The majority of schools in developing countries still do not have adequate water, sanitation and washing facilities and many schools have none a all. This threatens the health of children and contributes to low school attendance, performance and completion rates, especially for girls.
While WASH in schools is not an MDG target, many sectoral stakeholders recognize the importance of the issue, and have prioritized programmes to address it. UNICEF has specifically committed itself to the goal of water and sanitation facilities in all primary schools by 2015.
New data collected by UNICEF in countries in which it works shows that there is still a long way to go to achieve this goal. In the 60 countries UNICEF has identified as priority for WASH interventions fewer than half of primary schools have adequate water facilities and just 37 percent have adequate sanitation facilities. In reality, the situation is likely even worse: these figures are primarily based on government standards, which are often outdated. For example, standards in many countries do not take into account the need for handwashing facilities near toilets, for private toilet facilities for girls, or for the need for lower student-to-toilet ratios for girls.
Substantial progress is being made by UNICEF and its partners in addressing the WASH-in-schools challenge, but it is also clear from these new figures that much more needs to be done to step up progress.
Hygiene and Sanitation Promotion
Hygiene
People everywhere in the world wash their hands, but relatively few wash their hands with soap at key times (after defecation and handling children’s feces, before eating and food preparation and before caring for children). If hand-washing with soap increased significantly, diarrhea rates would fall substantially and the incidence of other diseases would also be reduced, including pneumonia, trachoma, scabies and influenza. Consequently, the promotion of hand-washing with soap at key times is a cornerstone of UNICEF WASH programmes at sub-national, national and global levels.
Handwashing promotion was given a substantial boost in 2008 with the launch of the first-ever Global Handwashing Day (GHD), an initiative promoted by UNICEF through the Public-Private Partnership for Handwashing with Soap, which also includes USAID, the US Centers for Disease Control and Prevention, the Water and Sanitation Program (WSP), the Academy for Educational Development (AED), Unilever and Procter & Gamble.
GHD was celebrated on October 15th in a total of 82 countries, where some 200 million school children washed their hands with soap, including 80 million in India who washed their hands before their mid-day meal. The event was widely publicised through national media outlets as well as other means such as SMS messaging, school events, billboard campaigns and government outreach networks. Celebrities were engaged as spokespersons, including the Australian children’s music group, the Wiggles, the Angolan singer, Pedrito do Bie, and one of India’s best known cricketers, Sachin Tendulkar. In other populous countries large turnouts were also achieved, including in Bangladesh where over 15 million students from 75,000 primary and secondary schools participated, in Indonesia where 40,000 students from 600 schools participated and Ethiopia where 500,000 school children participated in events held across the country.
The Global Handwashing Day is helping to stimulate longer-term initiatives such as in Latin America where UNICEF, WSP, the Swiss development agency and PAHO/WHO launched a regional programme for developing national handwashing campaigns. Possibly the most far reaching spin-off effects from the GHD experience are new partnership possibilities opening up with the private sector for handwashing promotion in new countries due to the high degree of participation of soap manufactures and other companies in the event.
At country level UNICEF used the GHD strategically to reinforce existing initiatives, such as in Malawi were events were organized through the existing SOPO national handwashing promotion campaign, and in other countries where the GHD activities fed into existing WASH-in-Schools hygiene education programmes.
In an ongoing effort to mainstream hygiene into UNICEF’s broader child survival and development agenda, an increasing number of country offices are prioritizing handwashing with soap messages into integrated campaigns, such as in northern Sudan where five key messages (hand washing, personal hygiene, importance of routine immunization, mosquito nets and exclusive breastfeeding) were broadcast in 2008, targeting 31 million people and in Pakistan where almost 2 million children were reached with an integrated package of interventions including hygiene promotion.
In response to the growing evidence base, handwashing with soap is also increasingly prioritized within UNICEF-supported health and nutrition programmes. In Nepal, for example, new local evidence showing the importance of handwashing by both attendants and mothers on infant and maternal survival rates has prompted a revision of the national neo-natal care package.
Changing behaviour patterns around hygiene practices is a time-consuming process, and it is often difficult to measure progress directly. Most studies infer progress by using proxy indicators like soap availability or knowledge of handwashing, such as a 2008 study of the child health campaign in Pakistan that indicated a significant increase in the percentage of mothers who could identify key times for handwashing. This year there is also more direct evidence from one of UNICEF’s larger programmes that hygiene practices are improving. A mapping exercise in Bangladesh covering over 130,000 programme communities showed significant increases in handwashing after defecation (from 17 per cent to 30 per cent) and in caregiver handwashing after handling child faeces (from 22 per cent to 34 per cent). This same study, however, showed how much work still remains: only one per cent of the cohort washed their hands correctly using soap or ash.
It is clear that UNICEF and its partners at global and national levels will need to continue to stress the promotion of handwashing with soap within WASH programmes, and within the broader UNICEF agenda for children. Consequently UNICEF is taking steps to build capacity in this area both within in its own staff cadre and amongst partners.
The extensive field-level research through the “Project Champion” partnership with Unilever was concluded in 2008. The research yielded valuable knowledge on strategies and methodologies for promote handwashing amongst poor communities. The research showed, for example, that older girls are key change agents if they are targeted specifically and reached at critical points in their lives, and that a global promotional programme design is valid if it is executed in different ways across different communities. These and other findings are now being used to inform promotional programmes generally and to develop a handwashing with soap promotional programme with the Unilever Lifebuoy soap brand.
Sanitation
Like with hygiene, the importance of sanitation for children and their families is beyond dispute. Improved sanitation will help prevent the 1.5 million child deaths caused by diarrhoea each year, and it will reduce mortality rates from malnutrition and opportunistic infections such as pneumonia. Sanitation also improves the quality of life and dignity of women, protects the environment, and generates economic benefits for communities and nations.
Sanitation is a key part of all UNICEF WASH programmes in priority countries. Interventions cover a range of activities including advocacy for the prioritization of sanitation within global and national development agendas, the development of progressive national policy instruments, and field-level interventions designed to help people improve the sanitation situation in their households and communities.
The International Year of Sanitation was an unprecedented opportunity for raising the profile of sanitation amongst decision makers and UNICEF took full advantage of it. UNICEF coordinated the UN Water Task Force on Sanitation, which spearheaded promotional activities at the global level, provided support at regional and country level, and developed the core set of advocacy material.
In its own capacity, UNICEF used its extensive global presence to push forward the sanitation agenda through IYS-related activities. At regional level UNICEF helped to organize two key regional sanitation conferences linked to IYS in Africa (AfricaSan+5) and South Asia (SACOSAN III). Through the JMP, UNICEF also released special regional data compilation reports for five regions. At country level, UNICEF staff used IYS as a tool in myriad ways to promote the prioritization of appropriate sanitation programmes within national development agendas, including – notably – the development of new plans, agreement on new programming strategies, and new commitments from governments for increased resource outlays. In several countries – including Angola, Djibouti, Madagascar, Namibia and Sudan – IYS was the catalyst for strengthening the national sanitation institutional and policy environment.
The IYS initiative was designed to increase awareness, achieve political buy-in and accelerate progress towards the sanitation MDG. Preliminary feedback indicates that these expectations have been exceeded. The momentum that was created at a global level is translating into activities and activism at regional and country levels that should continue well beyond 2008. The IYS messages have taken root around the world and the products of this past year’s work
serve as structure and facilitation for much of the dialogue that has now begun.
For UNICEF the second key result of 2008 was a broad agreement within UNICEF on the programming framework for community approaches to Total Sanitation (CATS) within the organization, and its further expansion to new country programmes. Due to widely varying country conditions and programming contexts the exact design of total sanitation programmes in each country cannot and should not be dictated from headquarters. However, in a July meeting, consensus was reached on key principles and strategies for UNICEF-supported programmes based on CATS with a focus on building demand for sanitation, community leadership, integration of hygiene promotion and encouraging entire communities to abandon the practice of open defecation.
Capacity building for staff and partners on the new approach was carried out in cooperation with global experts and regional research and training partners. In the WCAR region, for example, UNICEF worked with CREPA (Centre Régional pour l'Eau Potable et l'Assainissement à faible coût) and WaterAid to introduce CATS through regional workshops, fundraising, evidence building and documentation. At country level, UNICEF and partners organized a range of CATS capacity building exercises.
Twenty UNICEF country programmes are now actively engaged in CATS; additional countries have carried out training and planning exercises, and plan to introduce pilots in 2009. The approach is increasingly being adopted by governments and its partners in Africa ncluding – encouragingly – in Eritrea and Ethiopia where sanitation coverage is very low.
Community sanitation approaches have led to unprecedented progress in some Asian countries. In Bangladesh, for example, government estimates indicate that the practice of open defecation has dropped by a third, from over 40 per cent in 2003 to 10 per cent in 2008.
There are now preliminary but concrete indications that the approach has similar potential in Africa. UNICEF-supported programmes based on CATS are registering unparalleled uptake rates in pilot areas, such as in Mozambique where the introduction of a CATS methodology in an existing programme area resulted in a many-fold increase in the rate of latrine construction by households. In other countries significant numbers of communities have already achieved certified open defecation free (ODF) status, including over 400 villages in Zambia in 2008.
UNICEF and most stakeholders in the sector believe that community-based sanitation approaches are the way forward for achieving the MDG sanitation target and the resulting health and societal benefits. Thus the spread of the approach is indeed a positive sign. However, CATS involves a great deal of effort, time and skill to implement correctly and to assure sustainability, thus UNICEF will increasingly focus on assuring the quality of the programming efforts. This will be done through careful study of existing programmes (such as the ongoing review of the related community led total sanitation programme in Cambodia) and continuing engagement with key partners.
Direct support for the construction of latrines and toilets is no longer the focus of UNICEF country programmes. Nevertheless, many are built in countries around the world as a result of UNICEF interventions, including in emergencies and through pilot activities. In 2008, an estimated 13 million people (including 2 million children under five) gained access to an improved sanitation facility, about two-thirds through regular programmes and one-third through humanitarian interventions in emergencies
Water Supply
While the number of people with access to improved water supply is steadily increasing, much remains to be done. There are still hundreds of millions of people around the world who have-never had adequate access, who have only limited access, or who no longer have access to safe drinking water due to breakdowns, emergencies, or the effects of climate change.
UNICEF helps to develop enabling environments – including progressive policies, improved budgeting mechanisms and strengthened institutions – and leverage new funding for safe, affordable and sustainable water delivery systems. This upstream work is highly effective because it is grounded in our ongoing practical work with communities, and our long partnerships with government and non-government stakeholders in countries around the world.
At the same time, UNICEF continues to directly support the construction and rehabilitation of water sources, with a continuing focus on rural communities that are marginalized in some way, are isolated geographically, have serious water quality problems, are in guinea worm endemic areas, or are affected by emergencies. In 2008 at total of 24 million people gained access to improved water sources, 8.1 million through regular programming and 15.9 million in emergencies. Of these beneficiaries, an estimated 3.8 million are children under five years old.
Included amongst these emergency programme beneficiaries are 2 million people in Iraq, 1.3 million in Sudan and just under a million in Zimbabwe in response to the cholera emergency. Other major WASH humanitarian response programmes in 2008 included DR Congo, Iraq and Tanzania.
The high cost of boreholes - especially in sub-Saharan Africa – is a key constraint to achieving water targets, and UNICEF redoubled efforts to address this in 2008. Globally, work with the Rural Water Supply Network (RWSN) continued on the development of a Code of Practice for Cost Effective Boreholes, and many country offices took steps to reduce local costs through the introduction of cost efficiency measures in drilling programmes and the promotion of low-cost alternatives.
In a development related to cost effective boreholes, UNICEF embarked on an initiative to promote manual drilling of boreholes in 2008 (manually-drilled boreholes are up to one-tenth the cost of machine-drilled boreholes). In partnership with specialist agencies (including EnterpriseWorks/VITA and Practica), the initiative is systematically assessing the hydrogeological potential of manual-drilling in 20 target sub-Saharan African countries, producing case studies and other advocacy material to promote manual-drilling as a viable alternative both globally and nationally, as well as developing maps, training manuals and other materials.
The sustainability of water supply systems continues to be a key area of focus for UNICEF, especially in Africa where breakdown rates for handpumps and other technologies can be very high. In an initiative described in previous annual reports, sustainability has been highlighted within an ongoing Government of Netherlands-supported WASH programme in Eastern and Southern Africa. In that programme, sustainability-related criteria (including a series of process-related indicators as well as the physical facility breakdown rates) are monitored by independent bodies and used to determine the overall success of projects in countries.
In 2008 two countries – Malawi and Mozambique – conducted these sustainability checks, with
the results being used to adjust and improve implementation. Also related to sustainability is the UNICEF-supported African Handpump Market Mapping Study, initiated in 2008, which is studying procurement patterns and manufacturing capacity on the continent. The results will be used to develop new support strategies to improve handpump and spare parts supply chains.
UNICEF is also becoming more active in the area of “self supply”: a model in which community members are encouraged to use locally-available skills, materials and technologies to construct or upgrade their own water sources, either in individual households or within groups of households. In some countries – notably in Africa – such programmes have been shown to be more cost effective and sustainable than government-led programmes in some situations. UNICEF initiated self supply rural water activities in Ethiopia, Mali and Zambia in 2008.
Finally in the area of water supply, UNICEF was a major contributor to guinea worm eradication efforts in all six remaining endemic countries in 2008 (Ethiopia, Ghana, Mali, Niger, Nigeria and Sudan), and continued to provide support ongoing surveillance and cross-border containment efforts in other countries (see Section 1 for additional information on the guinea worm eradication programme). In the endemic countries the focus of UNICEF support is on safe water source construction. In southern Sudan, where the most cases continue to be registered, the UNICEF-supported water point construction and rehabilitation programme is the key reason that case numbers are dropping so significantly: in 2008, 84 new water systems were constructed in affected villages, serving a total of 46,000 people.
Water Quality
UNICEF promotes water safety through interventions including the protection of the water sources, building national capacity for water safety planning and monitoring, developing new water quality monitoring methodologies, and support to a variety of interventions in communities.
A key area of support continued to be the promotion of household water treatment and safe storage (HWTS) as a high-impact, low-cost intervention for reducing diarrhoea, cholera and other water quality related diseases. In 2008, UNICEF took steps to improve the quality and consistency of interventions in this area by developing and disseminating a new set of HWTS guidelines for country offices (which will be incorporated into a WebEx training package in 2009).
More country offices are active in the promotion of HWTS than at any time in the past. Interventions include upstream work on building the evidence base, advocacy, defining strategies, developing national plans of action as well as the promotion of particular technologies such as locally-produced ceramic and bio-sand filters (e.g. in Cambodia, DPR Korea, Myanmar, Paraguay and elsewhere); low-cost home chlorination (Angola, Somalia, Tanzania) and no-cost solar disinfection (Kenya, Madagascar and Bhutan).
In partnership with American Express, UNICEF continued to support and monitor pilot HWTS interventions in four African countries and develop a documentation package to more widely promote cost effective techniques. At the same time, UNICEF helped to expand and inform the group of partners and private sector actors active in the area HWTS through work with WHO within the International Network to Promote HWTS, and by hosting two meetings at the global level: a consultation with global experts and an information exchange session with manufacturers of household water treatment products.
On the specific problem of arsenic-contaminated drinking water sources, UNICEF continued to support government mitigation programmes in Asia and Africa in 2008. Activities supported include source substitution, water treatment and the critical area of testing and mapping. In Nepal, for example, testing in the 20 affected districts is now complete, and in Bangladesh UNICEF has instituted a quarterly testing programme of a set of water sources to monitor treatment efficacy.
A comprehensive evaluation of the arsenic mitigation programmes in Cambodia, Lao PDR, Myanmar and Viet Nam was conducted in 2008. It yielded a valuable set of recommendations to improve mitigation programming that will be applied in these and other countries. The Arsenic Primer and the global occurrence study discussed in last year’s report were published and distributed in 2008. UNICEF has more experience in arsenic mitigation support than any other international agency; information tools like these that synthesize this experience help to improve detection and mitigation programmes in countries around the world.
Finally, UNICEF continued to build capacity and institutional environment for the promotion of water safety through a variety of training programmes and through the development of improved national water quality standards and of water safety plans (including in Myanmar, Nigeria, Pakistan and Viet Nam in 2008).
WASH in Schools
UNICEF continues to prioritize WASH-in-Schools programming to help improve education enrollment, retention and performance– especially amongst girls – as part of the Child Friendly School (CFS) initiative and in line with MDG Goal 2 for universal primary education and Goal 3 for gender equality. WASH-in-Schools programming also contributes to improved health outcomes for children and the health of communities as a whole.
Eighty-eight country offices supported WASH-in-schools activities in 2008, up slightly from previous years . A total of US$ 28.6 million was spent on WASH-in-Schools in 2008, representing 9 per cent of UNICEF’s total WASH expenditure.
Expenditure within UNICEF-supported WASH-in-schools programmes is increasingly weighted towards sanitation and hygiene. In 2008 74 per cent of expenditure was on sanitation and hygiene and only 26 per cent on water supply (compared to 56 per cent and 54 per cent on sanitation and hygiene in 2007 and 2006 respectively).
WASH-in-Schools activities vary widely from country to country, but in most cases involve an integrated programme that directly supports the construction of safe and private washing and sanitation facilities, improved drinking water, and hygiene education in target schools. In 2008, an estimated 4.2 million children benefited from these direct interventions, in a total of 20,489 schools. Most of these beneficiaries are in the regions of South Asia (notably in India with 1.6 million beneficiaries), West and Central Africa (e.g. Nigeria, 122,000), and Eastern and Southern Africa (e.g. Mozambique, 102,000).
Like other components of the UNICEF WASH programme, direct beneficiaries represent only the tip of the iceberg. Increasingly, UNICEF country offices focus on efforts to scale up WASH-in-Schools through mainstreaming in government programmes and institutions with support from civil society and the private sector, and through leveraging resources from government budgets and other finance streams.
There are signs that this type of upstream engagement with governments – both by UNICEF and its partners – is resulting in an increased recognition by government of the importance of WASH in schools: the number of priority countries that have developed national plans to provide water, sanitation and hygiene education to all primary schools is slowly but steadily increasing.
One example is Angola, where the UNICEF-supported WASH-in-Schools programme has led to the inclusion of school WASH facilities in national plans for the first time. Also in 2008, safe water supply and gender-segregated toilet facility designs were incorporated into national school standards in China, the Gambia, Pakistan and Thailand. In other countries, including DPR Korea and Tanzania – UNICEF supported ongoing development of new child-friendly school toilet designs.
There has also been success in ongoing efforts to institutionalize hygiene education within national education curricula – including in China, DR Congo, Nicaragua and Sudan in 2008 – and on institutionalizing hygiene education within teacher training programmes such as in Peshawar, Pakistan where a government School Sanitation and Hygiene Education Centre established in May 2007 with UNICEF support has already trained over 500 education managers, supervisors, administrators and school teachers.
Despite these and other signs of progress, there continue to be serious shortfalls. As discussed in Section 1.2, fewer than half of primary schools in UNICEF priority countries have adequate water and sanitation facilities. In some African countries the situation can be much worse, such as in southern Sudan, where only one in ten schools has adequate water and sanitation facilities. And even where facilities do exist, they are often inadequate. Elsewhere, even when national coverage averages are reasonable, disparities are marked – such as in parts of Albania where a recent study showed that fewer than 10 per cent of schools have adequate toilets.
In many cases the number of schools without adequate facilities is unknown, and this lack of data seriously constrains advocacy and planning efforts. Only 57 per cent of countries in which UNICEF is active have readily-available data on water supplies in schools, and only 49 per cent
have data on sanitation facilities.
UNICEF is working with government to improve data availability, such as in Malawi and Burundi where national school WASH facility surveys were conducted in 2008.
In addition to support to data gathering, UNICEF also continues to help build a broader WASH-in-schools knowledge base at country level through the sponsorship of studies and targeted research. Examples in 2008 include KAP studies of hand-washing in school settings (India and Tajikistan) and programme baseline studies and evaluations (such as in Bangladesh, Egypt, Mali and Yemen).
Key amongst these studies is the WASH-in-schools impact and sustainability study, discussed later.
While WASH in schools is not an MDG target, many sectoral stakeholders recognize the importance of the issue, and have prioritized programmes to address it. UNICEF has specifically committed itself to the goal of water and sanitation facilities in all primary schools by 2015.
New data collected by UNICEF in countries in which it works shows that there is still a long way to go to achieve this goal. In the 60 countries UNICEF has identified as priority for WASH interventions fewer than half of primary schools have adequate water facilities and just 37 percent have adequate sanitation facilities. In reality, the situation is likely even worse: these figures are primarily based on government standards, which are often outdated. For example, standards in many countries do not take into account the need for handwashing facilities near toilets, for private toilet facilities for girls, or for the need for lower student-to-toilet ratios for girls.
Substantial progress is being made by UNICEF and its partners in addressing the WASH-in-schools challenge, but it is also clear from these new figures that much more needs to be done to step up progress.
Hygiene and Sanitation Promotion
Hygiene
People everywhere in the world wash their hands, but relatively few wash their hands with soap at key times (after defecation and handling children’s feces, before eating and food preparation and before caring for children). If hand-washing with soap increased significantly, diarrhea rates would fall substantially and the incidence of other diseases would also be reduced, including pneumonia, trachoma, scabies and influenza. Consequently, the promotion of hand-washing with soap at key times is a cornerstone of UNICEF WASH programmes at sub-national, national and global levels.
Handwashing promotion was given a substantial boost in 2008 with the launch of the first-ever Global Handwashing Day (GHD), an initiative promoted by UNICEF through the Public-Private Partnership for Handwashing with Soap, which also includes USAID, the US Centers for Disease Control and Prevention, the Water and Sanitation Program (WSP), the Academy for Educational Development (AED), Unilever and Procter & Gamble.
GHD was celebrated on October 15th in a total of 82 countries, where some 200 million school children washed their hands with soap, including 80 million in India who washed their hands before their mid-day meal. The event was widely publicised through national media outlets as well as other means such as SMS messaging, school events, billboard campaigns and government outreach networks. Celebrities were engaged as spokespersons, including the Australian children’s music group, the Wiggles, the Angolan singer, Pedrito do Bie, and one of India’s best known cricketers, Sachin Tendulkar. In other populous countries large turnouts were also achieved, including in Bangladesh where over 15 million students from 75,000 primary and secondary schools participated, in Indonesia where 40,000 students from 600 schools participated and Ethiopia where 500,000 school children participated in events held across the country.
The Global Handwashing Day is helping to stimulate longer-term initiatives such as in Latin America where UNICEF, WSP, the Swiss development agency and PAHO/WHO launched a regional programme for developing national handwashing campaigns. Possibly the most far reaching spin-off effects from the GHD experience are new partnership possibilities opening up with the private sector for handwashing promotion in new countries due to the high degree of participation of soap manufactures and other companies in the event.
At country level UNICEF used the GHD strategically to reinforce existing initiatives, such as in Malawi were events were organized through the existing SOPO national handwashing promotion campaign, and in other countries where the GHD activities fed into existing WASH-in-Schools hygiene education programmes.
In an ongoing effort to mainstream hygiene into UNICEF’s broader child survival and development agenda, an increasing number of country offices are prioritizing handwashing with soap messages into integrated campaigns, such as in northern Sudan where five key messages (hand washing, personal hygiene, importance of routine immunization, mosquito nets and exclusive breastfeeding) were broadcast in 2008, targeting 31 million people and in Pakistan where almost 2 million children were reached with an integrated package of interventions including hygiene promotion.
In response to the growing evidence base, handwashing with soap is also increasingly prioritized within UNICEF-supported health and nutrition programmes. In Nepal, for example, new local evidence showing the importance of handwashing by both attendants and mothers on infant and maternal survival rates has prompted a revision of the national neo-natal care package.
Changing behaviour patterns around hygiene practices is a time-consuming process, and it is often difficult to measure progress directly. Most studies infer progress by using proxy indicators like soap availability or knowledge of handwashing, such as a 2008 study of the child health campaign in Pakistan that indicated a significant increase in the percentage of mothers who could identify key times for handwashing. This year there is also more direct evidence from one of UNICEF’s larger programmes that hygiene practices are improving. A mapping exercise in Bangladesh covering over 130,000 programme communities showed significant increases in handwashing after defecation (from 17 per cent to 30 per cent) and in caregiver handwashing after handling child faeces (from 22 per cent to 34 per cent). This same study, however, showed how much work still remains: only one per cent of the cohort washed their hands correctly using soap or ash.
It is clear that UNICEF and its partners at global and national levels will need to continue to stress the promotion of handwashing with soap within WASH programmes, and within the broader UNICEF agenda for children. Consequently UNICEF is taking steps to build capacity in this area both within in its own staff cadre and amongst partners.
The extensive field-level research through the “Project Champion” partnership with Unilever was concluded in 2008. The research yielded valuable knowledge on strategies and methodologies for promote handwashing amongst poor communities. The research showed, for example, that older girls are key change agents if they are targeted specifically and reached at critical points in their lives, and that a global promotional programme design is valid if it is executed in different ways across different communities. These and other findings are now being used to inform promotional programmes generally and to develop a handwashing with soap promotional programme with the Unilever Lifebuoy soap brand.
Sanitation
Like with hygiene, the importance of sanitation for children and their families is beyond dispute. Improved sanitation will help prevent the 1.5 million child deaths caused by diarrhoea each year, and it will reduce mortality rates from malnutrition and opportunistic infections such as pneumonia. Sanitation also improves the quality of life and dignity of women, protects the environment, and generates economic benefits for communities and nations.
Sanitation is a key part of all UNICEF WASH programmes in priority countries. Interventions cover a range of activities including advocacy for the prioritization of sanitation within global and national development agendas, the development of progressive national policy instruments, and field-level interventions designed to help people improve the sanitation situation in their households and communities.
The International Year of Sanitation was an unprecedented opportunity for raising the profile of sanitation amongst decision makers and UNICEF took full advantage of it. UNICEF coordinated the UN Water Task Force on Sanitation, which spearheaded promotional activities at the global level, provided support at regional and country level, and developed the core set of advocacy material.
In its own capacity, UNICEF used its extensive global presence to push forward the sanitation agenda through IYS-related activities. At regional level UNICEF helped to organize two key regional sanitation conferences linked to IYS in Africa (AfricaSan+5) and South Asia (SACOSAN III). Through the JMP, UNICEF also released special regional data compilation reports for five regions. At country level, UNICEF staff used IYS as a tool in myriad ways to promote the prioritization of appropriate sanitation programmes within national development agendas, including – notably – the development of new plans, agreement on new programming strategies, and new commitments from governments for increased resource outlays. In several countries – including Angola, Djibouti, Madagascar, Namibia and Sudan – IYS was the catalyst for strengthening the national sanitation institutional and policy environment.
The IYS initiative was designed to increase awareness, achieve political buy-in and accelerate progress towards the sanitation MDG. Preliminary feedback indicates that these expectations have been exceeded. The momentum that was created at a global level is translating into activities and activism at regional and country levels that should continue well beyond 2008. The IYS messages have taken root around the world and the products of this past year’s work
serve as structure and facilitation for much of the dialogue that has now begun.
For UNICEF the second key result of 2008 was a broad agreement within UNICEF on the programming framework for community approaches to Total Sanitation (CATS) within the organization, and its further expansion to new country programmes. Due to widely varying country conditions and programming contexts the exact design of total sanitation programmes in each country cannot and should not be dictated from headquarters. However, in a July meeting, consensus was reached on key principles and strategies for UNICEF-supported programmes based on CATS with a focus on building demand for sanitation, community leadership, integration of hygiene promotion and encouraging entire communities to abandon the practice of open defecation.
Capacity building for staff and partners on the new approach was carried out in cooperation with global experts and regional research and training partners. In the WCAR region, for example, UNICEF worked with CREPA (Centre Régional pour l'Eau Potable et l'Assainissement à faible coût) and WaterAid to introduce CATS through regional workshops, fundraising, evidence building and documentation. At country level, UNICEF and partners organized a range of CATS capacity building exercises.
Twenty UNICEF country programmes are now actively engaged in CATS; additional countries have carried out training and planning exercises, and plan to introduce pilots in 2009. The approach is increasingly being adopted by governments and its partners in Africa ncluding – encouragingly – in Eritrea and Ethiopia where sanitation coverage is very low.
Community sanitation approaches have led to unprecedented progress in some Asian countries. In Bangladesh, for example, government estimates indicate that the practice of open defecation has dropped by a third, from over 40 per cent in 2003 to 10 per cent in 2008.
There are now preliminary but concrete indications that the approach has similar potential in Africa. UNICEF-supported programmes based on CATS are registering unparalleled uptake rates in pilot areas, such as in Mozambique where the introduction of a CATS methodology in an existing programme area resulted in a many-fold increase in the rate of latrine construction by households. In other countries significant numbers of communities have already achieved certified open defecation free (ODF) status, including over 400 villages in Zambia in 2008.
UNICEF and most stakeholders in the sector believe that community-based sanitation approaches are the way forward for achieving the MDG sanitation target and the resulting health and societal benefits. Thus the spread of the approach is indeed a positive sign. However, CATS involves a great deal of effort, time and skill to implement correctly and to assure sustainability, thus UNICEF will increasingly focus on assuring the quality of the programming efforts. This will be done through careful study of existing programmes (such as the ongoing review of the related community led total sanitation programme in Cambodia) and continuing engagement with key partners.
Direct support for the construction of latrines and toilets is no longer the focus of UNICEF country programmes. Nevertheless, many are built in countries around the world as a result of UNICEF interventions, including in emergencies and through pilot activities. In 2008, an estimated 13 million people (including 2 million children under five) gained access to an improved sanitation facility, about two-thirds through regular programmes and one-third through humanitarian interventions in emergencies
Water Supply
While the number of people with access to improved water supply is steadily increasing, much remains to be done. There are still hundreds of millions of people around the world who have-never had adequate access, who have only limited access, or who no longer have access to safe drinking water due to breakdowns, emergencies, or the effects of climate change.
UNICEF helps to develop enabling environments – including progressive policies, improved budgeting mechanisms and strengthened institutions – and leverage new funding for safe, affordable and sustainable water delivery systems. This upstream work is highly effective because it is grounded in our ongoing practical work with communities, and our long partnerships with government and non-government stakeholders in countries around the world.
At the same time, UNICEF continues to directly support the construction and rehabilitation of water sources, with a continuing focus on rural communities that are marginalized in some way, are isolated geographically, have serious water quality problems, are in guinea worm endemic areas, or are affected by emergencies. In 2008 at total of 24 million people gained access to improved water sources, 8.1 million through regular programming and 15.9 million in emergencies. Of these beneficiaries, an estimated 3.8 million are children under five years old.
Included amongst these emergency programme beneficiaries are 2 million people in Iraq, 1.3 million in Sudan and just under a million in Zimbabwe in response to the cholera emergency. Other major WASH humanitarian response programmes in 2008 included DR Congo, Iraq and Tanzania.
The high cost of boreholes - especially in sub-Saharan Africa – is a key constraint to achieving water targets, and UNICEF redoubled efforts to address this in 2008. Globally, work with the Rural Water Supply Network (RWSN) continued on the development of a Code of Practice for Cost Effective Boreholes, and many country offices took steps to reduce local costs through the introduction of cost efficiency measures in drilling programmes and the promotion of low-cost alternatives.
In a development related to cost effective boreholes, UNICEF embarked on an initiative to promote manual drilling of boreholes in 2008 (manually-drilled boreholes are up to one-tenth the cost of machine-drilled boreholes). In partnership with specialist agencies (including EnterpriseWorks/VITA and Practica), the initiative is systematically assessing the hydrogeological potential of manual-drilling in 20 target sub-Saharan African countries, producing case studies and other advocacy material to promote manual-drilling as a viable alternative both globally and nationally, as well as developing maps, training manuals and other materials.
The sustainability of water supply systems continues to be a key area of focus for UNICEF, especially in Africa where breakdown rates for handpumps and other technologies can be very high. In an initiative described in previous annual reports, sustainability has been highlighted within an ongoing Government of Netherlands-supported WASH programme in Eastern and Southern Africa. In that programme, sustainability-related criteria (including a series of process-related indicators as well as the physical facility breakdown rates) are monitored by independent bodies and used to determine the overall success of projects in countries.
In 2008 two countries – Malawi and Mozambique – conducted these sustainability checks, with
the results being used to adjust and improve implementation. Also related to sustainability is the UNICEF-supported African Handpump Market Mapping Study, initiated in 2008, which is studying procurement patterns and manufacturing capacity on the continent. The results will be used to develop new support strategies to improve handpump and spare parts supply chains.
UNICEF is also becoming more active in the area of “self supply”: a model in which community members are encouraged to use locally-available skills, materials and technologies to construct or upgrade their own water sources, either in individual households or within groups of households. In some countries – notably in Africa – such programmes have been shown to be more cost effective and sustainable than government-led programmes in some situations. UNICEF initiated self supply rural water activities in Ethiopia, Mali and Zambia in 2008.
Finally in the area of water supply, UNICEF was a major contributor to guinea worm eradication efforts in all six remaining endemic countries in 2008 (Ethiopia, Ghana, Mali, Niger, Nigeria and Sudan), and continued to provide support ongoing surveillance and cross-border containment efforts in other countries (see Section 1 for additional information on the guinea worm eradication programme). In the endemic countries the focus of UNICEF support is on safe water source construction. In southern Sudan, where the most cases continue to be registered, the UNICEF-supported water point construction and rehabilitation programme is the key reason that case numbers are dropping so significantly: in 2008, 84 new water systems were constructed in affected villages, serving a total of 46,000 people.
Water Quality
UNICEF promotes water safety through interventions including the protection of the water sources, building national capacity for water safety planning and monitoring, developing new water quality monitoring methodologies, and support to a variety of interventions in communities.
A key area of support continued to be the promotion of household water treatment and safe storage (HWTS) as a high-impact, low-cost intervention for reducing diarrhoea, cholera and other water quality related diseases. In 2008, UNICEF took steps to improve the quality and consistency of interventions in this area by developing and disseminating a new set of HWTS guidelines for country offices (which will be incorporated into a WebEx training package in 2009).
More country offices are active in the promotion of HWTS than at any time in the past. Interventions include upstream work on building the evidence base, advocacy, defining strategies, developing national plans of action as well as the promotion of particular technologies such as locally-produced ceramic and bio-sand filters (e.g. in Cambodia, DPR Korea, Myanmar, Paraguay and elsewhere); low-cost home chlorination (Angola, Somalia, Tanzania) and no-cost solar disinfection (Kenya, Madagascar and Bhutan).
In partnership with American Express, UNICEF continued to support and monitor pilot HWTS interventions in four African countries and develop a documentation package to more widely promote cost effective techniques. At the same time, UNICEF helped to expand and inform the group of partners and private sector actors active in the area HWTS through work with WHO within the International Network to Promote HWTS, and by hosting two meetings at the global level: a consultation with global experts and an information exchange session with manufacturers of household water treatment products.
On the specific problem of arsenic-contaminated drinking water sources, UNICEF continued to support government mitigation programmes in Asia and Africa in 2008. Activities supported include source substitution, water treatment and the critical area of testing and mapping. In Nepal, for example, testing in the 20 affected districts is now complete, and in Bangladesh UNICEF has instituted a quarterly testing programme of a set of water sources to monitor treatment efficacy.
A comprehensive evaluation of the arsenic mitigation programmes in Cambodia, Lao PDR, Myanmar and Viet Nam was conducted in 2008. It yielded a valuable set of recommendations to improve mitigation programming that will be applied in these and other countries. The Arsenic Primer and the global occurrence study discussed in last year’s report were published and distributed in 2008. UNICEF has more experience in arsenic mitigation support than any other international agency; information tools like these that synthesize this experience help to improve detection and mitigation programmes in countries around the world.
Finally, UNICEF continued to build capacity and institutional environment for the promotion of water safety through a variety of training programmes and through the development of improved national water quality standards and of water safety plans (including in Myanmar, Nigeria, Pakistan and Viet Nam in 2008).
WASH in Schools
UNICEF continues to prioritize WASH-in-Schools programming to help improve education enrollment, retention and performance– especially amongst girls – as part of the Child Friendly School (CFS) initiative and in line with MDG Goal 2 for universal primary education and Goal 3 for gender equality. WASH-in-Schools programming also contributes to improved health outcomes for children and the health of communities as a whole.
Eighty-eight country offices supported WASH-in-schools activities in 2008, up slightly from previous years . A total of US$ 28.6 million was spent on WASH-in-Schools in 2008, representing 9 per cent of UNICEF’s total WASH expenditure.
Expenditure within UNICEF-supported WASH-in-schools programmes is increasingly weighted towards sanitation and hygiene. In 2008 74 per cent of expenditure was on sanitation and hygiene and only 26 per cent on water supply (compared to 56 per cent and 54 per cent on sanitation and hygiene in 2007 and 2006 respectively).
WASH-in-Schools activities vary widely from country to country, but in most cases involve an integrated programme that directly supports the construction of safe and private washing and sanitation facilities, improved drinking water, and hygiene education in target schools. In 2008, an estimated 4.2 million children benefited from these direct interventions, in a total of 20,489 schools. Most of these beneficiaries are in the regions of South Asia (notably in India with 1.6 million beneficiaries), West and Central Africa (e.g. Nigeria, 122,000), and Eastern and Southern Africa (e.g. Mozambique, 102,000).
Like other components of the UNICEF WASH programme, direct beneficiaries represent only the tip of the iceberg. Increasingly, UNICEF country offices focus on efforts to scale up WASH-in-Schools through mainstreaming in government programmes and institutions with support from civil society and the private sector, and through leveraging resources from government budgets and other finance streams.
There are signs that this type of upstream engagement with governments – both by UNICEF and its partners – is resulting in an increased recognition by government of the importance of WASH in schools: the number of priority countries that have developed national plans to provide water, sanitation and hygiene education to all primary schools is slowly but steadily increasing.
One example is Angola, where the UNICEF-supported WASH-in-Schools programme has led to the inclusion of school WASH facilities in national plans for the first time. Also in 2008, safe water supply and gender-segregated toilet facility designs were incorporated into national school standards in China, the Gambia, Pakistan and Thailand. In other countries, including DPR Korea and Tanzania – UNICEF supported ongoing development of new child-friendly school toilet designs.
There has also been success in ongoing efforts to institutionalize hygiene education within national education curricula – including in China, DR Congo, Nicaragua and Sudan in 2008 – and on institutionalizing hygiene education within teacher training programmes such as in Peshawar, Pakistan where a government School Sanitation and Hygiene Education Centre established in May 2007 with UNICEF support has already trained over 500 education managers, supervisors, administrators and school teachers.
Despite these and other signs of progress, there continue to be serious shortfalls. As discussed in Section 1.2, fewer than half of primary schools in UNICEF priority countries have adequate water and sanitation facilities. In some African countries the situation can be much worse, such as in southern Sudan, where only one in ten schools has adequate water and sanitation facilities. And even where facilities do exist, they are often inadequate. Elsewhere, even when national coverage averages are reasonable, disparities are marked – such as in parts of Albania where a recent study showed that fewer than 10 per cent of schools have adequate toilets.
In many cases the number of schools without adequate facilities is unknown, and this lack of data seriously constrains advocacy and planning efforts. Only 57 per cent of countries in which UNICEF is active have readily-available data on water supplies in schools, and only 49 per cent
have data on sanitation facilities.
UNICEF is working with government to improve data availability, such as in Malawi and Burundi where national school WASH facility surveys were conducted in 2008.
In addition to support to data gathering, UNICEF also continues to help build a broader WASH-in-schools knowledge base at country level through the sponsorship of studies and targeted research. Examples in 2008 include KAP studies of hand-washing in school settings (India and Tajikistan) and programme baseline studies and evaluations (such as in Bangladesh, Egypt, Mali and Yemen).
Key amongst these studies is the WASH-in-schools impact and sustainability study, discussed later.
