Posted by: Wasrag | January 11, 2015

Thinking Strategically about WASH in Schools

Charles Adams & PDG Alexandra Martinez – Dominican Republic — December, 2014

“WASH in Schools” is the theme for Rotary’s 2015 Water Summit in Brazil. Why is that important? How do you do it? Where do we go with it?

Inspired by Rotary’s PolioPlus, we’re motivated to take a serious look for ways to get more bang for the bucks that Rotary invests in other humanitarian programs. Basically, like PolioPlus, this goal will translate into Rotary’s becoming an “advocate” that can find and motivate partners to share the commitment, share the funding, and extend the scope of Rotary’s programs.

Increasingly, it is thought that one of Rotary’s greatest achievements in the fight against polio has been as an advocate.  While Rotary has put up something over 10% of the world’s budget to fight polio, it has been most visible as a “change agent” in motivating hundreds, perhaps thousands, of other organizations and multitudes of individuals to fight polio.

Advocacy clearly gave Rotary two bangs for the buck in polio.  One was the direct benefit to hundreds of millions of children through immunizations.  The second was in giving legs to the campaign by energizing hundreds of thousands of other people to share Rotary’s commitment.

The question is:  can we do that with water, sanitation, and hygiene projects? First, an example.

Studies show that handwashing can reduce diarrheal diseases by more than 40% and upper respiratory diseases (like pneumonia) by 23%. With documented results like those, handwashing and hygiene should be at the top of the list of anyone who wants the cheapest, fastest, and most effective way to dramatically improve the health of a nation. [i] That’s what happened in the U.S. in the 1800s and early 1900s, and that will likely be the pattern in developing nations.

This is what motivates the Rotary Handwashing Campaign in the Dominican Republic. And it can be looked at as a program that potentially fits the advocacy model.  In this campaign, Rotary recruits schools and it funds the training of teachers and the production of classroom teaching materials to use in the schools’ health curricula. The teachers then train and monitor the handwashing behavior of students.  Thus, because schools have a vested interest in the health of their students, we create advocates among schools, principals, teachers, and students that continue to do Rotary’s work well beyond anything that Rotary can do by itself.  And they do it year after year.

Who could ask for better partners than a nation’s schools – or the schools of the world — to help accomplish Rotary’s mission in handwashing and hygiene?

But what about clean water?  That’s more problematic because Rotary’s typical WASH projects have followed a “benefit/charity” model.  We drill a well; that’s the end of it; great benefits but no more advocacy. We install rainwater harvesting; great benefits but nothing else happens.  We put a filter in people’s homes; finish; nada; no legs.  All of that makes us feel good; but, increasingly, Rotary must look for leverage to optimize its investments. However, it will take a different model to get leverage.

So where can we turn?  What can we create?

Let’s look again at the schools.  After all, everyone will agree that “the health of a nation tomorrow depends upon what we teach our children today.”  That realization has profound implications not only for personal health but also for the productivity of a nation’s economy and its health costs.

One of the largest expenses in public health is the treatment of waterborne diseases. A new WHO/UN study in 94 countries shows that, for every $1 invested in WASH, the economic benefits in a developing nation can be a $4.30 reduction in health costs. Sounds compelling, but that’s not all. The study also showed that nationwide WASH can produce a gain of 1.5% in GDP. [ii]

So what do we have here? A major reduction in diseases and a four-to-one return on the invested WASH dollar and something that sounds equivalent to a big dollop of foreign aid with a 1.5% increase in GDP. That sounds like three big bangs for the humanitarian buck. But if we want a nation’s commitment to these WASH benefits tomorrow, we have to be teaching its children how to do WASH today. Just how do we do that?

Here we have a problem.

One of the first things we learned starting the Handwashing Campaign was how ill-prepared we were for reality in the schools. Here we were, teaching thousands of students in hundreds of classrooms about handwashing; but, guess what? At least 80% of the schools we were in had no facilities for washing hands.  Pretty hard to make handwashing advocates just with book learning.  So we designed simple, economical handwashing stations for schools that had none.  Now students learn about handwashing, then do it, then take the habit home with them (slow at first, but getting better).

We’ve discovered the same problem with clean water.  Our surveys show that 80%-90% of Dominican schools do not provide clean drinking water for students — unless they buy bottled water so they can distribute a few ounces a day.  Imagine hundreds of schools, each with hundreds of students, that provide no drinking water at all (or, at most, a small cup).

There’s something else. We know that clean water can reduce diarrheal diseases by more than 50%. But no one is talking about reducing the serious stealth effects of dehydration — the silent enemy of children — on learning, health, and nutrition. Forget the hit on health and nutrition for a moment, studies show that a child’s learning ability can easily drop 15%-25% due to dehydration during a school day. [iii] That’s a serious erosion of dollars invested in education. What do we do about that?

In 2013, we introduced a new, low-cost, water filter for homes based upon hollow-fiber membrane technology (see photo). [iv] It is now being used in the Dominican Republic, Haiti, Honduras, and other countries.

[i] See: http://globalhandwashing.org/sites/default/files/Handwashing_Handbook.pdf and

http://globalhandwashing.org/sites/default/files/GlobalHandwashingDayPlannersGuide.pdf

[ii]   See p.10 at: http://apps.who.int/iris/bitstream/10665/143953/2/WHO_FWC_WSH_14.01_eng.pdf

[iii] See: http://www.teachingtimes.com/articles/brains-shrink-water.htm or file:///C:/Users/User/Downloads/JACN%202012.pdf .

[iv]   For information about the Aqua Clara filters, contact the authors of this article. Other filters using hollow-fiber technology include Agua Limpia in Mexico (http://agualimpia.mx/productos.php). A vendor widely known for its recreational filters now being used for humanitarian projects is Sawyer (http://sawyer.com/products/type/water-filtration/). A new study using Sawyer filters showed the efficacy of hollow-fiber filtration in 904 households. It reported 75%-85% mean reduction in diarrheal diseases over a three-month period (see:  http://www.ajtmh.org/content/91/1/190.full ).

Charles_Adams
This technology can remove all bacteria and all parasites, and it is fully scalable.  That means that we can design small filters for homes and large filters for large applications – even for entire villages.   So why can’t we do something about schools?      Well, now we can.

This is new ground for Rotary because, to our knowledge, nowhere in the world has Rotary ever had economical programs to provide pure drinking water for students in any but the smaller schools.  (Neither has any other NGO.)  Systems installed in the larger schools typically involve electrical components, chemicals, and replacement parts.  The reasons such systems have not proliferated is, first, because of their capital cost and, second, because schools can’t or don’t have the capacity or the will to manage the upkeep costs.

(To its credit, the bio-sand filter (BSF) has tried to serve this market.  It was a great workhorse and the best many of us had to work with for years; but, for schools, we pushed it far beyond its design specs.)

So how do we break new ground?  How can Rotary transform a benefit/charity WASH program into an advocacy WASH program?

One way is to go back to our handwashing model.  We need partners (a) that can share our commitment to a goal, (b) that have broad outreach, (c) that are highly respected, (d) that strongly influence community behavior, and (e) that have lots of boots on the ground to do the work.  Is there a better candidate than a nation’s schools?

Charles2So, without getting technical, we now have the ability to work with schools making clean water available to their students economically. Is there any school that does not want to do that?  To accomplish this, the hollow-fiber filters have, so far, been scaled up into five sizes that can serve schools of 50 to 500 students.  (Three sizes are shown.) Larger schools, of course, can use multiple filters in multiple locations; or we can scale up to larger, even centralized, systems to suit their needs economically.

These filters remove all bacteria and parasites. They are user-friendly, easily maintained, and require no electricity, chemicals, or replacement parts. They have multiple spigots for easy student access. They are fully mobile for use in high traffic areas (daytime) but easily secured in a locked room (at night).

The economics?  For the full cost of building one latrine for one family, we can produce a filter that, filled twice, provides one liter per day of water free from bacteria and parasites for a school of 220 students. It doesn’t get simpler than that.

What do we get for this?

First, we get the direct benefit of improved health for students from drinking clean water.  Second, we get penetration of the community through the training and advocacy of principals, teachers, and students.  In this way, we transform a simple one-time WASH benefit program into a continuing WASH advocacy program that has the potential to cover a nation.

And not only can it work in one nation, it can work in many nations. That’s what we’ve been looking for!

But how can we make it happen?

We have to more fully document and operationalize this model to bring it to scale for large regions and small nations. An operations manual must be developed to share expertise on how to design, build, fund, organize, and implement school filter campaigns. This will take some time, but it isn’t rocket science.

Is it all worth the effort? We think so. By transforming WASH charity programs into advocacy programs – as in the handwashing and school filter campaigns – Rotary can add substance to its slogan of “WASH in Schools.” With a full strategic commitment, Rotary could truly energize the world’s schools and can make a significant difference in the world’s health just as it has done with its partners in polio.

Is this pie in the sky, or could we really do that with WASH? Of course we could! In fact, since 1990, deaths of children under five have been cut in half [i] largely by programs like Rotary has been funding for decades. Is there any reason why 1.2 million Rotarians in 34,000 clubs in 200 countries, 12,000 Interact clubs in 133 countries, 8,000 Rotaract clubs in 167 countries, and 7,500 Rotary Community Corps in 75 countries — all working with partners like the world’s schools — can’t put extra bounce in those numbers just like we’ve done with our partners in polio?

Rotary has the ability to make that happen. The question is: what’s the next step?

 

For more information: charles@taeria.com (in English) or doctoralexandra@gmail.com (in Spanish)

[i] See: http://www.un.org/millenniumgoals/childhealth.shtml

[1] See: http://globalhandwashing.org/sites/default/files/Handwashing_Handbook.pdf and

http://globalhandwashing.org/sites/default/files/GlobalHandwashingDayPlannersGuide.pdf

[1]   See p.10 at: http://apps.who.int/iris/bitstream/10665/143953/2/WHO_FWC_WSH_14.01_eng.pdf

[1] See: http://www.teachingtimes.com/articles/brains-shrink-water.htm or file:///C:/Users/User/Downloads/JACN%202012.pdf .

[1]   For information about the Aqua Clara filters, contact the authors of this article. Other filters using hollow-fiber technology include Agua Limpia in Mexico (http://agualimpia.mx/productos.php). A vendor widely known for its recreational filters now being used for humanitarian projects is Sawyer (http://sawyer.com/products/type/water-filtration/). A new study using Sawyer filters showed the efficacy of hollow-fiber filtration in 904 households. It reported 75%-85% mean reduction in diarrheal diseases over a three-month period (see:  http://www.ajtmh.org/content/91/1/190.full ).

[1] See: http://www.un.org/millenniumgoals/childhealth.shtml

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Responses

  1. Never been inspired to take action like i am after reading this article. I am setting up a WASH program in my area ( Mbale – Uganda) involving the Rotary family and all stakeholders in schools so we can create change. I am looking forward to your support.

    Sydney Nsubuga – Past President RC Mbale /PHF
    Email: sydneynsubuga2002@yahoo.com

  2. Reblogged this on rehemauganda and commented:
    Be the change you want to see in the world. REHEMA is joining the WASH campaign.

  3. So how do I connect with the authors Adams and Martinez to learn more about the filters they are using???

  4. Hello

    Thanks for the innovation to build cheap toilets in Rwanda. The walls for the sample toilet ought to be raised up to provide for more privacy. Thanks

    Miriam Namutebi
    RC Kampala West, Uganda


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