JSI Research and Training Institute

Living Well: Water, Sanitation, and Hygiene for Rural Africa’s Health

Water access, sanitation and hygiene

This project aims to reduce disease transmission in rural Africa by improving water, sanitation, and hygiene in health facilities and local communities.

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To learn more about – or provide significant funding to – this project, please contact Lever for Change.

Project Summary

Availability of adequate water and sanitation for health facilities and families is a problem of global magnitude. Twenty-five percent of facilities lack basic water and 20% lack proper sanitation. Globally, this affects about 2 billion people by allowing infectious diseases to spread. Our program will collaborate with local governments in Guinea, Liberia, Sierra Leone (and two other countries to be determined by Year 4) to improve the quality of primary health services in rural villages, especially for children and mothers. Through water and sanitation improvements and community access to clean water, our program will strengthen infection prevention in approximately 2,000 health facilities and 10,000+ villages/communities. Disease prevention is an investment in human capital, allowing people to thrive at work, in school, and at home. This project will increase opportunities for healthier lives, and improved education and employment opportunities for millions of rural Africans.

Problem Statement

Access to clean water means better health and hygiene. In health facilities, clean water enables health workers to practice effective infection prevention, the most critical element of safe patient care, and an important component of disease prevention and outbreak preparedness. Adequate sanitation and good cleaning practices also make facilities safer and more sanitary for patients and staff. However, according to the World Health Organization (WHO), one in four health facilities lacks basic water services, impacting more than two billion people worldwide. Poor water and sanitation is common in the least-developed countries, especially in rural Africa. The 2014–2016 Ebola outbreak highlighted widespread problems with water access, infection control, and triage in health facilities and communities in Guinea, Liberia, and Sierra Leone. More than 500 health workers died from cross-infection, and thousands of patients died from unsafe care (UNDP). In 2016, JSI found that 59% of Sierra Leone’s health posts lacked access to clean water, 48% had no waste pits or working incinerators, and none had lighting for services after nightfall, like childbirth. These problems are the consequence of a lack of investment in rural communities. Even when infrastructure is upgraded, insufficient maintenance results in premature breakdowns and wasted resources. Poor access to clean water and sanitation is also a widespread problem for families; 785 million people worldwide lack clean drinking water (WHO). In households, simple behaviors that improve hygiene and reduce disease transmission, such as handwashing with soap, are not commonly practiced due to poor knowledge, unfavorable conditions, and limited resources.

Solution Overview

This project will contribute to healthier lives for 10–15 million rural Africans by strengthening disease prevention through enhancements of WASH in health facilities and communities, first in Guinea, Liberia, Sierra Leone, then in two additional countries (see “Amplifying Impact” section). Our ambition is to improve the physical WASH conditions of approximately 2,000 health facilities in these countries by upgrading infrastructure and drilling or digging wells to enable access to safe water. Our program will also support: - Community structures (e.g., FMCs) to develop maintenance plans and source in-kind (labor, materials, etc.) and cash contributions to maintain the project’s infrastructure investments.- Provision and sale of clean water from the new wells to people who live near the health facilities.- Strengthening handwashing and other hygiene behaviors among health workers and residents through evidence-based learning and behavior change approaches. These strategies will help health workers and people living and working in these remote communities reduce disease transmission. The project will operate in partnership with local authorities at every stage to enhance local ownership and sustainability. While the benefits of improved access to clean water and better sanitation will be immediate, the project will also measure progress by assessing improvements in health and wellness, especially of women and children, who are the principal clients of rural health facilities. Better health will allow rural families to live happier and more productive lives.

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