Category Archives: IYS Themes

WHO update on cholera in 2018

November 29, 2019 – Weekly Epidemiological Record

An excerpt – While the true global disease burden is not entirely captured by annual reporting of cholera epidemiological indicators by Member States to WHO, the overall number of cholera cases was 60% lower in 2018 than in 2017. who

The decrease in the global cholera burden is attributable to a large reduction in the number of cases in Yemen and significant decreases in other countries, such as the Democratic Republic of Congo (DRC), Somalia and South Sudan.

Overall, in 2018, 34 countries reported 499 447 cholera cases and 2990 cholera deaths to WHO, with a case-fatality rate (CFR) of 0.6% (Figure 1, Map 1 and Table 1).

Africa – Overall, in 2018, 34 countries reported 499 447 cholera cases and 2990 cholera deaths to WHO, with a case-fatality rate (CFR) of 0.6% (Figure 1, Map 1 and Table 1). After exclusion of cases reported in Yemen (where reporting is imprecise), the total numbers of cases and deaths reported globally in 2018 were 128 121 and 2485, respectively, a 34% decrease in the number of cases and a 27% decrease in that of deaths from 2017. The case load represents the fewest cases reported worldwide since 2004, when there were 101 383 cases (with 2345 deaths).

The epidemiology of cholera on the African continent showed the typical regional tendency. In West Africa, cholera transmission was high in Nigeria (with 45 000 cases in 2018 and only 12 000 in 2017), with subsequent spill-over into Cameroon and Chad. Other countries in the West African region saw no cholera cases, and only 2 cases were reported in Liberia.

Middle East and Asia – As in 2017, Yemen reported by far the most cholera cases in a single country in 2018, with 371 326 cases and 505 deaths (Figure 2). This nevertheless represented a great improvement over the previous year, with a 64% decrease in the number of cases and a 78% decrease in the number of deaths. While the way in which cholera cases were reported changed during the year, the decreases in numbers of cases and deaths represented greater mobilization by the Government and partners in improving water, sanitation and hygiene and in providing adequate medical care of cases.

The Americas – In Haiti, a strategy for an integrated rapid response to outbreaks resulted in 2018 in the fewest cases since the start of the cholera epidemic in 2010 (Figure 2). The Dominican Republic continues to report relatively few cases, and the number is decreasing over time, in parallel with the numbers in Haiti.

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Market Based Programming for WASH in Humanitarian Situations

Market Based Programming (MBP) for WASH in Humanitarian Situations, December 2019

Case Studies/Country Reports

Water, sanitation, and hygiene access in southern Syria: analysis of survey data and recommendations for response. Conflict and Health, 2018.
Allowing market forces to manage WASH services and quantity, and targeting emergency response activities on increasing affordability with well-targeted subsidies and improving water quality and regulation via WSPs can be an effective, scalable, and cost-effective strategy to guarantee water and sanitation access in protracted emergencies with local markets. SWS

Strengthening market systems that provide water and hygiene items for cholera mitigation and emergency preparedness in Haiti. Waterlines, October 2018.
In the context of the cholera epidemics in Haiti, a pre-crisis market analysis (PCMA) was conducted in Artibonite to study the supply of and demand for various water- and hygiene-related items.

Pathways to professionalised community water services in a protracted crisis: a case from Juba. 41st WEDC Conference, 2018.
The paper depicts Oxfam South Sudan experience in professionalizing a community-based operating entity responsible for managing a water treatment plant in Juba, through WASH Market-based Programming. It describes how this was achieved by supporting the development of a business implementation plan and provision of tailored institutional support.

Refugees: The Most in Need of Zakat Funds. UNHCR, 2019.
Our cash assistance program is an innovative way to ensure that 100% of Zakat donations go to people most in need, to spend on what they need most, instead of providing them with truckloads of unwanted supplies.


WASH Market-Based Programming in Emergencies: Overview. Oxfam, 2018.
This overview, and the WASH and Markets in Crisis series linked to it, describes the impacts of crises on market systems, and introduces the benefits of market-based programming.

Using pre-crisis market analysis to strengthen emergency preparedness and resilience of WASH systems. 41st WEDC Conference, 2018.
This paper describes Oxfam’s experiences using pre-crisis market analysis in Bangladesh, Indonesia, South Sudan and Zimbabwe in order to support market-based programming to strengthen the resilience of market systems and prepare for reoccurring emergencies

Briefing note 2: Types of Market-Based Programming to Strengthen Emergency Responses. Oxfam, 2018.
This briefing note describes different types of WASH market-based programming used in pre-crisis, emergency or post-crisis contexts, giving examples from Oxfam’s experiences in Bangladesh, Indonesia and Zimbabwe.

Building evidence to inform the effective use of cash in emergency sanitation and hygiene programming. Save the Children; ODI, 2018.
An analysis of five case studies of utilization of cash/voucher assistance are presented and analyzed in the attempt of building evidence on their utilization in emergency WASH Sanitation and HP programming. Findings and recommendations are provided on coordination, situation and response analysis, program design, implementation, monitoring and evaluation.

Working with WASH market systems to improve emergency response and resilience in urban areas. HPN, 2018.
With funding from USAID’s Office of Foreign Disaster Assistance (OFDA), Oxfam set out to promote market-based responses to emergencies using pre-crisis market mapping and analysis in Bangladesh, Indonesia, South Sudan and Zimbabwe, focusing primarily in urban areas.

Measuring the benefits of using market based approaches to provide water and sanitation in humanitarian contexts. Journal of Environmental Management, June 2018. The results of the work revealed that CT/MBP can be used to support household, community and market level interventions to effectively reduce transmission of diseases. Efficiency, effectiveness, sustainability, appropriateness and equity were identified as useful parameters which correlated to widely accepted frameworks against which to evaluate humanitarian action.

Cash and Markets In the WASH Sector: A global WASH Cluster position paper. GWC, 2016. The proposed benefits of working through existing market systems include improvements to speed, efficiency and effectiveness of programming and increased beneficiary dignity and choice.

WASH and Cash and Voucher Assistance. Cash Learning Partnership.
In recent years the use of conditional Cash and Voucher Assistance to achieve WASH outcomes has steadily grown. CVA has been used to increase access to drinking water through water vendors or small shops, or through the use of kits for treating and storing water. Cash for work has been used for the repair and recovery of the piped water network.

Other Studies/Reports

Mobilising cash and voucher assistance programmes: The case for mobile money. GSMA, 2019.
Although the fastest means of disbursement at the immediate onset of a crisis is to deliver physical cash, digital options offer greater benefits longer term.

What does gender-sensitive cash and voucher assistance look like? CARE, 2019.
The study aimed at understanding the: Extent to which women, men, boys, and girls have been involved in the design of CVA and the implications of this involvement. Potential for CVA to foster positive and sustainable gender roles and relations that contribute to gender equity.

New financing partnerships for humanitarian impact. ODI, 2019.
Innovative finance applies to using market-based investments – which generate a financial return – rather than grants.

Cost-Effectiveness in Humanitarian Work: Cash-Based Programming. IDS, 2018.
The evidence reviewed also points to the limits of CBR; cash interventions are unable to tackle systemic issues around quality of service provision, education and largely also health (albeit they can help cover costs of dealing with small ailments, or channel some resources into the WASH sector

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Bruce Gordon and Oliver Subasinghe on the 2019 Global Analysis and Assessment of Sanitation and Drinking Water (GLAAS) Report

In the latest USAID Global Waters Radio podcast, hear the World Health Organization’s Bruce Gordon, one of the creators of the 2019 Global Analysis and Assessment of Sanitation and Drinking Water (GLAAS) Report, share key takeaways from this year’s data, collected from more than 100 countries. podcast

As we move closer to 2030, how are countries doing in their pursuit of the Sustainable Development Goals for water and sanitation?

Click below to give a listen to this important progress report, and feel free to share with interested colleagues.

Link to the podcast.


Implications of recent WASH and nutrition studies for WASH policy and practice – WHO/UNICEF position paper

Implications of recent WASH and nutrition studies for WASH policy and practice – WHO/UNICEF position paper, November 2019. Children wash their hands outside school in Samabogo, Mali.

The WHO/UNICEF position paper summarizes the studies, contextualizes the findings within the wider body of evidence and distills the implications for future investments. The paper is accompanied by a recorded interview with the heads of WASH for WHO and UNICEF and the lead author of a consensus statement from leading researchers.

An excerpt – What are the implications for WASH programming?

The findings of WASH Benefits and SHINE are not a reason to do less on WASH. Conversely, the historical significance of WASH in disease control, the strong conceptual basis for WASH (Box 2) and the need for WASH to reduce the potential for outbreaks in addition to breaking endemic transmission all indicate that the WASH sector collectively needs to do more and better to reach the ambitious targets of the SDGs.

The findings also highlight blind spots in typical WASH programming – particularly the role of animal waste and fecal contamination of food during irrigation and food preparation that are often overlooked in WASH programme design.

Many have called for transformative WASH In response to the studies but with some ambiguity around what is meant. While the consensus is that this implies interventions that lead to a comprehensively clean environment (Box 1), the path to this result is not universally agreed.

Impact of Early Life Exposure to Environments with Unimproved Sanitation on Education Outcomes: Evidence from Bangladesh

Impact of Early Life Exposure to Environments with Unimproved Sanitation on Education Outcomes: Evidence from Bangladesh. World Bank, November 2019.

Despite Bangladesh’s notable progress toward the eradication of open defecation, the country still faces severe deficits in the availability of improved sanitation. bank

This paper analyzes the impact of exposure to unimproved sanitation early in childhood on primary school enrollment status, using pseudo-panel data for children ages six to nine years in Bangladesh.

The results indicate that unimproved sanitation has a negative and significant impact on primary school enrollment. A child’s early exposure to unimproved sanitation decreases the likelihood of being enrolled in primary school by eight to ten percentage points on average compared with a child with access to improved sanitation.

The effect is particularly strong — a difference of 8 to 10 percentage points — for children ages six to seven. It is also strong in rural areas. The results are statistically robust to errors due to potential omitted variable bias.

A humanitarian WASH update – November 20, 2019

Dear Colleagues:

Please contactTravis Yates,, if you have any questions about the GWC Resource Center. Also below are news from Elrha, USAID, studies from Lebanon and Bangladesh and some interesting blog posts from UNHCR, CGIAR and others. emergencies

The Global WASH Cluster is maintaining a resource center focused on humanitarian WASH with links to relevant journal articles, toolkits, and NGO learnings ( There are nearly 200 cataloged documents covering a variety of WASH themes. A sample of documents includes:


We are looking for robust research studies that generate practical, comparative evidence around HIF-funded WASH innovations. The evidence will be useful for both the innovations themselves and the humanitarian sector as a whole. These studies need to be collaborations between WASH innovators, researchers and humanitarian agencies.

USAID Announces Nearly $56 Million in Additional Humanitarian Assistance to Contain Ebola in the Democratic Republic of Congo. USAID, November 2019.
With this funding, the United States is continuing to provide life-saving assistance through on-the-ground partners, including activities to prevent and control infections in health facilities, enhanced surveillance for the disease, training for health-care workers, community-engagement efforts, the promotion of safe and dignified burials, and food to support people and communities affected by Ebola.


Refugees, water balance, and water stress: Lessons learned from Lebanon. Ambio, November 2019.
Results of our spatial analysis show that while the impact of refugees and indirectly conflicts’ on water stress is of paramount importance and it cannot be neglected, opportunities exist for the international community to intervene and provide for water supply and network efficiency improvements, which can relieve the induced stress.

Occurrence of Escherichia coli and faecal coliforms in drinking water at source and household point-of-use in Rohingya camps, Bangladesh. Gut Pathogens, November 2019. Despite the limitations and challenges faced, this is the first study of water quality assessment in the Rohingya camps involving almost half of the total drinking water sources.

A Synthesis Report Analyzing Menstrual Hygiene Management Within a Humanitarian Crisis. OIDA International Journal of Sustainable Development, November 2019.
The lack of universal policy surrounding  the  implementation of  MHM  in a crisis has implications not only for women’s health and dignity, but also for a country’s progress towards  the related SDG targets.

Beyond mapping: a case for geospatial analytics in humanitarian health. Conflict and Health, November 2019.
This paper explores a variety of historical and contemporary geospatial applications in the public health and humanitarian fields and argues for greater integration of geospatial analysis into humanitarian health research and programming.


Groundwater can prevent drought emergencies in the Horn of Africa. Here’s how. The Conversation, November 2019.
The idea is that drought-driven humanitarian emergencies can be prevented if groundwater is reliably made available at strategic locations.

The Growing Threat of Water Wars. Project Syndicate, November 2019.
Today, hundreds of international water agreements are coming under pressure.

Bringing toilets into the home boosts refugees’ health and security. UNHCR, November 2019.
Burundian refugees in eastern Democratic Republic of the Congo receive cash to construct houses and toilets, improving access to better sanitation.

11,000 Steps to Water: How data visualization can impact American perceptions of refugees. UNHCR, November 2019.
One of the prototypes developed was an activity tracking app. This app helps Americans see how their daily activity compares to the daily activity of refugees.

New project offers circular economy solutions for refugee and host communities in East Africa. CGIAR, October 2019.
‘We have developed solutions like pellets from fecal sludge for agriculture and safe wastewater reuse for urban agriculture,’ said the Ethiopian economist. ‘These RRR solutions and other innovations from low-space farming can be adapted to work in refugee settlements.’


Safer water, better health: 2019 update. WHO, 2019.
The report also presents selected WASH interventions that have been shown to improve health and complements them with available cost–effectiveness analyses.

Guidelines on Inclusion of Persons with Disabilities in Humanitarian Action. Inter-Agency Standing Committee (IASC), 2019.
The guidelines set out essential actions that humanitarian actors must take in order to effectively identify and respond to the needs and rights of persons with disabilities who are most at risk of being left behind in humanitarian settings. Chapter 18 is on WASH issues.

Global Waters Stories – November 2019: Celebrate World Toilet Day

Global Waters Stories – November 2019: Celebrate World Toilet Day

World Toilet Day 2019: These Countries are Making Sanitation Gains with USAID’s Help
As we celebrate the transformative public health impacts of improved sanitation this November 19, USAID takes you from Ethiopia to Indonesia in this photo essay to showcase how innovative thinking, government action, and private sector participation have helped generate some of the greatest recent sanitation success stories around the world. globalwaters

Strengthening Urban Indonesia’s Water and Sanitation Systems – USAID is working with Indonesia’s government and private sector to tackle the challenge of untreated waste through the regulation of sludge removal and provision of financing for septic tank construction.

Podcast: 2019 Global Analysis and Assessment of Sanitation and Drinking Water Report – Global Waters Radio presents the WHO’s Bruce Gordon and USAID’s Oliver Subasinghe discussing this report’s key takeaways and how its data help inform the Agency’s approach to WASH investments

Read the complete issue.