Menstrual Hygiene Management Programme Kicked off with a Training of Trainers in Oromia and Somali Regions

By Kalkidan Gugsa

OROMIA and SOMALI, February 2017 – Poor menstrual hygiene management (MHM) negatively impacts the education, health and empowerment of girls and women, as well as the environment. The impacts are compounded during emergencies, such as the protracted drought crises across Ethiopia. What fuels these negative effects of managing menstruation are cultural taboos and other societal barriers.

Girls across Ethiopia face social, cultural and economic barriers related to menstruation which not only prevents their right to dignity, but often prevents their right to education due to inadequate menstrual hygiene education, insufficient WASH facilities and poor access to sanitary materials.

With support from the Netherlands Government, UNICEF Ethiopia, in partnership with regional health and education bureaus (RHB, REB), is implementing an MHM programme to break the silence and bring change in beliefs and attitudes towards menstruation. The programme aims to support girls and women across the country to overcome the barriers that prohibit them from managing menstruation with dignity.

Why MHM?

Menstrual hygiene management is a complex and sensitive issue that requires a contextualized, multi-sectoral approach to adequately support girls and women across Ethiopia. A package of services that leads to improved MHM includes private, minimum-standard toilets, handwashing stations and adequate waste disposal in addition to allowing the safe space for discussion to increase awareness amongst men, boys and girls utilizing social and behavioural change communication (SBCC) methods. In addition, improvements in the supply chain for sanitary pad production complements the community- and school-based efforts in MHM.

In collaboration with UNICEF, the Ethiopia Ministry of Health developed a national MHM guide based on the package of services, which is designed to address the topic across the contexts of schools, communities and workplaces as well as in emergencies.

By working with both the RHB and the REB, and supporting the development of a sanitary supply chain, improved MHM facilities and services will keep girls in school where they can reach their full potential.

MHM social and behaviour change communication materials in Amharic and Oromiffa languages

On 15 February 2017, UNICEF kicked off the community- and school-focused MHM training of trainers (ToT) workshops for a total of 120 staff of the RHB and the REB in Oromia and Somali regions. These were the first of such trainings made possible by support from the Netherlands Government.

The TOT workshop established coordination between the education and health sectors and equipped focal persons with global, national and regional menstruation facts. It also introduced participants to the MHM package of services: SBCC activities concerning menstruation, establishing safe spaces to enable girls to receive peer support, counselling and emergency kits as well as improved WASH facilities and sanitary pad production.

Throughout the training, participants highlighted the lack of discussion on this important topic, with one male participant explaining, “In our societies, the lack of information about menstrual hygiene creates a culture of taboos and misinformation about menstruation and therefore potential health problems. Now we know what to do from this training and how to react.”

The regional and woreda (district) focal persons who participated in the ToT, in turn will cascade the training to health extension workers (HEWs), school management committees and school club coordinators (teachers). The trained HEWs and teachers will then facilitate activities for the Health Development Army and the WASH, gender and girls’ club members in their respective areas.

The sanitary supply chain

The sanitary pad supply chain component of the programme establishes women’s groups to produce reusable sanitary pads and provides support to local manufacturers through partnerships to improve the production, packaging, distribution and use of sanitary pad products in target regions. On the manufacturing end, partner companies will engage in backward integration of the production of raw materials such as absorbents and liners. On the sales end, pharmaceutical and family planning outlets, such as pharmacies, drug stores and clinics, will be utilized at local and regional levels to bring the improved products to communities.

Additional MHM training and launch workshops are planned to kick off in March and April 2017 in Gambella, SNNP and Afar regions. Together with Government partners, UNICEF will support the positive change in the dynamics of MHM in Ethiopia and contribute to better futures of girls across the country.

Baby WASH – the missing piece of the puzzle?

By Samuel Godfrey

Mustapha and his one year old daughter Meia at Teza Wota Health Center ©UNICEF Ethiopia/2012/Getachew

The January 2016 Huffington Post article entitled Why are Indian kids smaller than Africa kids: hint its not race authored by Sanjay Wikesekera, UNICEF Global WASH Chief and Werner Shultink, UNICEF Global  Nutrition Chief, highlighted the link between child stunting[1] and lack of access to toilets. Children growing up in an environment where people are defecating in the open will result in kids crawling around on dirty floors, putting feacally contaminated material and objects in their mouths and ultimately will results in children having high rates of diarrhea which will result in their stunted physical and mental development.

To understand this better, UNICEF Ethiopia WASH team and John Hopkins University undertook a systematic review of more than 1000 peer reviewed academic articles with the aim of identifying interventions that health and WASH professionals can take or promote to reduce the contact of children with feacally contaminated material. The review identified strong evidence on the linkage between open defecation, stunting and early child development (See figure below from Ngure et al (2014).

The review also notes good knowledge of how to do hygiene and sanitation promotion to safe disposal of adult feaces but limited evidence on safe disposal of baby feaces.

UNICEF Ethiopia is using the review to design specific Baby WASH interventions that can complement our current Infant Young Child Feeding programmes. Ethiopia has substantially reduced Open Defecation during the last 25 years. In 1990, an estimated 9 out of 10 people were “pooing” in the open and by 2015, this had reduced by 64 per cent to less than 1 in 3 people. However, despite this progress, almost half of children were recorded as ‘stunted’ or not achieving their full physical and mental growth by 2015. The literature suggests that Baby WASH, as we have termed it, may be one of the key “missing pieces” in reducing stunting. Baby WASH comprises of a ‘menu’ of physical and promotions activities which will reduce the exposure of the BABY to ingestion of feaces and ultimately reduce stunting and improve Early Childhood Development.

Watch this space for more details on field evidence on Baby WASH from UNICEF Ethiopia as we work closely with the Government of Ethiopia and development partners to expand this intervention throughout Ethiopia in our new Country Programme of Cooperation between 2016 and 2020. For the time being, UNICEF Ethiopia is using its own financial core resources. Interested development partners are welcome to join this groundbreaking initiative.

UNICEF Ethiopia is collaborating with the US based Johns Hopkins Bloomberg School of Public Health, Department of International Health, Program in Global Disease Epidemiology and Control. A researcher from the school was an intern in the UNICEF Ethiopia WASH section in 2015 and has collaborated with the WASH section on producing a paper entitled Evidence on Interventions Targeted at Reducing Unsafe Disposal of Child Feaces: A Systematic Review.

UNICEF Ethiopia’s rural wash activities are supported by the UK Department for International Development (DFID), the Government of Netherlands, the Government of Canada and the UNICEF National Committees from Germany, UK and New Zealand.

Dr. Samuel Godfrey is Chief of WASH for UNICEF Ethiopia, and has a PhD and MSc in Civil Engineering and Water and Waste Engineering.

[1] Stunting is a sign of ‘shortness’ and develops over a long period of time. In children and adults, it is measured through the height-for-age nutritional index. In Ethiopia approximately 40 per cent of children are stunted.

Leadership matters: The case of community led total sanitation and hygiene

By Araya Mengistu

Ethiopia is a country showing strong progress in achieving global and national goals for WASH services. It has achieved the MDG target 7c for water supply. Although still behind for sanitation targets, considerable progress is made. As of 2012, 37 per cent of communities practiced open defecation, as compared to 92 per cent in 1990[1]

The progress on sanitation is mainly achieved through the national Health Extension Programme (HEP) and the community led total sanitation and hygiene (CLTSH) approach. CLTSH is an approach that helps to mainly rural communities to understand undesirable effects of poor sanitation, and through a process of “triggering” – igniting a change in behaviour – achieve sustained behaviour change leading to spontaneous and long term abandonment of Open Defecation (OD) practices. Since its introduction in 2006/7, CLTSH has remained the only instrument in Ethiopia to induce behaviour change of communities to consider construction of latrines and use them – discouraging the practice of open defecation. Although the achievements in the past decade are significant, the success of the approach varied significantly from place to place.

For example, the Oromia regional state, the largest in the country, consists 265 rural and 39 urban districts or woredas. Out of 6,531 kebeles (sub-districts each with an average population of 5,000) in rural areas, about 16 per cent are open-defecation free (ODF) – meaning no-one, including visitors and passing pedestrians, are openly defecating and all have access to basic latrines with handwashing facilities.

UNICEF supports 24 woredas in Oromia state between 2011 and 2015. Of the supported woredas, 24 per cent (116 of 477 kebeles) have achieved ODF status. Compared to regional average of 16 per cent, this is a huge achievement. Sire, one of the supported woredas, has recently been graduated in 2015 with 100 per cent performance, declaring all 18 rural kebeles ODF. Other woredas are at various stages. 11 woredas are between 20-50 per cent progresses, while the rest 12 woredas are of 0-10 per cent progress. Compared to these, Sire Woreda shows an outstanding performance.

Such exceptional achievement requires successfully overcoming a number of challenges. A key challenge is lack of thorough understanding of the steps involved in CLTSH and their importance. Usually CLTSH is about training facilitators and triggering communities. However, many practitioners agree that this is the easiest part. Rendering adequate supervision after the triggering stage and providing support that is necessary to sustain the momentum is the difficult part. Other challenges include diffusion of information to neighbouring communities that make the approach ineffective, lack of trainers with actual field experience, high staff turnover, poor coordination among stakeholders, weak commitment of staff and trained people and application of CLTSH without adequate or proper organisation and preparation.

Growing over all these challenges and as a result of four years of effort, Sire Woreda celebrated 100 per cent ODF achievement in April 2015, with all rural villages and kebeles free from open defecation.

Even though, some of these kebeles were declared ODF two or more years ago, , they continued to sustain their status despite the usual trend of falling-back to OD practice noticed as time elapses. This demonstrates an effective post-triggering activity by the Woreda that effectively complimented the planning and triggering activity.

How was this achieved? The Woreda administration leveraged existing structures to sensitize the leadership ladder down to village level on CLTSH and built it in to the regular reporting and evaluation process. This has helped to mobilize the largest possible support to the effort of Health Extension Workers (HEWs) and CLTSH facilitators, including teachers and students under the guidance and support of the Woreda Health Office. It has also avoided diversions of focus (including manpower, logistics, and resources) as CLTSH has become an official woreda priority.

Two notable practices can be praised in the woreda for this success.  (a) the technique of triggering one full kebele at a time in contrast to the usual practice of village by village, and (b) use of different post-triggering follow-up technique suited to context. The advantage of the first technique was twofold. It helped to avoid diffusion of information in to neighbouring communities. Since, focusing in one kebele at a time required more trained people, the coordinators called upon trained and experienced facilitators from adjacent woredas to support, which worked really well. On the other hand, the woreda experts consciously applied different post-triggering follow-up methods. In highland areas, they applied the ‘flag system’, where by communities themselves awarded white flags to households who have constructed basic latrines, and red flags to those who did not. In low land areas, students were organized to alert the community when they see any one defecating in the open, who will then ensure the person buries the excreta.

Currently, the Woreda continues to strengthen the community platforms for monitoring progress and pro-actively works with local leaders to provide the necessary guidance and technical support to sustain the achievement. As a result of this, they are expecting at least two kebeles to achieve secondary ODF, which includes upgrading of basic latrines to improved latrines (with washable slab, vent pipe, hole-cover) with hand washing facility by the whole community. The commitment of leaders, and subsequent effective coordination in the Woreda has benefited the wider community to keep children, women and the society at large healthy.

[1] Joint Monitoring Programme 2014.

Ministers of Water, Sanitation and Hygiene to meet in Ethiopia

Minister of Water, Irrigation and Electricity, H. E Motuma Mukassa, announces that Ethiopia is hosting the meeting of Ministers of Water, Sanitation and Hygiene which is organized by the Sanitation and Hygiene for All (SWA) and convened by UNICEF. ©UNICEF Ethiopia/2016/Bizuwerk

Ministers of Water, Sanitation and Hygiene from around the world will meet in Ethiopia from 15-16 March 2016 to plan and prepare for the implementation of the Sustainable Development Goals (SDGs) related to sanitation, water and hygiene.

The meeting is organized by the Sanitation and Water for All partnership (SWA), and convened by UNICEF. SWA has over 100 partners, mostly governments, and works as a platform for encouraging and coordinating political dialogue and action around water, sanitation and hygiene issues.

“This meeting will be different from all other high level meetings organized by SWA previously, mostly because of the timing: it will be the first global meeting on these topics after the UN Member States agreed on the Sustainable Development Goals last September, “says Motuma Mukassa, Minister of Water, Irrigation and Electricity of Ethiopia. Mr Motuma also underscores that the SDG targets on water and sanitation requires a higher level of coordination, alignment and communication both at global and national levels.

Ethiopia is selected to host this meeting for its commitment to implementing innovative ways towards achieving universal access to sanitation, water and hygiene by coordinating different ministries, increasing sector funding and investing in the training of health workers. The country’s One WASH National Progrmame (OWNP), launched in September 2013, is one of the most ambitious in the sector. It is based on a sector-wide approach and involves the ministries of water, health, education and finance and the government’s main development partners. Ethiopia devises this programme to modernize the way water and sanitation services are delivered to its people.  Recently, with UNICEF’s support, Ethiopia also started a South-South collaboration with Brazil in the area of urban sanitation and regulatory framework for WASH service delivery.

The Ministerial Meeting is a unique opportunity for countries to identify the major bottlenecks to achieving the SDG water, sanitation, and hygiene targets and lay groundwork for clear action plans, strategies and milestones.

High-level delegates, including the Prime Minister of Ethiopia, Hailemariam Desalegn, Kevin Rudd, Chair of SWA and the 26th Prime Minister of Australia and Anthony Lake, Executive Director of UNICEF will attend the meeting.

 

UNICEF: Without toilets, childhood is even riskier due to malnutrition

Fatuma Nuior, 16, and her cousin Audi Arab, 12, stand by her latrine next to her house in Ber’aano Woreda in Somali region of Ethiopia ©UNICEF Ethiopia/2015/Ose

NEW YORK, 19 November 2015 – Lack of access to toilets is endangering millions of the world’s poorest children, UNICEF said today, pointing to emerging evidence of links between inadequate sanitation and malnutrition.

Some 2.4 billion people globally do not have toilets and 946 million – roughly 1 in 8 of the world’s population – defecate in the open. Meanwhile, an estimated 159 million children under 5 years old are stunted (short for their age) and another 50 million are wasted (low weight for age).

A report issued today, Improving Nutrition Outcomes with Better Water, Sanitation and Hygiene, from UNICEF, USAID and the World Health Organization, for the first time brings together years of research and case studies which demonstrate the link between sanitation and malnutrition. More importantly, it provides guidance for action.  

Lack of sanitation, and particularly open defecation, contributes to the incidence of diarrhoea and to the spread of intestinal parasites, which in turn cause malnutrition.

“We need to bring concrete and innovative solutions to the problem of where people go to the toilet, otherwise we are failing millions of our poorest and most vulnerable children,” said Sanjay Wijesekera, head of UNICEF’s global water, sanitation and hygiene programmes. “The proven link with malnutrition is one more thread that reinforces how interconnected our responses to sanitation have to be if we are to succeed.” 

Diarrhoea accounts for 9 per cent of the deaths of children under 5 years old each year and is essentially a faecal-oral disease, where germs are ingested due to contact with infected faeces. Where rates of toilet use are low, rates of diarrhoea tend to be high. 

Children under 5 years old suffer 1.7 billion cases of diarrhoea per year. Those in low income countries are hit hardest, with an average of three episodes per year. The highest frequency is in children under 2 years old, who are weakest and most vulnerable. Multiple episodes of diarrhoea permanently alter their gut, and prevent the absorption of essential nutrients, putting them at risk of stunting and even death.  

Some 300,000 children under 5 years old die per year – over 800 every day – from diarrhoeal diseases linked to inadequate water, sanitation and hygiene. The poorest children in sub-Saharan Africa and South Asia are particularly at risk.

Intestinal parasites such as roundworm, whipworm and hookworm, are transmitted through contaminated soil in areas where open defecation is practiced. Hookworm is a major cause of anaemia in pregnant women, leading to malnourished, underweight babies. 

Some countries have made significant progress in addressing both access to sanitation and the nutritional status of their children. Many have successfully used UNICEF’s Community Led Total Sanitation approach, in which the affected populations themselves devise local solutions to the problem of open defecation. 

• Pakistan met the 2015 Millennium Development Goal to halve the proportion of people who in 1990 did not have access to improved sanitation. Using CLTS, entire communities abandoned the practice of open defecation, leading to improved health and nutrition indicators among their children.

• Ethiopia mobilized community workers and achieved the largest decrease globally in the proportion of the population who defecate in the open. Despite population growth, the practice reduced from 92 per cent (44 million people) in 1990 to 29 per cent (28 million people) in 2015.

• In Mali the CLTS approach was also used in communities with high malnutrition rates, exacerbated by drought in the Sahel region. Improved access and use of latrines ensued, and improved health and nutrition in children.

• During the emergency linked to conflict in the Democratic Republic of the Congo, integrated nutrition and WASH interventions were used for displaced communities. Children under 5 years old saw significantly reduced undernutrition and waterborne diseases. Around 60 per cent of the population constructed latrines and some 90 per cent of malnourished children returned to normal weight during a 12-month period.

“There are no excuses not to act on access to toilets, even in the poorest communities, or during emergencies,” said Wijesekera. “On the other hand, there are millions of reasons – each one a child who is stunted or wasted, or worse, who sickens and dies – to treat this with the urgency it deserves.”

UNICEF, WHO: Lack of sanitation for 2.4 billion people undermining health improvements

A south Sudanese refugee Nvakuache Tut takes a shower by the way of water poured from a jerry can. 26, June 2014 Burbie South Sudanese Refugees Reception Centre Gambella Ethiopia. ©UNICEF Ethiopia/2014/Ayene

Final MDG progress report on water and sanitation released 

NEW YORK/GENEVA, 30 June 2015 – Lack of progress on sanitation threatens to undermine the child survival and health benefits from gains in access to safe drinking water, warn WHO and UNICEF in a report tracking access to drinking water and sanitation against the Millennium Development Goals.

The Joint Monitoring Programme report, Progress on Sanitation and Drinking Water: 2015 Update and MDG Assessment, says worldwide, 1 in 3 people, or 2.4 billion, are still without sanitation facilities – including 946 million people who defecate in the open. 

“What the data really show is the need to focus on inequalities as the only way to achieve sustainable progress,” said Sanjay Wijesekera, head of UNICEF’s global water, sanitation and hygiene programmes. “The global model so far has been that the wealthiest move ahead first, and only when they have access do the poorest start catching up. If we are to reach universal access to sanitation by 2030, we need to ensure the poorest start making progress right away.”

Access to improved drinking water sources has been a major achievement for countries and the international community. With some 2.6 billion people having gained access since 1990, 91 per cent of the global population now have improved drinking water – and the number is still growing. In sub-Saharan Africa, for example, 427 million people have gained access – an average of 47,000 people per day every day for 25 years.

The child survival gains have been substantial. Today, fewer than 1,000 children under five die each day from diarrhoea caused by inadequate water, sanitation and hygiene, compared to over 2,000 15 years ago.

On the other hand, the progress on sanitation has been hampered by inadequate investments in behaviour change campaigns, lack of affordable products for the poor, and social norms which accept or even encourage open defecation. Although some 2.1 billion people have gained access to improved sanitation since 1990, the world has missed the MDG target by nearly 700 million people. Today, only 68 per cent of the world’s population uses an improved sanitation facility – 9 percentage points below the MDG target of 77 per cent. 

“Until everyone has access to adequate sanitation facilities, the quality of water supplies will be undermined and too many people will continue to die from waterborne and water-related diseases,” said Dr Maria Neira, Director of the WHO Department of Public Health, Environmental and Social Determinants of Health. 

Access to adequate water, sanitation and hygiene is critical in the prevention and care of 16 of the 17 ‘neglected tropical diseases’ (NTDs), including trachoma, soil-transmitted helminths (intestinal worms) and schistosomiasis. NTDs affect more than 1.5 billion people in 149 countries, causing blindness, disfigurement, permanent disability and death.

The practice of open defecation is also linked to a higher risk of stunting – or chronic malnutrition – which affects 161 million children worldwide, leaving them with irreversible physical and cognitive damage.

“To benefit human health it is vital to further accelerate progress on sanitation, particularly in rural and underserved areas,” added Dr Neira.

Rural areas are home to 7 out of 10 people without access to improved sanitation and 9 out of 10 people who defecate in the open. 

Plans for the new Sustainable Development Goals to be set by the United Nations General Assembly in September 2015 include a target to eliminate open defecation by 2030. This would require a doubling of current rates of reduction, especially in South Asia and sub-Saharan Africa, WHO and UNICEF say. 

WHO and UNICEF say it is vitally important to learn from the uneven progress of the 1990-2015 period to ensure that the SDGs close the inequality gaps and achieve universal access to water and sanitation. To do so, the world needs:

• Disaggregated data to be able to pinpoint the populations and areas which are outliers from the national averages;
• A robust and intentional focus on the hardest to reach, particularly the poor in rural areas;
• Innovative technologies and approaches to bring sustainable sanitation solutions to poor communities at affordable prices;
• Increased attention to improving hygiene in homes, schools and health care facilities.

27,000 People to benefit from Multiple Village Clean Water Supply Project in Tigray

The Ebo clean water project benefits 27, 000 people in seven villages including 15, 000 school children with clean water in their school and households. Young girls now can attend school regularly without spending more time looking for water. ©UNICEF Ethiopia/2015/Bizuwerk

Ebo, Raya Azebo woreda, Tigray 11 February 2015: A multiple clean water supply scheme in Ebo, Raya Azebo woreda of the Tigray National Regional State goes operational today. The project will benefit 27,000 people in seven villages including 15,000 school children with clean water in their school and households.

The Ebo clean water project, with a total cost of 20 million Ethiopian Birr, is a unique project as it not only demonstrates how investments in long term sustainable water supplies can reduce the carbon emissions from water trucks, but also contributes to making Ethiopian towns and villages greener and healthier for women and children. The project shows how resilient water supply solutions can be implemented in areas where there is low average rainfall and difficult hydrological conditions. In addition, it is 70 per cent cheaper than water trucking which has been the practice previously in the villages.

The Regional Government of Tigray and the woreda Administration of Raya Azebo actively partnered with UNICEF Ethiopia to undertake a detailed technical groundwater assessment to locate deep groundwater which could be exploited for this water supply scheme. UNICEF also called on its large national and international expertise to provide high technical support and mobilised funds from UNICEF Germany to finance the construction of the entire water supply scheme.

H.E Ato Alemayehu Tegenu, Minister of Water, Irrigation and Energy and Ms. Anupama Rao Singh, UNICEF Ethiopia Representative a.i. cut the ribbon inaugurating the Ebo multiple water supply scheme facilities. ©UNICEF Ethiopia/2015/Bizuwerk

Inaugurating the project, Minister of Water, Irrigation and Energy, H.E Ato Alemayehu Tegenu said, “We went to every corner of the possible system to make the voice of water and sanitation heard. And to promote synergies between all those whose mandate mattered to water. Now, our country has made tremendous progress over the past decade in the water and sanitation sectors and lowered the incidence of water-borne diseases significantly. We now have the opportunity to witness such a breakthrough, made possible through the committed effort of the government, development partners, NGOs, the private sector and the community. Raya Azebo Multiple Village Clean Water Supply Project in Tigray region is one of the exemplary project, providing the community with reliable access to safe water.”

UNICEF Ethiopia Representative a.i. Ms. Anupma Rao Singh said, “UNICEF will increase its technical and financial support to the water supply and sanitation sector in the Tigray Region. We also reaffirm our commitment to finance another 3 multiple village water supply schemes similar to the Ebo scheme with the aim of alleviating the burden of water collection for tens of thousands of women and children in the Tigray region.”

Ethiopia has made substantial progress in improving access to water supply and sanitation coverage since 1990. The recent National WASH Inventory data helps to confirm that, with the 2015 prediction of 57 per cent water supply coverage, Ethiopia is well on track to meet the water target of halving the 86 per cent of the population without water. The completion of such cost effective schemes is an indication that the country is now heading into innovative approaches to address people especially the hard to reach areas who are without access to safe water services.

Government of Ethiopia and UNICEF compile national water & sanitation inventory

 

Reblogged from akvo.org

Improving access to water and sanitation through better data collection
Akvo is working with UNICEF and the Ethiopian government in all woredas (districts) of the Somali Region of the country to support the development of the national WASH inventory (NWI). The inventory provides data on water supply schemes in urban and rural areas, sanitation and hygiene practices of households, and the status of water supply and sanitation facilities at health institutions and schools.

Above: (l to r) Musie Harun Hassen, Water Resource Development Bureau; Muhyadin Abdirahman Hassen, Education Bureau; Mowlid Akil Aden, Health Bureau; and Ali Regah Ahmed, UNICEF.
Below: (l to r) Muhyadin Abdirahman Hassen, Education Bureau; Musie Harun Hassen, Water Resource Development Bureau; Mowlid Akil Aden, Health Bureau; and Ali Regah Ahmed, UNICEF.
Photos by Mulugeta Ayene. Jijiga, Somali Region of Ethiopia, 11 December 2014.

Solving the problems of paper-based data collection
The Ethiopian government began work on the NWI in 2008. Over a four year period, data was collected across all parts of the country apart from the Somali Region.

Initially, data gathering for the NWI was paper-based, but this proved problematic. As well as leading to lengthy data entry and cleaning procedures, the data was of poor quality and lots of important information was incorrect or missing, such as GPS data, functionality status, number of households within 1.5km from water sources and type of latrine or water supply.

To overcome these challenges, UNICEF Ethiopia advised switching to smart phone technology and partnered with Akvo. During 2014, data was collected using Akvo FLOW across the whole Somali Region. This data is instantly available through an online, secure interface which allows any problems with data collection to be identified in real time and corrected straight away. Akvo has been providing technical support and direct oversight of data collection and transfer of data to the Government of Ethiopia’s management information system (MIS). The result is a robust, reliable data set for the region that can be used for policy planning and infrastructure management.

Collecting data at scale in ‘difficult’ places
The Somali Region is a vast desert area to the east of Ethiopia that is sparsely populated and prone to violent political conflicts. When planning the data collection operation, the security of survey enumerators was a concern. UNICEF reached out to all the NGOs working in the WASH sector in the region to ask for help. Everyone who could help did, providing transport, safe accommodation and car batteries or solar powered electricity points for phone-charging. The general approach was to take no chances with people’s safety. If progress was slow, so be it. At one point data collection stopped altogether for around three weeks until the situation was safe again.

The scale of the operation was impressive with a total of 5,696 surveys completed in three months (including the three-week hiatus). 220 Samsung smart phones were configured with the Akvo FLOW software. A field test run was carried out to see how long the phone batteries would last so that an itinerary could be drawn up around that.

Initially 45 government and UNICEF employees were trained on the use of Akvo FLOW at a master class designed to enable them to then train their colleagues. As well as a detailed explanation of the FLOW system, the master class covered: proper GPS calibration to increase the accuracy of the GPS coordinates; data collection in completely offline settings including manual uploading to computers and getting the data off the SD cards in the devices; and tips and tricks on how to conserve battery power as much as possible. Read more

Jo Pratt is communications manager at Akvo, based in the UK.

Global Hand washing Day (GHD) 2014 celebrated in Oromia, Ethiopia

By Kulule Mekonnen

Kimbibit woreda community welcomes participants of Global Handwashing Day participants colourfully with their decorated horses ©UNICEF Ethiopia/2014/ Sewunet

Hundreds of people marked Global Hand Washing Day with a colourful celebration at Garachatu School in Kimbibit woreda, Oromia region.

The region has been celebrating Global Hand Washing day since 2008, which was International Year of Sanitation.

Community members travelled to the event on foot and on horseback, wearing colourful traditional clothes to welcome government officials and invited guests to the celebrations.

The event is marked in many countries every year to underline the importance of handwashing in the prevention of common but potentially lethal diseases such as diarrohea, pneumonia, Severe Acute Respiratory Syndrome (SARS), Ebola and others.

The event at Garatchu School included the reading of poems by students, songs and performances, focusing on the importance of handwashing.

Dr Zelalem Habtamu, Deputy Head of the Oromia Regional Health Bureau, said: “We believe that we could prevent over 60 % of communicable diseases by implementing proper environmental health interventions. This is why we focus on advocating proper hand washing practices at critical times.’’

Oromia has made solid progress in improving hygiene, deploying 13,000 health extension workers and 4.5 million health development armies. These are small groups of women that meet regularly to discuss and solve issues relating to public health, socio-economic, environmental and economic concerns.

Students of Garachatu School perform a play on the importance of handwashing at the Global Handwashing Day celebration ©UNICEF Ethiopia/2014/Sewunet

Dr. Zelalem added: “We are celebrating this year’s GHD in Garachatu School, with the school community and their families, with the intention of reaching every family, as we believe that students could carry on the positive hand washing behaviours learnt at schools with their families and their neighbourhood.”

Hand washing with soap removes germs from hands, preventing the transmission of infections when people touch their eyes, nose or mouth. It can also prevent germs getting into food and drink, as often happens when they are prepared by people with unclean hands. These germs can then multiply, risking the spread of infection to more people.

Germs from unwashed hands can also be transferred to objects like handrails, table tops or toys and spread easily.

Removing germs through proper hand washing helps prevent diarrhoea and respiratory infections and may also help prevent skin and eye infections.

Research shows that community hand washing education has a number of hygiene benefits. It reduces cases of diarrhoea by 31 percent, diarrheic illness in people with weakened immune systems by 58 percent and respiratory illnesses, such as colds, in the general population by 21 percent.

Figures released recently by UNICEF and the World Health Organisation show that in 2013 more than 340,000 children under five – almost 1,000 a day – died from diarrheic diseases due to lack of safe water, sanitation and basic hygiene. As the Ebola response takes its toll on the health services in the affected countries, the practice of hand washing is even more important to prevent these common diseases.

Participants wash their hands at the Global Hand washing Day celebration in Garachatu School, Kimbibit woreda of Oromia region, Ethiopia ©UNICEF Ethiopia/2014/Sewunet

UNICEF works with regional government and non-governmental organisations to improve access to safe drinking water, sanitation and healthy environments and better hygiene practices.

It also focuses on capacity building to eliminate open defecation and improve hand-washing facilities in schools and health centres, focusing on the needs of girls.

W/ro Zewuditu Areda, Head of the North Shewa Zonal Health Department, said: “Proper hand washing prevents disease and saves lives, hence hands should be properly washed.”

The event ended with a demonstration of 10 steps of proper hand washing by Belay Techane, a Kimbibit Woreda Health Worker. The steps include:

• First hand should be rinsed and wet
• Apply soap and thoroughly scrub hands and forearms up to elbow. Give special attention to scrubbing your nails and the space between your fingers
• Rinse with generous amount of clean water flowing
• Air-dry with your hands up and elbows facing the ground, so that water drips away from your hands and fingers
• After the demonstration, all participants of the day practiced proper hand washing using soap as demonstrated by the health worker.

Lack of toilets dangerous for everyone, UNICEF says

Girls’ toilet at Beseka ABE Center in Fantale Woreda of Oromia State ©UNICEF Ethiopia/2014/Ose

NEW YORK/Addis Ababa, 19 November 2014 – Slow progress on sanitation and the entrenched practice of open defecation among millions around the world continue to put children and their communities at risk, UNICEF warned on World Toilet Day.

Some 2.5 billion people worldwide do not have adequate toilets and among them 1 billion defecate in the open – in fields, bushes, or bodies of water – putting them, and especially children, in danger of deadly faecal-oral diseases like diarrhoea.

In 2013 more than 340,000 children under five died from diarrhoeal diseases due to a lack of safe water, sanitation and basic hygiene – an average of almost 1,000 deaths per day.

“Lack of sanitation is a reliable marker of how the poorest in a country are faring,” said Sanjay Wijesekera, head of UNICEF’s global water, sanitation and hygiene (WASH) programmes. “But although it is the poor who overwhelmingly do not have toilets, everyone suffers from the contaminating effects of open defecation, so everyone should have a sense of urgency about addressing this problem.”

The call to end the practice of open defecation is being made with growing insistence as the links with childhood stunting become clearer. India, with 597 million (half the population) practising open defecation, also has high levels of stunting. Last week, UNICEF convened a conference in New Delhi called ‘Stop Stunting’ to call attention to the effect of open defecation on the entire population, particularly children. UNICEF’s ‘Take Poo to the Loo’ campaign in India also works to raise awareness of the dangers associated with open defecation.

Asfaw Legesse a model in his community washes his hand after using a latrine. ©UNICEF Ethiopia/2014/Sewunet

“The challenge of open defecation is one of both equity and dignity, and very often of safety as well, particularly for women and girls,” Wijesekera noted. “They have to wait until dark to relieve themselves, putting them in danger of attack, and worse, as we have seen recently.”

Compared to other African countries, Ethiopia has made huge progress in reducing open defecation rates from 92 per cent in 1990 to 37 per cent in 2012. The Joint Monitoring Programme (JMP) 2014 report from UNICEF/WHO confirms that Ethiopia is leading the charge in Africa in reducing open defecation.The community total sanitation and hygiene approach, supported by UNICEF and utilizing the 38,000 Health Extension Workers in the country, has greatly contributed to this success.

“The challenge of improving sanitation levels to ensure that the minimum standards of toilet construction remains in many rural areas across Ethiopia. With the rapid urbanisation of the country there is also a need to “reinvent the toilet” to make it affordable, durable and appropriate for high density urban dwellings. UNICEF is advocating for these, and greater focus on toilets in schools and health centres nationwide, to ensure greater access to improved sanitation,” said Patrizia DiGiovanni, Acting Representative of UNICEF Ethiopia.

UNICEF’s Community Approaches to Total Sanitation addresses the problem at the local level by involving communities in devising solutions, and has led to some 26 million people across more than 50 countries abandoning the practice of open defecation since 2008.

Eighty-two per cent of the 1 billion people practising open defecation live in just 10 countries: India, Indonesia, Pakistan, Nigeria, Ethiopia, Sudan, Niger, Nepal, China, and Mozambique. The numbers of people practising open defecation are still rising in 26 countries in sub-Saharan Africa, though they have declined in Asia, Latin America and the Caribbean. In Nigeria, numbers of open defecators increased from 23 million in 1990 to 39 million in 2012.

Globally, some 1.9 billion people have gained access to improved sanitation since 1990. However, progress has not kept up with population growth and the Millennium Development Goal target on sanitation is unlikely to be reached by 2015 at current rates of progress.

The inter-governmental Open Working Group on the post-2015 Sustainable Development Goals have recommended that the new goals include a target of achieving adequate and equitable sanitation and hygiene for all and ending open defecation by 2030.