Author: Stephen Ntow
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Following nine months of implementing Water access, Sanitation and Hygiene (WASH) Package Approach in selected counties of Liberia, the program has been assessed and found to have met most of its objectives. The results and other outcomes of the evaluation which took place in Grand Cape Mount, Margibi, Grand Bassa, Grand Gedeh and Maryland have been compiled as the central theme of this report.
The 2007 Liberian DHS estimates that only 65% of Liberian households have access to an improved water sources according to the classification of improved and unimproved water sources by the WHO/UNICEF Joint Monitoring Program for Water Supply and Sanitation. The LDHS showed that 16% of households reported treating their drinking water with bleach or chlorine and 80% of household report doing nothing to treat their drinking water. (Blanton 2008). The survey also pointed out that treatment frequency is not standardized, and monitoring of residuals typically does not occur.
Health indicators show very high mortality rates for children under-five years old at 110 per 1,000 live births (LDHS, 2007) - 20th lowest in the world (UNICEF, 2009). Preventable childhood diseases including diarrhea, malaria, and acute respiratory infections continue to be major killers. The Liberia Demographic and Health Survey (LDHS, 2007) reported that 29% of children between the ages of 6-11 months had diarrhea in the 2 weeks preceding the survey. Cholera is endemic in Liberia.
This situation, partly accounts for UNICEF‟s resolve to adopt measure that will rapidly increase access to WASH facilities and services in an integrated fashion, and with the potential reducing diarrheal diseases (especially among children) including cholera through its WASH Package approach. A program which seeks to promote:
Household water treatment and safe water storage (HWTS) using a chlorine based product distributed under the brand name “WaterGuard”.
Improved personal hygiene with emphasis on hand washing with soap (HWWS), and
Improved access to sanitation through Community - Led Total Sanitation (CLTS).
The purpose of the evaluation is to assess the WASH package approach, its impact on target population and key lessons learnt in order to improve the design of subsequent projects. The evaluation is expected to look at the project efficiency, effectiveness, sustainability and appropriateness.
A multi-stage random sampling process was adopted and following the conduct of 743 structured interviews with mothers of children five years or less, 34 Focus/Group Discussions, 87 Key Informants Interviews with community leaders and volunteers, 98 non-obtrusive semi-structured observations in both intervention and non-intervention communities, and testing of 350 water samples, relevant information was generated to meet the objectives of the evaluation.
Findings and Conclusions:
WASH package approach has made significant difference between project and non project communities. It has also made immense progress compared with benchmark statistics selected at the start of the program. In spite of the high levels of achievement, some potentials remain untapped just as other aspects have attracted marginal attention. They include garbage disposal, mainstreaming gender and HIV/AIDS (among other vulnerable groups) into WASH and development of profiles for expected hygiene behaviors at inception phase of the program.
Program planning, implementation, monitoring, partnership arrangements and collaboration have been effectively done. These offer several lessons for scale up. However, most implementing partners have demonstrated limited capacity to deliver. There is likely potential to increase internal coordination between WASH and other units within the Child Survival (CS) section of UNICEF. Other possibilities exist for the WASH unit to receive technical support from the Communication and Education sections of UNICEF beyond the current levels. The difficult roads transport situation is another challenge.
Sector learning and review of WASH package components
• UNICEF and partners should disseminate achievements and lessons to facilitate learning among sector players.
• They should also emphasize garbage (refuse) disposal component of the package.
• Mainstream gender, HIV/AIDS and other sustainability considerations into future WASH program to optimize returns on investments, increase health outcomes in communities and to ensure sustainability of the program.
• UNICEF and partners should compile expected hygiene behavior profiles at the design stage of WASH package program as part of baseline information.
WASH in Schools
• School Health Committee/Clubs (SHC) committees should be assisted and encouraged to display action plans by placing them on school notice boards or walls. They should prepare updates on their activities as part of routine school reports. Education authorities should make school WASH assessment part of routine school inspections.
• UNICEF and partners should institute a scheme for school authorities to ensure proper use the WASH facilities in general and hand washing facilities in particular.
Internal coordination and program management
• Intensify efforts in Child Survival section of UNICEF to promote planning, implementation and coordination within and between other sections as planned. The activities of the Communication Working Group (CWG) is one of the platforms to be used.
• The WASH unit should organize a review workshop on the current program planning and management processes with all stakeholders to validate its strengths, and share these as lessons to facilitate sector learning.
• WASH unit should intensify its current monitoring arrangements of carrying out purposive visits aimed at spending more days with partners who may be in distress and so require extended support. This should be applied to partners performing very well in order to capture and share best practice with other sector players.
Improving partnership and collaboration
• UNICEF should continue to implement WASH through government and NGO partners. However, there is need to select and build capacity of partners in both technical and management departments of WASH programs.
• UNICEF should also Intensify WASH unit’s innovative strategies in addressing inaction among some partners.
Community management structures and sustainability
• WASH section of UNICEF in collaboration with Government and NGOs should work closely with communities leaders to develop a criteria for selecting volunteers for training after which they must be given definite periods to serve their communities.
• The regular meetings and training programs for WASH committee members should be continued for not less than one year. It should offer the opportunity for members to present themselves for scrutiny and be accountable to the wider community.
• Future programs should adhere to key sustainability factors at all stages of program design through implementation. They include; Financial, Technical, institutional, Environmental and Social/Cultural factors emerging from baseline assessments.
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