Recent research on water ATMs, water tariffs, MHM, sanitation


Pop-up infrastructure: Water ATMs and new delivery networks in India. Water Alternatives, 2020.
The article develops a novel approach to water ATMs as ‘pop-up infrastructure’ in which the movement of matter is operationally independent from, and only contingently reliant on, existing water delivery networks.

Reflecting SDG 6.1 in Rural Water Supply Tariffs: Considering ‘Affordability’ Versus ‘Operations and Maintenance Costs’ in Malawi. Sustainability, January 2020.
Local tariffs in the form of household contributions are the primary financial mechanism to fund the maintenance of rural water supplies in Malawi. An investigation was conducted into the tariffs set by rural service providers to sustain drilled boreholes equipped with Afridev handpumps.

Stool-Based Pathogen Detection Offers Advantages as an Outcome Measure for Water, Sanitation, and Hygiene Trials. The American Journal of Tropical Medicine and Hygiene, 5 Feb 2020.
Stool-based enteric pathogen detection offers several advantages over the conventional WASH trial outcome of caregiver-reported diarrhea.

Menstrual health intervention and school attendance in Uganda (MENISCUS-2): a pilot intervention study. BMJ Open 2020.
The intervention comprised training teachers to improve delivery of government guidelines for puberty education, training in use of a menstrual kit and pain management, a drama skit, provision of analgesics and improvements to school water and sanitation hygiene facilities.

The value of monitoring data in a process evaluation of hygiene behaviour change in Community Health Clubs to explain findings from a cluster-randomised controlled trial in Rwanda. BMC Public Health, January 2020. A cluster-Randomised Controlled Trial evaluation of the impact of the Community Health Clubs (CHCs) in the Community Based Environmental Health Promotion Programme in Rwanda in 2015 appeared to find little uptake of 7 hygiene indicators 1 year after the end of the intervention, and low impact on prevention of diarrhoea and stunting.


Planning and communicating prototype tests for the Nano Membrane Toilet: A critical review and proposed visual tool. Gates Open Research, November 2019. A visual test planning tool is proposed that encompasses the entire product development process and can be used to plan and communicate prototype tests for the Nano Membrane Toilet to ultimately achieve compliance with international standards

Harnessing the power of WASH in the fight against NTDs by Yael Velleman

While in Uganda last week, I had the unique opportunity to sit down with the Ugandan Ministry of Health’s National Program Officer for Trachoma Control, Gilbert Baayenda.

Gilbert Baayenda

Trachoma is a devastating bacterial infection and the world’s leading infectious cause of blindness. It is one of 20 Neglected Tropical Diseases (NTDs) that cause extreme pain, disability and even death. Yet NTDs are preventable. They are diseases of poverty and marginalization that affect over one billion people across 149 countries globally.

Access to safe water, sanitation and hygiene (WASH) is essential for the prevention, treatment and care of NTDs. Recognizing this, the World Health Organization (WHO) and the NTD NGO Network (NNN) developed, “WASH and health working together: A ‘how-to’ guide for Neglected Tropical Disease programmes,” the first step-by-step guide for building successful WASH and NTD partnerships.

Since its launch last year on what is now World NTD Day, the toolkit has been utilized in a number of countries across sub-Saharan Africa and Asia, including Uganda. As the lead on collaboration with the WASH sector on behalf of Uganda’s National NTD Control Program, Gilbert has championed greater coordination between WASH and NTD partners, and is now in the process of adapting the innovative WHO and NNN toolkit to meet national and district-level needs.

What motivates you, as a healthcare professional, to be a WASH champion?

GB: I have lived and worked at the community and sub-national level for about 15 years and have seen what it means to have access to water and sanitation. I’ve worked in nomadic communities where WASH is non-existent – where there is no safe water, no latrine, no hygiene facilities, and water is scarce. Even where we believe that access is relatively good, we hear communities complain that there is only one water source and they must travel far to access it.

What motivates me is the decisions we make and their impact on the community. If even one family that currently has difficulties in access can say that the WASH problem has been resolved, then I would be relieved. If we solve half of the cases of disease within the next couple of years, I would be motivated to scale up to as many homes as we can get to.

What challenges have you faced in addressing WASH and NTDs?

GB: One challenge is that service providers, as well as communities, are not aware of the connection between WASH and NTDs. We must get the message out that without improvement in WASH, we may not be able to sustain the gains we have made in the fight against NTDs.

This is clear when you compare progress on trachoma and schistosomiasis; while we have eliminated trachoma in most endemic districts, we have seen progress on schistosomiasis reversed despite added treatment. The only way we can address this is if we improve WASH.  

In terms of achieving this improvement, we are challenged by natural disasters such as floods, poor soil conditions that make latrine construction difficult, and long distances to water sources. When we conduct health education, we try to emphasise the vital role of WASH.

Getting all the players to sit at the same table and view themselves as part of one WASH community instead of medical, engineering, NGO, social science or hydrology specialists, and initiating collaboration, has been a challenge. Another challenge is that Uganda has a decentralised government system, so whatever we do at the national level has to also reach all 126 districts if we want to make an impact.

Coordination of the collaboration itself is also a challenge as it is important to ensure that one sector does not appear to dominate the others – we’ve therefore tried our best to get everyone together and this is expected to improve as the concept of WASH and NTD collaboration gets more buy in.

How have you begun to overcome these challenges and improve cross-sectoral coordination?

GB: We decided to adopt the WASH and NTDs toolkit [“WASH and health working together”] and customise it to the Ugandan context. We have held meetings at the national level and we would like to hold specific WASH and NTDs meetings with district officials in which we can explain the toolkit and the expected results, to get them to appreciate that collaboration and partnership with WASH stakeholders and relevant ministries is vital. WASH is a very big challenge and we cannot do it alone.

What difference can collaboration make?

GB: Even if we come up with one innovation that can ensure coverage in fishing communities, which are right on the water, yet they have no access to safe water, that will be a huge success. If the communities that are very far from the water source can benefit from innovation to resolve this problem, I would be proud to have been a part of this effort.

For more information:

About the author:
Yael Velleman is the Director of Policy & Communications at SCI Foundation, and co-chairs the NNN WASH Working Group

Can a toolkit make a difference to WASH and NTDs collaboration?

Yael Velleman, WASH Working Group Co-Chair, Neglected Tropical Disease NGO Network, Director of Policy and Communications, SCI Foundation

Leah Wohlgemuth, WASH Working Group Co-Chair, Neglected Tropical Disease NGO Network, Technical Adviser, Sightsavers

One year on from the launch of the first-ever practical guide on WASH and NTDs collaboration, the co-chairs of the NNN WASH Working Group reflect on its impact

A year ago today, Dr. Mwele Malecela, WHO Director for the Department of Control of NTDs, unveiled the first-ever step-by-step guide for building NTD and water, sanitation and hygiene (WASH) partnerships to a crowded auditorium at the London Centre for Neglected Tropical Disease (NTD) Research.

WASH and health working together: A ‘how-to’ guide for Neglected Tropical Disease programmes” is the culmination of more than two years of collaboration between the World Health Organization and the NTD NGO Network (NNN), incorporating real-life program perspectives and tools to improve coordination between the NTD and WASH communities. On this inaugural World NTD Day, the toolkit is celebrating its one-year anniversary and the significant headway made since its launch.

2019 saw a burst of activities to disseminate the toolkit far and wide; it was translated into French and Spanish, transformed into an interactive online version, and featured in two webinars for the NTD and WASH communities. Blogs by WaterAid and the NNN highlighted the mutual benefits of the toolkit to the WASH and NTDs communities, and the toolkit was highlighted in a USAID Water Currents issue on the importance of WASH and NTD integration.

Interviews with The Carter Center’s Kelly Callahan, Director of the Trachoma Control Program, and Dr. Wondu Alemayehu, Technical Advisor at The Fred Hollows Foundation, demonstrated the value of the resource in the eyes of those who have worked towards NTD control and elimination for many years.

The toolkit also made a splash at a number of WASH and global health convenings, with workshops delivered at Stockholm’s World Water Week, UNC’s Water and Health Conference, and the 10th Annual NNN Conference.

More importantly, however, the approach set out in the toolkit was implemented in a number of countries. Inspired by this resource, the Ethiopian Ministry of Health, which was also a major contributor to the toolkit’s content, developed a national framework to guide all government and non-government stakeholders on resourcing, planning and monitoring joint interventions, along with a woreda-level WASH and NTDs coordination toolkit.

Various tools including the situation analysis protocol and planning workshop were also utilized in Benin, Burkina Faso, Cameroon, Côte d’Ivoire, Ghana, Guinea, Kenya, Liberia, Niger, Nigeria, Senegal, Tanzania, Zambia and Zimbabwe.

More recently, the Government of Uganda formally adopted the toolkit as a whole and has begun a process of coordination, and adaptation of the toolkit to the national and local context.

The toolkit has also informed the design of WASH activities with the UK Aid funded Ascend programme in West and Central Africa, including coordination structures and joint planning processes.

As we look ahead to 2020—with the anticipated launch of the 2030 Global NTD Roadmap and complementary Global Strategy on WASH and NTDs, as well as renewed commitments to be made in Kigali this summer—nothing is clearer: cross-sector collaboration is essential to sustainably beating NTDs.

This World NTD Day, we’ll celebrate the progress made in 2019 following the launch of “WASH and health working together”, but know that as a global community, we still have much to do to build successful partnerships.

This will mean taking collaboration to the next level, by convening and supporting capacity building initiatives at the regional and national level, by supporting the development of country and local tools, and by documenting the use of the tools to ensure that the toolkit is continuously enhanced to achieve the ultimate aim: end the scourge of NTDs by 2030.

USAID WASH updates | Literature review on WASH systems

USAID Updates

Journal Articles

System Approaches to Water, Sanitation, and Hygiene: A Systematic Literature Review. Int. J. Environ. Res. Public Health 2020. Authors: by Nicholas Valcourt 1,2,*,Amy Javernick-Will 1,2,Jeffrey Walters 2,3 and Karl Linden 1,2 – 1-Department of Civil, Environmental, and Architectural Engineering, University of Colorado Boulder 2-USAID Sustainable WASH Systems Learning Partnership, United State Agency for International Development | 3-College of Engineering, George Fox University, Newberg, OR 97132, USA

We conducted a wide-ranging systematic literature review of systems approaches for WASH across peer-reviewed, grey, and organizational literature. Our results show a myriad of methods, scopes, and applications within the sector, but an inadequate level of information in the literature to evaluate the utility and efficacy of systems approaches for improving WASH service sustainability. Based on this analysis, we propose four recommendations for improving the evidence base including: diversifying methods that explicitly evaluate interconnections between factors within WASH systems; expanding geopolitical applications; improving reporting on resources required to implement given approaches; and enhancing documentation of effects of systems approaches on WASH services.

Social Network Analysis for Water, Sanitation, and Hygiene (WASH): Application in Governance of Decentralized Wastewater Treatment in India Using a Novel Validation Methodology. Frontiers in Environmental Science, January 2020. Authors: Abishek Sankara Narayan1,2*, Manuel Fischer 1,3 and Christoph Lüthi 1 – 1 Eawag, Swiss Federal Institute of Aquatic Science and Technology, Dubendorf, Switzerland, 2 Institute of Civil, Environmental and Geomatic Engineering, ETH, Swiss Federal Institute of Technology

The use of SNA as an appropriate diagnostic tool for planning Citywide Inclusive Sanitation is explored. Missing data is a major problem for SNA in the studies of governance situations, especially in low- and middle-income countries. Therefore, a novel validation methodology for incomplete SNA data, relying on information from internal and external experts is proposed. SNA and the validation method is then applied to study the governance of decentralized wastewater treatment in four cities of India. The results corroborate key differences between mega and secondary cities in terms of institutions, community engagement and overall sanitation situation including aspects of decentralized wastewater treatment plants, based on the city types.

Menstrual Hygiene Preparedness Among Schools in India: A Systematic Review and Meta-Analysis of System-and Policy-Level Actions. Int J Environ Res Public Health. 2020 Jan 19. Authors: Sharma S1,2, Mehra – 1 Researcher, Department of Clinical Sciences, Lund University, 2 MAMTA Health Institute for Mother and Child.

Less than half of the girls were aware of menstruation before menarche. Teachers were a less common source of information about menstruation to girls. Separate toilets for girls were present in around half of the schools.


Video – Transforming health systems: the vital role of water, sanitation and hygiene. WaterAid, January 2020. 

Dan Campbell

USAID WASH updates | WASH research on MHM, hygiene, financing, etc.

USAID Reports/Blog Posts

Tackling Southern Africa’s freshwater challenges by Dr Chris Brooks, USAID Resilient Waters Programme. IUCN, January 2020. Local communities in Southern Africa are facing severe water challenges regarding freshwater for drinking, sanitation, and other services. The Okavango and Limpopo river basins are key transboundary water bodies in this region, where USAID’s Resilient Waters Program operates.

USAID/CENTRAL ASIA ENVIRONMENT AND WATER FACTSHEET. USAID, Jan 2020. USAID’s introduction of integrated water resources management principles at the basin level provide a model for cooperation, governance and climate change adaptation that demonstrate the benefits of shared water management to the broader watershed.

PARTNERSHIPS FOR ENHANCED ENGAGEMENT IN RESEARCH (PEER) FACT SHEET. USAID, Jan 2020. The goal of PEER in Central Asia is to improve domestic and regional water management for better cross-border cooperation and less water waste.

Water for Life: Using CLA to Transform a WASH System into a Self-Reliant Apparatus. CLA, 2019. The CLA approach, still ongoing, has resulted in a self-reliant, functioning system that connects self-managed and self-financed community structures to local government institutes that are now implementing transparent and evidence-based resource allocation for WASH needs, and to trained, accountable government service providers and a stronger WASH private sector. – New blog posts, stories, news and events


The Global Risks Report 2020. WEF, Jan 2020. Water crises, in acknowledgement of their far-reaching consequences, are now categorized as a societal risk.

Untreated and Unsafe: Solving the Urban Sanitation Crisis in the Global South. World Resources Institute, Dec 2019. Cities must ensure universal access to safe, reliable, and affordable sanitation so that all urban residents can lead productive, healthy, and thriving lives. New analysis of 15 cities in the global South shows that on average, 62 percent of sewage and fecal sludge is unsafely managed somewhere along the sanitation service chain.

Journal Articles

Ruminant Fecal Contamination of Drinking Water Introduced Post-Collection in Rural Kenyan Households. IJERPH, Jan 2020. Authors: Latifah Hamzah, Alexandria B. Boehm, Jennifer Davis, Amy J. Pickering, Marlene Wolfe, Maryanne Mureithi and Angela Harris
Three combinations were identified:(i) ruminants in the compound, safe water extraction methods, and long storage time, (ii) ruminants, unsafe water extraction methods, and no soap at the household handwashing station, and (iii) long storage time and no soap.

Antimicrobial resistant enteric bacteria are widely distributed amongst people, animals and the environment in Tanzania. Nature Communicatons, Jan 2020. Multivariate models show no evidence that veterinary antibiotic use increased the odds of detecting AR bacteria, whereas there is a strong association with livelihood factors related to bacterial transmission, demonstrating that to be effective, interventions need to accommodate different cultural practices and resource limitations.

Can we ‘WaSH’ infectious diseases out of slums? International Journal of Infectious Diseases, Jan 2020. Authors: Allen G. Ross, Mahbubur Rahman, Munirul Alam, K. Zaman, & Firdausi Qadri –
In sum, a range of low cost WaSH solutions have been trialed but their impact has been modest when deployed with vaccination. Clinical trials of more expensive WaSH options are required in order to determine the best available technology at an affordable price. We can WaSH infectious diseases out of slums but at what cost?

What’s missing in MHM? Moving beyond hygiene in menstrual hygiene management. SRHM, Dec 2019. A focus on rights emphasizes both the naturalness of menstruation and the individual girl or woman as a rights-bearing agent. This reorientation can help to begin to shed the stigma around menstruation, and also to act as a catalyst to bring new voices into the global movement for better menstrual practices.

Poultry Ownership Associated with Increased Risk of Child Diarrhea: Cross-Sectional Evidence from Uganda. American Journal of Tropical Medicine and Hygiene, Jan 2020. Children in households with the above-median number (> 5) of poultry had 83% higher diarrhea prevalence than those with ≤ 5 poultry (adjusted PR = 1.83 [1.04, 3.23], P = 0.04). Children in households with the above-median number (> 2) of cows had 48% lower prevalence of respiratory infection than those with ≤ 2 cows (adjusted PR = 0.52 [0.35, 0.76], P < 0.005). There were no other significant associations between domestic animals and child health.


Closing gaps and financing taps: The next step for rural water supply. Water Blog, Jan 2020.  A new model in Tanzania is experimenting with a bold solution combining blended financing with emerging technologies. The pilot seeks to demonstrate that rural communities can repay 40% of the capital investment and maintenance service contracts without increasing the price of water.

Solving the big challenges of inclusive services through peer-to-peer learning. WSUP, Jan 2020. There is no greater way for city authorities and regulators to learn about developing inclusive water and sanitation services than from their peers – other institutions around the world who are confronting similar issues.

Sanitation in the News – January 14, 2020

We will update this page regularly with sanitation news items. Please let us know if you find this useful:

Liberia: ‘Water, Sanitation Key to Citizens’ Growth’ – New Dawn, January 14, 2020

Cholera symptoms can take five days to develop — Expert. Punch, January 13, 2020

Urgent health challenges for the next decade – WHO, January 13, 2020

Research on water economics, CLTS and other WASH research updates

The latest issue of the Oxford Review of Economic Policy has several interesting articles:

Evidence-based policy analysis? The strange case of the randomized controlled trials of community-led total sanitation. Oxford Review of Economic Policy, Spring 2020. We show that cost–benefit analysis may still ‘save’ CLTS because small treatment effects may still yield net positive economic benefits if the costs of implementing CLTS programmes are modest. We also discuss the need to move beyond the desire for sanitation policies that are proven to be effective globally, and the importance of focusing on analysis of the local sanitation situation.


Shelmel Terefa, a school teacher, demonstrates face washing to students at his school in Aware-Golje village in the North Shewa Zone, Oromia, Ethiopia. Photo credit: Michael Amendolia/The Fred Hollows Foundation

Rethinking the economics of water: an assessment. Oxford Review of Economic Policy, Spring 2020. The conventional economic policy recommendations—privatization, pricing, and property rights—have struggled due to a failure to account adequately for the politics of water and the associated distributional conflicts.

We identify distinctive social and physical characteristics of water supply and demand, and explore their implications for three central areas of water policy: financing infrastructure, pricing, and property rights reform.

Rethinking the economics of rural water in Africa. Oxford Review of Economic Policy, Spring 2020. We explore why rural water is different for communities, schools, and healthcare facilities across characteristics of scale, institutions, demand, and finance. The findings conclude with policy recommendations to (i) network rural services at scale, (ii) unlock rural payments by creating value, and (iii) design and test performance-based funding models at national and regional scales.

Continue reading