wash for health project - quarterly report - USAID

WASH FOR HEALTH PROJECT

QUARTERLY REPORTJanuary 1, 2018 to March 31, 2018

Submission Date: April 13, 2018

Agreement Number: AID-641-A-15-00005

Submitted by: Alberto Wilde, Chief of Party

Global Communities

Tel: +233 302 522568, +233 025 4404

Email: [email protected]

This document was produced for review by the United States Agency for International Development/Ghana

ACTIVITY INFORMATION

Activity Title Water, Sanitation and Hygiene for Health

Agreement Number AID-641-A-15-00005

Name of Prime Implementing Partner Global Communities

Name(s) of Subcontractor(s)/Subawardee(s)

The Manoff Group CWSA UDS Research Team SAL Consult Natalex Environmon Geohydro Tracks Super Hydro Links Drilling and Construction Company Matapo Keldem Ltd. Hydronomics Ltd. Joissam Ltd. Medeboa Ltd. Sebb-Say Company Ltd. Jonakot Construction Ltd. Nakwab Trading Enterprise Ltd. Heisa Engineering Medeboa Ventures Ayidiki Water and Sanitation Organization (AWSO) Rural Development Network (RUDNET)

Activity Start Date February 06, 2015

Activity End Date February 05, 2020

Reporting Period January 1, 2018 – March 31, 2018

DISCLAIMER The author’s views expressed in this publication do not necessarily reflect the views of the United States Agency for International Development or the United States Government.

WASH FOR HEALTH PROJECT FY18 QUARTERLY REPORT i

CONTENTS ACTIVITY INFORMATION ................................................................................................... 1 ACRONYMS AND ABBREVIATIONS ................................................................................. ii 1. EXECUTIVE SUMMARY .................................................................................................. 4 1.1. Activity Description ..................................................................................................... 6 1.2. Summary of Key Accomplishments during Reporting Period ..................................... 9 1.3. Summary of Major Challenges and Lessons Learned .................................................. 9 2. ACTIVITY PROGRESS ...................................................................................................... 9 2.1. Measurable Results to Date ........................................................................................ 14 2.2. Progress Narrative ...................................................................................................... 14 2.3. Trends and Deviations ................................................................................................ 16 3. CROSS-CUTTING ISSUES .............................................................................................. 18 3.1. Gender Equality and Female Empowerment .............................................................. 18 3.2. Local Capacity Development ..................................................................................... 19 3.3. Science, Technology, and Innovation ........................................................................ 19 3.4. Public Private Partnerships (PPP) .............................................................................. 19 3.5. Environmental Compliance ........................................................................................ 20 4. STAKEHOLDER COLLABORATION ........................................................................... 20 4.1. Collaboration and/or Knowledge Sharing with Other USAID Activities .................. 20 4.2. Collaboration and Coordination with Other Key Stakeholders .................................. 21 5. LESSONS LEARNED ........................................................................................................ 21 5.1. Challenges and Relevant Solutions to Activity Implementation ................................ 21 5.2 Adaptive Learning................................................................................................................ 21 6. SUSTAINABILITY ............................................................................................................ 22 7. AGREEMENT MODIFICATIONS .................................................................................. 23 8. ACTIVITIES PLANNED FOR NEXT QUARTER ........................................................ 24 APPENDICES .......................................................................................................................... 25 I. Performance Data Table (PDT) ...................................................................................... 25 II. Success Stories and Press Coverage ........................................................................... 27 III. Financial Information ................................................................................................. 27 IV. Activity Oversight & Technical Assistance Support.................................................. 27 V. M&E Issues ................................................................................................................ 28 VI. Management and Administrative Issues ..................................................................... 28 VII. Follow-Up Actions ..................................................................................................... 28 VIII. Map of Project Activity Sites/ Facilities by District ......................................................... 29 IX. CLTS Updates Extract ............................................................................................... 30 XI. Photos ......................................................................................................................... 32

WASH FOR HEALTH PROJECT FY18 QUARTERLY REPORT ii

ACRONYMS AND ABBREVIATIONS

AOR AWSO

Agreement Officer’s Representative Ayidiki Water and Sanitation Organization

BCC Behavior Change Communication CBO Community-Based Organization CDO CHPS

Community Development Officer Community-Based Health Planning and Services

CLTS Community-Led Total Sanitation COMDEV Community Management for Sustainable Development CSO Civil Society Organization CWSA Community Water and Sanitation Agency DA District Assembly DEHO District Environmental Health Officer DICCS District Interagency Coordinating Committee on Sanitation DQA DWST

Data Quality Assessment District Water and Sanitation Team

EAWAG Swiss Federal Institute of Aquatic Science and Technology ESDM EHA

Environmentally Sound Design and Management Environmental Health Assistant

EHO Environmental Health Officer EHSD Environmental Health and Sanitation Directorate EMMP Environmental Mitigation and Monitoring Plan FY16 Fiscal Year 2016 FY17 FY18

Fiscal Year 2017 Fiscal Year 2018

GAMA GDA

Greater Accra Metropolitan Area Sanitation and Water Project Global Development Alliance

GHACEM Ghacem Limited GHS Ghana Health Service GIS GOG GSA GWCL

Geographic Information Systems Government of Ghana Ghana Standards Authority Ghana Water Company Limited

HPNO Health, Population and Nutrition Office IE&C Information, Education, and Communication KVIP Kumasi Ventilated and Improved Pit LNGO Local Non-Governmental Organization LOP Life of Project M&E Monitoring and Evaluation MHM MIS

Menstrual Hygiene Management Management Information System

MOH Ministry of Health MOU Memorandum of Understanding MSWR Ministry of Sanitation and Water Resources NADMO National Disaster Management Organization NGO Non-Governmental Organization ODF Open Defecation Free ODK Open Data Kit ORAP Obooman Rural Action Program PCV Peace Corps Volunteer PDT Performance Data Table PPP Public-Private Partnership PVC Polyvinyl Chloride RI Rotary International

WASH FOR HEALTH PROJECT FY18 QUARTERLY REPORT iii

RICCS Regional Interagency Coordinating Committee on Sanitation RING Resiliency in Northern Ghana RUDNET Rural Development Network Ghana SBCC Social Behavior Change Communication SG Fund Small Grant Fund SHEP School Health Education Program SIRDA Savana Integrated Rural Development Aid SOP Standard Operating Procedures STMA TA TAF

Sekondi-Takoradi Metropolitan Assembly Technical Assistance Technology Applicability Framework

UNICEF United Nations International Children’s Emergency Fund USAID United States Agency for International Development USG United States Government VSLA Village Savings and Loans Association WADA Water and Development Alliance WASH Water, Sanitation and Hygiene WHI WHO

Water Health International World Health Organization

WSMT Water and Sanitation Management Team

WASH FOR HEALTH PROJECT FY18 QUARTER REPORT 4

1. EXECUTIVE SUMMARY

The WASH for Health Project, a five year project awarded to Global Communities in February 2015, is in the fourth year of implementation with this report covering the second quarter of FY18. The goal of the project is to accelerate sustainable improvement in water and sanitation access and improve hygiene behaviors in target districts in Ghana. Altogether the project has entered a total of 30 districts to date in six regions (Greater Accra, Northern, Volta, Eastern, Central, and Western Regions).

WASH for Health’s community-led total sanitation (CLTS) approach continued to promote rural sanitation delivery in all project communities. As in previous quarters, the project worked with previously identified and trained Natural Leaders, CLTS Field Staff, Environmental Health Assistants (EHA), and local NGOs (LNGO) to implement CLTS and provide technical support. Within the second quarter of FY18, 140 new communities were entered for CLTS activities, with a total of 1,041 communities entered to date. 280 additional communities were triggered, with a total of 1,030 communities triggered to date. Over the past quarter, 78 new communities joined the rank of ODF communities, taking the total to 402 communities in the ODF continuum; 369 certified ODF by RICCS, 34 verified ODF by DICCS, and 77 declared ODF Basic by DICCS. 1,976 household latrines were completed in the quarter, providing 15,800 individuals with safe sanitation. Cumulatively, 10,598 household latrines have been completed to date.

WASH for Health started the second quarter of FY18 having commenced processes for adding on 61 more boreholes for communities. Consultants had already been engaged for hydrogeological investigations and siting of boreholes. Tenders had also been invited for the drilling and construction of the boreholes. Within the quarter, these tenders were evaluated, and contractors engaged to undertake the drilling activities; which has reached advanced stages now. There has also been substantive progress on the development of the proposed Tuna Small Town Water System with boreholes drilled and design of the system set to commence.

The project continued to collaborate with sector agencies and stakeholders at all levels, which has proven to be important to tackle WASH challenges sustainably. The project continued its support to the RICCS and DICCS to keep these essential bodies functional and carry out their mandated core activities like verification visits, declaring and certifying communities ODF. With their participation, 369 communities have been certified ODF to date representing 58% of the Life of Project (LOP) target, of which 78 got their certification by RICCS in the second quarter of FY18. The DICCS have also declared communities ODF Basic as well as verified some others. At the end of the quarter, 74 and 57 communities were ODF Basic and ODF respectively.

The BCC team continued their planned activities towards achieving the second subcomponent of integrating Nutrition into WASH (NuWASH). Within the quarter, a Training of Trainers workshop was held on the research protocol followed by field testing in Amanfrom and research in Asebi, both in the Shai Osudoku District. At this stage, the team is trying to identify behaviors that are easy to adopt and practice related to nutrition among residents, particularly mothers of young children or other people who take care of young children. The ultimate aim is to develop a module on nutrition to complement the BCC Communication Package which has already been rolled out.

Partnership activities continued on all fronts. A second phase of the Unilever project was discussed and secured within the quarter, whereas follow-ups were made on Diageo and Royal Bank regarding their interests in supporting the provision of improved water sources. The BeGirl partnership saw a baseline


survey and piloting of the BeGirl Menstrual hygiene product in selected schools in the Greater Accra, Western, Volta and Northern Regions. Schools in the Ayensuano and Kwaebibirem Districts which were provided institutional latrines under the partnership with Rotary International were engaged in the development of Facility Management Plans and other trainings to sustainably use their latrines. The Urban Sanitation promotion partnership with WADA also saw the completion of 145 latrines to date in Apowa (Ahanta West District) and Anyaa (Ga Central Municipality). Other partnerships with Duraplast and GHACEM continued, allowing for the supply of latrine construction materials to project communities for the construction of basic but durable and hygienic latrines. The production, sales and installation of the Digni-Loo also continued through Q2 of FY18. After successfully passing all the stringent testing by the Ghana Standards Authority (GSA), Global Communities applied for final certification for the Digni-Loo from the GSA, which is expected to be granted shortly.

WASH for Health continued activities towards the construction of 38 institutional latrines in FY18. After the evaluation of bids received last quarter, successful construction companies were offered contract to construct the latrines for the institutions. At the close of the quarter, work is ongoing at all sites with four latrines already at the roofing stage.

Global Communities through the WASH for Health Project continued its support to the Central Regional Health Directorate of the Ghana Health Service (GHS) and the Cape Coast Metropolitan Assembly to prevent the recurrence of cholera in the Metropolis. This involves periodic disinfection of drains, markets and public latrines while sensitization is also done through radio panel discussions and regular playing of relevant 1-minute hygiene messages. Lastly, the WASH for Health Small Grant Program continues to accept applications from Civil Society Organizations (CSO) and individuals on a rolling basis. Eight grants have been awarded so far in the quarter to finance various activities related to WASH in the project communities.

Within the quarter, the project continued the development of a pro-poor policy to guide the entire sector in the delivery of WASH services. The policy/guidelines are being developed under the auspices of the Ministry of Sanitation, and Water Resources and have reached its final stages with major stakeholder consultations and validations completed. This policy will regulate the provision of support to the poor under the WASH for Health Project when launched.

Within this quarter, the project launched NuWASH and prepared and submitted Regional Budgets and itinerary for NuWASH Exploratory research. Researchers piloted the SaniPath Exposure Assessment tool on 30th March 2018 to discuss the use of the tool in the NuWASH research.

Overall, Q2 of FY18 is deemed a successful one but not devoid of challenges such as resituating of Digni-Loos and Socio-economic issues of communities. These challenges, to WASH for Health, are opportunities to implement innovative solutions that resonate with the beneficiaries in the next quarter and beyond.


1.1. Activity Description

The WASH for Health project was developed in response to the health effects of inadequate or nonexistent WASH services for people across Ghana. Health effects are more profound in some regions than in others. Districts in the Northern, Central, Western, and Volta Regions are poorly served in terms of potable water coverage, averaging about 65% according to the rural water supply coverage statistics published by the CWSA.

Regarding sanitation, virtually all regions are faring very poorly, though poor sanitation is more pronounced in the Northern, Upper East, and Upper West Regions with nearly 75%1 of all households lacking access to basic sanitation, and practicing open defecation. It is, therefore, unsurprising that water and sanitation-related diseases appear to top out-patient attendance at healthcare centers in these areas. The scourge of cholera in recent years has been devastating, taking the lives of over 240 people, and infecting almost 30,000 Ghanaians between 2014 and 2015 in eight regions2. Cholera can be prevented by the use of basic sanitation facilities, the provision and use of safe drinking water, and the observation of good hygiene practices.

The goals of the WASH for Health project are to accelerate sustainable improvement in water and sanitation access and to improve hygiene behaviors in target districts. These goals will be achieved through six mutually reinforcing objectives (components), which are listed below:

1. Increased use of improved household sanitation 2. Improved community water supply services 3. Improved sector governance and policies 4. Expanded key hygiene behaviors 5. Leveraged public-private partnership (PPP) investment to magnify the impact of United States

Government (USG) funding 6. Improved water supply and sanitation infrastructure for schools and health facilities

Global Communities is the lead organization responsible for project management and administration, as well as for the implementation of water and sanitation infrastructure development, and CLTS implementation. The Manoff Group, a sub-recipient on the project, is responsible for promoting Social Behavior Change Communication (SBCC), which is mainstreamed throughout the above-listed project components.

Other project partners include Rotary International (RI) and Coca-Cola, both of which are USAID Global Development Alliance (GDA) partners. Rotary International is extending project activities into a sixth region (Eastern Region), and is working with the CWSA as a consultant/implementing partner. WASH for Health will match one to one funding in the already selected areas across six regions for Water and Sanitation projects with Rotary. Coca-Cola partnered with Water Health International, which has installed water supply stations in urban communities in two project regions (Greater Accra Region and Western Region). The WASH for Health project will match the investments of Coca-Cola with WASH interventions in schools while undertaking basic sanitation interventions in two urban communities.

1 GSS (2013), 2010 PHC Report, page 391. 2 http://reliefweb.int/report/ghana/situation-report-cholera-outbreak-ghana-20-september-2015-week-38 accessed 11th January 2016; http://reliefweb.int/report/ghana/situation;http://reliefweb.int/report/ghana/situation-report-cholera-outbreak-ghana-30-august-2015-week-35report-cholera-outbreak-ghana-30-august-2015-week-35.


WASH for Health engaged LNGOs as sub-recipients to support community mobilization, sensitization, CLTS facilitation, hygiene education promotion, and Water and Sanitation Management Team (WSMT) formation and training. A later shift in approach involved direct implementation with CLTS field staff partnership with local assembly staff to carry out the same activities. The project is also being implemented in collaboration with other USAID-funded projects: the USAID Systems for Health project, the Resiliency in Northern Ghana (RING) project, Communicate for Health and the Evaluate for Health project.

The six objectives of the project were translated into components as action areas, with particular activities detailed out in the project implementation plan. Though activities are currently being implemented in five regions (Volta, Central, Western, Northern, and Greater Accra) the degree and amount of activity is varied depending on any other previously existing interventions (i.e. existing water and sanitation coverage, prevailing health issues or interventions or other related projects present in the communities). WASH for Health will enter the Eastern Region when the implementation of partnership activities with Rotary International begins. The planned activities and expected results, as well as the outputs realized from the various components, are presented below.

Component One: Increased Use of Improved Household Sanitation WASH for Health proposes a comprehensive approach that lays the foundation for effective, demand-led CLTS by building strategic alliances with local government counterparts, improving CLTS facilitation skills, and developing an efficient sanitation market that offers low-cost technologies for toilet construction and financing options before triggering demand for toilet acquisition. Over the Life of the Project, 10,100 household toilets are expected to be constructed in project communities, including toilets that the poorest of the poor have support to build.

Component Two: Improved Community Water Supply Services To maximize the outcomes of our health indicators and to create a sustainable impact on project deliverables, the water supply activities will be implemented alongside the sanitation activities. Sanitation and increased access to water supply complement each other by reinforcing the outcome of improved health. The availability and proper use of safe water and basic sanitation eventually protect water sources from contamination that results from poor hygiene practices, like open defecation. Improvements in water supply services promote good hygiene practices as water is made available for bathing and handwashing.

Community water supply interventions are planned in collaboration with local government institutions and stakeholders including the regional CWSA, the District Water and Sanitation Team (DWST) of the District Assemblies (DAs), and other relevant organizations. DWSTs and CWSAs handle long-term support to WSMTs. Both the DWST and the WSMTs will provide oversight, and their involvement in all aspects of WASH for Health interventions will promote national-level recognition of the CWSA and the DWST as service authorities and community resources in the future. By the end of the project implementation, the following targets for water supply facilities are expected to be achieved:

160 machine-drilled boreholes fitted with hand pumps 50 existing, non-functional boreholes rehabilitated 1 Small Town Water Supply system developed

Component Three: Improved Sector Governance and Policies Using participatory approaches to rural and peri-urban WASH planning and implementation, the WASH for Health project seeks to strengthen Ghana’s WASH sector governance and policies. The CLTS approach adopted for rural sanitation delivery derives from the National Rural Sanitation Model


and Strategy, while the project’s BCC strategy will borrow from the Urban WASH BCC Strategy for Ghana. Each of these approaches conforms to the National Community Water and Sanitation Program and strategies for WASH delivery in Ghana.

WASH for Health also aims to create a WASH environment at the community level by building the capacity of communities and community-based organizations to identify local water and sanitation needs and properly manage WASH resources. The project will form and train WSMTs and build the DWSTs’ capacities to monitor project implementation and conduct post-project monitoring for sustainable WASH services. WASH for Health will also extend support to the line ministries: the Ministry of Sanitation and Water Resources, the Ministry of Health and its allied agencies in policy formulation, review, and dissemination (if it is deemed necessary).3

Component Four: Expanded Key Hygiene Behaviors By considering the local context in which a change takes place, Global Communities’ approach to communication for social and behavior change helps our projects achieve lasting impact. The specific behavior change goals established by the WASH for Health team help guide the implementation and leading decisions of all project components. WASH for Health works closely with statutory government entities like the CWSA and the Environmental Health and Sanitation Directorate (EHSD) within the Ministry of Sanitation and Water Resources, and with projects like Communicate for Health, Systems for Health, and RING so that the project’s behavior change strategy reinforces and extends that of these other projects.

Component Five: Leveraged PPP Investments to Magnify the Impact of USG Funding Global Communities anticipates that facilitating partnerships between state and non-state actors, especially the private sector, will unlock synergies that will complement and extend the span of WASH interventions to promote good health. Under this component, WASH for Health partners with Rotary International and Coca-Cola—both USAID GDA partners—and expects to work with the private sector to support WASH interventions in selected communities in the six regions by the end of the project.

Component Six: Improved Water Supply and Sanitation Infrastructure for Schools and Health Facilities Providing water and sanitation infrastructure in schools and health facilities has an immediate positive impact on the health of patients, healthcare workers, students, and teachers, all while reinforcing the CLTS process and WASH for Health hygiene messaging. This component addresses an issue revealed by a World Health Organization (WHO) 20144 report indicating that neglect of WASH in schools and healthcare facilities undermines a country’s capacity to prevent and respond to disease outbreaks.

Beneficiary schools and health centers will be selected in close coordination with USAID, other USAID-funded projects, and government institutions. Conforming to national policies on institutional toilet facility delivery, WASH for Health will provide both disability-friendly and gender sensitive toilet facilities. Toilets will have separate entrances for men and women, as well as a changing room for women to ensure privacy during menstruation. All the institutional toilet facilities will have handwashing facilities in the form of rainwater harvesting tanks with water taps and wash basins, Veronica buckets, or other appropriate technologies, depending on the availability of water resources

3 The newly elected administration in Ghana has eliminated the Ministry of Water Resources, Works and Housing and the ministry of Local Government and Rural Development. The new ministry is the Ministry of Sanitation and Water Resources. 4 http://www.who.int/water_sanitation_health/publications/glaas_report_2014/en/ accessed 18-09-2015.


and drainage capacity. By the end of the project, the following are expected to be achieved under this component:

Provision of 40 institutional water supply facilities. Provision of 190 institutional toilets.

1.2. Summary of Key Accomplishments during Reporting Period

The following have been accomplished during the second quarter of FY18:

140 new communities entered for CLTS activities, with 1,041 communities entered to date. 280 additional communities were triggered, with a total of 1,030 communities triggered to

date. Over the past quarter, 78 new communities joined the rank of ODF communities, taking the

total to 480 communities in the ODF continuum5; 369 certified ODF by RICCS, 34 verified ODF by DICCS, and 77 declared ODF Basic by DICCS.

1,971 household latrines were completed in the quarter, providing about 15,800 individuals with safe sanitation. Cumulatively, 10,593 household latrines have been completed to date.

1.3. Summary of Major Challenges and Lessons Learned

The challenges of implementation can be classified into two: seasonal and perennial. The perennial challenges include those related to hydrological and geological conditions like soil formations, groundwater availability and quality and how they impact implementation. The seasonal challenges include but are not limited to socio-cultural practices and economic conditions prevailing in communities.

The shift in implementation approach appears to be paying off with significant ground covered by the team, cementing the decision to continue direct implementation unless significant evidence arises to the contrary.

2. ACTIVITY PROGRESS

Component One: Increased Use of Improved Household Sanitation With the objective of increasing the use of improved household sanitation facilities, WASH for Health continued using the three-pronged approach to sanitation promotion with CLTS. This strategy involves a) capacity building and training of trainers for triggering and post-triggering activities, b) triggering communities, and c) sanitation marketing using innovative approaches.

Capacity building and training With the commencement of activities in FY18, a total of 250 new communities were expected to be entered for sanitation promotion activities. As part of the community entry, natural leaders have been identified and trained to assist the community as they journey towards open defecation-free status. In addition to these natural leaders who were trained, other local assembly staff and other people with significant roles in the implementation have started receiving training. These include head teachers,

5 ODF Basic by DICCs, ODF by verification by DICCS and ODF certification by RICCS.


school health and hygiene coordinators, PTA Chairpersons and circuit supervisors from schools that received institutional latrines. Triggering Up to 250 communities are planned to be entered using the CLTS approach in FY18. Utilizing only WASH for Health CLTS Field staff and their partnership with trained Natural Leaders and Environmental Health Officers/Assistants or Community Development Officer and other facilitators were possible, 280 new communities were triggered in the second quarter. Triggering communities into action (start construction of household latrines) varies from community to community, usually ranging from about a month to three months, and planned to fall in sync with the communities’ socioeconomic activities. Appendix IX presents more detailed information from the rural communities and districts.

As a result of triggering, households begin to construct latrines for their use in order to stop defecating openly. Within the reporting period, 1971 household latrines were completed with more at advanced stages of construction. The ultimate aim of the CLTS approach to sanitation promotion is declaration of communities as Open Defecation Free (ODF). Under the WASH for Health project, at least 640 communities must be helped to begin the CLTS approach in order to reach ODF status - a prerequisite of which involves the presence and use of household latrines by the majority of residents. Therefore, as the rate of completion of latrines increases, communities are drawing closer to the enviable status of ODF and spare no effort until they attain it. At the end of the second quarter, a total of 480 communities are in the ODF continuum, and a further 242 communities have passed the community self-assessment test and are poised to gain ODF status. Of the 480 ODF communities, 369 are certified ODF by RICCS, 57 are verified ODF by DICCS and 74 declared ODF Basic. Sanitation Marketing The third leg of the approach involves making it easy for residents of project communities to construct the latrines of their choice using locally available materials and inputs that ensure the basic latrines meet the minimum requirements of safe latrines (ensuring no contact with fecal matter, ventilation pipe, and privacy). The Project continued to promote three primary latrine technologies in target communities using the posters developed earlier in the project and distributed to CLTS Field Officers, Environmental Health Assistants, Latrine Artisans and Natural Leaders. Additionally, partnerships with private sector companies to channel latrine construction materials such as cement and vent pipes through existing distribution depots to project communities remained in place throughout the year. These materials/inputs help residents construct durable and hygienic latrines by stabilizing pits and providing ventilation for household latrines. CLTS field officers monitored the purchase and use of these inputs for latrine construction purposes.

Additionally, the introduction of the Digni-Loo to the Ghanaian sanitation market augments the technology option available to rural communities and households. Identification and training of entrepreneurs for the sales of the Digni-Loo in the Northern, Greater Accra and Volta Region is ongoing. At the close of the quarter, 154 Digni-Loos have been sold through vendors. Community members are reported also to be paying for the supply of Digni-Loos in installments.

As support to the poor in communities that are declared ODF already and who have not been able to construct their own latrines, the Project, in partnership with the leadership and the communities, incorporates installing Digni-Loos for such people. These individuals were identified, registered and validated using criteria adapted from what the Department of Social Welfare uses to identify Livelihood


Empowerment Against Poverty (LEAP6) beneficiaries. A total of 639 people have been registered and validated to receive the support, with 358 receiving their Digni-Loos so far of which 161 was in the second quarter.

Bill & Melinda Gates-Funded CLTS Research Facilitators of the Swiss Federal Institute of Aquatic Science and Technology (EAWAG) research team continued monitoring the communities to encourage and provide technical support for the adoption of good sanitation and hygiene behaviors. Particular attention has been in the communities that have not yet attained ODF. The EAWAG team arrived to commence the endline survey. The survey is ongoing currently.

Component Two: Improved Community Water Supply Services It is envisaged that a minimum of 61 boreholes will be drilled and developed to provide potable water to project communities in the Central, Western, Volta and Northern Regions. Drilling of boreholes has been completed in all but two communities in the Central Region. Related to the drilling, formation of Water and Sanitation Management Teams (WSMTs) has commenced for communities with successful wells. All WSMTs in Nkwanta North and Nkwanta South has been completed.

The development of a Small Town Water System sited in Tuna, in the Sawla-Tuna-Kalba District, is ongoing. Drilling of the boreholes for the system has been completed with the pumping test complete. Two boreholes with water yield of approximately 300 litres per minute have been selected for the mechanization. The consultant on the project has commenced design works for the system. Component Three: Improved Sector Governance and Policies WASH for Health continued to work with local institutions to build capacity for policy implementation, especially on rural water and sanitation delivery and management. In line with sections of the Revised National Environmental Sanitation Policy, and through its CLTS activities, WASH for Health support DICCS and RICCS as they work with and assess communities’ progress towards ODF.

In the first quarter of FY18, Global Communities solicited for consultants on behalf of the Government of Ghana (GoG) to conduct a sector-wide assessment of existing pro-poor sanitation strategies. The consultant is tasked to facilitate a WASH sector-wide validation workshop through the Ministry of Sanitation and Water Resources after which a final strategy document will be developed by the consultant for Global Communities and GoG to be used as a national document to guide all interested in supporting the poor to have access to basic sanitation. Within Q2, a validation meeting was held for major sector players to make critical inputs into the formulation of the policy. The result of the meeting was the formation of a Technical Working Group that supported the consultants to move the process. Towards the end of the quarter, a consultative stakeholder validation and dissemination workshop was again held to fine-tune the policy and guidelines. With unanimous support for the policy and guidelines, participants agreed to put the end product into use to harmonize the support given to the poor in the provision of WASH services. It is anticipated that the policy will be launched in the next quarter when published.

The WASH for Health project also supported and participated in the observation of the World Water Day held on 22nd March 2018 at Galilea Fish Market in the Ga South Municipality. Speakers at the event highlighted the need to conserve and protect water sources from encroachment and pollution.

6 A social intervention implemented by the Government of Ghana, involving direct transfer of money to registered vulnerable persons in communities across the country.


Component Four: Expanded Key Hygiene Behaviors

CLTS field staff continue to embark on sanitation promotion and hygiene education using CLTS. With the ever increasing rate of latrine completion, particular attention is now being given to latrine user education to reap the full benefits of owning household latrines. Further, armed with the completed BCC Communication pack, and downstream training, CLTS field staff and their partners have more resources at their disposal to carry out hygiene education.

The team continued work on Component 4:2 of the WASH for Health Project which is to integrate promotion of essential nutrition and WASH actions. The ultimate aim is to develop a module on nutrition to complement the BCC Communication Package which has already been rolled out. The formative research for identifying possible and practical changed behavior is being planned. This has been preceded by the training of trainers on the research protocol and field testing in Amanfrom and research in Asebi, both in the Shai Osudoku District.

Finally, the construction of tippy-taps to facilitate regular handwashing after using a latrine and before handling food and food items continued. At the close of the quarter, a total of 9,724 tippy-taps have been constructed to date and 6,581 soakaways meant for the management of waste water for bathrooms have also been completed to date across all project communities.

Cholera Response Although no cholera cases were reported within Q2, cholera prevention activities such as quarterly disinfection exercises, educative radio talk shows, BCC messages on cholera prevention, regular inspection of markets, the abattoir and food vending points have been planned with other actors (Red Cross, Environmental Health Officer Officers, Ghana Health Service, NADMO among others to preventing the outbreak of the disease. Component Five: Leveraged PPP Investments to Magnify the Impact of USG Funding Coca-Cola Water and Development Alliance (WADA) Water quality tests at each of the institutional WASH facilities was conducted in the quarter with results showing the water remains safe for use for all purposes. These tests are scheduled to be repeated quarterly until the end of FY18.

Under the second component of the partnership with WADA, which supports the provision of 100 household latrines to two urban communities, Anyaa and Apowa in the Ga Central Municipality and Ahanta West District respectively, two LNGOs were selected to implement activities in these locations. At the end of FY17, both organizations completed their target; as a result, Global Communities, with support from WADA, granted a cost extension of their subgrants with additional deliverables: construction of an additional 50 latrines. As of the close of Q2 in FY18, 45 of the added-on latrines had been completed, leaving five more which are under construction.

Rotary International Global Communities signed the contract to undertake the soft component of the partnership activities and had already completed training of stakeholders from schools who received institutional latrines in FY17 in the Northern and Volta Regions. In Q2 of FY18, schools in the Eastern Region, specifically Ayensuano and Kwaebibirem Districts were also covered. Such trainings help prolong the use of the institutional WASH facilities as participants are helped with the development of facility management plans and get the commitment and buy-in of all stakeholders for the management and operation of the facilities.


Other Partnerships Global Communities maintained several additional partnerships throughout the Fiscal Year. Together with Unilever Ghana Foundation, WASH for Health with Unilever has committed to undertake a second phase of the partnership. Ten hygiene stations will be built or rehabilitated for schools in Tema and Ashaiman.

Additional partnership activities continued throughout the year: Collaboration with Ghacem continued to supply cement at reduced prices to CLTS beneficiary communities, while collaboration with Duraplast Ghana Ltd. continued with sales of vent pipes at discounted prices in project communities as well as support production and sale of the Digni-Loo.

New partnerships to support improved access to water are being finalized with Royal Bank, which will support the provision of boreholes. The budding partnership with Diageo still holds promise of taking up part of the cost of constructing the proposed Tuna Small Town Water System.

An additional partnership with BeGirl, a U.S. based company that produces menstrual hygiene products, has also been established, with a pilot project activity already underway in selected schools within the WASH for Health Project districts as well as the Unilever Project beneficiary schools. It is anticipated that the BeGirl Menstrual Hygiene products will be made available across all the public basic schools reached by the WASH for Health Project.

Component Six: Improved Water Supply and Sanitation Infrastructure for Schools and Health Facilities

Preparations are underway to provide additional 38 institutional latrines to public basic schools to improve their access to safe sanitation. The latrines will be located in the Central, Western, Volta, Greater Accra and Northern Regions. A competitive tendering process led to the engagement of construction companies to execute the works. At the close of the quarter, construction is ongoing at all sites and according to schedule. Four of the latrines have been roofed, 23 at superstructure level, seven at the substructure with four having their pits excavated.

In addition 16 schools and health facilities will benefit from improved water supply. The boreholes were drilled in the quarter and water samples have been sent to the laboratory for analyses.

WASH for Health Small Grants Scheme New awards for the scheme have been granted after evaluation of applications received up to the second quarter. The Small Grants are intended for utilization in project communities on new or innovative WASH ideas that benefit large segments of the communities. An overview of the Scheme, qualification criteria, the scope of activities considered and application forms are available for download from https://www.globalcommunitiesgh.org/index.php/home/contact-us/11-programs/wash-for-health/31-apply-for-wash-for-health-small-grants. Hard copies of the forms and materials are also available at the regional field offices.


2.1. Measurable Results to Date

Objective 1: Increased use of improved household sanitation WASH for Health continued to use CLTS to sensitize households on the dangers of open defecation and the need to construct and use basic, safe household latrines. The project, through its field staff, continues to provide technical support and monitor latrine construction so each latrine meets basic safety standards and can be classified as improved latrines. Up to the end of quarter two of FY18, a total of 10,981 latrines have been completed, with this result, W4H has exceeded the LOP target by 8%. These household latrines have facilitated access to basic sanitation for 85,005 individuals.

A total of 1,030 communities have been triggered to date with post-triggering activities happening in 992 communities. Owing to the project’s CLTS activities, a total of 742 communities are now in the expanded ODF Continuum; 242 passed the community self-assessment towards ODF, 74 have been declared ODF Basic by DICCS, 57 verified ODF by the DICCS and 369 communities certified ODF by the RICCS.

Objective 2: Improved community water supply services At the close of FY17, 85 boreholes were completed, benefitting over 23,000 people. Within the first and second quarter, no drilling and construction activities are underway, thereby leaving the results at the previous level. Altogether the project has provided access to improved water sources to about 41,400 individuals across all the project communities.

Objective 3: Improved sector governance and policies WASH for Health has demonstrated considerable capacity in tackling WASH challenges and has remained a major stakeholder in the sector. This is evidenced by the invitation extended to the project to be part of decisions regarding WASH in the country currently. The project as reported earlier is supporting the sector Ministry to develop a policy for subsidized distribution of sanitation products to the poorest of the poor.

Objective 4: Expanded key hygiene behaviors The 72 research-based BCC materials were finalized and were launched on June 20 together with the Digni-Loo. The materials were rolled out in Quarter 4 and at the end of the Fiscal Year. In that same period, 23 trainings were conducted throughout the five project regions reaching 600 practitioners. After training additional 32 people in the use of the package in the quarter, 353 packages of the BCC Communication Materials were distributed for use by WASH and health practitioners; it is believed it will be of immense benefit to communities as they received reinforced messages.

Objective 5: Leveraged PPP Investment to Magnify the Impact of USG Funding Coca-Cola / USAID WADA Activities under the WADA GDA were successful. Seven institutional latrines were constructed at five schools in the Sekondi-Takoradi Metropolitan Area (STMA) and Ahanta West District in FY17. Work on the construction of a revised target of 150 household latrines in the Greater Accra and Western Regions is ongoing with 130 household latrines completed to date.

Rotary International 42 institutional latrines and 21 boreholes were completed in FY17. Within the first quarter, Global Communities continued supporting the Rotary Project Manager to monitor ongoing construction


activities in common districts7 and also carry out facility user training for schools receiving institutional latrines funded by Rotary.

Objective 6: Improved water supply and sanitation infrastructure for schools and health facilities Contractors for the construction of FY18 institutional latrines were fully engaged in the second quarter, and they have commenced the construction of the 38 institutional latrines for 26 schools in Amenfi Central, Amenfi East, Ajumako Enyan Essiam, Nkwanta South, Shai Osudoku and Bole Districts. The construction of these institutional latrines is expected to continue and completed in quarter three of FY18. In the next quarter, the process will continue to select and engage the contractors to execute the works.

2.2. Progress Narrative

The WASH for Health Project has sustained its momentum towards the project’s target on all fronts. Leading in the achievements is the completion of 10593 latrines, marginally surpassing the life of project target. Also of importance in progress towards open defecation free status by 480 communities with a further 242 lined up.

In terms of augmenting water supply through provision of boreholes, 151 have been developed, representing 94% of the LOP target with 61 expected by the close of FY18. At the close of the quarter, drilling activities are ongoing in selected communities in the central region. Drilling has already been completed in the Northern, Western and Volta Regions. Based on the results of pumping test, further development of the test wells will occur. Already, a request for proposals for the supply and installation of the Ghana Modified Indian Mark II borehole hand pump has been advertised.

In the area of promoting hygiene behaviors, the downstream training of users of the BCC Communication package at the district and local levels significantly prepares the grounds to quickly achieve the desired outcomes in this component. Activities to integrate nutrition into WASH began in Q1 and gained momentum in Q2. Within the quarter, the research protocol for the formative research was developed and finalized alongside the training of trainers for the field work. The protocol has been field tested ahead of the actual trials of improved practices to identify changed behaviors that can be easily adopted by people especially mothers of young children and other people who tend to children.

Global Communities through the WASH for Health Project continues to be a pacesetter in the WASH sector. The project continued the development of a pro-poor policy to guide the entire sector in the delivery of WASH services. The policy/guidelines is being developed under the auspices of the Ministry of Sanitation, and Water Resources and have reached its final stages with major stakeholder consultations and validations completed. This policy will regulate the provision of support to the poor under the WASH for Health Project when launched.

WASH for Health continued to build on its partnerships with the private sector as well as other not-for-profits. A second phase of interventions with funding from Unilever Ghana Foundation has commenced to provide improved WASH conditions for schools in the Tema Metropolis and the Ashaiman Municipality. The Request for proposals for the construction and rehabilitation of hygiene stations for the schools have been advertised for submission of proposals by interested bidders. The partnerships with Diageo and Royal Bank are pending with the former possibly funding a part of the proposed Tuna

7 These are Districts where WASH for Health and Rotary are implementing activities either jointly or separately.


Small Town Water System in this fiscal year. The partnership with BeGirl has blossomed with piloting of their menstrual hygiene products done in selected schools where WASH for Health has earlier provided institutional latrines in the Western, Northern, Volta and Greater Accra Region. In the Greater Accra Region, the schools benefiting from Unilever Hygiene Stations were used for the pilot. These partnerships continue to add up to the investment of the USG to reach many more communities and people.

WASH for Health has gained recognition for our work in combating cholera through prevention and education. After successfully working in Accra during the 2014-2015 epidemic, the project is now helping the Cape Coast Metropolis which was being hit sporadically in 2016. The project continues to embark on periodic disinfection and educational campaigns to prevent another outbreak.

The Project has also intervened to improve sanitation conditions in public institutions like basic schools and Community-Based Health Planning and Services (CHPS) compounds. A total of 226 such latrines have been provided of varying technologies to suit the need. In this fiscal year, another 38 institutional facilities are under construction to provide safe sanitation to pupils of the beneficiary basic schools in across the project districts.

2.3. Trends and Deviations

Number of People Gaining Access to Basic Sanitation Service as a Result of USG Assistance

15,808 people gained access to basic sanitation service this quarter, through the construction of 1,976 household latrine. Even though the project predicted a sharp increase in access to basic sanitation this quarter, the number recorded for the indicator exceeded the target of 10,666 by 5,142. Year on year, Wash for Health recorded an 18% increase in access to basic sanitation.

Results for this quarter exceeded the Q2 target by 48%, this is because at beginning of the fiscal year, 280 communities were triggered and most of these households unable, to complete their latrines in the first quarter, have now completed their latrines due to the increased mobilization of communities by EHA’s and CLTS officers. This was done in attempt to encourage communities to complete their facilities before this year’s rains set in. The project expects the rate of construction to remain steady from now till the planting season starts, where the rate may begin to drop.

Number of communities Certified as ODF

78 communities were certified as ODF this quarter, exceeding the quarter target of 50. This can be attributed to the project’s shift in focus from construction of latrines to getting more communities to ODF certified. CLTS officers are focusing their on encouraging communities with high percentage in latrine constructed than communities which are lagging behind. This is being done to enable the project achieve its ODF target of 640, since the target for latrine construction has already been achieved. Results for this quarter is as a result of a high number of communities passing being prepared and passing the ODF certification inspection.

Number of people in target areas with first-time access to improved drinking water supply as a result of USG assistance

WASH for Health is in the process of drilling boreholes whose results will be recorded by Q3 when drilling will have been completed and boreholes handed over to the beneficiary communities. The project is also in the process of constructing one small town water system, when complete data from


the facility will also count under this indicator. By the end of FY18, Wash for Health hopes to facilitate access of potable water to 20,520 individuals and is on course to achieve and perhaps exceed the target.

Number of People Receiving Improved Service Quality from Improved Drinking Water Sources

WASH for Health is in the process of identifying contractors and consultants to undertake activities whose results will be recorded for this indicator. Data for this indicator will be recorded by Q3 when drilling will have been completed and boreholes handed over to the beneficiary communities.

Number of Individuals Trained to Implement Improved Water and Sanitation Methods

In Q2, 739 natural leaders were trained taking the total number of individuals trained this year to 1,207 and exceeding the quarter target. This has come as a result of the project triggering more communities than initially anticipated. At the beginning of the fiscal year, it was planned that the project will engage 200 new communities but due to demand by communities who were not initially considered this fiscal year, 280 communities have been triggered. This has resulted in more natural leaders to be trained than earlier planned. Targets for this indicator will therefore be revised to reflect the number of communities triggered and yet to be triggered.

Percent of Households in Target Areas Practicing Correct Use of Recommended Household Water Treatment Technologies

The Project launched its BCC materials in FY17 with focus on three key hygiene messages: build, use and maintain household latrines; handwashing at critical times; and safe retrieval, transport, storage and treatment of drinking water. Prior to the launch of the materials government officials and project field staff were trained in the use of the materials in the communities. With the full deployment of the materials in Q4 of FY17, data collection (through survey) has been scheduled for Q3 FY18 by which time, households would have adopted some of the behaviors.

Percent of Households with Soap and Water at Hand Washing Stations Commonly Used by Household Members.

All households under the WASH for Health project have been educated to construct basic hand washing facilities close to a latrine and/or a cooking area to encourage hand washing after defecation and before handling food. This indicator seeks to measure households who do not just have tippy taps in their homes but ensures that the facility is used by all household members. The target for the entire fiscal year is 60%, and this will be measured in Q3 when the annual survey is conducted. For this reason, no targets were set for the first and second quarters. However, within the quarter 45% of households have already been observed practicing this behavior. With this trend, the project is set to achieve or perhaps exceed its target by the end of the year.

Number of Basic Sanitation Facilities Provided in Institutional Settings as a Result of USG Assistance.

4 of the targeted institutional latrines for this year have been completed this quarter. Targets were not set for this indicator in quarter two as the project did not anticipate completion of any of the facilities by this period. Historically, most of the facilities are completed by the 3rd and 4th quarters of the fiscal year. Completion of these facilities ensures that the project has now constructed 226 institutional facilities for schools and CHPS compounds.


Indicators with Results Within 10% of Target

The following indicators had results within 10 percent of the expected target and do not require a deviation narrative.

Number of people gaining access to safely managed sanitation service as a result of USG

assistance.

3. CROSS-CUTTING ISSUES

3.1. Gender Equality and Female Empowerment

The WASH for Health project, as conceptualized and implemented, is cognizant of gender issues and mainstreams gender into all activities. Culturally, women in Ghana are more often responsible for ensuring that their households have water, and for teaching children basic hygiene practices. Because most of WASH for Health’s communities are patriarchal, the project ensures a minimum of 60% female representation and participation in all Water Sanitation and Management Teams (WSMT), which is based on CWSA’s minimum requirements. This quota for female participation in WSMTs enables women to participate in decision-making concerning WASH facilities and services in their communities. All WASH for Health CLTS Field Officers and LNGOs implementing CLTS work guarantee female membership when working with communities to establish WSMTs. As a communal activity, CLTS requires and ensures the participation of all sections of society, including people in leadership positions, women, men, and children. Therefore, the CLTS approach enables all genders to participate in their community’s progress toward ODF status. Furthermore, project activities in no way reduce the amount of power held by one gender, and in no way restrict beneficiaries’ access to services or resources based on their gender. Equal opportunity to benefit from project activities is given to all community members; WSMT participant lists are recorded and shared with WASH for Health staff to certify the gender quota is met.

In FY17, WASH for Health began to identify an additional need among female students within schools where institutional latrines had been constructed. Menstrual Hygiene Management (MHM) among female students poses a significant challenge, often causing them to be absent or drop out entirely from school. Though increased access to improved sanitation facilities has proved beneficial for menstruating female students at school, Global Communities identified an opportunity to broaden the impact of these facilities by specifically addressing MHM through a pilot project implemented in partnership with BeGirl. Through the partnership project, Global Communities provided two BeGirl products (the BeGirl hygienic sanitary product, and a user-friendly Smart Cycle tool to help girls understand their monthly cycle) to approximately 1,560 students in 12 schools throughout Ghana. A baseline was done, followed by training of school hygiene coordinators, teachers, parents and guardians as well as identified female pupils. A session was held for boys too since it was recognized that adolescent boys had a tendency to make menstruating girls uncomfortable by teasing them; a situation that sometimes leads to girls choosing not to attend school. It was thus necessary to educate the boys to see menstruation as natural occurrence. The pilot trainings have been completing, currently W4H is monitoring the feedback from the girls. It is expected that the BeGirl menstrual hygiene product will, in the long run, reduce absenteeism among female students during the period of menstruation.


3.2. Local Capacity Development

WASH for Health continues to build on local knowledge of Natural Leaders to drive home the message of safe sanitation. WASH for Health CLTS Field staff is now working with over 4,200 Natural Leaders who have been trained and facilitate CLTS activities in their communities and nearby ones. WASH for Health also continues to build the capacity of Environmental Health Officers and Assistants and Community Development Officers so they can implement WASH and CLTS activities in other communities not covered by the project within their districts.

The project also trains WSMTs in order to reinforce their ability to operate and maintain WASH infrastructure in the communities, mainly boreholes. Additionally, through the project’s sub-grant award mechanism, the Project supports the growth and capacity of local organizations by enhancing their management, logistical and technical experiences to provide WASH services in both urban and rural areas.

WASH for Health continued to supported volunteers and officials from Ghana Health Service to disinfect locations that are likely to help spread cholera within the Cape Coast Municipality. This includes open drains, beaches, markets and waste disposal sites. They are also provided with BCC/IE&C materials to ensure they facilitate cholera prevention awareness as they carry out the disinfection exercises.

3.3. Science, Technology, and Innovation

Final approval from the Ghana Standards Authority after six months of rigorous testing has been granted, permitting the Digni-Loo to have the GSA seal embossed on the slab, providing another layer of guarantee of safety for users in Ghana and beyond. Global Communities has written to GSA requesting for a final certificate of approval which is still pending.

After the developmental phase of the Digni-Loo which was crowned with its approval and acceptance by the Ministry of Sanitation and Water Resources as well as its reception by the WASH sector in Ghana, WASH for Health has commenced some initial business development with a view to attract more entrepreneurs into the sales and installation of the Digni-Loo. Currently, there are vendors selling the Digni-Loo in the Volta, Northern and Greater Accra Regions.

Another focus area of improvement is the design and production of a seat for the Digni-Loo so as to make its use convenient for the aged and physically challenged persons who otherwise would have found it difficult to squat and use the latrine. The seat is designed to lock onto the footrest on the slab and prototypes have already been produced but are yet to be tested in the field,

3.4. Public Private Partnerships (PPP)

As described in Section 2 (Activity Progress) above, WASH for Health continues to partner with several private sector organizations, including Duraplast Ghana Ltd. which has supported the production of vent pipes and the Digni-Loo. Additional partnerships include collaboration with Ghacem Limited, Unilever Ghana Foundation, Rotary International, Coca-Cola/WADA, and BeGirl, with prospecting for new partnerships ongoing with Diageo and Royal Bank.


3.5. Environmental Compliance

Incorporating Environmental Sound Design and Management (ESDM) into project implementation ensures sustainability of facilities. To this end, the project has made ESDM one of its implementation tools to guide field implementation of the various components. In the design of water supply and sanitation facility, project engineers take into account the materials requirement and possible areas contractors can outsource them in order to minimize the potential negative impact of the construction on the environment. In all the project designs, the current and anticipated future use of the immediate surroundings are considered to ensure that the facilities will be able to withstand changes in the environment without any negative consequences.

During the selection of communities and institutions to benefit from project interventions in this FY, initial environmental scoping was done and none of the communities has environmental condition that will be exacerbated during the project implementation. In accordance with the project’s Environmental Mitigation and Monitoring Plan (EMMP), environmental compliance assessments will be done before sites are handed over to contractors and during the construction phase. The Project Environmental Monitoring Team, with the DCOP as the lead, will conduct regular visits to project sites to ensure all construction activities are in compliance with the CFR.216.

4. STAKEHOLDER COLLABORATION

4.1. Collaboration and/or Knowledge Sharing with Other USAID Activities

WASH for Health continued to actively participate in USAID health program implementing partners Chief of Party meetings, while also contributing to the Knowledge Management Platform. These meetings are held every quarter and hosted by the USAID Systems for Health project.

The WASH for Health project is also part of the USAID Health, Population and Nutrition Office (HPNO) Monitoring and Evaluation Community of Practice where all USAID health partners, including Systems for Health, Communicate for Health, RING, DELIVER, and Vector Works, meet to learn and share knowledge on Monitoring and Evaluation (M&E), Knowledge Management, and Geographic Information Systems (GIS). Meetings are held every quarter and are hosted by Evaluate for Health, which is the USAID partner solely responsible for M&E technical support on all USAID health programs. Within the 2nd Quarter, WASH for Health participated in the USAID-UNICEF-GHS Collaborative Workshop held in Accra. Besides showcasing the implementation approach, outputs and achievements of the WASH for Health Project, the team participated in the breakout session focusing on WASH and Infection Control and Prevention in the provision of health service in Ghana.

Out in the field, especially in the Northern Region where USAID RING and WASH for Health intersect, extensive collaboration continued, especially in the training of and partnership with EHAs, EHOs, and Natural Leaders who undertake CLTS activities like triggering in shared districts.

In the previous quarter, WASH for Health participated in the planning meeting towards the Rotary International Family Health Days, which were tentatively scheduled for the late November or early December but had to be rescheduled for 2018 to allow for better coordination in organizing the events concurrently in Ghana and Benin. The event was hosted by Rotary International, a USAID Global Development Alliance partner with participation and support from the Health Promotion Unit of the


Ghana Health Service and USAID through Communicate for Health, WASH for Health, and Healthkeepers Network. The event was held at 50 locations in the Greater Accra, Central, Western, Eastern, Volta, Brong Ahafo and Northern Regions from 22nd February to 24th February 2018.

4.2. Collaboration and Coordination with Other Key Stakeholders

WASH for Health continues to work in collaboration with the sector ministries and agencies on sector policies and activities, and at the local level with DAs, in CLTS facilitation. This collaboration has extended to international agencies such as UNICEF, WHO, International Red Cross/Red Cross Ghana cholera response activities. Over the period WASH for Health was invited to participate in the development of an urban sanitation strategy organized by the Ministry of Sanitation and Water Resources with support from UNICEF.

The private sector and LNGOs also serve as partners when implementing activities under other components of the project and the unique partnership with Duraplast Ghana Ltd. remains ongoing. Collaboration with CWSA to implement software activities under the Rotary International GDA has commenced.

5. LESSONS LEARNED

5.1. Challenges and Relevant Solutions to Activity Implementation

The challenges confronting the WASH for Health Project as discussed earlier are twofold, requiring different approaches to ameliorate their effect on implementation. The introduction of the Digni-Loo gives the project another opportunity of providing safe latrines in locations with loose top and subsoils as the stackable rings are able to hold back the walls of the pit and prevent cave-ins. With regards to the ground water availability and quality, the engagement of consultants for hydrogeological studies, siting and drilling supervision tends to minimize the occurrence of dry or marginal wells but timing of the entire activity remains key to developing wells that yield all-year. Drilling activities are best done during the dry season, primarily to access water from aquifers at their lowest possible depth when recharge levels are low which gives assurance of better yields when the rainy season sets in with improved recharge rates. The other reason for dry season drilling is to allow the rigs to move easily from one site to the other without being hampered by the bad nature of rural roads during the rainy season.

Socio-economic challenges are being addressed by working in tandem with the communities’ norms and using natural leaders who have an insight into the communities’ livelihood activities and social activity timing.

5.2 Adaptive Learning

After transitioning from part LNGO-led implementation to WASH for Health identified that for certain communities and districts, achievement of ODF occurs at a higher rate when the CLTS process is facilitated directly by WASH for Health staff, rather than through an LNGO that receives a sub-grant to implement activities. As a result, WASH for Health transitioned all CLTS activities from LNGOs to WASH for Health staff, ensuring direct implementation. The Project expects positive results due to this change.


Based on feedback from users of the Digni-Loo during the pilot phases, WASH for Health designed an attachable seat and handrail to be included in the design of the Digni-Loo. These additional components can be attached to the slab and will help disabled or elderly individuals better use the slab.

Furthermore, upon launching the Digni-Loo, Global Communities identified a need to specifically support the poorest of the poor in communities. As a result, the Project is working closely with the Ministry of Sanitation and Water Resources to develop a pro-poor sanitation policy that will enable donors or others in the WASH sector to provide subsidized sanitation products (such as the Digni-Loo) to the poorest individuals/households in communities.

WASH for Health has constructed 121 institutional latrines throughout the country. Though this has improved access to sanitation for students, Global Communities identified a further need to address Menstrual Hygiene Management. As a result, the Project is partnering with BeGirl to assess whether the BeGirl products positively impact female students’ school attendance, and improve their menstrual hygiene management. Based on findings from the pilot, WASH for Health will work to incorporate the product and MHM activities into all project activities to the extent possible.

6. SUSTAINABILITY

Sanitation Provision From inception, WASH for Health has built on local knowledge and structures, working with local government staff, LNGOs, Natural Leaders, and Latrine Artisans to drive household sanitation facility construction and ownership, and to improve sanitation uptake and behaviors through CLTS. This approach ensures that local capacities are developed to continue CLTS activities even after project completion. Following assessment of LNGO performance in the implementation of CLTS activities. Global Communities determined that a more sustainable and impactful approach is to implement CLTS directly; the Project no longer uses LNGOs but continue to work directly with staff of District/Municipal Assemblies and also build the capacities of the community volunteers to ensure project sustainability.

Water Supply The provision of publicly-owned facilities and services works in tandem with facility-user education. The formation and training of facility management committees, small town Water and Sanitation Management Teams, and the identification of caretakers ensures the optimal use and proper management of boreholes. Further, Area/Pump Mechanics have been trained in borehole repairs to help sustain water infrastructure under the project. These mechanics have been given a basic set of tools and have been linked to the District Water and Sanitation Teams and for spare parts suppliers in their districts. This same approach is being utilized as the boreholes are drilled.

BCC Collaboration with the Environmental Health Unit and Natural Leaders on BCC campaigns is a means toward strengthening and sustaining local knowledge of hygiene behaviors. In schools, activities with school health coordinators and school health clubs have increasingly improved hygiene practices among school children who act as change agents both in school and at home. WASH for Health implements BCC education at schools and throughout all project activities in order to ensure that all infrastructure provided to institutions, or any household latrines constructed through CLTS, is long lasting and improves the health and wellbeing of the beneficiaries. Additionally, with the introduction


and rollout of the BCC Package, Ghanaian officials and their partners will have improved tools to implement sound BCC messaging throughout the country.

7. AGREEMENT MODIFICATIONS

No modifications were received in the reporting period


8. ACTIVITIES PLANNED FOR NEXT QUARTER

As the Project enters the third quarter of FY18, the following activities are planned (see FY18 Work Plan for more details):

Component 1: Increase Use of Improved Household Sanitation: Increase access to improved sanitation products and services Undertake ODF verification and certification by the DICCS and RICCS Undertake ODF celebrations in project districts Continue introduction and construction of Digni-Loo in select districts.

Component 2: Improve Community Water Supply Services: Drilling and construction of 40 new boreholes Form and train WSMTs Construct Small Town Water System Solicitation of bids for rehabilitation of 50 broken down boreholes

Component 3: Improve sector governance and policies: Strengthen local governance and management Support broad engagement with WASH sector Support WASH sector programs and activities Work with the Ministry of Sanitation and Water to finalize guidelines for supporting poorest

of the poor in the WASH sector

Component 4: Expand Key Hygiene Behaviors: Increase adoption of key hygiene behaviors (e.g., handwashing with soap at critical times, safe

storage and use of drinking water, safe confinement of faeces) Begin preparation to integrate essential nutrition and WASH actions (e.g., use of safe water,

improved sanitation, and good hygiene practices) Improve integration of WASH, Maternal and Child Health, and nutrition services (Develop,

pilot, train and field test new tools Continue to promote and distribute BCC materials for use at community and district levels

Component 5: Leverage PPPs to magnify the impact of USG investments: Partner with Rotary International and Unilever Ghana Foundation, and other partners (Diageo,

Caterpillar) to deliver WASH facilities to communities and schools Continue engagement with WADA in support of construction of 150 household latrines Continue to collaborate with partners to supply affordable household latrine construction

(cement, plastic latrine slab, etc.) Finalize the SOW with Unilever for provision of institutional latrines at schools.

Component 6: Improve Water supply and Sanitation infrastructure for Schools and Health Facilities: Continue construction of 38 institutional latrines in schools and CHPS; and Drill and construct 16 boreholes for schools and CHPS

Cholera Prevention Activities Digni-Loo

Utilize mass media to broadcast BCC Messages Continuous distribution of Aqua Tabs as needed Disinfection of Cape Coast Metropolis Mobilize and train volunteers

Support GoG in roll out of Pro-Poor Policy Work with entrepreneurs in project communities/districts to

facilitate purchase and distribution of Digni-Loos; Install 1,500 Digni-Loos; Patent Digni-Loo in U.S. and select West African Countries; Promote and feature Digni-Loo broadly; Participate in USAID study on Pro-Poor Sanitation models.

WASH FOR HEALTH PROJECT FY18 ANNUAL REPORT 25

APPENDICES

I. Performance Data Table (PDT)

Indicator

FY 18

FY 18 TA

RGET

FY 18 RE

SULTS

LOP TA

RGET

LOP RE

SULTS

PERC

ENTA

GE

ACHIEVE

D

1st Qtr 2nd Qtr

Target

Achieved

Target

Achieved

OBJECTIVE 1:INCREASE USE OF IMPROVED HOUSEHOLD SANITATION FACILITIES Number of people gaining access to a basic sanitation service as a result of USG assistance. 6400 4653 10666 15787 38400 20461 60600 85005 140%

male 3008 2187 5226 7736 18816 2187 29694 41559 140% female 3392 2466 5440 8051 19584 2466 30906 43445 141%

Number of people gaining access to safely managed sanitation service as a result of USG assistance. 206 221 604 469 825 690 2250 2115 94%

male 101 103 101 230 404 333 1102 1029 93% female 105 117 105 239 421 356 1148 1085 95%

Number of individuals trained to implement improved water and sanitation methods 250 468 432 739 900 867 2500 4953 198%

Number of communities certified as “Open defecation free” (ODF) as a result of USG assistance 30 35 50 78 180 47 640 369 58%

Number of basic household latrines constructed 1200 554 1200 1971 4800 2525 10100 10593 105% Number of safely managed latrines installed 13 17 38 38 55 55 150 150 100% OBJECTIVE 2: IMPROVED COMMUNITY WATER SUPPLY SERVICES

Number of people gaining access to basic drinking water services as a result of USG assistance. 0 0 0 0 30900 0 66000 41400 63%

Male 0 0 0 0 12348 0 32340 20286 63% Female 0 0 0 0 12852 0 33660 21114 63%

Number of people in target areas with first‐time access to improved drinking water supply as a result of USG assistance 0 0 0 0 12900 0 42930 23100 54%

male 0 0 0 0 6,321 0 21465 11319 53% female 0 0 0 0 6,579 0 21036 11781 56%

Number of people receiving improved service quality from existing improved drinking water sources

0 0 0 0 3000 0 4770 0 0%

male 0 0 0 0 1470 0 2337 0 0% female 0 0 0 0 1530 0 2433 0 0%

Percent of households in target areas practicing correct use of recommended household water treatment technologies 0 0 0 0 20 0 40 0 0%

Liters of Drinking water disinfected with USG supported point of use treatment products N/A N/A N/A N/A N/A 0 N/A 12408000 N/A


Indicator

FY 18

FY 18 TA

RGET

FY 18 RE

SULTS

LOP TA

RGET

LOP RE

SULTS

PERC

ENTA

GE

ACHIEVE

D

1st Qtr 2nd Qtr

Target

Achieved

Target

Achieved

Number of boreholes installed 0 0 0 0 80 0 220 138 63% OBJECTIVE 3: IMPROVE SECTOR GOVERNANCE AND POLICIES Number of New policies, laws, agreements and regulations implemented that promote access to improved WATSAN

0 0 0 0 1 0 1 0 0

OBJECTIVE 4: EXPAND KEY HYGIENE BEHAVIOURS Number of people practicing handwashing with soap under running water 8204 3603 8204 14438 32,816 13382 48480 29046 60% Percent of households with soap and water at a hand washing station commonly used by all family members 60 45 60 67 60 67 80 79 99%

OBJECTIVE 5: LEVERAGE PUBLIC/PRIVATE PARTNERSHIPS TO MAGNIFY THE IMPACT OF USG INVESTMENT

Number of MOUs signed with organization for new GDA or similar partnership 0 0 0 0 0 0 6 5 83% OBJECTIVE 6: IMPROVE WATER SUPPLY AND SANITATION INFRASTRUCTURE FOR SCHOOLS AND HEALTH FACILITIES

Number of basic sanitation facilities provided in institutional settings as a result of USG assistance. 0 0 0 4 30 4 190 226 119%

School Facilities 0 0 0 4 30 4 180 206 114% Health Facilities 0 0 0 0 0 0 10 10 100%

Number of institutional settings gaining access to basic drinking water services as a result of USG assistance.

0 0 0 0 17 0 40 13 33%

Schools 0 0 0 0 17 0 20 13 65% Health Facilities 0 0 0 0 0 0 20 0 0


II. Success Stories and Press Coverage

None.

III. Financial Information

The form 425 will be submitted separately.

IV. Activity Oversight & Technical Assistance Support

TABLE 1: MONITORING VISITS DURING REPORTING PERIOD

Date of Site Visit Monitoring

Team Members Site(s) visited

Major observations and/or findings from site visits (Concise bullet points)

Jan. 22 – Feb. 13, 2018

James Obed Lomotey

Adaklu, Krachi East, Nkwanta North and Nkwanta South

Re-orientation of District officers to use BCC Communication Package Monitor CLTS activities in Project communities

Feb. 11 – Feb. 20, 2018

Martin Sumbo Twifo Hemang Lower Denkyira District and Asikuma Odoben Brakwa

Monitoring of CLTS activities in project communities

March.20 – March 22. 2018

Felix Amofa Ada West and Ada East Monitor CLTS activities in Project communities, Provided refresher for EHAs in Ada West

March, 2018 Samuel Agyarko Amenfi Central, Bodi and Wiawso Monitor CLTS activities in Project communities. Support distribution of Digni-Loos and ODF sign post to project communities

TABLE 2: TECHNICAL ASSISTANCE (TA) PROVIDED DURING REPORTING PERIOD

Organization and/or person(s) who provided Type of TA Purpose of TA Dates of TA

TABLE 3: INTERNATIONAL TRAVEL

Name of traveler(s) Purpose of international travel

Destination Travel dates


V. M&E Issues

Indicator and/or Target Adjustments

None

VI. Management and Administrative Issues

Staff Changes/Updates

Within the second quarter of FY18, two CLTS Field Officers parted ways with Global Communities due to personal reasons. Some reposting and reassignment was done to ensure work in their respective districts and communities continue. No other significant changes have occurred on the staffing front.in the quarter.

Budget Issues

None

Issues with Collaborators and Other Stakeholders

None

Other

None

VII. Follow-Up Actions

A/COR comment/recommendation from previous reporting period

and/or relevant evaluation/research recommendation

Brief Description of Follow-up Action Taken

Date Action was taken or is planned to be

taken

NONE NONE NONE


VIII. Map of Project Activity Sites/ Facilities by District


IX. CLTS Updates Extract

S/N DISTRICT

INTERVENTIONS COMMUNITY‐LED TOTAL SANITATION ACTIVITIES HOUSEHOLD LATRINES

EHAs

HWF constructed

Soakaw

ay

constructed

Commun

ities

Pre‐triggered

Triggered

Post‐trig

gered

NLs iden

tified

Passed

Self‐

assessmen

t

Declared

ODF

Basic

by DICC

S

Verified ODF

by

DICC

S

Certified

ODF

by

RICC

S

HHLs Targeted Under construction Completed

Pit Level

Sub‐

structure

Supe

r structure

Curren

t Week

Cummulative

CENTRAL REGION 1 TWIFO ATI MOKWA *** 15 15 15 15 54 0 0 0 0 250 0 0 0 0 14 2 5 3 2 TWIFO HEMANG LOWER DENKYIRA 29 29 29 29 155 7 2 3 2 475 79 53 38 0 281 8 379 250 SUB TOTAL 44 44 44 44 209 7 2 3 2 725 79 53 38 0 295 10 384 253 3 ASIKUMA ODOBEN BRAKWA 47 47 47 47 244 15 10 5 8 667 160 92 10 0 243 109 322 228 4 ASSIN NORTH *** 29 27 27 27 126 5 1 1 0 250 96 20 7 0 119 9 112 58 5 UPPER DENKYIRA EAST *** 15 15 15 15 108 0 0 0 0 225 0 0 0 0 26 6 26 0 SUB TOTAL 91 89 89 89 478 20 11 6 8 1142 256 112 17 0 388 124 460 286 WESTERN REGION 6 AMENFI CENTRAL 37 37 37 37 203 10 0 0 11 385 102 72 46 1 244 12 268 232 7 AMENFI WEST 26 26 26 26 180 10 0 0 8 352 32 44 34 0 401 7 380 50 8 AMENFI EAST *** 10 10 9 8 69 2 0 0 0 180 0 0 0 0 28 2 23 5 SUB TOTAL 73 73 72 71 452 22 0 0 19 917 134 116 80 1 673 21 671 287 9 SEFWI WIAWSO 33 33 33 33 146 17 11 0 10 442 75 44 30 2 307 9 202 22 10 SEFWI BODI 46 46 46 46 187 15 8 0 21 667 90 45 36 2 371 14 278 142 11 SEFWI AKONTOMBRA *** 10 10 10 10 62 0 0 0 0 150 53 0 0 0 30 4 9 1 12 MPOHOR *** 10 10 9 9 40 0 0 0 0 150 17 0 0 0 11 4 0 0 SUB TOTAL 99 99 98 98 435 32 19 0 31 1409 235 89 66 4 719 31 489 165 VOLTA REGION 13 ADAKLU 25 25 25 25 107 22 5 1 6 394 24 12 40 2 113 7 115 22 14 AGOTIME 48 48 48 41 224 22 10 8 12 667 46 58 25 0 167 12 239 140 SUB TOTAL 73 73 73 66 331 44 15 9 18 1061 70 70 65 2 280 19 354 162 15(a) NKWANTA NORTH 13 13 13 13 78 12 0 0 9 250 121 3 47 0 124 2 93 90 16(a) NKWANTA SOUTH 15 15 15 15 56 7 0 0 7 250 127 16 42 0 218 2 202 80 SUB TOTAL 28 28 28 28 134 19 0 0 16 500 248 19 89 0 342 4 295 170 15(a) NKWANTA NORTH 41 41 41 41 215 17 2 2 12 667 129 131 185 2 444 14 440 435 16(a) NKWANTA SOUTH 46 46 46 46 279 21 2 0 17 667 52 70 324 1 731 15 564 254 17 KRACHI EAST 31 31 31 29 154 14 2 0 8 417 55 47 140 2 313 11 322 90 SUB TOTAL 118 118 118 116 648 52 6 2 37 1751 236 248 649 5 1488 40 1326 779


S/N DISTRICT

INTERVENTIONS COMMUNITY‐LED TOTAL SANITATION ACTIVITIES HOUSEHOLD LATRINES

EHAs

HWF constructed

Soakaw

ay

constructed

Commun

ities

Pre‐triggered

Triggered

Post‐trig

gered

NLs iden

tified

Passed

Self‐

assessmen

t

Declared

ODF

Basic

by DICC

S

Verified ODF

by

DICC

S

Certified

ODF

by

RICC

S

HHLs Targeted Under construction Completed

Pit Level

Sub‐

structure

Supe

r structure

Curren

t Week

Cummulative

GREATER ACCRA 18 ADA EAST 44 44 35 32 310 17 8 2 19 475 44 54 159 0 241 10 241 0 19 ADA WEST *** 25 25 25 13 82 13 4 1 8 250 0 0 0 0 185 3 185 0 20 SHAI OSUDOKU 24 24 24 12 144 6 0 6 2 324 245 174 117 2 163 8 193 28 SUB TOTAL 93 93 84 57 536 36 12 9 29 1049 289 228 276 2 589 21 619 28 NORTHERN REGION 21(a) SAWLA TUNA KALBA 148 148 148 148 698 0 0 2 106 2220 249 174 473 0 2310 22 2502 3003 21(b) SAWLA TUNA KALBA (TUNA ZONE) 77 77 77 77 263 0 6 0 18 1155 356 33 260 3 793 0 172 395 22 WEST MAMPRUSI 47 47 47 47 294 0 3 2 11 705 81 107 58 2 893 13 910 83 23(a) BOLE 82 82 82 81 280 10 0 0 48 885 68 119 270 0 1203 20 1055 602 23(b) BOLE (BAMBOI ZONE) 70 70 70 70 195 0 0 24 26 1050 104 121 56 2 620 2 487 368 SUB TOTAL 424 424 424 423 1730 10 9 28 209 6015 858 554 1117 7 5819 57 5126 4451

GRAND TOTAL 1043 1041 1030 992 4953 242 74 57 369 14569 2405 1489 2397 21 10593 327 9724 6581


X. Photos

Group photo of participants at the first validation workshop for the pro-poor guidelines held at ISGC, Teiman

A resource person explaining the use of the BeGirl Menstrual Hygiene product to pupils of a basic school where the pilot was done.

A group session during stakeholders’ validation and dissemination workshop for the pro-poor policy.

Drilling activities about to commence at a site in the Western Region

A focus group discussion at Asebi, Shai Osudoku District where a NuWASH research was carried out.

The Chief of Party makes a contribution at the stakeholders’ validation and dissemination workshop for the pro-poor policy.

wash for health project - quarterly report - USAID

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