The interface WASH / NTDs – why this topic?
Neglected Tropical Diseases (NTDs) affect more than 1 billion people worldwide. Disproportionately impacting the poorest and most marginalised communities, NTDs often cause devastating health, social and economic consequences. NTDs should not be considered in isolation, but rather as part of a broader approach. Underlying factors that contribute to the transmission and persistence of these diseases, include inadequate Water, Sanitation, and Hygiene (WASH) services. The interface between WASH interventions and the majority of NTDs is a key focus area to address their global burden. The provision of WASH services, which is one of the core strategic interventions within the global WHO-NTD roadmap, makes critical contributions to advancing the fight against NTDs. Intensified, interdisciplinary approaches can accelerate and sustain progress towards disease elimination and control.
GIZ’s portfolio contains many projects related to the water sector, both, WASH approaches and water resource management, outside the classical public health field. However, the potential of the One Health approach combined to NTD control is not yet fully recognized or incorporated in these projects’ context.
Water is at the center of the fight against NTDs!
- NTD vector ecology (snails, mosquitoes, etc.)
- Direct and indirect NTD transmission
- NTD prevention (clean drinking water, wound & hand washing)
Intersectoral WASH interventions are more powerful in addressing:
- Prevention and control of diseases at the source
- Trade-offs between public health and other sectors
- Environmental concerns of NTD control
Theory of change for NTD/WASH
Project profiles
Sudan – Food Security for Refugees and Host Communities
About the project
Project Food Security for Refugees and Host Communities in Gedaref and Kassala State
Goal the food and nutrition security of refugees in selected camps and of residents of selected neighboring communities in the states of Gedaref and Kassala has improved.
Implementation period 09.10.2017 – 30.09.2023
Starting points to One Health
- waste management
- food safety
- hygiene measures
- surveillance (diarrhea)
- communal water dam management (humans, animals separately)
- awareness campaigns (nutrition and hygiene)
- schools
- land-use planning
What facilitated project implementation?
- tapping into knowledge of manager of local company
- overlap between existing WASH project in region and value chain values
- grouping of smallholders into networks that gave them legitimacy and trading power
Project impact
- the prevalence of diagnosed cases of acute watery diarrhea in Shagarab Camp has decreased by an average of 20%.
- approximately 68,500 additional people have consistent access to clean water of adequate quantity and quality.
- 500 school children have access to hand washing stations and latrines.
- four water supply systems (tanks and pumping stations) have been built, rehabilitated, or improved through solar systems.
- 200 people (members of WASH committees and participants of Focus Group Discussions) report that they use hygiene practices daily.
Challenges
- only about 30% of the population has access to clean water and sanitation facilities
- insufficient water management and inadequate adaptation of agricultural production methods to climate change are limiting factors for increasing agricultural production
- about 80% of the population in Gedaref and Kassala relies on agriculture
- lack of access to adequate food, clean water, and sanitation facilities leads to the spread of diseases and an increase in the proportion of malnourished individuals
Solutions
- three main areas of action – agriculture, nutrition, and WASH – which are interlinked through various activities (e.g., hygiene and healthy eating awareness campaigns in schools)
- involvement of the Ministry of Agriculture, Ministry of Urban Planning, and collaboration with the Ministry of Health
- a “Chapeau” paper has been created with UNICEF, UNHCR, and WFP to ensure coherence and coordination of interventions towards a common logic
What was achieved so far?
- 3,350 smallholders apply improved cultivation techniques
- 12 schools (600 students and 42 teachers): awareness campaigns for healthy nutrition and hygiene. The teachers were further trained in a Training of Trainers program to continue educating students
- 17 schools (approximately 7,000 students) were provided with handwashing stations and latrines
- 2 water supply systems have been built
- 44 hygiene promoters selected, and 4 WASH-Committees were established. Promoters and committees have been trained to promote clean water, sanitation, and hygiene practices in households
Mali – Integrated Agriculture and Livestock Farming
About the project
Project Integrated Agriculture and Livestock Farming in Gao, Menaka and Mopti
Goal the capacities of the population and responsible institutions for a climate-adapted, resilient and inclusive management of natural resources are increased.
Implementation period 01.11.2019 – 30.11.2024
Starting points to One Health
- communal water pond management
- hygiene measures
- disease management measures (plants, humans, animals)
- socio-cultural coherence
- disaster risk management
- climate change
- agroecology approach
What facilitated the project implementation?
- rehabilitation of basic infrastructures related to water for humans, animals, agriculture
- intersectoral approach anchored locally through interdigitation with existing projects, and their sectoral activities, also due to security concerns
- additional WASH-measures due to COVID-19
Project Impact
- rehabilitate or set up 10 publicly accessible water points according to Malian standards with accompanying Corona-relevant educational measures.
- support relevant service providers to secure animal vaccination campaigns and other animal health activities.
- 75% of 800 grouped women in selected areas of the Gao, Ménaka and Mopti regions confirm a substantial improvement in the benefits of ecologically sustainable management of natural ponds/lakes and small weirs.
- 75% of the 600 members of the supported pastoralist organizations confirm an increase in competence in the sustainable management of deep wells, pastures and herds.
Challenges
- only about 60% of the population has access to safe drinking water, more than 30% have access to appropriate sanitation
- limited access to public services and frail infrastructure for water resource management
- mal- and undernutrition, low productivity of agriculture
- socio-economic tensions, land use conflicts, migration, limited economic perspectives
- consequences of climate change impact the availability of safe drinking water or food and disease occurrence
Solutions
- definition of stakeholders active in the project area, creation of local, intersectoral technical committees
- consideration of communities’ priority needs and for social cohesion, use joint-logistics to reach them
- trainings, awareness campaigns and sanitation kits included in the support against COVID-19
- future plans to link water resource management with WASH measures
What was achieved so far (examples)?
- since 2020, 3 livestock vaccination campaigns against major animal diseases reached 1,7 million heads
- 23 agricultural cooperatives switched to agroecological practice
- water-saving, mobile gardens for 25 displaced families contributed to their income and food security.
- 3 health referral centers connected to safe water, installation of permanent handwashing facilities, training of 9 trainers on hygiene and COVID-19 measures (Gao)
OH-Support to ESPEN
About the project
Project Strengthening the ESPEN partnership (Expanded Special Project For Elimination of Neglected Tropical Diseases) through integration of the One Health approach
Goal accelerate progress towards the prevention, control, elimination, and eradication of NTDs
Implementation period 01.11.2021 – 30.03.2024
Starting points to One Health
- integration of OH into national NTD Master Plans
- improving diagnostics and surveillance for zoonotic NTDs
- support to implementing OH measures, capacity building of human and animal health workers
- improved hygiene measures and awareness raising
What facilitated the project implementation?
- global goal to significantly reduce the prevalence of five NTDs in the African region
- existing networks on surveillance and early warning systems with intersectoral partners (regional, global)
- NTD master plan development according to guidance of NTD roadmap requiring integrated and intersectoral approaches
Challenges
- intensification of elimination programmes for five NTDs, epidemiological assessments and more targeted drug administration (preventive and treatment) require information from and involvement of other sectors
- promoting the effective use of donated medicines
- geographic coverage gap and undeniable side effects of treatments due to other (zoonotic) NTDs present mass drug administration can impact the environment (flora, fauna)
Solutions
- training of community health workers and community animal health workers together
- improve diagnostic and surveillance capacity in support of targeted health interventions, link national NTD-departments and zoonosis or One Health platforms
- build intersectoral capacity on NTD laboratory techniques
- include a One Health approach in the national masterplans for NTDs
What was achieved so far?
- two workshops to strengthen and build capacity of delegates of 20 NTD programs in the region
- seven countries finalized their NTD master plans, including One Health
- intersectoral community worker trainings in Cameroon, Tanzania, and Zambia
- two intersectoral trainings on NTD laboratory diagnosis in Tanzania
- pre-surveys of countries to scale down or stop mass drug administration/achieve elimination of onchocerciasis reviewed by ESPEN
Cross sectional benefits
Cross-sectional efficiency benefits in Sudan
| Extension point | Animal health | Human health | Environment |
|---|---|---|---|
| animal health | reducing risk of exposure to hazardous waste materials | reducing risk of exposure to hazardous waste materials | reducing pollution and contamination of soil, air, and water |
| food safety | reducing risk of foodborne illnesses and diseases | reducing risk of foodborne illnesses and diseases | reducing pollution and contamination of soil, air, and water |
| hygiene measures | reducing risk of illness and disease transmission | reducing risk of illness and disease transmission | promoting cleanliness and reducing pollution and contamination |
| surveillance | early detection and control of (zoonotic) diseases | early detection and control of (zoonotic) diseases | early detection and control of diseases or pollution that can harm ecosystems, including habitats and water sources |
| communal water dam management (humans, animals separately) | reliable source of water, reducing the risk of dehydration and waterborne illnesses | access to clean water sources for drinking, sanitation, hygiene, reducing the risk of waterborne illnesses | conservation of water resources, but also creation of breeding sites for insects and habitats for snails |
| awareness campaigns (nutrition and hygiene) | better husbandry, improved diets, and reduced risk of disease transmission | healthier lifestyles, improved sanitation practices, reduced risk of diseases related to poor nutrition and hygiene | promote sustainable agriculture practices |
| schools | better handling of animals improving animal health | healthier lifestyles, reducing the risk of infection esp. in children, improving overall health and well-being | increased awareness of the conservation of the environment and reducing pollution |
| settlement planning | preserve natural habitats | sustainable and healthy communities with access to green spaces and reduced exposure to environmental hazards | conservation of natural resources and reduce pollution and degradation of ecosystems |
Cross sectional efficiency benefits in Mali
| Extention points | Animal health | Human health | Environment |
|---|---|---|---|
| communal water pond and irrigation management | regulated access to water by animals, sustainable fodder cultivation | more production, safe transformation of agropastoral products of quality, improved nutrition, less exposure to NTD vectors in the water, potential increase of mosquito breeding sites | avoids over-/misuse of scarce water resources, ecologically sustainable management of natural ponds, accompanied by land-use measures includes management of grazers and removed fish |
| hygiene measures | decrease of infections through humans and fomites | functional hygiene infrastructure particularly at schools/health facilities, less transmission of diseases, outdoor defecation/urinating, more education in breaking NTD transmission cycles), safe transformation of agro-pastoral products and fish (food safety). | wastewater management, fecal slurry management |
| disease management measures (plants, humans, animals) | vaccination against (transboundary) animal diseases, veterinary care, management of zoonotic diseases at source | decreased mal- and under-nutrition, and life-threatening diarrhea (children <5), indirect effect on food- and water-borne diseases | prudent use of antimicrobials and pesticides, their containers and residues |
| disaster risk management | access to fodder and veterinary care | local, participatory social security system in case of disasters, access to safe drinking water | fewer flooded areas due to ponds retaining water, access of wildlife to water during droughts |
| climate change | resilience against droughts and flooding through fodder | food security, mitigation of water-borne diseases in case of flooding, cutting peaks of mosquito-borne diseases? | fewer flooded areas due to ponds retaining water, access of wildlife to water during draughts?, |
| agroecology approach | production of natural fertilizer, improved animal health & welfare, prudent use of veterinary drugs, tillage | resilience in food security, healthier nutrition, AMR reduction | biodiversity conservation, less pollution (pesticides, chemicals), soil health/erosion addressed, sustainable water use |
Cross sectional efficiency benefits ESPEN
| Extension point | Animal health | Human health | Environment |
|---|---|---|---|
| NTD master plans | animal health activities and stakeholders included at policy level | more risk-based interventions, combating disease at source, sustainable NTD elimination | included and consulted as a stakeholder (WASH, insecticide use, etc.) |
| food safety | improving data and animal health on zoonotic foodborne diseases (at source), slaughter inspection | reducing the risk of foodborne illnesses and diseases, food safety inspections | reducing pollution and contamination of soil, air, and water |
| awareness of hygiene measures | reducing the risk of disease transmission, improved animal husbandry practice | reducing the risk of disease transmission at human-animal interface | promoting cleanliness and reducing pollution and contamination |
| surveillance and diagnostics | early detection and control of (zoonotic) diseases | early detection and sustainable control of (zoonotic) diseases | early detection and control of diseases or pollution that can harm ecosystems, including wildlife habitats and water sources |
| OH capacity building | improved exchange of information and knowledge, saving of resources for continuous education | connecting with animal health counterparts, exchange of information and knowledge |
Link list – WASH & NTDs
Toolkit WASH and health working together: https://www.who.int/publications/i/item/9789240068032
One Health Joint Plan of Action (2022 – 2026) | UNEP – UN Environment Programme see Action track 3 in particular
Policy brief Improved health and behavior through integration of food hygiene and WASH: 3-3735-7-1575543720.pdf (susana.org)
Training module GIZ (in French) water and hygiene: https://dms.giz.de/dms/llisapi.dll/app/nodes/105373398
Study report (in French) with practical examples from Burkina Faso, focus on food safety: 34 (d-nb.info)