Hi Elisabeth,

I think there are a few interesting aspects that cause the area of WASH and NTDs to move faster.

1. Urgency - quite a few of the NTDs are scheduled for elimination, which means a clear deadline as well as, in many cases, large grants that can be used by government and NGOs to improve coordination, hire staff and implement interventions. When this happens for NTDs for which there is a clear prevention framework that includes WASH, there is a stronger incentive to collaborate with the WASH sector. This has worked quite well especially for trachoma, which has the SAFE strategy (surgery, antibiotics, facial cleanliness, environmental improvement) and for which funders require full 'SAFE' implementation. Progress is not equal across all NTDs, however, and there has been an attempt to build on the successful application of SAFE to other NTDs, through the development of the BEST Framework (Behaviour, Environment, Social Inclusion, Treatment and care - see www.ntd-ngonetwork.org/best-framework).

2. Communities of practice: Organisations working in NTD control tend to be highly-networked at global and national level, through disease-specific coalitions and a broader network (the NTDs NGO Network); this makes it easier to learn quickly, share lessons and support ministries of health in implementation. The WASH and NTDs toolkit I mentioned in my previous comment (to be launched later this month), for example, was developed in collaboration between the NNN and WHO, based on this fast learning process.

I would recommend reading the WHO's Global Strategy on WASH and NTDs (www.who.int/water_sanitation_health/publ...and-ntd-strategy/en/), which sets out the logic of collaboration between the two sectors. But to make collaboration and improved targeting happen, most countries will need more than just good reasons - the strong rationale needs to be accompanied by sufficient funding and practical coordination mechanisms.

Yael

Dear Sophie,

I like the recommendations of Chapter 4 but I am just wondering if the term "health authorities" is sufficiently clear? Does everyone know what is meant with "health authorities" (I don't) or is it left intentionally vague to encompass any health system that a country might have in place?

I assume in the health sector there might be a bit of a split between preventative health (public health) and the "curing of diseases" health. Is that so? I once read that within the health profession the public health people have a lower status than those who cure diseases which is a bit unfair (but typical human nature).... Perhaps we need to work on raising the image of public health work within the health sector?

And Yael, that is an interesting parallel that you draw to the Neglected Tropical Diseases (NTDs). Could you please elaborate a bit more why it worked there but why it's not working as well for the prevention of the "common diseases" such as childhood diarrhea?

For anyone not familiar with NTDs, I recommend this Wikipedia article which is pretty good:
en.wikipedia.org/wiki/Neglected_tropical_diseases

It even includes a section about integration with WASH programs (which could be improved):
en.wikipedia.org/wiki/Neglected_tropical...n_with_WASH_programs

Regards,
Elisabeth

Hi, I'm Nelson from Maasin City, Southern Leyte, Philippines. I work as a sanitation inspector for our local government just this April 2018. I think we can accelerate making toilets in our communities if only our local government will give it a priority. Information and education campaign is not enough when people simply cannot afford for the construction. At present, we are using used tires in building septic tanks but we are running out of supply to complete the 900+ OD households in my city alone.

There is another source which is very abundant out here in our city dumpsite and wish to experiment these trash into bricks next year. Hoping we could ignite cooperation from our local government to turn these garbage into toilets.

Thank you so much and advance Merry Christmas to us all.

Thank you for starting this great discussion on Recommendation 4 - this one is perhaps the most challenging of the four recommendations as in many cases, it entails addressing established and sometimes rigid governance, budgeting and decision making structures. For me, 4.d is possibly the "key" for unlocking this challenge, since better use of information for targeting resources can lead to better outcomes and cost efficiencies, for both "sides" (the "WASH sector" and the "health sector"). This is usefully backed up by the Good Practice Actions and Chapter 3, which recommend a health-based risk-assessment approach to planning and prioritizing sanitation interventions.

A promising area where this is starting to happen already is Neglected Tropical Diseases; since WHO issued the Global Strategy on WASH and NTDs in 2015, there's been increasing recognition that information on access to WASH can help identify areas where disease prevention efforts are needed (helping the disease programmes meet their control and elimination objectives), and that disease information can help improve WASH investment targeting (helping the WASH sector achieve its goal of universal access more efficiently and sustainably). Experience shows that when the agencies involved can see a clear benefit for engaging, it is easier to set up the necessary coordination structures and develop integrated programming approaches.

[Excitingly, this experience will be captured in very practical terms in a forthcoming publication by WHO and the NTDs NGDO Network: "WASH and Health working together - a practical guide for NTD programmes" - COMING SOON!]

Sorry Mansoor - I see now it was you and raised this point in the webinar! I hope the previous response is helpful along with the details of what the health sector should focus on under Recommendation 4.

During the webinar on World Toilet Day someone asked if we should have a Ministry of Sanitation – In addition to the role of the health sector (Rec.4), I also referred wider roles and responsibilities and coordination within the sector. Here’s what the guidelines say under Chapter 4.5 page 68- 69 on Coordination and Roles:

“Sanitation spans many sectors and requires coordinated action by many stakeholders, and complete responsibility cannot be assigned to one ministry or agency. This means that it is necessary to establish a multi-sectoral platform for dialogue between the main stakeholders and to develop and oversee coordinated plans of action. This requires specific administrative support, such as a secretariat, to function effectively. Experience has shown that this is best situated in a senior ministry or bureau with a governance rather than a service provision role, such as planning, finance, or the prime minister’s or president’s office.
Political leadership for the coordination and implementation of safe sanitation systems and services is also needed, by a minister from one of the principal ministries involved or another senior political figure ready to assume the challenge of driving progress on sanitation. The secretariat should prepare information (possibly with support from development partners) to help in making the case for allocating resources to sanitation. A short- to medium-term strategy with feasible interventions and potential evidence based quick wins, should also be outlined, so that visible action can follow swiftly from political decisions. “

I always promoted for a separate national ministry on sanitation. Always thought this will raise the profile and importance of a neglected sector. In the last 3 years. I am re-thinking this - when worked with health and nutrition programmes. I am getting supportive of sanitation within health ministry. Why? It provides a great outreach through health workers, health ministries are changing globally to more integrated and health is a larger and important area. Politicians understand this better. I feel that sanitation is a bit isolated sector. I accept the importance of a separate water ministry. But sanitation fits well within health. Any views?

Welcome to the e-discussion on the role of the health sector in sanitation.

One comment frequently made by practitioners and experts when we were developing the guidelines was the low engagement of health actors in sanitation policies and actions. It is true that sanitation programs are typically delivered by infrastructure ministries, agencies and utilities, but the health sector should also play its part to ensure sanitation actions are protecting people’s health.

The core functions of health authorities are articulated in recommendation 4 of the guidelines (below) and further detailed in Chapter 4 .

‘Recommendation 4: The health sector should fulfill core functions to ensure safe sanitation to protect public health
4.a) Health authorities should contribute to overall coordination of multiple sectors on development of sanitation approaches and programmes, and sanitation investment.
4.b) Health authorities must contribute to the development of sanitation norms and standards.
4.c) Sanitation should be included in all health policies where sanitation is needed for primary prevention, to enable coordination and integration into health programmes.
4.d) Sanitation should be included within health surveillance systems to ensure targeting to high disease burden settings, and to support outbreak prevention efforts.
4.e) Sanitation promotion and monitoring should be included within health services to maximize and sustain health impact.
4.f) Health authorities should fulfil their responsibility to ensure access to safe sanitation in healthcare facilities for patients, staff and carers, and to protect nearby communities from exposure to untreated wastewater and faecal sludge.’

From your experience, to what extent do you see health authorities fulfilling these core functions?
How do you think health authorities should be more engaged in sanitation policy and practice?

Looking forward to your comments!