Bringing existing information from different organisations into one place, the compendium provides guidance, local examples of and further resources on accessible low-cost handwashing facilities, environmental cues and physically distanced hygiene promotion.
The compendium is a living document which will be updated regularly as more examples and good practice emerge. It has been developed and disseminated quickly so immediate, relevant and timely actions can be taken. This version is the third edition. This updated version includes new or heavily edited sections on:
Please share feedback and contributions via email (SLH@ids.ac.uk) or Twitter (@SanLearningHub). We are interested to hear how the compendium is being used as well as feedback and inputs to improve it. For those with limited internet access, individual sections of the compendium can also be sent upon request.
]]>The WASH programme provides up to £164.8 million over a seven-year period (2013 – 2020) to increase the availability of sustainable WASH services in the DRC. The programme consists of four pillars that together aim to deliver quality, scale and sustainability of WASH sector results in DRC:
1. Creating community incentives to deliver individual lasting behaviour change;
2. Increasing affordable access to WASH education;
3. Strengthening systems of empowerment and accountability between the communities, service providers and local and provincial government structures; and
4. Improving the capacity of service providers, institutions, and communities to monitor, operate, maintain, and deliver WASH services, and improving the capacity of national government to coordinate, monitor, and set appropriate priorities in the WASH sector.
Based on the overall progress summarised in the main report, the details described in the subsequent sections and the project score calculator, the overall score for this annual review is an “A”.
]]>Infections such as AWD are public health concerns, especially in emergency settings where they can be spread quickly unless an outbreak is halted. Hence the need for rapid and accurate reporting of cases. The US Department of State Humanitarian Information Unit (HIU, 2017) reported 43,015 AWD/cholera cases in the Horn of Africa. The electronic Disease Early Warning Surveillance (eDEWS) system, supported by WHO, allows suspected cholera and AWD cases to be reported (OCHA Yemen, 2018). Government reports state that Federal Ministry of Health (FMoH) water, sanitation and hygiene (WASH) clusters also strengthen community-based AWD surveillance to detect new cases for timely response (Government of Ethiopia/OCHA, 2017).
However, it is not always stated who reports AWD cases: according to the WHO, rumours of
AWD/cholera outbreaks in certain areas can also be helpful to responses in disease situations (WHO Ethiopia, 2017a). The United Nations Children’s Fund (UNICEF) report that their Communications for Development (C4D) interventions focus on preventing the resurgence of AWD and integrate nutrition related messages in sites for internally displaced people (IDP) (UNICEF, 2017a).
Examples of interventions from neighbouring countries show that community-centred campaigns are also successful in stopping AWD outbreaks, e.g. in Bangladesh (UNICEF, 2017b). Since July 2016, volunteers from UNICEF and the Ethiopian Red Cross Society have been conducting mass public awareness campaigns using audio trucks deployed in each of the 10 sub-cities of Addis Ababa (Kiros, 2016). Response Plans focussing on both prevention and treatment (UNICEF, 2017b), such as the World Health Organisation Ethiopia (2017a) ‘1-to-5 network’, successfully advise families and individuals on how to protect themselves and seek treatment. Such Plans are implemented by woreda (district) and zonal administrators, and organised into seven pillars, namely: coordination team; surveillance; case management; social mobilisation; regulatory; logistics, and WASH interventions (Fisseha, 2016).
]]>For community-based approaches, involvement of the community, enthusiasm of community leaders, having a sense of ownership, the implementer being part of the community, gender of the implementer, trust, income generating activities, clear communication and developing a culture of cooperation facilitated the implementation. For sanitation and hygiene messaging, barriers identified were (SMS) messages that were too long or culturally inappropriate, passive teaching methods in schools, the need for longer intervention periods and frequent reminders with children, overlap of school level intervention with interventions in the community, and lack of interest and involvement from the family in case of a school intervention, as well as illiteracy. For the social marketing approach barriers were mainly about the use of sanitation loans (lack of communication to latrine business owners about which area to cover, sanitation loans not reaching poor people, attitude of the loan officers, interest rate of loans, loan processing times), lack of financial knowledge and poverty.
An important implication is that there is a need for a more uniform method of measuring and reporting on handwashing, latrine use, safe faeces disposal, and open defecation. This will facilitate making conclusions on the effects of promotional approaches in the future. It is also important to further assess barriers and facilitators, identified in this review, when implementing promotional approaches.
International Initiative for Impact Evaluation (3ie) have also produced a related Systematic Review Brief from their findings: Handwashing and Sanitation Behaviour Change in WASH Interventions
]]>Furthermore, well-developed legal, policy, and strategy frameworks exist but need to be fully implemented. It’s important to note that sanitation has not been a public funding priority and households bear the bulk of the costs. To conclude, from lack of prioritisation to insufficient demand and limited supply, barriers to developing pro-poor sanitation services remain significant.
]]>In addition, the legal framework for sanitation remains fragmented and focuses on sewerage services. The policy framework sets high ambitions and recognises a range of solutions and service provision models. There is significant institutional fragmentation and overlap, especially between the Ministry of Health and the Ministry of Water and Irrigation and investments in sanitation for low-income areas are almost entirely donor-funded. To conclude, inadequate institutional capacity, inadequate sector financing and insufficient data are major barriers to pro-poor sanitation.
]]>In addition, there is significant overlap in institutional responsibilities, contributing to the limited supply of FSM services. Funding has focused on rural sanitation, and sewerage services to urban areas. Rapid urbanisation, low decentralisation, lack of demand for and supply of FSM services and lack of investment are all major barriers to pro-poor urban sanitation. To conclude, despite challenges, the sector has an opportunity to bring about change.
]]>Intensive handwashing promotion can reduce diarrheal and respiratory disease incidence. To determine whether less intensive, more scalable interventions can improve health, we evaluated a school-based handwashing program. We randomized 87 Chinese schools to usual practices: standard intervention (handwashing program) or expanded intervention (handwashing program, soap for school sinks, and peer hygiene monitors). We compared student absence rates, adjusting for cluster design. In control schools, children experienced a median 2.0 episodes (median 2.6 days) of absence per 100 student-weeks. In standard intervention schools, there were a median 1.2 episodes (P = 0.08) and 1.9 days (P = 0.14) of absence per 100 student-weeks. Children in expanded intervention schools experienced a median 1.2 episodes (P = 0.03) and 1.2 days (P = 0.03) of absence per 100 student-weeks. Provision of a large-scale handwashing promotion program and soap was associated with significantly reduced absenteeism. Similar programs could improve the health of children worldwide.
This is one article in a four-part PLoS Medicine series on water and sanitation.
Summary Points
2.6 billion people in the world lack adequate sanitation—the safe disposal of human excreta. Lack of sanitation contributes to about 10% of the global disease burden, causing mainly diarrhoeal diseases.
In the past, government agencies have typically built sanitation infrastructure, but sanitation professionals are now concentrating on helping people to improve their own sanitation and to change their behaviour.
Improved sanitation has significant impacts not only on health, but on social and economic development, particularly in developing countries.
The health sector has a strong role to play in improving sanitation in developing countries through policy development and the implementation of sanitation programmes.