Baby WASH – the missing piece of the puzzle? 

By Samuel Godfrey

Mustapha and his one year old daughter Meia-Teza Wota Health Center Clinic
Mustapha and his one year old daughter Meia at Teza Wota Health Center ©UNICEF Ethiopia/2012/Getachew

The January 2016 Huffington Post article entitled Why are Indian kids smaller than Africa kids: hint its not race authored by Sanjay Wikesekera, UNICEF Global WASH Chief and Werner Shultink, UNICEF Global  Nutrition Chief, highlighted the link between child stunting[1] and lack of access to toilets. Children growing up in an environment where people are defecating in the open will result in kids crawling around on dirty floors, putting feacally contaminated material and objects in their mouths and ultimately will results in children having high rates of diarrhea which will result in their stunted physical and mental development.

To understand this better, UNICEF Ethiopia WASH team and John Hopkins University undertook a systematic review of more than 1000 peer reviewed academic articles with the aim of identifying interventions that health and WASH professionals can take or promote to reduce the contact of children with feacally contaminated material. The review identified strong evidence on the linkage between open defecation, stunting and early child development (See figure below from Ngure et al (2014).

Picture1

The review also notes good knowledge of how to do hygiene and sanitation promotion to safe disposal of adult feaces but limited evidence on safe disposal of baby feaces.

UNICEF Ethiopia is using the review to design specific Baby WASH interventions that can complement our current Infant Young Child Feeding programmes. Ethiopia has substantially reduced Open Defecation during the last 25 years. In 1990, an estimated 9 out of 10 people were “pooing” in the open and by 2015, this had reduced by 64 per cent to less than 1 in 3 people. However, despite this progress, almost half of children were recorded as ‘stunted’ or not achieving their full physical and mental growth by 2015. The literature suggests that Baby WASH, as we have termed it, may be one of the key “missing pieces” in reducing stunting. Baby WASH comprises of a ‘menu’ of physical and promotions activities which will reduce the exposure of the BABY to ingestion of feaces and ultimately reduce stunting and improve Early Childhood Development.

Watch this space for more details on field evidence on Baby WASH from UNICEF Ethiopia as we work closely with the Government of Ethiopia and development partners to expand this intervention throughout Ethiopia in our new Country Programme of Cooperation between 2016 and 2020. For the time being, UNICEF Ethiopia is using its own financial core resources. Interested development partners are welcome to join this groundbreaking initiative.

UNICEF Ethiopia is collaborating with the US based Johns Hopkins Bloomberg School of Public Health, Department of International Health, Program in Global Disease Epidemiology and Control. A researcher from the school was an intern in the UNICEF Ethiopia WASH section in 2015 and has collaborated with the WASH section on producing a paper entitled Evidence on Interventions Targeted at Reducing Unsafe Disposal of Child Feaces: A Systematic Review.

UNICEF Ethiopia’s rural wash activities are supported by the UK Department for International Development (DFID), the Government of Netherlands, the Government of Canada and the UNICEF National Committees from Germany, UK and New Zealand.

Dr. Samuel Godfrey is Chief of WASH for UNICEF Ethiopia, and has a PhD and MSc in Civil Engineering and Water and Waste Engineering.

[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.

Leadership matters: The case of community led total sanitation and hygiene

By Araya Mengistu


Ethiopia is a country showing strong progress in achieving global and national goals for WASH services. It has achieved the MDG target 7c for water supply. Although still behind for sanitation targets, considerable progress is made. As of 2012, 37 per cent of communities practiced open defecation, as compared to 92 per cent in 1990[1]

The progress on sanitation is mainly achieved through the national Health Extension Programme (HEP) and the community led total sanitation and hygiene (CLTSH) approach. CLTSH is an approach that helps to mainly rural communities to understand undesirable effects of poor sanitation, and through a process of “triggering” – igniting a change in behaviour – achieve sustained behaviour change leading to spontaneous and long term abandonment of Open Defecation (OD) practices. Since its introduction in 2006/7, CLTSH has remained the only instrument in Ethiopia to induce behaviour change of communities to consider construction of latrines and use them – discouraging the practice of open defecation. Although the achievements in the past decade are significant, the success of the approach varied significantly from place to place.

For example, the Oromia regional state, the largest in the country, consists 265 rural and 39 urban districts or woredas. Out of 6,531 kebeles (sub-districts each with an average population of 5,000) in rural areas, about 16 per cent are open-defecation free (ODF) – meaning no-one, including visitors and passing pedestrians, are openly defecating and all have access to basic latrines with handwashing facilities.

UNICEF supports 24 woredas in Oromia state between 2011 and 2015. Of the supported woredas, 24 per cent (116 of 477 kebeles) have achieved ODF status. Compared to regional average of 16 per cent, this is a huge achievement. Sire, one of the supported woredas, has recently been graduated in 2015 with 100 per cent performance, declaring all 18 rural kebeles ODF. Other woredas are at various stages. 11 woredas are between 20-50 per cent progresses, while the rest 12 woredas are of 0-10 per cent progress. Compared to these, Sire Woreda shows an outstanding performance.

Such exceptional achievement requires successfully overcoming a number of challenges. A key challenge is lack of thorough understanding of the steps involved in CLTSH and their importance. Usually CLTSH is about training facilitators and triggering communities. However, many practitioners agree that this is the easiest part. Rendering adequate supervision after the triggering stage and providing support that is necessary to sustain the momentum is the difficult part. Other challenges include diffusion of information to neighbouring communities that make the approach ineffective, lack of trainers with actual field experience, high staff turnover, poor coordination among stakeholders, weak commitment of staff and trained people and application of CLTSH without adequate or proper organisation and preparation.

Growing over all these challenges and as a result of four years of effort, Sire Woreda celebrated 100 per cent ODF achievement in April 2015, with all rural villages and kebeles free from open defecation.

Even though, some of these kebeles were declared ODF two or more years ago, , they continued to sustain their status despite the usual trend of falling-back to OD practice noticed as time elapses. This demonstrates an effective post-triggering activity by the Woreda that effectively complimented the planning and triggering activity.

How was this achieved? The Woreda administration leveraged existing structures to sensitize the leadership ladder down to village level on CLTSH and built it in to the regular reporting and evaluation process. This has helped to mobilize the largest possible support to the effort of Health Extension Workers (HEWs) and CLTSH facilitators, including teachers and students under the guidance and support of the Woreda Health Office. It has also avoided diversions of focus (including manpower, logistics, and resources) as CLTSH has become an official woreda priority.

Two notable practices can be praised in the woreda for this success.  (a) the technique of triggering one full kebele at a time in contrast to the usual practice of village by village, and (b) use of different post-triggering follow-up technique suited to context. The advantage of the first technique was twofold. It helped to avoid diffusion of information in to neighbouring communities. Since, focusing in one kebele at a time required more trained people, the coordinators called upon trained and experienced facilitators from adjacent woredas to support, which worked really well. On the other hand, the woreda experts consciously applied different post-triggering follow-up methods. In highland areas, they applied the ‘flag system’, where by communities themselves awarded white flags to households who have constructed basic latrines, and red flags to those who did not. In low land areas, students were organized to alert the community when they see any one defecating in the open, who will then ensure the person buries the excreta.

Currently, the Woreda continues to strengthen the community platforms for monitoring progress and pro-actively works with local leaders to provide the necessary guidance and technical support to sustain the achievement. As a result of this, they are expecting at least two kebeles to achieve secondary ODF, which includes upgrading of basic latrines to improved latrines (with washable slab, vent pipe, hole-cover) with hand washing facility by the whole community. The commitment of leaders, and subsequent effective coordination in the Woreda has benefited the wider community to keep children, women and the society at large healthy.

[1] Joint Monitoring Programme 2014.

Ministers of Water, Sanitation and Hygiene to meet in Ethiopia

SWA Meeting of Ministers Announcement
Minister of Water, Irrigation and Electricity, H. E Motuma Mukassa, announces that Ethiopia is hosting the meeting of Ministers of Water, Sanitation and Hygiene which is organized by the Sanitation and Hygiene for All (SWA) and convened by UNICEF. ©UNICEF Ethiopia/2016/Bizuwerk

Ministers of Water, Sanitation and Hygiene from around the world will meet in Ethiopia from 15-16 March 2016 to plan and prepare for the implementation of the Sustainable Development Goals (SDGs) related to sanitation, water and hygiene.

The meeting is organized by the Sanitation and Water for All partnership (SWA), and convened by UNICEF. SWA has over 100 partners, mostly governments, and works as a platform for encouraging and coordinating political dialogue and action around water, sanitation and hygiene issues.

“This meeting will be different from all other high level meetings organized by SWA previously, mostly because of the timing: it will be the first global meeting on these topics after the UN Member States agreed on the Sustainable Development Goals last September, “says Motuma Mukassa, Minister of Water, Irrigation and Electricity of Ethiopia. Mr Motuma also underscores that the SDG targets on water and sanitation requires a higher level of coordination, alignment and communication both at global and national levels.

Ethiopia is selected to host this meeting for its commitment to implementing innovative ways towards achieving universal access to sanitation, water and hygiene by coordinating different ministries, increasing sector funding and investing in the training of health workers. The country’s One WASH National Progrmame (OWNP), launched in September 2013, is one of the most ambitious in the sector. It is based on a sector-wide approach and involves the ministries of water, health, education and finance and the government’s main development partners. Ethiopia devises this programme to modernize the way water and sanitation services are delivered to its people.  Recently, with UNICEF’s support, Ethiopia also started a South-South collaboration with Brazil in the area of urban sanitation and regulatory framework for WASH service delivery.

The Ministerial Meeting is a unique opportunity for countries to identify the major bottlenecks to achieving the SDG water, sanitation, and hygiene targets and lay groundwork for clear action plans, strategies and milestones.

High-level delegates, including the Prime Minister of Ethiopia, Hailemariam Desalegn, Kevin Rudd, Chair of SWA and the 26th Prime Minister of Australia and Anthony Lake, Executive Director of UNICEF will attend the meeting.

 

UNICEF: Without toilets, childhood is even riskier due to malnutrition

Fatuma Nuior, 16, and her cousin Audi Arab, 12, stand by her latrine next to her house in Ber'aano Woreda in Somali region of Ethiopia 12 February 2014. The village is the first village declared ODF (Open Defecation Free) and All but one household has a latrine. While flags fly over each latrine. In Somali Region water supply coverage is estimated at 59.7%, lower than the national average of 68.5%. The need for water supply normally increases in the dry season, especially at the time of drought such as in recent years. However, the technical and organizational capacity of the Somali Regional State Water Resources Development Bureau (SRWDB) the government agency responsible for water supply and facilities management in the region to satisfy the water supply need is not adequate to cope with the situation. Donor agencies and NGOs are making efforts to ameliorate the situation by constructing and repairing water supply facilities across the region, supplying water by water trucks during chronic shortages, but the supply is still significantly below the demand.
Fatuma Nuior, 16, and her cousin Audi Arab, 12, stand by her latrine next to her house in Ber’aano Woreda in Somali region of Ethiopia ©UNICEF Ethiopia/2015/Ose

NEW YORK, 19 November 2015 – Lack of access to toilets is endangering millions of the world’s poorest children, UNICEF said today, pointing to emerging evidence of links between inadequate sanitation and malnutrition.

Some 2.4 billion people globally do not have toilets and 946 million – roughly 1 in 8 of the world’s population – defecate in the open. Meanwhile, an estimated 159 million children under 5 years old are stunted (short for their age) and another 50 million are wasted (low weight for age).

A report issued today, Improving Nutrition Outcomes with Better Water, Sanitation and Hygiene, from UNICEF, USAID and the World Health Organization, for the first time brings together years of research and case studies which demonstrate the link between sanitation and malnutrition. More importantly, it provides guidance for action.  

Lack of sanitation, and particularly open defecation, contributes to the incidence of diarrhoea and to the spread of intestinal parasites, which in turn cause malnutrition.

“We need to bring concrete and innovative solutions to the problem of where people go to the toilet, otherwise we are failing millions of our poorest and most vulnerable children,” said Sanjay Wijesekera, head of UNICEF’s global water, sanitation and hygiene programmes. “The proven link with malnutrition is one more thread that reinforces how interconnected our responses to sanitation have to be if we are to succeed.” 

Diarrhoea accounts for 9 per cent of the deaths of children under 5 years old each year and is essentially a faecal-oral disease, where germs are ingested due to contact with infected faeces. Where rates of toilet use are low, rates of diarrhoea tend to be high. 

Children under 5 years old suffer 1.7 billion cases of diarrhoea per year. Those in low income countries are hit hardest, with an average of three episodes per year. The highest frequency is in children under 2 years old, who are weakest and most vulnerable. Multiple episodes of diarrhoea permanently alter their gut, and prevent the absorption of essential nutrients, putting them at risk of stunting and even death.  

Some 300,000 children under 5 years old die per year – over 800 every day – from diarrhoeal diseases linked to inadequate water, sanitation and hygiene. The poorest children in sub-Saharan Africa and South Asia are particularly at risk.

Intestinal parasites such as roundworm, whipworm and hookworm, are transmitted through contaminated soil in areas where open defecation is practiced. Hookworm is a major cause of anaemia in pregnant women, leading to malnourished, underweight babies. 

Some countries have made significant progress in addressing both access to sanitation and the nutritional status of their children. Many have successfully used UNICEF’s Community Led Total Sanitation approach, in which the affected populations themselves devise local solutions to the problem of open defecation. 

  • Pakistan met the 2015 Millennium Development Goal to halve the proportion of people who in 1990 did not have access to improved sanitation. Using CLTS, entire communities abandoned the practice of open defecation, leading to improved health and nutrition indicators among their children.
  • Ethiopia mobilized community workers and achieved the largest decrease globally in the proportion of the population who defecate in the open. Despite population growth, the practice reduced from 92 per cent (44 million people) in 1990 to 29 per cent (28 million people) in 2015.
  • In Mali the CLTS approach was also used in communities with high malnutrition rates, exacerbated by drought in the Sahel region. Improved access and use of latrines ensued, and improved health and nutrition in children.
  • During the emergency linked to conflict in the Democratic Republic of the Congo, integrated nutrition and WASH interventions were used for displaced communities. Children under 5 years old saw significantly reduced undernutrition and waterborne diseases. Around 60 per cent of the population constructed latrines and some 90 per cent of malnourished children returned to normal weight during a 12-month period.

“There are no excuses not to act on access to toilets, even in the poorest communities, or during emergencies,” said Wijesekera. “On the other hand, there are millions of reasons – each one a child who is stunted or wasted, or worse, who sickens and dies – to treat this with the urgency it deserves.”

Global Hand washing Day (GHD) 2014 celebrated in Oromia, Ethiopia

By Kulule Mekonnen

Kimbibit woreda community welcomes participants of Global Handwashing Day participants colourfully with their decorated horses
Kimbibit woreda community welcomes participants of Global Handwashing Day participants colourfully with their decorated horses ©UNICEF Ethiopia/2014/ Sewunet

Hundreds of people marked Global Hand Washing Day with a colourful celebration at Garachatu School in Kimbibit woreda, Oromia region.

The region has been celebrating Global Hand Washing day since 2008, which was International Year of Sanitation.

Community members travelled to the event on foot and on horseback, wearing colourful traditional clothes to welcome government officials and invited guests to the celebrations.

The event is marked in many countries every year to underline the importance of handwashing in the prevention of common but potentially lethal diseases such as diarrohea, pneumonia, Severe Acute Respiratory Syndrome (SARS), Ebola and others.

The event at Garatchu School included the reading of poems by students, songs and performances, focusing on the importance of handwashing.

Dr Zelalem Habtamu, Deputy Head of the Oromia Regional Health Bureau, said: “We believe that we could prevent over 60 % of communicable diseases by implementing proper environmental health interventions. This is why we focus on advocating proper hand washing practices at critical times.’’

Oromia has made solid progress in improving hygiene, deploying 13,000 health extension workers and 4.5 million health development armies. These are small groups of women that meet regularly to discuss and solve issues relating to public health, socio-economic, environmental and economic concerns.

Students of Garachatu School perform a play on the importance of handwashing
Students of Garachatu School perform a play on the importance of handwashing at the Global Handwashing Day celebration ©UNICEF Ethiopia/2014/Sewunet

Dr. Zelalem added: “We are celebrating this year’s GHD in Garachatu School, with the school community and their families, with the intention of reaching every family, as we believe that students could carry on the positive hand washing behaviours learnt at schools with their families and their neighbourhood.”

Hand washing with soap removes germs from hands, preventing the transmission of infections when people touch their eyes, nose or mouth. It can also prevent germs getting into food and drink, as often happens when they are prepared by people with unclean hands. These germs can then multiply, risking the spread of infection to more people.

Germs from unwashed hands can also be transferred to objects like handrails, table tops or toys and spread easily.

Removing germs through proper hand washing helps prevent diarrhoea and respiratory infections and may also help prevent skin and eye infections.

Research shows that community hand washing education has a number of hygiene benefits. It reduces cases of diarrhoea by 31 percent, diarrheic illness in people with weakened immune systems by 58 percent and respiratory illnesses, such as colds, in the general population by 21 percent.

Figures released recently by UNICEF and the World Health Organisation show that in 2013 more than 340,000 children under five – almost 1,000 a day – died from diarrheic diseases due to lack of safe water, sanitation and basic hygiene. As the Ebola response takes its toll on the health services in the affected countries, the practice of hand washing is even more important to prevent these common diseases.

Participants washes their hands at the Global Hand washing Day celebration in Garachatu School, Kimbibit woreda of Oromia region, Ethiopia.
Participants wash their hands at the Global Hand washing Day celebration in Garachatu School, Kimbibit woreda of Oromia region, Ethiopia ©UNICEF Ethiopia/2014/Sewunet

UNICEF works with regional government and non-governmental organisations to improve access to safe drinking water, sanitation and healthy environments and better hygiene practices.

It also focuses on capacity building to eliminate open defecation and improve hand-washing facilities in schools and health centres, focusing on the needs of girls.

W/ro Zewuditu Areda, Head of the North Shewa Zonal Health Department, said: “Proper hand washing prevents disease and saves lives, hence hands should be properly washed.”

The event ended with a demonstration of 10 steps of proper hand washing by Belay Techane, a Kimbibit Woreda Health Worker. The steps include:

  • First hand should be rinsed and wet
  • Apply soap and thoroughly scrub hands and forearms up to elbow. Give special attention to scrubbing your nails and the space between your fingers
  • Rinse with generous amount of clean water flowing
  • Air-dry with your hands up and elbows facing the ground, so that water drips away from your hands and fingers
  • After the demonstration, all participants of the day practiced proper hand washing using soap as demonstrated by the health worker.

Lack of toilets dangerous for everyone, UNICEF says

Girls' toilet at Beseka ABE Center in in Fantale Woreda of Oromia State
Girls’ toilet at Beseka ABE Center in Fantale Woreda of Oromia State ©UNICEF Ethiopia/2014/Ose

NEW YORK/Addis Ababa, 19 November 2014 – Slow progress on sanitation and the entrenched practice of open defecation among millions around the world continue to put children and their communities at risk, UNICEF warned on World Toilet Day.

Some 2.5 billion people worldwide do not have adequate toilets and among them 1 billion defecate in the open – in fields, bushes, or bodies of water – putting them, and especially children, in danger of deadly faecal-oral diseases like diarrhoea.

In 2013 more than 340,000 children under five died from diarrhoeal diseases due to a lack of safe water, sanitation and basic hygiene – an average of almost 1,000 deaths per day.

“Lack of sanitation is a reliable marker of how the poorest in a country are faring,” said Sanjay Wijesekera, head of UNICEF’s global water, sanitation and hygiene (WASH) programmes. “But although it is the poor who overwhelmingly do not have toilets, everyone suffers from the contaminating effects of open defecation, so everyone should have a sense of urgency about addressing this problem.”

The call to end the practice of open defecation is being made with growing insistence as the links with childhood stunting become clearer. India, with 597 million (half the population) practising open defecation, also has high levels of stunting. Last week, UNICEF convened a conference in New Delhi called ‘Stop Stunting’ to call attention to the effect of open defecation on the entire population, particularly children. UNICEF’s ‘Take Poo to the Loo’ campaign in India also works to raise awareness of the dangers associated with open defecation.

Asfaw Legesse a model in his community washes his hand after using a latrine.
Asfaw Legesse a model in his community washes his hand after using a latrine. ©UNICEF Ethiopia/2014/Sewunet

“The challenge of open defecation is one of both equity and dignity, and very often of safety as well, particularly for women and girls,” Wijesekera noted. “They have to wait until dark to relieve themselves, putting them in danger of attack, and worse, as we have seen recently.”

Compared to other African countries, Ethiopia has made huge progress in reducing open defecation rates from 92 per cent in 1990 to 37 per cent in 2012. The Joint Monitoring Programme (JMP) 2014 report from UNICEF/WHO confirms that Ethiopia is leading the charge in Africa in reducing open defecation.The community total sanitation and hygiene approach, supported by UNICEF and utilizing the 38,000 Health Extension Workers in the country, has greatly contributed to this success.

“The challenge of improving sanitation levels to ensure that the minimum standards of toilet construction remains in many rural areas across Ethiopia. With the rapid urbanisation of the country there is also a need to “reinvent the toilet” to make it affordable, durable and appropriate for high density urban dwellings. UNICEF is advocating for these, and greater focus on toilets in schools and health centres nationwide, to ensure greater access to improved sanitation,” said Patrizia DiGiovanni, Acting Representative of UNICEF Ethiopia.

UNICEF’s Community Approaches to Total Sanitation addresses the problem at the local level by involving communities in devising solutions, and has led to some 26 million people across more than 50 countries abandoning the practice of open defecation since 2008.

Eighty-two per cent of the 1 billion people practising open defecation live in just 10 countries: India, Indonesia, Pakistan, Nigeria, Ethiopia, Sudan, Niger, Nepal, China, and Mozambique. The numbers of people practising open defecation are still rising in 26 countries in sub-Saharan Africa, though they have declined in Asia, Latin America and the Caribbean. In Nigeria, numbers of open defecators increased from 23 million in 1990 to 39 million in 2012.

Globally, some 1.9 billion people have gained access to improved sanitation since 1990. However, progress has not kept up with population growth and the Millennium Development Goal target on sanitation is unlikely to be reached by 2015 at current rates of progress.

The inter-governmental Open Working Group on the post-2015 Sustainable Development Goals have recommended that the new goals include a target of achieving adequate and equitable sanitation and hygiene for all and ending open defecation by 2030.

South-South Cooperation: Brazil shares models for universal access to water and sanitation services in urban Ethiopia

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Opening session of the two-day seminar in Brasilia, Ministry of Cities. ©UNICEF

Brasilia, 14 October 2014. – Within the framework of  the Brazil–UNICEF Trilateral South–South Cooperation Programme, the Government of Brazil hosted a high-level mission of the Government of Ethiopia between the 15th and the 20th of September. The objective of the mission was to get insights on how Brazil has advanced in providing Water, Sanitation and Hygiene (WASH) in urban areas, which has reduced child mortality significantly.

Ethiopia is currently urbanizing at a 6 per cent rate per annum and is predicted to become one of the most populous urban nations in Africa by 2050. Thus, the Ethiopian Government is expected to face complex challenges in terms of expanding access and improving quality of WASH services for its growing urban population, especially for the most vulnerable groups. Through the visit, Ethiopia is keen to learn from Brazil, a country that has faced rapid urbanization over the last 50 years.

The delegation was composed by high-level government officials from Ethiopia, including Dr. Kebede Worku, State Minister of Health, Mr. Kebede Gerba Gemosa, State Minister of Water and Energy, and Mr. Wanna Wake, General Director of the Water Resources Development Fund and Member of the Parliament. In addition the mission included representatives from the Ministry of Urban Development, Housing and Construction; Oromia Water, Mines and Energy Bureau; Amhara Water Resources Development Bureau; Water Resources Development Fund; Tigray Water Resources Bureau;  Somali Water Resources Development Bureau and World  Vision Ethiopia as well as Samuel Godfrey, WASH Section Chief, and Michele Paba, Urban WASH Manager of UNICEF Ethiopia.

The Brazilian Ministry of External Relations, through the Brazilian Agency for Cooperation and the Brazilian Ministries responsible for the planning and implementation of the national WASH policy (namely, the Ministry of Cities, the Ministry of Health through the National Health Foundation, the Ministry of National Integration, the Ministry of Environment and the National Water Agency)  worked together with UNICEF to prepare the agenda for the visit, which included  high-level meetings and field visits, in order to provide  the Ethiopian Delegation with an overview of the water and sewage systems in Brazil at the national, state  and municipal levels.

The opening session of the two-day seminar, which took place in Brasilia from 15th to 16th September, was inaugurated by Senior officials of the Brazilian Government, the UNICEF representative in Brazil and DFID Brazil Country Office Manager. The session focused on exchanging ideas on how both the Ethiopian and Brazilian WASH sectors are structured.

After the seminar, field visits were conducted in Fortaleza (capital of the Northeastern State of Ceará) and surrounding municipalities, including Sobral and Santana, where the Ethiopian Delegation was  warmly greeted by the Mayors and the community, who opened their homes to show the delegation how the water and sewage systems are installed at the household level as well as how they benefit each citizen.

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Field visit to Storm Water Cisterns in a rural community of the Ceará State. @UNICEF

On the last day of the mission, the delegation visited the water treatment plant of the Water and Sewage Company of the State of Ceará (CAGECE), and met with its President, who explained the state’s strategy for providing services through public-private partnerships. This meeting was followed by a presentation and discussion with the State Regulatory Agency for these services.

The mission was accompanied by Mr. Marcelo Lelis, Project Manager of the National Secretariat of Environmental Sanitation of the Ministry of Cities, and Ms. Michelle Correia, Coordinator of Technical Cooperation of the National Health Foundation of the Ministry of Health, and in Fortaleza by the Superintendent of National Health Foundation, Mr. Regino Antônio de Pinho Filho, besides other technicians who were available to assist the delegation and answer technical questions at all times.

As concrete results, by the end of the mission, the representatives of the Ethiopian Government identified key areas in which technical assistance from the Government of Brazil would benefit Ethiopia, by sharing knowledge and building capacities of policy makers, managers  and technicians on how to develop WASH integrated policy, implement management models  and regulatory schemes for service provision, drawing on Brazilian models like the Integrated Rural Sanitation System  (SISAR) and the social tariffs.

As pointed out by His Excellency Ato Kebede Gerba, State Minister of Water, Irrigation and Energy, Ethiopia, “Brazil is a learning center for urban water and sanitation.”

Dr. Samuel Godfrey from UNICEF Ethiopia further noted that “Brazil offers a good learning ground for African nations such as Ethiopia, as its recent developments are understandable and obtainable in Africa’s emerging economies.”