Harvested rainwater: quality,adequacy, and proximity in Ghanaian rural communities

This article presents a study that aimed to assess the accessibility, use, and quality of harvested rainwater in three rural communities in Ghana where the government of Ghana and local and international development organisations have sponsored domestic rainwater harvesting. The results showed that rainwater storage facilities were within the recommended distance of 1000m from each house. The amount of rainwater per person per day was below the recommended amount. The majority of the respondents therefore depended on other sources of water. Though the physico-chemical quality of rainwater met the WHO guideline limit for drinking water, the bacteriological quality did not. The majority of common water-associated infections experienced prior to the project have not been experienced after the project.     

WaSH as a maternal health issue: three perspectives from rural Uganda

Inadequate water, sanitation, and hygiene (WaSH) knowledge and practices affect maternal and newborn morbidity and mortality. This article describes postpartum knowledge, resources, and practices in three rural Ugandan hospitals. A lack of WaSH resources was problematic for both staff and newly-birthed mothers who demonstrated a lack of knowledge about the appropriate use of WaSH resources and the links between WaSH and health protection. These results suggest that in addition to increasing the availability of medical interventions, basic preventative public health practices should be reflected in policy and practice integrated across the spaces inhabited by pregnant women to achieve improved maternal and newborn outcomes.     

Socio-economic dynamics in slums and implications for sanitation sustainability in Kisumu,Kenya

Lack of sanitation facilities is a major challenge in slum areas, and this has implications on the health and well-being of residents. Sanitation in slums is complex due to slum living conditions, and a detailed understanding of dynamics in slums and how they impact sanitation is required. This study sought to understand the relationship between socio-economic dynamics, and sanitation provision and management in the slums of Kisumu, Kenya. The results indicate a mix of social, cultural, economic, tenancy, and relationship dynamics, all of which influence sanitation provision and management. The article calls for collaboration among various stakeholders and the use of local knowledge dissemination approaches.     

Toilet is not a dirty word: close to meeting the MDGs for sanitation?

Improving access to water and sanitation facilities has been a priority on the international development agenda. Halving the number of those who do not have access to sanitation facilities is an MDG target. This study assessed the toilet conditions in an urban slum in Ghana. Many felt that the sanitary conditions were deplorable; they were unsatisfied with having to walk over half a kilometre before using a toilet. Government efforts to improve hygiene and address sanitation problems need to take into account financial, religious, and other factors that promote the supply and maintenance of appropriate toilet facilities and services in urban communities.

Toilettes n'est pas un mot tabou : à deux doigts d'atteindre les OMD en matière d'assainissement ?

L'amélioration de l'accès à l'eau et aux installations sanitaires a été une priorité de l'ordre du jour international en matière de développement. La réduction de moitié du nombre de personnes qui n'ont pas accès à des installations d'assainissement est un OMD. Cette étude a évalué les conditions sur le plan des toilettes dans un bidonville urbain du Ghana. De nombreuses personnes estimaient que les conditions d'assainissement y étaient déplorables; elles n'étaient pas satisfaites de devoir parcourir plus d'un demi-kilomètre pour pouvoir utiliser des toilettes. Les efforts fournis par les pouvoirs publics pour améliorer l'hygiène et résoudre les problèmes d'assainissement doivent tenir compte des facteurs financiers, religieux et autres qui favorisent la fourniture et l'entretien d'installations et de services de toilettes dans les communautés urbaines.

Excusado no es una mala palabra: ¿se está próximo a cumplir con los odm en el área de saneamiento?

La ampliación del acceso al agua potable y al saneamiento ha sido una prioridad del desarrollo internacional. Una de las metas de los odm es reducir a la mitad el número de personas que actualmente carecen de acceso al saneamiento. El presente artículo valora las condiciones en que se encuentran los excusados en un barrio pobre de Ghana. Muchos de quienes residen allí consideran que las condiciones de saneamiento son deplorables, manifestando su desacuerdo con tener que caminar más de medio kilómetro para hacer uso del excusado. Los esfuerzos realizados por el gobierno para mejorar la higiene y enfrentar los problemas de saneamiento, deberán tomar en cuenta tanto los factores financieros como los religiosos u otros que promuevan la oferta y el mantenimiento de excusados, así como la posibilidad de otros servicios de saneamiento en las comunidades urbanas.

Banheiro não é uma palavrão: estamos prestes a cumprir os ODMs para saneamento?

Melhorar o acesso a redes de abastecimento de água e saneamento tem sido uma prioridade na agenda de desenvolvimento internacional. Reduzir pela metade o número de pessoas que não têm acesso a redes de saneamento faz parte dos Objetivos de Desenvolvimento do Milênio (ODMs). Este estudo avaliou as condições de banheiros em uma favela na zona urbana de Gana. Muitos sentiam que as condições de saneamento eram deploráveis e estavam insatisfeitos em ter de caminhar mais de meio quilômetro para usar um banheiro. Esforços do governo para melhorar a higiene e abordar os problemas de saneamento precisam levar em conta fatores financeiros, religiosos, além de outros, que promovam o fornecimento e manutenção de instalações de banheiros e serviços adequados nas comunidades urbanas.     

Environmental sanitation and pollution control measures in the Odaw-Korle River catchment,Ghana

This article reports on a study that sought to understand the major factors to consider in changing poor environmental sanitation practices in urban communities in Accra, Ghana. The study focused on three main issues: the drivers of sanitation and pollution control measures in the communities; community members’ perceptions on the influence of poor planning on environmental sanitation and pollution; and how existing local governance arrangements influence environmental sanitation and pollution control. It found that efforts are made at the city, community, and individual levels to control poor environmental practices. In order to control environmental pollution, policy initiatives on sanctions should be coupled with the provision of efficient sanitation facilities and services.     

Improving the effectiveness of Ugandan water user committees

This article outlines issues affecting the functionality of Ugandan water user committees responsible for managing communal water and sanitation (WASH) services. Research undertaken demonstrated that their effectiveness is compromised by poor understanding of their rights and responsibilities by stakeholders within and outside the committees. Following the research, a handbook was produced that explained the rights and responsibilities in a form that is accessible to all community members. Preliminary feedback from committees that have used the handbook suggests that it has the potential to improve the functionality of the water user committees, thereby helping to improve the local management of WASH services in Uganda.     

Centring African culture in water,sanitation, and hygiene development praxis in Ghana: a case for endogenous development

International development aid is driven by actors steeped in Western neo-liberal theory and practice. Africa has largely received failed Western aid, administered mainly through international NGOs in neo-comprador relationships. This article calls for African-centred and -led development, revitalised through endogenous development (ED) praxis. Using a water, sanitation, and hygiene (WASH) sector case study from Ghana, the article theorises Africa's WASH development within the context of globalisation and the politics of knowledge production on Africa. It shows how ED provides African people with self-determining and culturally relevant development necessary for WASH justice and improved health and livelihoods.     

The role of marginalised women in sanitation initiatives: Somali women in northern Kenya

Research has shown women from marginalised communities have significant articulated needs for sanitation that are often unmet. Using focus group discussions with displaced Somali women living in rural villages in northern Kenya, this study found that women’s central concerns were for personal safety and convenience rather than hygiene; and for alleviation from the pain and discomfort associated with female genital mutilation and reproduction. Based on the findings, the article recommends organisations supporting sanitation initiatives should adopt approaches responsive to women’s particular concerns and needs. It makes specific recommendations for implementing an agenda of participation in a context where women are highly marginalised.     

A comprehensive approach to providing services to survivors of sexual and gender-based violence in Democratic Republic of Congo: addressing more than physical trauma

ABSTRACT

The eastern Democratic Republic of Congo (DRC) is impacted by a prolonged conflict and humanitarian crisis. Sexual and gender-based violence (SGBV) affects an estimated 39.7% of women and 23.6% of men in the region, and is associated with serious medical, psychological, and socio-economic outcomes for survivors and communities. IMA World Health, a faith-based non-profit organisation, implements a USAID-funded project, Ushindi, which is a collaborative effort with three national NGOs and one technical partner in response to SGBV in eastern DRC. The consortium provides a comprehensive package of services to SGBV survivors, focusing on medical, emotional, psychological, legal, and socio-economic needs.     

Assessing the fit of RapidSMS for maternal and new-born health: perspectives of community health workers in rural Rwanda

This article examines field results that show the potential for mobile health (mHealth) technologies to support community health workers (CHWs) in delivering basic maternal and new-born services in Rwanda. The fit of RapidSMS, a UNICEF/Ministry of Health (MOH) mHealth technology is examined through focus groups with CHWs. The results highlight the need for more training in the use of RapidSMS, continued upgrading of mobile phones, devising innovative ways of charging mobile phones, and ensuring the availability of ambulances. We suggest that CHW supervision be a two-way process built into RapidSMS utilising real-time communication to enhance effectiveness.     

Reaching beyond the health post: Community-based surveillance for polio eradication

This article discusses the CORE Group Polio Project Ethiopia's introduction of community-based surveillance (CBS) of acute flaccid paralysis (AFP) to support polio eradication. A USAID-funded collaboration among Ethiopian and US-based NGOs, the CGPP supports volunteers in education about AFP and encouraging case reporting. Volunteers also conduct active case searches, visiting community leaders likely to have contact with paralysis cases. The project's methods strengthen communities' awareness of AFP and their connection to the health system. Data indicate a near doubling of AFP reporting in project areas since the implementation of CBS, according to MOH-E (Ministry of Health, Ethiopia)/WHO statistics.

Allant au-delà du poste de santé: surveillance communautaire pour éradication de la poliomyélite

Cet article traite de l'introduction par le Projet sur la polio du CORE Group (CGPP) en Éthiopie de la surveillance communautaire (SC) de la paralysie flasque aiguë (PFA) pour soutenir l’éradication de la polio. Le CGPP, collaboration financée par USAID entre ONG éthiopiennes et basées aux États-Unis, aide des volontaires à mener une éducation sur la PFA et à encourager la notification des cas. Les volontaires effectuent aussi des recherches actives de cas, rendant visite aux leaders communautaires susceptibles d’être en contact avec des cas de paralysie. Les méthodes du projet renforcent la prise de conscience par les communautés de la PFA et leurs liens avec le système de santé. Les données indiquent que le nombre de cas de PFA signalés a presque doublé dans les zones du projet depuis la mise en ?uvre de la SC, d'après les statistiques du Ministère de la Santé, éthiopien et de l'OMS.

Llegar más allá del puesto de salud: vigilancia comunitaria para erradicación de la poliomielitis

Este artículo examina el Proyecto contra la Poliomielitis llevado a cabo en Etiopía por CORE Group (CGPP por sus siglas en inglés), así como el uso que realiza del método de vigilancia comunitaria (VC) para el seguimiento de la parálisis flácida aguda (PFA). El objetivo de este proyecto es erradicar la polio. Constituye un esfuerzo conjunto de ONG etíopes y estadounidenses, financiado por USAID. CGPP apoya la formación de voluntarios para la vigilancia de la PFA, promoviendo la elaboración de informes sobre distintos casos. Asimismo, los voluntarios dan seguimiento a los casos vigentes, realizando visitas a los líderes comunitarios que, con frecuencia, tienen contacto con personas con parálisis. La metodología del proyecto impulsa la conciencia comunitaria en relación a la PFA y al vínculo entre las comunidades y el sistema de salud. Las estadísticas reportadas por el Ministerio de Salud de Etiopía y la OMS indican que, desde que inició la VC, se han duplicado los informes sobre PFA en las áreas abarcadas por el proyecto.

Indo além do posto de saúde: investigação baseada na comunidade para a erradicação da polio

Este artigo discute a introdução da Investigação Baseada na Comunidade sobre casos de paralisia flácida aguda (AFP) do Projeto Pólio do Grupo CORE da Etiópia, voltada para apoiar a erradicação da pólio. Uma colaboração financiada pela USAID entre ONGs baseadas na Etiópia e EUA, o CGPP apóia voluntários na educação sobre AFP e incentiva o relato de casos. Os voluntários também conduzem pesquisas de caso ativas, visitando líderes de comunidade que provavelmente tenham contato com casos de paralisia. Os métodos do projeto fortalecem a conscientização das comunidades a respeito da AFP e sua conexão com o sistema de saúde. Os dados indicam que o número de relatos de AFP nas áreas do projeto quase dobrou desde a Implementação da Investigação Baseada na Comunidade, de acordo com estatísticas da MOH-E/WHO.     

Using Rwandan traditions to strengthen programme and policy implementation

Implementing change is far harder than making policy pronouncements that call for change. Rwanda, in the 20 years since the 1994 genocide, has made substantial progress in turning around its economy and in meeting key Millennium Development Goals (MDGs). Real GDP in Rwanda grew at a rate of over 8% per year in the past years, the percentage of the people living in poverty has dropped by 14%, and UNDP reports that Rwanda is on track to meeting many but not all MDGs by 2015. Rwanda's progress in economic and social spheres stands out in Africa, where many countries, despite commitments to the MDGs, lag behind on performance. The difference in Rwanda is the leadership's attention to implementation, and the incorporation of endogenous practices, particularly into planning and accountability. This article is based on observations of practice at national and community levels and of policy design and implementation. It is a by-product of a study of the impact of different approaches to community health delivery systems in Rwanda, completed as part of the author's doctoral dissertation, and also of the author's experience working within the government in Rwanda.     

“We want financial accountability”: deconstructing tensions of community participation in CHPS,Ghana

This article reports on the ways and factors that facilitate or constrain community participation in the Community-based Health Planning and Services (CHPS) programme in Nsanfo, a village in Central Region of Ghana. We found that the community made an important step through mobilising the necessary resources in establishing the CHPS compound, which has resulted in improved access to health care. Yet maintaining the facility did not matter most to community members, owing chiefly to unmet demands for financial accountability pertaining to the running of the programme. Failure to clearly identify various actors and their roles potentially explains this state of affairs.     

Pro-poor budget analysis of Kenya's free primary education policy

This practical note outlines Concern's approach to pro-poor budget analysis using the case of the Kenya Free Primary Education (FPE) policy. Analysis conducted on the outcomes of the FPE policy for Nairobi's urban slum-based poor suggests that the policy is not being implemented evenly within the city. The reasons stem from poor allocation and planning approaches, to political interference and unwillingness of teachers to work in slum-based schools. These have the unintended effect of increasing inequities for the urban poor, the reverse of the policy intention. The note outlines the pitfalls and practicalities of conducting this type of analysis.     

Not just any toilet – women’s solutions to sanitation in informal settlements in Nairobi

Evidence suggests sanitation development is more effective when women are involved. The purpose of this study was to provide women with an opportunity to share their perspectives and solutions to sanitation in informal settlements. Data were collected through 55 in-depth interviews with women in Mathare Valley informal settlement in Nairobi, Kenya. The most common solution was to build more toilets, but women had a variety of suggestions – including gender-specific solutions. Findings from this study suggest that it is imperative to start addressing women-specific burdens associated with sanitation in informal settlements.     

Network development for non-state health providers: African Christian health associations

ABSTRACT

Substantial effort has been put into forming and strengthening national networks of non-state, non-profit health providers in lower- to middle-income contexts. Christian health associations (national umbrella networks of faith-inspired health providers) were first established in the 1950s, and are currently present in an estimated 23 of the 54 countries in Africa. The establishment of CHAs was equally encouraged by faith-based health providers, governments, and external stakeholders. CHAs look different in each context, but perform similar roles: networking diverse institutions and facilities together into a loose system; and establishing a more cohesive sector to simplify and strengthen advocacy and engagement with the government.     

Models of engagement between the state and the faith sector in sub-Saharan Africa – a systematic review

ABSTRACT

In sub-Saharan Africa many individuals rely on non-state health providers, and engagement between state and non-state providers is increasingly common. Little analytic work has been done on the varied models of engagement, resulting in a lack of clarity about the promises and challenges of public–private engagement (PPE) for health. Despite their prevalence, PPEs often fail. Faith-based health providers (FBHPs) form a significant proportion of the non-state health sector in sub-Saharan Africa, and the number of partnerships with FBHPs is increasing. Building on a prior systematic review project that developed a typology of organisational models for PPE for health, this article reports on a secondary analysis, highlighting PPE initiatives with FBHPs.     

Factors affecting the sustainability of a community water supply project in Kenya

This paper examines how three sustainability factors (water supply, regulatory policy, local management) are affecting the sustainability of a community water supply project in Kenya. Findings show that after 10 years the project is at a threshold of sustainability – it may yet fail. Changing rainfall patterns and additional withdrawals from new projects are threatening available water supply. The community is resisting compliance with water sector reforms including those intended to benefit community-managed projects. Community management deficiencies and a lack of supportive external relationships are impeding project continuity and sustainable local water management.