My “SH” conversion in Ethiopia

For years, I have talked about sanitation and hygiene as crucial components of sustainable water development. The acronym WASH (Water, Sanitation, and Hygiene) rolls off my tongue, and I cheer when I hear our supporters using it themselves. But do I really believe that WASH can change lives? After a “conversion” experience in Ethiopia, I can confidently vouch for WASH—or even just the SH part of it—as an effective means of community transformation.

In April 2010, I traveled to Ethiopia to document a 22-month project carried out by my organization, Lifewater International, in ten rural communities (kebeles) near the town of Hosanna. With a total population of 56,000, the communities had often requested help in obtaining safe water. As usual, requests for sanitation and hygiene education were far less common. In fact, many people were fearful of latrines; the crumbly soil had caused a number of latrine collapses, making sanitation efforts understandably unpopular.

When Lifewater received USAID funding in 2007, it worked with an in-country partner to develop plans for sustainable WASH development in Hosanna. Planning was complicated by the fact that well drilling in Hosanna is challenging and expensive—the region is remote and the geology is difficult. Lifewater decided that immediately drilling wells would leave too few resources for sanitation and hygiene education. Because new wells result in only limited health improvements if not bolstered by adequate sanitation facilities and effective hygiene practices, Lifewater decided to invest in the latter while continuing to seek funding for safe water sources.

When Lifewater began working in Hosanna, 43 percent of young children suffered acute watery diarrhea, 40 percent of families had no latrine at all, only 26 percent of individuals surveyed washed their hands after defecating, and only 12 percent washed their hands with soap or ash. Diarrheal diseases and deaths were common.

Lifewater decided to launch the Hosanna project with a “training wave.” Utilizing small teams of qualified North American volunteers, Lifewater trained local project staff and key community leaders in community health through hygiene, WASH promotion, and latrine design and construction. Course facilitators emphasized participatory training methodologies that affirmed the active involvement of all people in the learning process, regardless of their education or status.

As they learned through various Lifewater training courses, community leaders began initiating change in their spheres of influence. School directors and teachers mobilized student health clubs to educate students and their families, clean school compounds, and construct school latrines with handwashing stations. At the same time, health promoters and community leaders began WASH efforts among local families. For the first months of the project, ten to twenty “model households” were nominated from each community. These households agreed to receive sanitation and hygiene education and then implement changes in their own households. The efforts were highly successful, bringing dignity and health to the model households. Model household members enthusiastically began teaching their neighbors about safe latrine construction, effective handwashing, using waste as fertilizer, and safe water transportation, storage and use.

In addition, health promoters formed sanitation committees to oversee sanitation education and latrine construction among families. To de-stigmatize discussion about sanitation, they intentionally gave the committees a provocative name: “chiro committees” (“feces” committees). The project coordinator reported, “The best thing we did was to teach people to use the word for ‘feces’ in their local language: ‘chiro.’ Before the training, they would not even say that word. Now the people talk about ‘chiro’ without problem.”

The results of the Hosanna Project’s multi-pronged promotion strategy were outstanding. Innovatively utilizing their own labor and resources, individual families constructed 3,335 new latrines. A local leader said, “Where would you like to go? You can go to any home in our community and you will see very clean grounds and good latrines.” Latrines were also constructed at ten schools, with separate facilities for girls, boys, and teachers. School administrators report that absenteeism is down and enthusiasm for WASH activities remains high.

According to government surveys, the independent baseline survey, and the final project evaluation, the Hosanna Project boosted latrine coverage in the project area from 60.9 percent to 97.2 percent. One community achieved 100 percent latrine coverage and was declared by the Ethiopian government as the nation’s second “Open Defecation Free” community. This honor resulted in national media coverage and interest in replicating this success in other communities. In addition, handwashing increased dramatically as a result of the project. Handwashing with soap, a proven method in mitigating health risks, increased by at least 150 percent.

Another notable result of the project is improved local capacity. Lifewater and its partner worked intensively to build initiative, confidence, and skills at all levels. The project coordinator himself learned about good community development. He shared, “[Before this project] I was working on a different latrine project in one kebele. We gave out more than one thousand latrine slabs but we did not do the sanitation training well enough. At that time even I myself was not changed. We would pile information on them. Go! Go! Go! We just wanted to get it done. When we went back, we found out that many people had broken up the slabs to get the metal. With Lifewater training, it was very interesting, because I learned that the most important thing is to get the people involved.”

Most encouraging was a report from the local government health offices that acute watery diarrhea, which had been the number two health risk to children dropped completely out of the top ten.

Witnessing the overwhelming community initiative and marked health improvements in Hosanna, I am now a firm believer in SH (Sanitation and Hygiene) as a vital part of water development—even when the “WA” (Water) of WASH is delayed. When communities like those in Hosanna, Ethiopia, successfully carry out sanitation and hygiene education, they experience dramatically improved health, and I am confident that they will be good stewards of water systems once they are installed.

By Leslie Hawthorne Klingler