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2012 Ghana: Evaluation of the Government of Ghana - UNICEF Integrated Approach to Guinea Worm eradication through Water Supply, Sanitation and Hygiene in Northern Region, Ghana (I-WASH)



Author: Erik Toft, Boluwaji Onabolu

Executive summary

"With the aim to continuously improve transparency and use of evaluation, UNICEF Evaluation Office manages the "Global Evaluation Reports Oversight System". Within this system, an external independent company reviews and rates all evaluation reports. Please ensure that you check the quality of this evaluation report, whether it is "Outstanding, Best Practice", "Highly Satisfactory", "Mostly Satisfactory" or "Unsatisfactory" before using it. You will find the link to the quality rating below, labeled as 'Part 2' of the report."

Background:

This report is an end-of-project evaluation of the Ghana-UNICEF Integrated Approach to Guinea Worm Eradication through Water Supply, Sanitation and Hygiene in the Northern region, Ghana (I-WASH) project. The project was implemented from 2007 to 2012 in the ten districts of the Northern Region that had the highest number of cases of guinea worm infections in 2005. The project is financed with funding from the European Development Fund (EUR 14.5 million) and UNICEF (EUR 5,050,528).

Purpose/Objective:

The objective of the project is to break the transmission of guinea worm infections and to ensure a decrease in childhood morality and childhood diarrhoea. It aimed to do this with an integrated intervention of water supply provision, improved sanitation and hygiene coverage and behaviour change facilitation.

Methodology:

The project consists of four components: i) development of the capacity of ten District Assemblies and other stakeholders; ii) increased access to, and use of, sustainable safe drinking water; iii) basic sanitation delivery and coverage increased; and iv) improved hygiene behaviour practices with focus on hand-washing.

The evaluation fieldwork took place in June 2012, at the end of the operational phase of the project.

Findings and Conclusions:

Relevance: The I-WASH project is relevant to the eradication of guinea worm and is in line with the priorities of the Government of Ghana. The objectives for a reduction in child mortality and diarrhoea cases in communities were unrealistically high.

Effectiveness: The capacity development component has effectively achieved the expected result; in one district the usefulness of the component was less obvious. The reported number of beneficiaries with access to year-round drinking is 246,000 against an expected result of 267,000. Furthermore, not all water supply facilities visited were providing or were used year-round. O&M structures have been put in place and funds are in general collected on a regular basis with spare parts available and minor repairs taking place. The project has not achieved its targets for household and institutional sanitation coverage, but has facilitated processes that will enhance the acceleration and scaling up of CLTS in Ghana if the challenges are addressed. Progress have been made towards achieving the expect result of improved hygiene. Especially the hand washing with soap interventions have been successful whereas the progress in cleaning communities has been limited.

Efficiency: The project made good use of existing capacities in partner organisations although delays in implementing some aspects of the project led to a one-year no-cost-extension. The cost of the activities is found to be reasonable.

Impact: The I-WASH project has contributed to breaking the transmission of guinea worm and is likely to have contributed to a reduction of in childhood mortality and diarrhoea. The I-WASH project has also had an impact at the organisational, policy and strategic level.

Sustainability: Despite the lack of an explicit exit strategy, there are encouraging signs that many aspects of the I-WASH project will nevertheless be sustainable. It is likely that the break of guinea worm transmission will be sustained and that improvements in sanitation and hygiene practises are sustained. The institutional sustainability is ensured with organisational structures being sustained as well as replicated in other sectors. The O&M system of the water supply facilities is functioning and preventive maintenance and minor repairs are generally taking place with community contributions. Technical support might be required to sustain the household latrines and monitoring to ensure that the agreed institutional latrine designs and standards are adhered to.

Visibility: Only a limited number of visibility measures had been implemented.

Previous recommendations: Most of the recommendations from previous reviews of the project have been implemented. 

Recommendations:

Given that the I-WASH project has entered its closing phase the recommendations below are categorised into recommendations that can be undertaken by the I-WASH project and those that should be considered for future projects.

Key recommendations for action within the I-WASH closing phase
This section contains a shorter version of the key recommendations. For more details of the recommendations, please refer to chapter 7.
Carry out a follow-up assessment to determine how training and other types of capacity building support provided is being used and to determine follow-up assistance.
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 Initiate a small-scale research to determine the scale of the health impact.
Urgently develop an exit strategy and start implementation immediately before end of the I-WASH project.
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 The institutional latrines already constructed should be assessed, and discussions about design compliance should be undertaken
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 The I-WASH project should strengthen the O&M system through the Regional Project Management team.

Key recommendations for future action in conjunction with other projects
- Ensure that future projects have realistic indicators for overall objectives and project purposes.
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 In order to verify that year-round access to water is provided, future projects should include regular monitoring of functionality and use of water facilities based on definitions of what functionality and use entails.
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 Future household water treatment interventions should be strengthened by monitoring and documenting the adoption of the household water treatment technologies and the level of compliance with appropriate use.
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 Future CLTS triggering should be at a level which the Environmental Health Officers can provide sustained close mentoring and supervision in an agreed time frame.
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 The CLTS process should include technical support to latrine construction for those who wish to construct and use their own latrines during the process of achieving ODF.
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 Future institutional latrines should take into consideration of gender and the physical challenged. Explore avenues for complementing the facilities provided through the I-WASH project, to ensure a complete package of water, sanitation and hygiene facilities.
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 Ensure that planning include realistic time for UNICEF procedures for hiring of staff and purchases and take into consideration local contractors' capacity.
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 UNICEF together with partners should undertake high-level advocacy to ensure funding by district assemblies for monitoring and facilitation in communities.
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 UNICEF and partners should support the establishment of a system for monitoring of the abstraction of water to ensure sustainable use.
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 A clear visibility plan should be developed at the on-set of future projects and implementation should be undertaken simultaneously with implementation of activities.



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