Adapting Response Efforts to Stop the Spread of Acute Watery Diarrhoea 

By Rebecca Beauregard

SOMALI Region, 20 April 2017 – When Basazin Minda was requested to support the acute watery diarrhoea (AWD) response in Somali region, he did not hesitate. In fact, within one week, he handed over his duties to colleagues in UNICEF Oromia team and was in Jigjiga office.

Complex emergencies are not new to him. He was in Gambella when a South Sudanese refugee influx necessitated immediate WASH response. And when an AWD outbreak threatened lives in the southern cross-border town of Moyale, Basazin led the AWD WASH response and coordinated joint Kenya and Ethiopia control mechanisms. This is part of why he loves working with UNICEF – there is full support and resources to take quick action as well as the flexibility to respond where needed when communities are facing crisis, such as the AWD outbreak.

One lesson he learned from those past emergencies was that to have an impact, it required extensive human resources in the affected areas. Recently hired WASH Information Management Officers (IMOs) were available to support his team and he soon learned about UNICEF Health section’s C4D (Communication for Development) consultants, which could help spread the critical WASH messages to stop the spread of AWD.

Adapting Response Efforts to Stop the Spread of Acute Watery Diarrhoea
On site community mobilization concerning poor drainage and optimal water collection methods. Lasoaano kebele, Shilabo woreda ©UNICEF/2017/Mualid

AWD describes infections that can result in easily transmitted and potentially deadly diseases. The spread of such disease is very high in areas with water scarcity and can have a devastating impact on children who may already be undernourished. Additionally, those living in crowded spaces with poor access to WASH facilities, like the many temporarily displaced families, also face a higher risk.

The recent AWD outbreak peaked in Somali region in February 2017 and now more than 50 per cent of the woredas (districts) are reporting active cases. Particularly due to the current Horn of Africa drought, there are refugees coming from neighbouring Somalia, as well as temporarily displaced Ethiopian Somalis, as people move in search of water, food and pasture for their livestock. The predominately pastoralist Somali region is the worst drought-affected area in Ethiopia with over 30 per cent of the region’s population requiring food assistance in 2017. Living conditions of these temporarily displaced people are often inadequate and widespread open defecation poses a risk of the spread of AWD, among other disease outbreaks.

Upon arrival, Basazin began a series of discussions with people from UNICEF, the Regional Water Bureau (RWB) and the zonal command post. What he learned immediately on the ground was a little different than he had prepared himself for. He came for mass chlorination of boreholes to stop the spread of AWD. However, he identified that boreholes are protected. “This is what can be so interesting about emergencies. You go in with one mind set and task and immediately are faced with a reality that may differ. The problem was not the water sources, so the contamination had to be happening at some point after water is collected, either during collection or storage,” Basazin explains.

Like detectives, Basazin and the newly formed team began contacting local water office staff and meeting with various community members to pinpoint where this contamination was coming from. The team concluded that contamination was occurring from water trucking, during the transport of water (usually by donkey cart) and at the household level, where dirty jerry cans were utilized repeatedly. Now the task has shifted to a multi-effort approach including mass chlorination of water trucks, community awareness campaigns to ensure clean jerry cans and training sessions for local water staff on chlorination standards.

The RWB staff know about chlorination, however at this critical time of drought and AWD, with a mobile team equipped with testing kits, jerry cans and barrels of HTH chlorine solution, everyone was eager to learn more from practical demonstrations. A key lesson that was missing before now was how to calculate correct measurements of chlorine according to the container size to ensure disinfection. Referencing UNICEF WASH guidelines, Basazin prepared a guideline of chlorination and turbid water purification with these specific calculations included and it was subsequently distributed to all water offices in the region.

Adapting Response Efforts to Stop the Spread of Acute Watery Diarrhoea
Basazin demonstrating residual chlorine with technical staff and community mobilizers at the Lasooano kebele health centre in Shilabo woreda ©UNICEF/2017/Mead

The feedback was positive after the training and RWB staff proliferated the learning by sharing demonstration photos through their Viber group, a mobile messaging application utilized by all Somali RWB staff.

One water office participant commented after a demonstration, “Assistance has come through here and sometimes guidance is offered, but not like this. Receiving evidence-based participatory training makes a big difference.”

Basazin did not always explain the calculations and guidelines. Another lesson his work has taught him is to tailor his WASH messages according to the audience. “AWD bugs will attack the water if it finds it without chlorine and consequently the attack will reach to human beings.” There was laughter when Basazin used this metaphor.

The team is working through Good Friday, the big Easter holiday and weekends to curb the outbreak and spirits remain high. Basazin’s energy and commitment to ensuring his work has impact is easily detected as he speaks. “I like to learn today and implement for tomorrow,” he says. “Perhaps another idea coming from this mission is that we should highlight a jerry can and water truck washing day, just as we promote handwashing day.” He is also quick to admit this is not a one-man show. With the UNICEF Jijiga and Addis team and the community, mass chlorination is taking place exactly where needed to curb the AWD outbreak.

“Everything has a solution,” Basazin declares.

 

UNIVERSAL or UNIVERSALITY – it’s all part of the ONEWASH

By H.E. Ato Motuma Mekassa (Minister of Water, Irrigation and Electricity and Chair of the ONEWASH Steering Committee)

Mekdes Zewdu drinks water from a newly built water point by UNICEF with the support of DFATD.
Mekdes Zewdu drinks water from a newly built water. Since the UNICEF-supported pump was installed two weeks ago, life has changed dramatically. ©UNICEF Ethiopia/2016/Sewunet

The World has endorsed the new Sustainable Development Goals (SDGs) in September 2015 which is the master world document till 2030. The SDGs are “pushing” us all as water and sanitation professionals to look beyond the “low hanging fruits” of the MDGs and start working for water supply, sanitation and hygiene provision in urban areas, remote rural settlements and in rapidly expanding small and medium size towns. The SDGs are also demanding us to think “universally” and to bring technological and social engineering solutions for everyone, everywhere…always.

So comes to the Sanitation and Water for All (SWA) High Level Ministerial Meeting in Addis Ababa in March 2016. My Government (the Government of Ethiopia) are hosting this event as it presents an opportunity for us as Ethiopians to show how we have tried to practice a universal access plan for all, everywhere…always. Our ONEWASH national programme was launched during the Millennium Development Goal era in 2013 and we set out to rapidly scale up WASH services to our population by aligning ourselves and our partners around a ONEWASH programme with ONE plan, ONE budget and ONE report. So far, progress has been good and Ethiopia was able to declare that it had reached the MDG Goal 7c target 10 for water supply last year in 2015. We as Ethiopians are proud to share this experience during the SWA meeting in March.

However, looking forward, the SWA platform also provides us an excellent opportunity to take the Ministerial participants to visit our beautiful country and to see some of our work in the field. One area we are working hard to address is water supply and sanitation services in emerging small and medium size towns.  We call it URBAN WASH and it is very new for us. Until 2013, most of our people resided in rural areas. However now, our government is promoting a Growth and Transformation Plan-II (GTP)-II in which we are promoting small and medium towns as HUBS for industrial and manufacturing development….so naturally, more people (particularly our YOUTH) are migrating to our towns to work in enterprises. These all need water supply and sanitation that is appropriate and affordable. I therefore proud to say that we have partnered with the Government of Brazil and UNICEF to bring in new financial regulation and urban sanitation models to address this need.

I am personally looking forward to the SWA meeting in March and I hope to see you there.