USAID/Angola launches new WASH program

July 22, 2013 · 0 comments

USAID/Angola launches new WASH program | Source: Gindungo Newsletter, May/June 2013 (pdf)|

On June 19, 2013, USAID/Angola launched a new water and sanitation program (WASH) in Benguela province. This program is funded by the Development Grants Program and implemented by ADPP, a local organization. The program supports the Water for All efforts of the Angolan government. The launch was attended by over 200 participants and attended by the Director of Education, representing the Governor of Benguela and the Director of Water & Energy.

An ADPP staff member demonstrates the ‘tip-tap” method of hand washing.

The program will support teacher training in WASH and also construct over 100 latrines in area schools. The project will mobilize a total of 5,000 families around 150 schools in latrine construction and the permanent systems for washing hands and train 800 teachers in sanitation and hygiene. The project includes building capacity for teachers from ADPP School of Future Teachers with component education for basic sanitation and hygiene.

Evolution of Access to Drinking Water and Sanitation Coverage in Urban Centers of African Countries

July 3, 2013 · 0 comments

The Evolution of Access to Drinking Water and Sanitation Coverage in Urban Centers of Selected African Countries. Mediterranean Journal of Social Sciences, July 2013.

The lack of adequate provision of drinking water and sanitation coverage is one of the major challenges facing humanity in the 21st century. Natural constraints, demographic pressures and managerial deficiencies such as sporadic precipitations, population explosion, rapid urbanization, and poor management of available resources were respectively main contributing factors to this undesirable situation across the globe. Taking these factors into consideration, this study found that urban centers of countries with abundant physical water supplies but poor water policy like Cameroon and Nigeria achieved low levels of access to drinking water and improved sanitation coverage compared to urban areas of countries endowed with limited water resources but sound water policy like Egypt and South Africa. Hence, it recommends the development of good water policy in countries that are fortunate to have copious amount of water resources.

Rural-urban disparities in child nutrition in Bangladesh and Nepal.

July 3, 2013 · 0 comments

Rural-urban disparities in child nutrition in Bangladesh and Nepal. BMC Public Health. 2013 Jun 14;13(1):581.

Srinivasan CS, Zanello G, Shankar B.

Abstract
BACKGROUND: The persistence of rural-urban disparities in child nutrition outcomes in developing countries alongside rapid urbanisation and increasing incidence of child malnutrition in urban areas raises an important health policy question – whether fundamentally different nutrition policies and interventions are required in rural and urban areas. Addressing this question requires an enhanced understanding of the main drivers of rural-urban disparities in child nutrition outcomes especially for the vulnerable segments of the population. This study applies recently developed statistical methods to quantify the contribution of different socio-economic determinants to rural-urban differences in child nutrition out comes in two South Asian countries – Bangladesh and Nepal.

METHODS: Using DHS data sets for Bangladesh and Nepal, we apply quantile regression-based counterfactual decomposition methods to quantify the contribution of (1) the differences in levels of socio-economic determinants (covariate effects) and (2) the differences in the strength of association between socio-economic determinants and child nutrition outcomes (co-efficient effects) to the observed rural-urban disparities in child HAZ scores. The methodology employed in the study allows the covariate and coefficient effects to vary across entire distribution of child nutrition outcomes. This is particularly useful in providing specific insights into factors influencing rural-urban disparities at the lower tails of child HAZ score distributions. It also helps assess the importance of individual determinants and how they vary across the distribution of HAZ scores.

RESULTS: There are no fundamental differences in the characteristics that determine child nutrition outcomes in urban and rural areas. Differences in the levels of a limited number of socio-economic characteristics – maternal education, spouse’s education and the wealth index (incorporating household asset ownership and access to drinking water and sanitation) contribute a major share of rural-urban disparities in the lowest quantiles of child nutrition outcomes. Differences in the strength of association between socio-economic characteristics and child nutrition outcomes account for less than a quarter of rural-urban disparities at the lower end of the HAZ score distribution.

CONCLUSIONS: Public health interventions aimed at overcoming rural-urban disparities in child nutrition outcomes need to focus principally on bridging gaps in socio-economic endowments of rural and urban households and improving the quality of rural infrastructure. Improving child nutrition outcomes in developing countries does not call for fundamentally different approaches to public health interventions in rural and urban areas.

WSUP – Get to scale in urban sanitation

June 25, 2013 · 0 comments

Scale-up of urban sanitation remains an elusive goal in most low-income cities. Donor interventions are often macro-investments without adequate attention to low-income communities, or small pilots that do not address the challenges of scale.

Taking urban sanitation to scale requires ‘scaling out’ models that work for poorer communities, and at the same time ‘scaling up’ sustainable management processes.

This Practice Note reports scale-out and scale-up experience from WSUP‘s programmes in Maputo and Antananarivo.

Get to scale in urban sanitation

For a more in-depth look at lessons for scale-up deriving from these programmes, see our accompanying Topic Brief on Getting to scale in urban sanitation.

Community-driven sanitation improvement in deprived urban neighbourhoods

June 25, 2013 · 0 comments

Community-driven sanitation improvement in deprived urban neighbourhoods: Meeting the challenges of local collective action, co-production, affordability and a trans-sectoral approach, 2013.

Gordon McGranahan.

There is an international consensus that urban sanitary conditions are in great need of improvement, but sharp disagreement over how this improvement should be pursued. Both market-driven and state-led efforts to improve sanitation in deprived communities tend to be severely compromised, as there is a lack of effective market demand (due to collective action problems) and severe barriers to the centralized provision of low-cost sanitation facilities. In principle, community-driven initiatives have a number of advantages.

But community-driven sanitary improvement also faces serious challenges, including:
1) The collective action challenge of getting local residents to coordinate and combine their demands for sanitary improvement;
2) The co-production challenge of getting the state to accept community-driven approaches to sanitary improvement, and where necessary to coinvest and take responsibility for the final waste disposal;
3) The affordability challenge of finding improvements that are affordable and acceptable to both the state and the community – and to other funders if relevant;
4) The trans-sectoral challenge of ensuring that other poverty-related problems, such as insecure tenure, do not undermine efforts to improve sanitation.

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Environmental indicators of intra-urban hetererogeneity

June 20, 2013 · 0 comments

Cad. Saúde Pública, June 2013.

Environmental indicators of intra-urban hetererogeneity

REGO, Rita Franco et al.

A large number of human diseases are related to poor access to water and sewer systems, inadequate solid waste management and deficient storm water drainage. The goal of this study was to formulate environmental sanitation indicators and classify sanitation conditions in specific sewer basins and their respective neighborhoods. The database used contains information on the following sanitation components in these areas: water supply, sewer systems, urban drainage, road pavement, building typology and public cleaning.

Data was analyzed using cluster analysis. The key variable of each component was identified, and eight sewer basins and twenty-three neighborhoods were classified into the following categories: good, regular, and poor. The use of environmental sanitation indicators allows decision makers to identify critical areas and define priorities for improving environmental sanitation conditions.

Contracting urban primary healthcare services in Bangladesh – effect on use, efficiency, equity and quality of care

June 4, 2013 · 0 comments

Contracting urban primary healthcare services in Bangladesh – effect on use, efficiency, equity and quality of care. Trop Med Int Health. 2013 Apr 24.

Heard A, Nath DK, Loevinsohn B. Consultant, Washington, DC, USA.

OBJECTIVE: To evaluate a large, ongoing effort to improve urban primary health care (PHC) in Bangladesh through expansion of publicly funded urban health facilities and contracting with partner non-governmental organisations (NGOs).

METHODS: A part of Chittagong was assigned to a contracted NGO while the other parts of the city were contracted to the local government. Performance was assessed by baseline and follow-on household surveys, an endline health facility survey and routinely collected data.

RESULTS: The results of a health facility survey indicated that overall quality of care was better in the NGO area, and routinely collected data showed that the NGO provided many more services per capita. Based on household survey data, the NGO area of Chittagong was poorer and had lower coverage at baseline. There were significant improvements in both government and NGO-run areas. However, larger improvements were observed on some coverage indicators in the NGO area compared to the government area. Improvements in coverage among the poorest 50% of the population were greater in the NGO-run area. The cost per service delivered was 47% lower in the NGO area.

CONCLUSIONS: Investments in urban PHC led to an improvement in the coverage of basic services. Contracting with an NGO had an additional effect in terms of improving coverage, equity, quality of care and efficiency. Increased investments in PHC facilities and contracting with NGOs may be effective in improving urban health services.

Diarrhoea-related knowledge and practice of physicians in urban slums of Kolkata, India

June 4, 2013 · 0 comments

Diarrhoea-related knowledge and practice of physicians in urban slums of Kolkata, India. Epidemiol Infect. 2013 May 10:1-13.

Kanungo S, Mahapatra T, Bhaduri B, Mahapatra S, Chakraborty ND, Manna B, Sur D. National Institute of Cholera and Enteric Diseases, Epidemiology, Kolkata, West Bengal, India.

SUMMARY – Diarrhoeal management practices are unsatisfactory in India especially in the slum areas. Dearth of information regarding physicians’ diarrhoea-related knowledge and practice in India ncessitated this cross-sectional study of allopathic practitioners in the slums of Kolkata, to assess the distribution and interrelationship between physicians’ characteristics, knowledge and practice regarding diarrhoea. A total of 264 randomly selected consenting practitioners were interviewed using a field-tested questionnaire. Nineteen percent had good overall knowledge, 49% and 80% prescribed antibiotics to diarrhoea and cholera patients, respectively, and 55% advised stool examination for every case.

Qualified and Government physicians had better knowledge regarding diarrhoea [MBBS: odds ratio (OR) 5·96, P < 0·001; postgraduates: OR 9·33, P < 0·001; Government physicians: OR 11·49, P < 0·0001] and were less likely to prescribe antibiotics for all diarrhoea cases (MBBS: OR 0·30, P = 0·002; postgraduates: OR 0·20, P < 0·001; Government physicians OR 0·24, P < 0·029). Better knowledge was associated with a lower likelihood of prescribing antibiotics for diarrhoea (OR 0·72, P < 0·001), cholera (OR 0·78, P = 0·027) and investigative procedure (OR 0·85, P = 0·028).

In the slums of Kolkata, diarrhoea-related knowledge and practice were poor with the exception of qualified physicians, hence an improvement in the knowledge of pharmacists and unqualified practitioners is necessary for the overall improvement of diarrhoeal management in these slums.

What Is the Role of Informal Healthcare Providers in Developing Countries?

June 4, 2013 · 0 comments

What Is the Role of Informal Healthcare Providers in Developing Countries? A Systematic Review. PLoS ONE 8(2): 2013.

Sudhinaraset M, Ingram M, Lofthouse HK, Montagu D

Informal health care providers (IPs) comprise a significant component of health systems in developing nations. Yet little is known about the most basic characteristics of performance, cost, quality, utilization, and size of this sector. To address this gap we conducted a comprehensive literature review on the informal health care sector in developing countries. We searched for studies published since 2000 through electronic databases PubMed, Google Scholar, and relevant grey literature from The New York Academy of Medicine, The World Bank, The Center for Global Development, USAID, SHOPS (formerly PSP-One), The World Health Organization, DFID, Human Resources for Health Global Resource Center. In total, 334 articles were retrieved, and 122 met inclusion criteria and chosen for data abstraction.

Results indicate that IPs make up a significant portion of the healthcare sector globally, with almost half of studies (48%) from Sub-Saharan Africa. Utilization estimates from 24 studies in the literature of IP for healthcare services ranged from 9% to 90% of all healthcare interactions, depending on the country, the disease in question, and methods of measurement. IPs operate in a variety of health areas, although baseline information on quality is notably incomplete and poor quality of care is generally assumed. There was a wide variation in how quality of care is measured.

The review found that IPs reported inadequate drug provision, poor adherence to clinical national guidelines, and that there were gaps in knowledge and provider practice; however, studies also found that the formal sector also reported poor provider practices. Reasons for using IPs included convenience, affordability, and social and cultural effects. Recommendations from the literature amount to a call for more engagement with the IP sector. IPs are a large component of nearly all developing country health systems. Research and policies of engagement are needed.

SHARE – City-Wide Sanitation Project Situation Analyses

May 30, 2013 · 0 comments

City-Wide Sanitation Project Situation Analyses, 2013. SHARE.

The SHARE-Funded City-Wide Sanitation project is investigating the failures of conventional approaches to urban sanitation. It is a collaboration between the International Institute for Environment and Development (IIED) and Shack/Slum Dwellers International (SDI), and is being conducted in four cities across sub-Saharan Africa: Chinhoyi (Zimbabwe), Kitwe (Zambia), Blantyre (Malawi) and Dar Es Salaam (Tanzania). This report provides a summary of the situational analyses that have taken place in these four cities following a project meeting which took place in Dar Es Salaam from 10th to 12th of February 2013.

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