Baby WASH: increasing communities’ awareness through health extension workers

by Hiwot Ghiday, Selamawit Yetemegn, Anina Stauffacher

Sekota Woreda, Northern Amhara region, 5 October 2018– Nigist lives 20km north of Sekota town in the mountainous and remote northern part of Ethiopia. Together with her husband and two children she lives in a one-room rock-built house in the centre of the village. The village is surrounded by rocky crop fields, where the men plough with the help of two oxen.

In early August, during the rainy season, everything looks not lush but pleasantly green. As Nigist takes a seat on a dusty plastic chair, the neighboring children come closer sitting and standing on the gravely dirt curious to hear and see what she is about to tell.

With the youngest child safely on her back, Nigist starts talking about how she cares for him. She explains how she washes the baby’s hands and face three times per day often with soap. “I would always like to wash my baby with soap, but we sometimes find it difficult to afford soap, then I wash him with water only”, she says. “I also wash his body every other day, for my older child it is less frequent”. Nigist’s understanding of the consequences of not properly washing her children’s hands and face with soap seems limited and leads her not to prioritize buying soap rather than other items.

UNICEF in collaboration with the BBC Media Action is currently piloting an EU-funded Baby WASH project in Zequalla and Sekota Woredas, Wag Himra Zone, northern Ethiopia. The aim of the Baby WASH project is to reduce the microbial burden encountered by young children in their play and feeding environments. In addition, the project aims to reduce trachoma and other disease exposure of children and therefore help reducing child stunting [1].

In August 2018, health extension workers were trained to work with the communities to change hygiene practices improving early childhood development. The focus lies on safe disposal of child feces, handwashing with soap, face hygiene, shoe wearing, protective play areas and food hygiene.

During the training, health extension workers learnt about Baby WASH activities and how to work with the communities to effectively change behavior. Listening groups and group discussions at community level using radio recordings are part of the methods the health extension workers use to raise Baby WASH issues in their own community. Additionally, during public discussion led by the local health office, key expectations were raised and discussed.

Debessa, a health extension worker describing the training on Baby WASH activities and how she plans to work with mothers in her community ©UNICEF2018Stauffacher
Debessa, a health extension worker describing the training on Baby WASH activities and how she plans to work with mothers in her community ©UNICEF/2018/Stauffacher

Debessa is one of the two health extension workers in the kebele where Nigist lives. Debessa says: “I know about safe sanitation and hygiene practices, but these interventions focusing on babies and young children are new for me. It is very interesting and I am learning a lot during the training.” Debessa is happy about attending the training together with other colleagues from Sekota Woreda.

She and her colleague working in the same kebele agree: “we are very motivated to go back home and work with the mothers on the Baby WASH, it is exciting. For the handwashing practices specifically focusing on babies and young children, we will connect it to previous handwashing promotion activities. To encourage families to properly dispose child feces, we expect that it will need some time for the change to be effective because this is a new concept for many in the community. And potties are expensive, it isn’t a priority for the families to spend money on potties particularly at this time of the year where families invest most of their money in farming”.

The key actions promoted during the training are summarized in form of pictures with both Amharic and Hemtegna language so training material can be used at community level.

Piloting the EU-funded Baby WASH project in collaboration with the government is a promising way forward to start triggering behavioral change with a focus on pregnant women, babies and children under 3. Shifting from a “have to” approach to a stronger focus of “how to”, Baby WASH requires close integration with existing interventions on maternal, new born and child health, early childhood development and nutrition.

A paper published by UNICEF and John Hopkins University in the Journal of Tropical Medicine and International Health highlighted the need to target interventions to reduce unsafe practices of disposal of baby and child feces. UNICEF Ethiopia WASH has included Baby WASH into its strategy for the new country program to contribute to the improvement of early childhood development.

[1] Stunting is a sign of ‘shortness’ and develops over a long period of time. In children and adults, it is measured through the height-for-age nutritional index. In Ethiopia approximately 40 per cent of children are stunted.

Ethiopia inaugurates model water supply and waste management project

26 May 2018, WUKRO, Tigray region – Today marks another major milestone in the Water Supply, Sanitation and Hygiene (WASH) sector in Ethiopia with the inauguration of a model water supply, sanitation and waste management system in Wukro Town, Tigray Region. Part of the One WASH Plus programme, the system integrates innovative and resilient solutions to provide WASH services to 73,000 people, including 35,000 children under the age of 15, residing in the town and its satellite villages.

Attending the inauguration were His Excellency Dr. Negash Wagasho, State Minister of Water Irrigation and Electricity, Dr Christian Rogg, Head of the UK’s Department for International Development (DFID) in Ethiopia, Ms. Gillian Mellsop, UNICEF Representative in Ethiopia, officials from the Tigray Regional Government and Wukro Town administration officials.

“Ethiopia’s rapid urbanization and population growth has resulted in increased water stress,” said Dr. Negash Wagasho. “The development of adequate, resilient, sustainable and inclusive WASH services is therefore a must to ensure sustainable development of rapidly growing towns. Thus, what we are seeing today is what can be achieved when we put our concerted efforts together.”

“The UK is the largest bilateral donor in the Ethiopian WASH sector and we are proud to fund the excellent work taking place in Wukro, which is supplying vital water and sanitation services to the town and its surroundings,” said Dr Rogg. “I hope the progress in Wukro can serve as an example to be emulated on a national scale.”

UNICEF Representative Gillian Mellsop said the project was one of the greatest achievements of the One WaSH Plus programme and stands as a testament to the tremendous good that can be achieved when everyone pools their resources together towards one common purpose.

“Investments of this nature, both in Wukro and elsewhere in Ethiopia, are not just improving access to essential services but are changing entire lives,” said Dr. Samuel Godfrey, Chief of WASH at UNICEF. “Women and girls no longer have to walk long distances and spend many hours fetching water. Girls can go to school and attend to their schoolwork while mothers have enough time to spend with their children and engage in other productive activities. For communities, a safe and clean environment means fewer disease outbreaks.”

The Wukro project involved expanding the capacity of the town’s existing system to supply water to the town and five satellite villages, integrating it with a “full chain” system for managing liquid sludge and waste (from containment to recycling), improving water and sanitation in institutions such as schools and health facilities, and establishing a business model for managing the facility comprising the local administration and private operators. The low-cost technology deployed in treating domestic liquid waste in selected social housing developments in the town was sourced through a partnership with the Government of Brazil.

The One WASH Plus programme, fully funded by DFID, is implemented by UNICEF in collaboration with the Ministry of Water, Irrigation and Electricity, regional sector bureaus, and the Water Resource Development Fund. The programme also works with the Ministry of Health, the Ministry of Urban Development and Construction, and respective Sector Regional Bureaus, as well as town administrations and town water supply and sewerage utilities.

The programme, which began in 2013, will benefit 250,000 people in eight small towns and surrounding rural villages in Amhara, Oromia, Somali and Tigray regions with a total investment of some US $36 million by targeting communities living in towns and in peri-urban areas. Models such as the one in Wukro, some large and others medium sized, are now a key component of the One WaSH programme across more than 1,000 towns in the four regions in Ethiopia.

Ethiopia’s rapid urbanization and urban development has resulted in increased water stress and high potential for disease outbreaks. The development of adequate, resilient, sustainable and inclusive WASH services is therefore a must to ensure sustainable development of the rapidly growing towns to meet the targets set in the SDGs.

Linking One WASH National Programme and Water Resources Management: UNICEF Ethiopia’s Leverage in the Sector

By Kaleab Getaneh and Jorge Alvarez-Sala

There is a high interdependence between Water, sanitation and hygiene (WASH) services and Water Resources Management. A sustainable supply of good quality drinking water highly depends on how properly the water sources are managed. Similarly, if WASH services provision is not sustainably managed it will have a huge negative impact on the water resource.

The UNICEF and USAID supported project to strengthen the Water Sector Working Group (WSWG) Secretariat started in July 2015 with the aim of establishing a well-functioning platform for the water sector consisting of the WASH and Water Resources Management (WRM) subgroups that contribute to the sustainable development and management of the water resources in the country.

The project has been supporting the reactivation of the WRM Sub Group and the organization of the first-ever Joint Technical Review (JTR) for the WRM sub-sector. The main purpose of the JTR is to bring various stakeholders together and ensure a sustainable coordinated development and management of water, land and related resources in order to maximise the economic and social welfare of the population. This is the basis for the ongoing and future water sector interventions in general and One WASH National Programme in particular.

Developing climate resilient sustainable WASH services under the umbrella of One WASH National Programme require looking into the bigger water resources management picture, including the protection of water sources and the overall water governance issues. To this end, the reactivation and capacitation of the WRM subgroup and the launching of the JTR is significantly contributing to the development of a clear and common agenda for the water resources sector in Ethiopia.

The WRM sub-group has been able to bring together three concerned Ministries: Ministry of Water, Irrigation and Electricity (MoWIE); Ministry of Agriculture and Livestock Resources (MALR); and Ministry of Environment Forest and Climate Change (MoEFCC) and key development partners (DPs), academia and civil society organizations (CSOs).

The priorities established by the WRM sub-group include: 1.Irrigation for growth; 2.Legislation of groundwater use; 3. Conflict resolution; 4. Communication/Management Information System; 5. Institutional and Human Capacity; 6. Water quality; and 7. Water Charges/Tariff and Scheme Sustainability. Following the identification of the priority areas, six WRM technical working groups have been established to further pinpoint key bottlenecks and gaps.

Opening speech by H. E. Ato Kebede Gerba, the state Minister of MoWIE. © UNICEF Ethiopia/2018/Jorge Alvarez-Sala

On the 19th April 2018, the WRM JTR kick-off meeting was successfully held by involving more than 85 participants from academic institutions, CSOs, development partners, basin authorities, concerned federal ministries, and regional bureaus of water, environment and agriculture. The workshop was attended by H.E. Ato Kebede Gerba, the state Minister of MoWIE and H.E Ato Kare Chewicha, the state Minister of MoEFCC. It has laid the foundation by bringing the three ministries (MoWIE, MoEFCC and MoANR) together to talk about water resources management in the country.

 

Currently, the six working groups are actively organizing a field mission to review the state of WRM in three selected river basins (Awash River Basin, Rift Valley Lakes Basin and Abay River Basin) and come up with high impact implementable actions. The findings of the field mission will feed into the upcoming Multi Stakeholders Forum, which will bring both WASH and WRM subsectors together for the first time.

The whole process of JTR and MSF is expected to culminate in the preparation of a National WRM Programme document, which is currently being developed with technical and financial support from UNICEF.

UNICEF’s support to the Water Sector Working Group (WSWG), and its sub-groups is possible thanks to the generosity and support of USAID. The JTR kick-off meeting was also financially supported by JICA and the Italian Cooperation Agency.

Canada partners with UNICEF to improve reproductive health and nutrition among adolescent girls in Ethiopia

8 March 2018, ADDIS ABABA – On the occasion of International Women’s Day, the Government of Canada is pleased to provide CDN$ 14.8 million (US$ 12 million) to UNICEF Ethiopia to improve the reproductive health and nutritional status of adolescent girls. The initiative will reach over four million girls in districts with high food insecurity and a high prevalence of child marriage. It will be implemented between 2018 and 2022.

“As part of our feminist approach, Canada is committed to advancing sexual and reproductive health and rights in order to empower women and adolescent girls in Ethiopia and around the world,” says Ivan Roberts, Head of Cooperation at the Embassy of Canada in Ethiopia.

In Ethiopia, 25 per cent of the population is made up of adolescents (aged 10 to 19 years), of which 11 million are girls.  Adolescent girls experience numerous barriers that hinder them from fully realizing their potential. A significant portion of these barriers is related to their sexual and reproductive health and to their nutrition.

Canada’s contribution will help girls access adolescent-friendly sexual and reproductive health services and nutrition facilities by training health workers to clearly understand the physiological and psychological needs of adolescent girls. This initiative will also leverage gender clubs in schools to provide life skills and sexual and reproductive health knowledge to young people. In addition, adolescent-friendly spaces will be created to ensure out-of-school children freely discuss nutrition and sexual and reproductive health issues and practices including family planning.

To improve personal hygiene, the programme will support the local production and supply of sanitary pads, education of girls on pre- and post menstruation, improve sanitary facilities through upgrading and rehabilitation, provide spaces in schools for menstruating girls to rest, enhance counselling and peer-to-peer support, and promote informal discussions among girls on issues that concern them.

“We appreciate the timely support from the Government of Canada which will allow us to address the challenges that Ethiopian adolescent girls face today,” says Gillian Mellsop, UNICEF Representative in Ethiopia. “We believe that this contribution will help adolescent girls break out of discriminatory social and gender norms that hamper their education and hinder their ability to meaningfully contribute to their nation’s development.”

UNICEF will use its strong monitoring and evaluation tools to ensure the success of this programme and invest in regular compilation of health and nutrition data to better understand trends and uptake of services by adolescent girls.

MIND THE GAP – BABYWASH Launched on World Toilet Day to Improve Integrated Early Childhood Development in Ethiopia

By Samuel Godfrey

When you travel in a car through Addis Ababa, you will note that adult women and men vary greatly in height. There are tall people and short people. So which ones of these are actually stunted? And why? Scientifically stunting is defined as a reduced growth rate in human development and is a primary manifestation of malnutrition or more accurately under nutrition. The definition of stunting according to the World Health Organisation (WHO) is for the “height for age” value to be less than two standard deviations of the WHO Child Growth Standards median.

So how does under nutrition occur? Recent scientific evidence suggests that under nutrition is a result of recurrent infections such as diarrhoea or helminthiasis in early childhood and even before birth. In 2016, UNICEF Ethiopia, published a blog entitled BABY WASH – the missing piece of the puzzle[1]?, in which evidence from a paper published by UNICEF and John Hopkins University in the Journal of Tropical Medicine and International Health[2] highlighted the need to target interventions to reduce unsafe practices of disposal of baby and child faeces. To convert this evidence into action, the Government of Ethiopia, UNICEF and partners have developed a BABYWASH implementation guideline. The guideline aims at contributing to improving Integrated Early Childhood Development (IECD) through improving the baby and child environment.

World Toilet Day 2017: safe disposal of child faeces
Lack of knowledge on the health risk related to child faeces is a key factor behind poor hygiene practices in faeces disposal. ©UNICEF Ethiopia/2017/Mulugeta Ayene

The 2017 World Toilet Day was a perfect opportunity to launch the BABYWASH guideline. The document includes guidance on how to implement programmes with safe disposal of child faeces, providing protective environments through play mats and similar measures as well as prevention of soil transmitted helminths. The strategy was endorsed for implementation alongside regular safe sanitation and hygiene practices which are already being promoted by health extension workers. In his statement, H.E Dr Kebede Worku, State Minister of Health of Ethiopia said, “In Ethiopia, there is a common misconception that children’s faeces are not harmful while evidence shows otherwise. The current sanitation and hygiene promotion efforts, at times, overlook safe disposal of children’s faeces. In addition, most toilets are not designed keeping children’s special needs in mind. Hence, I am proud to endorse the Baby WASH manual today which was developed by the Federal Ministry of Health with the support of UNICEF and other partners in order to ensure a healthy environment for children’s growth and development especially those under three years of age.”

Ms Gillian Mellsop, UNICEF Representative to Ethiopia on her part said, “UNICEF is pleased to support the Ministry of Health in preparing these excellent guidelines on Baby WASH. We know that a contaminated environment harms infants and young children and puts them at risk of increased child mortality and stunting. Together, we have to ensure that parents and guardians, teachers and community leaders are aware of the importance of Baby WASH.”

According to the Knowledge, Attitude and Practice (KAP) baseline survey on Water, Sanitation, and Hygiene carried out in eight regions of Ethiopia, there is a general misconception about child faeces disposal. The survey showed that a lack of knowledge on the health risk related to child faeces is a key factor behind poor hygiene practices in faeces disposal. According to the survey, only half (49 per cent) of women knew that child faeces are dangerous to health. Misconception is higher among rural pastoralist women where only 39 per cent said child faeces are dangerous as compared with 50 per cent among rural non-pastoralist women and 54 per cent of women in urban areas. Although it may not be clear who is stunted and who is not just by looking at a child, it’s clear that safe disposal of child faeces helps improve a child’s health. Therefore, UNICEF will continue to support the Government with the implementation of the guideline throughout the country.

[1] https://unicefethiopia.org/2016/05/24/baby-wash-the-missing-piece-of-the-puzzle

[2] https://www.ncbi.nlm.nih.gov/pubmed/27546207

Children Takeover Minister Roles as Ethiopia celebrates World Children’s Day and UNICEF Ethiopia’s 65th Anniversary

20 November 2017, United Nations Conference Centre, Addis Ababa: Today, Ethiopia joined the global World Children’s Day celebrations by giving children high profile roles to become champions of their rights. In line with the event’s theme ‘For children, By children’ child parliamentarians took over the roles of the Ministers of: Women and Children’s Affairs; Health; Education; Water, Irrigation and Electricity; Labour and Social Affairs; and Urban Works and Construction. In addition, children took over the roles of the Attorney General and UNICEF Representative. In their new roles as ‘shadow Ministers’, children shared their ideas on issues that affect their lives.

World Children's Day and UNICEF Ethiopia 65th anniversary
Sara Beshir shadow Minister of Women and Children Affairs. Her message on World Children’s Day: attitudes towards violence angst children and women need to be changed. ©UNICEF Ethiopia/2017/Nahom Tesfaye

At the event, which was truly owned by children, some of the key recommendations proposed by children include:

  • Accelerate efforts to end harmful traditional practices, including child marriage and Female Genital Mutilation/Cutting
  • Provide clean water and sanitation services for all children across the country, no matter where they live
  • Build more hospitals that are focused on child health and ensure health professionals treat children with care and love
  • Involve children in child justice
  • Ensure quality education for all children through skilled teachers, including pre-primary education
  • Ensure that girls stay in school and finish their education
  • Provide more playgrounds and safe spaces, especially in urban and peri-urban settings
  • Include children’s voices when adults and local authorities discuss issues that affect children’s lives.

Child parliamentarians from different regions also had an opportunity to discuss issues relevant to children in Ethiopia with shadow Ministers and dignitaries through a Q&A session.

In her opening remarks, H.E Ms Demitu Hambisa, Minister of Women and Children’s Affairs, stated that this year’s World Children’s Day is a day of action for children by children. She highlighted that decision makers need to ensure that children’s voices are heard and reflected in decisions that affect their lives.

World Children's Day and UNICEF Ethiopia 65th anniversary
Minister of Women and Children Affairs , Ms Demitu Hambisa speaking during World Children’s Day. She says; listening to children’s voices and involving them in decision making is key. ©UNICEF Ethiopia/2017/Nahom Tesfaye

Ms Gillian Mellsop, UNICEF Representative to Ethiopia, emphasising the need for the participation of children said, “Meaningful participation of children is not only a fundamental right – and enshrined as such in the Convention on the Rights of the Child – but is also key to ensuring that decisions made by adults are relevant to the actual needs of children.”

World Children's Day and UNICEF Ethiopia 65th anniversary
Ms Gillian Mellsop, UNICEF Representative to Ethiopia speaking on World Children’s Day. ©UNICEF Ethiopia/2017/Nahom Tesfaye

In addition, UNICEF Ethiopia launched its publication ‘Hulem Lehisanat- Always for children’ depicting its 65 years history serving children and women in Ethiopia.

The event highlighted the importance of including children’s voices by providing children with an opportunity to share their own solutions on how to keep every child in Ethiopia healthy, well-nourished, in school and protected.

‘BABY WASH’ boosted at this year’s World Toilet Day in Ethiopia

Addis Ababa, 15 November 2017 – Today, Ethiopia celebrated World Toilet Day by holding a half-day workshop with the theme “Safe Disposal of Child Faeces.

At the workshop, the national ‘Baby WASH’ strategy, which focuses on hygiene of children under three years, was endorsed by the Federal Ministry of Health. The strategy includes safe disposal of child faeces, providing protective environments through play mats and similar measures as well as prevention of soil transmitted helminths. The strategy will be implemented alongside regular safe sanitation and hygiene practices which are already being promoted by health extension workers.

World Toilet Day 2017: safe disposal of child faeces
At the workshop, the national ‘Baby WASH’ strategy, which focuses on hygiene of children under three years, was endorsed by the Federal Ministry of Health. ©UNICEF Ethiopia/2017/Mulugeta Ayene

In his statement, H.E Dr Kebede Worku, State Minister of Health said, “In Ethiopia, there is a common misconception that children’s faeces are not harmful while evidence shows otherwise. The current sanitation and hygiene promotion efforts, at times, overlook safe disposal of children’s faeces. In addition, most toilets are not designed keeping children’s special needs in mind. Hence, I am proud to endorse the Baby WASH manual today which was developed by the Federal Ministry of Health with the support of UNICEF and other partners in order to ensure a healthy environment for children’s growth and development especially those under three years of age.”

Ms Gillian Mellsop, UNICEF Representative to Ethiopia on her part said, “UNICEF is pleased to support the Ministry of Health in preparing these excellent guidelines on Baby WASH. We know that a contaminated environment harms infants and young children and puts them at risk of increased child mortality and stunting. Together, we have to ensure that parents and guardians, teachers and community leaders are aware of the importance of Baby WASH.”

According to the Knowledge, Attitude and Practice (KAP) baseline survey on Water, Sanitation, and Hygiene carried out in eight regions of Ethiopia, there is a general misconception about child faeces disposal. The survey showed that a lack of knowledge on the health risk related to child faeces is a key factor behind poor hygiene practices in faeces disposal. According to the survey, only half (49 per cent) of women knew that child faeces are dangerous to health. Misconception is higher among rural pastoralist women where only 39 per cent said child faeces are dangerous as compared with 50 per cent among rural non-pastoralist women and 54 per cent of women in urban areas.

World Toilet Day 2017: safe disposal of child faeces
Lack of knowledge on the health risk related to child faeces is a key factor behind poor hygiene practices in faeces disposal. ©UNICEF Ethiopia/2017/Mulugeta Ayene

A strong early childhood foundation, which includes a safe and hygienic environment coupled with adequate nutrition as well as nurturing parenting and stimulation for optimal brain development, is critical to ensure toddlers can develop to their full potential. This will facilitate a smooth transition to primary school and a better chance of successfully completing basic education. Therefore, investing in early childhood development through improved hygiene practices and environments is one of the most critical and cost‑effective ways to improve a child’s future health, education and productivity.

The Ministry of Health and UNICEF urge citizens, parents, teachers, health workers, policy makers and government officials to play their role in making sure that every child receives the benefits of Water, Sanitation and Hygiene (WASH) in their homes, communities, schools and health facilities.