USAID CLA Case Analysis Deep Dive: Zambia’s Community-Led Total Sanitation Program

USAID CLA Case Analysis Deep Dive: Zambia’s Community-Led Total Sanitation Program, July 2019. usaid.png

This case study focuses on Akros’ CLA-aligned approach to improving sanitation in Zambia, conducted as part of the Zambian Sanitation and Health Program (ZSHP) in partnership with UNICEF and funded by DFID from 2012 to 2018. Akros’ involvement began in 2014 with its introduction of a Mobile-to-Web (M2W) application to the CLTS process in a small number of pilot districts.

Upon successful completion of these pilots, Akros scaled the M2W application to 68 rural districts. Akros eventually incorporated into its intervention close collaboration with traditional leaders. As part of USAID’s efforts to build the evidence base for CLA and one of two Deep Dive case studies (the other concerns Global Communities’ response efforts to the Ebola outbreak in Liberia), this analysis seeks to assess evidence about whether intentional, systematic, and resourced approaches to CLA made plausible contributions to development outcomes in this case

Conclusions: This deep dive into CLA integration, implementation, and impact in CLTS efforts in Zambia yields a number of insights into the specific contributions CLA made to the response. It suggests that strategic collaborations with government officials, traditional leaders, and community members led to greater feelings of local ownership, self-reliance, and in many cases, effective behavior change.

An important dimension of this shift was rooted in CLA’s focus on social inclusion and facilitating diverse, culture-specific adaptations. Enabled by donor flexibility, and strengthened by a broad range of leadership support and participation, CLA approaches in this case incorporated innovative digital monitoring using the M2W app that led to better quality data and speedier feedback loops.

Chiefs/chieftainesses and headmen/women were also involved in ways that supported development outcomes, thereby demonstrating how traditional leaders can be constructive agents of change rather than anachronistic obstacles to development.

This case study utilizes and adapts innovative methods for assessing the contribution of CLA to intervention outcomes through process tracing and contribution analysis. Drawing on numerous sources of evidence, the study provides detailed descriptions of how CLA was integrated into program activities, which may inform future program design and implementation of CLA approaches for USAID staff, implementing partners, and other development practitioners.

Emergency WASH biweekly update, July 16, 2019

Dear Colleagues:

Please see the note below from Tom Corellis and be sure to check out the website he refers to. We have been asked to compile biweekly updates on specific Emergency WASH topics and issues so starting with this update, the first biweekly update each month will be a webliography of the most recent Emergency WASH studies, reports, resources, etc. The second monthly biweekly update will focus on a specific Emergency WASH topic. We have listed some possible topics below and welcome your suggestions.

Member Update


Tom Corellis, – Colleagues, Shelter Centre, which I direct, is a long-standing global partner of the WASH Cluster and developed with OFDA support To our knowledge, this contains one of the largest collections on WASH. It is crowd-sourced and community moderated, meaning your members can share knowledge onto it and collate that knowledge into collections useful to their work. We have WASH interns working around the world adding to their Collections.

Recent Journal Articles

The link between mental health and safe drinking water behaviors in a vulnerable population in rural Malawi. BMC Psychology, July 8. This research is especially relevant in emergency contexts, as it indicates that mental health measures before any WASH interventions will make them more effective.


Cholera prevention and control in refugee settings: Successes and continued challenges. PLoS Negl Trop Dis. 2019 Jun. Cholera continues to be a significant problem in humanitarian settings, with recent outbreaks in displaced populations in South Sudan, Yemen, Cameroon, Nigeria, Tanzania, Uganda, Haiti, and Iraq. The success of cholera prevention and control in refugee camps over the past 2 decades highlights the possibility of managing this deadly disease, even in complicated humanitarian crises.

Residual Maintenance Using Sodium Hypochlorite, Sodium Dichloroisocyanurate, and Chlorine Dioxide in Laboratory Waters of Varying Turbidity. Special Issue – Water, Sanitation, and Hygiene in Humanitarian Contexts, June 2019. Sodium hypochlorite (NaOCl) and sodium dichloroisocyanurate (NaDCC) are commonly used for household water treatment (HWT); chlorine dioxide (ClO2) is a potential new HWT option.

Continue reading

Recent WASH reports, blogs and research

In addition to the reports and studies listed below, be sure to check out the latest updates to Globalwaters.orgMeet the Plumber Breaking Gender Norms in Côte D’IvoireWebinar Discusses the Use of Monitoring Data in WASH Sector Decision-Making and articles from Niger, Egypt, the African Water Association and Urban Links in USAID in the News. wateraid


Service delivery models for universal, safe and sustainable water services in Ethiopia. MWA, June 2019.

Planning Differently: Developing long-term, strategic plans for district-wide water, sanitation and hygiene services. MWA, May 2019.

Cost-Effectiveness Analysis of USAID/Nigeria’s Livelihoods Project Final Report, USAID, 2018.

The Next Frontier in Water Supply Service Delivery: An Assessment of the Performance of Water Sector Service Providers in Pourashavas in Bangladesh. World Bank, June 2019.

PRO-WASH Human Centered Design Workshop Tools. PRO-WASH, June 2019.

Ready for the Dry Years: Building resilience to drought in South-East Asia. UN ESCAP, 2019.

Policy Brief: How can Alternative Service Delivery improve water services? SIWI, July 2019.

Implementing the source-to-sea approach: A guide for practitioners. SIWI, July 2019.

Vietnam: Toward a Safe, Clean, and Resilient Water System. World Bank. 2019.


The link between mental health and safe drinking water behaviors in a vulnerable population in rural Malawi. BMC Psychology, July 2019.

WASH practices and its association with nutritional status of adolescent girls in poverty pockets of eastern India. BMC Women’s Health, BMC Women’s Health, July 2019.

What motivates open defecation? A qualitative study from a rural setting in Nepal. PLoS One, July 2019.

Effects of single and combined water, sanitation and hygiene (WASH) interventions on nutritional status of children: a systematic review and meta-analysis. Italian Journal of Pediatrics, July 2019.

3D-printed clay-based ceramic water filters for point-of-use water treatment applications. Progress in Additive Manufacturing, July 2019.


Period Poverty Occurs in the United States, Too. Engineering for Change, July 2019.

UN High Level Political Forum 2019: an opportunity to protect the human rights of sanitation workers and manual scavengers. WaterAid, July 2019.

Digital exhibition on Women, Water and Work, curated by Living Waters Museum, a member of the Global Network of Water Museums, 2019.

Bill Frist: Lessons not learned in Congo’s Ebola outbreak. Fox News, July 2019

WASH Benefits and SHINE trials: interpretation of WASH intervention effects on linear growth and diarrhea

The WASH Benefits and SHINE trials: interpretation of WASH intervention effects on linear growth and diarrheaLancet Global Health, August 2019.wateraid

Summary: Child stunting is a global problem and is only modestly responsive to dietary interventions. Numerous observational studies have shown that water quality, sanitation, and handwashing (WASH) in a household are strongly associated with linear growth of children living in the same household.

We have completed three randomised efficacy trials testing improved household-level WASH with and without improved infant and young child feeding (IYCF) on stunting and diarrhoea in Bangladesh, Kenya, and Zimbabwe. In all trials, improved IYCF had a statistically significant benefit, but WASH had no effect on linear growth.

In observational analyses of data from the control groups of the three trials, baseline sanitation was a strong risk factor for stunting in the study populations, suggesting this frequently reported association might be confounded by unmeasured factors of household wellbeing. WASH interventions reduced diarrhoea in Bangladesh, but not in Kenya or Zimbabwe.

Intervention promoters visited participants six times per month in Bangladesh compared with monthly in Kenya and Zimbabwe; a review of the literature shows that virtually all published studies that have reported an effect on diarrhoea through home-based water treatment and handwashing promotion achieved high adherence by visiting participants at daily to fortnightly intervals.

Despite achieving substantial behavioural change and significant reduction in infection prevalence for some enteric pathogens, detection of enteropathogens among children in the WASH groups of the trials was typically at ten times higher prevalence compared with high-income countries.

Considering these results, we recommend that future research in the WASH sector focus on developing and evaluating interventions that are radically more effective in reducing faecal contamination in the domestic environment than the interventions implemented in these trials.

Water Currents: Handwashing Research, January – June 2019

Water Currents: Handwashing Research, January – June 2019

The January to June 2019 Handwashing Research Index is the result of a collaboration between the Global Handwashing Partnership and the USAID Water Communications and Knowledge Management Project. hw

The index includes 36 peer-reviewed studies from 2019 that explore handwashing in connection with diverse programmatic areas. It also includes several studies from 2018 that were not included in the 2018 Index due to publication timelines.

This issue of Water Currents features selected studies from the index, as well as links to handwashing-related websites.

Progress on Household Drinking Water, Sanitation and Hygiene 2000–2017: Special Focus on InequalitiesWHOUNICEF, June 2019. In 2017, 22 percent of the global population (1.6 billion people) had handwashing facilities that lacked water or soap, and 18 percent (1.4 billion people) had no handwashing facility at all.

Handwashing with Soap after Potential Faecal Contact: Global, Regional and Country Estimates for Handwashing with Soap after Potential Faecal ContactInternational Journal of Epidemiology, December 2018. Researchers found that many people lack a designated handwashing facility, but even among those with access, handwashing with soap is poorly practiced. People with access to designated handwashing facilities are about twice as likely to wash their hands with soap after potential fecal contact as people who lack a facility.

Community Settings
Child Defecation and Feces Disposal Practices and Determinants among Households after a Combined Household-Level Piped Water and Sanitation Intervention in Rural Odisha, IndiaAmerican Journal of Tropical Medicine and Hygiene, April 2019. A study in rural India found that disposal of child feces into a latrine was uncommon, even among households with access to an improved pour-flush latrine that was used by adults in the household.

Read the complete article.

Factors Influencing Revenue Collection for Preventative Maintenance of Community Water Systems: A Fuzzy-Set Qualitative Comparative Analysis

Factors Influencing Revenue Collection for Preventative Maintenance of Community Water Systems: A Fuzzy-Set Qualitative Comparative Analysis. Sustainability, July 8, 2019.

Authors: Liesbet Olaerts, Jeffrey P. Walters, Karl G. Linden, Amy Javernick-Will and Adam Harvey

This study analyzed combinations of conditions that influence regular payments for water service in resource-limited communities. To do so, the study investigated 16 communities participating in a new preventive maintenance program in the Kamuli District of Uganda under a public–private partnership framework.

Overall, the findings from this study reveal distinct pathways of conditions that impact payment compliance and reflect the multifaceted nature of water point sustainability. Practically, the findings identify the processes needed for successful payment compliance, which include a strong WUC with proper support and training, user perceptions that the water quality is high and available in adequate quantities, ongoing support, and a lack of nearby water sources.

A comprehensive understanding of the combined factors that lead to payment compliance can improve future preventative maintenance programs, guide the design of water service arrangements, and ultimately increase water service sustainability.

Associations between open drain flooding and pediatric enteric infections in the MAL-ED cohort in a low-income, urban neighborhood in Vellore, India

Associations between open drain flooding and pediatric enteric infections in the MAL-ED cohort in a low-income, urban neighborhood in Vellore, India. BMC Public Health, July 10, 2019.

Authors: David M. Berendes, Juan S. Leon, Amy E. Kirby, Julie A. Clennon, Suraja J. Raj, Habib Yakubu, Katharine A. Robb, Arun Kartikeyan, Priya Hemavathy, Annai Gunasekaran, Sheela Roy, Ben Chirag Ghale, J. Senthil Kumar, Venkata Raghava Mohan, Gagandeep Kang and Christine L. Moe

Open drains are common methods of transporting solid waste and excreta in low-income urban neighborhoods. Open drains can overflow due to blockages with solid waste and during rainfall, posing exposure risks. The goal of this study was to evaluate whether pediatric enteric infection was associated with open drains and flooding in a dense, low-income, urban neighborhood.

Children in areas susceptible to open drain flooding had increased odds of enteric infection as rainfall increased. Results suggested that infection increased with rainfall due to neighborhood infrastructure (including poor fecal sludge management) and not frequency of contact. Thus, these exposures may not be mitigated by changes in personal behaviors alone. These results underscore the importance of improving the neighborhood environment to improve children’s health in low-income, urban settings.