USAID, August 2015
One year ago this month, advocates raised their glasses in a virtual toast to celebrate the lifesaving impact of safe drinking water, sanitation, and hygiene (WASH). Then in December, members of Congress clinked their glasses in return through the unanimous passage of the Water for the World Act, which more effectively targets US funds to communities with greatest need; promotes coordination across US government agencies working on WASH, including integration with other health and development areas; and creates more robust monitoring and evaluation measures to ensure that resources are invested in the most impactful way possible.
As we mark World Water Day on March 22, we applaud the US government for prioritizing this important policy. The improved targeting of US funds for WASH will doubtlessly buoy maternal, newborn, and child health outcomes. Consider the simple fact that if everyone had access to safe drinking water, almost 90% of deaths due to diarrhea could be prevented.
The policy also acknowledges that creative approaches to on-the-ground implementation are just as important as innovative health tools, a priority that we also share. A relentless focus on results and the practical implementation of what works for the world’s poorest communities are woven into PATH’s DNA. Though today we are known simply by our acronym, PATH’s abbreviation stands for Program for Appropriate Technology in Health. It is this emphasis on appropriate technology that drives every project we undertake, including our strategies on safe water and sanitation.
Handwashing station design testing with our end users in Tanzania.
PATH develops WASH technologies, but these tools are not the core compass of our program. The hallmark of our market-based safe water and sanitation programs is user-centered design and testing; our truest laboratory is the community itself. Do the water filters that people are using promote correct and consistent use? Is this newly designed water filter a practical (and appealing) solution for Taramma, a mother in Vavilala, India? What features do villagers in Tanzania want in a handwashing station? How can we redesign a water filter in Cambodia to make it more appealing to customers? How can we make a latrine that is inexpensive, faster to build, and still considered pucca by end-users in India? We test, incorporate feedback, and test again until we have a product people will buy and consistently use.
One community member summed it up perfectly when she said, “This is a problem beyond technology.” Technology is critical, but we can’t be blinded by an attachment to a particular tool or approach and forget that the end goal is about meeting the needs of the user, however quiet and subtle that may be. Innovation may mean a tiny pivot rather than a fundamental shift, like an adapter ring in a water filter that will accommodate several different sizes of ceramic pots or an aesthetically pleasing design upgrade.
This year, PATH’s WASH Team is celebrating World Water Day with a trip in India to talk to users about redesigned latrines in Bihar, to continue the conversation with our most important target audience, and to reaffirm our belief that the best policies and programs never lose sight of their true compass: the children whose parents want to give them the healthiest start in life. Thanks to the Water for the World Act and to programs that embody its principles, we’re pointed in the right direction, toward a world where every raised glass of water contributes to that universal wish: “Cheers… To your health.”
Photo credits: PATH.Read more
BRAC, based in Bangladesh, is the largest non-governmental development organization in the world, measured by the number of employees and the number of people it has served. Formerly known as the Bangladesh Rural Advancement Committee, BRAC was established more than four decades ago offering a broad array of programs to reduce poverty.
In the south-east Asian region, Bangladesh is often quoted as a model for effective for water, sanitation and hygiene (WASH) initiatives, and BRAC’s own WASH program, initially aimed at achieving Millennium Development Goal 7 (reducing the proportion of people without access to safe drinking water and basic sanitation by half), lives up to this standard. Since 2006 the program has provided sustainable and integrated WASH services in rural and isolated areas, breaking the cycle of contamination caused by unsanitary latrines, contaminated water, and unsafe hygiene practices, including open defecation.
DefeatDD caught up with Md Akramul Islam, director of BRAC’s WASH programme, at the World Toilet Summit (WTS) in New Delhi in January, where BRAC was recognized for its significant contributions to the sanitation sector in Bangladesh. Over eight years, the BRAC hygiene and sanitation programme has reached more than 66 million people, about half of the rural population of Bangladesh.
What would you attribute to helping Bangladesh bring its open defecation from 42 percent in 2003 down to three percent in 2014?
Akramul Islam: Strong political commitment in the early 2000’s, along with the sustained involvement and engagement of the local government; civil societies (NGOs) and private sectors; and also stakeholders’ participation and collaboration at the village level. We facilitated a bottom-up approach in participation and planning with strongly representationby the poor and women as well as other rural institutions.
How have men contributed to this remarkable achievement?
Akramul Islam: BRAC provided WASH services in 250 sub-districts—which is 40 percent of the country’s population—through community involvement. It established Village WASH Committees (VWCs) in every single village in those 250 sub-districts with 11 members (six women and five men) to help educate and empower the community, map WASH requirements, and ensure WASH services and use of facilities. These members play a central role in providing hygiene education, identifying targeted clients and their access to safe water.
Besides that, BRAC involved others, like school teachers, students, Muslim religious leaders, village elites, and local government representatives to support and contribute to these efforts. Over 18,500 religious leaders were involved in delivering sermons across the country, not only to provide hygiene messages, but also to promote men’s role in domestic chores to reduce women’s work burden.
In your experience what are the steps to success?
Akramul Islam: Continuous efforts need to be made to create demand, ensure supply (infrastructure) by developing rural sanitation centers, and improve use by regular cleaning and maintenance. Only this will simultaneously ensure meeting the demand that is generated through behavior change and infrastructure (the supply side).
For example, from 2006-2014, we co-financed (for developing ownership) building of separate toilets for boys and girls in over 4,900 secondary schools, complete with water and waste disposal facilities to cater to girls’ menstrual needs. Teachers were trained and this helped maintain facilities.
How do you think Bangladesh will achieve its last mile to become open-defecation free?
Akramul Islam: Through continued hygiene education of underprivileged people – including the extremely poor, floating populations, and those living in slums – and by providing financial support to the extremely poor. Beside these, appropriate and affordable technologies in coastal and water logging areas are also needed.
Photo credit: M.Dorgabekova.Read more
Adolescent girls in Maharashtra, India.
Lorelei Goodyear is a senior program officer at PATH and a committed advocate for women’s health. Her work on PATH’s Healthy Households Initiative empowers women through entrepreneurship that enables their communities to live healthier lives. Lorelei, and the women reached through this project, truly know how to #MakeItHappen.
My whole career has focused on increasing options for women and girls so that they can achieve their full potential. I have focused primarily on reproductive health because deciding if and when to become a mother is such a pivotal point in a woman’s life. Eight years ago I became a mother and took on a new role leading PATH’s research and evaluation on safe water technologies. I quickly learned that diarrhea caused by unsafe water is a leading killer of children and safe water plays a crucial role in maternal and child health.
There are many effective water treatment methods, but getting people to use them is a big challenge. After experimenting with a variety market models, we had the best results (highest rates of adoption) by training local entrepreneurs to sell water filters in their communities and providing consumer loans that made filters affordable through small payments over time. In nine months, we tripled the use of water filters in a community in Cambodia. We tested the same approach with latrines, and Cambodian customers were four times more likely to buy them when offered a loan.
For our Healthy Household Initiative (HHI), we built on this success and added clean cookstoves and solarlights (to reduce indoor air pollution that contributes to respiratory illnesses). By selling a product bundle, homes would become healthier and social entrepreneurs would have an incentive (profits) to sustain and scale up without relying on donor support.
Early this year, I traveled to Maharashtra, India, to review the results of our first HHI test run. The trip had a profound effect on my understanding of the power of this approach to not only reduce childhood illnesses, but also radically improve the lives of women and girls.
In Maharashtra we brokered a new relationship between Sakhi Unique Rural Enterprise (SURE) and their sister organization Sakhi Samudaya Kosh (SSK). SURE trains women to sell an array of health products. These entrepreneurs are called Sakhis, or “friend” in the local language. SSK makes loans for income generation, but had never offered consumer financing for products sold by Sakhis. The HHI pilot was also the first time Sakhis had ever tried to sell latrines.
Varsha shows the HHI sales flipbook to women in her village.
I met Varsha at a gathering of Sakhis. She wore a bright red sari and spoke in a soft voice. I recognized her as one of the more shy Sakhis I had met 7 months earlier. She said that initially she had serious doubts about trying to sell a bundle of products, especially the latrine, which cost much more than any of her other products (US $200) and was embarrassing to talk about.
Her husband supported her joining the project, even though it took time away from her being at home and working as a tailor. But her in-laws complained that the HHI training took her away from home and she had nothing to show for it. Her field supervisor encouraged the family to be patient.
After Varsha started earning a ten percent margin on the sale of latrines, filters, stoves, and lamps she became bolder. She even described to me a sales pitch that she presented at a community gathering of 1500 people. As she spoke, her voice became stronger. She started laughing at her own story and positively beamed. After six months, Varsha had earned $630, which is six times what a Sakhi normally earns.
Varsha receives an award from Lorelei and a local official for being a top selling Sakhi of HHI products.
I also met Uma, one of Varsha’s customers. Over seventy percent of families in Uma’s village do not own a latrine, so they have to defecate in the open. Uma had long wanted a latrine, but her husband wasn’t interested. She would get up before dawn to do her business under the cover of darkness. She used to go to the field near her house, but farmers chased her away. So she and her daughters squatted along the main dirt road that ran through their village. It was embarrassing when men would come by, but the women wear saris so can just stand up and not be exposed. It is harder for girls, who have to quickly get their pants up.
Uma’s daughter Gita recently started her period. Uma noticed that Gita intentionally ate and drank less during her period to minimize how often she would have to relieve herself. By going less, she tried to avoid the shame she felt because all she had were rags to catch her blood and nowhere to change or clean them.
This renewed Uma’s argument that it was time to get a latrine, and her husband finally gave in when he learned she could get a loan. Today, having a latrine makes her feel safer, and she asked if, in the future, we could also offer loans for girls’ higher education, because she wants Gita to go to college.
Varsha and Uma taught me that having access to healthy household products and loans is transformative. So much so that we are now seeking funding to expand the model to include an explicit focus on gender equity and women’s economic empowerment.
The government of Maharashtra has asked our partners at SURE and SSK to scale up HHI to reach 90,000 households. PATH played a catalytic role in helping launch HHI, but it is our partners and the Sakhi entrepreneurs who are well on their way to taking it to scale.
Photo credits: PATH.Read more
DefeatDD is a team of movie buffs. So you can imagine our excitement when we saw this photo of our pal Thorsten Kiefer of WASH United with Patricia Arquette… holding our Places We Go toilet calendar! We think the diarrhea crisis is big news, but it’s not often that we find ourselves in the middle of a trending topic.
Earlier this week, Patricia Arquette won an Oscar for her role in Boyhood, and during her acceptance speech we learned that she is also a co-founder of GiveLove, a group working on ecological sanitation solutions in Haiti. Here’s what she has to say about her work (from the GiveLove website):
"When you work on improving sanitation, like we do in Haiti, you start to really see the big picture. Sanitation is the keystone to solving so many problems in the world-- improving public health, reducing child mortality, recycling and reducing waste, and protecting water resources -- and yet no one is really talking about the problem of untreated sewage or the fact that 40% of the world’s poorest people live without a toilet. The global community needs to commit resources to finding sustainable solutions.”
Hear, hear! And as we bask in the toilet-shaped glow of seeing our calendar in such illustrious company, we wanted to also honor four additional celebrities you may be surprised to learn aren’t afraid to talk shit. Let’s just call it the DefeatDD Oscars list, where every nominee is a winner!
Matt Damon: You’ve just got to love a celebrity to can laugh at himself. His role as co-founder of Water.org would be enough reason to include Matt on this list, but he doesn’t stop there. Between his toilet strike, and most recently, his unique take on the ALS Ice Bucket Challenge, he is a fearless (and hilarious) advocate for safe drinking water and sanitation. His source of inspiration? His three daughters (Cue the collective “awwww”).
Our own Alfred Ochola got to hang out with PSI Ambassador Mandy Moore before speaking on a panel together about the lifesaving impact of US foreign aid.
Mandy Moore: As a PSI Ambassador, Mandy Moore has traveled to Africa, spoken with families who have benefitted from PSI’s programs, tasted water made safe to drink by purification tablets. On Capitol Hill, she speaks passionately about the simple solutions to address diarrhea. She even stood in the world’s longest toilet queue on World Water Day! Humbly, she says that her role is to observe, listen, and learn as much as she can, but don’t let her modesty fool you: she knows her shit.
Bono: Bono is responsible for perhaps the first and only mention of the “d” word in Vanity Fair: “Diarrhea may be inconvenient in our house, but it's not a death sentence.” He’s the brains behind this little group of grassroots advocates you may have heard about – the ONE Campaign – that continues to be a co-conspirator for DefeatDD awareness-raising efforts, including great coverage of rotavirus vaccine news and enthusiastic participation in our Poo Haiku Challenge (ONE’s Global Health Policy Director Erin Hohlfelder was one of our winning pooets!).
Chelsea Clinton: She’s not a movie star or singer, but she’s still a household name. This former First Daughter is anything but shy about diarrhea. Quite the opposite, in fact: she is obsessed with it! Within 30 seconds of the start of her interview at the South by Southwest Festival, she asked the moderator if she could talk about diarrhea. Now that’s the kind of urgency we like to see! She has dedicated her career to domestic and global health in her role at the Clinton Foundation. We’re not sure if she interrupts every meeting with facts and figures about the solutions to defeat diarrheal disease, but we’d like to think so.
As you can see, as a DefeatDD blog reader and advocate, you are in good company. What other celebrities would you add to this list?Read more
Kolkata, on the eastern part of India, has long been a public health hub. The city boasts of the School of Tropical Medicine, All India Institute of Hygiene and Public Health, National Institute of Cholera and Enteric Diseases (NICED), and the headquarters of the Indian Public Health Association (IPHA). As the secretary general of the IPHA, I had the chance to work on planning the recently concluded 14th World Congress on Public Health (WCPH) that was co-hosted by the World Federation of Public Health Associations and the IPHA earlier this month.
Planning for the WCPH began way back in 2013 when the IPHA Conference was hosted in Kolkata. Hectic planning and strategizing went into hosting the WCPH, with the theme of ‘Healthy People –Healthy Environment.’ For India, the timing for the WCPH aligned the Government of India’s gearing up to take up sanitation on a war footing. I have been associated with NICED for 17 years and for somebody who has conducted scientific research on enteric diseases, this was one of the most appropriate platforms to bring before the global public health fraternity the importance of the Clean India Campaign as envisaged by the Indian Government.
I was the Principal Investigator for the Indian site of the Global Enteric Multicenter Study (GEMS), which was conducted in Kolkata at NICED. GEMS was the largest study ever conducted on diarrheal diseases in developing countries, enrolling more than 20,000 children from seven sites across Asia and Africa and its results were disseminated in 2013.
This landmark study pinpointed the key causes of childhood diarrhea. In Kolkata, and in other similar GEMS sites, rotavirus was the commonest cause of moderate-to-severe diarrhea cases. Presentations at the enteric diseases sessions at WCPH emphasized the importance of proper sanitation to help countries tackle this high disease burden.
The importance of public health cannot be underscored enough. With India aligning with global leaders to work towards the eradication of polio and measles being next in line, there needs to be sharper planning around the one thing that has been pulling India back: open defecation.
In countries like India, an unhealthy environment continues to be responsible for the spread of communicable diseases. Over the past year, I worked with PATH’s Japanese Encephalitis team and I have seen first-hand the horrifying possibilities of disease outbreak – once again linked to negligible or no attention paid to the direct relation of sanitations systems breakdowns and epidemics.
Having been a life member of IPHA since 1988 and presently the secretary general of the association, I and the members of IPHA were indeed privileged to have been able to host the 14th WCPH in Kolkata at such a meaningful time for public health in India.
Photo credit: PATH.Read more