An old piece of railroad track is laid across a pit toilet. The walls are crumbling. The stench is overwhelming. It’s the only toilet for a school in rural Ghana, and most children refuse to use it. They do their business outside instead — or quit school altogether.
This is an all-too-common experience: Half of Ghana’s population lives in rural areas, and only 10 percent of those people have access to basic sanitation. Two-thirds can obtain safe drinking water — after a 30-minute round trip.
Since 2009, Rotary has been working to fix those deficiencies through a partnership with the U.S. Agency for International Development (USAID). The partnership combines the business skills and local community leadership of Rotarian volunteers with the technical expertise of USAID. Rotary is contributing $9 million to the $18 million partner- ship; outside of eradicating polio, it is Rotary’s largest partnership effort. “We wondered how these two
organizations could come together and exploit the synergy between them,” says Rotarian Ron Denham, a member of the Rotary-USAID steering committee.
Ghana was one of three pilot countries when the program kicked off. Projects were implemented in two phases: Phase 1 concluded in 2013, and Phase 2 will end in 2020. “As a result of this partnership, we’ve been able to reach out to some very deprived communities,” says Emmanuel Odotei, WASH management specialist for USAID/Ghana. “If USAID had tried to do this alone, or if Rotary had done it alone, we would never have achieved as much as we have today.”
Throughout, the focus of the program has been on accomplishing three goals: improving sanitation and hygiene in schools and health facilities; in- creasing community access to safe drinking water; and advocating for ample government financing of WASH — that is, water, sanitation, and hygiene.
The installations and the number of people who benefited from the program were significant. But that’s only part of the story. The partnership also trained school health educators and community- based hygiene promoters to lead behavioral change campaigns that would deter open defecation (see page 38). It helped establish local committees to manage the water and sanitation systems after Ro- tary and USAID departed. And it empowered com- munity leaders by showing them how to go to their district assemblies and demand that funds be allo- cated — and used — for water and sanitation services. “Rotarians are very well-connected,” says Alberto Wilde, the director in Ghana for Global Communi- ties, a development agency contracted by USAID to implement the program in Ghana. “It’s easier for us to make changes in policy if we have the right people who can open doors with decision-makers.”
The scale of the program demanded the close involvement of more than 100 Rotarians. Roughly 30 of Ghana’s 50 Rotary clubs participated, and each of those clubs assigned members to remain engaged throughout its involvement. Each club supervises the implementation of multiple projects, some of which might be a six-hour drive away along dirt roads that are impassable in the rainy season. “Rotarians are making big sacrifices for the projects,” says Ako Odotei, a member of the Rotary Club of Tema and the Phase 2 chair of the host committee of local Rotarians directing the partnership alongside USAID. “These projects are their babies.”
Last summer, representatives of the partnership toured some of the communities where it had implemented projects. As is the case globally in the water and sanitation sector, some of the projects were successful and some were failures. Most were somewhere in between. Some of the lessons learned are described on the following pages — lessons that can help ensure success in future programs.
KADE PRESBYTERIAN SCHOOL, KADE | Kwaebibirem Municipal District,
Rotary clubs of Accra Ridge and Tema-Sakumono
Students at the Kade Presbyterian School learn hand washing and personal hygiene formally in the classroom. But how can teachers ensure that translates into daily practice? Some schools have health clubs, which reinforce healthy habits such as washing hands before meals. Or schools might use triggers, such as putting the hand-washing facility directly outside the bathroom or displaying posters or murals of people doing healthy things.
Meanwhile, the preferred method for reaching adults is community-led total sanitation (CLTS), which teaches residents how to analyze their sanitation habits and collectively mobilize to change unhygienic behavior.
The Rotary-USAID partnership provided two toilet blocks at Kade Presbyterian School. But many families in the surrounding communities don’t have toilets, so students struggle when they go home. This also puts pressure on the school facilities, be- cause other people living in the community want to use them. This is common in areas where schools receive toilets, says Andy Osei Kontor, a field officer from Global Communities. Community members break the locked doors to get into the latrines, and then, lacking training, use them in an unsanitary manner. Schools are left to use their resources to clean up the messes. “But after the schools fix such issues, the intrusions persist,” Kontor says. “Eventually the schools give up” — which underscores the importance of long-term planning.
BEPOSO (ADEKYEMSO) | Kwaebibirem Municipal District,
Rotary Club of Accra-Achimota
It’s a winding drive through thick forest to reach Beposo, a village so remote that residents had to help clear the roads so a truck could come in and drill a Rotary-USAID borehole.
Before the borehole, residents used water from a nearby river for drinking, cooking, bathing, and washing clothes. “Though that wasn’t good, we had no choice but to use it,” explains Dede Christiana, a member of the local water and sanitation manage- ment committee. “I used to have upset stomachs, and because the children had to journey long dis- tances for water, they were always tired and couldn’t study in the evening. This new source of water has brought us joy and relief.”
Rather than charge per use, the community levies
a 2-cedi (36-cent) monthly fee from residents; those who can’t afford it make their payment whenever they sell their agricultural products. The treasurer of Beposo’s water and sanitation management com- mittee provides reports on the finances at commu- nity meetings and deposits the money in 100 cedi (roughly $18) increments to the bank. “I pay for the water because it’s very important, and I know that the money is going to be used in operating and maintaining the borehole,” says Kwame Frimpong, a resident of the community.
Frimpong and his neighbors in Beposo understand the necessity of the water fees. But a study of proj- ects in Phase 1 of the Rotary-USAID partnership found that the local management committees in nine of 12 communities failed to collect fees on a regular basis. Without those funds, the committees would be unable to buy spare parts, hire mechanics, and maintain the borehole, which would ultimately negate the benefits of the partnership’s projects.
To overcome those shortcomings, Ghanaian Ro- tarians act as mentors to committee members. “We have to teach them accountability and convince them to establish an accounting system and put money in the bank,” says Ako Odotei, the Phase 2 chair of the host committee of local Rotarians. “In- variably, any equipment you install will break down. That’s why we have them try to set up a system to collect tariffs and reassure the community that the money is being used appropriately.”
ABUTIA TETI | Ho Municipal District
Rotary Club of Ho
In August 2011, it seemed as if the entire town of Abutia Teti gathered to welcome a delegation that included RI President Kalyan Banerjee and his wife, Binota. Men, women, and children sang and danced, celebrating a new electric pump that would provide the town with safe drinking water.
But several years later, the situation in Abutia Teti had changed. The community’s water and sanita- tion funds had been poorly managed, electric bills had gone unpaid, and the pump was broken and had been disconnected from the national power grid.
Younger townspeople stepped in and assumed management of the local water and sanitation com- mittee. Today, the power is back on and the pump has been replaced. Still, there are challenges, includ-
ing debt and more infrastructure issues. “When you do a life cycle cost analysis, we have certain costs that are beyond the community,” says Theophilus Mensah, program manager for the partnership.
Managing a water system is a huge responsibility for a community to undertake. One of the lessons learned during the partnership was the need to get government officials involved right from the beginning. “Rotary cannot stay in one com- munity forever,” says Kwadwo “Willie” Keteku, who chaired Ghana’s Rotary host committee for the program’s first phase. “So it’s important we build sustainability into projects. That takes cooperation not only from beneficiaries but also from local government officials.”
KADE METHODIST SCHOOL, KADE | Kwaebibirem Municipal District
Rotary clubs of Accra Ridge and Tema-Sakumono
Rotarians inspect the school’s water and sanitation records with teachers.
Diarrhea kills 2,195 children every day world- wide. But there’s a simple solution that can cut that figure nearly in half: hand washing. Studies have found that this low-cost intervention can have as great an effect on health as the much bigger project of providing access to clean water.
In Ghana, the School Health Education Program is the national government’s initiative to promote healthy living, and school sanitation and hygiene education falls under its purview. To increase the sustainability of the water and sanitation projects such as the one at Kade Methodist School, Rotary’s partners — Global Communities and the government of Ghana’s Community Water and Sanitation Agency — train the schools’ health coordinators in the use
and maintenance of latrines and the national school health education strategy, among other topics.
The partnership also trained local hygiene promot- ers to deliver key messages about hand washing and other hygiene tips to the broader community. An assessment of Rotary-USAID Phase 1 projects found that most heads of households understood the im- portance of hand washing and encouraged it in their families; children, however, had poor hand-washing practices, and a majority of residents wash their hands with soap in only 17 percent of communities. There is often not much governmental support for the work of community-based hygiene promoters, and many of those who were trained as part of the first phase of the program have since moved on.
ABUVIEKPONG | Shai Osudoku District
Rotary Club of Accra-South
A resident of Abuviekpong, an open-defecation-free com- munity, shows off a latrine he built himself; the partnership needed to install iron removal devices on both of the bore- holes it drilled; the clean water is used for washing maize.
Abuviekpong is a community of 550 people near the Volta River. The river is the source of their livelihood — fishing and farming — and, until re- cently, their drinking water.
After Rotary-USAID installed two boreholes with manual pumps, tests found excessive levels of iron in the water — prompting the partnership to install iron removal devices on both boreholes. (With the device in place, the iron in the water will precipitate into a solid material when exposed to oxygen; the water is then run through a series of filters to remove the precipitate.) Community members therefore received two trainings: one showing how to operate and maintain the pumps, and a second about the operation and maintenance of the devices that remove the iron.
The Phase 1 assessment of the partnership’s projects found that their water and sanitation infrastruc- tures were well constructed and that local water and sanitation committees understood their roles and have remained vigilant and involved. In addition, there are clearly outlined national policies for rural water supplies and frameworks in place for imple- menting them. But with only 4 percent of water and sanitation funding coming from government sources, local authorities have few resources for ongoing sup- port of projects completed by Rotary-USAID and other nongovernmental organizations. Without that government support, communities are often left to manage complex water facilities on their own.
AJUMAKO-TECHIMAN CATHOLIC SCHOOL | Ajumako-Enyan-Esiam District
Rotary Club of Accra-Osu RE
“I give Rotary multiple thumbs-up,” says Ransford Kwesi Nyarko (third from left), chief executive for the Ajumako-Enyan-Esiam District Assembly. “They equipped stakeholders so they know they have a role in managing the facilities.”
Thirty-one percent of the schools in Ghana do not have proper sanitation facilities. One of them was the Ajumako-Techiman Catholic School. So the Rotary-USAID partnership replaced the school’s malodorous pit latrines with environmen- tally efficient microflush toilets; it also installed a manual borehole with a hand pump so students and teachers could wash their hands. But when program representatives returned to monitor and evaluate the latrines, they found filthy condi- tions due to after-hours use by other members of the community.
One student explained that if they use the dirty toilets, the stench stays with them, and they feel embarrassed in front of their teachers. “We don’t want to come here because of the bad smell,” she says, referring to the fairly new latrines.
Seven of eight school latrine blocks assessed in the Rotary-USAID study of Phase 1 projects were found to be in unsanitary condition. Many of the schools had not implemented a regular cleaning schedule, did not have cleaning supplies readily available, and did not provide toilet paper or water for hygienic purposes. Meanwhile, there is inad- equate funding for the proper training of govern- ment staff who are supposed to support and monitor these facilities.
A device known as a “tippy tap” is used for hand washing.
At the school in Techiman, the partnership is building a mechanized borehole with a microflush toilet system, a novel technology that uses a small amount of hand-washing water to flush the toilet. The excreta goes into an underground biodigester that creates compost.
But what will happen if this system breaks? The Phase 1 assessment found that schools are not able to set money aside for maintenance and repairs and that local governments rarely provide funds to schools for this purpose. With that in mind, an important part of the Rotary-USAID program has been training communities in how to advocate for their own needs once the partnership has moved on. “We are coaching communities on how to ap- proach the district assembly and how to get their voices heard,” says Dominic Osei, deputy chief of party at Global Communities.
HEALTH CLINIC, OSEDZI | Ajumako-Enyan-Esiam District
Rotary Club of Accra-Osu Oxford Street
The Rotary-USAID partnership provided this clinic in Osedzi with a bore- hole and a solar-powered pump. The pump sends water from the borehole into the tank; propelled by gravity, the water then flows through pipes into the clinic.
Nobody goes to a hospital to get sick. But nearly 900 million people globally use health clin- ics that don’t have access to clean water, increas- ing the risk of infections. That was the case with the clinic in Osedzi.
The Rotary-USAID partnership initially provided the clinic with a manual borehole with a hand pump. That provided the clinic with clean water, but health care personnel had to fetch buckets of water from the pump and fill larger containers within the clinic to use while they treated patients. “There was a lot of going back and forth,” says Eric Defor, a member of the Rotary Club of Accra-Osu RE.
With that in mind, the partnership made a sec- ond improvement: It provided an overhead water storage tank and mechanized the borehole so that water could flow through pipes into the clinic. Finally, the partnership provided a solar panel to generate the electricity that powers the pump. The Rotary-USAID contributions, says Defor, have “substantially increased” the clinic’s ability to treat patients.
There was a broader lesson learned in an assess- ment of Phase 1 projects. It found that manual bore- holes with hand pumps were most successful in remote rural areas where there were no other op- tions for safe water. People in peri-urban communi- ties value mechanized boreholes and reticulated systems and are willing to pay to maintain them, making them more sustainable than hand pumps.
BOSOAFISE (ZOGLO) | Ga South Municipal District
Rotary Club of Accra Legon East
WASH advocacy consultant Rockson Dutenya (top far right photo) uses a spider web analogy to help local water and sanitation commit- tee members review their performance and make a plan to address weaknesses. “If we don’t work on these gaps, we know we won’t have sustainable water and sanitation services,” he says.
Providing water and sanitation facilities –often called the hardware — is the easy part. But if the facilities aren’t sustainable, that’s money and time wasted. That is why accountability is necessary for sound management of water, sanitation, and hygiene improvements. With that in mind, Rockson Dutenya, a WASH advocacy consultant working on behalf of the Rotary-USAID partnership, works alongside Rotarians to lead local water and sanitation committee members in Bosoafise to help them dis- cover where they have been successful in maintain- ing services and learn where there are problems.
Not everybody in the communities that the partnership serves is literate, so the Rotarian team uses the analogy of a spider web. “People understand how the spider weaves the web and the important role it plays in the life of a spider,” Dutenya says. “If there are gaps or holes in the web, it’s defective.” Commit- tee members assess how they are doing on each of their roles and responsibilities, and compare their work to the best practices they were taught during their training. They then rank themselves up to 10.
As they draw a spider web based on these assessments and rankings, any gaps in performance be- come obvious. “At the end, they are able to see that all of their roles are connected,” Dutenya says. “It makes a salient point.” The exercise gives commit- tee members the opportunity to hold themselves accountable, and they make an action plan to ad- dress any shortcomings.
In Bosoafise, the partnership provided two bore- holes with hand pumps, alongside CLTS. Community members praised the benefits of the project: less waterborne disease; no longer having to make the two-hour walk to fetch water from the Densu River; children able to spend more time in school. But when they drew their spider web, members of the local committee realized there was a gap in the community meetings, where the committee was supposed to explain its accounting methods. They developed a plan to address this gap in financial stewardship.