Author: Josef Decosas, Marie-Claire Durand
The I-WASH project is implemented in ten districts of the Northern Region of Ghana. It is a four year collaborative project of UNICEF and the European Commission with a total budget of €19,6M. Implementation started in June 2007. At the time of the Second Performance Monitoring Mission, UNICEF Ghana reported the expenditure of €5,9M, about 30 percent of the available budget.
The objective of our mission was to assess the relevance, effectiveness, efficiency, impact and sustainability of the project with regard to its purpose, objectives and expected results. In addition, we were asked to assess progress on the implementation of recommendations made by the Preliminary Performance Monitoring Mission in April 2008. The terms of reference of the mission are attached in Annex 1.
We conducted the mission from May 11th to June 3rd 2009. We worked as independent experts in the field of Public Health (Josef Decosas) and Water & Sanitation (Marie Claire Durand). We conducted our work with impartiality, without interference, and with full access to all relevant documents.
During the mission, we reviewed project documents and interviewed key stakeholders of the I-WASH project at national, regional, district and community level. The only omission was a meeting with the National Authorising Officer which could not be arranged.
We visited six of the ten districts where I-WASH is being implemented and had group discussions with the District Project Delivery Teams and with selected individual team members. In each district, we inspected project sites and had discussions with members of Water and Sanitation Committees, members of Community Water and Sanitation Development Boards, groups of Community Hygiene Volunteers and groups
of school children. We attended a portion of a meeting of the Project Steering Committee as observers. Our interview and field visit notes are attached in Annex 6.
Before reporting our preliminary findings to the members of the Project Steering Committee, we discussed them with the I-WASH project management team and with senior management of UNICEF Ghana. We prepared an Aide Memoire for a final debriefing meeting with members of the Project Steering Committee. The feedback received during the meeting was considered in the preparation of this report. A copy of the Aide Memoire is attached in Annex 7.
Findings and Conclusion:
Summary of findings
The project addresses both the immediate tasks to control outbreaks of Guinea worm disease and the long-term developmental tasks related to drinking water, sanitation and hygiene. This strategic orientation is highly relevant to the social and economic development of the project area. It is appreciated by all stakeholders at the national, regional, district, area council, and community level.
There is a tension between the disease control paradigm and the long-term development paradigm that is not always easy to reconcile. The effort to control and eradicate Guinea worm disease requires rapid and highly focused actions, guided by firm targets. The developmental activities of the project require a focus on processes to affect social change and individual behaviour change.
In all of our interviews with community members, we heard accounts that the I-WASH project activities have improved the health of their children. This applies both to the provision of safe drinking water and the improvement in sanitation. The I-WASH project is clearly working in synergy with other priority rural health programmes in Ghana.
The capacity building activities of the project are showing positive results at the District Assembly level. There is a strong sense of ownership of the project by District Assemblies. This attests to the effectiveness of the I-WASH project. The activities are likely to generate sustained results as they are synergetic with Government policy and with other programmes supporting the decentralisation of Government in Ghana.
Targeted responses by the I-WASH project to the disruption of water supply to communities at high risk of outbreaks of Guinea worm disease have been slow. However despite this, there is documented evidence that the effort to eliminate Guinea worm disease in Ghana is on track, and that the I-WASH project is providing a significant contribution to this effort.
The activities undertaken to-date in the area of hygiene promotion in schools and in the community are largely ineffective.
The project design of I-WASH is complex and required bringing many different partners on-board. This increases the sustainability and the developmental impact, but it did slow down the project start-up. It would be less costly to have a more direct management and implementation structure for I-WASH, but the benefits in terms of sustainability justify the approach chosen by UNICEF.
It will be difficult for the project to achieve its targets in supplying safe drinking water. The main reason is the poor borehole drilling success rate due to low groundwater resources in most of the project area. In the area of sanitation, the target of latrine construction set in the initial project document will not be achieved. However, in view of the adoption of the Community-Led Total Sanitation approach, a target in terms of numbers of latrines is no longer relevant.
Delays in the release of money for activities by District Assemblies continue to be a major bottleneck in project implementation. This also affects the salaries of District Resource Persons who are paid from the district budgets. Another major bottleneck for project implementation by District Assemblies is the delayed mobilisation of vehicles to the districts.
Sustaining the water supply facilities and services introduced by I-WASH will require continued effort. The development of a maintenance system for hand pumps is well advanced. Of concern is the maintenance of the mechanised systems. Most of the established Water Boards have good reserves to pay for operation and maintenance, but spare parts and skilled mechanics are difficult to find.
Summary of recommendations
The Second Performance Monitoring Mission formulated 26 recommendations in the five areas of (1) project design and management, (2) capacity building, (3) provision of drinking water, (4) sanitation services, and (5) hygiene promotion. The recommendations were discussed with the Project Steering Committee at the time of the debriefing.
In the area of project design and management we recommend:
A review and revision of the high level project targets;
A separation of the management of the long term developmental activities from the disease control activities of the project, including the creation of a distinct Guinea worm elimination and outbreak control response;
A clarification of the authority and accountability of project committees;
A uniform application of quality assurance procedures for all contracted work;
An improvement in the collection and communication of project management information.
In the area of capacity building we recommend:
An increased effort to engage in the development of District Water and Sanitation Plans;
A rapid mobilisation of vehicles to the districts;
The development of more functional procedures to provide financial support to District Assemblies and to pay the salaries of District Resource Persons.
In the area of drinking water provision we recommend:
A reduction in the targets for new boreholes to be drilled and a more intensive effort to develop alternatives to groundwater sources;
The systematic inclusion of operation and maintenance cost and of community acceptability in feasibility studies for water supply systems;
The preparation of a definitive list of communities to be supplied with water before the end of the project;
Support for a maintenance system for mechanised water schemes.
In the area of sanitation services we recommend:
Replacement of the target for latrine construction with a target that is more appropriate for the Community-Led Total Sanitation approach;
A shift in emphasis from the marketing of sanitation models to rolling out community-led sanitation programmes;
Setting a feasible target for communities to be covered by Community-Led Total Sanitation programmes;
Exploring the inclusion of subsidised latrine ventilation pipes in the programme;
Re-assigning the task of procuring household latrine slabs from the Regional Office to the District Administrations.
In the area of hygiene promotion we recommend:
Moving the environmental sanitation activities and results from the hygiene promotion area to the sanitation area;
Reviewing and revising the community hygiene promotion component;
Reviewing and revising the approach to hygiene promotion in schools.
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