World Water Day 2013 – Integration of Water is Key to Achieving Kenya’s’ Health Goals

AMREF Kenya urges building of partnerships and synthesis of interventions for effective and sustainable outcomes

 As the world marks World Water Day, AMREF Kenya continues to advocate for integration of Water, Sanitation and Hygiene (WASH) in all development programmes, especially health-related interventions. Established by the United Nations in 1992 to focus attention on the importance of freshwater and to advocate for the sustainable management of freshwater resources, this year’s World Water Day theme is dedicated to cooperation around water.

Working through communities, AMREF has learnt that extending access to safe water and basic sanitation and improving hygiene practices, lowers the incidence of diseases related to water and improves public health, especially for women and children. Lack of clean water and inappropriate water resource management in Kenya has had a negative domino effect, resulting in widespread, multifaceted illnesses, loss of life and entrenching a cycle of poverty. This is further complicated by the vagaries of climate change and the global economic crunch. The centrality of water resources to everything – from agriculture, food security and nutrition; to sanitation, hygiene and overall health; to industry, human settlement and development in general – means that WASH has to be at the core of all health intervention efforts.

AMREF Kenya advocates for power-balanced partnerships to ensure sustainable results. The Kenya WASH Alliance, a partnership that includes AMREF Kenya and several actors in water and sanitation, has successfully facilitated joint learning and acquisition of grant funding and equity finance for programmes in the country. The partnership has improved the ability of Alliance members to network, share knowledge and draw from each others’ strengths using a multistakeholder approach.

Reaching the nearly 16 million people who do not have access to improved sources of drinking water and another estimated 27 million people with no access to improved sanitation facilities in Kenya will require concerted effort and cooperation among stakeholders in the WASH sector. For the message that access to water and sanitation is a fundamental human right and essential to life, health and dignity to be widely appreciated, more Public-Private Partnerships (PPPs) should be encouraged. Shared intervention efforts with consumers, nongovernmental organisations (NGOs), environmental health groups, independent service providers, regulators, donors and governments should be encouraged in all WASH interventions.

AMREF and several partners including the European Union, USAID, Aqua 4 All, Dutch Ministry of Foreign Affairs, Rotary International, Tullow Oil and other NGOs continue to work together with community members and local government authorities to strengthen community structures and ensure sustainability of interventions, including WASH activities across the country.

For PPPs to thrive, it is important that there be shared incentives in managing water and sanitation interventions. Delegated management systems should not only deliver value for money, but should add value over and above that delivered by previous water and sanitation service providers. Importantly, too, PPPs must offer both financial and non-financial incentives for contracting parties and stakeholders, based on transparent and mutually negotiated expectations.

Accountability for service delivery has various complementary layers in delegated water service management. Governments, particularly local authorities, should go beyond policy accountability to actual allocation of sufficient resources for water and sanitation programmes. And to ensure transparency, which is a prerequisite for accountability, AMREF Kenya recommends provision of clear and comprehensible information to – and openness to interrogation by – project beneficiaries.

AMREF Kenya advocates for shared management of WASH services and facilities to ensure their sustainability. In this regard, it is important that development actors realise the limits of community-managed WASH services. Communities are already burdened with many other development interventions; leaving sustainability of services such as maintenance of water pumps to them is untenable. Development actors should instead budget for post-implementation activities to ensure sustainable and effective performance of WASH facilities.

Even as we seek ways to improve and develop WASH systems and services, it is important to establish measures to significantly reduce water pollution, increase water quality, significantly improve treatment of waste water treatment and water efficiency by ensuring water is delivered to people as close as possible. In order to achieve this, we stress the need for increased local investment in WASH while also leveraging on international assistance and cooperation.

In recognition of the fact that access to water and sanitation is closely linked to key development and poverty alleviation approaches, AMREF urges the Government of Kenya – national and county – to reaffirm its commitment to uphold the human right to safe drinking water and sanitation as stipulated in Kenya’s new constitution and Vision 2030.

AMREF further advocates for commitment by the Kenyan government to the 2005-2015 International Decade for Action ‘Water for Life‘, whose challenge is to focus attention on action-oriented activities and policies that ensure long-term sustainable management of water resources, including measures to improve sanitation.

Let this be our emboldening commitment as we mark the World Water Day.

Dr Lennie Bazira Kyomuhangi – Country Director, AMREF Kenya

I Have Seen Trachoma Cases Dwindle

My name is Mary Lentumunai, I have lived in Sirata Oirobi (Samburu for cool plains) all my life. I did not get trachoma, but I have witnessed age mates and some of my children suffer from the disease. We did not know that it was an avoidable disease. We thought that it was a curse brought to us by the gods. I am 93 three years old, and some of my children have passed on. Two of them died blind. We were ignorant then, and we did not know that washing with water would save us from the trachoma scourge.

We were not educated, at least not in the formal way of Western education. As you can see, this is a remote place, and it has always been like that. The environment was not always like you see it today.

When I was a young girl, there were many trees in the region. It was an arid area alright, but it was green. Then our people started cutting down the trees, using them for firewood and burning charcoal. After the deforestation, cases of drought increased and water became scarcer. At first we did not connect the two, but we later learnt that the flies came in swarms to our houses since we did not have sufficient water to keep ourselves and our homes clean.

Things are changing now. AMREF has come in with a life saving initiative, and the whole community is experiencing the change. When my grandchildren came to me with stories about the importance of washing my face and hands, I thought it was just another classroom lesson they had been taught. I tried it and sure enough, the flies disappeared from my face.

AMREF has been training my grandchildren in school on the basics of hygiene. They have learnt that trachoma need not afflict them if they observe basic hygiene rules. It is very simple: wash your hands and your face. They also trained me on the importance of using latrines.

We used to go to the bush, but now we know better. There were so many ailments like diarrhoea and we did not know that the cures or prevention methods were in our hands. Many of my age mates have died blind or are living with blindness, and it is all due to our ignorance. We did not know.

It is a good thing that AMREF has now come in to stop this preventable disease. AMREF has ensured that all people in the area know how to prevent this terrible disease, and now we can literally look forward to a brighter future.

Washing Away- Health and Poverty with Well Water

 

While the international target on Millennium Development Goal (MDG) 7 is to halve the number of people who do not have access to safe drinking water before the 2015, MDGs 4 and 5 focus on reducing child mortality and improving maternal health. At community level, the three seemingly distinctive goals are intricately roped together.

Phyllis Kamene, a 40-year-old mother of five, hails from Mutulu location in Matinyani District of Kitui County, located in the lower eastern region of Kenya. The area is among the poorest in Kenya with over 56 per cent of the population living in absolute poverty. The climate of the district is arid and semi-arid, with erratic rainfall. Due to limited rainfall, surface water sources are scarce, being mainly seasonal rivers that dry up when there is no rain.

Phyllis is the coordinator of the Orphanage Women’s Self Help Group, which helps needy children in Mutulu location. In 1998, AMREF trained several members of the group as well artisans and helped them to construct wells for the community. Some other group member was trained to manage the wells.

Fifteen years later, the group has built numerous wells for individuals and groups at a fee, greatly contributing to improved health and poverty reduction for themselves and members of their community.

Using well water, the group makes bricks for sale. Members have also used the financial skills they received from AMREF on well management to pool resources and venture into informal financing businesses such as table banking, giving member and non-members access to small loans for self-improvement.

The Orphanage Group operates kitchen gardens to feed its members and their families, as well as elderly people, orphans and other vulnerable children and people living with HIV in the community.

“We are now able to feed the needy children, take them to school and buy them clothes,” says Phyllis.

Working in partnership with the Orphanage Group and over 100 other local groups in Kitui County, AMREF has supported construction of over 900 wells serving 87,000 people. AMREF adopts an integrated approach in implementing its programmes across the entire country. The wells form an effective entry point for interventions and improvement in other areas of health.

In Kitui where both infant and maternal mortality rates are higher than the national average, the well committees, comprised of both men and women, have provided a useful platform for discussion of maternal and child health issues, which are then cascaded to the rest of the community. The forums have helped to ensure high male involvement, which is a crucial element in decision making in regards to the health of women and children in Africa.

Whereas women had to walk long distances in the past to fetch water for domestic use, leaving them little time for other activities, proximity to the water points gives women the time to attend ante-natal clinics, as well as immunisation and child welfare clinics, improving the health of the women and their children.

A mid-term evaluation of the Makueni Maternal Newborn and Child Health project carried out in 2011 showed that 52 per cent of women had delivered with the assistance of a skilled health provider, compared with 40 per cent at the beginning of the project. There was also an increase in the number of children being immunised and receiving nutritional supplementation in the project area.

In line with this year’s World Water Day theme of ‘Water Cooperation’, AMREF’s integrated Water, Sanitation and Hygiene and Maternal, Neonatal and Child Health programmes, working with groups like the Orphanage Group, have demonstrated a clear improvement in health outcomes in a cost-effective way that has made a positive impact on thousands of lives in Kitui.

 

Integration of Water is Key to Achieving Africa’s Health Goals

AMREF urges building of partnerships and synthesis of interventions for effective and sustainable outcomes

As the world marks World Water Day, AMREF continues to advocate for integration of Water, Sanitation and Hygiene (WASH) in all development programmes, especially health-related interventions. This day was established by the United Nations in 1992 to focus attention on the importance of freshwater and to advocate for the sustainable management of freshwater resources. The theme this year is dedicated to cooperation around water.

From our work in communities, AMREF has learnt that extending access to safe water and basic sanitation, and improving hygiene practices, lowers the incidence of diseases related to water and improves public health, especially for women and children. Lack of clean water and poor water resource management in Africa has had a negative domino effect, resulting in widespread, multifaceted illnesses, costing millions of lives and entrenching a cycle of poverty. This is further complicated by the vagaries of climate change and the global economic crunch. The centrality of water resources to everything – from agriculture, food security and nutrition; to sanitation, hygiene and overall health; to industry, human settlement and development in general – means that WASH has to be at the core of all health intervention efforts.

AMREF advocates for power-balanced partnerships to ensure sustainable results. The AMREF-Dutch Alliance, for example, a partnership that includes several other actors in water and sanitation, has successfully facilitated joint learning and acquisition of grant funding and equity finance for programmes in Ethiopia, Kenya and Uganda. The partnership has improved the ability of Alliance members to network, share knowledge and draw from each others’ strengths using a multi-stakeholder approach. Without doubt, working in such quality partnerships is proving to be an effective tool for managing water and sanitation programmes.

Reaching the nearly 312 million people in Africa who do not have access to improved sources of drinking water and another estimated 533 million people with no access to improved sanitation facilities will require concerted effort and cooperation among stakeholders in the WASH sector. For the message that access to water and sanitation is a fundamental human right and essential to life, health and dignity to be widely appreciated, more Public-Private Partnerships (PPPs) should be encouraged. Shared intervention efforts with consumers, NGOs, environmental health groups, independent service providers, regulators, donors and governments should be encouraged in all WASH interventions. The Katine Community Partnership model in Soroti District of Uganda exemplifies this principle. Several partners including Barclays Bank, the Guardian/Observer Newspaper (UK) and AMREF worked together with community members and local government authorities to strengthen community structures and ensure sustainability of interventions, which included WASH activities.

 

For PPPs to thrive, it is important that there be shared incentives in managing water and sanitation interventions. Delegated management systems should not only deliver the best value for money but should add value over and above that delivered by previous water and sanitation service providers. Importantly, too, PPPs must offer both financial and non-financial incentives for contracting parties and stakeholders, based on transparent and mutually negotiated expectations.

 

Accountability for service delivery has various complementary layers in delegated water service management. Governments, particularly local authorities, should go beyond policy accountability to actual allocation of sufficient resources for water and sanitation programmes. And to ensure  transparency, which is a prerequisite for accountability, AMREF recommends provision of clear and comprehensible information to – and openness to interrogation by –  project beneficiaries.

AMREF advocates for shared management of WASH services and facilities to ensure their sustainability. In this regard, it is important that development actors realise the limits of community-managed WASH services. Communities are already burdened with many other development interventions; leaving sustainability of services such as maintenance of water pumps to them is untenable. Instead, development actors should budget for post-implementation activities to ensure sustainable and effective performance of WASH facilities.

Even as we seek ways to improve and develop WASH systems and services, it is important

to establish measures to significantly reduce water pollution, increase water quality, significantly improve treatment of waste water treatment and water efficiency by ensuring water is delivered to people as close as possible. AMREF’s has made inclusion of household water treatment and human waste treatment a key component of all WASH interventions. In order to achieve this, we stress the need for increased local investment in WASH while also leveraging on international assistance and cooperation.

In recognition of the fact that access to water and sanitation is closely linked to key development and poverty alleviation approaches, AMREF recommends that all African Governments reaffirm their commitment to uphold the human right to safe drinking water and sanitation. AMREF further advocates commitment by African governments to the 2005-2015 International Decade for Action ‘Water for Life’, whose challenge is to focus attention on action-oriented activities and policies that ensure the long-term sustainable management of water resources, including measures to improve sanitation. Achieving the goals of the ‘Water for Life’ Decade requires sustained commitment, cooperation and investment by all stakeholders from 2005 to 2015 and far beyond. This includes a commitment to marking World Water Day.

 

 

Monday 19th November 2012- World Toilet Day

Monday 19^th November is World Toilet Day observed annually on 19 November since 2001. This international day of action aims to break the taboo around toilets and draw attention to the global sanitation challenge. From a moral and humanitarian perspective, this is unacceptable – hundreds of children under five die each day from entirely preventable water-related diseases; women and young girls are attacked and raped as they try to find a safe place to defecate; teenage girls are denied total access to higher education through lack of toilet facilities.

What is AMREF doing on 19^th November?

 Here is a quick summary of what will be happening collectively in AMREF.

In Kenya – AMREF is the co-chair of the Sanitation Technical Working Group (TWG) and an active member of the Environmental Sanitation and Hygiene ICC, AMREF Kenya has been providing leadership in the planning of the celebrations at the national level. The World Toilet Day will be marked at Nambale in Busia County, and is a culmination of the official declaration of the district as the 1^st fully ODF (Open Defecation Free)  district in Kenya. AMREF will be conspicuously represented at this function expected to be graced by the Minister for Public Health and Sanitation.

Across the country, our teams are working closely with the District Public Health Officers (DPHOs) to support celebrations at County and District levels. Notably, we’ll use this day to reaffirm our commitment to supporting MoPHS CLTS (Community Led Total Sanitation) campaign in Northern Kenya which records high open defecation (OD) but attracts minimal resources for sanitation. APHIAplus IMARISHA is supporting this initiative. Afterwards a brief will be shared to all.

 

In Tanzania: AMREF has been part of the national committee under the Ministry of Health and Social welfare in planning for the World Toilet Day – national commemorations that will be held in Mbeya region, Rungwe district – Tukuyu Township. To date, AMREF has participated in four planning sessions.

Among key activities lined up for the day are mass hand washing for children, road show by TawaSanet (Tanzania Water and Sanitation Network) which will start from Dar es Salaam the capital ending in Mbeya a southern tip end town of the country over a 1000 kilometres on 19^th November.

 

The road show will involve multiple partners involved in WASH sector along the Dar es salaam – Mbeya highway. At each of the regional or district headquarters, local CBO/NGO will take up the rally up to another regional/district boundary and hand over to another one. All the way, various messages will be demonstrated and discussed and we though this will help to bring up the attention and create a high level of awareness among them.

 

Other events on this day in Tanzania – AMREF Tanzania will participate at these events through the AMREF Makete field office. A number of IEC materials will be displayed that demonstrates some of the key hygiene practices and what AMREF is doing.

 

In Ethiopia: AMREF is part of national activities in both Addis Ababa -Ketchen WATSAN project and in Afar Region WASH Alliance project. More information will follow.

 

You can also participate on this day – join us on twitter as we advocate for sanitation for all.

Community Led Total Sanitation (CLTS) in a Maasai Home

In Intinyika village of Kajiado district, the Maasai community has declared total war on a dirty environment, characterized by indiscriminate disposal of inkik – the Maasai word for faecal matter.

It is also here that the Community Led Total Sanitation (CLTS) is being implemented under the MFS II WASH project where the community has come to the realization that improper disposal of inkik leads to water contamination and an increase in sanitation related diseases such as diarrhoea.

In the knowledge that the power to change that situation and improve their health lays squarely and inherently in their hands, the Maasai communities in Kajiado district are now on their own volition constructing toilets out of mud and some in the shape of traditional manyattas as a first step towards addressing hygiene and sanitation within the homestead and curbing the spread of diarrhoeal diseases. Some of these toilets have grass thatched roofs which are subsequently replaced with iron sheets to shield them from the elements particularly during the rainy season.

“This project has led to a great reduction of diarrhoeal diseases in the community and mothers have enough time to look after their families as they no longer frequent hospitals.” Explains Josephine, the Community Natural Leader in Sanitation (CNLS) as she leads a team from the Kenya WASH Alliance on a tour across the village.

In Kajiado, toilet access and utilisation of toilets is at a meagre 20% compared to the national average of 52%. So far, the project has led community education on sanitation in 60 out of the 309 villages in Kajiado district, where construction and use of toilets and hand washing facilities is greatly evident.

“Slowly but surely, we shall have covered the entire district.” says Wycliffe Manyulu, the Project Officer, Kajiado MFS II WASH Project.

Out of the Closet: Placing Menstrual Hygiene on the water, sanitation and hygiene agenda in Africa

 

The world is changing very fast. Water and sanitation have become a human right since 2010; there is more freedom to speak on gender issues than before.  The world has recently reflected on the work done since 1990 to half the number of people without water and is happy that the milestone is achieved. Unfortunately, this has just revealed major disparities that exist in the WASH sector. Sanitation the sister MDG target to water is way behind schedule. 2.6 billion people in the world do not still have access to improved sanitation. Most of those still affected are women and children particularly girls. Linked with women and girls is the issue of menstruation which is a forgotten challenge to achieving improved access to sanitation particularly for women and girls.

Menstruation is a major part of life for millions of young girls and women worldwide. It is a normal, natural process that occurs in all healthy adolescent and adult women who haven’t reached menopause. Girls begin to menstruate normally between eight and twelve years. In the life time of a woman, she has to manage 3,000 days of menstruation. For her basics schooling period ranging from the fifth grade to the 12^th or 13^th grade the number of such days is 450[i]. According to UNICEF[ii], one in 10 school-age African girls stays home during her period or drops out entirely. In countries where menstrual hygiene is taboo, girls in puberty are typically absent for 20 percent of the school year. Nor is this quandary limited to adolescence; working women also lose productive time during their periods. And even women who attend classes and jobs despite a lack of access to sanitary protection often substitute materials such as bark, rags or mud, with detrimental health consequences. Women become prone to more infection if they do not maintain a proper hygiene during the time.

However, the needs and challenges faced by many young women and girls as they struggle to manage their menstrual hygiene are largely ignored, especially in Sub Saharan African communities. This situation persists despite new developments in the hygiene and sanitation sector in recent years.

Addressing this issue is complex and dynamic; there is so much secrecy about this issue. There is the embarrassment that prevents young girls and women sharing their questions, the shame often associated with menstruation, and the cruelty of people laughing at young girls and women when they find out they are menstruating. This situation gets even more complicated if young girls and women have to go to schools or other public places where there is no toilet or no hygienic toilet, no water and soap, and no facilities for disposal of materials.

A review of the menstrual-related evidence from African countries remains limited in terms of specific research conducted on menstrual hygiene and women linked with their rights to WASH. There exists a body of literature on topics that are more indirectly related to the question of menstrual- hygiene management but are few. Such research includes the literature on adolescent sexual and reproductive health (SRH), such as the school-based intervention explored by Plummer et al (2006) in Mwanza, Tanzania that provides insights into young people’s SRH beliefs and practices; the randomized health education intervention initiated by Mbizvo et al (1997) in Zimbabwe which provides evidence of the need for early school-based reproductive health education; and the mixed-methods research conducted by Munthali and Zulu (2007) in Malawi, exploring the timing and role of initiation rites in preparing young people for adolescence. All of these, and related studies, provide insights into gaps in girls’ SRH knowledge, and potential intervention approaches for enhancing existing knowledge.

From the work done so far on this issue, it is evident that menstrual hygiene management has long been taboo in many countries of Africa. Only a limited work has been done in Africa mainly in schools. Largely there is need to break the silence on the topic, work with women and girls more to ensure menstrual hygiene management needs are addressed through WASH programs. Available evidence on menstrual hygiene largely comes from Asia particularly India and Bangladesh. The African context has its own intricacies that are still largely unknown and secretive.

 

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[i]  Addressing special needs of girls challenges in schools

[ii] UNICEF Menstruation Challenge Project

Menstrual Hygiene Management and WASH

 

Menstruation and menstrual practices are still clouded by taboos and socio-cultural restrictions resulting in adolescent girls remaining ignorant of the scientific facts and hygienic health practices, which sometimes result into adverse health outcomes. Menstrual Hygiene Management (MHM) is a critical aspect of Water Sanitation and Hygiene (WASH) service provision and needs to be considered and discussed in a sensitive manner with communities and partners. Talking directly with adolescent girls and women to understand their needs and preferences is essential if access to sanitation is to be accelerated on the African continent. Unfortunately for many women and girls, knowledge on menstrual hygiene is not readily available. While during menstruation, personal hygiene is a common concern for most women, menstruation remains a forgotten challenge to achieving improved access particularly for women. Knowledge on the link between menstrual hygiene and access to WASH is very low. The feminization of particularly domestic water supply (72 percent) has resulted in specific sanitation challenges faced by women left to women alone and out of the mainstream WASH agenda. The social restrictions that limit women’s participation in projects and the shame associated with menstruation relegate the issue to the closet. The challenges to bringing access of improved hygiene and sanitation particularly to women is more complex and requires further understanding.  There is a dearth of evidence on the challenges of menstruation and the role it plays on improved sanitation and health for women specifically.

About The Washman

The Washman blog is a result of a personal passion and experience working in the field of water, sanitation and hygiene for about 20 years.  The idea is to create a platform for sharing experiences and thoughts on WASH programming.  Water, Sanitation and hygiene issues are dear to my heart. I believe that affordable access to a sufficient quantity of safe water, improved sanitation and improved hygiene behaviour is fundamental to the health and dignity of all. An estimated 400 million Africans remain without access to safe drinking water and over twice that number are denied access to adequate sanitation. These numbers are of great concern and alarm to me. Millions of lives are at risk from preventable water and sanitation related diseases and the future of millions of Africans women and children are blighted by the multiple deprivations of poverty, lack of education ill health that often accompany poor water and sanitation.

Smart investments in sanitation can reduce disease, increase family incomes, keep girls in school, help preserve the environment, and enhance human dignity. The adoption of water and sanitation as human rights by the UN General Assembly in 2010 gives me the impetus to advocate WASH for all. Every person especially women and children should have access to water and sanitation.

I trust that this blog will bring a new perspective and guidance to the task ahead – ensuring that the fundamental and basic human right to water and sanitation is realised for everyone’s health and dignity in Africa – Austin Bhebe

Some Lessons from working in Water Sanitation and Hygiene since the 1990s

Having been active in the field of water and sanitation, I have learnt the following key lessons:

1. That as with all development sectors WASH programming has greatly evolved over the past two decades and sustainability of both activities and services remains an ongoing challenge. Since the water decade, the challenges have basically remained around the same issues.
2. That extending access to safe water and basic sanitation and improving hygiene practices lowers the incidences of diseases carried by water and improves public health especially for women and children. WASH is not a priority of many development programs, little wonder, we are still going in circles decades after resolving to attach WASH challenges in the world
3. That for improved hygiene practices to become lasting and prominent, there needs to be a change in the social norms that relate to hygiene behaviour practices. It does not matter how much investments you make in building toilets, they will never be used until you begin to change the societal norms.
4. That triggering demand for sanitation is a crucial starting point for improved sanitary behaviour, but poor households cannot always afford to build improved latrines and so basic pit latrines are a legitimate step on a sanitation ladder. While we need the use of improved sanitary facilities everywhere, we should be realistic that not everyone can afford that. We should therefore, be happy when we see even basic toilets made out of anything as long as they are in use.
5. That community management models alone cannot lead to sustainability of services. Beyond the simple transfer of responsibility to communities, there must be referencing to other actors such as the local government and the private sector. Community management systems have failed. It is time to think again. Back to the drawing board. Communities alone are over burdened with so many investments.
6. That the quality of partnerships formed by organisations and agencies in WASH are critical to the sustainability of WASH outcomes. You cannot do it alone. Particularly governments, they must begin to own up and budget and invest in WASH.
7. That having  access to safe drinking water and  sanitation is central to living a life of dignity… the rights to water and sanitation further require an explicit focus on the most disadvantaged and marginalised. Too many projects in WASH forget that there are people with special needs. We need to be more sensitive in programming.
8. That development programs should consider long-term design implications especially in use of WASH facilities by people with disability.