plan 561Better Health through WASH in Lira District Uganda

Summary

Improvements made to community water supplies and sanitation facilities at schools, coupled with WASH education, encourages school attendance and sustains family health year-round.

Background

Northern Uganda is rebounding after 20 years of oppression and civil war. With the return of peace, communities are rebuilding and embracing opportunities for growth and development. However, water, sanitation and hygiene are needed to sustain healthy communities and improve the quality of life for families. Lira District exhibits some of Uganda's worst health indicators. For example, Lira District government health center data from June 2013 shows 69% of disease cases recorded were WASH related infections and illnesses. Although access to safe water is increasing, sources are not equally distributed, leaving no alternative but to drink from ponds or unprotected springs. Latrine coverage at households is gaining but high-levels of environmental contamination negatively impacts community health, especially during the rainy season.

School enrollment in Lira sub-county Uganda has increased in recent years due to universal primary education and an increase in cultural awareness on the importance of education for girls and young women. However, many conditions still limit school attendance by students in Uganda.

According to a recent sample of five local schools, an average of 35 % of the students missed school due to some form of illness during the rainy season. Records show water-borne diseases including dysentery, diarrhea and typhoid fever as common illnesses, primarily attributed to poor hygiene and sanitation practices in households and schools.

Another limiting factor for school attendance by girls is the lack of sufficient hygiene and sanitation facilities at schools. Because of a shortage of latrines and a lack of privacy, the drop-out rate among girls is high during monthly menstrual periods.

Lifewater and its implementing partner Divine Waters Uganda provide WASH services in northern Uganda, benefiting 130,000 people with safe water and providing WASH education to more than 70,000 people in the past five years. Training Water and Sanitation Committees ensures governance and sustainability.

Location

To be named, Fall 2013, Lira Sub-county, Lira District , Uganda
  • 2 participants | show more

    WASH and UGANDA

    Erin Huber of Drink Local. Drink Tap.

    Hello and thank you for the great work you are doing in Uganda through DWU. Does Lifewater have staff or offices there as well? If so, I'd love to connect in person with Lifewater and/or DWU during my 2 month stay in UG in between our projects Dec-Feb. Since we have not yet done a latrine project, I'd like to ask you more about your WASH ...

    Hello and thank you for the great work you are doing in Uganda through DWU. Does Lifewater have staff or offices there as well? If so, I'd love to connect in person with Lifewater and/or DWU during my 2 month stay in UG in between our projects Dec-Feb.
    Since we have not yet done a latrine project, I'd like to ask you more about your WASH education? What materials do you use? The menstral pad training for girls seems interesting (and necessary I know)-what do you use for that? During our WASH trainings, we have used different approaches and we are currently looking for materials that make sense for Uganda.
    In your budget, you have expenses for trainings, movies, etc- is this mostly for on the ground staff? printed materials? I'd love to learn about the details there.
    Have you or DWU had any mishaps with the local governments?
    How do you choose your next projects (who gets the water and why?)
    How often do you get reports on the projects success and who sends them?
    Thank you for all the good work you do in the world and for contributing as a member on PWX.
    ~Erin
    erin@drinklocaldrinktap.org

    • Julie Smith of Lifewater International

      Hi Erin, We appreciate your encouragement and interest in the program and materials. Lifewater does not have an office in Uganda, but I will be visiting our partner in mid-late February, and would be happy to meet up with you if you are still there at that time. Please feel free to follow up with me at jsmith@lifewater.org. Lifewater ...

      Hi Erin,
      We appreciate your encouragement and interest in the program and materials. Lifewater does not have an office in Uganda, but I will be visiting our partner in mid-late February, and would be happy to meet up with you if you are still there at that time. Please feel free to follow up with me at jsmith@lifewater.org.

      Lifewater has produced its own WASH in Schools curriculum, which will soon be on our website and if you would like to see it sooner, let me know and I will send it to you. The curriculum is called “10 Building Blocks for Better Health” and goes through 10 lessons on critical WASH knowledge and behaviors. The menstrual pad training is facilitated based on curriculum from a few different organizations, including SNV which has a Re-Usable Menstrual Pad program in Uganda.

      The budget costs for the trainings include materials, supplies, and some transportation and communication costs. Staffing costs are not included in this funding request.

      DWU was initially founded as a result of frustration with government corruption in the water sector. The government now has an overarching plan for community development and coordinate the efforts of all organizations working in WASH, for example, to ensure proper distribution of aid. Lifewater and DWU work within the government’s plan by focusing programs in the region we have been assigned. Within this region, Lifewater and DWU use baseline surveys and follow-up monitoring to determine in which specific communities and schools wells will be drilled. This is based on a combination of most critical need and demonstration of high likelihood that the community will maintain and properly manage the water source.

      Lifewater is in regular communication with DWU through weekly phone calls and frequent emails for progress updates. Based on Lifewater’s excellent history and track-record with DWU, we have recently shifted from monthly to quarterly reporting (from DWU to Lifewater). DWU receives reports from the community health workers and various community stakeholders much more frequently and visits the communities regularly to monitor program progress and success.

      Thank you again for the interest.

  • 2 participants | show more

    Monitoring Criteria

    Christine Roy of International Lifeline Fund

    Thank you for your detailed description of your implementation plan. It is clear that you have experience in implementing these projects. I'm also glad to see that your evaluations show that your wells are still functioning two to fours years later. What criteria are used to determine the community selection? What information is collected ...

    Thank you for your detailed description of your implementation plan. It is clear that you have experience in implementing these projects. I'm also glad to see that your evaluations show that your wells are still functioning two to fours years later. What criteria are used to determine the community selection? What information is collected during your baseline survey?

    • Julie Smith of Lifewater International

      The Ugandan government determines which sub-counties different organizations work in, to help coordinate the various NGOs and make the process as effective as possible. WIthin the region, Lifewater determines which communities in which to work. Lifewater selects communities based on need as well as based on motivation to change. Lifewater ...

      The Ugandan government determines which sub-counties different organizations work in, to help coordinate the various NGOs and make the process as effective as possible. WIthin the region, Lifewater determines which communities in which to work. Lifewater selects communities based on need as well as based on motivation to change. Lifewater generally determines motivation to change based on conversations with our local implementing partner who visits the communities and discusses their needs and resources with them. However, this program will be piloting a strategy whereby each community in need of a new safe water point will be required to reach a level of 80% household latrine coverage before Lifewater's partner will construct the well. This will be agreed to by communities in dialogue meetings together with the local government authorities. Local community leaders will lead the discussion meetings with their communities in order to mobilize and prepare the communities to reach the sanitation coverage target. Lifewater's local partner and Village Health Trainers (government-trained community members responsible for training communities in health and hygiene) will carry out a survey to confirm when a community has reached the target. Lifewater has found that communities with high motivation to maintain their health will protect and repair their water source effectively for years to come. However, communities in which wells are drilled without any effort on their part tend to let their water points fall into disrepair. Lifewater is hopeful that this strategy will increase sanitation as well as sustainable access to safe water. Local partner staff and health promoters will be operating in the communities, helping teach them how to construct latrines and promoting better understanding of the benefits of improved sanitation.

      Lifewater does not yet have a standardized baseline survey which we apply to every program, however, this program's baseline survey will include general health information (rates of diarrhea in children under 5, top illnesses affecting the community and children under 5), specific WASH information (current water source, distance to water source, type of sanitation facility, number sharing sanitation facility, if a latrine is used- does it have a door? roof? cement or wooden slab? walls?, handwashing facilities, handwashing knowledge of critical times, self-reported handwashing practice) and general societal information (what does the community see as its greatest resources? greatest problems?). These are just a few of the questions asked in our baseline. Is that helpful?

  • 2 participants | show more

    Measured success

    Lynn Roberts of Agua Para La Salud (APLS)

    I am familiar with this process of hygiene education through the Healthy Schools Peace Corps project in Guatemala. The children and teachers are required to reach a specific level of voluntary action such as washing hands without being prompted at an 85% observed activity. Do you have any such criteria in this project? Are specific ind...

    I am familiar with this process of hygiene education through the Healthy Schools Peace Corps project in Guatemala. The children and teachers are required to reach a specific level of voluntary action such as washing hands without being prompted at an 85% observed activity. Do you have any such criteria in this project?

    Are specific individuals given the responsibility for repairs and costs of maintaining the pump? What is the distance from the school to the source of repair parts for the pump? Are the parts in local hardware stores? Is the school or community required to have on hand at the school the most common parts for repairing the pumps or a fixed fund to buy the parts??

    • Julie Smith of Lifewater International

      That is an interesting hand washing requirement, Lynn, which I have not seen implemented. What is the consequence to the children and teachers if they do not meet this level of voluntary action? Do you find observation to be an un-biased, accurate, and cost-effective way to measure hand washing? Lifewater does not have any such requirement...

      That is an interesting hand washing requirement, Lynn, which I have not seen implemented. What is the consequence to the children and teachers if they do not meet this level of voluntary action? Do you find observation to be an un-biased, accurate, and cost-effective way to measure hand washing? Lifewater does not have any such requirement, although we do measure impact and activity through regular monitoring whereby teachers report club activities and Lifewater's partner staff conduct follow-up visits at the schools. Final program evaluations at schools are compared with baseline school surveys to show change in hygiene behaviors and maintenance of water, sanitation, and hygiene facilities. These are conducted without notice to school faculty in order to provide more accurate results.

      The Water Source and Sanitation Committees are responsible for collecting and keeping regular dues from community members so that when the well breaks down, the funds are available for repair. These committees are also responsible for contacting local repair technicians who have been trained by Lifewater and are part of a Ugandan government-organized society of hand pump repair technicians. The distance varies based on school location and what specific part(s) is needed for the repair. Local technicians are generally able to get the most common parts such as pipes in the community, while more serious repairs tend to require parts from bigger towns such as Lira town.

      I hope this gives you a better understanding of how the program works and its sustainability. We are happy to explain further if anything remains unclear.

    • Lynn Roberts of Agua Para La Salud (APLS)

      Thanks for the comments on repairs. Do you have any information on how well the committees function when repairs are needed? Do they function without prompting by your representatives? Have you made any inspections after three years for example to note the condition of the school facilities? The tracking of voluntary hygiene practices ...

      Thanks for the comments on repairs. Do you have any information on how well the committees function when repairs are needed? Do they function without prompting by your representatives? Have you made any inspections after three years for example to note the condition of the school facilities?

      The tracking of voluntary hygiene practices is done by the PC volunteer on the site in the Guatemalan Peace Corps Healthy project. The observations are done by the Peace Corps volunteer; Peace corps supervisors; and teachers. Having the PCV on site for up to 6 years paid for by the US government is most helpful as you can imagine. The school does not get a certification from the Ministry of education unless they meet these criteria. This is why some schools require 6 years and other just 2 years and some school do not get their certification, but the majority do manage. This is due in great part to the constant presence of the PCV. I understand that you and I do not have this funding base so are not able to be as diligent. Do you have any quantitative information 2 or 3 years after your intervention?

    • Julie Smith of Lifewater International

      Lifewater recently completed a post-program evaluation in which we surveyed wells drilled between 2-4 years ago. Of the wells we drilled in schools during this time period, all are still functioning. Those which have had minor repairs needed contacted either a local technician or Lifewater's local partner, who remains in the region even af...

      Lifewater recently completed a post-program evaluation in which we surveyed wells drilled between 2-4 years ago. Of the wells we drilled in schools during this time period, all are still functioning. Those which have had minor repairs needed contacted either a local technician or Lifewater's local partner, who remains in the region even after a program ends and anew one begins. I certainly see the benefit of having a peace corps volunteer on site for a long period of time, but Lifewater finds the presence of local partner staff to be a critical aspect to the sustainability of the program impact.

    • Lynn Roberts of Agua Para La Salud (APLS)

      Positive change in education requires long term exposure to positive experiences to change habits. Would you outline how many times a month and for how many years the educators work with the teachers/students? Is the WASH process ongoing through one generation of children grades 1-6?

      Positive change in education requires long term exposure to positive experiences to change habits. Would you outline how many times a month and for how many years the educators work with the teachers/students?
      Is the WASH process ongoing through one generation of children grades 1-6?

    • Julie Smith of Lifewater International

      Lynn, great question- indeed, long term exposure is one of the fundamental elements of successful behavior change and true community transformation. Lifewater's partner staff will be working with the teachers throughout the 2 year program through initial training as well as refresher/ experience sharing workshops, and follow-up visits in t...

      Lynn, great question- indeed, long term exposure is one of the fundamental elements of successful behavior change and true community transformation. Lifewater's partner staff will be working with the teachers throughout the 2 year program through initial training as well as refresher/ experience sharing workshops, and follow-up visits in the teachers' classrooms. The teachers will be working with the students, generally, weekly or biweekly through the WASH Club meetings and activities. The WASH clubs include students of all ages in both primary and secondary schools.