Category Archives: Research

150,000 Refugee women and girls to receive transformative menstrual health management solution

The UN refugee Agency UNHCR and AFRIpads have just begun the largest rollout of reusable sanitary pad distribution and Menstrual Health Management (MHM) sensitization of refugees in Uganda. The project aims at benefiting some 150,000 women and girls in south-western Uganda. With this, UNHCR Uganda is putting critical spotlight on the challenges refugee women and girls face during their periods. In addition to providing the AFRIpads kit to refugee women and girls, they have been providing MHM capacity building since late September to equip hundreds of NGO field staff with the appropriate knowledge and tools dedicated to breaking taboo and stigma around the topic of menstruation.

The project is in response to a 2018 UNHCR and AFRIpads pilot study in South West Uganda, which found that:

  • The number of girls that reported missing school during their period was cut in half when using AFRIpads reusable pads
  • 84% of refugee schools girls indicating they would prefer to use AFRIpads over disposable pads

Read the full press release and the announcement (with photos) on the AFRIpads website.

Tackling slippage – Frontiers of CLTS: Innovations and Insights

Tackling slippage – Frontiers of CLTS: Innovations and Insights, September 2019.

This issue of Frontiers of CLTS explores current thinking and practice on the topic of tackling slippage of open defecation free (ODF) status. clts

It looks at how slippage is defined and identified, and at different patterns of slippage that are seen after ODF is declared.

Although a considerable amount has been written on how to establish strong Community-Led Total sanitation (CLTS) programmes that prevent slippage from happening, this issue looks at how to reverse slippage that has already taken place.

From the literature, there is little documented evidence on how slippage can be reversed; evidence and guidance tend to focus on prevention. This review begins to address this gap.

Implementers are encouraged to use the proposed patterns of slippage
framework and slippage factors section to understand the type and extent of slippage experienced, then use the examples in the section on tackling slippage to identify potential slippage responses.

Recent WASH research on water carrying, behavior change, container-based sanitation, etc.


Putting the “A” into WaSH: a call for integrated management of water, animals, sanitation, and hygiene. Lancet Planetary Health, August 2019. The first step—putting the “A” into WASH—is to shift the thinking to accelerate progress towards transformative WASH by considering pathways of enteropathogen transmission that are not currently central to WaSH strategies. We believe more substantial reductions in household and environmental fecal contamination are possible through concerted efforts to collectively improve the health of animals, humans, and the environment, while maintaining the benefits of livestock ownership. ghana

The association of water carriage, water supply and sanitation usage with maternal and child health. A combined analysis of 49 Multiple Indicator Cluster Surveys from 41 countries. International Journal of Hygiene and Environmental Health, 2 September 2019. Fetching water is associated with poorer maternal and child health outcomes, depending on who collects water. The percentage of people using improved sanitation seems to be more important than type of toilet facility, and must be high to observe an association with reduced child deaths and diarrhea. Water access on premises, and near universal usage of improved sanitation, is associated with improvements to maternal and child health.

Theory-driven formative research to inform the design of a national sanitation campaign in Tanzania. PLoS One, August 2019. The resulting Theory of Change recommended that the intervention should surprise people with a novel conversation about toilets, promote toilets as a means of conferring status, and introduce a perceived urgency to ‘act now’.

Behaviour settings theory applied to domestic water use in Nigeria: A new conceptual tool for the study of routine behavior. Social Science & Medicine, August 2019. Improving public health will require the disruption of settings, for example, through bringing water infrastructure directly to the home, through the sale of new props that facilitate hygienic routines, or in the disruption of gender roles via the promotion of new norms.

Evaluating the viability of establishing container-based sanitation in low-income settlements. Waterlines, July 2019. Drawing on an initial review of existing CBS services, this paper identifies and evaluates these factors in relation to establishing CBS in a new service location. By applying a weighted scoring matrix to these factors, the potential viability of CBS services has been assessed for urban informal settlements in Kathmandu Valley, Nepal.

How does water-reliant industry affect groundwater systems in coastal Kenya? Science of The Total Environment, 1 December 2019. The results show that the lack of aquifer systems data can be overcome, at least partly, by integrating different sources of information.

Continue reading updates|WASH research|Reports from World Bank, UNICEF, MWA, Nature Conservancy

In addition to the studies and reports below, recent updates to include a new Resources page and the blog post USAID at World Water Week: How Strong Governance Attracts Investment


The implications of three major new trials for the effect of water, sanitation and hygiene on childhood diarrhea and stunting: a consensus statement. BMC Medicine, August 2019. Our view is that these three new trials do not show that WASH in general cannot influence child linear growth, but they do demonstrate that these specific interventions had no influence in settings where stunting remains an important public health challenge. We support a call for transformative WASH, a comprehensive package of WASH interventions is needed that is tailored to address the local exposure landscape and enteric disease burden.

Effects of complexity of handwashing instructions on handwashing procedure replication in low-income urban slums in Bangladesh: a randomized non-inferiority field trial. Jnl WASH for Dev, Sept 2019. Simple handwashing steps are easier to remember for long time periods compared to complex steps.

Continue reading

USAID WASHPaLS study – Policy Diffusion in the Rural Sanitation Sector: Lessons from Community-Led Total Sanitation

Policy Diffusion in the Rural Sanitation Sector: Lessons from Community-Led Total Sanitation (CLTS). World Development, August 2019.

Authors: Valentin Zuin; Caroline Delaire; Rachel Peletz; Alice Cock-Esteb; Ranjiv Khush; Jeff Albert

Worldwide, 892 million people practice open defecation, most of whom live in rural areas of South Asia and Sub-Saharan Africa. Community-Led Total Sanitation (CLTS) is the most widely deployed approach to generate demand for, and use of sanitation facilities. CLTS relies on behavioral change and community self-enforcement to end open defecation.

Since its genesis in Bangladesh in 1999, CLTS has spread to approximately 60 countries, mostly in Asia and Africa, and is employed by the majority of development organizations operating in rural sanitation. This paper uses a qualitative approach to analyze the reasons and processes that drove the wide diffusion of CLTS.

We show that CLTS was embraced because it was perceived as a fast and effective solution to the problem of open defecation, one which was in line with the decentralization and community participation paradigms, at a time when donors and governments were looking for strategies to meet the MDG for sanitation.

CLTS spread under the leadership of influential donors, NGOs, persuasive practitioners, and academics. Face-to-face interactions among members of this network and local governments at conferences and workshops played a central role in the diffusion of the approach.

The use of experiential learning during study tours and workshop field visits has been crucial to persuade government actors at different levels, NGOs, and donors to use the CLTS approach. Notably, robust scientific evidence played little role in the diffusion of CLTS. We conclude by making suggestions to strengthen the evidence base for rural sanitation policies.

Sustainable Total Sanitation – Nigeria: Final Research Report – Institute for Fiscal Studies

Sustainable Total Sanitation – Nigeria: Final Research Report – Institute for Fiscal Studies, 2019.

Key findings and policy lessons

  • Reducing OD is intimately tied to increasing toilet ownership in Nigeria
  • CLTS improved sanitation and reduced OD in poor communities
  • Door-to-door sales agents are important
  • Targeting CLTS interventions based on community characteristics (in particular their relative wealth status) can increase policy impacts.
  • CLTS increased toilet ownership among households in poor areas without actually removing financial constraints, but these constraints remain important for households with no toilet.
  • SanMark is still a young intervention, and it is difficult to assess its effectiveness at addressing the sanitation gap at this stage.
  • Policymakers should monitor and continue to evaluate the costeffectiveness of this intervention further before considering a SanMark scale-up.
  • Policymakers should consider alternative policies that address financial constraints in both poor and richer areas, such as targeted subsidies or credit lines. These policies could complement the efforts of both CLTS and SanMark by alleviating households’ main constraints

USAID Updates | Aug 2019 WASH research | Blog updates


USAID Participation at Stockholm World Water Week 2019 – USAID sessions this year will cover topics ranging from the role of women in water leadership to promoting self-reliance through financing of water and sanitation services to building resilient water and food systems. armenia


Effect of in-line drinking water chlorination at the point of collection on child diarrhoea in urban Bangladesh: a double-blind, cluster-randomised controlled trial. Lancet Global Health, Sept 2019. Passive chlorination at the point of collection could be an effective and scalable strategy in low-income urban settings for reducing child diarrhea and for achieving global progress towards Sustainable Development Goal 6.1 to attain universal access to safe and affordable drinking water.

Experiences of capacity strengthening in sanitation and hygiene research in Africa and Asia: the SHARE Research Consortium. Health Research Policy and Systems, Aug 2019. Strategies that yielded success were learning by doing (supporting institutions and postgraduate students on sanitation and hygiene research), providing fellowships to appoint mid-career scientists to support personal and institutional development, and supporting tailored capacity-building plans.

Toward Complementary Food Hygiene Practices among Child Caregivers in Rural Malawi. American Journal of Tropical Medicine and Hygiene, 7 Aug. Selected contextual (i.e., presence of handwashing facility, locally made dish rack and ownership of animals) and psychosocial factors which include normative, ability, and self-regulation (remembering) factors have been identified as strong predictors for the success of an intervention that focuses on washing of utensils with soap, keeping of utensils on an elevated place, and hand washing with soap at critical times.

Broad approaches to cholera control in Asia: Water, sanitation and handwashing. Vaccine, Aug 2. Household interventions only marginally reduce cholera risk. Water and sanitation infrastructure provides multiple benefits. New approaches and institutional flexibility needed to address cholera.

The future of groundwater in sub-Saharan Africa. Nature, Aug 7. An analysis of aquifer replenishment in sub-Saharan Africa shows that reduced precipitation does not always deplete groundwater reserves, challenging the idea that these reserves will decrease in response to global warming.


What Proportion Counts? Disaggregating Access to Safely Managed Sanitation in an Emerging Town in Tanzania. Preprints, Aug 6. This study demonstrates the possibility of using simple survey tools to collect reliable data for monitoring progress towards safely managed sanitation in the towns of global south.

Monitoring Menstrual Health and Hygiene: Measuring Progress for Girls related to Menstruation Meeting Report. Columbia University and WSSCC, 2019. Overall, findings highlight the complexity of addressing menstruation in societies around the world that have ongoing menstrual restrictions and taboos that are relevant for the design of interventions.

Running Dry: Tackling the myths about urban water and sanitation. WSUP, July 2019. WSUP has identified five myths which are stopping investors, agencies and policymakers from properly addressing the inadequate access to essential water and sanitation services in cities across Africa and South Asia.


Reflections on a Review of Studies on the Physical and Emotional Toll of Carrying Water. Engineering for Change, Aug 1. UNC’s review includes takeaways for developing strategies to meet the challenge of water provision. The health problems associated with water carriage can only be eliminated if all households have water on premises, which is one of the parameters of ‘safely managed’ water called for under the Sustainable Development Goals. In areas where water fetching must continue, strategies should focus on reducing the distance to water sources, providing alternatives to carrying water on the head, such as wheelbarrows, and eliminating gender-based violence

For street vendors, finding water and toilets isn’t just a nuisance, it’s cutting into earnings. IIED, Aug 7. Guest blogger Carlin Carr argues that providing street vendors access to safe, clean water, sanitation, and hygiene resources benefits not just sellers, but the wider community too.

Rooted in Research, Handwashing Stations Designed to Encourage Kids to Wash Their Hands. WASHfunders, Aug 2019.


World Resources Institute Aqueduct 3.0 Country Rankings – This dataset shows countries and provinces’ average exposure to six of Aqueduct 3.0’s water risk indicators: baseline water stress, riverine flood risk, and drought risk. Scores are also available for all industrial, agricultural, and domestic users’ average exposure to each indicator in each country and province basin.