USAID Hiring Water and Sanitation / Diarrhea Expert

I have received this note through various channels from USAID in Washington DC – a very interesting senior watsan position at USAID on its Environmental Health Team. Note the focus on ‘diarrheal disease and associated mortality’.

Public Health Advisor – Environmental Health
U.S. Agency for International Development (USAID)

The USAID Bureau for Global Health, Maternal and Child Health Division (MCH), based at USAID headquarters in Washington DC, is seeking a Public Health Advisor to provide leadership in its environmental health activities. The major activities of the MCH environmental health team are focused on reduction of diarrheal disease and associated mortality for vulnerable populations in developing countries, especially children under 5, through improvements in drinking water quality and availability, sanitation, and hygiene. Other areas of activity vary over time, but may include improvement in indoor air quality, reduction of health vulnerabilities from climate change, and other topics related to health impacts from environmental degradation.

The successful candidate will participate in and provide leadership to the development of USAID environmental health strategies, plans, program guidance, and dissemination of results. S/he will provide specialized expertise to USAID Missions and host-country governments on new developments and the most effective approaches to environmental health problems in a region or country. S/he will be responsible for communicating such strategies and program results to diverse audiences within and outside USAID, including the U.S. Congress, external partners, and senior USAID and U.S. government staff.

This is a senior position requiring effective program management and communications skills. For further details on qualifications and to apply for this position, please see http://www.avuecentral.com/vacancy.html?ref=NRKVN.

Note that U.S. citizenship is required. Application deadline is 9/9/2009.

Water Advocates is hiring - Water, Schools and Health

Director of Global Water, Health and Schools

Water Advocates (www.wateradvocates.org) is a small but influential nonprofit advocacy group in Washington DC (DuPont Circle area) dedicated to helping solve the global safe drinking water and sanitation challenge. Water Advocates neither implements programs overseas nor seeks funding for itself, but works to raise awareness of and funding for the global water and sanitation sector as a whole.

The Director of Global Water, Health and Schools is responsible for planning and implementing Water Advocates’ outreach and advocacy program focused on a) water, sanitation, and global public health and b) the Water, Sanitation and Hygiene (WASH) in Schools Initiative. He/she will play a leading role in the growth of Water Advocates’ ambitious outreach program and will serve as one of the main advocates and representatives of Water Advocates and its allies.

Responsibilities

The Director’s main role will be to support the overall mission of Water Advocates to significantly increase awareness of and financial support for the global safe drinking water and sanitation sector from private and public US-based supporters. He/she will maintain and grow the existing WASH in Schools Initiative, and identify and pursue new funding opportunities, special initiatives, communications efforts, and other projects concerning the linkages between water, sanitation and global public health.

Qualifications

Knowledge of and experience with the global safe drinking water and sanitation sector and linkages to other international human development challenges; experienced in working with global health and education
· Networking expertise, preferably with strong existing relationships in the community of potential funders; ability to broker partnerships, including across development sectors
· Excellent research skills, and the ability to deliver compelling arguments to new and existing funders (strong written and oral communication)
MPH or related degree preferred
· Able to travel occasionally (domestic)
· Able to work independently and creatively

Desired Skills
Commitment to values, mission and vision of Water Advocates; engagement in global health and/or development issues, preferably with a focus on safe drinking water and sanitation, health and education challenges
Strong background in outreach/advocacy/program management; record of proactive efforts to build new relationships with potential supporters/funders and expanding/strengthening existing relationships
Experience with basic fund-raising and communications techniques
Ability to develop, plan and implement specific short- and long-term outreach goals
Demonstrated public speaking skills, and experience in planning and facilitating meetings
Ability and desire to work in a small organization with a consensus-oriented environment with different work styles
Ability to use modern/leading edge communications tools and software applications, and excellent written communication skills
High-energy, love of challenge, and ability to be effective in a constantly changing environment

Writing samples will be required.

This position is located in Washington, DC. This is a full-time exempt position, lasting from date of hire through December 31, 2010. Salary range is commensurate with experience. Some domestic travel may be required. Water Advocates is an Equal Opportunity Employer/Affirmative Action Employer that is committed to diversity in the workplace.

Please send résumé and cover letter to joldfield@wateradvocates.org.

Cholera in Africa: More crappy news

It really (really) pisses me off when cholera is in the news - again. Cholera should not exist. It angers me even more when it is featured so prominently in so much of the reporting reaching my desk from many parts of the developing world, particularly in Africa. Cholera is preventable. If cholera kills someone, the world is doing something wrong.

The latest piece of shitty news is this disturbing piece from Kenya, where cholera is hitting a little too close to home:

Obama Brother May Have Cholera


and from the Associated Press:


Official: Obama's half-brother falls ill in Kenya


We hope that it is just a nasty case of diarrhea. We hope that this will be treated (as it can be quite easily) and that Malik Obama will be back at work soon. We hope that it is not cholera, and if it is, we hope even more that it doesn't kill him like it does many other Africans, preventably.

Keys to cholera:

- It is dangerous (viz. fatal all too often).
- It is easily spread through lack of simple safe drinking water and sanitation facilities.
- It is treatable.
- Most importantly, it is preventable, and both the international donor community and every government throughout the developing world can do something about it.

Sources:

• My other recent blog post on the issue. There will likely and distressingly be more such posts.


• An insightful piece from the Centers for Disease Control and Prevention.


• Cholera at the World Health Organization

This steady stream of cholera in the news has to stop. Cholera mortality and morbidity must stop. The White House is in an extraordinarily strong position to contribute to the elimination of fatal cholera and other diarrheal disease. For an interesting and related take on unnecessary and preventable childhood mortality please see Nicholas Kristof's piece Good News: Karlo Will Live. And call the White House.

No more excuses

How to prevent a tenth of the global disease burden...

Actually, unsafe water and inadequate sanitation cause in many cases up to 15% of the disease burden according to a new World Health Organization report Safer water, better health.

The connections between water, sanitation, hygiene and health are becoming more clear with each passing report, conference, and Lancet editorial. The latest is here:

How to prevent a tenth of the global disease burden

Take the time to read, and forward the editorial or this post to those doubting Thomases who need to better see the linkages between water and health. Some of its findings:

• 9·1% of the global burden of disease could be prevented by improving water, sanitation, and hygiene
• in 32 worst-affected countries, this figure is 15%
• health-care agencies could save US$7 billion a year on health-care costs
• 320 million productive working days could be gained, and
• there could be an extra 272 million school attendance days a year.

In summary, there could be a total payback of $84 billion a year from the $11·3 billion annual investment needed to meet the drinking water and sanitation target of MDG 7.

The piece goes on to say the links between water and health "have been neglected by policy makers in strategies aimed at improving child survival and development" and "this issue remains largely neglected in international development efforts."

"So what?" I whinged halfway through this editorial - another report expressing in ever more graphic terms the disease burden attributable to bad water and no toilets, not to mention the suffering and economic privations associated with hauling water and thus not attending school. Thankfully, the Lancet asked the same question: "But is the international community paying any attention to this wealth of information and evidence?"

The answer is increasingly yes - this piece mentions specifically the recent African Union meeting in Egypt and a number of other reports/series on the issue due soon from The Lancet, WaterAid, etc. All will contribute to the record, and all should call out the global health community and child survival organizations in the strongest terms for not adequately dealing with one of major - if not the largest - contributors to childhood morbidity and mortality.

TED Conference - Dave Eggers - idea

This came out of the TED.com conference this week:

http://onceuponaschool.org

Dave Eggers - author of A Heartbreaking Work of Staggering Genius - was one of three winners of the TED prize, and wished for:

"I wish that you - you personally and every creative individual and organization you know - will find a way to directly engage with a public school in your area and that you'll then tell the story of how you got involved, so that within a year we have 1,000 examples of transformative change."

Little is more transformative than seeing that a school in the developing world gets safe drinking water, single gender sanitation and hygiene education. Kids have the opportunity to go to school, they - especially girls - have the change to stay in school, they suffer fewer cases of diarrheal and other waterborne diseases, they continue their educations past secondary school, they wait longer to start families, they have more economic opportunities, and so on.

Patty Hall is a schoolteacher from Minnesota who has recently launched H2O For Life: School to School.

"H2O for Life is the “sleeping giant” that lies within the potential of students and teachers in schools to raise funds to support people in need."

Check out their projects - Kenya, Mozambique, Mali, Nicaragua... transformative change indeed. Give Dave Eggers a call.

WASH in Schools Event: March 12, Washington DC

You’re Invited to the Launch of the WASH-in-Schools Initiative

Wednesday, March 12, 2008

The National Geographic Society Grosvenor Auditorium
1600 M Street NW
Washington, DC

8:30am Doors open

9:00 – 11:00am Program and videos

11:00 – 11:30am Coffee and tea

Media interview opportunities will be available from 11:00am – 11:30am

*We encourage parents to bring their children to this event.

Please join Water Advocates and a growing list of non-governmental organizations (NGOs), foundations, corporations, and schools to launch the U.S. Water, Sanitation and Hygiene (WASH) in Schools Initiative—an effort to help the 50% of schools in the developing world that lack access to safe drinking water, sanitation, and hygiene education.

The morning’s events will feature videos of schoolchildren in the developing world as well as comments from Gil Grosvenor, Chairman, Board of Trustees, National Geographic Society; Ambassador Hattie Babbitt; Carol Bellamy, President and CEO, World Learning and UNICEF Executive Director from 1995-2005; Dr. Peter Gleick, President and Co-founder Pacific Institute; Gil Garcetti, Photographer of "Water is Key: A Better Future for Africa;" and Alexandra Cousteau, co-founder Earth Echo International.

While much is already being done for WASH in Schools, there is still an enormous unmet global problem—half the schools in the developing world lack adequate water and sanitation. This initiative will focus on expanding WASH to 1,000 schools in developing countries while creating the momentum to help as many additional schools as possible worldwide. Water Advocates encourages interested corporations, foundations, organizations, and individuals to use this event as a platform to highlight their activities or to pledge their support to do more for WASH in Schools.

For more information on the WASH in Schools Initiative and how you can be involved, please contact Andra Tamburro 202-293-4047, atamburro@wateradvocates.org.

*** To attend the event, please RSVP to Katie Delisio at WaterAdvocatesRSVP@gmail.com

For a map to the event: http://www.nationalgeographic.com/explorer/map.html

Please share this invitation with your friends and colleagues.

Save The Date - March 12, 2008

******************************************************************

Save the Date -- March 12, 2008

******************************************************************

For: The Launch of a Water, Sanitation and Hygiene (WASH) in Schools Initiative

Where: The National Geographic Society Auditorium, Washington, D.C.

When: Wednesday, March 12, 2008, 9:00am - 11:00am

Water Advocates and a growing list of non-governmental organizations, foundations, corporations, and schools will launch a Water, Sanitation and Hygiene (WASH) in Schools Initiative on Wednesday, March 12, 2008 at the National Geographic Society Auditorium in Washington D.C. While much is already being done for WASH in Schools, there is still an enormous unmet global problem - half the world's schools lack adequate water and sanitation. This initiative will focus on expanding WASH to 1,000 schools in developing countries while creating the momentum to help as many additional schools as possible worldwide. Water Advocates encourages interested corporations, foundations, organizations, and individuals to use this event as a platform to highlight their activities or to pledge their support to do more for WASH in Schools.

Doors will open at 8:30am and a half hour social will follow the event.

Media interview opportunities will be available from 11:00am - 11:30am.

Open Source Water and Sanitation

The Global Water Challenge, an initiative of the United Nations Foundation, has partnered with Ashoka, one of the most impressive idea generation factories (and social-entrepreneur-finders) on the planet. They are today launching Tapping Local Innovation: Unclogging the Water and Sanitation Crisis.

"Ashoka’s Changemakers and Global Water Challenge have partnered to open a worldwide search for ideas and projects that, when scaled-up, have the potential to transform the provision of sanitation and water. We hope you will join us. Between January 9 and March 16, 2008, we invite you to submit your proposals."

To get folks thinking they have pulled together a good initial landscaping of the sector here:

http://changemakers.net/en-us/node/1828/mosaic

[If you want several hundred pages - several hundred GOOD pages - of landscaping, go here:

http://www.irc.nl/page/35947 ]

Ashoka is very good at identifying entrepreneurs tackling major social issues - read How to Change the World if you have time - or make the time - it's that inspiring. This competition will give water and sanitation entrepreneurs an opportunity to get an open source review from their peers and others. Winners get plenty of exposure. Then it's up to the growing funding community to support their efforts. And that funding community is growing.

Untold Stories

Even in the under-reported water and sanitation sector, we are constantly bombarded by stories and reports about what doesn’t work, what hasn’t worked, how we are failing as a planet to meet the water and sanitation MDGs. So in a belated Happy Thanksgiving post, I offer a couple of stories and snaps that show the progress the sector is making in small but meaningful ways:

There is a child in school in Niger because she doesn’t have diarrhea thanks to an extraordinarily simple bucket half full of clean water and a little sliver of soap that she and her family use to wash their hands every day.

A woman’s hands in Guatemala are no longer calloused because her village recently acquired a borehole with a handpump. The story – more of a human dignity story than a water story - involves her coming up with gratitude to the project leader and insisting that he feel how soft her hands were. (Thanks to Gil Garcetti for the great photo.)

There is a village in Tibet that is 100% free of open defecation because of some bold little kids running around sticking ‘poo flags’ in each pile, with the names of their shamed depositors written on those flags.


There is a woman in Senegal who no longer has to wait until nightfall for cultural reasons to defecate, because her family invested $4 in a household pit latrine. I couldn’t find a picture of ‘less severe constipation’ or ‘fewer liver problems’ to post, but you get the point.

Onward.

Donde esta el baño?

What is the first thing you learn in any foreign language, other than perhaps the name of the most popular intoxicating beverage in the country (e.g. cerveza, vino, slivovitza)? It is:

"Where is the bathroom?"

If that isn't the best way to communicate the primacy of sanitation I don't know what is. Brilliant (thanks David!)

OK - now imagine that the answer, in whatever language, is "We don't have one, or any paper, or any water." NOW what would you like to be able to say in that foreign language? You will find those phrases here.

I should change the name of this blog to Blogging on Sanitation the way recent events have been going...

Beat the Rush

One of the things that keeps me awake at night is that the global safe drinking water and sanitation sector can't compete with Heifer International during the holiday buying frenzy and the end-of-year search for tax breaks. Buying two shares of a pig or a flock of chicks strikes me as more fun than buying a toilet or a pump.

But WaterAid comes close:

How about a puppet show for hygiene promotion for 31 quid, or a soap-making business for 100?

One of the keys to attracting more financial and political support for the water is telling the right stories to the right people, and making it fun. Go WaterAid.

World Dunny Day! Cheers!

I imagine that all six of my readers already know that it is World Toilet Day today, but just in case one of you out there just woke up, Happy World Toilet Day! Or as the Aussies say World Dunny Day.


To the 2.6 billion without such amenities, hold on, I'll be right out.

A Good Scratch

I made the mistake recently of asking a British friend of mine “What are the first three things you do in the morning?” His reply: “Well, I finish me gin from the night before, I smoke a ciggy, and I have a good scratch.”

I suspect that safe, clean water will be more important for those of us with less vigorous mornings.

Imagine your morning without water. Imagine your bathroom trip, your shower, your coffee/tea, imagine brushing your teeth without water. If you woke up and realized your home didn’t have safe water, what would your first three actions that morning look like? Forget the first three things – what is the first ONE thing you would do?

Water is vital not only to our morning rituals in the developed world; water is life in its barest essence. Water is security, human security.

Without water, women and families in Africa, Asia, Latin and Central America and elsewhere spend significant parts of their days NOT learning, NOT working, NOT being productive members of society, NOT watching their children play. We in the States are increasingly aware of this challenge abroad – throughout the developing world – and are increasingly active on behalf of the issue. Yet effectively tackling the global safe drinking water and sanitation problem is not as easy as driving to the local soup kitchen and ladling soup to homeless people on Thanksgiving - which reminds me - do that too. Ensuring that poor communities in Africa, Asia and elsewhere have safe water and sanitation is tough work – and requires money, political support, thoughtfulness, and patience. And of that list the most important may well be thoughtfulness.

The recent announcement of the Howard G. Buffett Foundation’s commitment to the sector - called the Global Water Initiative - is an important one, and one which displays many of the best – or at least emerging practices in the sector. It is also an announcement which merits MUCH more attention in the media than it received. John Sauer nailed it in The Huffington Post, trying valiantly to get this announcement the coverage it deserves.

$150m is important. Having a name like Buffett associated with its support for the global safe drinking water and sanitation sector is important in that it minimizes the risk of the next philanthropist getting on board. The focus on both water and sanitation is important. However, arguably more important are the Global Water Initiative's (GWI) efforts to streamline and decentralize decisionmaking throughout the entire process. Long before the formal launch GWI was consulting with a select group of several of the finest implementing organizations on the planet. Long before the launch the GWI was looking at ways not simply to build more systems but to catalyze systemic change in the world's most vulnerable communities. Long before its launch GWI was looking at ways not to measure quarterly or even annual results, but looking at what it could achieve over a ten year period and beyond. And long before its launch GWI was streamlining the process of distributing these grants and the process of receiving these grants in-country, so the focus could be on making the work itself as sustainable, as holistic and as inclusive as possible.

I myself would have chosen fewer countries to minimize dissipation of effort, and to make it more likely that this initiative will produce meaningful successes at scale - the sort of successes that generate headlines like "Every School in Guatemala Now Has Access to Safe Drinking Water" and "Every HIV/AIDS Clinic in Uganda Now Has Private Sanitation Facilities." It is money, it is political support, it is lots and lots of technical know-how and elbow grease that will push this sector onward. However, it is thoughtful initiatives like the Global Water Initiative that are likely to demonstrate not the gravity of the water problem or quick technical fixes, but how solvable the problem is if approached thoughtfully.

International Year of Poo

Hooleintelligence has it right - I have been delayed in my posting due to my being a little too excited about the upcoming International Year of Sanitation. I'm not so sure that getting all worked up about another UN Year for something is advisable, but at least I am not alone:

World Toilet Association General Assembly - tickets still available. Seriously. Go. (Seoul, Nov. 21 - 25)

'Mr. Toilet' builds commode-shaped house

World Toilet Summit in Delhi - Check out my friend Dave Praeger's updates from the World Toilet Summit here. Poop humor just never gets old.

So how can we determine whether we are making progress with the global sanitation challenge? How about when news about sanitation shows up in mainstream media and not in the "Offbeat News" or "News of the Absurd."

And now the underlying harsh reality of this post: what kills and sickens more people, water or inadequate sanitation? A recent UNICEF report answers that clearly:

Reduction in diarrhoeal diseases morbidity resulting from improvements in drinking water and sanitation services:

• 25% from improved drinking water
• 32% from improved sanitation
• 45% from improved hygiene (viz. handwashing)
• 39% from household water treatment

Yes, we need all three. But we need an invigorated response to the global sanitation challenge. But Blogging on Sanitation.blogspot.com doesn't have the cachet that toilets deserve.

Faecal Attraction Redux

Just when you thought it was safe to take the provenance of your drinking water and the disposal of your feces for granted, I give you:

Faecal Attraction: Political Economy of Defecation

This is worth three minutes of your time. Watch, then continue below...

__

Unfortunately this lack of knowledge is not unique to India - most of us in the West would be hard pressed to answer the same questions with any more eloquence.

Here are a couple of select Youtube comments so you don't have to read through them all:

• Super! although it would be great if you also gave us the answers to the questions being asked...coz i don't know shit either(pun intended!)!
• Hmmm
• So...this wonderful video only offers the problem, not the solution. WHAT THE F___ IS THE SOLUTION? MAKE A VIDEO ABOUT THAT.
• this is nice probably they should put this on tv

Agreed that it belongs on TV (a 30 minute documentary in prime time would be a good start).

Agreed that the video only offers education and awareness-raising. For some answers to these questions (at least in the US), I offer:

From the U.S. Environmental Protection Agency:

"Drinking water can come from either ground water sources (via wells) or surface water sources (such as rivers, lakes, and streams). Nationally, most water systems use a ground water source (80%), but most people (66%) are served by a water system that uses surface water. This is because large metropolitan areas tend to rely on surface water, whereas small and rural areas tend to rely on ground water. In addition, 10-20% of people have their own private well for drinking water. To find the source of your drinking water, check your annual water quality report or call your water supplier."

Also visit EPA's Local Drinking Water Information page.

Now, where does your poo go?

The Water Environment Federation is a leading source of water quality information. They deal with the least sexy thing that we all take for granted: pipes - to bring us clean water and to take dirty water far away and treat it. WEF's newest campaign is called "Water is Life, and Infrastructure Makes It Happen."

WEF's job is to take the mystery out of where your poo goes. Click here for a nice Flash diagram of wastewater treatment - believe it or not this stuff is reasonably entertaining.

Be in the Know...Go With the Flow

So how do you solve the sanitation problem in many parts of the world? Here is a good start - from the most simple (latrines) to one of the seven wonders of the industrial world, London's sewage system.

And one of my perennial favorites: Sulabh International and their two-liter pour-flush latrines.

15,200 miles to go for safe drinking water

The New York Inquirer is duly impressed by several statistics associated with the Blue Planet Run: the 15,200 miles the BPR runners are putting in around the world to raise awareness of the global safe drinking water and sanitation challenge, over four continents and 95 days.

Even more meaningful statistics, however, compellingly link the issues of safe drinking water and human mobility:

• Poor women in Africa and Asia walk an average of six kilometers a day to collect water.


• Poor rural women in developing countries may spend eight hours a day collecting water, carrying up to 20 kilos of water on their heads each journey.

We have all seen and cooed at the glorious, romantic photographs of women in the developing world carrying those buckets of water on their heads with a baby strapped to their backs while dressed in colorful saris.



You think that’s romantic? You try it. A twenty liter bucket of water weighs 45 pounds, in some cases half the body weight of the woman carrying it. Add wild animals, snakes, and unduly interested men to the commute, and you’ve got a recipe for trouble.

The Blue Planet Run is performing admirably in raising ‘name recognition’ of the global health crisis of unsafe water and inadequate sanitation (which remains largely unreported in the U.S.) Name recognition will get an issue far, but not far enough (who hasn’t heard of Howard Dean?). It is up to everyone now to capitalize on the awareness that has been raised by the Blue Planet Run and move toward meaningful political and financial support:

• How can we keep each of the actors who designed sneakers for the campaign engaged in the issue (Hilary Swank, Courteney Cox, Rosie O’Donnell, Lance Bass, Alan Cumming)? Thanks to the Blue Planet Run they are now aware of this issue, and likely interested in doing more.
• How can we all encourage the New York Giants, also supporters of Blue Planet Run, to dedicate a day at the field to global safe water?
• How can the Blue Planet Run Foundation best prepare for its 2009 round-the-world footrace, which is expected to travel through the southern hemisphere? What can the world community do now to encourage the governments in the countries through which the 2009 runners will travel to greet those runners with increased budgetary commitments to water and sanitation infrastructure, particularly in rural communities? How many of those countries will commit at that point to universal coverage of water and sanitation (such as we enjoy in the US, Europe and Japan)?

Faecal Attraction

So I’m reading a book about poo, and its contribution to civilization. Somehow this got left out of my undergrad class on Western Civilization at Georgetown.

The book I reference is Poop Culture: How America Is Shaped By Its Grossest National Product. I haven’t reached the end yet, but I don’t expect any real surprises – I think I know how this one ends. It’s an awfully interesting read, with insights about poo that I hadn’t considered (or wanted to). We all would benefit by paying closer attention to this issue, and Poop Culture adds some interesting blue-sky approaches to human waste treatment that we should consider – e.g. converting it to energy.

Executives from the Water Environment Federation consistently and justifiably argue that what separates developed from developing countries is not human rights, respect for the environment, or Internet access but PIPES – unglamorous infrastructure. E.g. what happens to poo once it leaves the body?

My challenge is seeing that what happens to that poo around the world doesn’t result in unnecessary mortality and morbidity such as from diarrheal diseases. Over 2.6 billion around the world lack adequate sanitation facilities, or quite literally a place to go to the bathroom. This doesn’t mean that they are NOT going to the bathroom, but rather that 2.6 billion people do so in a way that often negatively impacts their health and the health of their neighbors, kids, passersby. Many organizations are struggling with a way to make this massive public health challenge more compelling. What would make it as cool to talk about poo/defecation/shit at cocktail parties as it is to talk about HIV/AIDS?

Dave Praeger’s book gives us a hint, or at least a lesson to be learned from history:

“By the end of the nineteenth century, state and social reformers in both England and America were working hard to spread the flush toilet across society and alleviate critical sanitary threats. Much of the strategy involved the state extending and maintaining modern sewer and water infrastructures, but reformers still needed to convince skeptics that the new bathroom technology was a boon and not a power-grab by the government. To overcome resistance in people who had been pooping in privies or chamber pots all their lives and were quite content with them, they associated health, happiness, refinement, and civilization with the flush toilet. The corollary of that, of course, was that people who didn’t use flush toilets were the opposite.”

This approach hits close to that of today’s social marketing experts, primus inter pares PSI. Social marketing is defined as “the systematic application of marketing alongside other concepts and techniques to achieve specific behavioral goals for a social good.” The bottom line is that 2.6 billion people need the health benefits associated with improved toilet facilities – the best way to make that happen may well NOT be preaching about those health benefits, but rather finding clever ways to make toilets/pit latrines more cosmopolitan, hip, cool, fun, refined, or alternatively to make it embarrassing to NOT have one.

So what can we learn from PSI’s approach and late nineteenth century America and England. Hopefully a lot – precisely zero people died from cholera in these two countries in 2007.

Comfortably Numb

Hello…hello…hello.
Is there anybody in there?
Just nod if you can hear me.
Is there anyone home?

The world’s gravest public health crisis is unsafe drinking water and inadequate sanitation. Diseases related to this problem kill 5x more kids than HIV/AIDS, and twice as many as malaria. Four billion cases of debilitating diarrhea occur each year, and diarrheal diseases alone kill well over two million kids on an annual basis.

So, the good news: The world came together last week at the Stockholm International Water Institute’s World Water Week to discuss precisely this issue.

And the bad news: the three of you who read this blog are hearing more about World Water Week through this medium than most other people through what I'll humbly call more popular media.

Those mainstream media may well tackle water and climate change, ocean conservation, the bottled water industry, water as a human right, privatization and related issues. But they shy away from unsafe water as the gravest – and most solvable – global public health challenge. This was manifested by the paucity of coverage of World Water Week in at least the U.S. media. Neither The New York Times nor The Washington Post had even a poorly-turned phrase on World Water Week. The only Associated Press story picked up (according to a Google news search) in the U.S. media focused entirely on bio fuels, never even mentioning the severity of this global problem. (Way to go John Sauer at Water Advocates for tracking this.)

Solving the world’s drinking water and sanitation crisis is difficult – it is not a soundbite or silver bullet issue. As my cohort Dennis Warner of Catholic Relief Services says, it’s not rocket science – it’s harder than rocket science. How long did it take to train your kids to wash their hands after they use the bathroom? Do you wash your hands after each trip to the john even today? What’s our water infrastructure financing gap in the U.S. up to now?

But solving this problem is possible. How many English die of cholera in 2007? How many Japanese die of diarrhea? How many Americans have guinea worm, schistosomiasis or malaria?

The unsafe water issue will soon drive the international development agenda itself – it’s unfortunately a matter of time before the media are forced to come to terms with this global challenge whether they like it or not.

I suggest instead that the 1.1 billion people without safe drinking water throughout the developing world need the U.S. and European media to lead the target. As the NYT looks to the FT for story ideas, and as the Economist looks to The New Yorker, one well-placed story on unsafe water as the world’s biggest cause of preventable infant/child mortality and morbidity will punch well above its weight (and win a Pulitzer or two, people).

Some get it: one particularly insightful, clever piece comes from Carl Ganter at the Pacific Institute’s Circle of Blue: Navigating the Mainstream: The Challenge of Making Water Issues Matter. Read it and visit Circle of Blue. Seriously.

Another: Gil Garcetti (yes, that Gil Garcetti) is now an amazing professional photographer covering the world’s water crisis. See his new book Water is Key.

Another: Matt Damon’s new movie Running the Sahara is scheduled for release this fall.

There are stories lined up - there are high profile testimonials lined up – there are convincing water experts lined up. If that’s not enough, there’s always the crushing grip of reason which is tightening. We need to act – there are billions of the world’s poorest waiting for their governments to properly prioritize this issue. There is an opportunity for the Western media to get out ahead of this issue and pull the world along.

I’ll be damned if I’m gonna pay to take a piss

Direct quote from a tourist during a recent trip to Paris: “I’ll be damned if I’m gonna pay half a euro to take a piss. I’m going to McDonald’s!”

So people have a difficult time paying to go to the bathroom in France. Not exactly a newsflash, and I think the same will be said once public toilets start becoming more prevalent in NYC. Tourists will still whistle nonchalantly through hotel lobbies to get away with doing their business for free.

In several woredas (districts) in Ethiopia, however, it’s now the hip thing to not only have your own pit latrine by your home, but to pay for the privilege. How did this happen, and in Ethiopia of all places, where the per capita GDP is $US1,000, and where only 6% (sic) of the population has access to improved sanitation facilities? What’s the secret?

Trachoma is the world’s leading cause of preventable blindness, and is caused by a lack of safe water and inadequate sanitation facilities. Transmission of trachoma can be decreased significantly by using improved sanitation facilities like pit latrines. The Carter Center’s Trachoma Control Program, in cooperation with the Ethiopian Ministry of Health, launched a program in 2002 to catalyze the building of 10,000 pit latrines to stem trachoma. If there is one global public health story over the past few years that deserves to be above the fold in every mainstream periodical, it is this one:

Pit Latrines for All Households: The experience of Hulet Eju Enessie Woreda, Amhara National Regional State, Northwest Ethiopia

The full report (in Amharic) is a bit of a read. The gist of this executive summary (in English) is this:

• 89,000 pit latrines were built (the actual number is now 225,000)
• Ethiopians have for the most part done this themselves
• Most households paid nothing for their latrines; of those who paid anything, the median amount was USD$2.80.
• The secret to success was not throwing money at the problem, or pushing some inappropriate top-down technology or infrastructure.

The secret to success is what the Carter Center calls "community mobilization, the presence of a strong political commitment among local leaders, and integration into the pre-existing community structures and practices." The latin taxonomic name for that is “Ethiopicae grandmae,” less technically “Ethiopian grandmothers,” or “informal village leaders.”

Pit latrines do not sell themselves in most cases, particularly in rural and peri-urban areas where the need to find an unspoiled place to leave a #2 is less urgent because there is simply more real estate. Latrines are frequently expensive to build and maintain, even if the local demand exists. It is often very difficult even to create that demand though, particularly in more rural communities, and difficult to ensure that those latrines are used for their intended purposes, not as homes or as cow-dung storage sheds.

This particular Carter Center program did not have the resources to build latrines themselves, but only to do the community mobilization and training. I spent several years in the late 1990s working for USAID and U.S. Department of State contractors on democracy and governance initiatives throughout Africa. Not infrequently I found that the fewer financial resources we had available for a project, the more successful it turned out to be. This was because less money led to non-financial commitment(s) being provided by local leaders, and by women’s groups in particular. Once those local commitments were made available, the sustainability of our work increased dramatically.

This Carter Center report indicates similar results from a similar approach. If Patty Stonesifer would come to me today with the “How would you spend $5b” question, my answer would be “Scale the sanitation work of both the Carter Center and Sulabh International by customizing their approaches for every country/community in the world, and blow the sanitation MDG out of the water.”

It is not cost-effective to vaccinate a newborn against polio or mumps if that child will die at three years old from a preventable waterborne disease like diarrhea or malaria or be forced into a life of leading a trachoma-blinded adult around for the rest of his/her life.

“Using a pit latrine is freedom, comfort, and honour!” — Villager from Hulet Eju Enessie Woreda

Hearts and Minds

Rear Admiral William McRaven had an intriguing quote in The Economist on June 14, 2007:

American officials insist that AFRICOM will not be all about building bases and airstrips but will co-operate with development agencies, NGOs and diplomats to win African hearts and minds and so deny terrorists havens from which to operate. Rear Admiral William McRaven, head of the special forces now operating in the Sahara, says his men are much more likely to drill boreholes and build houses than to shoot at anyone. “I don't want a fragile state collapsing any more than Greenpeace or USAID does,” he says.

Rear Admiral McRaven is Special Operations component, SOCEUR (Special Operations Command, Europe). His comment comes in the broader context of The Economist article called Policing the undergoverned spaces.

This post is not to suggest that the U.S. will win the long war by drilling boreholes, nor is it to suggest that U.S. military forces, much less the Special Forces, should be taking care of the water needs of the developing world (in fact I argue against this). There is, however, a growing recognition that along with traditional military operations we should be pursuing less militaristic methods of winning hearts of minds, particularly in countries deemed most likely to become breeding grounds for terrorists. The provision of water and sanitation becomes a particularly salient intervention in this equation. The U.S. intelligence community has realized for some time that overlaying the map of water scarce countries with the map of countries deemed the biggest threats to U.S. national security gets an almost perfect match. Plus the USG gets the biggest bang for its development dollar (in both direct and indirect returns) by investing that dollar in relatively simple water and sanitation initiatives.

One good recent example where this all comes together is CSIS's recent post on Below the Surface: U.S. International Water Policy. Erik Peterson notes:

Targeting water would also yield other geopolitical dividends—including removing what is a serious obstacle to stability and security within states and reducing the possibility for conflict or tension between countries with shared water resources. Finally, water represents an avenue for the United States to demonstrate leadership in the world at a time when its image has eroded so considerably. In short, a water-centered set of policies could represent a remarkable opportunity for the United States to “do good” while “doing well” when it comes to pursuing its own interests in the world.

So maybe this post is about how to win the long war after all.