Overview

One of the main development challenges in Sub-Saharan Africa is access to safe water, sanitation and hygiene (WASH). It is estimated that more than 40 per cent of the population in Sub-Saharan Africa lack access to safe drinking water and more than 70 per cent live without toilets and hand-washing facilities.⁵ This contributes to diseases and the death of thousands of people daily. Diarrhoea, which is caused predominantly by inadequate water, sanitation and hygiene, is now the biggest killer of children in Africa.⁵

People with disability are often overlooked in the design of WASH services, which can mean resorting to unhygienic and unsafe practices. In many marginalised communities, people with disability face discrimination and stigmatisation that prevents them from using public facilities and participating in community development initiatives. In some communities, discriminatory practices continue to deny people with disability access to basic human needs, such as access to safe water, improved sanitation and safer hygiene practices. A key priority for AACES partners during the year was to promote an enabling environment so that people with disability have better access to WASH services and greater influence and engagement with decision-makers.

In 2012–13, AFAP, Caritas, Oxfam and WaterAid improved access to WASH for marginalised communities by:

• delivering WASH services to marginalised communities and schools
• promoting safe hygiene practices
• increasing engagement between communities and local government.

Delivering WASH services

Improved access to clean water has benefited marginalised communities, particularly the lives of women and girls who previously spent several hours each day collecting water. From data collected in 25 countries in Sub-Saharan Africa, it is estimated that women in these countries spend a combined 16 million hours each day⁶ collecting drinking water (compared to men who spend a combined six million hours).⁷ With increased access to clean water, women have more time for other household tasks and productive income-generating activities. It has also enabled young girls to attend school, which increases future involvement in economic and community activities.

The lives of people with disability have also improved through access to clean water. For instance, the construction of accessible toilets and water facilities in schools has contributed to improved school attendance among children with disability. People with disability have also been empowered to actively participate in development activities and contribute to community life.

Increased access to safe drinking water

WaterAid helped 9011 people in Ghana access safe drinking water by providing a mechanised water system, drilling two boreholes, rehabilitating and providing hand pumps, and building three rainwater harvesting systems and two water kiosks.

In Tanzania and Malawi, Caritas helped 12,844 people to access sustainable, safe water through community managed village water supply schemes. Caritas reported a reduction in cases of diarrhoea and other water-borne diseases due to improved sanitation and hygienic practices as a result of the schemes. As part of Oxfam's activities in South Africa, 574 adults and children gained access to sustainable, safe water. Accordingly, health outcomes have improved for communities as home-based care and health workers now understand the link between hygiene practices, water quality and better health.

Improved access to sanitation

AACES partners improved access to sanitation for marginalised communities, particularly for women and girls. AFAP's partner Concern Universal built family latrines in Mozambique, enabling 2437 people to access appropriate sanitation facilities. In Ghana, WaterAid used the community led total sanitation (CLTS) approach to encourage the building of latrines. The positive changes resulting from this initiative led to the National Sanitation Task Force declaring two communities as 'open defecation free.'⁸

School sanitation

School children who have access to safe water and sanitation are more likely to be healthy and do well in school. For menstruating girls, safe and separate sanitation facilities allow them to practice proper hygiene, which can improve school attendance.

WaterAid built 17 latrine blocks for girls and 16 for boys in primary schools in Tanzania. The 33 latrine blocks, benefiting more than 9000 pupils, include hand-washing stations, incinerators, a menstrual hygiene management change room, accessible facilities for pupils with disability, and urinals. Class attendance is up and girls in particular have reported that the new facilities offer more privacy. Children with disability are also relying less on their friends for help when using the toilet, encouraging more students with disability to attend school.

Promoting safe hygiene practices

Improving safe hygiene practices is fundamental to good health, which in turn leads to healthier communities and better standards of living. During the year, AACES partners increased awareness and demand for sanitation and hygiene services in schools and communities through hygiene promotion activities. A key focus was school WASH and health clubs. Children are receptive to new ideas and practices, therefore there is an opportunity to introduce good personal hygiene and sanitation practices at a young age. School WASH and health clubs are formed on a voluntary basis and managed by pupils and teachers.

WaterAid established school WASH clubs in Tanzania and trained school committees and teachers, reaching 10,539 pupils. In this 'child-to-child' approach, children pass on sanitation and hygiene messages to one another and to their families at home. WaterAid also conducted school WASH competitions to reward individual children performing well on hygiene behaviour change and to reward schools for encouraging cleanliness.

In Mozambique, AFAP's partner Concern Universal also trained 417 children from three primary schools in good hygiene and sanitation practices through health clubs. After the training, the children were able to promote good sanitation and hygiene practices in their schools and communities. Good hygiene practices were promoted through training, advocacy and the 'strength-based'⁹ approach. A total of 9000 people are now using improved hygiene and sanitation practices.

Oxfam's training of 71 WASH committees in Zambia increased hygiene knowledge in the community. Women who received training started asking their husbands and male relatives to build toilets, dish racks and bathing shelters.

Transforming communities through school WASH clubs

WaterAid and partners are piloting a school WASH project in Dodoma, Singida and Tabora regions of Tanzania. The aim is to provide WASH in schools as part of efforts to improve the quality of education. The project involves building water and sanitation facilities in schools, and promoting good health and hygiene practices through activities for school children, teachers and the wider community.

At Ikowa Primary School, WaterAid built latrine blocks, hand-washing stations, incinerators, a menstrual hygiene management change room and facilities for pupils with disability.

Ikowa's story has been replicated at Mpalanga Primary School. Here the WASH club has grown to more than 70 pupils who are very active in school. Angela Mlei, the school's health club teacher, says the club has had a positive impact on pupils' school attendance, the school environment, and children's lives. 'The health club members are the cleanest in the school, and incidentally the smartest. Thus they are good role-models in school, which motivates others to emulate them,' she says.

Increased engagement with communities and local government

AACES partners have helped communities to become more assertive in demanding their water rights and have lobbied decision-makers to influence change around water and sanitation services after receiving training from program partners.

With WaterAid's support, community members in Ghana, especially women, have demanded accountability and water access from government authorities and service providers. WaterAid has helped more than 80 people, (including 48 women) to understand their rights to WASH services and to assert them using community scorecards.¹⁰ Community hygiene volunteers were trained to help their communities adopt good
hygiene behaviour and build their own latrines.

AFAP's partner in Mozambique, Concern Universal, collaborated with the Forum of Association of Persons with Disability to lobby district authorities to plan for and target people with disability in the use of local investment funds with the aim of promoting more equitable use of resources.

Oxfam held WASH awareness-raising workshops for children, youth, women and people with disability, reaching 2965 participants, including 1741 women and 19 people with disability. These workshops built knowledge, skills and confidence around WASH rights, helping people with disability to actively engage in decision-making processes. As a result, people with disability expressed confidence in challenging some of the discriminatory attitudes often shown to them within the community by voicing their rights, and questioning responsibilities and accountability of some service providers. One workshop participant, Mr Dlamini from Mashakeni, shared how for the first time in his life he has been able to express himself and felt heard, respected and taken seriously: 'It is not my disability that is a problem but people's attitudes towards me that make my life difficult.'

During the year, AACES partners also increased the skills and knowledge of governments and decision-makers to deliver inclusive and sustainable WASH services to marginalised communities. This has been achieved by training and increased engagement.

In Zambia, government officials gained skills in participatory and inclusive development planning through training from Oxfam on gender and disability. Oxfam also held a 'school mapping' exercise that provided information to demonstrate to government how quality inclusive education services at primary schools can be provided and incorporate WASH services.

Challenges and opportunities

In Zambia, new drilling technology used by Oxfam is significantly reducing the cost of drilling boreholes. Oxfam's partner, Village Water Zambia, drilled water points for less than half the cost of conventional boreholes. This technology has the potential to increase the number of drilled water points, increase community participation in drilling and provide partners with opportunities to generate income by drilling boreholes for other development partners.

In Malawi, WaterAid noted a lack of openness in dealing with issues of menstrual hygiene due to cultural considerations of teachers and students, which may hamper progress. To address this challenge, WaterAid plans to engage mothers' clubs in all schools to provide a safe environment for open discussion.

The strength-based approach promoted by Caritas in Malawi and Tanzania is invigorating communities. It is encouraging them to be proactive in holding decision-makers to account for the delivery of WASH services. This approach has increased access to sanitation services for 5296 people, including women and people with disability.

5. UNICEF and WHO, Diarrhoea: Why children are still dying and what can be done: 2009, pp. 1-17

6. UNICEF and WHO, Progress on sanitation and drinking water: 2013 update, 2013 pp. 5 & 8.

7. UNICEF & WHO, Progress on drinking water and sanitation: 2012 update, p.31.

8. Open defecation free' refers to an environment without openly exposed faeces. Achieving this outcome might involve building and encouraging the use of latrines, preventing the occurrence of faeces exposed to the environment.

9. A 'strength-based' approach refers to policies, practice methods and strategies that identify and draw on the strengths of children, families and communities. The approach acknowledges individual or community strengths and challenges, and engages them as a partner in developing and implementing solutions.

10. 'Community score cards'are a community-based monitoring tool that enables citizens to assess how well priority public services are being delivered by scoring different elements. It is an instrument to elicit social and public accountability and responsiveness from service providers.