This post is part of a series created in partnership by WASH Advocates and Women Deliver. For more information, please contact Cecilia Snyder  and Janna Oberdorf.

To remind ourselves why it is so vitally important to make improvements to water, sanitation and hygiene (WASH), all we need to do is take a look at what’s in the dirty water. Lurking in infested water sources are parasitic worms that cause diseases such as human hookworm and schistosomiasis. These infections spread easily in communities that don’t have access to clean water or sanitation facilities.

Hookworm, schistosomiasis and other neglected tropical diseases (NTDs) infect more than 1 billion people around the world.

For women and children, NTDs are especially concerning. They are more likely to come into contact with NTDs while doing basic chores, like laundry or collecting water, bathing, or even just playing outside.

The effects of constant infection and re-infection can be devastating. For the estimated 40 million women of reproductive age infected with hookworm, the infection can cause serious health risks during pregnancy, including anemia. During childbirth, these women have a higher likelihood of experiencing complications and even death. Approximately 19 million girls and women are infected with a strain of schistosomiasis that makes them three to four times more likely to contract HIV.

That’s not all. Several NTDs can cause malnutrition and stunt a child’s physical growth throughout their childhood. They can also reduce a child’s ability to attend and perform well in school.

Luckily, the effects of these diseases can be controlled with simple medical interventions – most of which are donated by pharmaceutical companies; but, WASH improvements are what will make these treatment programs sustainable over the long term.

If we want to markedly improve maternal and child health and allow girls to learn and grow to their fullest potential, we must address NTDs. WASH improvements can help control and protect people from many NTDs. By combining these improvements with regular treatment programs, we can see the end of these diseases as early as the end of this decade.

On Earth Day, it is important to take action to protect our environment. It is equally important to realize that we share the same environment as those in sub-Saharan Africa, South Asia, and around the world.

This is especially true for water resources. Although 70.9% of the water is covered by water, only three percent of that water is fresh water, and two-thirds of that is trapped in the glaciers. In the developing world, 783 million people lack access to an improved drinking water supply. Americans use 100 gallons of water per day, while residents in sub-Saharan Africa only use 2-5 gallons each day.

The same is true for sanitation – 2.5 billion people lack access to basic sanitation. In the developing world, 90% of sewage is discharged into bodies of water, contributing to human disease and impacting marine life. “Dead zones” are caused by this discharge and agricultural runoff.

The poor and most vulnerable populations are most likely to be adversely affected by climate change and natural disasters, and lack of water, sanitation, and hygiene (WASH) contributes to the losses caused by these emergency situations. Proper WASH can mitigate effects on both humans and the environment.

Today, on Earth Day, let’s protect our shared environment and work together to conserve our resources. Here are some easy ways to take action on Earth Day:

• Calculate your water footprint
• Turn off the tap while brushing your teeth or shaving
• Take shorter showers
• When washing dishes by hand, don’t leave the water running for rinsing
• Flush the toilet only when necessary
• And many more…

• Monitoring the Finance Needed for Service Delivery
• Country-led and Country-wide Monitoring of Rural and Small Town Water Supplies
• Project Monitoring: A Vicious Cycle of Donor Accountability or a Necessary Stepping Stone to Better National WASH Sector Monitoring?
• Information and Communication Technologies (ICTs) for monitoring sustainable service delivery
• Monitoring for Sanitation and Hygiene
• Building Coherence in Global-Regional-National WASH Monitoring

One thing that made this conference so interesting was the government representation. The African Ministers Council on Water (AMCOW) met before and after the Symposium which provided an opportunity for high level officials from across Africa to discuss and try to address their country-specific monitoring issues and try to create some harmonization across the continent. In addition to their side meetings, ministry representatives were active participants.

Like any large conference, the Symposium provided so much great content that is was hard to take it all in. That said, there were a couple of themes that seemed to be reoccurring throughout the sessions as well as during the many side meetings and conversations throughout the week.

One theme that stood out is what I would call post-implementation monitoring. Others may refer to it as monitoring service delivery. What is the difference, you ask? Monitoring service delivery is ongoing just as the WASH service should be. Post-implementation monitoring usually refers to snapshot in time to make sure a project is functioning as intended. This may occur at 1, 3, 5, and/or 10 years after the initial hardware, training, or hygiene promotion was done.

Although as a sector our ultimate goal would be government run WASH services including monitoring, we have a ways to go. Therefore, post-implementation monitoring is a great solution until everyone in the WASH sector is focused on long-term service delivery for entire communities in lieu of project-based work.

Elynn Walter is the WASH in Schools Director for WASH Advocates.

The goal is ambitious but achievable: to end preventable childhood deaths due to pneumonia and diarrhea by 2025. At the launch today in Washington, DC, special emphasis was placed on the fact that the interventions exist to prevent and control these diseases, but coverage of these interventions is poor, especially in the most marginalized populations and the poorest of the poor. Scale-up and collaboration of all efforts surrounding pneumonia and diarrhea is necessary to reach this goal by 2025.

Samira Aboubaker of WHO noted, “The message is clear: we do not want a new plan. We want the existing plan to reflect the priorities of [all the sectors], epidemiology, birthing, etc. Therefore, it is an opportunity to look at the existing plan and identify the missing pieces. The water and sanitation group has to be part of our plan. Clearly we’ve seen we have to protect, prevent, and treat pneumonia and diarrhea, and that needs to be reflected in this plan.”

The GAPPD strategy seeks to establish good health practice from birth, preventing children from becoming ill from pneumonia and diarrhea, and treating children who are ill from pneumonia and diarrhea with appropriate treatment. Promoting handwashing and improving water supply, sanitation, and hygiene are among the interventions that have been proven to be effective in fighting these killers of young children, in addition to exclusive breastfeeding, vaccines, disease case management, oral rehydration salts, demand creation activities for behavior change, and reduction of household air pollution.

The key messages of GAPPD are:

1. Working together, we can end preventable deaths of young children around the world from two of the leading child killers, pneumonia and diarrhea.
2. The integrated Global Action Plan for the Prevention and Control of Pneumonia and Diarrhea (GAPPD) from WHO and UNICEF goes to the heart of the challenge: recognizing that prevention and control of pneumonia and diarrhea cannot be adequately dealt with separately but only through integrated programs.
3. Without these urgent accelerated and coordinated efforts, each year more than two million of the world’s most vulnerable children will continue to die from these two diseases. We must close this equity gap.
4. Successfully reducing pneumonia and diarrhea deaths requires engagement by a wide range of actors and sectors, and first and foremost, it requires national political will.
5. These diseases must be addressed if we are to move the needle significantly in achieving the Millennium Development Goal to save the lives of children under the age of five (MDG4), as well as successful implementation of the UN Global Strategy for Women’s and Children’s Health, and the Promise Renewed commitment to child survival.

We at WASH Advocates have signed on to the Statement of Support for the GAPPD and are excited to participate in the collaboration of existing programs and interventions to produce synergies and efficiencies and end preventable child deaths from pneumonia and diarrhea.

Jordan Teague is a Research Assistant at WASH Advocates

1)     The Sanitation and Water for All Partnership: This partnership was launched only in 2010, but has the potential to attract the attention not just of Water Ministers, but of Prime Ministers and Finance Ministers across the globe. How many Finance Ministers can it attract to its next High Level Meeting?

2)     You want to get the attention of Finance Ministers, and make it possible for them to prioritize safe drinking water and sanitation? The Economics of Sanitation Initiatives was developed just for you.  If more Finance Ministers and Prime Ministers knew the positive impact of sanitation on their countries’ GDP growth rates, more would be able to make those tough budgeting decisions in favor of this basic human need.  [One data point: Inadequate sanitation costs India the equivalent of 6.4% of its GDP - in lost economic productivity and increased healthcare costs.]

3)     The launch today at the United Nations of the Deputy Secretary General’s Call to Action on Sanitation. Think about how many competing development challenges Mr. Eliasson could have chosen, and that he chose to stick his head above the hedge and tackle sanitation. And he is winning: At a high-level United Nations lunch yesterday, ‘ending open defecation’ was suggested over two dozen times by the seniormost diplomats at the United Nations.

4)     Here in the U.S. we anticipate the launch of USAID’s first-ever water strategy, and the (re)introduction of the Senator Paul Simon Water for the World Act by the U.S. Congress.

5)     And let’s talk political will in its purest form: End Water Poverty has produced an Elections Toolkit which should be used by water and sanitation organizations all over Africa, Asia, and Latin America, to urge their elected political leaders to prioritize this issue. What if every candidate in the recent Kenyan election, for example, had committed (during the campaign) to meet the water and sanitation needs of every single Kenyan in the next few years? Those sorts of commitments (aligned with the Sanitation and Water for All Partnership) have a chance to significantly compress the timeline for universal coverage of both safe drinking water and sanitation.

Lastly, I am grateful for the philanthropic community’s continuing efforts to be more strategic in grantmaking for the WASH sector. I’ll certainly include our own donors on this list (Conrad N. Hilton Foundation, Howard G. Buffett Foundation, Wallace Genetic Foundation, and Osprey Foundation), but want to also highlight the work of The Foundation Center’s WASHfunders.org portal and its efforts to increase the amount and (more importantly) the effectiveness of grantmaking in the sector.

John Oldfield is WASH Advocates’ CEO.

Egyptian mother and children during a home visit. (Photo courtesy of MCHIP/PATH.)

Reprinted with permission by MCHIP-Maternal and Child Health Integrated Program

This World Water Day, Community Health Workers (CHWs) in Egypt are focusing on key messages concerning water and hygiene to improve health outcomes and nutrition in the areas where they live.

The SMART project—a USAID-funded MCHIP project that focuses on improving maternal and neonatal health and nutrition—is collaborating with the Egyptian Nursing Syndicate to raise the awareness of nurses on the importance of infection control, especially around newborn babies and postpartum mothers. The Water and Food Sanitation program for nurses working in public and private hospitals in the six SMART target governorates aims to reduce the incidence of gastric and diarrheal diseases by emphasizing simple precautions that nurses can take to reduce the spread of infection.

And to disseminate this information at the household level, these nurses are working closely with CHWs, who have proved themselves to be an indispensable link between women and health services. CHWs are helping to inform mothers and the general public about the role of good nutrition in strengthening a child’s immune system, and sharing critical messages about hygiene and sanitation during their home visits.

Of the 1,200 CHWs currently enrolled in the SMART project, all are women between the ages of 19 and 48. After an intensive training course to give them the necessary information and skills to assist women in their local communities, they find out which women in their area are pregnant or have recently given birth. They make frequent home visits to support these women, giving advice on nutrition, hygiene and health care for both themselves and their babies.

For example, if a CHW identifies an infant’s failure to grow properly, she will encourage and/or accompany the mother to the nearest clinic for a check-up and for counseling on how to improve the infant’s growth. This includes discussions and cooking classes run by the CHWs, who also organize regular nutrition classes for women, mothers-in-law and husbands. Through demonstrations, attendees learn how to prepare simple, healthy meals made from readily available foods within the context of proper hygiene in food preparation.

Some of the households visited by CHWs do not have running water; instead, they collect water in jerrycans from a nearby standpipe, making advice on water storage very useful. CHWs are also counseling mothers on proper handwashing prior to preparing food or feeding their babies, the need to wash toddlers’ hands and faces often, and how to correctly bathe their babies.

To further spread these important messages, SMART has distributed brochures in Arabic on personal hygiene and clean food preparation to Community Development Associations and CHWs.

Fran Roots is with MCHIP/Egypt.

This post originally appeared on the Plan International USA Blog

A day on ‘The Hill’, Maame (right) with Lauren Yamagata, Plan WASH Program Associate

While Ghana has one of the strongest emerging economies in Africa, over a quarter of the population does not have access to clean safe drinking water. The problem is particularly dismal in most parts of Ghana where diarrhea causes 25 percent of all deaths of children below the age of five each year, according to UNICEF. The figures get even higher in the Northern parts where most of the population fetches water from the wells, rivers, streams, ponds and other natural water sources that often contain disease causing organisms.

When I was 15 years of age, I attended a public boarding high school in Ghana which was in a relatively developed area in Southern Ghana. There were days when the water flow was irregular which meant my housemates and I had to wake early to walk to the nearest water source to look for water before class. This could take thirty minutes to an hour depending on how close the water source was and how many people were already in line waiting to fetch water from this limited resource. My friends and I would carry buckets on our heads and jerry cans in our hands in order to avoid repeating the long journey it took to look for water and to minimize the time lost in going back and forth from the boarding house to the water source to fetch water. Often times we would go to the water pump at the school entrance when we heard there was water there. But, by the time we would get there, there would be long lines of people waiting to fetch water which meant it was likely we would get none to fetch. When it finally got to our turn, unfortunately the water source will be depleted and we would have to resort to other sources to find water. While this did not happen too often, it was very frustrating and infuriating when it did.

Apart from the time lost in fetching water, most of my friends and I became unproductive at school and would sleep in class due to fatigue. I remember one time when I felt like my head was about to fall off because of how heavy the bucket of water was. Carrying water on your head and on your shoulders has dire physical consequences which might not manifest themselves at that point in time but will affect the body in the future. The water was sometimes dirty so we did not drink it but rather we drank sachet water which is water in plastic bags. This could get very expensive especially when we had to buy more than ten packs for chores, consumption and for taking showers. While I had the privilege of fetching water and going to school, many people especially women and girls were deprived of an education, deprived of a normal productive life and deprived of a healthy body because of this inadequate access to water.

In my efforts as a “WASH ambassador”, I create awareness about this important issue and encourage citizens to support WASH – clean drinking water, sanitation and hygiene – efforts mostly in developing countries. On the 20th of March, 2013 as part of the World Water Day Congressional Advocacy Day, I visited the offices of members of the Senate and the House of Representatives to encourage them to rally their support for the Water for the World Act, which will be introduced in the near future. This act seeks to modify the 2005 Senator Paul Simon Water for the Poor Act and improve the efficiency with which the U.S gives foreign aid for WASH without incurring additional costs.

As part of this process, I joined other WASH advocates to demonstrate the breadth of support for WASH issues and to create awareness and gather support for the act which is yet to be introduced. Our day began with advocacy training including a short address from former Senator Bennett from Utah. Along with three other team members; Lauren Yamagata, (Plan International WASH Program Associate) Ryan Quinn (Save the Children) and Angel Lopez (9th grade, HB Woodlawn High School and H2O for Life advocate), we attended three different meetings with congressional staff to make them aware of this act and to get them to promote it when they report back to their bosses. I shared my personal story of growing up without access to water with the staff and explained the importance of targeting the poorest of the poor who really need water.

It was very enlightening to see how “Hill Day” goes and how advocacy is done at the congressional level. This was my first time seeing how the process works, learning the dynamics of Congress, learning how lobbyists and advocates make their cases by either been seen in the Capitol building or having meetings with congressional staff who will in turn convey the message to members of Congress. I got to share my personal story with them which brought a face to the issues we were talking about. It was a great learning experience and very rewarding as I know once this bill is passed, millions of people will have access to clean water, sanitation and hygiene.

My hope is that you will educate yourself on water issues, educate your community and support the WASH work done by Plan International USA.

Guest post by Lisa Schechtman, Head of Policy and Advocacy for WaterAid in America

Water is a women’s issue.

It’s an important adage, one that highlights how we expect governments to prioritize investments in safe drinking water, sanitation, hygiene (WASH), and water resource management.

There is a great deal of evidence behind it, too. Every year, 40 billion working hours are lost to water collection worldwide, mostly by women and girls. This violates their rights to employment and education by taking up time and energy; and their rights to safety and dignity by exposing them to injury, animal attack, and physical and sexual violence. Since the water they collect is usually unsafe, it violates their right to health, exposing them to a variety of diseases, diarrhea, and even uterine prolapse from carrying heavy loads.

Sanitation is a women’s issue, too. Lack of sanitation, combined with poor hygiene, allows for the ingestion of fecal matter, creates breeding grounds for vectors of diseases like trachoma, and contaminates water sources. Emerging research emphasizes how inadequate WASH impacts maternal health.  In fact, one estimate is that 4% of all maternal deaths can be linked to poor WASH.

Any effort to improve women’s health and rights must address WASH. Yet, WASH suffers from the same siloed approach as many other health, development and human rights issues. Policies abound, from a new USAID water strategy expected soon, to the agency’s lauded Gender Equality and Female Empowerment Policy. It remains to be seen whether USAID will show leadership by requiring that the one be in service to the other. Or, if there will be accountability for using WASH to make the most of the US President’s Global Health and Feed the Future Initiatives, both of which recognize the role of WASH to their success while doing little to support or promote it.

Recently, I analyzed the U.S. Department of State’s annual report on compliance with the Senator Paul Simon Water for the Poor Act of 2005, which mandated USAID and the State Department prioritize WASH and water investments for the world’s poorest, and those who would benefit most from receiving access, including women and girls. There are many ways that this requirement might be met, including by providing private, secure latrines and menstrual hygiene management supplies at school, since many girls drop out once they reach adolescence. However, in spite of the fact that WASH access could address a major, direct barrier to girls’ secondary education, only 7.5% of U.S. government investments in WASH are spent in the 10 countries where women and girls have the lowest rates of secondary education completion. To me, this is a real missed opportunity—and an example of poor targeting of WASH funds for integrated approaches and cross-cutting benefits to women and girls.

This and other problems like it are why the Senator Paul Simon Water for the World Act has had such strong, bipartisan support in both the US House and Senate in recent years. While it didn’t become law last year, we remain in need of the bill’s efforts to require improved attention to the needs of women and girls and the many positive ripple effects of providing WASH to the world’s poorest people. We stand ready to support our Congressional champions in getting the bill to the President’s desk this year. We hope you will join us.

This blog post is part of the Wash and Women’s Health series hosted by the Maternal Health Task Force.

photo by Rebecca Fishman, WASH Advocates

The following guest post provides snapshots of WASH and gender interventions in India that are supported by the Bill & Melinda Gates Foundation.

By Akhila Sivadas, Project Director, Center for Advocacy and Research (New Delhi):

Rajasthani camp, a cluster of 600 households in South Delhi, is one of the 27 settlements where the Center for Advocacy and Research is facilitating the formation of Women’s’ Forums, which enable the community to collectively negotiate with the municipality for better sanitation services. Like all other settlements we have worked in, the women of Rajasthani Camp were frustrated with broken toilets, clogged drains, and garbage heaps in their community. The Women’s Forum launched a multi-pronged initiative this past fall. Armed with the community-specific disease data that emerged from a health conversation we convened, the Forum raised their concerns with a local leader who pressured authorities to fix the situation. Their persistence and determination has already paid off: toilet renovations are currently underway.

By Sampath Kumor, Project Director, Rajiv Gandhi Charitable Trust:

The Self Help Groups of Rajiv Gandhi Charitable Trust provide potent platforms to discuss and disseminate the objectives of the WASH and gender project. Women from socially and economically marginalized groups have now found a forum to discuss subjects that have always been disapproved and stigmatized. For communities with little choice but to defecate in the open, the process of identification of the risk and vulnerability of the same (particularly for adolescent girls) is a step closer towards the aim. In addition, targeted Self Help Groups for young women are utilizing peer-to-peer discussions to address menstrual hygiene management. The march is on!

By Kathleen O’Reilly, Principal Investigator, Texas A&M University:

In our research on successful sanitation habits in rural West Bengal and Himachal Pradesh, we have learned that using a toilet is so commonplace for mothers with young children that they often do not recognize the advantages gained by having a toilet. Despite casual replies to questions about the convenience of a household toilet, observation of mothers’ daily routines reveals that they take advantage of the toilet’s proximity by leaving children unattended when they use it. We have found that the toilet has become so useful and so habitual that women are no longer conscious of the burden it would be to take children with them for open defecation.

This blog post is part of the Wash and Women’s Health series hosted by the Maternal Health Task Force.