At the Mbabane dry sanitation and waste Management project site in Swaziland, we installed a Tippy Tap, but a kind of press tap as it works by creating rope tension (see the pictures provided below). When the user presses the wood panel resting on grass a tensile force is created on the rope that in turn presses the water holding container to squeeze water through holes provided at its bottom. The container must be closed tight with the help of plastic at the top to avoid waste. This device requires more of round container that are soft. We are currently working on another variation that still work on rope tension but applicable to containers with hard walls.







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Note by moderators: This post was made by a former user with the login name Ababu who is no longer a member of this discussion forum.

dear all,

I decided to inform about our group hand-washing facilities now only under the topic on 'Fit For School (F4S) in Moshi':
forum.susana.org/forum/categories/27-sch...moshi-tanzania#14816

ciao Hajo

This is a great question! Thanks for asking; I enjoyed reading other's comments as well. I would suggest you look at UNICEF's Group Handwashing Facilities in School Technical Design Manual .

You may also find the key resources page of the Global Public-Private Partnership for Handwashing's website useful.

Dear Marcel and all,

following my posting of beginning June we have finalised our design based on the ideas which we received from the Asia F4S programme. We have maintained the general idea and layout of the Core Module but have changed the bucket stand considerably and have omitted the union sockets for connections.

We have asked suppliers to produce a sample of the bucket stand and have tendered the production and supply of 160 Nos. of the hand-washing facility. The lowest bid gives us a unit price of 79 EUR ex works, excluding VAT. We are about to place the order and will keep you posted once the first HWF have been installed.

ciao Hajo

Thank you for your contribution and a piece of appreciation
Emmanuel

Great day Krischan,

thanks for the GIZ Hardware for Group Handwashing in Schools document.

It was informative and educative.

Tega

Hi Emmanuel and all,

We've had similar experience in Vietnam as mentioned by Nicole regarding the refilling:

For the tippy taps: the schools found different solutions for refilling the tippy tap bottles. Some indeed asked children to bring water from home while others made it a daily routine for children to refill the bottles in school in the morning.

The product marketed by HappyTap Co. in Vietnam was initially designed for households, yet a lot of schools are adopting it and involving the students in the refilling, so it's a nice surprise to see it being used a lot (and over time) in schools -- especially in primary and kindergarten level.

By the way, Krischan made an important comment about plastic in the sun:

(besides the general fact that the plastic containers usually break quickly because the UV irradiation makes them brittle and the handle breaks off).

HappyTap Co. had to start adding a special UV-blocking additive to the plastic to prevent this problem, but it is not normally found in plastic bottles because it makes the plastic a bit more expensive. Colours may fade a bit over time, but at least the plastic does not become brittle.

check out www.happytap.net

Regards,

Geoff

---

Geoff Revell
WaterSHED
www.watershedasia.org

@ Sowmya: I was referring to possible contamination of mud (not ash) with worm eggs and the like. Contamination of ash is rather unlikely, but of course also possible if stored improperly and mixed with soil etc.

As far as I know, ash is not nearly as effective as soap, mainly because it is missing the surfactant properties that make soap so effective in removing dirt and associated bacteria. Ash would probably only act via a high pH and as scrubbing particles.

However simple soap can be produced quite easily locally also.

Dear All,

Thank you for this wonderful and informative discussion. The TippyTap is most probably the most effective solution to achieving the proposed hand washing (HW) indicator of SDG goal 6.2 (sanitation and hygiene) . Three cheers to all of you!!!

Mughal’s post is awesome. I really liked the way he has brought the larger picture of the synergistic effects of water, sanitation and hygiene while discussing specific solutions. Which actually started me thinking about the provision of soap / ash for handwashing! While this discussion thread has started with schools, it is really about group HW / high-use situations. We need HW stations near where food is eaten (bus stops on long-distance routes with only one vendor with a handcart, for instance), near patient examination area (in emergency / resource-scarce situations), baby diaper changing area, etc. So, I was wondering if we could expand the scope of this discussion to all group HW / high-use situations and about the use of ash as one of the recommended solutions.



Also, some points regarding use of ash as an alternative to soap:

(1) Is ash considered as effective as soap in all situations?

Why is the question important? A large-scale public information message requires very simple wording. “It is okay to use ash in emergency situations or where soap is not available” requires explaining what constitutes emergency situation which, then, complicates the message beyond an easy-to-remember, catchy one-liner. Therefore, we need to know whether ash is de-recommended in certain situations.

For instance, can it be used in clinical situations during emergencies (natural disasters / road blocked & so vehicles cannot pass through)?

We are trying to recruit village health volunteers, traditional medicine practitioners, healers and people who give charm bracelets or spells to ward off bad spirits that cause illness (not sure what they are called though) to provide basic health interventions. The people who give charm bracelets etc., are actually an important group to reach people who go to them because of their beliefs (and not because scientific medicine is not available).

If we recommend ash as a possible HW solution, how do we know that this group of people (who do not have formal clinical training) would not use ash as a HW solution in a clinical situation, irrespective of how basic the health intervention is?

Or take a household situation. Soap is not available in the village. Outreach camp has provided eye drops for conjunctivitis and explained the importance of HW. Is it okay to use ash for HW before & after applying eye drops? Or, before and after changing / washing baby diapers?

Note:
The proposed HW indicator specifically states using soap (“ handwashing facility with soap and water ”). However, ash is also considered an effective HW solution. Please see the following in this regard (sorry, only read the discussion, not the docs listed as of now):
(a) SuSanA thread on (i) key HW documents , (ii) editing Wiki page on handwashing as well as (iii) published literature ,
(b) Wiki page on HW ,
(c) WHO recommendation for using ash where soap is not available.

Ash is inexpensive and can be prepared locally. Of particular importance is the WHO recommendation for its use in emergency situations where soap is not available [though not sure why it is recommended only in emergency situations – is it because (i) ash is considered less effective, (ii) whether evidence is inadequate or (iii) as Krishchan pointed out (sorry, I am unable to find the reference now!), ash can be contaminated if not prepared correctly].

Further, it is easier for nomadic population to prepare ash instead of carrying several bars of soap (distance from nearest shop…). Take a tough-to-contain disease such as Ebola. Ebola spreads via feces also and since Ebola is a zoonotic disease the most likely carriers being bats, antelopes, etc., nomadic tribes in forests probably require adequate & feasible HW solutions even though they may not be causing large scale contamination adequate to present a health hazard.

(2) The use of holy ash:

In Hinduism, Vibhuti (holy ash, please see Wiki page on Vibhuti ) forms an important part of the Shaivaite tradition (by community / custom, Hindus are Shaivaites – devotees of Shiva or Vaishnavaites – devotees of Vishnu though a lot of Hindus pray to both deities). If ash is very effective, it could be linked to a religious practice in which case, it would be easy to get buy-in from the people who give charm bracelets or spells to cure illness (this practice generally includes giving vibhuti or other holy substances for added strength of their solution). If they tell the people to wash hands in vibhuti mixed with water, people will do it – and this scientific recommendation can be implemented without diluting the religious tint of the practioner’s interventions.

Also, Ebola is transmitted through body fluids of infected humans. We do not have evidence regarding whether contact with body fluids of infected animals is enough to transmit the virus to a human being. If plastering the body with Vibhuti can help prevent infection from casual contact with body fluids of infected animals in the forest (brushing against leaves on which the sweat / other body fluids have not yet dried as opposed to eating the meat of an infected animal), it could be of help to people who go into forests in areas known to have had Ebola transmission.

In this context, I am reminded that elephants bathe in water and then plaster themselves with mud. This is considered to have cooling properties but could it have anti-bacterial properties also? However, other tall animals (like the giraffe) do not have this behavior, so are there any differences in mortality / morbidity rates between elephants and other animals of similar profiles? Which other animals plaster themselves in mud?


(3) Does the holy ash (Vibhuti) differ from other ash in its health effects?

Vibhuti (holy ash) has a specific method of preparation (please see Wiki page and another how-to page ). Briefly, it is prepared by spreading Karukkai (semi-grown grains of paddy) on the ground, placing layers of dried cow dung cakes, Karukkai and hay to form a pyrimadal shape 5-7 feet tall with a similar diameter. The fire placed on this pyramid burns out after some days. The ember is retained for a week or more which makes the cakes burn and get baked giving the bright white color. This process takes around a fortnight to be completed.

Therefore, does Vibhuti have different health effects compared to ash from other materials (such as, wood) due to differences in raw materials used and / or manufacturing process?

Vibhuti is applied on several parts of the body (please see URL ) by devotees while Aghoris cover themselves completely in Vibhuti. The Aghoris (please see note below if you would like additional info) have severe religious pratices (meditating in forests or cremation grounds) which would expose them to different bacterial & viral infections. However, they seem to be immune to these infections – this is just my surmise (while deaths may be written off as effects of past karma or inadequate adherence to religious practice, a significantly higher incidence / prevalence of morbidity / mortality would have most probably resulted in changes in religious practice considering that this is quite an ancient tradition). Could it be because of the anti-bacterial properties of the Vibhuti?

Also, pouring Vibhuti mixed in water over idols is part of religious practice (it is called ‘Abhishekam’ where several substances are poured over the idols but the sequence is the same irrespective of whether the idol is made of stone, metal or Panchalogam which is a 5-metal alloy). The idols are made to last for a very long time and so, the religious practice would also involve maintaining the idols in as excellent condition as possible through time. For instance, both oil and sandalwood paste have cooling properties and are poured / applied on the idol as part of different pujas.

Probably, the ancient Hindus were aware of the anti-bacterial properties of Vibhuti and incorporated it in religious practices relating to both idol worship and personal hygiene.

Note on Aghoris:

Aghoris are very devout in their commitment to Shiva, they are like sages but can be involved in tantric traditions also instead of only vedic traditions. (The Vedas, the principal religious texts of the Hindus, are classified into 4 parts. The fourth part is Atharvana Veda and includes some tantric hymns and practices also but generally most Hindus stay away from tantric traditions as it is sort of akin to black magic in concept.)

I am a Hindu and so know a little about Vibhuti and religious practices, etc. Since Vibhuti is also holy ash, I just thought of posting this info if it could be of any help for achieving hand hygiene SDG goals. It is a bit detailed but I was not sure of which info might be useful and some of this info may not be common knowledge [for instance, the Aghori tradition is ancient but the Aghori population at a given point of time is very small compared to the total Hindu population - to understand the population size - and joining is by individual choice (so, no genetic strengths)]. No other intent. Hope this is okay.

(4) HW without water:

Also of interest is another SuSanA discussion on handwashing without use of water Moringa plant as hand washing soap might also be considered as an alternative to TippyTap. The discussion thread also includes a reference to a gel produced from Senecio lyratipartitus extract .

With this, we also come back to the basis of the Thematic Discussion Series (TDS) on technological compared to functional sanitation ladder as the basis for the proposed SDG indicators: The proposed HW SDG indicator specifically states "soap and water". If an equally effective solution without soap and / or water is found, how would it be reflected in the proposed SDG HW indicator?

I also apologize for being so irregular in my posts. Will try to keep pace.

Thanks and warm regards,

Sowmya

Dear Elisabeth and Hajo,

the Fit for School Program is working right now on several publications to show how to produce and use the Core Module group washing facility.

One publication, the producer guide, will show how producers can prefabricate the Core Module and set up a quality system to ensure functionality.
The 'user guide' will help the school community to install,maintain and improve the Core Module step by step.
In addition we produce right now in cooperation with UNICEF a video demonstrating the installation of the Core Module.
Of course i'll be happy to share this final publications with all of you here!

The concept of the Core Module is a prefabricated, durable and functional group washing facility by relatively low costs, build with local resources and materials. So the Core Modules have slightly different designs in the Philippines, Cambodia and Laos right now.

I'm very exited to see the first prototype from Hajos Team in Tanzania soon. The mail conversation with him helped me and my team to clarify the producers guide.

Best regards
Marcel

Dear Mr. Kisembo Emmanuel,

I’m referring to your first post, wherein you say:

“I am looking forward to installing 2 Tippy Taps per school in twenty (20) schools in the western Uganda to reduce water related infections among children, but i am still nervous whether they can control diarrhea or reduce child mortality rate? what do you think i can do to improve on WASH within the community where i come from?”

There has been useful contributions from various users, where importance of handwashing and Tippy Taps has been highlighted. While handwashing, no doubt, is a great intervention, in your present context of reducing water-related infections among children, I’m afraid, you have to supplement handwashing with safe drinking water and appropriate sanitation.

Diarrhoeal diseases are a leading cause of death in children under 5 in developing countries worldwide, accounting for over 700,000 child deaths in 2011.

The frequency of diarrhoeal diseases in developing countries is largely attributed to a lack of clean water and adequate sanitation (Black et al. 2003).

(Black RE, Morris SS & Bryce J (2003) Where and why are 10 million children dying every year? Lancet 361, 2226–2234)

Leaving aside the confounding factors and the differences in underlying contextual factors (so as to keep this discussion simple), some key studies has this to say on water and sanitation vis-a-vis the reduction in diarrhoeal diseases:

Esrey (1996) showed that (a) improved water supply had no meaningful effect on health if improved sanitation was not concurrent; and (b) larger impacts were seen with both interventions than the improvements to water or sanitation alone.

(Esrey SA (1996) Water, waste, and well-being: a multicountry study. American Journal of Epidemiology 143, 608–623)

VanDerslice & Briscoe (1995) reported that improved water was most protective when a community had better sanitation.

(VanDerslice J & Briscoe J (1995) Environmental interventions in developing countries: interactions and their implications. American Journal of Epidemiology 141, 135–144)

Gundry et al. (2004) showed that the protective effect of improved water interventions was stronger when a greater proportion of households had access to improved sanitation.

(Gundry S, Wright J & Conroy R (2004) A systematic review of the health outcomes related to household water quality in developing countries. Journal of Water and Health 2, 1–13)

Water quality improvements may have little to no impact when sanitation conditions are poor (Eisenberg et al. 2007).

(Eisenberg JN, Scott JC & Porco T (2007) Integrating disease control strategies: balancing water sanitation and hygiene interventions to reduce diarrheal disease burden. American Journal of Public Health 97, 846–852)

Fink et al. (2011) says that improved sanitation infrastructure may have a greater impact on diarrhoeal disease than improved water infrastructure.

(Fink G, Gunther I & Hill K (2011) The effect of water and sanitation on child health: evidence from the Demographic and Health Surveys 1986–2007. International Journal of Epidemiology 40, 1196–1204)

Fewtrell et al. (2005) and Esrey et al. (1991) reported reduced risks of diarrhoeal disease of 32% and 22% for sanitation interventions and 22% and 17% for water interventions, respectively.

(Fewtrell L, Kaufmann RB, Kay D, Enanoria W, Haller L & Colford JM Jr (2005) Water, sanitation, and hygiene interventions to reduce diarrhoea in less developed countries: a systematic review and meta-analysis. The Lancet. Infectious Diseases 5:42–52)

(Esrey SA, Potash JB, Roberts L & Shiff C (1991) Effects of improved water supply and sanitation on ascariasis, diarrhoea, dracunculiasis, hookworm infection, schistosomiasis, and trachoma.
Bulletin of the World Health Organization 69, 609–621)

Fuller et al. (2014) say: “Water and sanitation infrastructure reduce the risk of diarrhoeal disease in children and that water and sanitation likely operate independently... Our results underscore the importance of both water and sanitation for preventing diarrhoeal disease in children under 5.... Combined interventions are more protective in reducing diarrhoeal episodes than single interventions."

(James A. Fuller, Joslyn A. Westphal, Brooke Kenney and Joseph N. S. Eisenberg (2014), The joint effects of water and sanitation on diarrhoeal disease: a multicountry analysis of the Demographic and Health Surveys, Tropical Medicine and International Health doi:10.1111/tmi.12441, John Wiley & Sons Ltd.)

Since water and sanitation cannot get the job done individually, it is likely that same can be expected from hygiene, when operated alone. The key message here is that all three – water, sanitation and hygiene – must work together, if you want to reduce water-related infections in children in Uganda.

Finally, please note that water, sanitation and hygiene (WASH) have synergistic effect; meaning that total effect of WASH is greater than the sum of individual intervention (water, sanitation and hygiene).

Good luck in your research work!

Best regards,

F H Mughal

dear Elisabeth, dear all,

following my posting to Marcel, we exchanged possibly more than 20 emails discussing details of the HWF design which we felt in its details and formats not appropriate for the forum. Nevertheless you may want to know what we have discussed about and I attach an excerpt from our 'production manual' which should guide the manufacturer. (Sorry, excerpt had to be withdrawn, draft was not yet authorised for publication)

The manual has been copied and compiled from information we received from our colleagues in Asia (thank you Bella, Nicole, Marcel, ...) as we have no own experiences yet in Tanzania and need not to re-invent the wheel.

But we have discussed the design with our potential suppliers and it seems we may come up with some amendments which will reduce the number of pipes and fittings in the actual bucket stand. That is the level we have reached at the moment and we will keep you posted.

ciao Hajo