Malawi: school menstrual hygiene management – more than toilets

School menstrual hygiene management in Malawi: more than toilets, 2012.

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SHARE; WaterAid

This study identifies the needs and experiences of girls regarding menstruation. It draws upon participatory group workshops, a questionnaire and semi structured interviews with school-age girls in Malawi to make various recommendations, including lessons about menstrual hygiene management (MHM), girl-friendly toilet designs, and the provision of suitable and cheap sanitary protection.

Zimbabwe, Chitungwiza: factors leading to poor water sanitation hygiene among primary school going children

Journal of Public Health in Africa, March 2012

Factors leading to poor water sanitation hygiene among primary school going children in Chitungwiza

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Blessing Dube, James January

Although the world has progressed in the area of water and sanitation, more than 2.3 billion people still live without access to sanitation facilities and some are unable to practice basic hygiene. Access to water and basic sanitation has deteriorated in Chitungwiza and children are at risk of developing illness and missing school due to the deterioration.

We sought to investigate the predisposing, enabling and reinforcing factors that are causally related to water- and sanitation- related hygiene practices among school going children. A random sample of 400 primary school children (196 males, 204 females) in four schools in Chitungwiza town, Zimbabwe was interviewed. Behavioural factors were assessed through cross examination of the PROCEED PRECEDE Model. The respondents had been stratified through the random sampling where strata were classes. A structured observation checklist was also administered to assess hygiene enabling facilities for each school.

Children’s knowledge and perceptions were inconsistent with hygienic behaviour. The family institution seemed to play a more important role in life skills training and positive reinforcement compared to the school (50% vs 27.3%). There was no association between a child’s sex, age and parents’ occupation with any of the factors assessed (P=0.646). Schools did not provide a hygiene enabling environment as there were no learning materials, policy and resources on hygiene and health. The challenges lay in the provision of hygiene enabling facilities, particularly, the lack of access to sanitation for the maturing girl child and a school curriculum that provides positive reinforcement and practical life skills training approach.

Kenya: assessing the impact of a school-based water treatment, hygiene and sanitation programme on pupil absence

Tropical Medicine & International Health, December 2011, doi: 10.1111/j.1365-3156.2011.02927.x

Assessing the impact of a school-based water treatment, hygiene and sanitation programme on pupil absence in Nyanza Province, Kenya: a cluster-randomized trial

Matthew C. Freeman, Leslie E. Greene, et al.

Objectives  There has been increased attention to access to water, sanitation and hygiene (WASH) at schools in developing countries, but a dearth of empirical studies on the impact. We conducted a cluster-randomized trial of school-based WASH on pupil absence in Nyanza Province, Kenya, from 2007 to 2008.

Methods  Public primary schools nested in three geographical strata were randomly assigned and allocated to one of three study arms [water treatment and hygiene promotion (WT & HP), additional sanitation improvement, or control] to assess the effects on pupil absence at 2-year follow-up.

Results  We found no overall effect of the intervention on absence. However, among schools in two of the geographical areas not affected by post-election violence, those that received WT and HP showed a 58% reduction in the odds of absence for girls (OR 0.42, CI 0.21–0.85). In the same strata, sanitation improvement in combination with WT and HP resulted in a comparable drop in absence, although results were marginally significant (OR 0.47, 0.21–1.05). Boys were not impacted by the intervention.

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Conclusion  School WASH improvements can improve school attendance for girls, and mechanisms for gendered impacts should be explored. Incomplete intervention compliance highlights the challenges of achieving consistent results across all settings.

Kenya, Eastern Province: Amina Abdalla, “You can’t maintain hygiene without water”

Amina Abdalla, a 45-year-old mother of seven, living in Marsabit District (pop. 121,000), Eastern Province, told IRIN/PlusNews about her daily struggle for water. She knows water is essential for hygiene, but there is not enough and it’s too expensive. She has to get up at 4 a.m. in the morning to queue for water.

“Some of us women come with small children to the water vendor and stay the whole day waiting for our turn. The children cry all day of hunger and the scorching sun, but getting water is the most important thing at that moment.

“At the vendor, it doesn’t matter what is the size of your family. We are just given five jerry cans of 20 litres each and they expect you to use it until after 10 days when you can return for more.

“When I finish my water – which I always do before the end of the 10 days because my family is large – we buy from people who hawk water. They sell one 20 litre container for 50 shillings [US$0.54], which is very expensive but there is little I can do. At times, you end up using money meant for food to buy water because even if you have food, you can’t cook it without water.

To save money, Amina Abdalla’s children can only bathe once every three days, and cannot wash clothes regularly.

“I have seven children but there would have been more; I lost three to cholera because the surroundings are dirty as a result of poor hygiene… You can’t maintain hygiene without water”.

There are boreholes in the forest but women risk be molested by men if they go there or are denied access by herders with their livestock.

“Here in Marsabit, we will have war one day and it will not be about animals or land… War will take place because people will be fighting for water.”

Source: IRIN, 24 Aug 2011

Ethiopia: “Biyo: water is love”, Somali-Italian singer discovers her roots

Saba Anglana’s album “Biyo: water is love” has risen to no. 11 in the October 2010 European World Music Charts. For her album, the Somali-Italian singer went in search of her roots in Ethiopia, home of her maternal grandparents. She travelled to Addis Ababa where some of her relatives still live and to the Oromo Valley in the south. There she found the inspiration for her album: the procession of women and children in their early morning journey to collect water. Her album begins and ends with water. The opening track is “Biyo” – the Somali word for water, and the last song is “Weha”, which is water in Amharic, the official language of Ethiopia.

Watch the beautifully shot clip of Biyo below. More video clips can be found on Saba Anglana’s YouTube channel. Audio clips and song lyrics from “Biyo: water is Love” are available on www.sabaanglana.com/Biyo.aspx

Ghana: You want a wife? Where is your water source?

Potable water, as it is often said is life. The lack of it affects all the spheres of human activity – health, social, education, agriculture, politics and economics. The lack of this essential commodity makes life meaningless. Its importance can only be equated to air.

The difficulty in accessing water in Sissala Communities has made young girls and women to ask suitors about the availability of potable water in their communities before accepting their proposals. If the suitor’s community does not have its own water source, they would want to know the distance from the nearest potable water source and if it is far, they would most likely to turn down the proposals.

They would also find out whether the community their lovers are coming from are good farmers and could produce enough food to feed their people.

The accessibility to clean water and food production are the determining factors for winning the love of many a young girl in the area. The reason for this is that the people in the communities are predominately farmers and any time lost in search of water by women will not be tolerated by their husbands, who would need their assistance on the farms.

These revelations came to light at a forum on water and sanitation held in Funsi in the Wa East District of Upper West Region, organised by ProNet North, a local non-governmental organisation, dedicated to the provision of potable water for communities in the Upper West Region in collaboration with WaterAid Ghana.

It was under the “End Water Poverty Campaign” for the often excluded voices, such as women, persons with disability, and children to speak out their minds on how water and sanitation poverty impacts their lives at the local level.

The overall objectives of the poverty hearings are to provide an empowering and engaging way for communities to advocate improvements in their lives, and provide depth, richness and legitimacy to the campaign being run in their interest by WaterAid.

Madam Adiata Marifa, a house wife from the Gbantala, told the forum that young men in the village were finding it difficult to get wives to marry because the community does not have potable water source nearby, in spite of numerous attempts by water agencies to provide potable water have failed.

The people have been continuously drinking from unsafe water sources, such as ponds, rivers and streams and during the dry season women in the community have to walk long distance daily basis to fetch water leaving their domestic chores unattended to.

Another woman from Tampaala, Madam Abeta Issahaku, said women spent more hours looking for water from unsafe sources. Besides, one can not go to the pond twice to fetch water because of the distance.

She said many children are dying in the community as a result of diarrhoeal and other waterborne diseases, adding that the eradication of guinea worm would be a mirage if some communities were still drinking from unwholesome water sources

The testimonies from Chaggu Paani and Jankori Deriyiri communities were not different. Mr Nousah Sobo from Jankori Deriyiri said the people have been drinking from a river and during the dry season the water became muddy and women had to add ash to it for the dirt to settle before they sieve it for drinking.

He said teachers posted to these communities to teach are unable to cope up with the situation and have abandoned the schools. He appealed to the Government and non-governmental organisations in the water sector to find alternative ways of providing potable water for the communities.

Looking at the situation in the Wa East District, this Writer is of the view that the seventh goal of the Millennium Development Goals (MDGs) “Ensuring environmental sustainability” can not be achieved in the stipulated period of 2015. More work has to be done to enhance the provision of potable water in communities that do not have water. Access and coverage rate of water and sanitation in most parts of the three Northern Regions is unacceptable and something needs to be done urgently.

Women, especially those undertaking sheabutter processing and other agro-based micro-businesses; school children; people living with HIV/AIDS as well as disabled persons suffer various levels of relative deprivation from potable water and decent sanitation scarcity which impacts negatively on their overall living standards.

In case of sanitation, the three Northern Regions, which are among the five poorest regions in Ghana, have the highest rate of open defecation. The “Ghana Statistical Service Multiple Indicator Cluster Survey (MICS) Report 2006″ indicated that while the national average of open defecation was 24 per cent, the practice was most widespread in the Upper East Region, which had about 82 per cent of the people having no access to decent latrine; followed by the Upper West Region with about 79 per cent and then the Northern Region with about 73 per cent.

Source: Bajin Dougah Pobia, Ghana News Agency, 30 August 2010

Ghana: Essential services platform calls for gender sensitive policies in water sector

The Essential Services Platform has called on government to formulate water-related gender sensitive policies that will  benefit women. The call follows disturbing revelations from a recent study on “Women’s Voices in Water Governance and Management” in Ghana.

According to the findings, women constitute more than 51% of the Ghanaian population and form 60% of those within the low income segment of the population living in rural and densely populated peri-urban areas with least access to water.

In general, men and women within the low income bracket pay 10 times more the official rates of water to water vendors and spend more than 10% of their incomes on potable water. Those who cannot afford such prices rely on unsafe resources for their upkeep.

The study, according to a press statement signed by Leonard Shang-Quartey, Convener of Essential Services, said besides the general difficulties which confront men and women regarding affordability and quality of water, “the burden of securing water for household use is borne by women and children with negative implications for their incomes and education respectively.”

“The stark reality of the situation is made clear when one considers the national coverage in the supply of water which hovers around 19% (household connections),” said the statement.

The research came up with some startling statistics. It said of the respondents interviewed, 76% acquired water outside of their household with the average distance to the nearest water source being 10.31 minutes and the highest 60 minutes. However, when water is not available at primary sources, respondents spoke of long walk in search of the commodity. They also have to wake up very early in search of water to avoid along queues at collection points.”

The statement recognizes the fact the conditions of affordability and access to water as captured by the study is not new and the problem could be attributed to years of neglect and limited investments by government.

“There will be no gain repeating the promised benefits that were said would arise from the engagement of Aqua Viten Rand Limited (AVRL), as the failure of both the company and the idea of commodifying water are presently common knowledge.”

To lift the burden of securing water off the shoulders of women and children, the Platform impresses upon government to consider the implications of policies of the sector on women and children. “Prioritizing and addressing concerns in relation to water management and supply will not only ensure access for all but would also lead to the bridging of the income and power gaps between men and women. The current conditions are inconsistent with our commitments as a country to gender equality and equity as they widen the already existing gaps.”

To remedy the situation and to reduce vulnerability and poverty levels, the Essential Services called on government to halt the demand driven approaches (Privatization) to water supply and management as such approaches are fast eroding people’s rights and entitlement to water and forcing many to turn to unsafe sources.

It also asks government to ensure that utility policies establish a linkage between gender, socio-cultural location of women and equal access to water. Similarly urges government to reintroduce public investments and establish transparent and accountable community management of water through a decentralized water supply system.

Source: Public Agenda /allAfrica.com, 13 August 2010

Kenya, Nyanza: water and sanitation improvements at Atono school

The water and sanitation facilities at Atono school, especially the girls’ urinal, have attracted visitors from within Kenya and from Tanzania, Saudi Arabia and U.S.A. Photo: IRC/Ingeborg Krukkert

Mr Daniel Odhiambo is headmaster of the Atono School in Nyanza – one of only four schools in Kenya with urinals for girls. Netwas Kenya and IRC visited his school recently as part of a UNICEF Kenya study of 43 schools in four districts: Coast (Mombasa); Nyanza (Rachuonyo & Kisumu); Rift Valley (Kajiado); and North Eastern (Garissa). The aim of the study was to find out if the national Kenyan Ministry of Health standard ratio of 1 latrine to 25 girls and 1 toilet to 30 boys can be downgraded if the pupils also have access to urinals, and if so, what would be the new ratio.

This was a follow-up of 2004-2005 research on the enhancement of sanitation and hygiene for Kenya’s school children, carried out by IRC together with seven partner organisations in Kenya. That study showed that school toilet standards were not being met.

Zimbabwe, Harare: a decade of water woes

At 12 midnight, Grandmother Ambuya Marvelous Mlambo makes her way quietly to the neighbouring borehole armed with her two 25-litre buckets. Scores of other women, young and old, are already at the borehole when she arrives so she has to join the queue.

Those waiting have an average of at least three containers each.

When her turn finally comes, it is already three o’clock in the morning. She laboriously fills her containers before making her way home. An hour later, she can finally sleep, only to get up again at six to prepare something for her 3 grand children before she sees them off to school.

Gogo Mlambo lives in the Gaza high-density suburb of Chipinge and this is the kind of life she has been living for the past 10 years.

Their water taps ran dry leaving them depending on water from springs that are dotted along the banks of a stream that runs along the outskirts of the suburb.

The residents’ situation had slightly changed for the better after UNICEF drilled some boreholes in August last year from which they are drawing water now.

But that was only done in an effort to elude the rampaging cholera outbreak that had hit the country.

But now the few boreholes are strained and some of them are fast wearing out due to excessive use.

Another non-governmental organisation also came in and built some water-holding structures around the springs but that does not protect the water from contamination.

“Raw sewerage is flowing freely as you can see in the direction of the stream and its final destination is in most cases those water holes.

“There are very high risks of disease outbreaks at the moment especially as there is no water in our houses yet we have to use toilets inside.

“All the taps we have in our houses are just there for decoration and last had water flowing through them a decade ago,” one resident Violet Mutanda said.

She complained that the council was deliberately ignoring them and not doing anything to right the situation yet they were sending huge bills of water at the end of every month.

“At one point I received a bill of US$900 and ignored it of course. It is surprising to note that council still acts as if everything is all right with the water situation and expects to generate some revenue from it. Why should we pay for services that we are not getting?” she asked.

Additionally, she said the council had at one point advised them that they (council) no longer had anything to do with their water services but ZINWA had taken over.

She further explained that council had deliberately allowed the situation to degenerate during that time when it was not clear who between them and ZINWA was supposed to be running the show.

On the contrary the council remains adamant that they have everything under control and are doing all they can to improve the residents’ situation even though it will take long for the residents to see and enjoy the results.

“We are currently repairing boreholes so that the water situation improves for the 12 000 residents that are affected.

“To date we have completed repairing two and we are left with one.

“We have all the resources that are needed for the programme, Chipinge town engineer Paul Mlauzi said recently.

He however conceded that the problem had haunted the residents for a very long time as council was incapacitated to draw water from Bangazani Dan about 4km away, a fact that had seen many households’ taps running dry.

At the moment the water crisis has disrupted the residents’ social life severely, as they can not host visitors lest they are embarrassed when the visitors fail to find toilets to relieve themselves.

“The situation is so bad that most people are crossing into the nearby farm to relieve themselves with the worst cases being those of people squatting behind bins to relieve themselves before burying the excretion in their yards or gardens,” one resident said.

She added that it was difficult for them to fetch water for cooking, bathing, laundry and toilets at the same time as they had other demanding domestic chores to attend to too.

“Most children are going to school on empty tummies because the mothers or guardians are busy looking for water, which is sometimes found at distances of between one and two kilometres.

“Imagine travelling all that distance with a bucketful of water on the head and dangling another one,” she added.

The visibly distraught resident also added that malnutrition was rife among children in the suburb, as parents were not getting adequate time to attend to their nutritional concerns, a feat that is difficult in the absence of reliable water sources.

The residents’ situation has been made precarious by the high incidence of free flowing raw sewerage that is evidently taking advantage of the sloping gradient to snake into the stream from which they draw water.

It is not surprising if another cholera outbreak or some other water borne disease were soon to be witnessed in the suburb that has more than 4 000 households, the bigger percentage of which is in dire need of water.

The suburb is now entirely dependent on springs and some bit of borehole water literally transforming it into a “springs suburb” yet the reality on the sanitation system is appalling and needing urgent attention.

Source: Obert Chifamba, The Herald / allAfrica.com, 12 Jun 2010

Kenya: Fear of attack leaves women prisoners in their homes

Women and girls in Nairobi’s slums live under the constant threat of sexual violence, leaving them often too scared to leave their houses to use communal toilet and bathroom facilities, Amnesty International said in a report released today.

Insecurity and Indignity: Women’s experiences in the Slums of Nairobi, Kenya details how the failure of the government to incorporate the slums in urban plans and budgets has resulted in poor access to services like sanitation, which hits women in slums and informal settlements especially hard.

“Women in Nairobi’s settlements become prisoners in their own homes at night and some times well before it is dark,” said Godfrey Odongo, Amnesty Internationals East Africa researcher. “They need more privacy than men when going to the toilet or taking a bath and the inaccessibility of facilities make women vulnerable to rape, leaving them trapped in their own homes.

“The fact that they are unable to access even the limited communal toilet facilities also puts them at risk of illness.”

The situation is compounded by the lack of police presence in the slums and when women fall victim to violence they are unlikely to see justice done. Kibera, Nairobi’s largest slum and home to up to a million people, has no police post.

“I always underestimated the threat of violence,” said 19-year-old Amina of Mathare slum. “I would go to the latrine any time provided it was not too late. This was until about two months ago when I almost became a victim of rape.”

Amina was set upon by a group of four men while she walked to the latrine at 7pm. They hit her, undressed her and were about to rape her when her cries were heard and a group of residents came to save her. Although she knew one of the men involved in the assault, Amina did not go to the police as she feared reprisal attacks.

Unable to leave their one-roomed houses after dark, many women in informal settlements resort to ‘flying toilets’ – using plastic bags thrown from the home to dispose of waste.

Women also told Amnesty International how the poor sanitary conditions they live in – which include widespread disposal of human excreta in the open because of lack of adequate access to toilets – directly contribute to cases of poor health and to high health care costs.

Other women describe the humiliation of bathing in front of their relatives and children.

Even by day, public bathroom facilities are few and far between and invariably involve walking long distances. According to official figures, only 24 per cent of residents in Nairobi’s informal settlements have access to toilet facilities at household level.

Despite some positive features, Kenya’s Millennium Development Goal (MDG) policies to meet the target on sanitation do not address the specific needs of women who face the threat of violence because they lack adequate sanitation.

They also do not address the lack of enforcement of regulations requiring owners and landlords to provide sanitation.

“There is a huge gap between what the government commits to do, and what is going on in the slums everyday” said Godfrey Odongo.

“Kenya’s national policies recognise the rights to sanitation and there are laws and standards in place. However, because of decades of failure to recognize slums and informal settlements, planning laws and regulations are not enforced in these areas.

“The lack of enforcement of these laws has ensured that landlords and structure owners in the slums can get away without providing any toilets or shower places for their tenants”

Lack of security of tenure also remains a long standing problem for tenants, despite a national land policy in place, removing any incentives that landlords or owners could have to ensure proper sanitation, and measures to increase security.

Amnesty International calls on the Kenyan government to enforce landlords’ obligations to construct toilets and bathrooms in the slums and settlements and provide assistance to structure owners who are unable to meet the costs of constructing toilets and bathrooms.

The government must also take immediate measures to improve security, lighting and policing and ensure that relevant government authorities coordinate their efforts to improve the water and sanitation situation in the settlements.

Source: Amnesty International press release, 7 July 2010

Download full document: Amnesty International (2010). Insecurity and indignity : women’s experiences in the slums of Nairobi, Kenya. London, UK, Amnesty International Publications.