sanitation

{Photo credit: MSH staff, Afghanistan}Photo credit: MSH staff, Afghanistan

In 2013 diarrhea killed 578,000 children under the age of five, 9 percent of all deaths in this age group globally. The tragedy of these deaths is that they are avoidable at many levels. The risk of contracting diarrhea can be drastically decreased through basic hygiene measures, such as consistent and exclusive use of a latrine and washing one’s hands with soap. Once a child becomes ill with diarrhea, most cases can be managed with oral rehydration salts and zinc. But the gap between what is known in the public health community regarding prevention and treatment of diarrhea, and what is practiced in many settings, is wide and deadly.

In Afghanistan, diarrhea killed 13,000 children under the age of five in 2013 and was the third most frequent cause of mortality (after neonatal conditions and pneumonia) in the age group. Many organizations, including Management Sciences for Health (MSH), have worked to improve access to treatment for children with diarrhea, but less attention has been paid to prevention.

 {Photo credit: Alison Corbacio.}A child in Rajasthan, India drinks from a public water source.Photo credit: Alison Corbacio.

Have you ever thought about water? I mean, really thought about the quality of the water you drink or use for your personal hygiene? Clean water is something many of us take for granted, but billions of people around the world lack access to a dependable source of fresh water and acceptable sanitation facilities.

This year, I joined a coalition of advocates from dozens of organizations to support HR 2901, otherwise known as The Senator Paul Simon Water for the World Act. The bill was introduced in the House of Representatives in August 2013 by Rep. Earl Blumenauer (D-OR) and Rep. Ted Poe (R-TX) and was referred to the House Foreign Affairs Committee. It has broad bipartisan support. This bill does not ask for any new funding from Congress; instead, it seeks to use existing funds to improve monitoring and evaluation of WASH projects, increase communication between agencies, and promote partnerships and cooperation among stakeholders.

In Moen Kas, one of the villages where the project introduced community-led total sanitation, officials and villagers celebrate Open Defecation Free (ODF) certification. {Photo credit: Noorgha CLTS Supervisor/Afghanistan.}Photo credit: Noorgha CLTS Supervisor/Afghanistan.

A new report from the USAID-funded Afghan Sustainable Water Supply and Sanitation (SWSS) Project, led by Tetra Tech ARD, describes the methodology and results from the Sustainable Health Outcomes component, led by Management Sciences for Health (MSH). The SWSS project worked to improve the health and infrastructure of rural Afghans, with an emphasis on providing water supply and sanitation facilities and improving community hygiene behaviors (read stories).

SWSS was the first project in Afghanistan to implement community-led total sanitation (CLTS) on a broad scale. While challenges for ongoing hygiene and sanitation remain, the project’s success led the Afghan Ministry of Rural Rehabilitation and Development to include CLTS as part of its national water and sanitation policy and strategy.

Moen Kas, Afghanistan {Photo credit: Noorgha CLTS Supervisor.}Photo credit: Noorgha CLTS Supervisor.

Moen Kas, a hilly remote Afghan village absent of latrines or even a functioning water well, became an Open Defecation-Free (ODF) community within 24 days of arduous commitment from its leaders and people.

Moen Kas’ remarkable milestone makes it the first village in Afghanistan to reach ODF status in less than one month--inspired entirely from personal stories that are spreading across the country regarding the benefits of living in ODF communities.

The quick transformation was the direct result of a man from Moen Kas who had attended an ODF certification ceremony in the nearby, yet secluded, village of Ghalani.

As he watched the ceremony and learned of ODF’s benefits, he asked to speak on behalf of his village. During his speech, he praised Ghalani’s achievements within the past two months and publicly vowed that his own village would achieve ODF status in under a month.

Recognizing that this ambitious goal could not be achieved through him alone, he urged the other Moen Kas’ villagers who were also present at the ceremony to stand with him and work together.

So determined was the man in his vision to transform his village, that he invited the audience to visit Moen Kas in one week to verify it as an ODF community.

Global Handwashing Day. {Image credit: MSH.}Image credit: MSH.

Today, October 15, children, schools, and communities around the world mark Global Handwashing Day.

Washing hands with soap is the "most effective and inexpensive way to prevent diarrheal and acute respiratory infections, which take the lives of millions of children in developing countries every year." In addition to handwashing with soap, proper sanitation and safe drinking water are key to preventing disease.

"Most of what we need to do to bring down the rate of child deaths is inexpensive & straightforward," USAID Administrator Raj Shah said today on Twitter. In addition to handwashing with soap, "add a bednet, vaccines, nutrition, rehydration, newborn care; we know how to drastically reduce child deaths."

SWSS team and NGO members visited a local shop for information, education, and communication materials in Baghalak village of Nahrin district, Baghlan province. {Photo credit: Bashir Ahmad, CLTS Supervisor/SWSS.}Photo credit: Bashir Ahmad, CLTS Supervisor/SWSS.

Afghanistan has yet another village which has successfully become an Open Defecation Free (ODF) zone. Baghalak is a village in Nahrin district with 630 inhabitants dispersed among 90 households --- each with unused latrines in poor condition. For this reason, Baghalak was selected by the USAID-funded project, Sustainable Water Supply and Sanitation (SWSS) and the Organization for Health Promotion & Management to partake in community-led total sanitation (CLTS) training.

Prior to CLTS’ involvement in the village of Baghalak, the traditional latrines also lacked hand washing facilities, which is crucial to proper sanitation. In addition, significant amounts of human waste could be seen on farms, gardens, and sidewalks. As is a common problem in communities without CLTS instruction, latrines tend to go unused due to the lack of communal education regarding their importance. While the hygienic and sanitation status of the community were in severe need of improvement, there also existed a strong desire within the community to reduce their high incidences of infectious illnesses, particularly diarrheal diseases.

A new hand-washing station in Toghak, Afghanistan. {Photo credit: Nikmohammad CLTS Facilitator/MSH.}Photo credit: Nikmohammad CLTS Facilitator/MSH.

In the small Afghan village of Toghak, where open defecation affected the sanitation and health of the community, two women took the initiative to mobilize themselves and others into transforming Toghak.

Ms. Fatima and Ms. Rukhsar attended a community-led total sanitation (CLTS) workshop in the neighboring village of Gheyas Said Abd and learned life-saving lessons they wanted to take back to their village. They learned that flies tend to breed in bacteria infested places, particularly human feces, and then transport the fecal matter to food meant for human consumption.

Knowing that this knowledge would motivate their community to improve their sanitation efforts, the women did not waste any time.

When the women returned from the workshop, they recruited twenty women from Toghak willing to help them improve the latrines. They also requested the assistance of CLTS facilitators to come to Toghak and map the high frequency defecation areas in order to identify the best locations for new latrines.

Within a week the women made improvements to 20 latrines. Within three months 50 new latrines were built.

 {Photo credit: Mahjan CLTS Facilitator.}Washing hands. Itarchi Hakimabad, Badakhshan, Afghanistan.Photo credit: Mahjan CLTS Facilitator.

The USAID-funded Sustainable Water Supply and Sanitation Project, Afghanistan (SWSS) project increases access to potable water and sanitation services in Afghan communities and decreases the prevalence of water borne diseases through household hygiene interventions. Led by the Association for Rural Development, in partnership with Management Sciences for Health, SWSS has led nearly 400 communities in Afghanistan to become Open Defecation Free. The MSH components of the project have succeeded under the astute leadership of Dr. Abdul Hatifie, the team leader for Sustainable Health Outcomes, and Dr. Logarwal, the BCC Material and Media Specialist. Together they have led the successful implementation of innovative approaches in all aspects of the SWSS project. To learn more about SWSS’s accomplishments, please see the cover article in this month’s USAID Global Waters magazine.

Three Afghan children. {Photo credit: MSH.}Photo credit: MSH.

About 7.6 million children under age five die each year of preventable causers; 3 million — 40 percent — are newborns (under 28 days old). Ninety-nine percent of these occur in developing countries; three-quarters are mainly due to preventable causes such as neonatal conditions, pneumonia, diarrhea, malaria, and measles. Many of these under-five deaths could be averted by known, affordable, low-technology interventions.

Any preventable child death is one too many.

Here are 10 important interventions for child survival --- a list that is by no means exhaustive:

  1. Exclusive breastfeeding

    Could keep 1.3 million infants from dying (including by preventing pneumonia)

  2. Long-lasting, insecticide-treated bednets

    Would save more than 500,000 children by preventing malaria

  3. Vaccines, such as PCV, Hib, and rotavirus

    Would help prevent common childhood illnesses, such as measles, and save children’s lives

  4. Micronutrient supplements, such as vitamin A and zinc

    Would fight malnutrition. (While not a direct cause of death, malnutrition contributes indirectly to more than one-third of these deaths.)

Ezekiel Kyasesa, village health team coordinator in western Uganda. {Photo credit: Margaret Hartley/MSH.}Photo credit: Margaret Hartley/MSH.

Ezekiel Kyasesa is a village health team coordinator and supervisor in Kasese District, western Uganda. He supports 11 villages, 90 parishes, and 2 health centers.

Ezekiel has been working in community health for a few years, but only on a small scale. A year ago, he was selected to attend a training provided by STRIDES for Family Health to learn new family planning, child survival, and reproductive health information and the skills to become a village health team member. He was then nominated by his peers to become the coordinator and supervisor.

Now Ezekiel is educated and has the skills to go out to the communities and talk to people about the benefits of going to the health center for a range of services. The village health teams are a crucial link to sharing knowledge and information between the clinics and the communities.

Ezekiel and his village health team visit 10 households two days each week (20 visits per team member each week). He explained that they discuss with the mothers --- the key person to a healthy family --- four topics:

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