The One WASH National Programme (OWNP) was created by the government of Ethiopia in response to the challenges of improving water, sanitation and hygiene throughout the country. The Module begins by asking the question: why do we need the OWNP?
In this study session you will be introduced to the concept of WASH and learn about its meaning and significance. You will identify the reasons why it matters to human health and economic development. In addition, you will also be introduced to the OWNP, the challenges the WASH sector was facing prior to the development of the Programme and how the OWNP aims to tackle those challenges
When you have studied this session, you should be able to:
1.1 Define and use correctly all of the key words printed in bold. (SAQ 1.1)
1.2 Explain the importance of WASH to human health. (SAQ 1.2)
1.3 Explain the importance of WASH to education and economic development. (SAQ 1.3)
1.4 List the reasons why the OWNP is needed. (SAQ 1.4)
1.5 Describe the overall aims of the OWNP. (SAQ 1.5)
WASH is an abbreviation that stands for water, sanitation and hygiene. The acronym has become popular during the last couple of decades as the focus on providing safe water supply, sanitation and hygiene to the global population has been growing. (Note that sometimes WASH is written with a small ‘a’, WaSH, from water, but the meaning is the same.)
The combination of water, sanitation and hygiene into one term recognises that the three are closely linked and should be considered together. However, before looking at their connections, it is important to understand their individual meanings. Box 1.1 provides some definitions of several key terms.
Water supply is the provision of water by public utilities, commercial organisations, communities or individuals. Public supply is usually via a system of pipes and pumps. In order to sustain human life satisfactorily, a water supply should be safe, adequate and accessible to all.
Safe water supply means the supply of water is free from any form of disease-causing agents. The main criteria are:
In addition to being safe, the water must also be acceptable to consumers by being odourless, colourless and without objectionable taste.
An adequate water supply fulfils the minimum amount of supply per person per day. The World Health Organization defines this amount as 20 litres of water per person per day. (Note that ‘per person’ is sometimes written as ‘per head’ or ‘per capita’ – they all mean the same.)
Accessible water supply is within safe physical reach from the home or institution, usually within 1 km or a 30-minute round trip.
Sanitation generally refers to the prevention of human contact with wastes, but is also used to mean the provision of facilities and services for the safe disposal of human urine and faeces. Sanitation can be further classified as basic or improved sanitation.
Hygiene: the word hygiene originates from the name of the Greek goddess of health, Hygieia. It is commonly defined as a set of practices performed for the preservation of health and healthy living. Handwashing with soap or ash is the most important element, but it also includes personal cleanliness of the face, hair, body, feet, clothing, and for women and girls, menstrual hygiene.
Before the term WASH became popular, various other abbreviations such as WATSAN (water and sanitation) and WES (water and environmental sanitation) were used. These acronyms acknowledged the link between water and sanitation but, in practice, these two basic services were generally not considered as a package. The tendency was to consider them separately (either water or sanitation), one service at a time. Furthermore, in these older acronyms, the ‘H’ for hygiene was missing. This reflected a common approach that did not recognise the connections between the three services.
An example of how the missing hygiene component has negatively affected the intended impact of projects can be found in some regions of Ethiopia where trachoma is a problem. Trachoma is a bacterial infection of the eye that causes pain and irritation and can lead to blindness. It is spread by direct or indirect contact with an infected person and is associated with poor personal hygiene and lack of washing. In some parts of Ethiopia, although many water supply projects have been completed, it is common to see people, especially children, with dirty faces. Unwashed faces and eyes encourage the infection and despite the improved water supply, the prevalence of trachoma in some locations has remained unchanged for many years. This implies that people are not using the water for hygiene purposes, even though it is easily available. If hygiene promotion had been included with the improvements to water supply, the situation may be very different.
After many years of unsuccessful efforts to raise awareness of the connections between water, sanitation and hygiene by governments, non-governmental organisations (NGOs) and United Nations (UN) agencies such as UNICEF, the term WASH as a combination of the three inseparable elements has gradually become popular and is now recognised at all levels.
The goal of water and sanitation projects in Ethiopia and throughout the world is to bring benefits to the lives of people by improving the supply of safe water and access to sanitation. Assessing the status of water and sanitation provision and measuring improvement requires a standardised set of definitions of the different types and levels of service. The Joint WHO/UNICEF Monitoring Programme (JMP) is mandated to give globally recognised definitions to the terms. Figure 1.1 clarifies the terms and presents them as ladders of improvements in water and sanitation.
Figure 1.1 uses the terms ‘drinking water ladder’ and ‘sanitation ladder’. What does the concept of a ‘ladder’ mean to you and why do you think it is used in this way?
A ladder is equipment for climbing from one level to a higher level by a sequence of rungs or steps. The use of ‘ladder’ in describing water supply and sanitation indicates that there is a progression from the basic unimproved provision in a sequence of steps up to improved services at the top of the ladder.
The idea of the ladder provides a useful measure of progress. Imagine you were employed as a community WASH worker with responsibility for promoting WASH improvements in your community. How do you think you might use the ladder concept in practice? You would need to start your work by collecting data about the WASH services that the community is using before you begin your promotional work. Once you have gathered this data, by using your knowledge of the sanitation and water supply ladders, you can identify where the majority of people are placed on the ladder. This will enable you, in collaboration with other partners, to come up with a plan to move the community members up the ladder.
In developing countries like Ethiopia, most of the diseases affecting the public are related to poor WASH services.
You have already read about trachoma as an example of a WASH-related disease. What other WASH-related diseases do you know of?
You will have your own answer but you may have thought of diarrhoea, typhoid, cholera or intestinal worms and other parasites.
Trachoma is linked to inadequate washing often caused by insufficient quantity of water but many WASH-related diseases are linked to the quality of water. The diseases included in the answer above are caused by people ingesting (eating or drinking) bacteria or other infectious agents, frequently in contaminated water.
For all these diseases, there are three essential components involved in transmission from one person to another. These can be described as the epidemiologic triangle, shown in Figure 1.2. (Epidemiology is the study of the patterns of distribution and causes of disease in a population.) The three components, shown as the three corners of the triangle, are:
All three components are involved in the spread of disease. For example, for trachoma, the agent is the bacteria that cause the infection, the host is the infected person and the environment includes the lack of water for washing. For diseases related to water quality, the agents are the bacteria, viruses and worms that cause disease, the hosts are the infected people, and the environment includes lack of safe water supply and lack of improved sanitation. These environmental conditions allow water to be contaminated with faeces. If the faeces originate from an infected person they will contain the disease-causing agent which can then infect a new host.
There are several different pathways or transmission routes, from faeces to host that are shown in Figure 1.3. This is a pictorial representation of how disease-causing agents spread from faeces through water, food or soil to another person. It is known as the ‘F diagram’ because the main elements all begin with the letter ‘F’, i.e. faeces, fluid, fingers, flies, fields and food. In each transmission route, the infection passes from faeces on the left through to the new host on the right. This is faecal-oral transmission of disease, meaning the infection passes from faeces to mouth (oral is from the Latin for mouth).
In Ethiopia, only 24% of the population use latrines that meet basic standards, and worse still, about 37% of the population practises open defecation (JMP, 2014a). This lack of adequate sanitation obviously makes faecal contamination of the environment and the spread of disease more likely. A 2014 study (WVE, 2014) summarised the impact on young children as follows:
As Figure 1.3 indicates, improving WASH creates barriers to the transmission of disease and has a direct and positive impact on the health and well-being of people.
Provision of WASH services in schools has a direct impact, not only on children’s health but also on their school attendance and educational performance. Preventing diarrhoea and parasitic infections that have the potential to make children sick can ensure they stay healthy and are not absent from school.
Schools should have child-friendly WASH services, meaning they should have improved sanitation with good handwashing facilities. It is particularly important that schools have separate latrine blocks for girls and boys. This is known to encourage girls to enrol in school and sustain attendance, which in turn enables them to achieve greater educational performance. As well as basic provision, the facilities should be convenient for older girls so they can take care of their personal hygiene during the menstrual cycle. The presence of good WASH facilities that are separate for girls and boys can be the factor that initiates parents to send their girl children to school.
For girl students, the WASH service away from school is also important. This is because in many areas of Ethiopia women and girls are responsible for fetching water for the family. Many water points are far away from villages, so girls may spend many hours collecting water which makes it difficult for them to attend school (Figure 1.4).
In addition to the direct human health-related importance, WASH has a very strong association with economic development. Estimates of the economic benefits from water and sanitation vary but a 2012 study for the World Health Organization (WHO) put the global economic return on spending on sanitation alone as US$5.5 for every US dollar invested (Hutton, 2012). Hygiene practices, such as handwashing and the use of improved sanitation facilities in homes and schools bring economic benefits for households, communities and nations by saving time and by reducing direct and indirect health costs.
People without easy access to sanitation spend a great deal of time each day queuing up for public toilets or seeking secluded spots to defecate. This has been estimated as approximately 30 minutes per person per day, amounting to 14 hours a week for a household of four people (UN-Water, 2008). This is time they could otherwise spend doing productive work.
Hygiene and sanitation are among the most cost-effective public health interventions or, to put it another way, preventing disease is cheaper than treating it. The costs of treating diarrhoeal disease drain both national budgets and family finances. In sub-Saharan Africa, which includes Ethiopia, it has been estimated that treating preventable infectious diarrhoea uses up 12% of the total health budget (UN-Water, 2008).
In addition to these direct health costs, there are indirect costs caused by reduced productivity of people. When people or their children are sick they cannot work and have to stay at home. The loss of working days affects their income and the wider economy.
The national economy can also benefit from improved WASH services by making the country more attractive to tourists which could boost tourism revenues. By protecting the environment and maintaining a healthy living environment everyone could benefit.
As the previous sections have shown, providing WASH services brings many benefits. Unfortunately, however, the reality on the ground is that globally we are a long way from achieving these benefits for all people. Studies have shown that in many parts of the world, access to WASH services is still very low (Figures 1.5 and 1.6).
Based on the 2008 data in Figures 1.5 and 1.6, what percentage of the population in Ethiopia used improved sanitation and what percentage got their drinking water from an improved source?
Less than 50% of Ethiopians used improved sanitation and less than 50% used an improved source for water.
Note that the data in Figures 1.5 and 1.6 is from 2008 and these numbers are changing quite rapidly. The situation is improving, but there is still a great challenge ahead. Data for 2012, the most recent available at the time of writing, indicates that in Ethiopia about 37% of the population are still practising open defecation (JMP, 2014a). In 1990 this figure was 92%, which indicates the significant change in the past 25 years but even with this improvement, the current situation is still appalling.
The first challenge facing the WASH sector in Ethiopia therefore is the scale of the problem. There needs to be a huge investment of time and money to design and build new infrastructure. The water supply system needs to be extended and be more reliable, with fewer breaks in service and less loss from leakage. Support services for the sector need to be improved to make it work effectively and sustainably. Monitoring needs to be increased so that breakdowns can be repaired in a timely manner. Regulations and enforcement should be stronger to protect the environment and human health. In addition there needs to be changes to the way projects are planned and implemented to overcome past difficulties. You have already learned about the problem of focusing on water supply in the majority of projects and missing the sanitation and hygiene components. There have been a number of other problems with past projects that have reduced their effectiveness. These problems include:
In response to these many challenges, the Ethiopian government has developed the One WASH National Programme (Figure 1.7). The One WASH National Programme (OWNP) is a consolidated national programme designed to improve WASH services for the Ethiopian people. The overall objective of the OWNP is:
…to improve the health and well-being of communities in rural and urban areas in an equitable and sustainable manner by increasing access to water supply and sanitation and adoption of good hygiene practices (POM, 2014).
The Programme is designed to be implemented in two phases. The first phase was from July 2013 to June 2015 and the second phase from July 2015 to June 2020.
The Programme was prepared by the active engagement and leadership of the Ethiopian government and with the full participation and all-round support of partners working in the sector. A special task force was established, consisting of experts drawn from relevant government ministries, NGOs and the UN agencies such as UNICEF, which played the central role in the preparation of the OWNP document. Recognition of WASH as a cross-boundary sector led to the initial involvement of the Ministry of Water, Irrigation and Energy, the Ministry of Health and the Ministry of Education. Later on the Ministry of Finance and Economic Development also became involved.
The Programme document (Figure 1.8) was published in September 2013. It includes a general description of the Programme elements such as its objectives and components, how the Programme is monitored and evaluated, funding and financial management, procurement, contract management, cost and budget, results, indicators, etc.
The OWNP is distinctive for several reasons but particularly because it recognises the multifaceted nature of WASH and brings together the previously diverse interests of different ministries and other actors. This integrated and collaborative approach is reflected in the motto of the OWNP which is ‘One Plan, One Budget, One Report’. One essential component of this integration is the creation of a unified funding channel called the Consolidated WASH Account (CWA) which allows all funds from major donors to be deposited in one bank account.
The main aims of the OWNP are:
These aims are reflected in the principles, components and implementation of the OWNP. The details of all these aspects of the Programme are discussed in following study sessions of this Module.
In Study Session 1, you have learned that:
Now you have completed this study session, you can assess how well you have achieved its Learning Outcomes by answering these questions.
Match the following words to their correct definitions.
Using the following two lists, match each numbered item with the correct letter.
hygiene
adequate water supply
sanitation
water supply
child-friendly WASH services
safe water supply
a.sufficient quantity of water to meet minimum requirements
b.facilities that are designed for schools and take account of the needs of boys and girls
c.a set of practices performed for the preservation of health
d.facilities and services for the safe disposal of human urine and faeces
e.water that is free from any disease-causing agent
f.water provided by public utilities, commercial organisations, community endeavours or by individuals
The F diagram (Figure 1.3) shows how WASH provides different barriers at more than one point in the same transmission route. For example, there are two different barriers in the ‘fluids’ transmission route.
The benefit of improved WASH services to people is not limited to their health and well-being. It also has economic benefits at different levels. In what ways can an individual benefit economically from using improved WASH services?
An individual can benefit economically from improved WASH services because they will save money on treatment for diseases. Improving WASH services also minimises time away from work or productive activities due to sickness, caring for sick children and queuing at public toilets.
Briefly describe the main problems that non-unified WASH projects have faced.
The main problems facing non-unified WASH projects are:
How does the motto ‘One Plan, One Budget, One Report’ reflect the main characteristics of the OWNP? Explain how the Programme aims to solve the problems you identified in SAQ 1.4.
The motto of ‘One Plan, One Budget, One Report’ highlights the unified approach of the OWNP, which is in sharp contrast with previous fragmented and divided interventions.
The motto provides a brief and memorable summary of these core elements of the OWNP.