Pakistan: sanitation crucial to survival for flood victims

Millions remain without proper sanitation in flood-affected Pakistan.

“Sanitation is ‘the invisible problem’ in disaster relief and by highlighting the problem, behaviour change happens,” according to Bill Fellows, the water, sanitation and hygiene (WASH) global cluster coordinator working with United Nations Children’s Fund (UNICEF), the WASH cluster lead agency.

Hygiene is four times as important as clean drinking water for preventing diarrheal disease according to research published in The Lancet medical journal [1]. Whilst in flood devastated Pakistan, access to clean drinking water is on the rise, thanks to the efforts of WASH cluster member agencies, with 2.5 million people receiving clean drinking water every day, the attention to sanitation has become critical in preventing disease outbreaks.

UNICEF, in cooperation with the government, is implementing hygiene education in relief camps through a “no open defecation campaign”. “This is based on a system developed in Bangladesh and helps affected communities take a first step to achieve basic sanitation in disaster affected communities”, said Fellows.

In addition, the hygiene education campaign includes teaching flood survivors to build open pit latrines. As part of the flood relief efforts 2,723 emergency latrines have been built, benefitting 40,000 people.

Female health workers and Pakistan Red Crescent volunteers are also on the frontline of hygiene education, which is one of the most critical components in reducing water-borne disease. To date, these volunteers have helped educate almost 750,000 people on the benefits of good hygiene.

To compliment hygiene education, soap and hygiene kits are needed. UNICEF reports 400,000 hygiene kits are in the pipeline along with three million bars of soap.

“It is crucial in disaster response that flood affected communities receive latrines and soap, as well as hygiene education to prevent illness and disease”, said Manuel Bessler, Head of the Office of Coordination for Humanitarian Affairs (OCHA) in Pakistan.

In addition to water and sanitation flood relief activities, UNICEF and its partners are engaged in an integrated approach to provide humanitarian assistance to millions of flood survivors through health and nutrition, child protection, education and prevention of child trafficking.

[1] The same conclusion can be found in a recent article by Cairncross et al. in the International journal of epidemiology

Read the latest Pakistan Floods WASH-related news on ReliefWeb

Related web site: Global WASH Cluster

Source: ReliefWeb, 14 Sep 2010

Viet Nam: hygiene promotion should build on community action

The path down to a stream where children defecate. Viet Nam, Lao Ca province. Photo: Danida

More affordable sanitation technologies and participatory community interventions will make future hygiene promotion more effective, say two PhD-fellows Xuan Le Thi Thanh and Thilde Rheinländer. They have spent 16 months in ethnic minority communities in the Northern Province Lao Cai to do research on hygiene and sanitation promotion in the Danida-funded research project SANIVAT (Water Supply Sanitation and Hygiene Promotion in Vietnam). SANIVAT supports research and capacity building on the impacts of water, sanitation and hygiene interventions and investigates how people perceive hygiene, health risks and hygiene promotion.

Afghanistan: chlorination drive to avert water-borne diseases

Health workers in flood-affected parts of Afghanistan are trying to prevent water-borne disease outbreaks by chlorinating drinking water and promptly delivering health services.

Dozens of small health teams have been sent to areas mainly in northern and eastern Afghanistan hit by flash floods [at the end of July 2010], Health Ministry officials said.

India, Tamil Nadu: promoting menstrual hygiene in the slums

Women of slums in the city [of Tiruchi] are awakening to the significance of personal hygiene, thanks to the efforts of three women from different self help groups advocating the use of sanitary napkins for better menstrual health.

Women from around ten slums [...] have switched over to sanitary napkins, after being enlightened on its benefits.

S.Jacqueline, N.Sathyavani and A.Fathima embarked on a door-to-door campaign in slums three years ago, creating awareness on safe menstrual practices and the use of sanitary napkins. The women were trained by WEAT (Women Entrepreneurs Association of Tamil Nadu) and were assisted in procurement of production machines by the People’s Development Initiative (PDI).

Self help group members selling sanitary napkins to women in a slum near Sangiliyandapuram in Tiruchi. Photo: R. Ashok

The production unit at Rural Mart, which started with 30 napkins a week, today produces an average of 200 pieces a day. Raw materials are purchased in bulk for five months from Rajapalyam at subsidised rates. They also sell their products in schools, colleges and through vending machines stationed at offices and institutions.

The cost of a packet of six pieces is Rs. 15 [32 US dollar cents] and single pieces are sold at an average of Rs. 2.50 per napkin [5 US dollar cents]. “We want to bring down the price to Rs. 1.50 [3 US dollar cents] per piece. We need advanced machines for which we are planning to approach financial institutions for loans,” said Ms. Sathyavani

The trio visit each slum weekly to distribute the napkins and to create awareness on safe menstrual practises . “Despite our persuasion, nearly 50 percent of the women are hesitant to use sanitary napkins, preferring the use of rags,” said Ms.Jacqueline. The main reason cited by these women is lack of facilities to dispose or replace napkins in their place of work, primarily building sites. Thirty women from districts like Salem, Erode and Dindigul have been trained so far. N.Manimekalai, Head, Department of Women Studies, Bharathidasan University, siad that the napkins produced are sterilised and WEAT would apply for BSI certification at the earliest.

Source: Olympia Shilpa Gerald, The Hindu, 17 Jul 2010

South Asia: is universal WASH access in reach?

Communications Director for Water Advocates John Sauer reports on a three-week field trip to Bangladesh and West Bengal visiting WASH field projects.

Five to ten years ago many villagers did not have safe drinking water or a sanitary latrine — the situation on the ground has improved. In Bangladesh, deaths caused by diarrhea have decreased significantly in the past several years.

Many folks I spoke with attribute the substantial drop in death rates to the increase in the amount of safe drinking water. In most villages I visited families had their own tube well, though some did share a well with a few other families. Before this rapid expansion of a water source close to the home, many families collected water from the ubiquitous unprotected ponds of Bangladesh and West Bengal. According to Water For People country coordinator Rajashi Mukherjee, “The ponds are absolute death traps; hygiene is the last thing you can associate with them.” Fortunately, with the proliferation of tube wells, most people can now avoid collecting water from unsanitary ponds.

This progress underscores the solvability of the problem when there is a convergence of partners — communities, local government, local NGOs and international donors and NGOs. The tube well example is interesting because it shows how scale can happen when an idea catches on and the private sector (mostly small businesses) gets involved. Nearly 8 million tube wells were sunk in recent years. Roughly 1 million were paid for and installed by the UN, government and other NGOs and 7 million by families/communities themselves by hiring private contractors. The scale of this push for clean water shows how progress was made when stakeholders perceived the need for clean water and took action into their own hands.

Nevertheless, diarrhoeal disease mortality remains high in both Bangladesh (70,000) and India (over 450,000).

One of the unfortunate and unforeseen side effects of the installation of the millions of tube wells is that a fair proportion of the wells are infected with naturally-occurring arsenic. Many programs have emerged to test and mark the wells, but large-scale solutions to rectify the problem are not yet in place. I did see several arsenic removal technologies of varying cost, but the very expensive options would be hard to bring to scale without large donor support. There were also other less expensive arsenic removal technologies that are still being tested that might hold promise in the future.

Overall the successful programs that I did see dealing with arsenic removal came about through contributions from the community level, local government and outside donor support.

Besides the arsenic problem, greatly improving sanitation and hygiene will be essential to further reduce WASH-related disease and sickness and improve the quality of life for the people of Bangladesh and West Bengal. The governments in both countries have made promoting sanitation a priority. Unfortunately, many challenges exist on the ground related to education about sanitary toilets and appropriate hygiene. There was limited use of “infotainment,” (using entertainment, such as television shows to pass key health and hygiene messages), even though some “infotainment” pilot projects appeared effective. Also there were an insufficient number of community health and hygiene promoters. The result is that people are not constructing or maintaining toilets or practicing good hygiene (such as washing their hands with soap). I did visit several communities that had achieved 100% WASH coverage. The trend in those communities was strong local leadership, active community health and hygiene workers and effective leadership from so-called “child brigades” to pressure the community into action. One idea being floated is to employ these local leaders as a cadre of “barefoot consultants” hired by other villages and local NGOs to greatly scale up these successes.

What particularly impressed Sauer was a successful school sanitation project.

In one of the schools I visited, the children had been involved in the design of their own toilets. The girls demanded a separate changing room where they could have privacy and an adjacent incinerator for safe disposal of sanitary pads during menstruation. Before these programs were in place many of the children missed school, walking home to use the toilet. Girls in particular would often miss three to four days a month of school, sometimes even missing exams.

Despite the “multitude of WASH problems”, Sauer remains optimistic.

Sanitary products are available everywhere, at reasonable prices and are accessible to almost everyone, except for the extremely poor and vulnerable. (I actually saw some very good examples of how motivated communities found ways to help out the poorest members of their communities). Communities transform with access to WASH–health improves, new job opportunities arise and more children finish school. I hope that donors take notice of this transformation and work with the people of Bangladesh and West Bengal to put this issue to rest once and for all.

Related web sites:

• Water Advocates
• Water for People

Source: John Sauer, Huffington Post, 29 Jun 2010

Bangladesh: children smash handwashing world record

Washing hands may not seem worthy of a certificate, but for thousands of children in Bangladesh the simple practice has got them into the Guinness Book of World Records.

On Global Handwashing Day last October [2009], Plan Bangladesh and its partners organised an event where 52,970 school children gathered at multiple locations across the country to wash their hands with soap and water. The campaign was set up to motivate people to change their attitude towards current hygiene practices and save lives.

Global Handwashing Day: handwashing demonstration in Sylhet, Bangladesh. Photo: MaMoni

Approximately 110,000 Bangladeshi children aged under 5 die due to diarrhoea every year. Hand washing with soap is the most effective and inexpensive way to prevent the disease.

New world record

The gathering smashed the 2008 record which was set by Bangladesh and stood at 1,213 . Now Plan Bangladesh has received a certificate from the Guinness World Records which seals their place in history. [The official Guinness site still lists the record set on 19 October 2009 by the Edenglen primary school in Johannesburg, South Africa with 1,802 handwashing students, while India also claimed it had broken the record when about 15,000 students from 23 schools converged in a sports stadium n Chennai].

Zillur Rahman, Plan Bangladesh’s water and environmental sanitation specialist who coordinated the event, said: “We are very happy we broke the world record in this. Plan got involved in this campaign to highlight the bad hygiene practices in the country and we believe the campaign has raised this issue amongst people especially in the life of children.”

Spreading the word

On the day, 25,000 children gathered in a school playground in Dhaka to take part. After the event, one of the children said: “Now we know the importance of washing hands with soap and water and we will definitely tell our family and community about its benefit.” Thousands more school children washed their hands with soap and water simultaneously all over the country.

In Bangladesh, hygiene practices are generally poor. The national figure of washing hands with soap and water after defecation is 58.8% while this figure drops to 50.4% in rural areas.

Related web sites:

• Plan International – water and sanitation
• Global Handwashing Day
• Guinness World Records

Source: Plan Bangladesh, 01 Jul 2010

India: scheme for low-cost sanitary napkins to rural girls approved

The Union Health and Family Welfare Ministry on [15 June 2010] approved a scheme for providing highly subsidised sanitary napkins to adolescent girls in the rural areas to promote menstrual hygiene. The scheme, to be launched in 150 districts across the country in the first phase, will cost Rs. 150 crore [Rs 1.5 billion = US$ 32.2 million] for the current financial year.

Approved by the Mission Steering Group – the highest decision-making body – of the National Rural Health Mission, at its sixth meeting here, the scheme envisages covering 1.5-crore [15 million] girls in the age group of 10-19 years every month. Of this, the approximate number of APL girls is 105 lakh [10.5 million] while that of the BPL category is 45 lakh [4.5 million]. The napkins will be supplied to the below poverty line (BPL) girls at a nominal cost of Rs.1 [2.15 US dollar cents] per pack of six while those girls living above poverty line (APL) will have to pay Rs.5 [10.7 US dollar cents] per pack.

Limited access

In India, menstruation and menstrual practices are clouded by taboos and socio-cultural restrictions for women as well as adolescent girls. Limited access to safe sanitary products and facilities is believed to be one of the reasons for constrained school attendance, high dropout rates and ill health due to infection.

Tamil Nadu, Haryana, Bihar, Rajasthan and Puducherry have already taken similar initiatives to promote menstrual hygiene among adolescent girls.

The 150 districts identified in the first phase include 30 from the four southern States, Maharashtra and Gujarat and 120 from northern, central and the north-eastern States. In the first year, the Centre will procure the napkins and supply these to the States that will in turn send these to Accredited Social Health Activists (ASHA) in the districts for distribution on a monthly basis or to the schools which will become distribution points for students.

As an incentive, ASHA will get one pack free every month in addition to Rs.50 [US$ 1] per meeting she holds on a Sunday for creating awareness regarding menstrual hygiene among girls. Subsequently, States can choose to involve self-help groups for manufacturing and marketing sanitary napkins. At least 50 districts with a strong network of SHGs will be involved in the manufacture of napkins in the first phase itself. The ASHAs will procure sanitary napkins from the sub-centre for which she will be given Rs.300 from the untied fund. Each month, ASHA will replenish the imprest fund with the amount collected through the sale of napkins.

Safe disposal

For safe disposal of the napkins at the community level, deep-pit burial or burning are the options being considered. Due environmental clearance has to be obtained from the States for this. Installing incinerators in schools that can be manually operated is another option. Consultations are on with the Ministry of Environment and Forests for use of environment-friendly raw material and disposal mechanism.

States have been given the option of leveraging funds for incinerators through the Total Sanitation Campaign of Sarva Shiksha Abhiyan.

The scheme will be expanded to other districts after the outcome of the first phase is evaluated. In that case, the States will be asked to contribute 15 per cent of the cost. The scheme can also be transferred to the Ministries of Women and Child Development and Rural Development at a later stage for self-financing and self-sustaining that will reduce the budgetary support.

Source: The Hindu, 16 Jun 2010

Viet Nam: designing evidence-based communications programmes for handwashing with soap

Since 2006, the Viet Nam Ministry of Health and the Viet Nam Women’s Union, with support from the World Bank’s Water and Sanitation Program (WSP), have been carrying out an evidence-based, comprehensive behaviour change communications programme to promote handwashing with soap (HWWS) among women aged 15-49 and schoolchildren aged 6-10 throughout Viet Nam. The ultimate objective is to reduce the incidence of diarrhoeal diseases in children under the age of five.

The programme has reached more than 1.8 million people in the first phase, with a target of 30 million in phase II. Viet Nam is one of four countries (along with Tanzania, Senegal and Peru) involved in a large global Scaling Up HWWS Behaviour Change project by WSP. This tests whether innovative behaviour change approaches can generate widespread and sustained changes in handwashing with soap habits in target populations. To date, the programme has developed two communications campaigns, one aimed at caretakers of children under the age of five and the other targeting rural and semi-urban schoolchildren in Viet Nam.

Read more: Source Bulletin, May 2010

India, Uttar Pradesh: transforming lives of people with HIV/AIDS through WASH services

In 2008 WaterAid India entered into a partnership with Uttar Pradesh State AIDS Control Society for a project titled Programme on Arresting Opportunistic Infections for People Living with HIV/AIDS (PLHA) to help improve the quality of their lives through water and sanitation. The project is being implemented through CREATE in 14 districts and involves anti-retro-viral therapy cells, located in the Medical Colleges and working with District Level Networks (DLNs) of HIV positives, Drop in Centres (DICs) and Community Care Centres (CCCs), which are care and support centres during opportunistic infection.

These have also become WASH information centres where people living with HIV/AIDS are able to learn about key hygiene practices. The centres share information through posters and pamphlets, display different toilet models, and offer a range of audio, video and other materials as well as group and individual counselling.

PLHAs are also able to use good quality facilities at the centres, such as water filters, washbasins, urinals and latrines. Staff are trained on WASH issues and are able to tell PLHA about the importance of good WASH practices in their lives.

Read more: Johnson Jeyaseelan, Source Bulletin, May 2010

Nepal: new study says impact of menstruation on school attendance is overstated

A new study stating that menstruation has little impact on school attendance casts serious doubt on the popular assumption that the provision of sanitary products can significantly affect the education gap. That assertion has been criticized by some Nepali experts, noting that the study was carried out in one of the country’s most developed urban areas.

“Such a claim can only undermine the much-needed menstrual hygiene and management to be introduced in schools by the government and integrated in the overall hygiene intervention,” one expert, who asked not to be identified, said. [IRIN, 2 May 2010]

The study [1] was part of the Menstruation and Education in Nepal project, supported by the University of Michigan, University of Chicago and Harvard University. Research in four schools in Chitwan District, nearly 300km west of the capital Kathmadu, revealed that girls missed only about a third of a day per year because of their period. This is much less than the 10 to 20 percent quoted by other sources such as the World Bank.

As the story goes, girls miss significant amount of school during menstruation, largely because of lack of modern sanitary products, and this contributes to lower attendance rates, eventual failure, or dropping out.

Part of the appeal of this explanation is that the fix is so easy. There is no need to change attitudes about female schooling, to provide funds for uniforms or textbooks, or to construct new schools closer to girls’ homes; instead, the menstruation theory suggests simply providing sanitary products could significantly affect the education gap.

At least one sanitary product manufacturer has jumped on this fix: In 2007, Procter & Gamble announced its support for the Protecting Futures Program, which provides sanitary pads and hygiene education to girls in Africa. Other organizations (the Clinton Global Initiative, for example) have pledged millions of dollars to finance better sanitary products in the developing world.

Mothers and daughters learn about modern sanitary products in Chitwan, Nepal. Photo: Krishna Ghimire

Researchers Emily Oster and Rebecca Thornton say the claim that girls miss significant amounts of school during their periods is largely based, up till now, on anecdotes and assumptions.

We started by asking girls whether they missed school during their period; similar to other studies, over half reported ever missing school days due to menstruation.

Rather than leaving the analysis there, however, we quantified the amount of school missed because of periods by collecting detailed information on dates of menstruation and school attendance for the entire school year.

Although girls in our sample were indeed less likely to attend school on days they had their period, the effect is very, very tiny. On non-period days, girls were in school about 85.7 percent of the time; on days they are menstruating, they were in school 83.0 percent of the time (a difference of only 3.2 percent).

The researchers also found that proving better sanitary products – in their case menstrual cups – made no difference in closing the (very small) attendance gap.

Based on the evidence on schooling and in our randomized study, we conclude that better sanitary products are not likely to be an effective “quick fix” for girls’ education. This does not suggest we should limit our efforts at increasing schooling for girls, but it does point to the need for quantitative data to evaluate what efforts will be the most effective.

[1] Oster, E. and Thornton, R. (2010). Menstruation, sanitary products and school attendance : evidence from a randomized evaluation. Forthcoming article in: American Economic Journal: Applied Economics. Full paper

Source: Emily Oster and Rebecca Thornton, Are ‘Feminine Problems’ Keeping Poor Girls Out of School?, New York Times Economix, 27 Apr 2010