Wash for Public Health

BACKGROUND

The WASH4PH (Water, Sanitation And Hygiene For Public Health) programme, sought to improve health outcomes (including maternal, newborn and child health) of boys, girls, women and men in Ghana’s Upper East Region, with a specific focus on Bongo and Kassena Nankana West Districts. This was achieved by supporting a more integrated approach to public health that incorporates improved WASH into district-wide health service delivery planning and implementation. The programme sought to strengthen and integrate WASH and health planning and deepen understanding and benefits of integrated health and WASH in the beneficiary districts. The purpose was to improve WASH service delivery in schools, health facilities, and communities, in both small towns and rural areas in the Bongo and Kassena Nankana West districts of the Upper East Region of Ghana.

CIKOD in collaboration with WaterAid Ghana (WAG) has been using the strength-based approach in its interventions over the past few years. One such strategy is the use of the Endogenous Development (ED) approach. This approach ensures that communities are fully involved in all aspects of the process in deciding their own strengths, resources, aspirations and playing a lead role in their own development processes.

OBJECTIVES OF THE PROJECT (WASH4PH)

The objectives of the WASH for Public Health Programme included the following:

Building the capacities of communities to ensure that their physical, spiritual, and social assets are mobilized and mapped effectively towards their development especially in the areas of WASH.
Contributing to improved well-being for communities by increasing partners` knowledge and skills on the application of Endogenous development at the national, regional and community levels.
To strengthen the capacity of partners to ensure that community level institutions/ structures are engaging actively with external development partners and are playing their role in sustaining services.
Contribute to project delivery effectiveness, efficiency, relevance and sustainability
Contribute to a functioning Monitoring and Evaluation system, which establishes accurate baselines and tracks progress on outputs, outcomes, and effectiveness in a systematic way.

METHODOLOGY AND APPROACHE TO WASH4PH

The core of CIKOD`s work is to promote Endogenous Development (ED) as an approach to sustainable development. The main strategy for implementation of the WASH4PHP project was the Endogenous Development (ED) process. The ED process promotes community development that empowers and builds on the existing indigenous institutions and resources as a means for them to leverage appropriate external resources for their development initiatives.

This approach ensures that communities are fully involved in all aspects of the processes in deciding their own strengths, resources, aspirations and playing a lead role in their own development processes. This facilitates community development that empowers and builds on the existing indigenous institutions and resources.

ACTIVITIES IMPLEMENTED

Pre-Intervention Community Led Documentation

A pre-intervention community-led documentation exercise was carried out before the start of the intervention in the project communities. The objective of this exercise was to tell the “before” the intervention story of WASH in the various communities. This was done using the Endogenous Development (ED) framework. The training covered the introduction to camera/video handling, assembling of parts and positioning of camera/video and position of self plus direction Community members were trained to use the camera and document the stories of their peers as they tell their story/stories. 18 community members comprising 7 women and 11men were trained.

Mapping of Institutions and Resources in The Community

The core of the ED process is to build on existing resources and institutions with the view to ensuring sustainability. To effectively map out these resources and institutions, 5-7 persons in each community were selected by their respective communities to form teams that led this exercise. This is premised on the local adage that “the stranger has big eyes but cannot see”. The community independently selected the CIRM team members using their own criteria. The selected persons from each community were trained on how to conduct the CIRM using a guide or a checklist. After the training, the ED Catalysts supported the CIRM Teams to gather the information from their respective community members. The information centred on:

Community profile: this captured the community background, religious and spiritual believes, ethnicity, myths, stories, demographic data, perceptions on WASH among others. This information was not to dispute baseline data but rather to give more revelations about the communities.

Resource and institutions mapping: the various resources (physical, material, social and spiritual) were mapped as well as the institutions that managed these recourses. Notable among these resources were the dams/dugouts, water sources, sacred places, rocks/stones, clay deposits etc. The institutions included the traditional institutions like chiefs, women leaders, spiritual leaders/landlords, youth leaders etc. as well as formal institutions like assemblypersons, unit committees etc. The data generated include the roles they play in the community including the roles they play in managing the resources identified in the community.

The information was processed with the support of the ED Catalysts and presented back to the respective communities for validation. During the validation exercise, community members took turns to thoroughly discuss the write up and filled in gaps as and where necessary. The data was captured as a written material as well as community maps depicting the location of the various resources in their respective community.

Community Visioning and Action Planning (CVAP)

Having identified the various resources as well as the institutions that manage them in the communities, the CVAP tool was used to help the communities decide how best to make use of their own resources. The purpose was to enable communities have a conclusive vision statement prioritizing appropriate water, sanitation and hygiene issues as well as developing action plans to achieving the vision. CVAP was used to identify the development direction of the community and how to get there in the context of the institutions and resources available in the community.

In each community the youth, women and men were asked to draw the past, current and future maps of their community from their various perspectives. They then presented their maps to the entire community for validation. After the various presentations had been made, the whole community developed a composite map using the various maps.
Using the currently maps as a working material, communities discussed how they will migrate from the current state into the future vision that they had developed. Various actions were proposed and discussed and this led to the development of Community Action Plans that clearly show what has to be done; how it would be done; resources that would be needed as well as who takes up the responsibility.

Fireside Chats

55 Fire side chats were organized in the 2 districts during the period under review. Discussions centered on general development in the communities especially the changes that were taking place in the community. Average attendance at these meetings was about 50 women and 35 men. Notable among these changes was the use of tippy taps by many households in the project communities. This platform also created space for the women’s groups in some of the communities to share their bye-laws and their development aspirations with the rest of the communities.

Interestingly, most of the discussions that took place within the final 24 months focused on the collapse of latrines and how to reconstruct them. Some community members reflected on the changes that have occurred in their communities because of the construction and use of household latrines. They noted that their animals used to chew rubbers with some salt content from the market and died but ever since they were educated to start burning the rubbers, their animals hardly die from this problem. Some members also remarked that the houseflies in their community have reduced because they no longer defecate openly. This also reduced the incidence of diseases in their respective communities.

One interesting phenomenon that emerged was the “groundnut shelling space” which is a platform for cultural education especially for the youth as noted at Badunu. This stemmed out of the cultural awakening through storytelling during the fireside meetings. The groundnut shelling space resonates very well with the fire side chats.
Another phenomenon that emerged was the “Atai Tea Base” as discovered at Boko Asakwa. Young men in the community gathered under a shed and brew the “Atai Tea”. They use relatively small pots with each round of brewing serving maximum four people. While they waited for their turn, they engaged in hearty discussions most of which centred on sports, movies etc. Using this same platform, they were encouraged to discuss issues on the development of their community. During one of such meetings, they resolved to help the women in keeping their environment clean and free from polythene as well support household to dig up pits for the construction of household latrines.

One major outcome of the community fireside engagements is the increased sense of commitment and responsibility towards communal activities that are organized in the community.

In all the project communities, the elders in the communities recounted their previous experiences with similar platforms that brought community members together in the evenings especially the weekends. These platforms served as spaces for cultural education as well as entertainment. In some of the communities, community members stated that they used to do this some time ago. Through the engagement with them, they now see the need to go back and use the platform again. The Akania community used the fireside chat platform to discuss their challenges prior to the 2016 elections. They then engaged the Member of Parliament (MP) on their water problem before the elections demanding that no water no elections.

In addition to the community level fireside meetings stated earlier, three paramountcy-level fireside meetings took place during the period. Two were done in collaboration with the paramount chiefs of Bongo and Kayoro. Communities that were doing well shared their stories with other communities within their respective paramountcy. The third was done to celebrate the Aberingabissi community in the Bongo paramountcy for ensuring that every household had a toilet as well as sensitizing neighboring communities to put up household latrines.

Radio Programme

The radio programmes commenced with a pre-assessment of hygiene behaviours of community members in the project area. This was carried out on Nabina Community Radio in Navrongo, Sahel FM in Bolgatanga and A1 Radio also in Bolgatanga. The purpose of this intervention was to establish the current situation in order to serve as a baseline for assessing the impact of the WASH4PH Project. A questionnaire was developed to assess current knowledge/awareness of hand hygiene and the critical times for hand hygiene practices.

The radio-based pre-assessment, dubbed “The Hygiene Segment” was aired three times a day on each station. It took place between 10 am and 12 noon for the morning, 3pm and 6pm for the afternoon and between 7pm and 8pm for the evening. Each segment lasted 30 minutes. The assessments run simultaneously on all the three stations for five days.

A total of 369 participants participated in the one-week show which involved all the 3 radio stations. This was made up of 263 males and 106 females.

Radio Discussions on Nabina Radio In Navorongo And Bongo Radio in Bongo

Over the period under review, 15 radio discussions and 7 documentaries were organized in the KNW and Bongo districts.

The radio discussions centred on curbing open defecation and the need for community members to own individual latrines. Other discussion created the opportunity for ODF communities to share their achievements with other communities in the two districts.
7 TV documentaries were produced during the period under review. The documentaries were on hygiene and sanitation, the Endogenous Development Process and promoting good sanitation practices through agroecology, role women groups are playing on WASH as well as improving sanitation and health through the cultivation of indigenous vegetable gardens.
8 jingles were aired thrice in both Bongo as well as Navina radio in Navrongo. Each airing covered a period of one month. The jingles were composed with songs on sanitation and hygiene as well as WASH messages from traditional authorities in Bongo and Kayoro.

Radio Extension Facility At Bongo Market.

A radio extension facility was established in Bongo. On market days which occurs every 3 days, the facility airs jingles (songs and messages on WASH) sensitizing and educating the public.

WASH Cooperative Development Programmes

Supporting women groups to grow into becoming self-reliant and sustaining cooperatives was one key output of WASH4PH. Over 22 women’s groups were engaged during the project period. It is worth noting that 17 of these groups were eventually registered with the department of cooperatives. The ED process helped these groups to contribute to improving hygiene and sanitation issues in their respective communities. Issues discussed included organizational development for the groups leading to the development of their visions, missions, as well as the constitutions and byelaws to govern their activities. A compilation of the vision, mission, core activities and constitution from each of the group has been documented for sharing with other stakeholders.

Environmental Analysis and Training

Waste collection and its management in general has taken a central stage in Ghana’s development agenda. The implications of the mismanagement of waste has resulted in both physical and health implications. To address this menace, the WASH for Public Health Project (WASH4PHP) was designed among other objectives to reduce health risks related to poor hygiene and sanitation thereby contributing to improved community well-being.

To achieve this, the Environmental Analysis and Training component of the project created a platform for project communities to discuss pragmatic ways in managing the waste generated in the communities. The key objective of this activity was to:

Identify specific environmental challenges in partner communities.
Identify and pass on simple environmental management methods like composting and tree planting in the community.
Strengthen the awareness of environmental management in the various communities.

PROJECT OUTCOMES

Increased awareness of hygiene practices in project communities. This is evidenced in the number of hand washing facilities (Tippy Taps) in various households. There are also clean up exercises organised by communities e.g at Abulu, Asakwa, Saa, Balungu, Akania, Kawania, Saboro, Nakong Saboro, Asaloko, Galangrun, Awiisi, Apeelinga, Asakwa, Soe-Yidongo and Aberingabissi to mention a few.
WaterAid and CIKOD in collaboration with the Bongo and KNW district assemblies organized celebrations for the Nineteen (19) partner communities that have achieved ODF status and certified at both the District and Regional levels. The communities include Nakong Saboro, Kumbulu-Kawania, Kadania (Kadania, Kadania Mwenia), Aneo, Adungo, Akania (Kayoro Akania, Akania Naboo), Kayoro-Saboro (Saboro Songo, Saboro Zingo) Akunduo-Apeelinga, Asaloko-Agoobou, Asaloko-Tinganepoore, Yidongo-Abungabiisi, Yidongo-Kantiisi, Yidongo-Voorese, Lungo-Dagongo, Boko-Asakwa, Feo-Asebre
Follow ups and monitoring support were conducted to encourage communities in-waiting for ODF verification as well as other project communities to improve their sanitation and hygiene practices. Kodorogo-Gingirigo and Akunduo-Bokin are potential communities in the Bongo district while Abulu Piukuri and Kachala are potential communities for KNWD. Data on ODK Collect for households in Kodorogo-Gingirigo and Abulu have been taken.

Learning, Sharing and Assessing Visits (LeSA)

LeSA is a peer review mechanism that enables communities with similar development agenda to exchange developmental experiences and knowledge. The methodology guides communities to learn from each other and share experiences amongst themselves – Learning, Sharing and Assessing (LeSA).

Ten Learning, Sharing and Assessing (LeSA) activities were organized during the period under review. Three of such activities were organized for several communities to converge and learn from one community. These visits took place at Kadare- Aberingabiisi and Apeeliga communities in the Bongo District and at Kayoro community in the Kasena Nankana-West District. An average number of 450 persons participated in each of these festival-type meetings with women numbering almost 60% of community people in attendance.

The purpose of the LeSA activity at Aberingabiisi was to create a platform for the host community to share their experiences and changes that have occurred since CIKOD/WAG entered their community. This was because every household in that community constructed a toilet within a short time. Neighbouring communities such as Azangabiisi, Zorko-Kodorogo, Akugubia, Balungu-Nabiisi, Awiisi, Asakwa, Dagongo, Akusebiisi and Abagnabiisi participated in the programme.
The meeting at Kayoro was dedicated to women from Akania, Aneo, Kawania, Banyiu, Navem, Adongo, Akaa/Acogson, Kabaa/Kachele, Saboro, Kadania, Wombio, Awongo and Kumbulu communities in the Kayoro Traditional Area. The role of the family in WASH development was one of the aspects that triggered participation and interesting discussions. Participants shared on the need for the families (households) to construct and use their own toilets without relying on external material support. They also shared the need to improve personal and environmental hygiene including mounting and practicing proper hand washing at the critical times, ensuring children’s personal hygiene and regular clean up exercise among others. The chief of the traditional area, PE Oscar Batabi Tiyiamu called on household heads to support their respective families to prevent water contamination by ensuring safe water transport, storage and consumption.
Similarly, the learning festival at Apeelinga provided Asaloko, Galangrun, Dagongo, Asakwa, Awiisi, Aberigabissi, Tadongo, Yidongo, Atukilla, Asaberi, Kabre, Vea-Tindongo, Vea Kulpelika, Zorko-Atiabissi, Apeeliga, Akunduo-Bokin, Akunduo-Zuen, Samboligo, Zorko-Kodorogo and Akugubia communities to share their experiences with each other.
A Learning visit was also organized for 65 selected women from groups in the project communities to SWOPA at Sirigu. Participants were taken through income generation activities of women such as basketry, pottery, weaving and arts. At the end of the visit, the women were exposed to other designs especially the basketry that have higher values and how they the women could earn more money to take care of their families.
Six other learning and sharing visits were organized for Kalvio-Gugoro, Abulu, Kayoro, Kawania, Asaloko, Asebre and Kabre communities. These visits were climaxed with discussion at the end of which the visiting communities were motivated to build household toilets and practice safe hygiene in their respective houses.

CONCLUSION

Having laid a good foundation in the previous years through the ED process, we see greater commitment and leadership from community members. This is evidenced in the resilience demonstrated in rebuilding toilets as well as the initiation of community-led activities and projects. We can reiterate and re-affirm the position that when people are empowered to lead their own development initiatives in a socially and culturally accepted way, remarkable and sustainable changes take place.

If sustainability is embedded into project conception, design through to implementation based on community ideals and ideas (culture, worldviews) it would promote the durability of WASH interventions. Sustainability will be practical and real if situated within the community socio-cultural systems.