Ebola, Water, Sanitation, and Hygiene

A few thoughts/data points on the linkages between Ebola and WASH:

Summary: Safe drinking water, sanitation, and hygiene (WASH) are important in treating patients infected with Ebola and in preventing the transmission of Ebola (and other infectious diseases). WASH is vital at household, community, and health facility levels. Longterm, sustainable public health and WASH infrastructure are important to better prepare communities, particularly in West Africa, for the next occurrence of such diseases.

From An Open Memo on Ebola and Water:

·         Water Supply Needs and Usage:

o   Any medical facility, hospital, field station, isolation unit must have a supply of fresh water that is adequate in flow volume and quality. This requirement, and the need to develop such a reliable supply in advance of facility construction or placement, is as or more vital than the need for reliable electricity. . .

o   While . . . data suggest that emergency minimum water supply volumes on the order of 150 to 200 liters per person per day might be sufficient, it should be a top priority to inquire of current medical facilities in Liberia, Guinea, and other affected areas of West Africa for specific data and insights on their current level of water use as well as the end uses of that water (washing, sanitation, sterilization of equipment, cooking, etc.).

o   A wide range of water-treatment systems can ensure that water supply is safe, including chlorine-based treatments, ultraviolet light treatment, and top-quality reverse osmosis membrane systems. The CDC provides a short overview of various treatment options and their ability to remove viruses here. Before choosing a water-treatment system, . . .confirm that they are designed and can be operated to specifically remove or inactivate Ebola-type viruses with high reliability.

·         Water that may be contaminated with Ebola virus:

o   A separate water-quality risk is that during patient care and treatment, contaminated fluids, including water, will have to be reliable handled, treated, and neutralized.

o   According to the World Health Organization, Public Health Agency of Canada, and the US Centers for Disease Control and Prevention, Ebola virus is known to be susceptible to solutions of chlorine bleach, germicidal chemicals, gamma radiation, sufficient ultraviolet C light exposure, some soaps, alcohol-based sanitizer (at least 60% concentration), and by boiling water.

From Handwashing and Ebola: The Facts:

·         Ebola virus is present in all body fluids of an infected person, and once they become symptomatic, is transmitted by direct contact with these body fluids, including blood, sweat, vomit, diarrhea, urine, saliva, tears, semen and breast milk.

·         Direct contact may involve directly touching infected body fluids, or touching items and surfaces like doorknobs that have been recently contaminated with these infected fluids. Once it is on your hands, Ebola virus can enter your body through breaks in the skin of your hands, or when you touch your eyes, nose or mouth (mucous membranes). Similarly, if you are wearing gloves that have Ebola virus on them, Ebola virus can enter your body if you touch your eyes, nose or mouth with your gloved hands. Finally, when you remove gloves that may have Ebola virus on them, you must wash your hands immediately in case any Ebola virus on your gloves or other protective clothing is transferred to your bare hands during removal.

Newspaper Articles/Blogs

·         Professor Taylor of the University of Brighton said: "Our Environment and Public Health Research Group is currently developing low-cost ways to disinfect human waste following disease outbreaks,” and is advising the World Health Organization (WHO) to help control the spread of the disease. Source: University scientists help tackle Ebola

·         Médecins Sans Frontières epidemiologist Kamiliny Kalahne said outbreaks usually spread in areas where hospitals have poor infection control and limited access to resources such as running water. "People who become sick with it almost always know how they got sick: because they looked after someone in their family who was very sick -- who had diarrhea, vomiting and bleeding -- or because they were health staff who had a lot of contact with a sick patient," she said. Source: Ebola virus: Nine things to know about the killer disease.

·         As recently described by Laurie Garrett of the Council of Foreign Relations, the Ebola virus in West Africa should be tackled the same way it was done in 1976:  with soap, clean water, protective gear, safe medical practices, and quarantine; technology and vaccines are of no use. Source: The Ebola Threat: A “new normal”? (The World Bank)

·         Should hygiene be more of a priority for donors than health care? (Devex) UNICEF staff hands out soap and chlorine in Conakry to prevent the spread of Ebola in Guinea.

·         Interventions to Control Virus Transmission during an Outbreak of Ebola Hemorrhagic Fever: Experience from Kikwit, Democratic Republic of the Congo, 1995 (The Journal of Infectious Diseases)

Further Reading:

·         There are a number of resources here (http://www.medbox.org/ebola-toolbox/listing?q=water&sort) regarding the importance of water, sanitation, and general hygiene to treat and prevent the spread of Ebola.

Funding for Water and Sanitation / USAID / Development Grants Program

Dear nonprofit partners,

We would like to make you aware of a funding opportunity offered through USAID - the Development Grants Program (DGP):

http://www.grants.gov/search/search.do;jsessionid=kQ2pRgRDQDTnQgTvt58Y7Z4MfHKvkqKzPWQf9LwDH2wTpJ10fJcH!-337921640?oppId=237329&mode=VIEW

DEADLINE: August 8, 2013

(Awards up to $2million for US and Non US-based nonprofits.)

Background

USAID has established the Development Grants Program as a small grants program to increase the number and quality of NGO implementing partners who can partner with USAID. This Program is open both to U.S.-based nonprofits and those based around the world. A total of $45m is available through this program for the estimated fifteen grantees.

In its first three years, the program funded 145 organizations in over 26 countries. Water and Sanitation is one of the DGP’s selected technical sectors for the program, having providing funding for over 24 organizations focused in this sector. "In the water sector, the DGP supports activities that directly increase access to safe drinking water and sanitation and improve hygiene. This includes investments to support infrastructure as well as activities related to organizational/institutional capacity-building needed to create sustainable management, improve service delivery or promote human behavior change."

Here are some examples of DGP-funded WASH activities:

Development Aid from People to People (DAPP) Zambia

Received $2 Million to extend a WASH in schools programs that served over 320,000 pupils in over 800 schools

Alliance for Youth Achievement

Received a USAID DGP grant to implement 30 new clean water projects in Uganda

Pacific Institute

Received a USAID DGP grant to create a highly accessible communication and monitoring system that develops crowd-sourced map data to improve water and sanitation services for the urban poor in Indonesia

Palms for Life Fund

Received $1.9 M over 3 years for a WASH in schools project affecting 42,000 pupils in 120 schools in Swaziland

*** At WASH Advocates, we see this as an invaluable opportunity for WASH organizations doing vital work around the world to receive USAID funding. The August 8 application deadline is fast approaching. ***

TO APPLY:

1)     Go to www.grants.gov (or follow this link: Click Here)

2)     Left hand menu: select “find grant opportunities”

3)     Left hand menu: Select “browse by agency”

4)     Select “Agency for International Development”

5)     Select “Funding Opportunity Number: RFA-OAA-13-000020”

6)     Select “full announcement”

7)     Download the “full announcement” PDF. (See attached.)

To jumpstart this process, here are countries whose USAID Missions have prioritized water/WASH (these are listed on pages 1-3 of the Request for Applications):

Angola, Botswana, Dominican Republic, Honduras, Indonesia, Kazakhstan, Madagascar, Nepal, Nigeria, Office of Middle East Programs, Philippines, South Africa, South Africa (regional), and Ukraine.

I encourage those of you active in those countries in particular to consider applying for Development Grants Program assistance. Please distribute this notice as widely as you can – the more WASH applications they receive, the more likely a nice chunk of the $45m will go to WASH.

US organizations: please consider applying directly, and share with your local partners.

Nonprofits in Africa, Asia, Latin America: please consider applying directly, and share with other WASH groups as appropriate.

Please, contact Ben Mann at 571-225-5823 or bmann (at)  WASHadvocates (dot)  org with additional questions.

USAID’s new water strategy: Pros, Cons, and What’s Next?

The U.S. Agency for International Development has recently soft-launched its first-ever five-year water strategy. We’ve all been waiting a long time for this, so some initial and mostly positive reactions follow:

First of all, congratulations to USAID and its many partners for getting this out the door. Any such strategy involves a lot of blood, sweat, and tears, particularly so for an issue as wide-ranging and multidisciplinary as water challenges across the globe. So congratulations to USAID (Chris Holmes, John Pasch, many others). A great number of nonprofits, Hill allies, and concerned citizens deserve kudos for their involvement and support as well over the past couple of years.

What I like about USAID’s water strategy

• It focuses on safe drinking water, sanitation, and hygiene (WASH), and does so in a way that also elevates and institutionalizes Integrated Water Resource Management and water for agriculture. The strategy also strongly positions water as foundational to sustainable progress across many other vital development challenges including health, food, education, HIV, gender equality, and climate change. I also welcome its increased emphasis on sanitation, especially since USAID joined the Sanitation and Water for All Partnership in 2012. “In countries that are off track to meet the [Millennium Development Goal] for sanitation, and where diarrheal disease and under-nutrition are prevalent, Missions must add sanitation as a key element of their water, health, and nutrition activities.” That’s some strong language. Inadequate sanitation - water contaminated with human feces - is what really kills and sickens kids, not simple water scarcity. Those millions of kids are dying because of waterborne illness, not simple thirst, and USAID’s renewed emphasis on sanitation positions the agency to save and improve kids’ lives across the globe.
• The strategy draws much of its philosophy from USAID Forward, the agency’s attempt to transform itself and develop new models for development. The water strategy provides a refreshed vision of what USAID could/should look like in action across the board, with its focus on decentralized decisionmaking and ownership, local capacity strengthening, behavior change, and stronger monitoring and evaluation. This is perhaps the most important part of the strategy, and will hopefully be a big part of its implementation: the document leans forward into the sort of foreign assistance we should be supporting - less focused on direct service provision, and more focused on strengthening local capacity so that communities and countries will no longer require foreign assistance.
• There are hints in the strategy of stronger monitoring and evaluation, and even language which indicates they will do so “beyond the typical USAID Program Cycle and . . . . enable reasonable support to issues that arise post implementation.” This is good news, and I am all ears as to how this will be implemented. I know Susan Davis, IRC, SustainableWASH.org, WASH Advocates, Water For People and many others have ideas.
• Integral to the strategy are a number of smart, flexible, approaches to solving development challenges – approaches which also provide USAID much-needed leverage for its work: innovative financing (e.g. through USAID’s Development Credit Authority), policy reform, strengthening enabling environments, strengthening and building local capacity (e.g. through USAID’s Development Grants Program) and more opportunities for real partnerships like those with Rotary International and the Bill and Melinda Gates Foundation.
• Priority countries, selectivity and focus: the three tiers of countries make sense (with concerns noted below), as do the different levels of involvement envisioned in disparate countries and regions. Fewer countries (again, with concerns noted below) could provide increased opportunities for meaningful impact at scale, up to and including 100% coverage of WASH within certain discrete geographies (e.g. municipalities, provinces, even countries). This would obviate the debates about how to reach the poorest of the poor, gender focus, outlying farmers, distant huts, and so on. 100% is 100%, as inspired by Water For People’s Everyone Forever.

Perhaps most importantly, this strikes me as a learning strategy, a living document which has the potential to vastly improve USAID’s water programming in ways unforeseen at its launch. One example of something to be learned by the agency is how to differentiate between programming which focuses on first-time access to WASH and that which focuses on improved access, a distinction sometimes lost in DC but vitally important in the developing world. Another opportunity is to figure out how to best make sure that projects continue to function as intended long after the program has technically ended.

Areas on which I look forward to continuing to work with USAID

• The numbers are under-ambitious: a five year strategy to get safe drinking water to only 10 million people and sanitation to only 6 million? In FY11 alone, the figures were 3.8 million (water) and 1.9 million people (sanitation). I fully expect USAID to blow these numbers out of the water, both by providing more services, and by strengthening the capacity of local organizations across the globe to solve their own challenges.
• The strategy does a great job of segmenting its approach into “transformative impact,” “leveraged impact,” and “strategic priority” countries. I get the distinctions, but I remain concerned that there is little in the strategy to prevent the vast majority of resources from going to a small handful of strategic priority countries that may or may not suffer from water and sanitation scarcity. I would have preferred that a clear, specific and high percentage of funds be explicitly directed to countries and communities where water and sanitation coverage is the lowest in the world, and I look forward to continuing to work with USAID and the Hill on that front. Diplomacy and security concerns often trump development, and the strategy could have leaned further forward into this debate. An added benefit is that a more pro-poor approach to the implementation of the water strategy would more closely align it with the Senator Paul Simon Water for the Poor Act of 2005, which focuses clearly and explicitly on the world’s poorest countries.
• On a related note, I’m all for selectivity and focus leading to a smaller number of program countries for the water strategy. Dissipation is the enemy, but cutting from 62 countries to perhaps a couple dozen countries overnight is drastic, and will leave dozens of WASH-poor countries - with strong enabling environments (viz. “opportunity to succeed”) - high and dry. Country selection based on need and ‘opportunity to succeed’ requires very careful management. And a continuing omission is that, outside of Haiti, no country in the Western Hemisphere is a priority country for the Water for the Poor Act implementation. There are vast pockets of need in Latin America and the Caribbean, and I hope USAID takes this into account.
• With the exception of one key paragraph on page 15, the two Strategic Objectives (Water, Sanitation, and Hygiene and Water and Food Security) are inadequately linked. I would have liked to see the nexus of water, sanitation, and nutrition/food security highlighted. The problem is clear: repeated bouts of waterborne diarrheal disease lead to physical stunting and poor cognitive development of kids all around Africa, Asia, and Latin America. The solution is more integrated programming: making sure that children and families have safe drinking water with which to consume their food so that it is properly digested. I know USAID understands this and am surprised this linkage is not more prominent in the strategy. There are other solutions which would tackle concomitantly both Strategic Objectives (rainwater harvesting comes to mind) which aren’t included at all. 

What’s next?

Once the strategy is formally launched, USAID and its many partners across the U.S. and the globe have five years to make this work. The implementation phase of the strategy will build on many of the successes outlined above, and provide further guidance on the strategy’s shortcomings. The implementation of this strategy needs to closely align with the Senator Paul Simon Water for the Poor Act of 2005 and maintain and increase USAID’s focus on its core mission, “the eradication of extreme poverty and its most devastating corollaries, including widespread hunger and preventable child death.” 

Shortly after the strategy is launched, we can expect implementation guidance to better explain how to implement projects aligned with the strategy. That implementation guidance will very much color how the strategy will roll out over the coming years, the number of lives it will positively impact, and the return the U.S. taxpayer gets on his/her dollar.

I intend to make sure that the right people in both developed and developing countries are aware of and supportive to the extent possible of this strategy, and are positioned as allies for USAID as it works through the next five years. I envision better donor coordination, and I envision increased demand and supply for water assistance across the globe. I envision USAID reaching out to its philanthropic partners to leverage the taxpayer dollar, and I see millions of lives saved and improved.

Congratulations again to USAID – looking forward to the implementation phase.

World Water Day at the United Nations General Assembly

Happy to share with you my remarks as delivers at the UN General Assembly today. Happy World Water Day! 
 

High-level Interactive Dialogue of the UN General Assembly on World Water Day

United Nations, March 22, 2013

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Mister President,

Thank you for the invitation to join you today, and Happy World Water Day.

WASH Advocates is a nonprofit advocacy and lobbying group in Washington DC, entirely dedicated to the global safe drinking water, sanitation, and hygiene (WASH) challenge. We are independent and have been fully funded by four private philanthropists: the Conrad N. Hilton Foundation, the Howard G. Buffett Foundation, the Wallace Genetic Foundation, and the Osprey Foundation.

A famous American politician, Tip O’Neill, once said that all politics is local. I would suggest that on World Water Day we recognize that all water and sanitation solutions should be local as well. We at WASH Advocates are pushing not simply for access, but for sustainable solutions that are appropriate to local contexts all across the globe. This call echoes the Deputy Secretary General’s remark earlier today that “Global is somebody else’s local.” In the post-2015 context, we also look for solutions which lean forward into tomorrow’s sustainability challenges and threat magnifiers, including urbanization, climate change, and desertification.

This afternoon session is about cooperative solutions, so I’d like take my time to highlight three efforts of other organizations which push us in that direction:

-          Sanitation and Water for All Partnership (SWA): SWA is a powerful platform from which to create and strengthen the political will necessary to achieve zero open defecation by 2025, and universal coverage of WASH by 2030. I am proud that the US has now joined. www.sanitationandwaterforall.org

-          Economics of Sanitation Initiative (ESI) of the Water and Sanitation Program at the World Bank: one country in Asia lost the equivalent of 6.4% of its GDP to inadequate sanitation just a few years ago. ESI’s data shows a direct causality between sanitation and GDP growth rates, and is likely to get the attention of Finance and Prime Ministers, when little else will. On World Water Day 2013, let’s be sure we are using this data.

http://www.wsp.org/content/economic-impacts-sanitation

-          End Water Poverty has produced an Elections Toolkit that helps us get every candidate for elected office around the world to prioritize water and sanitation. On World Water Day, let’s redouble our efforts to make sanitation and water a part of every election between now and the end of 2015 at the least.

http://www.endwaterpoverty.org/campaign/election-campaign

These are uncertain times, but no one in this room is going to bed tonight worrying that his/her daughter will die from waterborne diarrhea tonight.  This is a solvable challenge, and we can do more. I salute you; I applaud your efforts; and I look forward to doing what we can with my colleagues in US civil society.

John Oldfield, CEO, WASH Advocates