United Purpose WASH Strategy Review

United Purpose WASH Strategy Review Synthesis Report Consultants Richard Carter 1, Sue Cavill 2, Jeremy Colin 3 Final version May 2019

Malawi, a solar-powered multiple-use water supply in Dedza district

richard@richard-carter.org sue.cavill@outlook.com 3 jeremy@jemcolin.co.uk 1 2

Table of Contents Table of Contents .................................................................................................................. ii Figures ................................................................................................................................. iii Tables................................................................................................................................... iii Text boxes ............................................................................................................................ iv Acknowledgments ................................................................................................................ iv Abbreviations ........................................................................................................................ v Executive summary ............................................................................................................... vi 1

Introduction to United Purpose ......................................................................................1 1.1 1.2

A brief overview of the organisation ......................................................................1 UP’s focus, countries and development sectors .....................................................2

2

The place of WASH in UP’s work ....................................................................................3

3

Approach to the review ..................................................................................................6 3.1 3.2 3.3 3.4 3.5 3.5.1 3.5.2 3.6

4

Terms of reference .................................................................................................6 Commencement ....................................................................................................6 Deliverables ...........................................................................................................7 General approach ..................................................................................................7 Components of the review .....................................................................................7 Country visits ......................................................................................................7 Desk reviews ......................................................................................................8 This report..............................................................................................................8

Looking back ..................................................................................................................8 4.1 4.2 4.2.1 4.2.2 4.2.3 4.2.4 4.2.5 4.2.6 4.3 4.3.1 4.3.2 4.3.3 4.3.4 4.3.5 4.3.6

Introduction and basis for evaluative judgments ....................................................8 Evaluation of UP’s WASH programming.................................................................9 Relevance ...........................................................................................................9 Effectiveness ....................................................................................................11 Efficiency ..........................................................................................................12 Sustainability ....................................................................................................13 Gender Equality and Social Inclusion (GESI) .....................................................15 Impact ..............................................................................................................18 Wider observations ..............................................................................................19 Innovation ........................................................................................................19 Partnerships......................................................................................................21 Advocacy and influencing for outcomes at scale ..............................................22 Integration........................................................................................................23 Monitoring and evaluation ...............................................................................23 The challenge of (dis)continuity ........................................................................25

ii

4.3.7 4.4 4.4.1 4.4.2 4.4.3 4.4.4 4.4.5 5

Documentation of learning...............................................................................25 Conclusions from the “looking back� component................................................26 From competence to consistency.....................................................................26 From projects to system strengthening ............................................................26 From expertise on the ground to influence nationally ......................................27 From invisibility internationally to a global presence ........................................27 Where to now? .................................................................................................27

Looking forward ...........................................................................................................28 5.1 5.1.1 5.1.2 5.1.3 5.2 5.2.1 5.2.2 5.2.3 5.2.4 5.2.5 5.3

Three key inputs...................................................................................................28 A Global WASH Adviser ...................................................................................29 A working budget ............................................................................................29 A document .....................................................................................................30 Five key outcomes ...............................................................................................31 Consistent quality across country programmes ................................................31 Systematically documented learning ................................................................31 Planning beyond projects.................................................................................31 Enhanced reputation and profile ......................................................................32 Stable, more predictable funding.....................................................................32 Intended impact...................................................................................................32

Material outputs of this assignment ....................................................................................33 Annex A United Purpose WASH country snapshots .............................................................34 Annex B Table of contents of Inception Report ...................................................................40 Annex C Benchmarking good WASH practice .....................................................................41 Annex D Summary of general and WASH strategies of other organisations ........................45 Annex E Draft job description for a Global WASH Adviser ..................................................55 Annex F Communicating the impact of WASH on health ....................................................57

Figures Figure 1 UP's keys to community empowerment ...................................................................2 Figure 2 Strategic options for UP's WASH programming ....................................................28 Figure 3 Inputs, activities and outcomes of a global WASH strategy ...................................28

Tables Table 1 United Purpose subsidiaries......................................................................................1 Table 2 Overview of WASH content of UP country programmes (last five years) ...................3 Table 3 Global WASH Adviser two-year working budget ....................................................29 Table 4 Possible table of contents for a Global WASH Strategy ..........................................30 Table 5 Material outputs of the global WASH review ..........................................................33

iii

Text boxes Box 1 Project funding challenges in Malawi and Bangladesh ................................................5 Box 2 Examples of UP's community-level relevance ..............................................................9 Box 3 The GoTAS project, Mozambique .............................................................................10 Box 4 Quality and outcomes of UP's WASH interventions ...................................................12 Box 5 Sustainability risks to sanitation outcomes in Nigeria.................................................14 Box 6 Gender equality and social inclusion in UP country strategies ...................................15 Box 7 Examples of UP's work addressing spatial- and group-related inequalities ...............16 Box 8 Examples of UP's work addressing individual inequalities .........................................17 Box 9 Examples of WASH-related innovations implemented by UP in West Africa .............20 Box 10 Observations about the quality of UP's partnerships ...............................................22 Box 11 UP global WASH indicators [Source: Annual Report 2017-18] .................................24

Acknowledgments We would like to thank all those from United Purpose’s offices in Cardiff and the seven countries visited during this assignment, for time generously given, and views and experiences openly shared. Thank you too to the three Foundations which together initiated this assignment and supported the work financially and in terms of quality assurance.

iv

Abbreviations CBM

Christian Blind Mission

CBO

Community-based Organisation

CEO

Chief Executive Officer

CHISHPIN

Community-led Health Improvement through Sanitation and Hygiene Promotion in Nigeria

CLTS

Community-led total sanitation

CUMO

Concern Universal Microfinance Organisation (Malawi)

DFID

Department for International Development (UK Aid)

DGIS

Directorate-General for International Cooperation (Netherlands Government)

DRR

Disaster Risk Reduction

EVD

Ebola virus disease

GBP

Great Britain pound sterling

GESI

Gender equality and social inclusion

GoTAS

Governação Transparente para Agua, Saneamento e Saúde (Transparent Governance for Water, Sanitation and Health) – project in Mozambique

GSF

Global Sanitation Fund

HIV/AIDS

Human immunodeficiency virus infection / acquired immune deficiency syndrome

(I)NGO

(International) non-governmental organisation

JMP

Joint Monitoring Programme (WHO/UNICEF)

LGA

Local Government Area (Nigeria)

M&E

Monitoring and evaluation

MDG(s)

Millennium Development Goal(s)

MWK

Malawi Kwacha

NCVO

National Council of Voluntary Organisations

ODF

Open Defecation Free

OECD-DAC

Organisation for Economic Cooperation and Development – Development Assistance Committee

RUSHPIN

Rural Sanitation and Hygiene Promotion in Nigeria

SDC

Swiss Development Corporation

SDG(s)

Sustainable Development Goal(s)

SHARE

Sanitation and Hygiene Applied Research for Equity

SM

Sanitation marketing

SWOT

Strengths, weaknesses, opportunities and threats

TA

Traditional Authority (Malawi)

TicMbay

Techniques de l'Information et de la Communication orientées vers l’Agriculture (ICT for Agriculture) – project in Senegal

TOR

Terms of reference

UNICEF

United Nations Children’s Fund

UP

United Purpose

USAID

United States Agency for International Development

VFM

Value for money

WASH

Water, sanitation and hygiene

WHO

World Health Organisation

v

Executive summary This Synthesis Report This is the Synthesis Report of a review of the global water, sanitation and hygiene (WASH) programming of the international development charity United Purpose (UP). The review has been funded by a consortium of foundations (One Foundation, Vitol Foundation and Waterloo Foundation) and undertaken by a team of three independent WASH consultants.

The review was undertaken between October 2018 and May 2019.

United Purpose UP began life as Concern Universal in 1976. Today it is a major INGO, focused on community development and empowerment. Together with its partners and subsidiaries it works in 15 countries in Latin America, Sub-Saharan Africa and Asia. It is a highly decentralised organisation, with an annual turnover of about GBP20m, of which approximately 95% is restricted funding. UP reports its WASH programming under the heading “better health”. This programming stream constitutes about one quarter of UP’s expenditure overall, and it includes health-related projects which extend beyond WASH. WASH in UP’s country programmes In UP’s country programmes, WASH is included as stand-alone development projects, incorporated within wider livelihoods and DRR projects, and as the subject of humanitarian interventions. At the present time, UP’s country programmes in Malawi, Nigeria and Guinea contain significant stand-alone WASH projects; in recent years in The Gambia and Senegal WASH has generally been a component of wider development projects; in Bangladesh, WASH is currently undertaken within a humanitarian emergency response; while in Mozambique, UP is engaged in an important WASH governance initiative. All seven countries mentioned were visited in the course of this assignment.

Key findings of the review On the positive side, 1. UP’s WASH programming is generally highly relevant to the needs of those it aims to serve, of high quality, and effective in terms of extending access to long-lasting WASH services and behaviours.

2. In general, UP undertakes its WASH projects in a cost-effective manner, and as an organisation it maintains appropriately modest but efficient offices and support services.

3. The services and practices which UP provides and promotes through its WASH work are long-lasting, primarily because the quality of the physical works and community engagement undertaken is high.

4. UP is well aware of the need to address gender equality and social inclusion (GESI) systematically and seriously. This is reflected to some extent in its literature and some of its country programme documents.

5. UP’s WASH projects have contributed to significant impacts on many or most of the communities and partners involved. Impacts on health have probably been smaller than UP has sometimes claimed, but this is not to say that the interventions themselves have been inappropriate. vi

6. There is evidence that UP has been open to, and creative in, undertaking innovations to address community problems regarding WASH. 7. UP generally works effectively with a wide range of partner organisations, including, in a few cases, in large consortia.

8. Where WASH is a small part of wider integrated projects, there can be a risk that quality may suffer. We did not observe this in the present review.

However, 9. UP’s focus is on responding to (sometimes very short-term) project funding opportunities, “following the money”. This results in a failure to secure sufficient core funding to achieve continuity of operations between projects, a corresponding risk of losing in-house WASH specialists and institutional memory, the neglect of reflection and learning, and communities experiencing “stop-start” interventions.

10. UP works routinely with local governments, but rarely if ever through them and even more rarely in a way which is led by them. This means that weaknesses of local governments persist; UP is not significantly engaged in efforts to address systemic weaknesses (one project in Mozambique provides the exception to this rule).

11. True sustainability requires effective WASH systems, locally and nationally; strengthening of WASH systems needs to become a greater priority for UP. By neglecting to focus sufficiently on local government weaknesses, true sustainability of WASH interventions is put at risk.

12. UP does not consistently and systematically plan and implement projects with a GESI focus. Some good practice exists within the organisation, but it is not routinely applied.

13. UP participates in national sector fora in countries where it has a significant scale of WASH activity. It does not however see such engagement as central to its raison d’être.

14. In WASH, UP is virtually invisible on the international stage. It contributes little to global thinking. It also misses opportunities to access funding administered at global level, including funding for multi-country programmes, many of which are implemented by consortia. This is a further consequence of UP’s very limited core funding.

15. UP’s global monitoring of its WASH programming is limited in scope and depth. It is not clear to what extent individual country programmes undertake more sophisticated monitoring, but we found no evidence of an appropriate organisation-wide approach.

16. In its evaluations, UP mostly undertakes relatively low-budget project- and outputfocused studies; few country programme or impact evaluations are undertaken.

Opportunities for in-depth learning are thus foregone.

17. UP’s documentation of its WASH sector learning is virtually non-existent.

A way forward In light of the foregoing, we propose that UP should take a major step up in its WASH programming. We recommend that UP should employ an experienced and well-connected WASH professional to lead in (a) the articulation of a clear WASH Strategy and M&E framework, (b) sharing of that strategy among potential collaborators and donors, (c) undertaking documentation of learning from country programmes, (d) representing UP’s WASH interests internationally, (e) supporting individual country programmes, and (f) preparing multi-country and consortium bids for larger, longer projects with inclusion of adequate core-funding elements.

vii

1 Introduction to United Purpose 1.1 A brief overview of the organisation United Purpose (UP) was originally established as Concern Universal, incorporated as a charitable company limited by guarantee in September 1976, and registered as a charity in England and Wales in December of the same year. It continues to this day as a UK-based generalist international development INGO. In early 2014 the present incumbent, Kathryn Llewellyn, took over the position of CEO of the organisation which was still named Concern Universal. Soon afterwards, UP merged with the Bakewell (UK)-based charity Village Aid. This strategy of mergers, acquisitions and partnerships has continued to the present.

In 2016 Concern Universal rebranded as United Purpose and moved its UK office from Hereford to Cardiff. At around the same time it merged with International Inspiration, the Sports Charity which aimed to maintain the legacy of the London 2012 Olympics.

In the period since 2016 UP has consolidated its mergers, and its published list of subsidiaries is currently as shown in Table 14. Further relationships are being developed with a number of other UK, US and European organisations. The extent to which potential synergies are realised between its component organisations is not however clear.

Table 1 United Purpose subsidiaries Organisation

Brief description

Financial scale

International Inspiration

Using the convening power of sport to empower and educate young people (especially girls and women)

No longer listed separately on Charity Commission website – fully merged with UP in 2016

Village Aid

Community-led solutions across livelihoods, health and rights, in West Africa

Income has been steadily falling from £318k in 2014 to £130k in 2018

CUMO

Malawi-based micro-finance organisation established in 2000 and wholly owned by UP described as not-for-profit, social enterprise

Serves more than 86,000 clients, made positive net surplus of MWK17m (approx GBP18k) in 2016

Carbon UP

Offsetting real and putative carbon emissions through sale of Gold Standard carbon credits

Not yet clear

UP is a major5 UK-based international development charity, with an annual expenditure of about GBP20m6. Approximately 95% of UP’s funding is project-specific (ie restricted) in Sources: https://united-purpose.org/our-initiatives; UK Charity Commissioners Charities with turnover in the range GBP10-100m per annum have been categorised in this way by NCVO (https://www.ncvo.org.uk/images/documents/policy_and_research/Britains-biggest-charitieskey-features_final.pdf ) 6 Expenditures in the last five reporting years were 2013-14 GBP21.7m; 2014-15 GBP 17.9m; 201516 GBP19.3m; 2016-17 GBP30.2m; 2017-18 GBP 18.5m. The high figure in 2016-17 was because of a large grant in-kind from the World Food Programme.

4 5

1

nature. UP is a highly decentralised organisation, with the country offices determining local context-specific strategies, and undertaking most of the fundraising.

UP has been recognised through a number of awards, most recently the award of CEO of the year to Kathryn Llewellyn in the Welsh Women’s Awards on 3rd April 2019.

1.2 UP’s focus, countries and development sectors United Purpose’s focus is on the alleviation of poverty, and empowerment of people and communities to take charge of their own development. In its branding and public stance, UP conveys its ambitions in terms of: • • •

Ending poverty and inequality Moving beyond aid Empowering communities to be independent

A draft global strategy7 has been broadly agreed internally, but at the time of writing work is under way to refine and simplify it, and turn it into a document which can both guide the organisation’s work and communicate clearly to a wider readership.

UP highlights the need to move from a response to poverty which focuses on meeting basic needs, to one which recognises the ways in which global and local systems keep the poor in poverty. It refers to “the transferal of power and the enablement of people to improve their lives themselves”. UP sees “sustainable access to, and influence over: money, information, and institutions” as key to this empowerment. Figure 1 (from UP’s draft publicfacing Global Strategy) illustrates this. What is less clear so far is how exactly interventions in particular sectors (including WASH) combine with these cross-cutting issues to achieve UP’s broader goals. This articulation by UP is an on-going work in progress.

Figure 1 UP's keys to community empowerment

At present United Purpose has offices in 8 countries8 and it has projects with partners in a further 7 countries9,10. Although it is beyond the scope of this assignment to undertake a The Strategy was developed through a four-month internal consultation process in 2018 involving UK and country offices and the Board.

8 Malawi, Mozambique, Ghana, Guinea, Nigeria, Senegal and The Gambia, Bangladesh, Brazil 9 Cameroon, Kenya, Zambia, India, Uganda, Rwanda and South Africa 10 https://united-purpose.org/where-we-work 7

2

comparative analysis of UP’s broad scope of work across countries, it is clear that the nature and mix of work in the countries varies widely according to need and opportunity.

For at least the last five years, UP has reported its work under the headings of: • • •

Resilient lives Better health Upholding rights

The first of these, representing two-thirds of annual average expenditure (about GBP15m per year), includes most of UP’s work in livelihoods and food security, DRR and climate resilience, and conflict resolution.

‘Better health’ has accounted for about one quarter of UP’s annual expenditure over the last five years (averaging around GBP5m). This category includes UP’s work in WASH, but also other significant interventions such as UP’s Ebola preparedness activities in West Africa during the Ebola Virus Disease crisis there (2014-16). Consequently WASH in United Purpose, at the present time, should be seen as a relatively small-scale activity, with significant scale and impact in only a small number of countries (see chapter 2).

The third category, ‘upholding rights’ is the smallest in financial terms (averaging 6% or GBP1.2m per annum over the last five years).

2 The place of WASH in UP’s work UP’s global WASH programming is diverse, and the focus and scale of activity varies greatly from one country to another. Table 2 illustrates this diversity. In some countries (Bangladesh and The Gambia) WASH programming mostly happens in the context of emergencies or disaster risk response, while in others it is normally more development-oriented (though the impact of the March 2019 cyclone Idai has already affected that balance in Mozambique and Malawi). Similarly, some country programmes mostly implement stand-alone WASH projects (Malawi, Nigeria and Guinea) while in others, WASH interventions tend to form part of projects or programmes with a broader scope, typically under the umbrella of livelihoods (‘resilient lives’) or ‘better health’. Mozambique is somewhat unusual in having a large WASH governance programme, implemented in partnership with another INGO (SNV).

Table 2 Overview of WASH content of UP country programmes (last five years)11 Country Programme Focus Country Programme Focus Humanitatrian Humanitatrian DRR DRR

Development Development

Malawi Malawi Nigeria Nigeria Mozambique Mozambique Senegal Senegal Gambia Gambia Guinea Guinea Bangladesh Bangladesh Brazil?

Brazil?

Key Key

/ /

WASH content of WASH content of country programme country programme

Stand-alone WASH Stand-alone WASH projects projects

WASH integrated in WASH integrated in other projects other projects

WASH technical focus WASH technical focus Water supply Water supply

Sanitation & hygiene Sanitation & hygiene

WASH policy WASH policy level engagement level engagement

Substantial Substantial Limited Limited None / Not applicable None / Not applicable

This table was prepared before Cyclone Idai devastated parts of Mozambique and Malawi in early March 2019.

11

3

For further information on the WASH content of each country programme, see the ‘country snapshots’ in Annex A. Project grants range from a few thousand to multi-million pounds - there seems to be no typical size. It follows that the scale of WASH activity also varies widely; some WASH projects operate in multiple districts over several years (as in Nigeria and Malawi) while others target only a modest number of communities or schools and are funded for just a single year or even (in rare cases) a few months. The latter includes many emergency projects, though there have also been also some development–oriented projects with fairly short timeframes.

While UP’s WASH programming is varied, a number of trends have emerged from the country visits conducted for this review: •

In most UP country programmes, WASH activity overall has reduced in recent years, and with it the number of WASH specialists employed. Bangladesh and Mozambique, for example, no longer have any permanent WASH technical staff whereas both had dedicated WASH teams in the past. Inevitably, such changes result in some loss of institutional memory on effective WASH programming. Nigeria is a notable exception, as WASH dominates the country programme thanks largely to funding from the Global Sanitation Fund, though the current round of funding will end this year. Malawi also has a sizeable WASH team, though it has reduced by more than half in recent years from around one hundred people to less than fifty.

•

The profile of sanitation and hygiene promotion has grown considerably in comparison to water supply, which dominated programming in earlier years (particularly borehole drilling and handpump installation). This change is much in line with sector trends, as many countries met their water-related MDG targets in 2015 while sanitation lagged behind. Furthermore, the emergence of Community-led Total Sanitation (CLTS) as a powerful tool for sanitation and hygiene promotion has led many development agencies to engage more actively in this area. Combined with sanitation marketing (SM), it is now possible to deliver sanitation results at scale in a relatively short period, and at relatively low cost.

•

UP prioritises community empowerment and the focus of WASH activity remains overwhelmingly at community level, with success defined primarily in terms of the number facilities installed and number of people benefitting. UP’s global WASH Capability Statement tends to reinforce this positioning. There are accompanying efforts in some projects to enhance local government capacity (especially in Malawi, Mozambique and Nigeria) but country offices tend not to be heavily engaged in the sector at policy level. The impression gained from country visits was that UP is seen primarily as an implementing agency and not a major player in support to sector strategy and planning; institutional strengthening; or knowledge management. This is not to downplay UP’s achievements at community level, which have at times been very impressive, for example delivery of the first ODF Local Government Areas in Nigeria and the exceptional longevity of some rural water points and ODF achievements in Malawi, where UP is recognised as a leading WASH implementing NGO.

Several factors have influenced the way in which UP’s global WASH programming has evolved: 4

•

UP’s global strategy is currently in draft form and (we understand) may change before it is formally adopted and made public. The current draft identifies a number of broad thematic priorities applicable across multiple sectors (better health, resilient lives, upholding rights) but does not include any specific objectives or commitments relating to WASH. Furthermore, not all country offices have a Country Strategy and only one (Malawi) has a Country WASH Strategy.

•

Country offices are responsible for generating their own funding, much of which is accessed by responding to calls for proposals from donors or other development agencies. To a large extent, therefore, their project portfolios reflect the funding opportunities currently available. In several countries, the availability of bilateral funding for WASH has reduced or ceased in recent years. Taking DFID as an example, it no longer supports WASH in Malawi while in Nigeria its funding is restricted to a few focal states which do not overlap with UP’s established programme areas. DFID and a number of other bilateral agencies are still major supporters of WASH, but there is a noticeable trend towards funding fewer, but larger, multi-country programmes planned and funded at global level. UP only occasionally pursues this type of funding, with mixed success.

•

While the availability of ‘traditional’ donor funding for NGO WASH programmes is reducing, there has been a growth in funding by charitable foundations and the private sector. This funding is valuable, but projects tend to be shorter, and sometimes more narrowly focussed, than those funded by traditional donors. This can result in some difficult compromises, for example when there is enough time to install new facilities but not enough to put in place essential arrangements to support sustainability. Similar challenges can arise even with traditional donors in the case of emergency (and postemergency) projects (Box 1).

•

UP is a highly decentralised organisation and the content of each country programme is also influenced by the priorities of the country office leadership.

•

The WASH component of some country programmes is a historical legacy, having been part of an emergency response which triggered the establishment of the country office.

Box 1 Project funding challenges in Malawi and Bangladesh At one site visited by the review team in Malawi, UP had been contracted for a three- month CLTS project in a location recently affected by cholera. According to extension staff, there was barely enough to time to complete the triggering process and very little for follow-up to ensure that the communities became open defecation-free (ODF).

In Bangladesh, former UP WASH staff commented that they had implemented a School WASH project with a timeframe so tight that it only allowed for the completion of physical works; there was very little space for hygiene promotion and other ‘soft’ activities needed to put in place viable operation and maintenance arrangements.

These examples highlight the limitations of working as a sub-contractor, or junior implementing partner, on projects designed and controlled by others; it is not always possible for UP to fully apply what it knows to be good practice in WASH programming.

5

3 Approach to the review 3.1 Terms of reference The terms of reference for this assignment stated as its core purpose “Evaluating the strengths and weaknesses of UP’s WASH work globally, and make (sic) recommendations for improvements”.

In the background section of the TOR the following statement of intent was made: ”UP would like to carry out a global review of our WASH work to evaluate our strengths and weaknesses across our WASH work. We hope the review will enable us to develop a more coherent WASH strategy, helping us with better programming within our Country Programmes and globally, and helping our donors to understand where best to invest to have a greater programmatic and/or strategic impact”.

In the terms of reference, the consultants’ expression of interest, and subsequent discussions with the assignment’s funders12 it was agreed that this Synthesis Report would present, in roughly equal measures, a “looking back” or evaluative perspective; and a forward-looking contribution to the WASH strategy which would be subsequently elaborated by UP. As far as the evaluative component is concerned, the TOR called for “... evidence of the relevance, efficiency, effectiveness, impact and sustainability13 of UP’s global WASH work”.

In the consultants’ Inception Report, comments were made about the extent to which these themes and the 22 evaluation questions listed in the TOR were able to be rigorously evaluated; but the principle that the team should make evaluative judgments on all these themes was accepted. Furthermore, we have commented on an additional 8 themes which were identified in the first part of the work, as set out in chapter 4.

In the “looking forward” part of this report (chapter 5) our intention is to go beyond the usual set of recommendations which would be part of any evaluation. We provide as much as possible of the rationale for, and content of, a WASH Strategy, short of explicitly drafting that document. The reasons for this are two-fold: first, our belief that an organisational strategy should be drafted and owned by the organisation, rather than by external consultants; and second, because the WASH Strategy will need to dovetail with the organisation’s Global Strategy, which has not yet been completed in its public-facing form.

3.2 Commencement The initial assignment meeting took place over two days, 15th-16th October 2018, with the consultants in Cardiff and most of the participating country offices connected remotely for an opening webinar and discussions. The consultants’ contracts were signed on 29th November. The first country visits (to Malawi and Mozambique) took place in December 2018.

One Foundation, Vitol Foundation, Waterloo Foundation.

In other words, the OECD-DAC generic evaluation criteria http://www.oecd.org/dac/evaluation/daccriteriaforevaluatingdevelopmentassistance.htm 12 13

6

3.3 Deliverables The contract with the consultants called for two specific deliverables, namely an Inception Report and this Synthesis Report.

The Inception Report was drafted and first submitted on 31st October 2018. After comments from the Quality Assurance group14 a revised version of the Inception Report was submitted to UP on 5th December 2018 and the final version was submitted on 24th January 2019. Annex B shows the table of contents of the final Inception Report.

This Synthesis (Final) Report was required to be of maximum 40pp excluding annexes, including an executive summary of maximum 2pp. The process for feedback prior to its finalisation, as proposed by the consultants and agreed by UP at meetings in Cardiff 20th21st March 2019 was that a draft would be submitted to UP and the funders by 19th April, with time for comments given until 17th May, and the report being finalised by 31st May.

3.4 General approach In our EoI we expressed the view that “ ... our ideal approach (would) be one which is as collaborative as possible; hence we propose regular meetings and calls to exchange views and report on progress. Furthermore, in the inception phase we would agree on a number of interim reports in order that all involved are fully informed”.

We also said that “(we would) place high importance on face-to-face meetings in the inception phase particularly, as the evaluation criteria, review questions and methods, and the selection and logistics of country visits are jointly determined”.

This collaborative ambition has largely been fulfilled, both through regular discussions with UP’s focal person, and through the numerous discussions held remotely and in-country.

3.5 Components of the review 3.5.1

Country visits

The TOR called for visits to four countries. The consultants took the view that a wider spread of countries, especially spanning Africa and Asia, would be preferable especially in view of UP’s highly decentralised nature. The consultation and participation which we sought and highlighted in our EoI would only be possible with more country visits, budget permitting. In the event we were able to stretch the travel budget to enable at least one consultant, and in a few cases two, to visit seven countries15.

Although not required contractually, we wrote up each country visit as a formal visit report, the content of which was checked and validated by the country programmes. Factual errors and omissions were corrected, but independent evaluative judgments were the responsibility of the consultants. The country reports (typically 10-20pp in length, excluding annexes) are summarised to single page “snapshots” in Annex A.

Consisting of UP’s focal point for the assignment, the funding partners and one of UP’s Board members 15 Bangladesh, The Gambia, Guinea, Malawi, Mozambique, Nigeria and Senegal.

14

7

3.5.2

Desk reviews

We undertook three discrete pieces of desk work to inform this report. First was a review of the strategies, especially WASH strategies, of INGOs and other international organisations.

The main findings and recommendations of this work inform chapter 5 of this report, and the detailed review is included as Annex D. Second was an explicit statement of what we consider (and believe the wider sector to agree) are the basic features of good WASH programming at country level by an international organisation. We refer to this as our “benchmark paper”. It is included here in full as Annex C. It forms the background and reference point for the evaluative judgments which we make in chapter 4.

Third was a short paper summarising the current state-of-the-art on the health impacts to be expected from WASH interventions. The document sets out what is known about the relationships between WASH and health, and how UP should communicate the impacts of its interventions in this area. It is included in this report as Annex F.

3.6 This report The remainder of this report is divided into two parts: a long chapter 4 “looking back” and providing evaluative judgments for UP’s WASH programming as a whole, under 13 thematic headings. This is then followed by a shorter chapter (5) “looking forward” and developing the rationale and content of a WASH strategy.

4 Looking back 4.1 Introduction and basis for evaluative judgments In this chapter we present our review of United Purpose’s WASH programming across the organisation as a whole. Our country visits provided valuable opportunities for discussions and observations, and it is the synthesis of findings from those visits which we set out here.

In a sense, each country visit provided a data point or set of data points, and this chapter brings them together corporately. Where it is useful to do so, specific examples from the country visits are highlighted.

Our synthesis here consists of the evaluative judgments of the consultant team. The team of three has around 90 person-years of sector experience, but bias is always possible. Bias may arise because of gaps in experience, or particularly good or bad experiences in the past; entrenched opinions may also contribute to bias. Whenever evaluative judgments are made they must therefore be made as transparently as possible. In our view, the two main ways of demonstrating explicit transparency are to refer to (a) evidence, and (b) sector good practices. In this review, evidence arises from the observations and discussions made during the country visits, together with the desk studies mentioned in chapter 3. Sector practice is set out in what we have called our “benchmark paper”.

The benchmark paper (presented in full in Annex C) is a short document drafted by the consultants, setting out in summary form what we believe constitutes good WASH development programming practice. It forms a reference against which the organisation’s programming can be evaluated. Assuming that the benchmark paper faithfully sets out

8

what most sector professionals would accept as good practice, then the evaluative judgments which follow should also be reasonable and rational.

The remainder of this chapter reviews UP’s WASH programming with reference to the relevant sections in the benchmark paper and with reference to the country visit reports.

4.2 Evaluation of UP’s WASH programming 4.2.1

Relevance16

The benchmark paper highlights the importance of responding to global / international consensuses such as the human rights to water and sanitation and the sustainable development goals; it emphasises the importance of working with, and strengthening national governments; and it underlines the importance of responding to local context and need.

Local community Taking each of these in turn, and working upwards from the local to the global, United Purpose’s key strength lies in its understanding of local contexts and community needs. In its country programmes UP is rooted in local communities and it sees their empowerment as central to its mission. Box 2 summarises a few examples of such community relevance.

Box 2 Examples of UP's community-level relevance In The Gambia UP has been working with urban communities in flood-prone Kanifing municipality for many years, assisting with surface drainage and sanitation in a low-lying area lacking effective municipal solid waste management. In Guinea and The Gambia, UP worked throughout the Ebola crisis to educate citizens about the risks of contracting the disease, and to promote good hygiene practices.

In Nigeria, UP has for several years focused its support on rural areas of two States, and has developed good working relationships with both communities and local governments in these locations. Its sanitation projects focus on community-led action to eradicate open defecation and have had an impact across entire Local Government Areas.

In Bangladesh, UP operates over a much wider geographical area, though the focus is on the most under-served and environmentally vulnerable parts of the country. Community engagement is again fundamental to UP’s work, though some staff noted that the programme might have a deeper and longer lasting impact if it could secure funding to operate in fewer locations over a much longer period, rather than relocating for each project opportunity.

Local government In all its countries of operation UP works closely with local government, involving relevant departments in the delivery of its programmes. However, to our knowledge there have been few attempts to engage with local governments as equal but complementary partners, or to support government-led initiatives. This is important because it has become normal for INGOs and others to involve local government as nominal partners or

The extent to which the aid activity is suited to the priorities and policies of the target group, recipient and donor [OECD-DAC] 16

9

collaborators while doing little to address the systemic issues of weak or under-resourced local government organs. UP could do more to break free from this way of working.

Perhaps UP’s strongest and most deliberate attempt to strengthen local government in the WASH sector is through the GoTAS17 project in Mozambique (Box 3). “Undoubtedly the most interesting feature of GoTAS for the purposes of this review is that it is implemented and (partly) funded through the government framework, with NGOs helping to support and strengthen government planning and investment processes. It also includes some elements of system strengthening to create enabling conditions for the sustainability of rural water supplies. As such, the programme embodies many elements of good practice in rural WASH programming as it is currently understood in the sector.”18 Naturally the possibility of undertaking work similar to that of the GoTAS project elsewhere would be highly context-dependent, but this example of UP’s work deserves to be more widely known and emulated.

Box 3 The GoTAS project, Mozambique GoTAS is funded by the Swiss Development Corporation (SDC) and operates in five districts of Niassa province, one of the poorest in the country. Its aim is to strengthen the government’s bottom-up annual planning process, helping to ensure that it operates in a transparent and equitable manner, and supports government investments in rural water supply and institutional sanitation.

There are two streams of funding: budget support via the Ministry of Finance to the Provincial Government of Niassa and participating local governments; and direct funding to an NGO consortium made up of SNV and UP, which supports the planning and implementation process. The principal role of the consortium is to help generate community demand for new services and to ensure equity and inclusion in the programme overall; it also provides technical support and quality assurance.

What makes GoTAS possible is the decentralised policy and institutional framework in Mozambique which actively identifies community needs and priorities and uses these as the basis for annual development planning. This is unusual, as is the fact that the donor has been able to successfully route investment financing though local government. These enabling conditions are absent in many other countries in Sub-Saharan Africa. However, GoTAS provides a valuable reference point for this review.

National In those countries where UP’s WASH presence and credentials are strongest (The Gambia, Guinea, Malawi and Nigeria), United Purpose has the ear of national government. It participates in national sector meetings in those countries, and is a respected implementing organisation. There are those however who believe that UP could be more pro-active in “setting the agenda” and providing greater leadership at national level.

UP’s presence in Guinea and its intention to develop its programme in Guinea Bissau demonstrate its willingness to go where there are few donors or INGOs – where the needs are great, but the corresponding funding opportunities are few.

Governação Transparente para Agua, Saneamento e Saúde (Transparent Governance for Water, Sanitation and Health) 18 Quotation from Country Visit report Mozambique, this assignment.

17

10

International Given the highly decentralised nature of United Purpose, it is perhaps understandable that there is less reference to international WASH accords and commitments in its outwardfacing literature. In the absence of some form of global coordinating or representative function for the WASH sector within the organisation, it is difficult for UP to present a coherent approach to its work in the sector, balancing global principles with contextspecific interventions. At global level UP is not an active and visible participant in sector fora and events. This plus the very limited documentation produced on UP’s WASH experience mean that the organisation is not widely recognised as a sector player and is potentially missing out on opportunities for funding and inter-agency collaboration.

Conclusion UP’s WASH programming at community level and with local government is highly relevant to its mission and to wider global goals. We believe that it may be possible to engage more closely with local governments in order to drive up access to WASH services at a replicable scale (eg TA, LGA, district, state or provincial level, depending on context). We also believe that UP could make a bigger difference nationally and internationally, were it to take on more of a visible sector leadership role.

4.2.2

Effectiveness19

In the benchmark paper we highlight the behaviours of service users, communities and organisations, together with the quality of both physical and ‘soft’ infrastructure, in bringing about actual use of water and sanitation services and practice of good hygiene.

Quality of work We have little doubt that the households and communities participating in UP’s WASH programming generally benefit from high quality interventions (eg facilitation of CLTS processes, construction quality of water points and institutional latrines) which are addressing real needs. Some examples of the quality and outcomes of UP’s WASH work are included in Box 4.

Quality of outcomes In short country visits it is difficult to judge the extent to which water and sanitation services are actually used, and hygiene behaviours practised. However, in all countries where we made observations in communities, it was our judgment that services were appreciated, and being used by households.

Constraints A constraint on effectiveness is that human and financial resources are almost entirely bound up in finding funding for and implementing projects, some of which have a narrow focus and short time span. Most country offices lack the human and financial resources to promote and enable the wider adoption of tested good practices, or simply to share lessons from programme experience for the benefit of government and other sector players 19

A measure of the extent to which an aid activity attains its objectives [OECD-DAC]

11

Some countries no longer have in-house WASH specialists and there has been a loss of expertise and institutional memory. This inevitably limits the capacity for effective project design and implementation.

Box 4 Quality and outcomes of UP's WASH interventions In Malawi, UP has undertaken its own borehole drilling operations for many years. Although this raises questions about UP’s seriousness in strengthening the local private sector, it does result in higher quality and lower cost physical infrastructure than would otherwise be available. Some of the water points implemented by UP in Malawi are still functioning after considerably more than ten years, testifying to the quality both of construction and maintenance arrangements. In The Gambia, Guinea, Malawi and Nigeria UP has a strong track record in implementing community-led total sanitation, leading to ODF status on an impressive scale. In The Gambia, the SMILE project 2004 – 2007) trained and equipped well drilling teams. In the RUSHPIN Programme (Nigeria), the planning and implementation of LGA-wide interventions was very systematic, with work progressing ward by ward. The principal implementing partner in each location was the LGA WASH Unit, and UP deployed a Technical Officer in each one to work closely with the staff, playing a mentoring and motivational role. To complement the work of the WASH Units, a number of CSOs were contracted to work in specific wards of each focal LGA. Contracts set performance targets for each CSO, and UP encouraged healthy competition between CSOs and WASH Units, and between LGAs.

Conclusion UP’s WASH interventions at community level are of good quality, and facilities are in use by households in those communities. Together with the relevance of its programming to community need, this evaluation criterion represents UP’s greatest strength in WASH.

4.2.3

Efficiency20

In the benchmark paper we highlight the trade-offs which need to be struck between quality and cost of both organisational overheads and programme components. Sufficient quality and effectiveness will not always be achieved at least-cost.

We have not undertaken rigorous analysis of cost-effectiveness or value-for-money in this assignment, so the brief comments below should be seen as general observations and impressions only.

Programme interventions We have noted in at least two of our country visit reports21 the specific efforts made (and realised) to achieve high quality of interventions. In one case (Guinea) we noted that “While it was reported that other organisations are cheaper than UP on bids, experience shows that their ODF outcomes are not always achieved or sustained. Thus, UP typically represents good value for money.”

Organisational overheads United Purpose’s offices and support arrangements (internet and other services, vehicles and transport) in the countries visited appear functional, efficient and appropriately modest.

20 21

Efficiency measures outputs - qualitative and quantitative - in relation to inputs [OECD-DAC] Guinea and Malawi

12

“Projectisation”22 of efforts The constraint imposed by a focus on “doing projects”, and noted above under “effectiveness”, also impinges negatively on efficiency, and for similar reasons.

Specialist staffing Some countries no longer have in-house WASH specialists and there has been a loss of expertise and institutional memory. This inevitably limits the in-house capacity for efficient project design and implementation.

Conclusion Our impression is of an organisation which operates cost-effectively both in terms of its general operations and its WASH programme outputs. However, the lack of continuity posed by the “projectisation” of operations means that opportunities to consolidate project achievements, to retain staff and institutional memory, and to reflect on and document experience are frequently lost. This represents an inefficiency of performance which the recommendations in this report attempt to address.

4.2.4

Sustainability23

In the benchmark paper we assert that an essential outcome of all WASH programming should be water and sanitation services and hygienic behaviours which are enjoyed with no time limit. Sustainability refers to the time dimension of beneficial change which programmes bring about. Once an improvement in service or behaviour, or the capacity of organisations to deliver such changes, has been achieved, that forward momentum must continue. Every effort should be made to minimise ‘slippage’ or regression.

Achieving sustainability The sustainability of WASH services and behaviours depends on communities, local and national governments, and others including faith-based organisations, NGOs, social enterprises and private entities, playing their parts. Ultimately, it is only where local governments have strong systems and human and financial resources in place, with support from central government, that community-level services can be truly sustainable.

UP has no specific conceptual framework for how sustainability of WASH services is to be achieved, but the implications of its wider beliefs and global strategic goals are that the key lies in community empowerment and independence, and the engagement of market-based solutions. This is not fully consistent with the experience of the WASH sector over the last two decades or more, in which the need for public sector support, including financial subsidy, of community-managed water services is widely recognised as important for sustainability.

By this we mean the predominant tendency to undertake work through time-bound (often quite short) projects in which little funding is available for activities beyond direct implementation at community level.

23 Sustainability is concerned with measuring whether the benefits of an activity are likely to continue after donor funding has been withdrawn. Projects need to be environmentally as well as financially sustainable [OECD-DAC] 22

13

Sustainability of UP’s WASH interventions High quality of physical infrastructure and of the processes used to engage and mobilise communities can establish WASH systems which may function for a long time (but not indefinitely) – and this is evident in UP’s WASH programming. In sanitation specifically, linking households and communities to informal private sector service providers, as done by UP in several of its country programmes may also enable households to progress up the service ‘ladder’ - though scaling up market-led approaches to sanitation improvements has been a challenge in UP’s work, as it has in the sector generally, especially in rural areas with low population density and high transportation costs. The wider issues of support to ODF communities are highlighted in Box 5.

Box 5 Sustainability risks to sanitation outcomes in Nigeria As in all CLTS programmes, ODF slippage (meaning people reverting to open defecation) is a significant risk to UP programming in Nigeria, and the country office acknowledges that this has already happened in some locations. UP has done much to enhance the technical capacity of LGA WASH Units, whose role it is to provide post-ODF support and monitoring, but the units remain grossly under-resourced by government. Funding for the RUSHPIN and CHISHPIN programmes is set to end in 2019 and this presents a critical sustainability challenge as some of the LGAs have only recently become ODF. Some respondents met during the visit suggested that a future programme with LGA-wide ambitions should be funded for a longer period to allow more time both to consolidate behaviour change and to promote the take-up of improved facilities. For now, UP is focusing on measures to consolidate community commitment to using, maintaining and upgrading their toilets.

UP works in countries which have weak24 governments which consistently fail to achieve their mandates in relation to water and sanitation provision. Under these circumstances, a two-fold approach may be the best which UP can pursue: (a) maximise the longevity of services through high-quality interventions at the outset, while emphasising community and household-level ownership and management, while (b) building the capacity of local governments to provide technical support to communities and advocating for their increased human and financial resource allocations.

Our impression is that UP’s focus is on the first of these. The second (part of the “systems strengthening”25 agenda) is neglected. This may be because of a higher priority being placed on community development, or because of a lack of human and financial resources for that task, or because of a lack of awareness of the systems strengthening agenda.

Conclusion Our view is that UP’s WASH interventions are long-lived because of the quality of the initial intervention, but do not necessarily address underlying systemic sustainability challenges to Lacking in effective leadership, poorly organised, possibly corrupt, and unable or unwilling to deploy adequate human and financial resources to fulfil their functions 25 System strengthening means working with others to identify and mitigate weaknesses in the components of the WASH system at local, national and global levels. IRC identifies nine components of the system: policy and legislation, institutions, planning, finance, regulation and accountability, water resources management, infrastructure, monitoring, and learning and adaptation 24

14

the extent desirable and possible. All interventions to improve water, sanitation and hygiene need post-implementation follow-up in order to minimise the likelihood of “slippage” (in the case of ODF status and practice of good hygiene), or of unaddressed service failures (in the case of water supply). Such follow-up is only possible if (a) local government or its delegated entities can fulfil that function, or (b) if UP has a long-term presence through which it can continue to maintain contact with communities. We believe that a high priority for UP should be to work towards a situation in which the first of these options is possible.

4.2.5

Gender Equality and Social Inclusion (GESI)

An essential outcome of all WASH programming should be water and sanitation services and hygienic behaviours which are enjoyed by all. Inclusion refers to the SDG objective to ‘leave no-one behind’. Special measures may need to be taken to facilitate representation and participation by marginalised groups and individuals, and to serve them well.

Strategy In its draft Global Strategy UP states that it will: “be placing a stronger emphasis on gender equality than ever before which we believe is an integral part of sustainable, inclusive development”. Furthermore, UP will “measure its success on whether its community empowerment is inclusive ie between that community and outside interests, but within it as well via distinctions of gender, ethnic identity, sexual orientation, age, disability, caste, and class”. However, only a few of the current UP country strategies include explicit reference to GESI. Box 6 sets out a number of UP strategies which do mention this topic.

Box 6 Gender equality and social inclusion in UP country strategies In Malawi, Gender Equity is a pillar under the UP country strategy (2017 to 2020). A staff training guide has been developed on ‘mainstreaming of crosscutting issues: social inclusion in UP focusing on disability’. A toolkit for ‘Capacity Building for Menstrual Hygiene Management in (WASH) programmes in Schools Programs’ has been produced.

The Mozambique strategy (2018-2021) intends to “mainstream Gender, HIV, climate change, culture and disability aspects and will proactively explore the role of sport in promoting more inclusive and equitable development”.

The Senegal, Gambia, Cameroon and Guinea Bissau (2017-2019) refers to a ‘focus on gender equality and women’s empowerment’.

The Bangladesh Strategy (2014-2019) mentions solidarity with disadvantaged groups, such as landless people, female headed households, orphans, elderly, disabled people.

A review of country strategies suggests that attention to gender within UP is more systematic in other programme areas such as agriculture (eg in Mozambique) or sport.

Aspects of inequality The JMP26 Equality Checklist draws attention to:

26

Joint Monitoring Programme of the WASH sector (WHO and UNICEF)

15

•

Spatial inequalities, such as those experienced by communities in rural areas and slum-dwellers in (peri-)urban areas

•

Group-related inequalities that vary across countries, such as those based on ethnicity, race, nationality, language, religion, and caste

•

Impacts of individual-related inequalities such as those based on sex/gender, age, disability, and health conditions - as they are experienced both inside and beyond the household

Box 7 sets out examples in relation to the first two of these dimensions.

Box 7 Examples of UP's work addressing spatial- and group-related inequalities Spatial inequalities

Much of UP’s WASH work focuses on remote and inaccessible rural areas. However, the daraa programme in Dakar (see below) addresses intra-urban inequalities too. An analysis of regional disparities in Guinea shows that the UP-targeted regions of Faranah, Mamou, and Kankan are currently underserved. UP has used technology to improve access to information in the TicMbay27 project in Senegal. This project uses radio and mobile alerts to share updates with smallholder farmers (although mostly male) as early warning systems and also to promote better sanitation and hygiene.

Group-related inequalities

UP is working with the Rohingya people in camps in Bangladesh – as well as refugees and IDP communities elsewhere - who lack access to safe water and sanitation in disproportionate numbers.

In Guinea, UP is working with Ebola survivors on WASH and livelihood opportunities as one way to reduce stigma. Young people have been targeted through the Court of Dreams programme that uses tennis to promote WASH to children growing up in Kibera, Nairobi. Boys in daraas (traditional Quranic schools) in Dakar have also been supported to overcome difficulties in accessing WASH in these boarding schools. Pastoralist and nomadic people are often seriously affected by limited access to WASH services. UP is working with such groups in Cameroon (although on conflictresolution rather than on WASH-programmes). The Senegal and Cameroon programmes have approaches and tested tools (such as Dialogue Platforms) to promote minority and cultural rights as well as to resolve inter-ethnic conflict.

Individual-related inequalities In the countries and communities visited, there was some evidence that individual-related inequalities had been considered in WASH programmes (Box 8). There have been efforts to document a programme approach in order to standardize this across the country programmes.

Techniques de l'Information et de la Communication orientées vers l’Agriculture (ICT for Agriculture, mbay being Wolof for agriculture) – project in Senegal 27

16

Box 8 Examples of UP's work addressing individual inequalities In Malawi, facilities in schools were designed for children with disabilities (toilet blocks with ramps and facilities for menstrual hygiene management). In Guinea, under the ‘Fit For School’ programme, UP plans to make simple adaptations to improve accessibility to school sanitation eg ropes or hand rails.

Natural Leaders in Guinea reported that effort was made to ensure that all people have a household latrine. In the context of a no-subsidy approach, UP facilitators provided support to older people and others who could not construct a latrine for themselves. In Nigeria, another no-subsidy context for sanitation, community-led action ensured that everyone in each community builds and uses an affordable toilet with hand washing facility. Programme staff explained that, where necessary, communities provide assistance in the construction of toilets for elderly, disabled or otherwise vulnerable people.

Some UP programmes include attention to people with acute or chronic illness (such as those with Ebola in Guinea). These people are often neglected or excluded on account of stigma – for instance for fear that sharing latrines can transmit diseases. In Malawi, UP has an approach for supporting people chronic diseases who are particularly vulnerable to WASH-related diseases, such as those with HIV/AIDS. In Mozambique and elsewhere, gender and equity are mainstreamed in programme operations including the membership and leadership of Village WASH Committees. Notably, however, women have not been consistently trained as masons (women masons were trained in Malawi and Mozambique, but not in Guinea for instance). There is scope for training or involving female entrepreneurs and women-led microenterprises in supply chains focused on sales of WASH products to promote hand washing and household water treatment such as buckets, bars of soaps and bottles of chlorine or sanitary materials.

Whilst there is a recognition of the burden women bear as household and community WASH managers, and this gendered work is unremunerated, few programmes were designed to provide systematic attention to these gender roles or aim to transform them.

Conclusion Many, if not all, of UP’s projects work with disadvantaged communities or groups in society, but in some cases they may not reach the most vulnerable within those communities.

Despite GESI being a stated global priority, it seems little systematic attention is given to gender disparities in decision-making or reaching the poorest and most vulnerable populations in UP’s country programmes. Given the importance of this issue to achieving the SDGs, a GESI lens is required in developing future policies, strategies, guidelines and training materials to ensure equal rights, opportunities and respect for all individuals regardless of their social identity. UP could take advantage of the strategies developed by the Malawi Country Programme as well as the growing evidence base in the sector on these issues (including WaterAid and partners as well as development and disability NGOs like CBM, and equity-focused WASH researchers like the SHARE consortium amongst others).

17

4.2.6

Impact

In the context of UP’s wider strategy, the question of impact28 requires an assessment of the extent to which the organisation’s WASH programming has contributed to key aspects of UP’s higher level goals, namely: •

Ending poverty and inequality

•

Moving beyond aid

•

Empowering communities to be independent

At the country level United Purpose has made some quite bold claims specifically about the health impact of its WASH programming. These were noted in the country reports for The Gambia, Guinea, Malawi and Nigeria.

Ending poverty Although inadequacies in water and sanitation services and poor hygiene practices represent part of the multi-dimensional nature of poverty, interventions addressing aspects of WASH are unlikely on their own to reduce or contribute to the end of poverty. Wider projects and programmes addressing livelihoods and food security, disaster preparedness and resilience, in which elements of WASH are embedded may however make such a contribution.

Independence – beyond aid It is difficult to see how meaningful water supply improvements of significance can be undertaken without significant assistance (from government or international organisation) for capital investments. Subsidies for capital maintenance, and government support to management are also a necessary part of sustainable water services.

Community-led total sanitation (CLTS) and sanitation marketing (SM) put the onus of capital and recurrent financial investment on households. However, the external organisation and implementation of CLTS and SM projects requires continuing government or donor funding.

The same goes for promotion of household hygiene, such as UP’s tippy tap interventions in The Gambia. The handwashing devices were and are constructed through household investments, but the promotion and follow-up costs are still significant, requiring external support to communities.

WASH and health Although there are clear conceptual linkages between inadequate WASH and poor health – mostly mediated through the ingestion of faecal pathogens, a number of areas of

The positive and negative changes produced by a development intervention, directly or indirectly, intended or unintended [OECD-DAC]. We use impact here to refer to the high-level results of WASH services being used or behaviours being practised. Better health is the most obvious, but it is not the only one, and in some respects it is the most elusive.

28

18

uncertainty still exist in the epidemiology of faecal-oral transmitted diarrhoeal disease29.

These include the following: • •

• •

The magnitude of WASH-attributable disease prevalence and burden in specific contexts The relative contributions of improvements in water (quantity and quality), sanitation (at different levels of service) and hygiene (hand, body, food) to improved health, in specific contexts The reasons why measured health impacts in randomised controlled trials are sometimes small or negligible The necessity or otherwise for WASH improvements to be complemented by interventions in other areas, in order to achieve health impacts

In recent years a number of high-profile, very expensive studies have attempted to unravel these and other unknowns, but the present picture remains quite confused.

It therefore behoves any organisation implementing WASH programmes to be cautious about its claims in relation to health impacts.

In Annex F we summarise the current state of the science inasmuch as it relates to UP’s claims about health impact.

Conclusion In an evaluation of this scale and scope, it is not possible to rigorously demonstrate the wider impact to which UP’s WASH programming contributes. However, it is our view that UP’s contribution to change at the community level is indeed significant, especially in those places where it has had a relatively long-term presence. UP’s impact on the capacity of local government partners, and its influence at national level (section 4.3.3) are even harder to quantify, but in at least four countries (The Gambia, Guinea, Malawi, Nigeria), this has been important. On the international stage, UP is virtually invisible as a WASH actor.

4.3 Wider observations In the remainder of chapter 4, still “looking back”, we reflect on a further seven aspects which we identified as important in evaluating UP’s performance in the WASH sector.

Taken together with the main OECD-DAC criteria analysed in section 4.2, they complete our analysis of the organisation’s WASH programming.

4.3.1

Innovation

In our benchmark paper we say that “... organisations implementing WASH programmes [should] constantly seek new and better ways of addressing issues in the sector. However, while innovation is important, especially in designing, piloting and scaling up approaches and technologies which address intractable problems, a balance needs to be struck with implementing tried-and-tested solutions. If too many organisations are innovating in too many aspects of their programming, there is a danger that well-established good practices

WASH-related diseases other than those transmitted by faecal-oral routes are also relevant, but the discussion here focuses on diarrhoea, and especially infant diarrhoea 29

19

may be neglected, or that mixed messages are conveyed to Governments and communities.”

Most international development organisations claim to be innovative in at least some of their work, and in this regard UP is no different to other international organisations. In its draft global strategy however UP qualifies its view of innovation in these words: “... we will seek out and put to work fresh, creative ideas to empower the most disadvantaged communities to make bigger change, faster – and so put transformative innovation at the centre of our strategy. We will also be clear that our embrace of innovation is not about pursuing faddish ideas – but finding the most creative ways to help communities solve the problems they face and bring tangible change in people’s lives. It is innovation for impact; what we call intelligent development.”

This bottom-up co-creation of solutions is problem-specific and context-specific, and it stands in contrast to the introduction of new ideas, technologies or approaches from outside – a more top-down process.

Such externally-created innovations are more visible, and UP can cite several in the WASH sector (Box 9 gives some examples from West Africa).

Box 9 Examples of WASH-related innovations implemented by UP in West Africa [Source: Senegal – Gambia country visit report, this review] “...the West Africa team and its partners identified at least 16 innovations30. Three in particular out of this list have relevance to WASH: ICT (and radio) applied for hygiene promotion, waste management, and the tippy tap for handwashing.

None of these are necessarily innovative in the sense of bringing entirely new technologies or approaches to the WASH sector. However, in bringing them to countries, communities, partners or collaborators which had not previously been exposed to them, UP has been innovative. The tippy tap is a case in point. Although this simple hand-washing device has been in existence since at least the early 1980s31, it appears that UP with Oxfam was the first to introduce it to Gambia in the 201112 drought-related food crisis. It has been adopted by MoHSW and UNICEF in their hygiene promotion initiatives.

The Senegal / Gambia team is very active in the field of information and communication technology for development (ICT4D). Although this has mainly been applied in the context of agriculture and livelihoods, as a generic tool it has application to all communication initiatives, including those related to health and hygiene. The expertise developed in this region, by UP and its partner Jokalante, is impressive.”

The use of millet husk as soil fertility improver, ICT services for reaching rural populations via their mobile phones and radio, ICT based market price service, farmer managed community rice irrigation, seed networks and on farm seed diversity conservation, waste management and recycling / waste disposal as livelihoods, tippy tap for handwashing, dialogue platforms, charcoal briquettes, oyster breeding, social enterprises for value chain and other services, working in the Fogni conflict zone and peace building.

31 Having been invented by Dr Jim Watt in Zimbabwe and later promoted there by the Blair Research Institute.

30

20

One of the innovations of which UP is most proud is its venture into carbon trading, with the intention of supporting handpump maintenance and repairs, initially in Malawi. The offsetting of putative carbon emissions due to the supply of clean water from functioning community boreholes, as opposed to (supposedly) boiled water from alternative (inferior quality) sources, has been demonstrated to yield significant sums of money – which in principle can be re-invested into maintenance and repairs. At the time of writing it is not clear what the reliable annual cashflows from this initiative are likely to be, and it is our understanding that the modalities for disbursing the funds have not yet been fully worked out.

Conclusion UP takes two broad approaches to its innovations, the first in which solutions to community problems are designed and adapted in the course of community-based projects; and the second in which new ideas, technologies and approaches are introduced from outside communities. Each has its place in further improving or supplanting existing tried-andtested solutions. It will be important in future to ensure that proposed innovations are sense-checked against the wider experiences of the WASH sector – to avoid re-inventing the wheel or repeating mistakes made by others.

4.3.2

Partnerships

In our benchmark paper we highlight the importance of INGOs developing a wide range of collaborative and respectful partnerships; joining relevant coalitions in order to achieve greater impact; developing the individual skills and organisational capacities of partners; and working to change the ‘operating environment’ where this creates obstacles to progress.

UP’s partnerships at country level vary from the purely contractual, to relationships in which capacity development is central. In all countries UP works in close collaboration with local government – but Mozambique is the only country in which UP’s WASH programme is government-led. In one country (Malawi), most of the WASH programme is still implemented directly by UP, as opposed to implementation through partners, which is the model elsewhere.

United Purpose works effectively with its partners of various sizes and types. Box 10 sets out some of the findings from our country visits.

The priority (or otherwise) which UP places on the capacity-building of its partners varies from country to country. In Bangladesh for example, UP has worked with some of its WASH partners for many years, and they have gained a lot of experience, but there may have been little systematic capacity building. At least one of the partners there still needs a lot of supervision and guidance.

21

Box 10 Observations about the quality of UP's partnerships In Guinea we noted that UP is a trusted partner at national and local level. UP has built strategic partnerships with national and international civil society organizations, strengthened communitybased networks at the grass-roots level and maintained a collaborative partnership with the Government. It has partnerships with a range of NGOs and donors.

In Nigeria and Malawi, UP has strong relationships not only with local governments, but also with international agencies and donors including DFID, USAID, UNICEF and, in the case of Nigeria, the Global Sanitation Fund (GSF).

In Gambia, even in project locations where no implementation has been undertaken for a few years (for example Kanifing Municipality32), it is very evident that the relationships built in previous project work are deep, respectful and enduring. This includes relationships with organs of Government (for example the Gambian Ministry of Health and Social Welfare, and Kanifing Municipal Council).

All of UP’s work in both Senegal and Gambia is undertaken through partner NGOs, in close collaboration with the relevant organs of Government. None is implemented directly by United Purpose. UP’s aim is to build the capacity of its partners, including enhancing their ability to be financially viable. The meetings with partners undertaken during this visit would suggest that this aim is achieved. One example is the partner Jokalante33, a social enterprise specialising in digital communication for development. UP has worked with Jokalante for several years, and the organisation is moving toward full financial viability, claiming to have 70% of its costs covered through charges to clients at the present time.

Conclusion Generally UP works effectively with partners ranging from communities, through local implementing CBOs and NGOs, to international NGOs and UN agencies, to small and large donors. The priority placed on partner capacity-building varies from country to country. We were made aware of a few examples in which UP works in consortia of multiple INGOs, with correspondingly large-scale funding. This experience bodes well for a future in which UP may move beyond implementation of relatively small, short-duration projects.

4.3.3

Advocacy and influencing for outcomes at scale

In our benchmark paper, we commented that “practical know-how and policy relevance go hand-in-hand. Effective organisations have strong on-the-ground practical experience of ‘what works’ in the sector. They combine this with a sound understanding of what needs to be articulated in legislation, policy, regulatory frameworks and sector guidance.

Understanding of WASH practice gives organisations the credibility to influence policy, while improvements to policies in turn help to reinforce their own and others’ practices.”

We noted earlier that UP engages actively in WASH working groups and national fora in those few countries where it has a significant WASH programme – namely Guinea, Malawi and Nigeria. However it is apparent that UP generally places higher priority on its WASH implementation than on influencing national policies and ways of working. This attitude appears to reflect in part a preference for making a direct difference at community level – Kanifing lies south of Banjul city. Aside from Banjul it is Gambia’s only urban municipality, and it was estimated at the last census (2003) to be home to 24% of Gambia’s population. This proportion is probably higher by now, given the uneven growth of urban and rural populations.

33 http://jokalante.com 32

22

though this can only ever reach a rather limited number of people – and in part a humility induced by an awareness of being a relatively small player.

Conclusion It is our belief that organisations such as UP which have a strong track-record and deep expertise at community level are well-placed to join with others to influence change. Such changes may include revisions of national policies and sector guidelines to better reflect realities on the ground; more extensive dissemination, promotion, and support to enforcement of national policies; working to bring about better local planning and coordination; and advocacy for more effective implementation of government decentralisation policies. By carefully balancing its implementation work at community level with deliberate and collaborative attempts to “influence the agenda”, UP could step up into a leadership role in the sector in at least some countries, and perhaps internationally too.

4.3.4

Integration

In our benchmark paper we advocate for concurrent interventions in water, sanitation and hygiene, and for their implementation within wider development initiatives addressing health, education, livelihoods, agriculture and DRR. However, whether implemented within wider integrated programming, or as stand-alone WASH projects, we stress the importance of high standards and good sector practices.

Our observations in the country programmes are that UP’s WASH work does not always combine water, sanitation and hygiene. Sanitation is often implemented through standalone CLTS projects (a practice which is not uncommon in other organisations too, despite inadequacies in water supply often acting as a constraint on latrine cleanliness and the practice of good hygiene). Water supply has sometimes been implemented without sanitation, and in at least one case brought to our attention this was at the insistence of the donor involved – and against UP’s better judgment.

In West Africa, WASH has generally been implemented within more extensive food security or DRR projects. In such circumstances it may not have received the specialist attention that would have accompanied larger stand-alone WASH projects.

Conclusion Implementing WASH through standalone projects, or within projects having a wider scope, are both appropriate and relevant in different contexts. However we emphasise the importance of paying due attention to all three components of WASH, and implementing to high professional standards.

4.3.5

Monitoring and evaluation

In our benchmark paper we look for (a) a mix of quantitative and qualitative indicators of outputs and outcomes34, designed to dovetail with national databases; (b) linkages between We use the usual understandings of these terms, in which outputs are the direct results of implementing a set of activities (these may be physical – taps and toilets – or ‘soft’ – for example numbers of people trained); outcomes are the changes resulting from those outputs, for example the 34

23

monitoring data and responsive action; and (c) at least some post-project evaluations examining outcomes, impacts and the extent to which UP’s strategic ambitions are being fulfilled.

In its public reporting, UP uses 8 indicators in relation to WASH (Box 11).

Box 11 UP global WASH indicators [Source: Annual Report 2017-18] 1 # people with access to safe water 2 # of water points provided or rehabilitated (boreholes, etc.)

3 # of water point repairers, local masons or water committee members trained/ supported 4 # of schools with a new or rehabilitated water point 5 # of school children who have benefited from rehabilitation of school water point 6 # of Open Defecation Free villages (e.g. CLTS) 7 # of new toilets built (subsidized or CLTS, direct or indirect) 8 # of school children with access to a single sex latrine

A number of observations can be made in regard to these indicators: • • • • •

All are quantitative, so limiting their information value None of the indicators related to “people” are disaggregated by gender or other dimension All represent output-level achievements, with none reporting on outcomes (actual use of services or practice of good hygiene, for example) None relate specifically to hygiene, whether at an individual or household level None can be described as strategic, in the sense of indicating progress toward some higher-level ambition – such as systemic change in the public or private sector

In our country visits we were unable to determine clearly how WASH data are collected, analysed and acted on. It would appear that country programmes each have their own project-specific systems35 for monitoring, but that monitoring is predominantly quantitative and at output level. We saw no evidence of attempts to monitor outcomes.

Outputs lie largely within the control of projects; since the achievement of outcomes is less certain and more dependent on factors beyond the control of project implementers, a focus of monitoring (and response) at this level is critical.

Furthermore, if UP is serious about gender equality and social inclusion, then genderdisaggregated data and data on other categories of individual are needed.

Conclusion UP’s WASH monitoring, at global level at least, is quite superficial. This is understandable since UP is not a WASH specialist INGO, and nor does it have a WASH Adviser who could lead on establishing appropriate indicators of performance and contribution. There seems actual use of WASH facilities or the practice of better hygiene. Outcomes are inherently harder to measure than outputs.

35 Guinea, for example uses the Open Data kit (ODK)

24

to be little evidence at country level that monitoring reflects anything beyond projectspecific outputs, and it is unclear whether even these are disaggregated by gender or other attributes of beneficiary. Evaluations have mostly been project-specific, and in reporting mainly on the achievement of outputs, they have rarely provided much insight into the achievement, or obstacles in the way, of higher-level outcomes and impacts.

4.3.6

The challenge of (dis)continuity

In the benchmark paper we acknowledge the reality that United Purpose faces in regard to funding. Short-term restricted funding makes continuity of effort and of staffing extremely challenging, and yet ways must be found to achieve that continuity.

The funding landscape for WASH is changing. Some bilateral and multilateral agencies are withdrawing from the sector; others are funding fewer, larger projects via consortia; more philanthropic and private funders are entering the picture, but they are not always wellinformed about WASH. For United Purpose, about 95% of its expenditure is from restricted (ie project-specific) grants. UP has been described by one of our informants as an organisation which “does projects”. In all of our country visit reports we noted the difficulty this poses for any sort of continuity or gap-filling, far less the possibility of pursuing strategic goals or reflecting on experience and documenting lessons for the wider organisation or for others in the sector.

In the times when staff are not implementing projects, they are chasing the next project grants.

This is a state of affairs which has persisted in the world of international development for too long, despite universal critique, and it is one which UP’s donors would do well to note.

Donor funding which is short-term and which has little room for the recipient’s core funding needs, its requirements for reflection and learning, and the many other actions which need to occur “between-projects” may contribute to sub-optimal organisational impact.

Nevertheless it behoves UP to find ways, within the existing funding landscape, to increase core funding of its head office and country activities.

Conclusion United Purpose is heavily dependent on project-restricted grant funding, with negligible unrestricted funds for the connecting activities – such as continuity of staffing, gap-filling, reflection and learning, documentation – all of which are essential for a well-functioning development organisation. As the funding landscape is unlikely to deliver a major change to this situation, UP should continue to open up an expanding flow of unrestricted funds in any ways that it can.

4.3.7

Documentation of learning

In the benchmark paper we say “Documentation of experiences and learning is frequently neglected in the pressures to win funding and to deliver projects. This results in much valuable learning being lost. Good ideas do not become known by others who may have the potential to implement them. Unreported failures get repeated by others. This neglect of documentation should be resisted as far as is possible, and organisations should work to ensure that lessons are identified, captured and shared beyond the organisation.”

25

UP’s limited public output of documented experience and learning is largely explained by (a) its lack of unrestricted funding which would free up staff time to permit this important work, and (b) the absence of a global WASH adviser who would be well-positioned to lead and coordinate such activity.

Although UP has much relevant experience and internal learning which could be shared with the wider sector, the organisation has a very low profile on the international stage.

One suspects that at least part of the reason for this is that its learning has not routinely been documented, and so it is not in a form that can readily be shared. This represents a lost opportunity.

Conclusion Like many practice-focused organisations, United Purpose does not routinely document its experiences and learning for a wider audience. Although the reasons for this are understandable, it represents a lost opportunity for sharing and mutual learning, and for exposure internationally, both of which could significantly enhance the organisation’s effectiveness.

4.4 Conclusions from the “looking back” component 4.4.1

From competence to consistency

In its WASH programming across at least the seven countries visited in this review, UP is a competent and effective organisation with a long track record of delivering project results at community level. Naturally some of UP’s country programmes are less strong in this regard than others, and we believe the consistency of UP’s WASH programming could be improved by greater sharing of experiences between country programmes, as well as through wider exposure to WASH sector thinking.

4.4.2

From projects to system strengthening

At country level, UP works constructively with a range of national and international NGO and local government partners. Its commitment to NGO and local government capacity building varies across the countries visited. In some, there is real evidence that UP has supported fledgling partners to near-independence, while in others long-term partners struggle to be fully effective.

The scope for undertaking a district-wide approach (or TA-wide, or LGA-wide, according to context) is being realised in some countries and has greater potential in others.

We believe that an evolution away from “doing projects” to enabling others – especially through explicitly engaging in government systems strengthening – is both necessary and desirable. This belief is driven in part by trends in sector financing, but more importantly by the imperative to enhance the ability of national and local governments to own, finance and lead the development of their own nations and people. It is unsatisfactory to criticise governments for their “weakness”, while operating in parallel with what are undoubtedly deficient systems, and not doing all in one’s power to address such weaknesses.

26

4.4.3

From expertise on the ground to influence nationally

In a few countries UP has the ear of national government, and it contributes to sector debates; however it is rarely in a leadership role in this regard, and it is not generally perceived as a key member of coalitions which are trying to bring about stronger government-led investment in, planning for, and support of, WASH services.

A move toward systems strengthening would not and should not mean that UP would cease direct project implementation, since it is this community-level experience and expertise which must form the foundation for wider advocacy and influencing.

Furthermore, the wider work of systems strengthening cannot be done alone. It absolutely requires collaboration and coalition-forming.

4.4.4

From invisibility internationally to a global presence

At international level, UP, at least in the WASH sector, is invisible. It does not routinely and strategically attend regular international WASH conferences where learning is shared and sector thinking developed. It is hardly known as a WASH player, except through the reputation of two or three of its country programmes where it has either had an implementing presence for a long time, or where it has accessed high-profile funding, and where results on the ground have been impressive.

UP’s virtual invisibility internationally means that it is potentially missing out on opportunities to participate in multi-country and consortium-led programmes funded at global level.

We believe that UP could take a more prominent place on the international stage, building on its undoubted expertise at community level and its understanding of a range of national contexts.

4.4.5

Where to now?

UP is at a cross-roads in terms of its involvement in the WASH sector. We see three broad options in regard to its next steps (Figure 2). Either UP could continue undertaking WASH projects, regularly or occasionally, according to the funding opportunities which arise incountry, and according to the priorities of country-level leadership. This is business-asusual (BAU).

In the second option UP builds on its existing experience, but works to raise its standards of work and consistency across countries, through a greater emphasis on cross-country learning and exposure to the global sector. This would be a small step up from BAU. The third option is a concerted and deliberate attempt to become an authoritative sector player, building on its experience in implementation and explicitly involving itself in government systems strengthening; extending its collaboration and membership of coalitions; building its international visibility; and undertaking systematic documentation of learning.

Given our understanding that UP has the appetite for the third option here, the last chapter of this report describes how we believe the organisation could set out on this journey.

27

Figure 2 Strategic options for UP's WASH programming

5 Looking forward In this chapter we sketch out an action plan through which UP could achieve the ambition of the third option illustrated in Figure 2.

We believe that three things are needed as a matter of priority, and that taken together these will start to develop five outcomes of a global WASH strategy (Figure 3).

This chapter is informed by our review of the WASH strategies of other organisations, a summary of which is included as Annex D. Figure 3 Inputs, activities and outcomes of a global WASH strategy

5.1 Three key inputs UP needs a global WASH leader or adviser who will, as a first priority, guide the finalisation of a WASH strategy document. This individual should be recruited as soon as funding permits. Adequate financial resources will be needed for this individual to undertake their role. Using the findings of this report, and further developing its content through 28

consultation with the country programmes, a participative process to produce a clear and compelling but concise WASH strategy document will be the WASH Adviser’s first task.

5.1.1

A Global WASH Adviser

Beyond the initial task of developing the organisation’s WASH strategy (including an improved M&E framework), the wider functions of a global WASH Adviser within UP would be as follows: • • • •

Representing UP’s WASH programming internationally and working to raise its profile Working with country programmes and fundraising teams to develop new funding opportunities, especially involving multiple countries and / or consortia Systematically working with country programme staff to document country programme experiences for wider dissemination and application of learning within and beyond UP Providing technical support to country programmes designing and implementing WASH projects and advocacy activities

Annex E provides a draft job description for such an individual.

5.1.2

A working budget

The Global WASH Adviser’s working budget would need to include the elements set out in Table 3. We suggest that an initial period of employment of two years, with budget assured for most of this duration will be necessary at the outset. We stress that these are very broad-brush indicative figures only. Given UP’s gap in core funding, this budget would need to be sourced as a stand-alone investment from donors.

Table 3 Global WASH Adviser two-year working budget Budget item

Basis of estimation

Salary and support costs

Salary (GBP60k per annum) plus NI, pension and overheads @ 40%

168,000

Travel and subsistence for country visits, donor and partner meetings, and conferences

Four ten-day trips to country programmes annually @ GBP2,000

16,000

Conference registration

Three conferences over two years @ GBP600 (T&S costs included above)

2,000

Consultancy for specific items of technical support and documentation of learning

20 days of professional time per annum @ GBP600, plus travel and subsistence costs (three trips over two years @ GBP2,000)

30,000

Total

UK/Europe/USA travel and subsistence GBP2,500 per annum

Budget estimate (GBP)

5,000

221,000

29

5.1.3

A document

As mentioned above the first task of a Global WASH Adviser would be to draft a compelling WASH Strategy – probably in more than one form for different readerships. A possible table of contents for a full version of such a document is set out in Table 4. Such a structure would take an informed reader through a logical sequence of reasoning from an introduction to the organisation, an understanding of the context and the problems, through a statement of strategic goals, the chosen approach(es), to the ways and means of delivering the intended results (and demonstrating this).

A document of this type would need to dovetail with UP’s Global Strategy which is in the final stages of editing at the time of writing, and with any other sectoral strategies (such as for livelihoods and food security, conflict resolution, DRR or humanitarian response) which UP may consider developing in future.

A full strategy document should probably not exceed about 15pp in length. Shorter and more highly illustrated versions may be needed, perhaps in infographic form.

The content of the full WASH Strategy could largely be drawn from UP’s existing WASH Capability Statement, this Synthesis Report, and the Country Visit Reports prepared as part of this assignment.

Table 4 Possible table of contents for a Global WASH Strategy Section and content Introduction The need for WASH: Rights to Water and Sanitation; SDGs; links with other goals / sectors Who we are Vision, mission, identity, values, principles What we do Comparative advantage; cross-programme synergy What we know about our operating environment Relevant macro-trends: climate change, urbanisation, fragility, sustainability, demographic changes, water security, inequality, aid architecture; new technologies and innovation What we plan to do to meet the need Priority intervention areas/ strategic goals (usually 4 or 5) How we will achieve this A programmatic approach; partnerships; advocacy and influencing Lessons learned Learning on WASH Our understanding of how change happens Theory of Change (diagram and narrative) Where we will work Countries; geographic areas; schools and health facilities; other institutions and locations Who and what we will work for Beneficiaries, leaving no one behind; systemic change How we will make sure we can deliver Resources, partnerships, policies, accountability How we need to change to deliver the strategy Organisational changes needed Monitoring and measuring progress M&E plan, baselines, research and evidence, documentation and knowledge management

30

5.2 Five key outcomes We anticipate that a coherent Global WASH Strategy, driven by an effective and adequately resourced Global WASH Adviser would lead to five key outcomes, which blend internal and more public-facing objectives. These constitute the expectations of returns from the financial and human investments outlined above. Simple indicators to monitor and evaluate progress towards these results will need to be developed.

5.2.1

Consistent quality across country programmes

The quality of WASH project implementation in country programmes does not give significant cause for concern at the present time, as chapter 4 attests. However there is always room for improvement, and the best practices in each country need to continuously inform and contribute to improved practices elsewhere in the organisation. UP needs to reach a position across all its country programmes in which, to the extent that projects and programmes are implementing WASH or (with others) advocating for changes to the operating environments in those countries, it is working according to internationally accepted good practice.

In regard to the implementation of WASH projects this means following the principles in the benchmark paper, or adaptations / developments of it.

In regard to advocacy and influencing – a relatively new departure for UP – it means developing a greater understanding of the principles and practices of political engagement at country level, and being clear and consistent about the issues which are being promoted.

5.2.2

Systematically documented learning

All UP’s WASH projects conclude with some form of final report, and many are subject to independent external evaluations. Few however are the focus of reflective learning, and in fewer still does any reflection and learning get documented for a wider readership.

Similarly, it is rare for UP to reflect on and learn from a body of WASH projects implemented over a period of time.

Assuming that UP does in future take some steps into systematic and collaborative attempts to remove WASH sector obstacles in country operating environments, then the imperative to reflect and learn from those efforts will be even stronger.

If each of the seven countries visited in this assignment were to identify a single project or period of effort which it considered could offer valuable lessons for UP and other WASH sector organisations, then the documentation of this learning would start to create a significant body of material.

Alternatively, some of the themes and examples highlighted in this report could provide rich material, if augmented with greater detail and critical reflection.

5.2.3

Planning beyond projects

A key role of the Global WASH Adviser will be to develop relationships with potential collaborators and donors, and to seek out opportunities for joint advocacy and consortium / multi-country bid preparation. This will require active networking with larger INGOs, key 31

academic and private sector organisations, WASH professionals, and a wide range of donors known to be interested in aspects of WASH. It will also require systematic monitoring of funding opportunities.

The intermediate results of efforts in this area will be (a) the network of contacts developed, (b) membership of key coalitions such as RWSN36, Agenda for Change37, SWA38, UK WASH Network39 and SuSanA40, (c) a number of multi-country and/or multi-partner bids submitted, and (d) a clear paper-trail of decision-making in relation to bidding opportunities which have arisen over the period.

UP will need to determine how this aspect of the Global WASH Adviser’s work should dovetail with the fundraising efforts of country offices and the Cardiff office, in order to optimise mutual support and avoid duplication of effort.

5.2.4

Enhanced reputation and profile

The combination of having a coherent WASH strategy document, individual networking, documentation of learning, and prominence at key WASH conferences and networking events will lead gradually to a raised profile and reputation for UP within the WASH sector.

The aim is to reach a situation in which donors and WASH professionals naturally think of UP alongside other generalist or specialist INGOs which are well-known in this sector.

This progression will take time. On the one hand, UP’s present status or prominence in the global WASH sector is virtually negligible. However, the organisation’s actual experience and standing in-country and at community level provides the opportunity and a strong foundation for repairing this situation.

5.2.5

Stable, more predictable funding

The ultimate aim and expected result of the work outlined so far is that UP should increasingly access larger and longer funding streams, through working increasingly with others in consortia. Such projects and programmes would also be expected to provide somewhat larger sums of core funding to enable continuity of staffing, learning and documentation, and consolidation of project efforts.

5.3 Intended impact Looking beyond the short- to medium-term outcomes for UP itself, it is appropriate to point out finally the greater good to which all of the foregoing is directed. Extending the quality and reach of UP’s WASH work has the potential to bring enhanced and longer-lasting benefits to a greater number and diversity of poor people in the low-income and fragile contexts where UP works. If a more effectual WASH programme in UP can contribute to stronger national WASH systems in which governments and NGOs can better fulfil their roles, then the impact of the proposed changes will be multiplied many-fold.

https://www.rural-water-supply.net/en/ https://www.washagendaforchange.net 38 http://sanitationandwaterforall.org 39 https://www.bond.org.uk/groups/uk-wash-network 40 https://www.susana.org/en/ 36 37

32

6 Material outputs of this assignment This review, in its “looking back” and “looking forward” aspects has produced a number of key outputs. These are listed and described in Table 5.

Table 5 Material outputs of the global WASH review Item

Description

Looking back

Chapters 1 and 2 of this report

A brief overview of UP and the place of WASH in UP’s country programmes

Chapter 4 of this report

Evaluative judgments regarding criteria of relevance, effectiveness, efficiency, sustainability, gender equality and social inclusion, and impact Observations regarding innovation, partnerships, advocacy and influencing, integration, M&E, the challenge of (dis)continuity, and documentation of learning

Annex A country snapshots

A set of one-page summaries of UP’s recent work in the seven countries visited in this review

Country visit reports (held separately by UP)

A set of six country visit reports detailing our observations and findings in the seven countries visited

Annex C Benchmarking good WASH practice

A 4pp document summarising key aspects of good WASH programming for INGOs such as UP; developed specifically for this assignment, as a benchmark by which performance would be reviewed

Looking forward

Chapter 5 of this report

A “roadmap” setting out how UP could step up to become an internationally recognised WASH player

Annex D Summary table of WASH Strategies of other organisations

A comparative analysis of the global and WASH strategies of generalist and specialist INGOs and similar organisations

Annex E Draft job description for Global WASH Adviser

A draft job description as a basis for a new appointment

Annex F Communicating the impact of WASH on health

A referenced and reasoned set of arguments for UP to exercise caution in its claims of health impacts of WASH interventions

33

Annex A United Purpose WASH country snapshots Country Snapshot: UP WASH in Bangladesh UP Bangladesh began operations in 1994, in Cox’s Bazar, and this year celebrates its 25th anniversary. The country office is now in Dhaka, but UP retains project offices in Cox’s Bazar and Khulna. Since inception, the country programme has prioritised support to communities in the most environmentally vulnerable and under-served parts of the country, particularly coastal and south-western areas and the Chittagong Hill Tracts.

UP normally implements via local partners, most of which are NGOs rather than government agencies.

The country office earlier had a Health and WASH Unit, but this closed in 2015 when a number of WASH projects ended and key WASH personnel left the organisation. Thereafter, country office leadership prioritised livelihoods, and WASH dropped off the agenda until the Rohingya influx from Myanmar in 2017. Inevitably, there has been some loss of institutional memory of UP’s earlier WASH experience.

The emphasis in programming has always been on disaster risk reduction (DRR) and humanitarian support, though there have been some projects with more of a development orientation. The technical focus was initially on health but later broadened to encompass WASH, education, environment, gender and livelihoods. Within WASH, UP was known for its work on disasterresilient WASH facilities.

BACHA is the only current UP project which includes the provision of WASH facilities, the other components being health and social protection. BACHA forms part of the massive humanitarian response to the Rohingya influx. This aside, dedicated WASH interventions do not form part of UP’s portfolio, though there is often an element of WASH (mostly hygiene promotion) in UP’s livelihoods and nutrition projects.

As in other countries, UP generates much of its funding by responding to calls for proposals.

While it has some multi-year projects in which it plays a lead role, UP often works as a subcontractor on fairly short projects, which raises questions as to how it can add value and ensure good quality work, especially when it has little control over resource allocation.

Bangladesh is transitioning to middle-income status and NGOs are finding it harder to secure funding from traditional donors outside of emergency contexts. For WASH, the sector is to some extent a victim of its own success, since Bangladesh met its WASH-related MDG targets and open defecation is now reported as almost zero. Nevertheless, challenges remain in terms of service quality and sustainability, and hygiene promotion.

UP has no country strategy at present, but the current leadership aims to establish a stable programme whose content is based on needs, not just the funding preferences of donors. Ideally this would include a mix of emergency / DRR and development projects, with a technical focus on nutrition and livelihoods. WASH might be integrated into some projects (especially nutrition) but there is limited interest in establishing stand-alone interventions. A lack of in-house WASH expertise might in any case be a constraint.

The documentation and dissemination of lessons learned has not been a strong feature of UP programming in recent years, though a manual of disaster-resilient WASH technology options was produced in 2011.

34

Country Snapshot: UP WASH in Guinea UP has been operating in Guinea for 23 years and has a Field Office in Forécariah prefecture.

Operations originally focused on humanitarian WASH, supporting refugees from Sierra Leone and Liberia, but later expanded to encompass both humanitarian and development projects in WASH, livelihoods, natural resources management and human rights. From 2013 onwards, market-based approaches were introduced within these thematic areas. Currently UP operates two major programmes, WASH and Livelihoods, in Coastal and Upper Guinea. Programme staffing includes a WASH team with approximately ten members.

UP’s WASH portfolio currently includes CLTS; enterprise development; WASH in Schools; water supply; and monitoring the government’s mosquito net distribution campaign. A recent WASH Approach Paper explains that the overall aim is to create demand from communities by combining CLTS, WASH committee capacity strengthening and Community-Based Epidemiosurveillance (CBE) while increasing the availability of WASH products and services at grassroots level. The geographical focus is on the prefectures of Forécariah, Kindia region and Faranah in Upper Guinea (for WASH in schools).

UP was the first NGO in Guinea to have an ODF certified village in Forécariah and to introduce market-based approaches in WASH. The latter included the production and sale of affordable WASH products including chlorine and soap, and this was challenging in the aftermath of the Ebola crisis under which such products were donated in large quantities by humanitarian actors.

WASH funding opportunities in Guinea have reduced following the end of the Ebola epidemic.

Future projects are likely to be short term but UP tries nevertheless to be strategic by piloting new approaches, facilitating their replication and promoting improved policies.

A review of the project documentation provided shows that UP’s WASH projects have generally achieved expected targets in accordance with the timeline, though they have not generally been on a large scale. UP’s efforts also contributed to ending the Ebola crisis. Regarding sustainability, CLTS projects include some post-ODF monitoring and there have been some problems with collapsing slabs during the rainy season. UP is working with communities to resolve this and sanitation marketing supports these efforts.

UP projects include a range of strategies in support of equity and inclusion, both in schools and communities. In the special context of Guinea these includes measures to include Ebola survivors in livelihood opportunities and so help to reduce stigma.

Innovation has also featured to some extent in UP programming though some initiatives, while new in the targeted locations, were not new to the sector – for example a market-based approach to WASH and data collection using mobile devices.

35

Country Snapshot: UP WASH in Malawi Malawi is the home of UP’s largest and longest-running country WASH programme. Until recently, UP had a Global WASH Adviser who was a longstanding member of the Malawi country team.

UP began implementing WASH projects in Malawi in 1992, initially as a response to the influx of Mozambican refugees. It plays the role of an implementing agency, undertaking WASH projects directly using its own staff, and indirectly by working through partners (especially local government) and contractors. The country office claims significant impact - supported by evaluation reports - in terms of extending access to services, achieving ODF status at sub-district and district level, and in terms of the continuing functionality of water points. At national level it is recognised as one of the leading NGOs in the WASH sector.

UP’s long experience has equipped it to undertake high quality physical works. UP also prides itself on the quality of its community mobilisation, the ‘software’ dimension of its work. It has been a leading champion of CLTS in Malawi, with its work leading to 19 Traditional Authorities (sub-districts) becoming ODF by 2017 - one quarter of all ODF TAs in the country.

Malawi is [the only] UP country programme with a dedicated WASH strategy. Amongst other things, this emphasises the health benefits of WASH and claims that UP projects have reduced diarrhoea cases by ‘an average of 30%’ in previous target areas, though no evidence for this is referenced. In addition, it indicates that UP supports the role of the local private sector in WASH; prioritises equity and inclusion; and seeks to strengthen government systems and structures. The latter is not given much attention in project reports, however, and the strategy does not explain how UP seeks to influence sector planning and operations beyond the boundaries of its own projects, though it is evidently an active player in sector fora at national level.

Changes in the donor funding landscape mean that, increasingly, UP WASH projects are funded by charitable foundations and the private sector. These projects tend to be shorter than those funded by traditional donors and this can result in some difficult compromises, for example when there is enough time to install new facilities but not enough to establish enabling conditions for sustainability. Continuity of activity between project grants has also been a challenge for the programme. A related constraint is that much of UP’s WASH funding in Malawi is generated by winning contracts to implement projects (or project components) designed and controlled by others. Some of these contracts have a fairly narrow focus, making it hard for UP to follow all of its stated principles and priorities, not least ensuring that all supported communities become ODF. An interesting recent development has been the introduction of a carbon financing initiative whereby additional funding can be accessed for completed boreholes, subject to confirmation of their continued functionality and use via ongoing monitoring and reporting by UP and periodic independent verification. How exactly the scheme will operate is still being worked out.

36

Country Snapshot: UP WASH in Mozambique UP began operations in Mozambique in 1996, in Niassa Province, primarily to support refugees returning from Malawi. Today it has offices in three locations and works in seven provinces. UP had a number of permanent WASH staff in the past, but currently has none - the last left in 2015.

Capacity building for both CSO and government partners is central to programme strategy.

UP was funded by AusAid for a programme covering WASH, governance and food security which ran for eight years up to 2015. It also received some WASH support from Irish Aid in the past, but on a fairly small scale.

At present, UP has just one programme with a WASH component, entitled Transparent Governance for Water, Sanitation and Health, or GoTAS for short.

GoTAS is funded by the Swiss development Corporation (SDC) with some counterpart funding from government. It operates in five under-served districts of Niassa, which is one of the poorest provinces in the country. The programme seeks to strengthen the government’s bottom-up annual planning process at local level, helping to ensure that it operates in a transparent and equitable manner, while also providing technical and financial support to government investments in rural water supply and institutional sanitation.

There are two streams of funding: budget support via the Ministry of Finance to the Provincial Government of Niassa and participating local governments; and direct funding to an NGO consortium (SNV and UP) which supports the planning and implementation process. SNV leads the consortium and partnered with UP as it considered that the latter had expertise in governance to complement its own WASH capability. The consortium operates via a Programme Management Unit (PMU) which includes some permanent UP staff, though none of them WASH specialists. The PMU has contracted three local NGOs as implementing partners.

It is notable that GoTAS is implemented through the government framework, with NGOs playing a supportive role, including some elements of system strengthening to support the sustainability of rural water supplies. What makes this possible is the decentralised policy framework in Mozambique which actively identifies community needs and priorities and uses these as the basis for annual development planning.

The visit was too short to enable a meaningful assessment of either the ‘soft’ or ‘hard’ aspects of GoTAS, but the quality of WASH infrastructure seen was good or reasonable and the processes described by programme stakeholders seemed well designed, with a strong emphasis on equity and sustainability. As in some other countries, the programme has made some claims of health impact which are not backed up by objective data.

The country office does not receive any core funding for WASH and is heavily dependent on winning implementation contracts in-country. Bilateral funding has reduced in recent times and donor support in WASH is focussed more on strengthening government institutions rather than funding direct implementation by NGOs or other contracted organisations.

37

Country Snapshot: UP WASH in Nigeria UP Nigeria has the second largest WASH portfolio after Malawi. The country programme began in 2000 in Calabar, Cross River State, and is still based there. It started with small WASH and livelihoods projects and, until 2012, the focus in WASH was on rural water supply, but this later shifted to sanitation and hygiene promotion. Currently, the country programme consists almost entirely of WASH projects.

The Global Sanitation Fund (GSF) began operations in Nigeria in 2008 and UP made a successful bid to become the Executing Agency for its first programme, RUSHPIN, which began in 2013.

The programme targeted 100% latrine coverage, 90% handwashing at critical times and 60% improved toilets, across entire Local Government Areas: three in each state. In 2015, UP began a second CLTS project (CHISPHIN) with DFID support, building on lessons from RUSHPIN. UP also secured funding from AusAid and other donors for a project known as SWISH that made water supply improvements in some of the most water-stressed communities where UP was promoting sanitation, as a reward for achieving ODF status.

UP’s ODF achievements are impressive: by January 2019, it had achieved a total a total of five ODF LGAs across the two states, out of a total of ten in the country as a whole. Underlying this success was a systematic approach to LGA-wide promotion, with work progressing ward by ward.

The lead implementing partner in each case was the LGA WASH Unit, into which UP deployed a Technical Officer to provide support and guidance. To complement the WASH Units, a number of CSOs were also contracted to work in specific wards of each targeted LGA. UP encouraged healthy competition between CSOs and WASH Units, and between LGAs. The programme also harnessed the support of natural leaders.

There have also been challenges, not least that the programme could not meet the 60% target for improved sanitation – most of the toilets built were very basic. Furthermore, ODF slippage has happened already in some locations. UP is focusing on measures to consolidate community commitment to remaining ODF, but RUSHPIN and CHISHPIN are both ending in 2019 (following extensions) and UP has no other funding that could be used extend its engagement with the LGAs and enhance their supportive role. An additional challenge is that neither state government provided the counterpart funding needed for replication in additional LGAs. As in some other countries, UP has on occasion reported anecdotal reports of health impact, but without objective evidence.

The achievements of RUSHPIN and CHISHPIN have helped to increase UP’s visibility at national level, though documenting and disseminating lessons for a wider audience has not featured much in the country programme to date. Programme managers acknowledge that UP is still seen as a minor player in the sector.

The prospects for a second phase of GSF funding beyond June 2019 are apparently good, though it has not yet been decided how and where the funding will be utilised. Beyond GSF, however, UP Nigeria is heavily dependent on securing grants from donors based in-country and does not receive any core funding from UK headquarters. It is very difficult to plan with any certainty in the absence of secure funding but there are some emerging new opportunities including partnership with UNICEF and, potentially, a role in a forthcoming USAID urban WASH project.

38

Country Snapshot: UP WASH in Senegal and The Gambia UP has been active in The Gambia since 1992, and Senegal since the early 2000s. In The Gambia it has long-established offices in Banjul and Bignona and opened its Senegal office in Dakar in 2016. Staff are split between the two countries.

UP has a common Strategic Plan for Senegal, The Gambia, Cameroon and Guinea Bissau for the period 2017-2019.

This addresses three challenges facing low-income communities: threats to traditional resilience, lack of access to livelihood opportunities and weak local-level governance. UP’s programming in Senegal and The Gambia pursues the overall goals of healthier lives and wellbeing; jobs and livelihoods; sustainable energy and natural resource management; and conflict resolution, with particular reference to water (for people, crops and livestock), hygiene and health.

All of UP’s work in Senegal and The Gambia is undertaken through partner NGOs, in close collaboration with the relevant organs of government. UP’s aim is to build partners’ capacity, including their financial viability.

Only one recent project in Senegal has included a WASH component. This was an ECHO-funded, 18-month DRR and Resilience project undertaken in 2018 covering water supply, sanitation and hygiene promotion. CRS was the lead implementing partner. The current absence of WASH projects is not a deliberate choice but a reflection of the country programme’s stronger focus on resilience, DRR, livelihoods and food security, and peace and conflict work.

UP’s thematic focus in The Gambia is similar, but six projects over the last ten years have included a WASH component. All were funded by Oxfam America or the European Union. These projects laid greater emphasis on sanitation and hygiene promotion (using CLTS) than water supply, and had fairly short funding periods, though in some locations there were successive projects due to repeated emergencies.

UP is highly dependent on funding opportunities that arise in the region, and the coherence of country programmes depends heavily on what UP bids for. Given UP’s long-term presence and the respect with which it is held by donors, some calls for proposals are a good fit to UP’s expertise and operational capacity. Nevertheless, the ‘projectisation’ of funding can lead to a lack of continuity in engagement in target locations, though UP values its relationships with communities and implementing agencies and tries to maintain them. Access to funding generally is getting harder as traditional donors tend to fund fewer, bigger consortium projects for which UN agencies are often seen as a safe pair of hands, thereby squeezing out NGOs. The main threats to sustainability in UP’s WASH programming relate to community members’ continued practice of improved hygiene and sanitation behaviours and the repair and maintenance of WASH infrastructure. In an environment of short-term project funding and underresourced local governments, these are likely to pose continuing challenges.

Some earlier project documentation made bold - but unsubstantiated - claims about the health impact of UP WASH interventions, notably the introduction of tippy taps for hand washing.

39

Annex B Table of contents of Inception Report

40

Annex C Benchmarking good WASH practice Introduction In making a critique or review of the approach adopted by any development organisation, the reviewer’s reference point is a set of principles which that reviewer considers to represent good practice. Sometimes these principles are not explicitly articulated, and so judgments made by reviewers may be perceived by others as subjective, opinionated or biased.

The purpose therefore of setting out the principles below is to make as explicit as possible the basis for evaluative judgments about an organisation’s approach to water, sanitation and hygiene (WASH). Naturally not all professionals and organisations working in the WASH sector would concur with every word of what follows. However, as the principles reflect sector initiatives such as Sanitation and Water for All and the WASH Agenda for Change we believe the consensus in the profession over the majority of the statements and arguments made here would be strong.

The principles set out below refer to WASH programming by international non-Government organisations (non-profit INGOs, multi-lateral agencies and other implementing partners) in lowand middle-income countries. They refer to development contexts, as opposed to humanitarian interventions; the latter are addressed in the Sphere Standards and related guidance.

Sanitation and Water for All (SWA) Sanitation and Water for All is a global partnership committed to achieving universal access to clean drinking water and adequate sanitation.

Sanitation and Water for All outlined a set of sector building blocks: policy and strategy, institutional arrangements (coordination, service delivery, regulation and accountability); sector financing (budgeting, financing); planning, monitoring and review; capacity development.

It also includes a set of collaborative behaviours including: •

Enhance government leadership of sector planning processes

•

Strengthen and use country systems

•

Use one information and mutual accountability platform built around a multi-stakeholder, governmentled cycle of planning, monitoring and learning

•

Build sustainable water and sanitation sector financing strategies that incorporate financial data on all 3Ts (taxes, tariffs and transfers), as well as estimates for non-tariff household expenditure

Relevance It is essential to understand, respect and respond to global and national contexts. Globally this means recognising and working within the consensuses expressed in, among others, the Sustainable Development Goals (SDGs), the Human Rights to Water and Sanitation, and the Fourth High-Level Forum on Aid Effectiveness in Busan (and its precursors in Rome, Paris and Accra). Nationally it means respecting the mandate and leadership of Government, and actively working in support of national and local Government policies and guidelines. Where Governments are weak or policies flawed, the imperative is to find ways, in collaboration with others, to strengthen and influence those institutions. Working around or independently of national systems is only defensible in highly fragile situations where the rule of law and the reach of Government is essentially absent.

Good programmes are relevant to need and based on sound assessments (and regular reassessments) of those needs. Generic approaches which are insufficiently adapted to specific

41

context and need are likely to be ineffective or inefficient. A sound assessment embraces a clear understanding of global need, detailed analysis at country level, and the specific needs of target populations.

Effectiveness Measures should be taken to ensure that water and sanitation services are used and improved behaviours are actually practised. Technology and infrastructure which stands idle, and knowledge of good hygiene behaviour which is not habitually practised represent wasted investments. It is only through the use of water and sanitation services and the practice of good hygiene that health and other benefits can arise.

Since the behaviours of service users are critical for achieving health and other benefits of WASH, specific and systematic behaviour change initiatives are needed to promote user actions such as using water and sanitation services correctly; paying for maintenance, repairs and replacements; and practising good personal and home hygiene. Behaviours of whole communities, those in leadership and in local and central Government may also need to be addressed in behaviour change programming.

Good practice emphasises the importance of high quality infrastructure, while recognising that it is simply one piece of a wider system which delivers services. Technology and physical infrastructure are necessary to provide services. Consequently, their quality is of great importance. However, technology itself is never enough. The knowledge, skills, institutional arrangements, procedures and financial resources to maintain, repair and replace technology are crucial. A focus on the wider enabling environment around physical infrastructure is therefore essential.

Efficiency A balance must be struck between the quality and the cost of interventions. Whether work is undertaken directly or through partners and contractors, the least-cost solutions are rarely of sufficient quality. It is often better (in terms of inclusion and sustainability) to spend a little more to achieve better quality – but this trade-off is often a matter of judgment.

Organisational overheads should be managed to acceptable levels. This means operating in modest but functional offices, with efficient ICT services and utilities; using vehicles which are fitfor-purpose; and remunerating staff at realistic levels. A balance should be struck between unnecessary extravagance on one hand and excessive cost-minimisation which hinders effectiveness, on the other.

Sustainability An essential outcome of all WASH programming should be water and sanitation services and hygienic behaviours which are enjoyed with no time limit. Sustainability refers to the time dimension of beneficial change which programmes bring about. Once an improvement in service or behaviour, or the capacity of organisations to deliver such changes, has been achieved that forward momentum must continue. Every effort should be made to minimise ‘slippage’ or regression.

Gender Equality and Social Inclusion An essential outcome of all WASH programming should be water and sanitation services and hygienic behaviours which are enjoyed by all. Inclusion refers to the SDG objective to ‘leave noone behind’. Numerous marginalised groups and individuals are left behind by ‘business-as-

42

usual’. These include people in the lower wealth quintiles (the poor); women and girls; rural populations (as opposed to urban); those in minority ethnic, caste or religious groups; pastoralists; people with HIV/AIDS, mental or physical disability; LGBT people; prisoners; and others, depending on context. Special measures may need to be taken to facilitate representation and participation by such groups, and to serve them well.

Innovation It is essential that organisations implementing WASH programmes constantly seek new and better ways of addressing issues in the sector. However, while innovation is important, especially in designing, piloting and scaling up approaches and technologies which address intractable problems, a balance needs to be struck with implementing tried-and-tested solutions. If too many organisations are innovating in too many aspects of their programming, there is a danger that well-established good practices may be neglected, or that mixed messages are conveyed to Governments and communities.

Partnerships Good programmes actively seek out collaborative and respectful relationships, most importantly with Governments (central and local), and also with other WASH sector organisations, large and small (including private sector organisations), having different statuses and functions. Working together makes it possible for external organisations to influence policies and strengthen capacities in ways that are not possible when they ‘plough their own furrow’.

Unity and diversity. It is understandable that organisations wish to retain their own identities and brands, but there is much value too in collaboration among implementing organisations. The informal peer review of approaches which results from working together also helps to ensure that individual organisations stay on message and on task. This balance is sought in the WASH Agenda for Change coalition.

Good programmes build the capacity of all collaborating partners. ‘Capacity’ refers to all the skills, knowledge, procedures and resources required to work effectively. Capacity starts with the skills and expertise of individuals, extends to the organisations and organisational systems within which those individuals work, and reaches out to the wider context or ‘operating environment’ which may enable or disable effective action. If aspects of that operating environment need to change, it is important that all interested stakeholders collaborate to advocate for relevant change.

Agenda for Change The Agenda for Change is a systems-wide approach that tackles policy, financing and institutions. It promotes harmonised district level work. It works to strengthen national level systems in order to enable all districts in the countries to reach everyone and that services continue forever.

Current member organisations of Agenda for Change include Aguaconsult, CARE, IRC, Splash, Water For Good, Water For People, WaterAid,and Welthungerhilfe

Advocacy and influencing Practical know-how and policy relevance go hand-in-hand. Effective organisations have strong on-the-ground practical experience of ‘what works’ in the sector. They combine this with a sound understanding of what needs to be articulated in legislation, policy, regulatory frameworks and sector guidance. Understanding of WASH practice gives organisations the credibility to influence policy, while improvements to policies in turn help to reinforce their own and others’ practices.

43

Integration There is value in implementing water, sanitation and hygiene together; and in undertaking WASH interventions within wider development programming. Integrated WASH programming refers to implementing water, sanitation and hygiene practices in the same area. Sanitation and hygiene interventions may be limited by inadequacies in water services; and the health impacts of water programmes are likely to be limited in the absence of attention to sanitation and hygiene; consequently good practice often requires that all three aspects are addressed together.

Integrated programmes can usefully implement WASH in the broader context of development interventions in the fields of health, education, nutrition, livelihoods, agriculture, and disaster risk reduction. When WASH is undertaken within wider programming however, it is important that good practices and high standards still prevail, and that compromises over quality are not made.

Monitoring and evaluation WASH implementing organisations should maintain simple, lean, accessible and relevant monitoring systems recording their own work. These should contain a mix of quantitative and qualitative measures of outputs and outcomes. They should be designed in such a way as to reflect both the organisation’s own activities, but also to enable straightforward delivery of data into national databases where these exist. Where such national databases do not exist, organisations should work with others to build such systems.

Monitoring is of little value without adaptive and responsive action. Consequently monitoring should explicitly link to organisations’ own ways of working, and to adjustments in these. In cases where, for example, the performance of water and sanitation services is monitored and deficiencies are found, then appropriate action should follow.

Baselines and post-project evaluation should be normal, with at least a sample of evaluations attempting to assess higher level outcomes and impacts . While most evaluations provide evidence of the achievement of planned outputs or deliverables, more searching evaluations should make professional judgments also about the achievement of inclusion and sustainable outcomes, and the likelihood or otherwise of contributing to higher level impacts. From time to time reviews should also assess the extent to which strategic ambitions have been fulfilled and what adjustments to strategic approaches may be necessary.

The challenge of (dis)continuity Despite the inherent challenges of short-term project funding, efforts should be made to design in continuity. Operational realities frequently mean that organisations receive short-term restricted funding to undertake specific actions in designated areas. Once projects finish, it is difficult to achieve the continuity which is necessary to achieve deep and sustainable change.

This is especially the case with short-term (6-12 month) humanitarian funding. Despite this real challenge, efforts should be made to deliver continuity of collaboration, support, capacity development, and other aspects of programming, and to document these over time.

Documentation of learning Documentation of experiences and learning is frequently neglected in the pressures to win funding and to deliver projects. This results in much valuable learning being lost. Good ideas do not become known by others who may have the potential to implement them. Unreported failures get repeated by others. This neglect of documentation should be resisted as far as is possible, and organisations should work to ensure that lessons are identified, captured and shared beyond the organisation.

44

Annex D Summary of general and WASH strategies of other organisations Organisation

Period

Structure of strategy

pp

Is WASH a standalone goal?

Other areas of focus

Separate WASH strategy or capacity statement (CS)?

ACF international technical policy and strategy Here

2012-2015

List of ACRONYMS; INTRODUCTION; Rationale; Structure and content of the document; TECHNICAL POLICY; ACF Technical Mission Statement; Core areas of focus; ACF’s Technical VISION; Areas of Technical Expertise; Values and Principles; Activities common to all sectors; Target groups by domain; CONTEXTUAL ANALYSIS – Technical Challenges & Recommendations for ACF TECHNICAL STRATEGY: Strategic Axis 1: Aligning technical interventions with nutrition; Strategic Axis 2: Scaling up of interventions to prevent and treat undernutrition; Strategic Axis 3: Provision of technical support to organizational advocacy; Strategic Axis 4: Ensuring improved response to and preparedness for, humanitarian crises; Strategic Axis 5: Striving for excellence

40

WASH as an area of technical expertise and strategic objective of reducing under-nutrition

Nutrition, Food Security and Livelihoods, Care Practices and Mental Health, Hygiene Promotion / Health Education, HIV/AIDS, Disaster Risk Management

No

ActionAid: Strategy 2028: Action for Global Justice

Strategy 2028

Introduction; Change is possible, and it’s visible in every region where we work; Who we are; Our Vision; Our Mission; Our Values; The world we live in; The following macro-trends are relevant to our work; Our understanding of how change happens and the contribution we can make; How we will

40

No mention of WASH

Priority 1: Address the structural causes of violence against women and girls and secure women’s economic justice;

No

contribute to change; Programme framework (rights, redistribution and resilience); 2017-2020 Collective Programme Priorities; Organisational shifts

Priority 2: Ensure increased civic participation and state accountability for the redistribution of resources and delivery of quality, gender-responsive public services.

Priority 3: Strengthen resilient livelihoods

45

and secure climate justice.

Priority 4: Drive transformative women-led emergency preparedness, response and prevention Amref : Global Strategic Plan (2018-2022)

2018-2022

Foreword; Acknowledgements; Amref Health Africa’s Global Presence; Executive Summary; The Golden Circle; Amref Health Africa at a Glance; Vision and Mission; Values; Leadership; Amref Health Africa Today; External Strategy Context; Cross-Cutting Themes; Amref Health Africa Legacy; The Big 5; Amref Health Africa Manifesto; Amref Health Africa Global offices

30

Amref Health Africa will therefore work towards SDG 6

BRAC Here

2015-2020

Vision; mission; Values; Welcome; What they say; Challenges; What we can do to meet our challenges; How are we different?; How BRAC works; Education and empowerment; Equitable economic development; Wellbeing and resilience

14

Wellbeing and resilience - Reducing diarrhoeal disease and enabling access to hygienic sanitation and clean water

Care 2020 Here

2020

The strategy purpose; The injustice of poverty; Our response: Care’s Strategy; What we do; The care approach; Our impact by 2020; Where we work; How we will implement the strategy; Accountability; Conclusion

8

Quality life saving humanitarian assistance; women and girls exercise their rights to sexual, reproductive and maternal health and life free from violence; food and nutrition security and

No

Education, empower adolescent girls, access to financial services and livelihood support, essential and reproductive, maternal and newborn health services.

CS BRAC: Here

No

46

resilience to climate change; women have greater access to and control over economic resources Caritas Strategic Framework Here

Concern Worldwide Towards 2030

CRS Here

2015–2019

2016-2020

2030 STRATEGY

One human family, caring for creation; We are Caritas; Our guiding principles; Five strategic objectives to 2019; Summary; Objective One: Caritas at the heart of the Church; Objective Two: Save lives, rebuild communities; Objective Three: Promote sustainable integral human development; Objective Four: Build global solidarity; Objective Five:Make the Caritas confederation more effective; Towards a civilisation of love

28

Introduction from the CEO; We are Concern Worldwide; Our values; What we do to achieve our mission; Where we work; We are principled; Strategic Plan: 2016-2020; Where and how we will work; Strategic Goal 1: Greater impact on long term poverty; Strategic Goal 2: Larger, faster, better humanitarian response; Strategic Goal 3: More influence, greater visibility and increased public engagement; Strategic Goal 4: Growing a new generation of Concern people; Strategic Goal 5: Building a global Concern to meet multiple challenges; Strategic Goal 6: Securing the financial resources to implement the plan; Conclusion

20

A Message From Our President & CEO; Enduring Mission; Universal Human Values; Guiding Principles; How we deliver our mission matters to us as much as what we do; Partnership and Capacity Strengthening Are at the Heart of Our Approach; Our Changing World; Call to Respond to Support Human Flourishing; Our 2030 Strategy, Their Destiny; Our Aspirations; Our 2030 Goals; Goal Area 1 All People Live in

19

Objective Three: Eradicate poverty by empowering people and changing unjust systems e.g.

Promoting good governance and

Caritas at the heart of the Church; Save lives, rebuild communities; Build global solidarity; Make the Caritas confederation more effective

No

Emergency Livelihoods Health Education

No

Programming expertise - Water, Environment

Emergency Response & Recovery

No

& Sanitation

Capacity Strengthening of Partners

equal access to the basic services and resources such as clean water,

Continue to strengthen health systems in maternal and child health; improve access to water and sanitation

47

Just and Peaceful Societies; Goal Area 2 All People Survive and Thrive in the Face of Disasters; Goal Area 3 All People Achieve Dignified and Resilient Livelihoods in Flourishing Landscapes; Goal Area 4 All Children Reach Their Full Health and Development Potential in Safe and Nurturing Families; Goal Area 5 All Youth Are Empowered to Thrive; How We Will Achieve Our Goals - Strategic Approaches; We Draw on Strong Organizational Capabilities and Assets; PROGRAMMING EXPERTISE; CORE COMPETENCIES; Conclusion

Agriculture & Livelihoods Education Justice & Peacebuilding Microfinance Health & Social Services

DanChurch.

Here

2015 2018

Introduction; Thematic Focus and Goals; Geographical Focus; Partnership for Change; Human Rights Based Approach and Gender Equality; Global Advocacy; Role as Danish Civil Society Organisation; Strategic Financing for Sustainability; Programme Management; Risk Management

22

?

Right to Food; Humanitarian Action; Safer Communities; Active Citizenship;

Goal Here

2012 2016

Introduction; Who we are; What we do; What we know about our operating environment; What we have learned about ourselves; What we want to achieve; How we will achieve this; Where we will work; Who we will work for; How we will deliver the right assistance, in the right way and with the greatest impact to the right people; How we will make sure we can deliver on these commitments; Where do we want to be in 2017?

32

WASH as core area; sits in public health approach and market systems approach

Livelihoods, Nutrition, Health, Education

Habitat for Humanity: Here

?

Strategic Plans for different locations

No

GOAL Uganda, WASH CS

health, water, sanitation and hygiene, nutrition, HIV, livelihoods, education, shelter and child protection and empowerment

WaSH programmes help to ensure that the homes we build have safe, decent facilities for a family to stay healthy and be able to live their lives to their fullest.

No

48

iDE: no strategy??

No

Islamic Relief Global Strategy 2017-2021

2017-2021

how we see the world; the world we’re working in; our vision for 2021; our 4 global goals

9

Impacts of conflict and natural disasters

Mercy Corp Here

2018-?

Strategic Framework; Global Context; Strategic Objectives

3

?

Mercy Corps CS: Here

?

No

Muslim Aid – plans to develop a 5year corporate strategy

?

MSF

??

Norwegian Church Aid: Here

2015-?

reducing the impact of conflicts and natural disasters; empowering communities; mobilising people and funds; strengthening our family

No

No Who we are; The world we seek to change; Who we work with; OUR long-term goals; How we work; Humanitarian response; Where we work; Organisational priorities

15

HUMANITARIAN RESPONSE Expertise on water, sanitation and hygiene

Two long-term goals: to save lives and to seek justice.

No

Supporting people to act as agents of change; accountable governance; advocating nationally and internationally; cooperate with the private sector; building the resilience of

49

communities affected by disasters Greater coordination with the ACT Alliance ODI: Here

5 years

Who we are; Responding to a changing world; What we do; Guiding principles; Our work; Four challenges; How progress happens: risks and enablers; A changing organisation for a changing world

8

Ensuring sustainable water, land, food and energy

Oxfam Here

?

our strategic aims; connecting systems; the sustainability challenge for water and sanitation; inequality in service delivery; inclusivity and governance; economic sustainability; vision; a new, sustainable approach for the water and sanitation sector; Oxfam working with different partners and perspectives.

8

Support and connect humanitarian and development actors and approaches, help build real resilience for marginalized populations to keep water and sanitation systems operational, accessible, equitable and affordable

Deliver greater impact for vulnerable children, especially girls; lead on girls’ rights; transform girls lives; leave no one behind; deepen partnerships; influence greater change at local and global levels

16

Programming focused on adolescent girls, focusing in areas like education; child marriage; sexual and reproductive health and rights; and water, sanitation and hygiene (WASH).

Plan International: Plan International's Global Strategy 2017-2022

2017-2020

Responding to humanitarian emergencies

Poverty and inequality; economies and work; sustainability; conflict and fragility

No

No

Working with men and boys on the barriers to girls’ rights.

Plan International USA CS: Here

• Growing fundraising for work which supports girls.

• Examining the reality of girls’ lives through publications Campaigning with and for girls through

50

our Because I am a Girl campaign Practical Action Here

2017-2020

People have access to technology to meet their basic needs and reach their potential

8

Improved access to drinking water, sanitation and waste services for urban dwellers

Samaritan’s Purse International -

?

Has a Samaritan’s Purse Fact Sheet

?

Works around the world to provide clean water and promote safe hygiene practices: Here

Save the Children: Here

Ambition for Children 2030

Building a better world for and with children; Who we are; A changing world; Who we will reach; Our 2030 Ambition; 2016–2018GlobalPriorities; Where we will work; funding our ambition

12

? Health and Nutrition or Education??

and 2016 – 2018 strategic plan

SNV Strategy Paper Here

2016-2018

Transform the way technology is used to transform the lives of people living (or vulnerable to) poverty

No

No

Survive: no child dies from preventable causes before their fifth birthday

No

Learn: all children learn from a quality basic education be protected: violence against children is no longer tolerated The challenge; The role of SNV; Our outline for 2016-2018; Our SNV; Our roles; Our sectors

12

Water, Sanitation, & Hygiene (WASH) focuses on three sectors – environmental health by reducing pathways for disease transmission,

Agriculture, Energy, and WASH

SNV in Ethiopia CS: Here

51

enhances nutrition especially with regards to stunting in children, and reduces both untreated human waste and wastewater SolidaritĂŠs International

?

? It has a charter with articles to guide its work here

Tearfund

?

? - not clear they have a strategy although they do have a Director of Strategy and Impact (Catriona Dejean)

?

No

Thrive Networks: here

??

??

WASH services to underserved populations by pioneering scaled, evidence-based programs in partnership with government institutions, citizens’ groups, grassroots organizations and researchers

No

Welthungerhilfe.

Here

2017-2020

Re-commitment to what works and new impulses to multiply impact; What we do; How we do it

WASH competences In our humanitarian aid we will concentrate on measures that improve the availability of food, on WASH and on securing basic needs

No

Food and nutrition security, agriculture, natural resource management

No

52

World Vision: Our Promise 2030

2030

Our strategic imperatives; Change Starts With Us

8

???

World Vision Afghanistan CS: Here

UNICEF WASH Strategy here

2016-2030

Rationale: SDGs in a Changing World; Why WASH; Unfinished Business; Lessons Learned Over the Previous Strategy Period; UNICEF’S Strategy for WASH; Vision and Objectives; Programming Principles; Programming Approaches; Results Areas; Evidence-Based Programming and Monitoring; Implementing the Strategy; Core Accountabilities: What UNICEF Will Do Where; Determining UNICEF’s ContextSpecific Contribution to WASH; Mobilizing the Entire Organization; Managing Talent; Partnering Effectively; Managing Knowledge and Using Evidence; Managing for Results; Resourcing the Strategy

75

Has a Theory of Change

No

WHO WASH Strategy (20182025): here

2018-2025

1. RATIONALE AND CONTEXT; Introduction ; WASH and health ; WHO and WASH; The need for transformation; The SDGs, WHO and WASH; Strengthening inter-sectoral and cross programme collaboration; Increasing WHO impact; THE WHO WASH STRATEGY; WHO strategic plan for WASH: 2018-2025 ; Strategic approaches 2018–2025 ; Priority intervention areas 2018–2025; WASH objectives within the WHO Global Programme of Work 2019-2023; Delivering WASH through this strategy; Resourcing the work; Investment case; Value for money; Strengthening impacts of the work; Monitoring and measuring progress; WHO WASH PRIORITY INTERVENTION AREAS ; Drinking-water and recreational water quality and safety; Sanitation and wastewater; WASH in health care facilities; UN-Water Global Analysis and Assessment of Sanitation and DrinkingWater; The WHO/UNICEF Joint Monitoring Programme; Estimation of burden of disease from inadequate WASH; WASH and health programme linkages ;WASH and cholera; WASH and emergencies; WASH and neglected tropical diseases; WASH and emerging issues; WASH and antimicrobial resistance; WASH and climate change; Water resources and health

64

Has a Theory of Change

No

53

DFID WASH approach paper

2018-2030

Context; fundamental importance of WASH Drivers of Change; SDGs, Other challenges, Population Growth and Urbanisation, Environmental Degradation and Water Insecurity, Climate change, Poverty and fragility; Global opportunities, Thinking Digital, ‘Whole Systems’ Approach to Sanitation, Mobilising Private Finance The UK’s Development Agenda; Ensuring a good fit with UK aid strategy, Engaging with the rest of DFID, Ensuring a better fit with the UK national interest; Technical capacity and global leadership on WASH DFID’s Future Approach to WASH; SWOT and Principles Moving from Principles to Practice (Exploiting internal synergy, Balancing direct delivery with system strengthening, Balancing Country and Centrally Managed Programmes and Core Support; Strengthening our internal WASH capacity)

25

Yes

Strengthen & support WASH systems;

No

Include urban as well as rural populations; Strengthen environmental sustainability and climate resilience; Respond to productive and domestic demands to maximise sustainability and impact; Geographical concentration on fragility; Focus on poverty eradication and reducing vulnerability

54

Annex E Draft job description for a Global WASH Adviser This job description is for a fixed term two-year contract initially (extendable depending on review). This is a full time role, requiring periodic travel (estimated up to 25% of time) as well as meetings away from UP’s Cardiff office.

Job purpose Working closely with fundraising (Cardiff) and implementation teams (Country Offices) the postholder will: •

Lead in the articulation of a global WASH Strategy and M&E framework for UP

•

Lead on developing networks and relationships (and potentially consortia) with donors and UK and global sector stakeholders

•

Lead on documentation of UPs WASH work

•

Play a key technical support role in programme development for new WASH proposals (working with Country Offices)

•

Provide targeted technical support in areas of highest priority (including capacity building)

First priority The post-holder’s first priority (expected to take between 3 and 6 months, while beginning other activities) is to assemble a coherent WASH Strategy and M&E framework for the organisation.

This will be based on UP’s existing WASH Capability Statement, building on the work of the consultants who undertook the 2018-19 Review of UP’s global WASH programming, dovetailing with the production of UP’s Global Strategy, and undertaken through a participative process involving all country offices.

Thereafter, it is expected that the post-holder’s time will be divided as follows:

Key deliverables and activities Key Deliverables

Key Activities

Awareness and Representation (30%)

•

Lead on representing UP’s WASH work and proposals to donors and potential partners in the UK

•

Foster productive relationships with WASH sector networks, donors and other actors, and use them to identify potential new funding opportunities and develop innovative partnerships

•

Stay up to date with key sector trends to ensure that proposals are informed by best practice

Documentation, sharing • and learning (15%) • WASH programme development (30%)

Ensure that learning processes capture the outcomes and impact of UP’s WASH work Lead on the documentation, publication and dissemination of good practices

•

Work with fundraising teams to identify WASH funding opportunities

•

Lead on opportunities to join or form consortia to bid for funding

•

Work with Country Offices and partner organisations to develop technically strong WASH proposals (e.g. by writing technical sections of proposals)

•

Participate in the shaping of new projects

•

Promote the inclusion of cross cutting issues within programming

55

Implementation support • to WASH • projects (15%)

Other Responsibilities (10%)

Provide targeted technical support to projects during implementation, with a particular focus on the largest and most complex projects.

Ensure that M&E and learning systems are put in place which reflect sector best practice

•

Undertake occasional trainings for Country Office teams

•

As required

Personal competence The post holder will have strong technical, communications, documentation and networking skills.

WASH technical • Demonstrate strong technical knowledge • Maintain and develop own knowledge and skill base • Demonstrate awareness of quality standards and take steps to apply new learning and opportunities Communication and networking • Network well and foster partnerships with a range of WASH stakeholders, including donors and organisations specialising in WASH • Maintain relationships with relevant platforms such as SWA, Agenda for Change, UK Water Network, RWSN, SuSanA Knowledge and documentation • Prepare and structure written and oral communication • Present at conferences and meetings Personal experience • At least 10 years’ experience in the WASH sector including designing, implementing and supporting WASH projects/programmes • 5+ years of experience of working in developing countries for international or local civil society organisations • Excellent writing and editorial skills • A post graduate qualification, or relevant development discipline Ability to • Develop strong WASH fundraising proposals targeted at institutional donors (and corporates) • Communicate WASH technical issues to a range of audiences • Network with sector and other stakeholders • Facilitate capacity-building and learning of staff in WASH technical areas • Manage consultants Knowledge of • Specialist and current best practice in WASH programming, including system strengthening approaches to WASH • Monitoring and evaluating the outcomes of WASH programmes • The funding and policy environment pertaining to WASH (global, regional and country) • Fluency in English and working knowledge of French and/or Portuguese an advantage Level of budget responsibility • Medium - Post has direct responsibility for the management of a small budget for travel, conferences, capacity building and consultancy, and an advisory role over effective spending of large budgets 56

Annex F Communicating the impact of WASH on health Inadequate WASH undermines good health Inadequacies in water supply, sanitation and hygiene have been known for more than 150 years to be contributing factors to ill-health41. Ingestion of pathogens (disease-causing organisms) having their source in human excreta has been recognised in the identification of a number of faecal-oral (faeces-to-mouth) routes of disease transmission, including via soil, contaminated water or physical objects, food, flies, and hands42.

Many such diseases cause diarrhoea, and it is estimated that in 2017 more than 440,000 children aged 0-4 died as a consequence of such infections – about 50 deaths per hour43. Recently, the importance of animal excreta in further complicating this picture has been highlighted44.

Ill-health may also be caused via other routes (ie not needing direct ingestion of the pathogen) which are also linked to poor sanitation, hygiene or water supply. These include some worm infections, mosquito- and other insect-borne diseases, infections having other (non-insect) intermediate hosts, and some skin diseases45.

Negative health impacts of poor WASH services also include the physical burden of daily water carrying on children and women, and in some cases the toxic effects of naturally occurring chemical species in drinking water (eg arsenic and fluoride).

WASH interventions WASH projects can address numerous aspects of water, sanitation and hygiene, individually or in combination. These include, in water: improvements to water access or proximity, enhanced reliability of water supply, increased quantity and better quality of drinking water; in sanitation: progression from open defecation to use of a basic latrine, upgrading of latrines from basic to improved condition, continuing up a “ladder” of quality and safety; in hygiene, promotion of handwashing at key times, improvements to food hygiene, and initiatives to ensure that toilets or latrines are kept clean and well-maintained.

WASH contexts WASH projects may be implemented in a wide range of contexts, in which poverty, population density, the baseline status of water and sanitation services, cultural and religious practices around hygiene, and wider gender and social-cultural aspects (to name a few) can vary enormously. It is against this background that questions about the magnitude of WASH impacts Snow, J (1849) On the mode of communication of cholera. London: John Churchill, Princes Street, Soho. https://collections.nlm.nih.gov/ext/cholera/PDF/0050707.pdf 42 The most common presentation of these routes is in the so-called “F”-diagram, originally published by WHO in 1958 (Wagner E G, Lanoix J N, Excreta disposal in rural areas and small communities). A modern version of the “F”-diagram can be found here: https://wedcknowledge.lboro.ac.uk/resources/factsheets/FS009_FDI_A3_Poster.pdf 43 http://apps.who.int/gho/data/view.main.CM1002015REG6-CH3?lang=en 44 Exposure to Animal Feces and Human Health: A Systematic Review and Proposed Research Priorities Gauthami Penakalapati, Jenna Swarthout, Miranda J. Delahoy, Lydia McAliley, Breanna Wodnik, Karen Levy, and Matthew C. Freeman Environ Sci Technol. 2017 Oct 17; 51(20): 11537–11552. Published online 2017 Sep 19. doi: 10.1021/acs.est.7b02811 45 Cairncross S, Feachem R (2018) Environmental health engineering in the tropics: water, sanitation and disease control. 3rd Edition. Routledge / Earthscan. ISBN 9781844071913.

41

57

on health need to be considered. Every context is different, and every WASH project is different (both in terms of what it set out to do, and how effectively it did so), so the question takes on many layers of complexity.

Impact of WASH on health Notwithstanding these observations, those undertaking research in the sector have been trying for many years to answer two key questions: first, what are the relative impacts on health (especially diarrhoeal disease, and especially diarrhoea in under-fives) of interventions in water, sanitation and hygiene? And second, what are the actual magnitudes of those impacts?

Studies and syntheses of studies Both before and since Stephen Esrey’s seminal review and analysis46 nearly 30 years ago, researchers have been undertaking field studies examining the health impacts of specific WASH interventions (in particular contexts and at particular times), and others have undertaken systematic reviews47 and meta-analyses48 of the data aggregated from studies which pass acceptable quality criteria. The most recent systematic review and meta-analysis is that of Wolf et al (2018)49, although large and influential studies (specifically the WASH Benefits50 trials) and the SHINE51 trial have been published since, or are in the process of publication.

Findings of studies and reviews Unsurprisingly, individual studies of the impact of WASH interventions – involving different types of intervention, in different contexts, and implemented more or less effectively - show a wide range of effects on the target population. Systematic reviews and meta-analyses both reflect that heterogeneity, and attempt to cut through it. A number of general comments can be made: 1. Health impact evaluation is extremely expensive.

2. The studies which are considered to offer the highest standards of evidence (randomised controlled trials or RCTs) were designed for use in clinical trials of drugs and other medical treatments, in which both those receiving the intervention (or those in the control group Esrey SA, Potash JB, Roberts L, Shiff C (1991) Effects of improved water supply and sanitation on ascaris, diarrhoea dracunculiasis, hookworm infection, schistosomiasis, and trachoma. Bull World Health Organ 69: 609-21. https://www.ncbi.nlm.nih.gov/pubmed/1835675 47 “A systematic review summarises the results of available carefully designed healthcare studies (controlled trials) and provides a high level of evidence on the effectiveness of healthcare interventions. Judgments may be made about the evidence and inform recommendations for healthcare” [https://consumers.cochrane.org/what-systematic-review ] 48 “Meta-analysis is the statistical procedure for combining data from multiple studies. When the treatment effect (or effect size) is consistent from one study to the next, meta-analysis can be used to identify this common effect. When the effect varies from one study to the next, meta-analysis may be used to identify the reason for the variation” [https://www.meta-analysis.com/pages/why_do.php?cart=] 49 Jennyfer Wolf, Paul R. Hunter, Matthew C. Freeman, Oliver Cumming, Thomas Clasen, Jamie Bartram, Julian P. T. Higgins, Richard Johnston, Kate Medlicott, Sophie Boisson, Annette Prüss-Ustün (2018) Impact of drinking water, sanitation and handwashing with soap on childhood diarrhoeal disease: updated meta-analysis and meta-regression. Tropical Medicine and International Health, Volume 23, Issue 5, pp508-525 https://doi.org/10.1111/tmi.13051 50 http://www.washbenefits.net 51 Humphrey J H et al (2015) The Sanitation Hygiene Infant Nutrition Efficacy (SHINE) Trial: Rationale, Design, and Methods. Clinical Infectious Diseases 61(suppl_7):S685-S702 doi: 10.1093/cid/civ844 https://academic.oup.com/cid/article/61/suppl_7/S685/358186 46

58

3.

4.

5.

6.

7.

receiving a placebo) and those collecting and analysing the data could be blinded to avoid bias. Blinding study participants and those collecting data is usually not possible in WASH trials.

When WASH RCTs are designed and undertaken well, they may be able to demonstrate impacts (or absence of impacts) in the particular context and the particular time, as a result of the project as implemented. They are described as having high internal validity. However, generalising the findings of a single RCT to other times and places is rarely appropriate.

Multiple RCTs undertaken in a range of contexts can help to address this lack of external validity.

The impact being measured – usually short-term (up to two years post-intervention) diarrhoea morbidity in infants or U5s (not diarrhoea mortality, nor usually other diseases) – is usually as reported by the mother or care-giver, giving rise to risk of bias. In the recent WASH Benefits and SHINE trials, impact of various interventions (components of WASH, in some cases combined with nutrition) have also examined effects on stunting.

Multiple systematic reviews and meta-analyses paint a common general picture – that WASH interventions do tend to have a positive health impact – but the specifics (the relative importance of different types of WASH intervention, and the actual magnitudes of those impacts) vary across successive reviews.

Across specific studies the health impacts of different types of WASH interventions apparently vary widely; the same goes for the pooled estimates provided by meta-analyses. Anomalously small (no impact) and large impacts occur.

Although it is generally accepted that all RCTs should be accompanied by equally rigorous process evaluations (to examine the likely effectiveness of the intervention), this is not always the case. Consequently, studies showing very limited impacts of ineffective interventions continue to be included in systematic reviews and meta-analyses.

Conclusions In the absence of adequate water and sanitation services and conducive hygiene practices, health is compromised, and seriously so. Undertaking WASH projects and programmes with the aim of contributing to better health is both defensible and evidence-based.

However, a number of caveats need to be made: first, better health should neither be the only, nor necessarily the main, aim of WASH programming, at least from the point of view of the beneficiaries; enhanced convenience, safety, privacy or dignity may rank higher than better health for those who are meant to benefit.

Second, it is rarely if ever possible for the health impacts of WASH interventions to be measured reliably or rigorously in field projects implemented by INGOs and local governments; research budgets exceeding the costs of the interventions themselves would be needed.

Third, diarrhoeal disease has many causes, and typical WASH interventions only affect some of them. Even if it were practicable to measure health impacts, they may turn out to be rather small.

Consequently it is important to be cautious about claims of health impacts made in WASH projects. Realistically UP can neither provide the necessary evidence to support bold claims of health impact, nor should it, in light of the current scientific “state of the art”.

59