if they consider it desirable,” said Geoff Revell, pro­gram manager for WaterSHED, which also targets communities in Laos and Vietnam. The Cambodian team col­laborated with local stakeholders to understand which design elements appeal to rural consumers—in this case a ce­ramic pan that is flushed with water—and then cultivated local entrepreneurs to produce the la­trines at a lower cost. Recogniz­ing the important role of community leadership in eliminating open def­ecation, the team engaged the local government in the project. 

The product is demonstrated at pro­motional events and door-to-door, and people in the crowd are encour­aged to tell their story to the sales­person, also a community member. Suppliers have sold well over 50,000 latrines at full cost to the consumer, without subsidies, and will remove an estimated 25,000 tons of human feces from the open environ­ment every year. 

“I think selling latrines is much better than pro­viding them for free to villagers because some just leave it unused or do not know how to install it,” noted Min Hi, a toilet sales agent in Battambang Province. 

WaterSHED’s overarching goal is to reduce wa­terborne illnesses in the region—for the long term. Wa­terSHED is now an NGO that carries out the work started by the program. “We want to fall back and let the local entrepreneurs and the local govern­ment carry it forward themselves,” Mr. Revell said. 

Building Sustainability

Extreme climate events like droughts and floods can take an additional toll on health. In arid and semi-arid parts of Kenya, where recurring droughts and flash floods have battered com­munities and killed scores of livestock that most families depend upon for food and income, a USAID-funded program combines disaster risk re­duction with WASH for increased health benefits.

The Millennium Water Alliance (MWA), a con­sortium of U.S.- based NGOs working in water and sanitation, is implement­ing USAID’s Ken ya Arid Lands Disas­ter Risk Reduc­tion (KALDRR) WASH program, which helps res­idents harness their intermittent rains to improve health. 

KALDRR is tar­geting rural com­munities in Gar­risa, Turkana, Marsabit (including Moyale District), Isiolo, and Wajir and plans to help communities build low-cost technologies to capture, store, and reuse one of the area’s most valu­able resources: rainwater.  KALDRR will develop or rehabilitate over 60 community ground and rainwater schemes and install rainwater tanks in 23 schools. 

Community leaders in the five areas have seen firsthand the need for im­proving WASH. “Water, hygiene, and sanitation are some of our biggest challenges as a community today,” said Abdi Sheikh, Sub Chief of the Eldere Location in Garissa County. 

Key to KALDRR’s success is target­ing 78 of the emergency nutrition and health centers supported by USAID’s APHIA Plus program. The team will help communities build water supply and storage structures at these clinics and install or upgrade latrines while providing education about the link between improved sanitation and hygiene and good health.  

“The main idea of this program is to transition away from emergency response programs that respond to crisis conditions over the short term to more long-term development-ori­ented thinking. That includes build­ing infrastructure and training people who can sustain the development,” said Daniel Smith, program officer for MWA. 

By using sustainable approaches that target infrastructure hardware, behav­ior change, and the policy environ­ment, USAID has been able to boost the health of millions. Hana of Khan Younis, Gaza is one of many who have seen the benefits of these ef­forts. “I thank USAID and ANERA for this project.  I wish the project had been implemented years ago,” she said. 

C.  Cooney

More Information

USAID Water and Development Strategy 2013-2018

WaterSHED website

Millennium Water Alliance website

Last updated: June 19, 2013

Share This Page