HYGIENE IMPROVEMENT FOR DIARRHEAL DISEASE PREVENTION

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Approximately 1.3 million children under the age of five die each year from diarrheal diseases. Although mortality figures from diarrhea have declined substantially over the past two decades, there is no evidence to show a parallel reduction in diarrhea morbidity. To address and reduce morbidity, EHP promotes hygiene improvement—an integrated approach that combines feasible primary prevention interventions: access to hardware (water, sanitation and household–level technologies); hygiene promotion through hygiene behavior change; and an enabling environment through policy improvement, public-private partnerships and institutional strengthening. Activities related to hygiene improvement for diarrheal disease prevention include:

  • Operations research to address key questions related to environmental interventions for diarrheal disease prevention
  • Development of guidelines for sanitation policy improvements
  • Development of tools to help PVOs/NGOs, program managers and communities design and implement hygiene improvement activities consistent with EHP’s Hygiene Improvement Framework
  • Implementation of field activities related to hygiene improvement 
  • Implementation of activities—assessments, pilot programs—to better understand specific urban health issues, particularly child health, for effective urban slum programming

Related EHP Publications: http://www.ehproject.org/Pubs/Topic_Listing.htm

Related EHP Briefs:

EHP Brief 24. Improving Small Town Sanitation in Jamaica- A Success Story

EHP Brief 23. Monitoring and Evaluation Plan for the West Africa Water Initiative

EHP Brief 22. Public-Private Partnership for Handwashing with Soap Initiative in Nepal 

EHP Brief 21. Cairo Healthy Neighborhood Program.

EHP Brief 18. Participatory Monitoring of Hygiene Behavior Change in Hato Mayor, Dominican Republic

EHP Brief 17. West Bank Village Water and Sanitation Program: Findings from Environmental Health Assessments

EHP Brief 16. Improving Urban Environmental Health in the Democratic Republic of Congo

EHP Brief 12. Local Government to Support Community Management of Environmental Health in Benin

EHP Brief 11. A Framework for Action: Child Diarrhea Prevention

EHP Brief 7. Improving Small Towns’ Sanitation in Latin America and the Caribbean

EHP Brief 6. Improved Hygiene in Kinshasa Markets, Democratic Republic of Congo

EHP Brief 5. Programming, Participation, and Partnerships under Duress: The West Bank Village Water and Sanitation Program

EHP Brief 4. Protecting the Health of Hurricane Mitch Victims in Nicaragua: The EHP Rural Water Supply, Sanitation, and Environmental Health Reconstruction Program

EHP Brief 1. Case Studies on Decentralization of Water Supply and Sanitation in Latin America

2. ENVIRONMENTAL CHANGE AND HEALTH OUTCOMES FOR PREVENTION AND CONTROL OF MALARIA AND VECTOR-BORNE DISEASES

EHP uses cross-sectoral surveillance and integrated vector management for prevention and control of malaria and vector-borne diseases.

Cross-Sectoral Surveillance

Cross-sectoral surveillance focuses on development of methods to carry out integrated analysis of epidemiological, environmental, demographic and other data to improve prevention and control of malaria, other vector-borne diseases, and other environmental health problems. Cross-Sectoral Surveillance activities include: 

  • Developing and testing methods for cross-sectoral surveillance
  • Creating tools to promote cross-sectoral surveillance as national policy
  • Application and institutionalizing cross-sectoral surveillance approaches in country settings

Integrated Vector Management (IVM)

IVM activities test the effectiveness of vector-control methods and identify the appropriate settings in which the methods are likely to be effective, particularly in urban and rural settings in Africa. IVM approaches are promoted as part of official national malaria control plans and procedures and include: 

  • Developing better tools for vector control, including promoting the use of environmental management and larval control 
  • Developing IVM strategies appropriate to particular settings
  • Promoting community participation in vector-control programs

See also: (http://www.usaid.gov/pop_health/id/malaria/techareas/ivm.html) 

Related EHP Publications: http://www.ehproject.org/Pubs/Topic_Listing.htm.

Related EHP Briefs: 

EHP Brief 20. Community-based Environmental Management for Urban Malaria Control in Uganda—Year 1

EHP Brief 19. The Nepal Survey on Malaria, Japanese Encephalitis and Kala-azar

EHP Brief 13. Best Practices for Dengue Control in the Americas

EHP Brief 10. Nepal Vector-Borne Disease Program Update

EHP Brief 9. Integrated Vector Management for Malaria Control in Africa

EHP Brief 8. Malaria Control in Eritrea

EHP Brief 3. Nepal Vector-Borne Disease Program

3. LINKING HEALTH, POPULATION AND THE ENVIRONMENT

Rapid destruction of Madagascar’s forests and ecological corridors, coupled with a growing population, initiated USAID’s efforts to assist NGOs and other groups working in health, population and the environment to link and integrate health, population and environment (natural resource management) delivery approaches and activities. EHP has played a major role in supporting the implementation of integrated activities in 120 Malagasy communities to increase family planning, practice less destructive natural resource management methods, increase food production, use forest resources in more sustainable ways, cross-train field agents in both population and environment, and work with schools to educate students on the environment and reproductive health. These activities focus on:

  • Building an enabling environment through local partnerships and organizational development
  • Developing and testing integration models
  • Implementation support to local NGOs
  • Monitoring, evaluation and operations research

Related EHP Publications: http://www.ehproject.org/Pubs/Topic_Listing.htm.

Related EHP Brief: 

EHP Brief 25. Healthy People in a Healthy Environment: Integrating Population, Health and the Environment in Madagascar

EHP Brief 2. Linking Health, Population, and the Environment in Madagascar.

4. URBAN HEALTH 

To better understand and address the health needs of the developing world’s exploding urban population, EHP is conducting activities focusing on the following:

  • Increasing available data related to the urban poor to better define the problems
  • Advocacy for improving health and other needs of the urban poor
  • Development of programmatic approaches for effective child health programs in urban poor settings

Related EHP Briefs: 

EHP Brief 21. Cairo Healthy Neighborhood Program.

EHP Brief 16. Improving Urban Environmental Health in the Democratic Republic of Congo

EHP Brief 14. Urban Poor Child Health in Asia and the Near East

EHP Brief 6. Improved Hygiene in Kinshasa Markets, Democratic Republic of Congo

5. IMPROVED TARGETS, INDICATORS, MONITORING AND EVALUATION FOR WATER, SANITATION, AND HYGIENE 

EHP partners with other organizations to improve the validity and reliability of existing water, sanitation, and hygiene (hygiene improvement) indicators and data collection methods and the development of new indicators and methods where necessary. Key partners include Water Supply and Sanitation Collaborative Council (WSSCC), the World Health Organization (WHO), the UN Children’s Fund (UNICEF), the UN Development Program (UNDP), Water and Environmental Health at London and Loughborough (WELL), Macro International Inc., the World Bank, NGOs, and PVOs. This activity is implemented at three levels—international level, program level, and community level: 

  • At the international level, the focus is on international consensus-building for key hygiene improvement indicators and data collection methods.  
  • At the program level, activities are designed to improve the ability of program managers to systematically monitor the effectiveness of interventions related to water, sanitation and hygiene for programmatic decision-making in water and sanitation programs as well as health and child survival programs. The focus of the activities is on the coordination of the development of methods for collecting data at national and local levels, since existing indicators and data collection instruments, such as the Demographic and Health Survey (DHS) and UNICEF’s Multiple Indicator Cluster Survey (MICS), are mostly appropriate for international comparisons.  
  • At the community level, activities support the development of appropriate community monitoring tools to improve communities’ abilities to identify problems and to increase community participation in planning and monitoring water, sanitation and hygiene activities. 

West Africa Water Initiative (WAWI) 

Ghana, Mali, and Niger have been selected as beneficiary countries for a $41 million West Africa Water Initiative (WAWI). EHP is providing technical support for the Initiative, which is supported by a public-private partnership led by the Conrad N. Hilton Foundation and USAID. Other partners include: World Vision; UNICEF; WaterAid; Cornell International Institution for Food, Agriculture, and Development; Winrock International; Lion’s Club International; World Chlorine Council; Desert Research Institute; the International Trachoma Institute; and the UN Foundation. The Initiative’s objectives include: increasing access to potable water and sanitation services among poor and vulnerable populations; reducing prevalence of waterborne diseases such as trachoma, guinea worm, and diarrheal disease (especially in children under five); and ensuring ecologically and financially sustainable management of water quantity and quality. 

Through EHP, USAID’s Bureau for Global Health is playing a leading/coordinating role in strengthening the monitoring and evaluation component of the Initiative.

For more information on WAWI, go to: http://www.waterforthepoor.org/initiatives/wawi/wawi.htm 

Related EHP Brief: 

EHP Brief 23. Monitoring and Evaluation Plan for the West Africa Water Initiative

6. RECONSTRUCTING WATER SUPPLY, SANITATION AND HYGIENE ACTIVITIES IN AREAS OF CRISIS

Nicaragua

In October 1998, Hurricane Mitch left unprecedented destruction through the heart of Central America, leaving thousands dead and billions of dollars in damage. Nicaragua was hit particularly severely by Hurricane Mitch. USAID allocated nearly $9.8 million over a 28-month period through the EHP Rural Water Supply, Sanitation and Environmental Health Reconstruction Program to rehabilitate the water supply and sanitation infrastructure and improve hygiene during the Hurricane Mitch aftermath.

Related EHP Publications: http://www.ehproject.org/Pubs/Topic_Listing.htm

Related EHP Brief: 

EHP Brief 4. Protecting the Health of Hurricane Mitch Victims in Nicaragua: The EHP Rural Water Supply, Sanitation, and Environmental Health Reconstruction Program

West Bank

USAID with technical support from EHP also provided substantial support to the West Bank related to infrastructure and management of water supply and sanitation services including environmental health assessments. The assessment was carried out by EHP in collaboration with Save the Children. Based on assessment findings and recommendations related to access to and quality of water, health outcomes and socioeconomic changes attributable to the continuing crisis as well as seasonal factors, EHP has identified next steps and continues its support to improve the delivery of safe and sustainable water and sanitation services to 170,000 people living in 50 villages in the West Bank. 

Related EHP Publications: http://www.ehproject.org/Pubs/Topic_Listing.htm.

Related EHP Briefs:

EHP Brief 17. West Bank Village Water and Sanitation Program: Findings from Environmental Health Assessments

EHP Brief 15. Water for War-torn West Bank: The Emergency Water Operations Center (EWOC)

EHP Brief 5. Programming, Participation, and Partnerships under Duress: The West Bank Village Water and Sanitation Program

7. INDOOR AIR POLLUTION

In collaboration with WHO and with technical support from EHP, USAID supported a Global Consultation on the Health Impact of Indoor Air Pollution and Household Energy in Developing Countries (Washington, DC, May 3-4, 2000). EHP served as the conference secretariat. The consultation was aimed at an audience interested in household energy, indoor air and health issues and was attended by participants from USAID, WHO, World Bank, UNICEF, the Harvard Institute for International Development, NIH, and PVOs and NGOs.

The meeting report is available at: http://www.who.int/mediacentre/events/HSD_Plaq_10.pdf  

Papers from the Indoor Air Pollution Consultation include: 

Related EHP reports:

For more information, contact EHP ([email protected]). 

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