Stories from the Field


Strengthening Community Cohesion

By Allen Clinton

Lantaa Nur or “togetherness” is the name of a new village savings and loan association (VSLA) in Tabier village in Ghana’s Upper West Region. Group members say the name fits, representing something they never thought was possible. Their VSLA provides not only a platform for collective savings but also a sense of solidarity and space for collective action.
As one of 22 communities targeted by CARE through the four-year USAID-funded West Africa Water Supply, Sanitation & Hygiene (WA-WASH), Tabier’s 44 farming households faced life-threatening problems in their daily lives, including scarcity of clean water and sanitation, food insecurity due to a shortened rain season, and social structures that prevented them from working together to solve local development problems themselves.

By introducing an innovative VSLA approach, the WA-WASH program provided women, men, village chiefs and district assembly representatives the opportunity to unite for the first time to strengthen social cohesion. Weekly VSLA meetings are used as a forum to promote a spirit of volunteerism that encourages members to help one another build latrines, adapt their crop production methods to the changing climate and increase local community-driven funding to sustain those local water and sanitation services they lacked before. Moreover, with additional funds saved through VSLAs, parents can now afford health insurance and pay their children’s school fees.

The VSLA approach was a core component of a deliberate approach to help communities solve their own problems. CARE began WA-WASH in October 2012 with a series of consultations with community leaders and local government representatives to better understand their problems and design a mix of interventions that empower participating communities, including marginalized women, while using locally available resources.

Participatory processes ensure that those people most affected by an issue are included. In the case of water, sanitation and hygiene, women and girls are the most affected. However, due to traditional roles that place men in control of everything, women often are excluded from participating in solving their own problems. In rural Ghana, women and girls spend much of their time – hours each day – simply fetching water for their families. For women, that time could be applied to income-generating activities; for girls, that time could be spent in school. Moreover, when there are no household latrines, women have to seek privacy after dark to quickly defecate behind bushes, exposing themselves to roving eyes, harassment and even snake bites. Such practices had never changed, until now.

To read the whole story and explore other Ghana WA-WASH stories, click here: WA-WASH Success Stories

Building Local Knowledge is Key to Solving Ghana's Sanitation Problem

By Allen Clinton

The deadline for the world to meet its Millennium Development Goals is just months away, yet in Ghana, while the country is on track to meet its 77 percent safe water source goal it is coming up short for reaching 53.5 percent improved sanitation access. The impediments to reaching that goal are more social than physical. “You can’t just go in and build a few million latrines,” says Issifu Adama, WA-WASH project manager, commenting on why subsidized latrines didn’t work in the past in Ghana. “People need to first understand why latrines are necessary, or they’ll just use them to store grain. When you make the link between sanitation, health and livelihoods, people are more likely to take action and invest their own resources in building and maintaining latrines themselves.”

That was the approach CARE took within its USAID-funded West Africa Water Supply, Sanitation & Hygiene (WA-WASH) program in Ghana’s remote Upper West region. So far, it has worked. The Community-Led Total Sanitation method involves building local knowledge rather than providing visible infrastructure gifts.

“In some 22 project communities where open defecation was done for generations – where not even one toilet existed – we now see entire villages working together, going house to house building latrines,” adds Issifu “Families now understand that open defecation has to stop and are invested in lasting change.”

According to Saabom Sebastanin, who took over as village chief in Tabier after his father passed away five years ago, “There was feces everywhere. It was around vegetables. It was in the mouths of pigs. We didn’t feel like eating. Children got diarrhea. We couldn’t even sit outside to have a meeting.”

Today, all 44 households in Tabier, and in the other 21 project communities, have latrines because of a CARE process that involved changing behaviors, improving the environment and developing skills.

To read the whole story and explore other Ghana WA-WASH stories, click here: WA-WASH Success Stories

Breaking Out of Traditional Gender Roles

By Allen Clinton

Change is taking place in the Upper West region of Ghana. Just three years since CARE’s West Africa Water Supply, Sanitation & Hygiene (WA-WASH) program began, participating villages now have a local clean water source, each household has built its own latrine, and families have saved money to invest in improving their crop production and also to pay for water maintenance, school fees and health insurance. But more importantly, men and women have done it together – something that once seemed unlikely in a place where common marriage negotiations ensure a wife will fetch water, cook and sweep. After paying a dowry, men essentially owned their wives. Today, husbands are helping their wives carry water and cook meals. And wives have become income-earning members of village savings and loan associations (VSLAs), and their husbands have given them their own acre of land to farm whatever they think will grow best – no questions asked. While it’s clear that men are still the heads of households, both genders have stepped outside their traditional roles. Couples say they are better off and happier as a result.

“Gender dynamics can either help or hinder a project’s sustainability,” says Issifu Adama, WA-WASH project manager. “Ghana is made up of 52 percent women. If that population is excluded, then we have a problem. Women need to be involved, and in our project area we’ve seen families and entire communities clearly benefit from their involvement.”

Participatory processes ensure that those people most affected by an issue are included. In the case of water, sanitation and hygiene, women and girls are the most affected. However, due to traditional roles that place men in control of everything, women often are excluded from participating in solving their own problems. In rural Ghana, women and girls spend much of their time – hours each day – simply fetching water for their families. For women, that time could be applied to income-generating activities; for girls, that time could be spent in school. Moreover, when there are no household latrines, women have to seek privacy after dark to quickly defecate behind bushes, exposing themselves to roving eyes, harassment and even snake bites. Such practices had never changed, until now.

To read the whole story and explore other Ghana WA-WASH stories, click here: WA-WASH Success Stories

Creating Space for Women to Participate Provides Mutual Benefits

By Allen Clinton

It’s another hot and humid August morning in Ghana’s Upper West region. As the sun rises, Peter and Eunice Surrunakum are already out working in their field, in what seems a race to finish before they swelter. Even at this early hour, their shirts are soaked with sweat. It’s quiet in the small village of Kambaa Tangzu, apart from the muffled thuds of their hoes breaking ground. The husband and wife are transplanting millet from one part of their field to another. Peter hands Eunice a few 2-foot-long plants. One by one in a row, she sticks them in the ground and uses her bare feet to pack the dirt around them. While their hoes, hands and feet symbolize the essence of hard work, being out here together represents newfound teamwork that transcends the farm.

“Whatever I have belongs to my wife and [seven] children,” Peter says. “We no longer separate what we do. We’ll never go back to old ways. Only death can stop us now.”

Back home, the couple recalls what it was like just three years ago, before CARE’s USAID-funded West Africa Water Supply, Sanitation & Hygiene (WA-WASH) program started in Kambaa Tangzu and 21 other nearby villages. They say they used to drink dirty water from the river. They defecated out in the open because they didn’t know about toilets. Their farm production was low. They had no savings. And there was no cooperation between men and women. Women’s place was in the home or out fetching water, and they had no say in household matters or how to farm on their husband’s land. Men in Kambaa Tangzu, including Peter, used to drink alcohol and take their problems out on their wives, particularly when the women asked for something like money to buy a simple bar of soap. There was a lot of fighting and yelling heard throughout the village.

To read the whole story and explore other Ghana WA-WASH stories, click here: WA-WASH Success Stories

Marking the End to Open Defecation

By Allen Clinton

It was a day to celebrate big change in Nandom, a town in Ghana’s Upper West region, and mark a concluding milestone for a successful USAID-funded West Africa Water Supply, Sanitation & Hygiene (WA-WASH) program, implemented by CARE. Twenty-four communities were certified as Open Defecation Free on August 20, 2015. While this may not be historical news to most outsiders, village chiefs and community members on hand today took great pride in acknowledging each other, knowing what it took to get every person in their villages to stop squatting behind bushes and build their own household latrines for the very first time. The WA-WASH program not only helped people understand why open defecation was a shameful act, but more importantly, why it was disastrous to the health of whole communities.

Reflecting on the progress made in these villages, Paramount Chief Dr. Puoye Chilr says, “It’s a sign my people are listening well.”

If you ask the villagers themselves, they will tell you there’s no going back to the old days. These 24 villages in Nandom district and neighboring Lawra are on their way to a healthier, cleaner, brighter future. Today’s celebration represented a reversal of the practice of open defecation for good.

To get there, the program took on an entirely different approach than others of its kind, putting gender roles and shared decision-making at the fore and implementing a multi-sector agenda from that base to address community-identified needs: WASH, food security, climate change adaptation, income generation and education. It was indeed an integrated program, and it worked.

To read the whole story and explore other Ghana WA-WASH stories, click here: WA-WASH Success Stories

Building Demand for Sanitation Marketing

By Allen Clinton

Most rural villagers in Ghana’s Upper West region had never considered installing a toilet. In fact, many people say they didn’t even know about toilets until three years ago, when CARE began the USAID-funded West Africa Water Supply, Sanitation & Hygiene (WA-WASH) program in 22 communities. While Ghana on the whole has been struggling to meet its Millennium Development Goal for sanitation, there are now successes found in those WA-WASH villages -- a pit latrine at every household and motivation of all families to never again go to the bathroom out in the open. The combination of Community-Led Total Sanitation (CLTS) and sanitation marketing has helped households stop open-defecation practices and quickly move up the sanitation ladder.

“Proper sanitation is a foundation for better health and a cleaner environment,” says Peter Yabepone, WA-WASH community mobilization officer. “It involves helping village chiefs and people realize a deep disgust for open defecation, the benefits of a pit latrine and then connecting them to products and services. The reasons for building a toilet have to far outweigh the alternative. It has to be their choice.”

Getting a household to build a pit latrine for the first time can be a complicated process. The CLTS approach is used upfront to trigger a community’s desire to change sanitation behaviors. Community members then decide together to create a clean and healthier environment. Once a family makes that choice to stop open defecation and becomes motivated to take action, they still face constraints. Ghana has a “no subsidy” sanitation policy, meaning that an organization like CARE can’t provide materials or build the latrine for them. So, how can a very poor farming family afford the cost? How do they build something they’ve never seen before? Where should they build it? How deep should the hole be? What materials are needed?

To read the whole story and explore other Ghana WA-WASH stories, click here: WA-WASH Success Stories

A Way Forward

By Allen Clinton

Baby Yelfaabasoglo vividly remembers the day three years ago when her children were chased from school because their school fees weren’t paid. It nearly broke her heart. She simply couldn’t afford the cost. Like most families in Brifo Maal village in Ghana’s Upper West region, back then, she and her husband barely grew enough food to eat and didn’t have a nearby clean water source. Baby spent her days doing arduous work. She walked 4 kilometers back and forth to fetch water from the Black Volta River. Back home, she cooked supper and helped her husband farm until well past dark so they could eat the next day. Exhausted, she had very little time for her four children. That was Baby’s never-ending routine. It was a stressful situation that often led to quarrels with her husband, particularly when she mentioned school fees or needing to buy a bar of soap to wash what few clothes they had. But instead of continuing that way of life, Baby embraced new opportunities and empowered herself to create lasting change.

“Any mother wants her children to grow up healthy, educated and contribute to the community,” Baby says, expressing her true motivation.

To read the whole story and explore other Ghana WA-WASH stories, click here: WA-WASH Success Stories

All WA-WASH Success Stories

October 2015
By Allen Clinton


Itaia's Story

January 2014
Mozambique Picture-Itaia.jpg
Itaia washing clothes at the water point constructed by the project

Itaia Gimo is a female farmer born and raised in Namige, a northern Mozambican village with 600 inhabitants. She is married and has three children, one girl and two boys. Through the Chiure WASH project, the inhabitants in Namige have learned about the health challenges related to open defecation. As a result, they have been motivated to construct household latrines as a means to assure that Namige becomes free from open defecation.

Itaia and the other community members have also learned the importance of sanitation and hygiene. Tippy Taps have been constructed within the village. Tippy Tap is a simple mechanism which allows the user to wash both hands under running water. Itaia says “we have learned how to wash hands in a way that prevents disease transmission. We have also learned how to adequately use and maintain latrines. When a latrine collapses (which is common, especially during the rainy season), we re-build it. Now there is no one in the village who does not have a latrine”.

As a result of the project, community members also have access to adequate water. Itaia explains that “before the project, we drank water from the river and unprotected wells. But now, the new water points are covered and the water is clean”. The photos below show where Itaia and other community members fetched water before and where they fetch water today. To assure continued functionality of the water point, water users pay 10 meticais (USD 0.32[1]) per month per household. The money is managed by an appointed community group, which assures maintenance and reparation of the water point.

Mozambique Picture-before water source.jpg
Richacho with milky looking water; This is where community members in Namige used to fetch water before the project
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Water point installed by the Bechgaard project, providing cleaner and safer water to Namige’s inhabitants.

Itaia believes that CARE´s WASH Chiure project, which ended in October 2013, has lead to a significant change for her and the
other community members. Now, women in Namige have time to wash clothes and fetch new drinking water every day. In the past, women would wait for the household to completely finish the water deposits before returning to the river for new water. Itaia explains, “We have sufficient water. As you can see, I am washing clothes now at my house. This would not have been possible before. I used to bring the clothes to the river to wash them there since it was too far to bring back sufficient water for drinking, bathing and washing clothes”.

Not only has project enhanced the quantity of water, but the quality of drinking water has also improved. Itaia says the village had many cases of cholera before the project but disease outbreak is less common now.

“The project has changed many things in my life and in the community in general” Itaia declares. “Now we have more time available for other activities such as working in the fields. We have been able to increase the area we cultivate. We even have time to rest. The walls around our latrines are no longer made of straw since water allows us to produce adobe to build our latrines. With sufficient water in the village to produce adobe, we are also able to build bigger and sturdier houses”.

[1] According to the exchange rate at as of 31st of March 2014.


Sophia's Struggle

By Carol Meyer
June 2012

Sophia Christine can’t sit still. She is nervous, anxious and not quite sure how to solve her dilemma. While Mr. Oremo, her seventh-grade teacher asks the class to repeat phrase after phrase in English, Sophia is weighing her options – devising a plan to discreetly slip out of the classroom and return home to deal with the stain she is absolutely certain exists on the back of her skirt. She knows the boys will laugh and taunt her. Some will even take note of the date and remind themselves to tease her again next month. She can feel her abdomen clench tighter at the thought.

The problem – Sophia doesn’t have a sanitary pad. Instead, this month she is using strips of old clothes which have obviously failed. She could ask Mr. Oremo if there are supplies in the classroom’s water, sanitation and hygiene (WASH) kit. But at 14, and in a culture where girls are encouraged to be timid, interrupting class and having to ask a man for something so personal is not an option. She’ll just wait until everyone leaves class before she gets up, ties her sweater around her waist and seeks out a female teacher to ask for permission to return home.

Families in the small community of Miongwe, in Muhoroni district of Kenya’s western Nyanza province, rely primarily on subsistence agriculture for their livelihood. Financial resources are strained if they exist at all. Women’s and girls’ needs fall second to those of men and boys. Like many families in this community, Sophia’s parents struggle to purchase even the most basic essentials. Toiletries are simply a luxury. And given the tradition of using old clothes or very inexpensive rolls of cotton batting during menstruation, girls learn to “do as their mothers do.”

In Kenya, the rite of passage to become a woman can be riddled with unanswered questions, fear and embarrassment. Discussion around menstruation at home is often limited to bare basics. As such, for girls, especially those as young as 9 years old when they have their periods, managing menstruation is daunting. Keeping track of when her period will arrive is yet another task to add to a long list of daily chores. If caught off guard, an unprepared girl can be the focus of ridicule – causing some girls to stay home from school, thereby derailing their education.

Breaking tradition
Beginning in 2007, Sophia’s school took part in a five-year research initiative of the Sustaining and Scaling School Water, Sanitation and Hygiene Plus Community Impact (SWASH+) project in Kenya. During a pilot phase of the God Abuoro Primary School received a “package” of WASH interventions including separate cement block-constructed latrines for girls; containers to store treated drinking and handwashing water; and a limited supply of cleaning products and bleach for latrine maintenance, toilet paper and a water treatment chemical known as WaterGuard.

Students formed a health club to learn about and share important health topics like puberty, sexuality HIV prevention, in addition to undertaking WASH activities including daily latrine maintenance. They also take responsibility for maintaining a clean and healthy school environment. Two teachers, one male and one female, were trained to serve as health patrons who oversee the club.

The female students are grateful for the new latrines and WASH supplies, but Sophia still longs for a bathing stall at school. “One thing I would change about this school is to have a place to cleanse, especially for the times when I’m having my period,” she says. “And if we had sanitary pads, we would find it easier to concentrate in class because we would not worry if blood will show on our clothes.”

Advocating for change
In its final phase, SWASH+ is building upon the in-depth research and analysis of rigorous quantitative studies in 185 schools to advocate for changes in the government’s school WASH allocations. In 2009, the Kenyan government’s school budget included five Kenyan shilling (KES) per child (approximately six US cents), per year for WASH activities. Electricity costs were also included in this five KES.

Representatives from the Ministry of Education (MoE), school administrators, and the SWASH+ team examined school budget allocations. They asked the Ministry of Education to consider reallocating certain line items to increase WASH services. For example, school budgets already contained line items for structural improvements such as fences. But a school with sub-standard sanitation facilities could not deviate from the budget guidelines and use those funds for latrine maintenance.

In 2010, the government raised the WASH allocation to 10 KES (12 US cents) and then in 2011, raised it again to 20 KES (24 US cents) per child per year. While these are certainly steps in the “right” direction, the SWASH+ team’s research has shown that it still is insufficient to cover the basic WASH needs of schools. For 34 KES (41 US cents) per child, per year, the SWASH+ team suggests that the Kenyan government provide a minimum package to include WASH supplies such as disinfectant for latrines, WaterGuard to kill bacteria in drinking and handwashing water, and necessary tool to clean latrines. An ideal package would cost 270 KES ($3.27) per child, per year and include the basic WASH supplies in the minimum package, with the addition of sanitary pads and toilet paper.

However, since fluctuations in currency and costs of products are common, the SWASH+ team is encouraging the Kenyan government and the MoE to think in terms of allocating a percentage of the budget towards WASH. Under the current budget, this would mean that 3 percent of the government’s school budget would be directed towards providing an optimal WASH package in schools. In 2011, after the SWASH+ team presented its research, the Kenyan government created a separate budget of 300 million KES ($3.6 million) for the purchase and distribution of sanitary pads to schools. The amount has since been reduced to 240 million KES ($2.8 million), which the government estimates will reach 500,000 girls in grades 7 and 8. Set to begin in May 2012, it is still unclear how the government arrived at these numbers or how the sanitary pads will be distributed, but nonetheless, it’s a noble step for the Kenyan government and a promising acknowledgement for SWASH+.

Sophia Christine read about the government’s new plan and has a few thoughts on how she would manage the supply of pads at God Abuoro Primary School if selected. “The pads could be stored with the WASH supplies in each classroom. Or better yet, we could store a few at a time in the girls’ latrine each day. If the government brings pads, we will find it easier to concentrate in class because we will not worry. The pads will prevent embarrassing situations.”

SWASH+ is a five-year applied research project to identify, develop, and test innovative approaches to school-based water, sanitation and hygiene in Nyanza Province, Kenya. The partners that form the SWASH+ consortium are CARE, Emory University, the Great Lakes University of Kisumu, the Government of Kenya, and formerly the Kenya Water for Health Organisation (KWAHO), and SWASH+ is funded by the Bill & Melinda Gates Foundation and the Global Water Challenge. For more information, visit //

The Number One Priority

A poor rural community finds itself gifted with an exemplary head teacher
By Carol Meyer
June 2012

“I have the ability to send my son to private school, but I want to lead by example. If this school is good enough for my own child, it is a good school.”

- Peter Otieno Rachier

When you look around Peter Otieno Rachier’s office, there is no question as to whether he leads by example. The walls are covered with quarterly teacher schedules, a teacher-on-call list and a motto he clearly lives by, “To provide the best learning environment for our pupils to enable them to succeed in life. Let’s aim high.”

Peter is the head teacher at God Abuoro Primary School in Miongwe village of Kenya’s Muhoroni district. He is responsible for the school’s administration and ensuring that 198 students, including one of his own, have a healthy learning environment. Today, Peter is not scheduled to teach morning class, but he arrives at school at 7:30 a.m. just the same. “I always come to school first, regardless of what my morning schedule is. I want to show my students and fellow teachers that school always comes first; it is my number one priority,” he says.

The community of Miongwe village is forever grateful that Peter landed in their community in 2008. Grades were poor when he arrived, with an average Kenyan Certificate of Primary Education (KPCE) score of 244 out of a possible 500. The water, sanitation and hygiene (WASH) situation was better than most, but not up to Peter’s standards. The school’s health club had won trophies in a competition with 10 nearby schools. But there was room for improvement. The handwashing water vessels were small, with no tap, only an old stick to plug the water hole. Students either drank directly from the handwashing container or from the nearby borehole. Children were always sick, resulting in high absentee rates. Peter knew this wasn’t healthy and that somehow they could do better.

In late 2008, Peter learned about the Sustaining and Scaling School Water, Sanitation and Hygiene Plus Community Impact (SWASH+) project during a regional teachers’ meeting. Grateful to be chosen as one of the implementing schools for one of the research pilots of the initiative, Peter rallied his students, teachers and health club members to introduce them to the program. The school received new handwashing and drinking water containers, along with a limited supply of WaterGuard to kill bacteria in drinking and handwashing water, bleach and detergent to clean the latrines, soap for handwashing, and toilet paper. A man of process, Peter set up another schedule on his office wall to designate two teachers as weekly health patrons to oversee the health club and to take responsibility if the WASH activities were not completed. He also asked for two students to volunteer for one year, to be in charge of treating the drinking and handwashing water with WaterGuard each day. The volunteers have the support of other students to make sure the latrines are disinfected, water is gathered, and the containers are cleaned properly.

Peter’s next project was new latrines for girls. Using plans provided by the government, he recalls that it was like they were constructing a house. It really improved the face of the school. “When people come to visit, they see the nice latrines and they know we are serious.” The students have embraced the new WASH facilities, showing their pride by adhering to the school’s new sanitation and hygiene standards. Peter observes, “The children behave differently now;

they Fullscreen capture 6192012 125216 AM.jpgbring a bottle from home to collect safe water; they ask for a cup in my office when they need one. Absenteeism has been reduced. Now that my students are healthier, using proper hygiene and clean water at school and home, they have a chance to succeed. That is the pride of a teacher.”

School test scores have also followed suit, rising on average to 284 out of 500 in 2010, a 16% increase. But despite the welcome new WASH additions, Peter quickly realized that the supplies would not last an entire year. The government’s budget allocation did not provide for things like toilet paper or bleach and the guidelines for how funds can be used are very strict. He’s constantly faced with the question of what to do next?

In times of financial need, God Abuoro Primary School relies on the school’s management committee, which is composed of parents from the community, to seek additional funding. Years ago, the school was given a small plot of land—approximately ¾ of an acre. The committee, along with the school’s teachers, decided to cultivate the land with sugar cane and place any in a separate bank account to use for school emergencies. A typical harvest can yield roughly 170,000 Kenyan shillings ($2,053) every 14 to 16 months. The funds have been used to pay for teachers’ travel expenses to workshops, furniture, maintenance and even WASH supplies when the yearly allotment runs out.

Peter wasn’t always determined to be a teacher. Originally he wanted to be an accountant, but needed money to help pay for his education. His uncle is a teacher and convinced him to become an “untrained teacher” as a way to help pay for his studies at the university. For two years, Peter taught pre-school children, which requires only a high school education in Kenya, and saved his money for a bachelor’s degree so he could teach higher grades. Two years was all it took to spark his interest and he continued working as an untrained teacher while studying education at Egerton University in Nyahururu, Kenya. Today, in addition to his head teacher duties, he teaches Math and History

Peter has developed a great working relationship with the school’s management committee and says they make his job easier. Peter recalls an incident in 2009 when he almost transferred away from the school. The Ministry of Education was looking to fill a head teacher position at a nearby school. To his surprise, 13 members of the school’s management committee wrote a letter to the District Education Officer, delivering it in person to stop the transfer. As a result, Peter is still the head teacher at God Abuoro. “It made me feel really valued because they have a lot of trust in me.”

When asked what makes him such an exemplary head teacher, Peter Otieno Rachier, says humbly, “It all boils down to relationships. I never forget that I am a teacher too.”

SWASH+ is a five-year applied research project to identify, develop, and test innovative approaches to school-based water, sanitation and hygiene in Nyanza Province, Kenya. The partners that form the SWASH+ consortium are CARE, Emory University, the Great Lakes University of Kisumu, the Government of Kenya, and formerly the Kenya Water for Health Organisation (KWAHO), and SWASH+ is funded by the Bill & Melinda Gates Foundation and the Global Water Challenge. For more information, visit //

Menstruation and Boys

Boys and Male Teachers Play a Role in Helping Girls Manage Menstruation
By Carol Meyer
June 2012

At Ogwodo Primary School, teachers and students have come a long way when it comes to discussing the often embarrassing subject of puberty. Teacher and health patron Peter Odhiambo at this school in Sidho community of western Kenya’s Muhoroni district recounts that the school used to have problems with water, sanitation and hygiene (WASH) as they relate to puberty. The toilets, he says, were a particular cause of worry for girls because they are shy and the toilets lacked privacy. Peter acknowledges, “Girls have things to deal with, like menstruation, which require more privacy than boys. The previous toilets were exposed and girls would go to the sugar cane fields or go home for privacy. Even though menstruation is a natural thing, the girls felt insecure and embarrassed.”

He admits that despite learning about bodily changes and sexuality in science class, boys still saw menstruation as an opportunity to tease girls. The Sustaining and Scaling School Water, Sanitation and Hygiene Plus Community Impact (SWASH+) project has helped minimize teasing by ensuring that girls have privacy, access to supplies and a place to cleanse themselves during menstruation. In the pilot phase, the school received a WASH “package” that included a new block of three latrines plus a bathing stall with a door. The government-designed latrine and bathing block is surrounded by a six-foot wall for added privacy. In their allotted supplies, the school also receives a small amount of sanitary pads for students, though not enough to last the entire year for every girl. The school health club serves as a place to reinforce positive messages, with boys and girls together, about a wide range of topics, including menstruation, prevention of early pregnancy, personal hygiene and WASH.

As the health patron, Peter feels it is critical that boys be part of the discussions about menstruation to help them understand what girls go through and to be more sympathetic towards female students. He volunteered as health patron because, he says, “Since becoming a teacher, I have been impressed by the closeness of children. I imagined that if I volunteered, I could make a real difference. I don’t see them as children, I see them as people who, when guided, can become responsible adults.”

Instilling a sense of compassion around menstruation is particularly important for men and boys. “As men, we need to be included in the discussions about menstruation because we can help offer solutions,” Peter says. “In cases where the madame health patron is not present, girls need to be able to ask me for sanitary pads and they need to be comfortable asking.”

Girls at Peter’s school agree, but also note that the new latrines have made a world of difference in the comfort they now feel at school. Thirteen-year-old Susan Awino says, “With the old latrines, we were terrified that boys would open the door or peak underneath to see us. With the new latrine, boys can’t see what we do behind the wall, so they don’t know whether we are bathing and have our periods or are just using the latrine.”

Still, having access to resources is a welcomed addition for the girls at Ogwodo Primary School. Peter attests,
Fullscreen capture 6192012 10005 AM.jpg
“Providing sanitary pads is a challenge for many students because they come from homes where things like pads are not seen as essential. Instead, they use strips of old
clothes or rolls of cotton batting. After we started the SWASH+ program, we had discussions with parents about helping their daughters manage their periods and the head teacher has been instrumental because he has access to some funds.” Peter knows that educating girls at school is only part of the equation. Parents need to support what their children learn. In part, Peter feels that his job as teacher and health patron is essentially helping to raise the next generation of his community. He elaborates, “Professionally, we are teachers, but your love for children helps you guide them into the future. This (primary school) is a foundation for children. If they are taken through a good learning process, they will become responsible members of society.”
In the end, Peter acknowledges that girls have traditionally been marginalized in rural Kenya, yet he feels they have the power to become important members of society. “The key,” he says, “is to make sure that neither girls nor boys have more opportunities than the other. Instead, we should lift up both boys and girls.”

SWASH+ is a five-year applied research project to identify, develop, and test innovative approaches to school-based water, sanitation and hygiene in Nyanza Province, Kenya. The partners that form the SWASH+ consortium are CARE, Emory University, the Great Lakes University of Kisumu, the Government of Kenya, and formerly the Kenya Water for Health Organisation (KWAHO), and SWASH+ is funded by the Bill & Melinda Gates Foundation and the Global Water Challenge. For more information, visit //

All the Difference

How water, sanitation and hygiene in a school changed one girl’s life
By Carol Meyer
June 2012

The family’s rooster is still asleep, yet 13-year-old Susan Awino is awake and on top of her morning chores. She walks 10 minutes down a dusty dirt road to fetch water for the family from a nearby pump, and balances a 20 gallon bucket on her head for the return trip home. Once home, Susan helps her mother treat the drinking water with WaterGuard and then helps her younger sister get ready for school, making sure her hair is combed and her hands and nails are clean.
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Not just a role model at home, Susan Awino is also helping to lead the charge to improve the health of her entire community, and that charge begins at school. Susan and her fellow students arrive at school two hours early in hopes of reaping the rewards of an early start. By 6:30 a.m., with the sun just barely on the horizon, Susan reads her lesson book by candlelight and raises her hand enthusiastically to answer the teacher’s questions. An extremely bright student, Susan had the highest marks in Grade 5 last year. Together with her teachers and fellow students, they are on a mission to not only improve the academic grades in Ogwodo Primary School, but also the health and hygiene of her community of Sidho.

Be the change
Three years ago, Susan and the residents of Sidho village may not have realized the degree to which their lives would change as the school embarked on a health initiative that would exponentially improve their learning environment and the community’s health and wellbeing. The Sustaining and Scaling School Water, Sanitation and Hygiene Plus Community Impact (SWASH+) project selected Ogwodo Primary School to participate in a quantitative study to assess the impact of a school-based water treatment, hygiene and sanitation program. The school received a water, sanitation and hygiene (WASH) “package” including a government-designed set of three cement block latrines for girls, with a separate bathing stall. Also included were: four containers for drinking water, four handwashing containers, and a supply of WaterGuard to kill waterborne bacteria. To ensure hygiene, the school received a small allotment of cleaning supplies such as bleach, soap and detergent. The school also established a health club that comprises 32 children between the ages of 11 and 15 who volunteer and take responsibility for the school’s WASH activities and share messages on preventing waterborne illnesses and on cleanliness standards for both home and school. Two teachers trained by the SWASH+ team oversee the student health club and impart a series of valuable health education lessons among students and parents.

When morning recess begins, health club members scatter among the schoolyard and go about the process of collecting water, cleaning the latrines, and setting up the handwashing and drinking stations. Everyone has a task; Susan takes on the essential job of treating the school’s daily drinking water with three capfuls of WaterGuard for 60 liters of water. She measures carefully and keeps track of time to make sure that no one drinks from the container until the required 30 minutes are up. Treating the drinking water is especially personal for Susan because she remembers what life was like before the school treated the water. “I remember feeling sick often. Stomach pains and diarrhea made it quite difficult to concentrate in class. I hated to interrupt the teacher, but in one instance, I was so sick that my parents had to take me to the hospital where I was treated and sent home with medicine for the diarrhea,” she says.

As if the pains from her illness were not enough, Susan also felt pangs of guilt because she knows that hospital fees are expensive. She realizes that her parents paid more money to treat her illnesses in the past than they now pay to prevent them – WaterGuard costs 20 Kenyan shilling (24 US cents) per bottle, which treats about 1,000 liters of water. Research findings from schools like Susan’s have since been shared by the SWASH+ project with the Ministry of Education and as a result, the ministry has doubled the per-pupil allocation of government funds to schools for supplies like WaterGuard and soap, and is seeking further increases.

Share the wealth
Participating in the school health club has taught Susan that young children are especially vulnerable to waterborne illnesses. Teaching them to wash their hands after using the latrine and to drink only treated water is critical to their health. But knowing that “children are children,” the school health club treats both the drinking and handwashing water in case the littlest ones drink while washing their hands. The same knowledge transfer applies to creating a sanitary environment. “As health club members, we have to be role models. If older girls want clean latrines, younger students will want them clean too because they copy us,” Susan shares. “Dirty latrines not only smell bad, but also contain worms or maggots that can enter the feet since some children do not wear shoes.”

Having separate latrines for girls is, in Susan’s opinion, a blessing. In the past, she says, girls would go to the sugar cane fields to urinate or defecate because they worried that boys might open the door to their latrine or peak through the large gap at the bottom. The cane fields pose a more ominous risk than curious boys. Venomous snakes are a real danger to girls seeking privacy in the fields. The new latrine design includes a wall that surrounds the entire facility, creating complete privacy.

Susan’s friend Mary, now 15 and in the same grade, dropped out of school when she first started puberty at 11. Mary says she realized she was growing up, but because no one had really explained to her what was happening, she felt shameful. Mary finally told her parents that she didn’t want to go back to school because there wasn’t anywhere she could go to clean up when she was menstruating. Three months later, Mary heard from some of her friends that the school was building separate facilities for girls. With her parents’ encouragement, she returned to school and is now a member of the school health club. Having a support network to learn and talk about issues like bodily changes, puberty and sexuality has given Mary newfound confidence.

Pay it forward
Susan is doing her part to share her new WASH knowledge. At home she teaches her mother about the lessons she learns in the health club. While her family’s latrine is not nearly as nice as the one at school, it is very clean. Susan advocates for sanitation and hygiene among her siblings and parents, helping her mother clean the latrine and maintain the younger children’s hygiene.

So what’s next for Susan? After primary school, she plans to eventually study law at the university. Susan wants to help communities solve their problems and would like to see other communities in her country have access to safe water. A lifelong learner and now health advocate, Susan Awino is helping to improve her classmates’ and communities’ health status and mitigate future outbreaks of waterborne disease. Susan lives by her own words, “A girl who goes to school is not only educating herself, but she will help to educate her community and her entire country.”

SWASH+ is a five-year applied research project to identify, develop, and test innovative approaches to school-based water, sanitation and hygiene in Nyanza Province, Kenya. The partners that form the SWASH+ consortium are CARE, Emory University, the Great Lakes University of Kisumu, the Government of Kenya, and formerly the Kenya Water for Health Organisation (KWAHO), and SWASH+ is funded by the Bill & Melinda Gates Foundation and the Global Water Challenge. For more information, visit //

A Manifold Solution

Water and sanitation open several doors in one school
Global Water Initiative, May 2010

Modika Primary School is no more a dry place, according to its school health club members. Ten kilometers east of Garissa town in Northern Kenya, since 2008, this school has been one of the recipients of a water and sanitation intervention from the Global Water Initiative (GWI). This includes a rainwater harvesting system with a main tank that has also been connected to the municipal water supply; the construction of four latrines (two for girls and two for boys); and supplies of containers and stands for drinking and handwashing water.

The water has many uses and has improved life in the school, according to the school health club members. Though it is mainly used for drinking and cooking lunch for the school feeding program, other applications include handwashing, personal cleansing after visiting the latrine, irrigating the school farm, watering trees and cleaning latrines.

The latrines too, have altered the school in important ways. Both the deputy head teacher and the students interviewed put it clearly: students used to visit the nearby bush before the construction of the latrines. This posed problems for the girls in particular for they would shy away from using the same bush as the boys. As a consequence, many of them dropped out of school and some totally failed to enroll. Sofia Yerrow a member of the health club said, “I used to go home in the middle of the lessons since there were no latrines in the school, and come back late for my lessons or even sometimes never come back until the next school day.”

Judging from the discussions held with them, the pupils appear to have sufficient knowledge on hygiene practices, proper sanitation, safe water treatment and storage and handwashing with soap. This came out clearly when Ibrahim Mohammed explained to GWI staff how to treat water using Water Guard[1]: “Using a 60-litre tank we use three full lids of WaterGuard to treat our drinking water,” he said.

A visit to the school’s administration office confirmed some of these dramatic results. “The availability of water has scaled up the school feeding program and along with latrine construction in the school has increased school enrolment,” said Mohamed Shurie, the deputy head teacher. He also noted that the school farm, made possible by drip irrigation, has boosted the children’s learning, especially for science subjects.

Despite these encouraging results, there is room for concern. There was no water available on the day of the visit from GWI as according to Mohamed, the water supply from the municipality is often erratic and there had not been sufficient rains to replenish the tank.

Opportunities Replace Water Scarcity

Tula Community, Kenya. May 2010


Water Can Bring Love

But Not Understanding. By Malaika Wright. July 2010

With Water Fees Collected

Akodokodoi Village Invests. By Malaika Wright. July 2010


Here I Am

CARE empowers one women to make a difference.
By Masoura

Although my name is Mansoura, which means "a winner", but I didn't feel that I am mansoura at all ! I was not here before; yes I was invisible, especially after I got divorced. I am a poor divorced woman, what worse could happen to me! Like any girl in our village; Alkon which a village that is part of Kafr Elsheikh governorate; I grew up helping my parents in the farm work, the house work, and preparing my self for marriage.

In my twentieth, I got married and I born my little daughter. Two years later, my husband divorced me to marry another woman. If I can hardly manage my self as a woman in our society, imagine the situation being divorced and had no source of income. Our society always looks down for divorced women and of course I can see that in their eyes and in the way they treat me. As if I am guilty for what happened and deserve that my husband leaves me.

I had to work to live and to rise up my daughter. I worked in the early morning as an officer, in the noon I worked in my parent farm which is one Fadden, I plant the seeds, fight for my right in irrigation water, and I do the harvest work. The worst thing in the farm work is when I fight for the land’s share in the irrigation water, especially in the summer time and when we plant the rice crop. The water distribution is badly managed here between the farmers, which eventually cause conflicts. Some of these conflicts end in the police station and some get injured and go to the hospitals. Most of the farmers who could not provide their lands with water get poor because the land here is the only source of income for most of us here. The reasons for most of these conflicts is that the amount of water needed is more than the water provided by the irrigation department, the bad behavior of the farmer especially in dealing with the irrigation water.

I witness many conflicts on irrigation water between the farmers and each other in one hand and between the farmers and the governmental irrigation engineers on the other hand. We always need water, and there is not always enough water. If it is not my fight, I just watch. I feel so bad when I see that. When the land needs water you have to give it, it is like if your child is thirsty and you must help him with water. And the crop is the only source of income to the farmers. Some leaders and good men in the village try to do their best to organize the situation and to solve the problems between the farmers.

One day, a man, who is member in the water user association in our village, invited me to a meeting and he informed me that there are researchers who would like to meet women in our village to ask about the irrigation water problems. I was not confident that I can help them. Normally I feel that I will never make a difference in anything, but anyway I went. And it was a changing point in my life. I meet with Care team; they explain to us their project which called Water and Stability project. Their goal is make farmers discuss with each other how to manage water between them instead of fighting. But first they told us that they will make a research on the reasons of the conflict over irrigation water in our village. They decided to select people from the village to be member in a local research team. I was very happy to know that finally conflicts over water can be reduced. I helped them as much as I can. And after two days they informed me that they selected me to be member in the local research team. The team was consisted of natural leaders, active men, active women, irrigation engineer. They trained us on how to make a research and how to work in a team. Our task was to gather information from people, men and women, about the conflict causes. Care team helped us and I managed to make several interviews with women in my village.

In the beginning I was afraid that people may treat me badly as usual or even careless, but strangely when I meet women and ask them a bout their problems considering the irrigation water , they respected me saying that I will help them if I could tell their problems to who is responsible and may these problems be solved . I arranged several meetings for Water and stability team to meet women and to discuss with them their problems. I even participated in meetings with men and women. I was so ambitious and happy for knowing that I can do these things.

After we finished from gathering data, W&S team informed us that our village ( ALKON) have been chosen to be the pilot to implement the project. In this project they will help us in solving conflicts between farmers with each other and to strengthen the relations with the governmental sector who can help us in the future; and to have better management for conflicts so every one can irrigate his land. They gave us several trainings on how to talk, how to negotiate, and how to communicate with each others. They also trained us on conflict management and how to be active member in the society .They also conduct several workshops between our association and the irrigation governmental department to enhance the relations with them. And as a result the irrigation department helped us many time in providing the water needed. Men and women was part of this project. I can not describe how this project is helpful for us, and for me. I managed to solve a conflict between two men.

One day I was leaving the land and going back home and I tried to solve a conflict between two men , I went there and talked with their wives to convince them to stop the fight and to set later to solve this problems , after few arguments , they were convinced . I was so happy, I felt that I can do what I have learned and I felt that I can do something to stop these conflicts. I attended a workshop conducted by the project about the women role in developing herself and her society. in this workshop I met a lady who work as coordinator for women association .I talked with here that I want to establish a small project in mushrooms plant to support my income and she helped me.

I am now and after one year of participating in this project one of two women who is members in conflict management committee in our Water Users association. Although I work hard to have money to rise my daughter, but I am also a volunteer also in this association. I believe now that I can make a difference. Thanks to Water and stability project and its team. I have learned how work in a team , I am encouraging other women to participate in the project and to have a good role in solving conflicts. I believe that may my daughter have better future than mine because of what we do.

And here I am, a strong confident woman.

Water Stability Project


Women Who Want to Catch Rain

A GWI/Running Dry/CARE case study from Borana, Ethiopia. March 2009

“Sanitation without water is nothing,” explains Ellema Sorra. After she received a water and sanitation training organized by CARE Ethiopia, her search for a sustainable water source led her and twenty other women from two neighboring villages to construct an 81 cubic meter underground rainwater harvesting system. The women hope their work will give them a safe water source during even the driest months of the year.
Ellema is 25 years old and has four children – two girls aged twelve and nine and two boys aged six and two. Her days are busy: “There’s no free space. Wherever I go, there’s a job to be done.” She wakes early to milk the cows and prepare tea and food for her children, before walking to fetch water from the nearby Melbana town, a trip that takes two to three hours. In the afternoon, she works around the house and with her family’s livestock. As the day draws to a close, she once again repeats her morning routine, milking the cows and preparing a meal for her children, before finally going to bed around 10pm.

Ellema lives in the Didema cluster of villages in Melbana kebele, part of Miyo woreda in the Borana zone of Oromiya National Regional State region, the southernmost part of Ethiopia that runs along the Kenyan border. This pastoralist zone suffers from cyclical droughts, demanding increasingly innovative ways of managing resources. As population continues to grow and traditional systems of rangeland and conflict management are eroded, people’s livelihoods are under great strain.

Ellema’s woreda is one of the focus areas of the new Global Water Initiative (GWI), which aims to ensure that vulnerable populations around the world have reliable access to clean water in such a way that their dignity, rights, culture and natural environment are not negatively impacted. In Ethiopia, GWI member organizations CARE, OXFAM America, and CRS have formed a partnership known as “Running Dry – Empowering Poor People to Manage Water in Arid and Semi-Arid Lands.”

CARE’s program, “The Borana Water Resources Management and Learning Initiative”, aims to improve access to and management of quality water sources for 3,400 pastoralist households. Working in partnership with local government and customary institutions, the project especially works to improve women’s access to safe water. Women in Borana bear heavy burdens, particularly during dry periods when the men migrate with their livestock or increasingly, travel to cities and towns to offer their services as day laborers.

As part of the project, in May 2008, CARE together with government health officials in Miyo woreda organized training on water and sanitation. 42 people were trained and 24 out this total were women. Emma was absent from her village during the selection process but this did not stop the village for selecting her to represent them in the training. “They asked who’s the strongest woman who can go to attend the training and bring this information back to our village?”

They learned how to improve the quality of drinking water and discussed personal hygiene and environmental sanitation. In particular, they were taught how to construct latrines, which were at the time very uncommon in the communities concerned.

“After the training”, Ellema reports, “I awoke from my sleep. We used to say just there is “

No Bad Mother and Water”. But now we think about our environment. If we defecate in the open, our feces will pollute the pond and we will drink dirty water. Also, our children put soil in their mouths – before the environment was clean, the children were exposed to soil that could cause disease. Now we are safe.”

Ellema & her son in front of the constructed latrine

After returning to her village from the training, she asked the kebele chairman to organize an educational meeting. Determined to share what she had learned, she explained to her community the importance of environmental sanitation and the benefits of constructing latrines. At that time, because of the drought, most of the men were away – and even some of the women were moving away as the land became drier. Undaunted, Ellema
gathered five women and had a discussion with them about building a latrine in the village. After a week of digging, they completed the first latrine.

“I decided I should be the model in my village so I took the initiative first,” Ellema declares. Indeed, now 8 of the 12 villages in her village have built or are building their own latrines. The elders have even created bylaws encouraging people to use latrines. Anyone who does not build a latrine is fined fifty birr – while those who have a latrine but do not use it are fined thirty birr.

However, Ellema explains, latrines are not enough: “We need to have a good water source in the village. The pond we use here dries out one week after the rains. There is a borehole nearby but it’s not possible to wash our clothes there; it’s only for watering livestock. So we raised this question with our group – how can we keep ourselves clean?”

The women brainstormed about the best way to create a more sustainable water point. A pond was ruled out because within Borana culture it would be available for all and used by livestock. The women finally decided to dig a rainwater harvesting system, often known as a cistern: “Moving around our area, we saw other cisterns built by NGOs and the government. We didn’t know how to measure the depth or the width but that doesn’t matter; what matters is it holds water. So we thought why not build a cistern like the ones we have seen.”

The women worked for a month and half, laboring six afternoons a week with help from male relatives on Sundays. They used tools that were available to them; there is another NGO project nearby where community members are rehabilitating a traditional well. When these workers come home, the women take their tools to their worksite to continue digging the large cistern.

Excavated Cistern

The group Ellema founded now includes twenty-one women from neighboring settlements, ranging in age from 16 to 45. They have determined to complete the work by themselves if they cannot find additional support from NGOs or the government. In particular, they have been saving to buy a plastic tarpaulin to seal the cistern: “We know that cement will prevent the water seeping into the ground when the rain comes, so why not plastic?” Every week each woman contributes ten birr. Ellema explains that she raises her contribution by selling eggs: “Each egg costs one birr; I spend no money on other expenses like tea; I save all my money for this project.” So far the women have saved 1000 birr.

Women led the Excavation
Today the cistern has a volume of 81 cubic meters. If the women succeed in sealing the deep hole, they will have a new supply of water for a significant amount of time during the dry season.

Their project is not finished however; day-to-day they continue to work. The group has to ensure the cistern will catch and store sufficient water during and after the rains. The women also face problems building latrines. The ground is hard and rocky and it is hard to find sufficient roofing materials, especially as wood in the area is vulnerable to termites.

The women have asked for advice and help, and CARE is in a position to respond to their needs. As a first step GWI project staffs plan to provide technical advice on how to construct silt barriers and complete the cistern. They also plan to provide learning visits with other communities building latrines so the women can exchange ideas and experiences. The work and commitment of Ellema and her twenty friends and neighbors promises to make a significant difference in their own and their families’ lives. With the support of CARE and local government, they can continue to build upon their knowledge and inspire others in their area to do the same.

Changing Beliefs about Latrines

By Woldu Terefe, DM&E Officer, CARE Borana
Women pastoralists are frontline promoters of environmental hygiene and sanitation.

Fighting Taboos in Borana

By Saro Konsole. November 2009


Paying It Forward

Equal Pay for Water Services Project. Teculután, Guatemala. July 2009

Located in southeastern Guatemala, close to the border with Honduras, Teculután is hot and dry – a stark contrast to the country’s cooler highlands. Under the relentless midday sun, cicadas croon loudly in all directions. Fields of okra and watermelon give way to rolling hills that form part of the Sierra de las Minas mountain range, which is home to an important watershed and a diversity of rare plant and animal species, including the long-tailed quetzal – Guatemala’s colorful national bird. While most of the Sierra de las Minas range is now a reserve, bald patches spot the hills near Teculután, showing signs of illegal deforestation. Without their own land or other economic opportunities, poor farmers in the area burned the forest for many years in order to use the land for cultivation.

Now, however, CARE and the World Wide Fund for Nature (WWF) are working with local farmers and governments to reforest and protect the reserve. We began conducting environmental and economic assessments in the area in 2005 and, based on the results of those analyses, project implementation began in early 2009. Currently, 300 community members are involved in the project.
[[image:file/view/Guatemala.JPG align="right"]]

Because we want to achieve sustainable results that continue for generations, CARE and WWF created a contract with the local government, which has agreed to establish a system by 2011 that will pay local farmers to conserve and reforest the area. Toward this end, the municipality has loaned farmers land in the valley for the next five decades, where they are cultivating okra, corn and watermelon. This has eliminated their need to clear the hillsides for cultivation. CARE also helped farmers to establish a drip irrigation system on their newly leased land to promote production and the conservative use of water. Moreover, we have done and continue to conduct market research to enable farmers to select the most profitable and sustainable crops for the region.

In the start-up period before the local government takes over the program, CARE and WWF are paying farmers to reforest the degraded hillsides. In the first half of 2009 alone, residents planted 90,000 seedlings. This work has also created jobs and pumped money into the local economy. For example, the project invested $10,000 in job creation (primarily reforesting work) in the first half of 2009.

Another important component of the project involves ensuring that big landowners and companies in the area, including a soft drink and beer company nearby, are paying for the water they are using. Currently, they do not pay anything even though they utilize vast amounts of water. CARE and WWF are now bringing companies together with farmers to talk about water quality and rights. To support the case that companies should pay for water use, CARE and WWF conducted a study to demonstrate that funding conservation efforts would actually save companies money in the long-run. Deforestation causes erosion, which contaminates the water supply, causing a serious and costly problem for companies. Reforestation is an easy and affordable solution to prevent such problems, so it makes good business sense for companies to invest in it now.

Water for Life

Mi Cuenca project. San Marcos department. Guatemala. July 2009

Water pours out of the tap in front of the Shexubei community school, splashing the arms of Crecencia Chavez and her young children as they wash their hands. Several months ago, this simple act would have been impossible. There was no tap stand here and no one in this small highland community in western Guatemala had running water. This absence was felt most acutely by women here, who had to walk an hour up and down the steep hillside on which Shexubei sits four to five times each day to collect water from the nearest well.

“It cost us, as women, to not have water,” said Maria Pelar Chavez, the only female member of Shexubei’s community leadership council. “Water is essential. It is the base of our health.”
Recognizing the enormous need facing families here, CARE helped Shexbui residents to construct a new water system in 2009 that now provides running water to all 101 households in the community.

“People were crying with excitement when the system was finished and they had water in their homes,” remarked CARE staff member Enri Maldonado. “They never had running water in their houses before.”

As in all of our work, CARE emphasized the importance of community participation and leadership. Shexbui residents played an integral role in building the new water system and were proud of their accomplishment.

“The water system extends to every house in the community,” remarked community leader Enrique Chavez with great satisfaction, while pointing to a home in thhands2.JPGe distance. “It took us three months to build.”

Access to safe water is crucial to people’s health and is fundamental in the fight against extreme poverty. Without it, people are extremely vulnerable to waterborne disease, which continues to be a leading cause of death among young children in developing countries. Furthermore, lack of access to water forces people – typically girls and women – to spend hours each day collecting water from distant sources, eating into time that could otherwise be used to earn income or gain an education.

“Before we (women) didn’t have time as we had to make four or five trips a day to collect water,” explained Crecencia Chavez. “Now that we have time, we are organizing a group of women and are using the time to learn new things. For example, CARE has provided us with trainings in health, nutrition and hygiene…Before, we didn’t know about many of these subjects.”

In addition to building infrastructure, CARE has taught families and schoolchildren in Shexubei to practice good hygiene to prevent disease. Inside Shexubei’s primary school, it’s evident from the frequent use of the new classroom hand-washing station that these hygiMagdalena.JPGene practices are becoming habitual. And that is a big step forward for community health.

“Now that we have running water, the school is so much cleaner. CARE provided support that we and the students really needed,” remarked primary school teacher Amparo Lucrecia Chavez. “We received hygiene materials, like soap, water filters, toothbrushes,
towels and cups too.”

To ensure the sustainability of Shexubei’s water supply, CARE also helped residents to form an environmental committee and to establish a tree nursery. Once mature, the trees will be planted in the watershed area to prevent erosion and maintain water quality. CARE’s goal is not only to provide reliable sources of safe water to poor communities, but to ensure the conservation of that water supply and the protection of the area’s natural resources.

For the 607 residents of Shexubei, the new water system marks a critical step forward on the path to overcoming poverty. By building new infrastructure, promoting hygiene education and protecting watersheds, CARE’s Mi Cuenca (“my watershed”) project is helping some 6,000 families in 42 similar communities in western Guatemala to make sustainable improvements in their health and wellbeing.


Unlocking the Demand for Water+ Services

“After using my previous open-pit latrine I had to take a shower to remove the smell. During periods of rain, feces could be seen floating in the runoff water,” recalls Mrs. Raharisolohanitriniala Holdefa, a widow and mother of 5 living the coastal city of Tamatave in Madagascar.

Mrs. Holdefa is one consumer who has benefited from “Rural Access to New Opportunities for Health and Prosperity” (RANO HP), a USAID-funded program implemented by CARE and partners to bring water services to rural Madagascar, engage its people, and encourage sustainable maintenance. She was able to use a microloan from the program to invest in an alternating double-pit pour flush latrine with sealed pits and a hygienic ceramic slab.

Madagascar is a country with 22 million people, but less than 30 percent of its rural population has access to safe drinking water and less than 20 percent use a hygienic toilet. Not only do people lack access, but the water sources that do exist are poorly maintained. In an inventory conducted in 2010, CARE found a water point functionality rate of only 20 percent in 42 rural communities.Lack of safe water inhibits the country’s development and increases the likelihood of poor health and disease among its people.

To address these problems, RANO HP has fostered public-private partnerships between communities and private companies to maintain and manage piped water supply systems. Under the partnerships, these water companies ensure the operation, management, and maintenance of water systems in rural areas. Households pay different fees for water based on whether they share a water connection with other families or have a private one on their property.

Through this project, CARE has seen reliable water services provided by the companies and consistent payment by the users. On the sanitation side, private providers that are linked to microfinance institutions offer a range of latrine models at different price points. RANO HP’s results show that even people with little disposable income in developing countries, like Mrs. Holdefa, are willing to invest in water or sanitation services when given the option. This is encouraging for the long-term return on aid dollars invested in these crucial services.

After three years, RANO HP has been able to increase water supply access and enhance sanitation coverage rates in 26 communes in rural Madagascar. Approximately 25,000 people are estimated to have gained access to an improved water supply as a result, and they are paying to maintain those services just like consumers in higher income countries.

Too many people still lack access to safe water and adequate sanitation, but by using aid funding to unlock the demand—and local payment—for these services, there is hope that people like Mrs. Holdefa will have the opportunity to invest in a better life and in better health for their families.

School WASH