Dear All,

Please note that an updated version of the WATSAN-Agriculture project website is online now! Follow this link for more information: www.zef.de/watsan.html

Best,
Samantha

Dear All,

The hygiene awareness posters that were designed for the WASH intervention work in Bangladesh can now be viewed in the SuSanA Library .

The poster on food hygiene below was prepared by our PhD student Monirul Hasan. You can read his impressions and the experiences he made during his fieldwork below the poster! It would be great to receive your feedback and learn more about your impressions if you have designed similar posters for your interventions!

Best,
Samantha




What were your experiences for designing the poster? Do you have any advice on how to design a WASH poster (DOs/DON’Ts)?

It was exciting for me to design the poster. At first I was struggled with the messages of the poster that can support my intervention. Later on, designing the poster was challenging as the real photos of the items were not encouraged. Lastly, we planned to sketch those items. But difficult thing was to find the right person who can do it. I had contacted several persons who are good in fine arts and also professionally working as cartoonist. But most of them couldn’t show up with the final outcome because of their lack of interest and commitment. So working with poster became frustrating at that time. Later on I found one of them who fulfill this commitment and finally could submit the work. I was really pleased with her works and the quality of the poster.

Dos:
- Decide first what could be the messages regarding the intervention
- Make a preliminary idea or sketch to the artist or cartoonist.
- Make sure the characters in the poster can represent the context and localities of the intervention.
- Rightly place the messages in right order with proper illustration.
- Print the poster in a PVC paper so that after printing it can last for several months.

Don’ts:
- Don’t put lot of things in the poster. Make it as simple as possible.
- At first lot of things can come up, but be precise.
- Put enough space between messages, so that it can be understandable.
- Make it self-explaining.


What were your experiences in the field in terms of acceptance and understanding of the messages? Did people show interest or was the intervention work rather a nuisance for them as they had other things to do?

The poster was welcomed by the households. But they wanted more (such as refreshment, gifts etc.) along with the poster. Most people understood the character in the poster and the messages. The organization of the training session was challenging as some of the households failed to participate in the session as they had other works to do. Although making frequent request to attend, the participation rate in the session was close to 70%. But all households were given poster and also conveyed the messages by personally going to each households as some households couldn’t able to attend. So ensuring the maximum participation was the most challenging part of the intervention.
People showed interest about the poster because they mostly didn’t know those messages from the scientific point of view. They actually learned new things from the poster with scientific proof (they get the test of E.Coli result in their hand during the training sessions).


Do you have any preliminary results or observations at this stage?

The preliminary result still is not ready. But the feeling from the field work is that most households adopted some of the hygiene messages and also started investing in this hygiene related issues. Hand washing has been increased. Water handling is improved and many households started boiling water for drinking purpose. The count of E.Coli also reduced after the intervention.


What are your lessons learned/recommendations if you had to prepare another WASH poster in the future?

If I have to prepare another WASH poster in future, I would recommend to start working on the country perspective to know about the existing practices and then design the messages based on the cultural and context specific terms which can be used to draw cartoons self-explaining. Because at the end, the poster will remain in the households.

The study is being conducted with a project contact between ZEF and BRAC under Gates funded WATSAN-Agriculture collaborative project. Dr. Mohammad Abdul Malek (BRAC RED and ZEF) is the Principal Investigator for this Bangladesh country study. Team Members from BRAC RED, namley, Ratnajit Saha, Priyanka Chowdhury, Tahsina Naz Khan and Ikhtiar Mohammad are also contributing in the project. The project is being implemented by BRAC Research and Evaluation Division (RED)taking assistance from BRAC WASH program.




Abstract


The economic literature has established that wealth is a key driver of the willingness-to-pay to protect oneself from environmental and health hazards. On the other hand, public health literature emphasizes the role of water, sanitation and hygiene information and knowledge to improve household behavior and achieve health outcomes. Knowledge and practices about contamination along the path from the drinking water source to use/consumption both in the households and farm fields is thus crucial to improve the health and developmental outcomes of farm households. How can the capacity of households and communities in monitoring their own water and sanitation environment be developed? How can water, sanitation and hygiene (WASH) behaviour be improved? We start from the assumption that information can increase demand for environmental quality, improve water sanitation and hygiene behaviour, and thus improve health outcomes at the household level. We test the effectiveness of packages of WASH interventions with the school students in terms of their impacts on the water and sanitation (or WATSAN) behaviour of adult household members both in the households and in the farm fields and on health outcomes for the household members.

To that effect, we devise Randomized Control Trial (RCT) with secondary school students in 6 WATSAN hotspots (sub-districts) of Bangladesh, conducted in fourth phases. First, following a multi stage cluster random sampling, a sample of 648 faecal-contaminated households is drawn from a water quality census conducted by the trained staffs. Second, we conduct a baseline survey (i.e. pre-intervention), to establish the similarity of the treatment and control groups. The baseline survey also highlights the salient WATSAN and agricultural hygiene issues. Third, we implement the treatment, consisting of three actions: informing the households about the initial water testing results obtained from the earlier census, deliver hygiene messages through a poster related with farm field and households use, and equip the student brigades with water testing toolkits and let them test water at different points and communicate the results back to their households. Finally, we conduct the end-line survey along with the water quality testing by the trained staffs.

Baseline results confirm similarities for most of the outcome indicators among treatment and control groups. Also, the results reveal that on average only one third of our sample used sanitary latrine facilities, open defecation is still being practiced in the farm fields, more than 50% of the households on average were found to have wastes in their courtyard and it was observed that only half of our sample had soap at the hand washing station. Most of the sample households (about 80%) used soap or detergent to wash storage container. Although the entire sample seemed to drink water from improved water sources, very few treated water to make it safer to drink. Initial results from the ongoing treatment suggest that the suggested intervention packages can be an effective strategy to motivate households and communities in improving their WASH environment, particularly using school students as agents of change and as a channel of conveying messages across households and communities.

Dear Forum Members,

Here's a link to the current issue of ZEF News which looks at water and environment in a mobile world.

On p.6 you'll find an article by Evita Pangaribowo which relates to our WATSAN-Agriculture project.

Regards,
Samantha

Dear Susana Forum Members,

I present to you a current study being undertaken as part of my PhD Thesis at the Center for Development Research (ZEF) of the University of Bonn, Germany.

Brief Introduction

Mr. Charles Y. Okyere is currently a Doctoral (PhD) student at the Department of Economic and Technological Change, Center for Development Research (ZEF) of the University of Bonn, Germany. Mr. Charles Y. Okyere holds a Master of Philosophy degree in Agricultural Economics from the University of Ghana and also worked with ISSER as a Research Assistant from February 2012 to September 2012. Mr. Charles Y. Okyere in 2007 graduated with second class upper division in Agriculture Technology (Agricultural Economics and Extension option) from the University for Development Studies, Tamale, Ghana. Mr. Charles Y. Okyere until now has worked for research organizations (including International Food Policy Research Institute, Food and Agriculture Organization, ACDI/VOCA, among others) on part-time basis since 2009. His interest areas include issues relating to child labour, natural disasters and hazards (especially flooding), water, sanitation and hygiene, rural development and agricultural budget process. He has skills in conducting socio-economic surveys (for instance, data collection and analysis) and has been involved in the collection of data in seven regions of Ghana on various development issues, using both quantitative and qualitative techniques.

He has fair idea on the use of socio-economic surveys and also a computer literate with good knowledge in computer programs such as SPSS, Excel, MS Word, Power point presentation, Eviews, STATA and Limdep for data management, data analysis and econometric modeling.

Working Title of Thesis
Water Quality in Multipurpose Water Systems, Sanitation, Hygiene and Health Outcomes in Ghana

Chapters of Thesis
1. Understanding the Interactions between Multipurpose Water Systems, Water and Sanitation, and Health Outcomes: Evidence from Rural Greater Accra Region of Ghana

2. The Impacts of Household Water Quality Testing and Information on Water Quality, Transport, Storage, and Treatment Behavior Changes: Evidence from an Experiment in Ghana

3. Household Water Quality Testing and Information: Identifying Impacts on Health Outcomes, and Sanitation and Hygiene Behavior Changes

Abstract of Thesis
About 1.8 billion of the world’s population consumes water from highly contaminated sources. Level of fecal contamination of water differs between point-of-source (POS) and point-of-use (POU). Providing water quality information to households is known to improve water, sanitation and hygiene behaviors and reduction of diarrheal diseases. Studies in which water quality information is disseminated to randomly selected households potentially underestimate the impacts, missing the potential learning experiences from household self-water testing and also missing the most effective channels in the delivery of such information to the treatment groups. We conducted water testing experiments in southern Ghana (Greater Accra region) in which students in public basic schools, and adult household members were randomly assigned to receive water testing kits and water quality improvement messages. Selected participants were also trained on the use of water testing kits in testing for E. coli; an indicator bacteria of fecal contamination of water. Baseline orthogonality tests are used to check the similarities and differences between the intervention groups (clustered randomized design). Difference in difference (or comparison of means) estimators are analyzed by gender and type of participants (students vs adult household members). Robustness checks and sensitivity analysis are performed by testing for heterogeneity in treatment effects in order to limit false predictions/estimates. Short-run program effects are estimated for a wide range of outcome variables including water sources, diarrheal diseases, water transportation, and handling and storage techniques, among others.

Preliminary Results

Demand for water quality testing (measured by participation rate) was high for students’ intervention group compared to adult household members group. Participation rate (used to proxy demand) was slightly higher for females compared to males.

Potential Areas for Future Studies Based on Collected Data

1. Household Water Security, Water Quality and Water Demand in the Greater Accra Region of Ghana

2. Household Demand for Improved Water, Sanitation and Hygiene (WASH) Practices: Aspirations, Preferences, Expectations and Choices in Selected Communities in Greater Accra Region of Ghana

3. Assessment of Drinking Water Quality of Communities and Public Basic Schools in the Greater Accra Region of Ghana

4. Modeling Household’s Decisions on Water Supply and Sanitation in Greater Accra Region of Ghana

5. A Study on Water, Sanitation and Hygiene Practices among Selected Public Basic Schools in the Greater Accra Region of Ghana

Dear Forum Members,

Today I would like to introduce Charles Yaw Okyere from Ghana. Charles is doing his PhD research under the scope of the WATSAN Agriculture project. He looks at water quality in multipurpose water systems, sanitation, hygiene and health outcomes in Ghana.

The case study in Ghana looks at improving the capacity of communities in monitoring their WATSAN Agriculture environment. Randomized control trials focusing on informational interventions on water, sanitation and hygiene behavior were implemented in 2014. Randomly selected school children and adult household members were provided with water testing toolkits to test their stored drinking water for the presence of fecal bacteria. The experiment design will allow to assess the most effective channel for WATSAN information delivery.

Charles is currently undertaking the final stage of his field work and will hopefully be able to share first results soon!

Here is a short abstract of his research:

About 1.8 billion of the world’s population consumes water from highly contaminated sources. Level of fecal contamination of water differs between point-of-source (POS) and point-of-use (POU). Providing water quality information to households is known to improve water, sanitation and hygiene behaviors and reduction of diarrheal diseases. Studies in which water quality information is disseminated to randomly selected households potentially underestimate the impacts, missing the potential learning experiences from household self-water testing and also missing the most effective channels in the delivery of such information to the treatment groups. We conducted water testing experiments in southern Ghana (Greater Accra region) in which students in public basic schools, and adult household members were randomly assigned to receive water testing kits and water quality improvement messages. Selected participants were also trained on the use of water testing kits in testing for E. coli; an indicator bacteria of fecal contamination of water. Baseline orthogonality tests are used to check the similarities and differences between the intervention groups (clustered randomized design). Difference in difference (or comparison of means) estimators are analyzed by gender and type of participants (students vs adult household members). Robustness checks and sensitivity analysis are performed by testing for heterogeneity in treatment effects in order to limit false predictions/estimates. Short-run program effects are estimated for a wide range of outcome variables including water sources, diarrheal diseases, water transportation, and handling and storage techniques, among others. Demand for water testing (measured by participation rate) was high for students’ intervention group compared to adult household members group. Participation rate (used to proxy demand) was slightly higher for females compared to males.

Dear All,

Let me introduce Ruchi Vangani to you: Ruchi is a Public Health expert and doing her research in collaboration with the Public Health Foundation of India (PHFI).

Ruchi is looking at irrigation agriculture in the peri-urban areas of Ahmedabad with particular focus on water quality, health impacts (diarrhea prevalence, waterborne illnesses, parasitic prevalence), nutrition impacts and hygiene behavior.

She also examines the economic tradeoffs between enhancing health outcomes through 1) facilitating behavioral change by providing information to communities (e.g. about infectious pathways), versus 2) changing WATSAN-infrastructure services (e.g. for improved drinking water and sanitation), versus 3) (re-) design of multi-use water systems, or all of the three above.

The detailed abstract of her research is presented in her post above!

Best,
Samantha

Exploring the Links and Dynamics therein for WATSAN and irrigation agriculture (AG-WATSAN Nexus) for a Better Nutrition and Health Outcome in Gujarat, India.
Abstract: Given the scarce and poor quality water resources for the growing urban population and use of different types of water use for irrigation viz. wastewater, river water, wells and freshwater there is a need for research to analyse the social, environmental, health and economic trade-offs of the type of water use in agriculture. The present field study was conducted in the peri-urban areas of Ahmedabad in Gujarat (India). Wastewater irrigation is a commonplace in peri-urban areas of Gujarat and its use in irrigation is even growing due to the scarcity of freshwater resources. The research specifically seeks to address the questions on the impact of irrigation water use on the health and nutrition outcomes of communities exposed to the irrigation and the produce. Conceptually, the study seeks to address the research questions in the context of the dynamic interactions between different irrigation water, water sanitation (WATSAN) and health to eventually identify better strategies of linking water uses for ‘WATSAN’ and irrigation agriculture activities to improve health and nutrition status.

The initial baseline survey included the household’s demographic, socioeconomic and water sanitation module followed by a follow up visit biweekly basis for 7 months to collect information water related sickness reported in under 5 children and adult members of the Household. The height and weight of under 5 kids was measured as per the WHO anthropometric guidelines. The water sampling at household source and storage was done in laboratory using the MPN method as per the WHO guidelines. The water samples were collected in sterile containers from the source and storage water of HH and transported to the laboratory for the presence of faecal coliforms and E coli. Stool samples of under 5 children were tested in laboratory for the presence of parasites.

Attached are some pictures.

Dear ZEF Colleagues,

Thank you for posting the AG-WATSAN activities in SuSanA forum. Indeed ZEF is doing wonderful research in the field of AG-WATSAN. As a part of that I am also partially contributing in the area of AG-WATSAN Which is mainly funded by Bill and Melinda Gates Foundation. Besides other funding institutions such as DAAD, Foundation of Fiat Panis is providing financial support for doing this research. There are also collaboration with the Institute of Biological Science (IBSc) of University of Rajshahi, Bangladesh for microbiological testing water and food preparing utensils in the lab. However, especial thanks to BRAC and IFPRI for supporting my field research in many ways.

My main research topic is: Investment in health within Agriculture-Water-Sanitation-Hygiene (AG-WATSAN) nexus for the rural households in Bangladesh.

This research is designed as RCT where Food Hygiene Education is being randomized in the 512 households in North-western Bangladesh. The drinking water and food preparing utensils are being tested for E.Coli bacteria in all three phases Baseline-Midline-and endline. The anthropometric measures (height and weight) of under five children of these sample households are also being taken.

The abstract of my research is here:

Safe drinking water is becoming scarce because of the water pollution, salinity and widespread arsenic contamination in Bangladesh. Still 14% of the households do not have access to safe water and 46% do not have access to improved sanitation facility. Besides, agriculture plays vital role for water, sanitation and hygiene maintenance in rural areas. The objective of this research is to identify how the agriculture-water-sanitation-hygiene (AG-WATSAN) nexus works in rural Bangladesh and how household and community investment can benefit the respective households and communities in terms of economic and health outcome. Water in the northern part of Bangladesh is scarce and contaminated by arsenic which is above the permissible level of human consumption. Public intervention such as domestic water supply from deep tube well provides the solution in some areas. The study also explores to what extent technological arrangement at community and household level such as domestic water supply from public intervention affect WATSAN status of rural households. Besides the public intervention, some collective institutional arrangement could also make some differences in the status of water and sanitation in the rural areas. This study also focuses on to what extent group-based lending of microfinance for longer period improves WATSAN status of the marginalized households in northern Bangladesh. It is expected that long term exposer of microfinance membership improves the water and sanitation status of the households. Finally it is very important to look at the food hygiene behavior of the households especially for the children under 5 who are vulnerable to different health shocks including diarrhea. The study will try to understand the economics of food hygiene within the household. The study will test bacteria such as E. Coli in water and food for three successive terms to see the impact of Food Hygiene Education (FHE) as they will be provided this education randomly within the village level. This study will attempt to identify the investment behavior in health within the nexus of AG-WATSAN of the rural households. Several econometric techniques will be applied to see the best outcome of the present research.

The treatment here is the combination of three things-
1) E.Coli test result of drinking water and food preparing utensils
2) 8 Keys to safe food (training session by a trainer who explain these messages to the households)
3) Food Hygiene Education poster (poster containing the 8 messages) to be hanged in the dinning area of the household.

Dear Susana Forum Members,

I would like to present the WATSAN-AGRICULTURE project which is granted by the Bill & Melinda Gates Foundation, the grantee is the Center for Development Research (ZEF) in Bonn, Germany.

We will keep you posted about ongoing activities and share the outcomes of our research with you!

Best,
Samantha Antonini

Title of grant:
WATSAN-AGRICULTURE: Guiding pro-poor investments in the nexus among domestic water quality and quantity, sanitation and hygiene, and agriculture from the bottom-up



Purpose: to improve the health and nutrition status of poor people in Africa and South Asia by guiding investments for a more effective water, sanitation and hygiene nexus, also considering the related links to agriculture

Name of lead organization: Center for Development Research (ZEF), University of Bonn

Primary contacts at lead organization:
Prof. Joachim von Braun (project director)
Dr. Nicolas Gerber (project management)
Dr. Samantha Antonini (coordination and administration)

Grantee location: Bonn, Germany

Developing countries where the research is being or will be tested: Ghana, Ethiopia, India, Bangladesh

Start and end date: 2012- end of 2015

Grant type: Other

Grant size in USD: $1,044,016 (see also: Website Gates Foundation )

Short description of the project:
It is important to look how to invest in water, sanitation, and hygiene in the most effective way. A review of the impact of water, sanitation and hygiene intervention undertaken by the International Initiative for Impact Evaluation documents that hygiene practice through hand-washing with soap and the usage of toilets reduces the diarrhea prevalence by 37% and 34%, respectively. Improved water quantity and quality and improved sanitation and hygiene enhance health and nutrition outcomes.

Yet, these areas overlap with irrigation agriculture having an additional impact on health and nutrition outcomes. Irrigation agriculture influences health through various ways: Water harvesting techniques, irrigation canals, ponds, tanks and/or dames are among the contributing factors that impair the human health. Irrigation water can create suitable conditions for the propagations of waterborne related diseases-vectors such as mosquitoes transmitting malaria.

Having an integrated approach from different scientific disciplines is crucial in addressing the issues of water and sanitation and their links to other sectors, particularly agriculture. The WATSAN project will involve scientists from a broad range of relevant disciplines (ecology, hydrology, agronomy, economy, sociology, and public health). The project compiles household data from Demographic and Health Surveys and primary data collection in the community to address the missing link between water, sanitation, hygiene and agriculture.

Goal(s):
Proposing policy recommendations on investment and priority activities and tools to empower households and communities to monitor their WATSAN environment

Objectives:
(1) identifying the critical sets of the tradeoffs between and synergies among domestic water quality and quantity, sanitation and hygiene and agriculture irrigation systems
(2) enhancing investments in technological and institutional arrangements for improving capacities of rural and peri-urban communities connected to multi-purpose water systems; and
(3) strengthening the capacity of households and communities to monitor and manage their own WATSAN environment, including to serve accelerated ‘ground truthing’ for the international monitoring schemes

Research or implementation partners:
Ethiopian Economic Association (EEA), Ethiopia
Institute of Statistical, Social and Economic Research (ISSER), Ghana
Public Health Foundation of India (PHFI) through Indian Institute of Public Health Gandhinagar (IIPHG), India
BRAC in Bangladesh

Links, further readings – results to date:
Documents in SuSanA library: www.susana.org/en/resources/library/details/2245
Project Website
Project Summary

Background paper:

Tsegai, D., Mc Bain, F., and Tischbein, B. “Water, Sanitation, Hygiene: The Missing Link with Agriculture”, ZEF Working Paper No 107, Center for Development Research, University of Bonn, 2013; available at: ZEF Website

Conference papers planned for 2015:

Usman, M. A. “Exploring the Trade-offs Between Irrigation and Drinking Water Supply under Multi-use Water System in Ethiopia”, will be presented at the IWRA XVth World Water Congress in Edinburgh on 25-29 May 2015

Okyere, C. Y. “Strengthening the Capacity of Households and Communities for Improved Water, Sanitation and Hygiene: water testing experiments with school children and adult household members in Ghana”, will be presented at the IWRA XVth World Water Congress in Edinburgh on 25-29 May 2015 and in an organized symposium at the 29th International Conference of Agricultural Economist in Milan on 8-14 August 2015.

Okyere, C. Y. “Modelling Household’s Decision on Water Supply and Sanitation in Greater Accra Region of Ghana”, will be presented at the IWRA XVth World Water Congress in Edinburgh on 25-29 May 2015

Pangaribowo, E., and Malek, M. A. “Informational Intervention and Behavior Change: experimental evidences on agricultural hygiene messages in Bangladesh”, will be presented in an organized symposium at the 29th International Conference of Agricultural Economist in Milan on 8-14 August 2015.

Current state of affairs:

One randomized control trial in Ghana, focusing on informational interventions on water, sanitation and hygiene behavior is implemented in Ghana. Randomly selected school children and adult household members were provided with water testing toolkits to test their household stored drinking water for the presence of fecal bacteria. The experiment design subsequently enables this study to assess the most effective channel for WATSAN information delivery. The end-line survey is about to start in April 2015.

One randomized control trial focusing on agricultural hygiene messages is being conducted in six sub-districts in Bangladesh. The core messages “Hygiene in the Field and at Household for a Better Life” are: 1. carry safe drinking water in the field, 2. wash hands with soap after farming and handling livestock in addition to wash hands with soaps at five critical activities, 3. protect drinking water and food, 4. treat the water before drink, 5. use hygienic latrines. The messages are distributed in a poster form. The end-line survey will be conducted in May 2015.

One randomized control trial on food hygiene messages is being implemented in 2 sub-districts in Bangladesh. The core messages of “8 Ways for Keeping Food Safe and Clean” are: 1. Wash hands with soap, 2. Wash food utensils with soap before and after use 3. Wash raw materials before cooking, 4. Use separate cutting utensils for meat and vegetables, 5. Cook food thoroughly 6. Drink safe water, 7. Protect kitchen and dining area from animals, 8. Cover cooked food to protect from dirt, dust and flies. The end-line survey will be conducted in April 2015.

Five PhD dissertations are being carried out in the four study countries:

Charles Yaw Okyere. Strengthening the Capacity of Households and Communities for an Improved Monitoring of Water and Sanitation (WATSAN) Environment: Experiments with School Children in Ghana

Florence Mc Bain. Can improved water-sanitation conditions together with health insurance effectively reduce poverty? (India).

Muhammed Abdella Usman. Leveraging Water, Sanitation, and Hygiene (WATSAN) Nexus: Synergies, Thresholds, and Trade-offs for a Better Nutrition and Health Outcome in Ethiopia.

Ruchi Vangani. Exploring the Links and Dynamics therein for WATSAN and irrigation agriculture (AG-WATSAN Nexus) for a Better Nutrition and Health Outcome in Gujarat, India.

Monirul Hasan: Investment in health within AG-WATSAN nexus for the rural households in Bangladesh.

Biggest successes so far:

The successful implementation of the research activities, especially in terms of field work, in Ethiopia, Ghana, and India.

The implementation of informational intervention (water quality information in Ghana, agricultural hygiene and food hygiene messages in Bangladesh).

Main challenges / frustration:

Bringing the multidisciplinary teams together in each country was challenging and it required some time to recruit experts who have sufficiently strong experience in public health, economics, hydrology and agronomy.

In Bangladesh the research implementation was slightly hindered due to a volatile and unstable political situation caused by the election in 2013/14.