This year’s gathering is the largest ever for the Water and Health conference. They are expecting some 680 people to participate, though the venue is set up to accommodate only 500 or so. 

JMP’s Session on the SDG Monitoring Framework. The U.N.’s recent decision to replace Millennium Development Goals (MDG) with Sustainable Development Goals (SDG) affects almost everyone at this conference. Representatives of UNICEF (Rob Bain) and WHO (Bruce Gordon, Rick Johnston) introduced the Joint Monitoring Program’s (JMP) new framework and explained some of the process. This was introduced as a ‘work in progress’, one that shifts the focus from ‘access’ to ‘services’.

In Bangkok this week a meeting of the Inter-Agency Expert Group is under way. This group is made up of 28 member states plus observers. They expect to finalize an SDG framework by March 2016. This process gives governments more control over decisions about the SDGs than they had with the MDGs. Considering that the SDG goals and targets are much more ambitious and detailed than those of the MDGs, and governments will have to increase their own implementation and monitoring efforts if they are to mean anything, increasing political participation makes sense. Indeed, as Bruce Gordon mentioned in his introduction, there is a risk that, ‘All the passion might deflate’, unless governments figure out how to actually do these things and measure them.

A new feature of the JMP approach will be a stronger focus on inequalities. As Rick Johnston said, ‘No target is met unless it’s met for all’. Data will be disaggregated by the already familiar urban, rural, and socioeconomic status groups, but also according to affordability. Countries are being asked to monitor ‘locally important disadvantaged groups’, which need to progress at faster rates than others, simply to catch up.

Latrine facilities still must be used by only one household to be considered ‘improved’; but JMP is adding safe disposal of faecal waste or adequate off-site treatment to its criteria for an improved latrine. The new standard includes not only dumping waste into sewers, but measuring how much of it actually reaches a treatment facility. There are currently no ways to collect national-level data on this, but “We’re building up a tool box,” said Rick Johnston.

Hygiene (defined here as handwashing with soap, MHM, and food hygiene) is getting more attention than previously at JMP, but it probably will not be confirmed as a separate indicator in the Bangkok meetings. Rather, it seems likely to be included as an aspect of sanitation. (Rick Johnston: ‘We don’t control this’.) WASH in schools and health facilities is intended to be ‘universal’, meaning available in all settings. Gender-separated toilets in such institutions will be part of that.

There was much discussion of various ‘ladders’ in this session. In addition to a sanitation ladder, there was a hand washing ladder (None -> Unimproved [no soap or no water] -> Basic). There also will be some ‘monitoring ladders’. (See picture) So JMP will be monitoring countries’ monitoring, it seems.

 

Opening Plenary Presentation by Dominick de Waal (Senior Economist, WSP, World Bank). Mr. de Waal talked about a 2009-2010 public sector expenditure review showing that sector aid has not had the expected impact on WASH progress or health. He talked about the predominant ‘project’ model, which separates aid funds from domestic finance, as an inefficient way to promote sustainable change. There are many resources available and supporting development in every nation, he pointed out. The mix between aid and domestic capital expenditures is very different from one country to another. His concluding suggestion was to consider these processes: 1) project financing and technical assistance pull the public sector, strengthening capacity and stabilizing institutions; 2) sectoral budget support can push development processes; 3) general budget support and technical assistance can squeeze more out of existing systems; and 4) support to households nudges development processes forward.

WASH in Schools: Operationalising Menstrual Hygiene Management (MHM) in Schools. Chaired by Therese Mahon of WaterAid-UK, this was the second half of a session hosted by the WASH in Schools Network (WINS). MHM was introduced as essential to girls’ rights to information, to health (both social and physical), to necessary materials, to education, and to privacy and dignity. All of this depends on ‘clean and functioning facilities’. Four break-out groups discussed ‘Four Guiding Principles’ promoted by the group: 1) Information on beliefs, 2) National plans, 3) Teacher training, and 4) National indicators and monitoring.

Session on Sanitation. Mahbub-ul Alam (International Centre for Diarrhoeal Disease Research, Bangladesh/ICDDR,B) reported on a study of factors affecting cleanliness of urban slum toilets in Dhaka. Only 34% of 1226 toilets observed in 23 slums were found to be clean (free of visible faeces, urine, and solid waste) Presence of water in or next to the toilet and a water storage container next to the toilet were the best statistical predictors of cleanliness. Qualitative data that might offer more insights are yet to be analysed. A follow-up study of a WaterAid sanitation project for very poor households in Orissa, India1 , found that latrine coverage had increased from 9% to 63%, but after four years general latrine coverage had dropped by 10%, and functional latrines (a pit connected to the pan, and a pan that seemed to be actually used) declined even more sharply. Thirty-three percent said their latrines were never used. Only 2.3% of 1494 pits had actually filled up. Some families were trying to avoid having to empty the pits. This project simply built latrines and went away. There was no follow-up.

Session on Hand Washing. A project in Bangladesh2  was piloted two rural primary schools. Students were not given any specific instructions or hand washing advice by their teachers or by observers. Rather, some environmental cues were established to coax (‘nudge’) them to wash their hands after they left the toilet. A small hand washing station was set up outside each toilet. After a while pictures of feet were painted on paths leading to the station, and pictures of hands were painted near it. The researchers observed 1000 children coming out of the toilets without talking to them at all. Hand washing increased from 4% at baseline, to 18% after the hand washing stations were set up, and up to 68% once the environmental cues (pictures of hands and feet) were introduced. Two weeks later hand washing increased to 72%, and it stayed at that 72% level six weeks later.

Suzanne Hanchett is a consultant and a partner in Planning Alternatives for Change

 

• 1. Coverage, Use and Faecal Sludge Management of Latrines in Orissa, India: a Cross-Sectional Study, presented by Thomas Clasen on behalf of Belen Torondel, London School of Hygiene & Tropical Medicine (LSHTM)
• 2. Nudging Hand Washing: Behavior Change - Without Behavior Change Communication - Among Primary School Students in Bangladesh, Presented by Robert Dreibelbis, University of Oklahoma