Figure 1:Map of Turkana showing Areas Covered by the Project.

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PROJECT EVALUATION REPORT

Hygiene and sanitation promotion and distribution of Water Filters in Turkana District of Kenya – a project funded by the

Norwegian Government

April, 2005

Figure 1: Map of Turkana Showing areas where the hygiene and sanitation promotion and filter distribution was carried out

1. Background and introduction

1.1 Turkana district of Northern Rift Valley of Kenya, can be termed as a

chronically food deficient and water scarce district. In the past the Turkana people, who are nomadic pastolarists, used the area a wet season grazing: to be used only during periods of favorable rainfall, and usually moved to the highlands surrounding the district during dry spells and drought. However with the setting of National borders, Uganda, Sudan and Ethiopia, and district boundaries, with West Pokot and Marsabit, the options of seasonal movement is more restricted. This movement across various borders still occurs but under greater risk of losing livestock. The 1984 El Nino related drought was the proverbial straw that broke the back of the Turkana pastoral economy. Then followed the 1992-1994 drought, then the 1998-2002 drought.

1.2 Although under five mortality is 117, very close to the national average,

malnutrition amongst children is chronic with “normal rates” being 10-15 %, soaring to above 30 % during droughts. In past surveys 40% of the children have had diarrhea episodes on 2 week recall1. Exclusive breast feeding is not practiced in Turkana and instead children are subjected to pre lacteal feeding within hours of birth. Turkana has a very low sanitation coverage of about 13 %2. Hyadid, a disease transmitted mainly through dogs, is prevalent.

1.3 In the 1999 census access to water was estimated at 55.9 %, higher than the

national average, and equated with Trans Nzoia and higher than Nyeri both considered high potential areas with much higher rainfall. However this access has high seasonal variability, very scarce during drought and some households have to travel large distances, more than 20 Km. The water is not always safe often drawn from dry river beds.

1.4 UNICEF has intervened since 1992 to save the lives of children affected by

the severe water and food shortage. This engagement continues to date. In the current 2004-2008 Country Programme Action Plan, Turkana was included as one of the focal districts where all sectors will converge. In Water and Sanitation sector there will be increasing focus on building community capacity in preventing WES related diseases, provision of water and sanitation in schools. The unit is taking the lead, in partnership with the nutrition section in promoting the other 15 child care practices using participatory methods.

1.5 In 2004 the Norwegian Government gave a donation in kind of 5,000 water

filters with a cash component for distribution and training on usage. The project was implemented from December 2004 to February 2005. An evaluation was carried out in March 2005.

1 Nutrition surveys in Turkana. Oxfam GB and UNICEF 2004. 2 Analysis of 1999 census report. UNICEF KCO. 2005

1.6 Evaluation of the Use of Emergency Water Filters Distributed inTurkana District, took place from 14th – 16th March 2005. Participants included, Mr. Fred Donde – Chief WES UNICEF KCO, Ms. Merja Karhu - Scan Water , Mr. Aggrey Chemonges – CEDS and a number of government official, community representatives.

1.7 The assessment tools ranged from , Meetings with district leaders, Interviews

with local leaders, Interviews with TOTs, Focal group discussions, Household visits and , Village transect walks and general observations

1.8 This report describes the findings of this evaluation and way forward.

2. Description of the project 2.1 Objective. Expected results: Result 1: Water quality at point of use improved through the proper use of Water Filters. and safe from contamination through practicing of appropriate hygiene and sanitation and Result 2: No faeces strewn within the village environment Outputs: Output 1: 5,000 households reached with hygiene and sanitation messages and

interact with them resulting in adoption of key hygiene and sanitation practices including hand washing and proper disposal of human waste.

Output 2: 5,000 households each own a filter, know why they need them, know how

to use and maintain them. 2.2 Programming Model: 2.2.1 Women in Turkana are responsible for virtually almost all the economic activities,

apart from grazing the main herds and raiding. Since they interact most with the WES environment they should take the lead in its improvement. All Turkana Villages have women groups, there are always some men as members. While the Turkana hold traditional beliefs on hygiene and sanitation issues these are open to discussion provided the Turkana themselves put to test these believes against what they learn through PHAST.

2.2.2 The Public Health Office is established to the location level however they are

constrained by logistics and the idea of giving the power of training to communities groups has only been tried in Trans Nzoia. A private training firm3 was hired to provide the technical as well as logistical, financial and management flexibility to implement the project in collaboration and together with the Public Health Office.

3 Community Empowerment and Management Services LTD.

2.2.3 The project shall look for the earliest indication, knowledge of hygiene and

sanitation, that the community is ready for the social marketing phase and immediately launch it.

2.2.4 Champions of hygiene and sanitation, will be identified will take the lead in the

process of change. 2.2.5 The distribution of filters will also be carried out through these 500 trainers who

are responsible to ensure that households know why they have to use the filters, hygiene and sanitation issues, how to use them and how to maintain them.

Text Box 1: Scaling up strategy: The strategy for scaling up is for the training firm to partner with existing women groups in each village. Train at least 10 women group members in PHAST and operation and maintenance of water filters. This TOTs will in turn train 9 other households each and thus per village at least 100 households will be covered. Now each of the trainers will be allowed to make her own choice on which households she is going to train, she can even choose her sisters or mothers house or in laws, and she will be encouraged to continue the training of her relatives who visit her from the grazing areas. To access additional support she can request to pair up with another trainer or can request the assistance of the sanitation champion4 in her village. Allowing her to choose the households enables the use of existing social networks and offering her additional support from her group members gives moral support. The groups later convene after a week and launch social marketing campaign. At the design stage of the project it was not determined what form this would take, but the project will motivate them to create the art forms and prepare presentations. From experience one of the most powerful tool at the village level is the megaphone. Messages transmitted through this device are never ignored and since it is loud the messages are always clear. Megaphone gives the power of projecting words. The areas covered in this project are key small urban centers that are nodal to the pastoral migration patterns. Later stages will target the mobile families in the interior. 2.2.6 Families will get the water kit ONLY after they have answered correctly at least

70 % of key hygiene and sanitation questions. These questions are :

a) Mention four diseases caused by contaminated water b) Describe the how a person can get a disease related to feaces ( routes) c) Describe the how you can prevent this diseases (faecal oral barriers)

4 Each village has a sanitation champion, an influential person, who takes the lead in driving the process.

d) Mention sources of safe water e) Mention of unsafe water f) How can you make our water safe for drinking at home g) Demonstrate how to use and maintain the water filter

2.3 The role of the filters: the Water Ladder: 2.3.1 The water ladder is presented below to inform strategy. While it is recognized

that while immediate provision of safe water is not possible due to budgetary and programmatic constraints, it is within possibility that the water that households access can be made safe through the use of various technologies, including the water filters

2.3.2 This is shown in the diagram. (b) For households to be motivated and actually sanitize water each and every time they consume it, it is necessary, though not sufficient, that they are aware of hygiene and sanitation issues. The expected result is that they know why they need to sanitize water and wish to carry this out. The provision of the filters completes the necessary conditions as the house now has the means

2.3.3 Operation and maintenance skills of the filter are important to maintain

sustainability of the device. ( d) There is a close link between the Water Ladder and other Sanitation and Hygiene practices. Proper disposal of faeces is necessary to reduce contamination of water as well as reduce risks of contamination of hands, as children play on the soil. Proper storage of water after filtering and hygienic cleaning is necessary to maintain water safety at point of use.

Tap inside the house or compound or protected well

Public tap or protected well

Unprotected well or river or laga and use of water sanitizing methods

Collection and consumption of raw water from river beds

Diarrhea disease risks, high burden on women

High burden on women if wood used to boil water

High burden on women if collection time and distance is long

Future goal: MDG -2015 achieved THE WATER LADDER

Position of water filters in the ladder; Reduces burden of collecting wood which is significant saving in drought

2.4 Implementation: 2.4.1 This started with mobilization of the clusters and then holding PHAST sessions in

early December 2004. The PHAST tools proved very effective and within two days it was thus possible for most of the clusters apart from Kerio to shorten the PHAST training period and instead discuss house to house campaign and plan social marketing.

2.4.2 House to house training was carried out in late December and in January while

the groups simultaneously prepared themselves for social marketing. The groups prepared songs, skits and poems. School children were also involved in the process. Which they used to organize village and household cleanups. Each trainer was to construct a dish rack, hand washing facility, if possible a latrine and keep the household and compound clean. They were to give weekly classes to their 9 households emphasizing their importance.

2.4.3 Social marketing was officially launched in February. In the first week of February

the groups went round the villages singing sanitation and hygiene songs, praising of households that have adopted hygiene and sanitation and exerting pressure on those who have not done so to do it “so as not be left behind by development”. Then there within village competitions where cleanest house and cleanest village within the cluster was identified by a team from the Public Health Offices. Then there were sanitation days held where there were inter village competitions on songs and skits. Then there were inter cluster competitions where the Kaalokol Cluster won.

2.4.4 Distribution of filters was carried out at the end of February through the 500

trainers. Each trainers was responsible to ensuring that the household understood why they were using the filter, hygiene and sanitation issues and how to use and maintain it. In addition each households should have adopted at least the dish rack, hand washing and cat method of disposal of faces, before they get the filter. This is done through question and answer sessions. The sanitation champion in the village was responsible for monitoring this process.

3. The Evaluation

3.1 Objectives of the evaluation were as follows

a) The acceptability and use of filters in Turkana at household level determined

b) Skills for utilization and maintenance by household level determined c) Evaluation of the results of Hygiene and Sanitation training d) Distribution of the filters assessed e) Assessment of partnerships with women groups in promoting hygiene

and sanitation as well as distributing the filters. f) Determination of future programming strategies

Participants 1. Mr. Fred Donde – Chief WES UNICEF KCO 2. Mr. Aggrey Chemonges – CEDS 3. Mr. Henry Karithi –UNICEF 4. Ms. Concepta Etaan, Lead Community Trainer 5. Ms. Elizabeth Ekai, TOT Kalokol 6. Ms. Merja Karhu - Scan Water 7. Mr. George Mulala – Photo Journalist The Evaluation team visited a total of 8 villages and 60 households in Lokichoggio, Lodwar, Lokorio and Kalokol clusters.

A family in Lodwar demonstrate how to use the water filter during the evaluation

A woman in Lokichoggio demonstrates how to assemble the water filter during the evaluation

3.2 Evaluation Results

Objectives of the mission Results- Remarks

The acceptability and use of filters in Turkana at household level determined

All houses visited were using the filters, They said the filter retains the good taste of water. They can actually see the change of color. Children also knew how to use them and why.

Should have different target groups in terms of size. One was eaten by rats, one was punctured, some had lost the corks, and cleaning sponge.

Skills for utilization and maintenance by household level determined

Almost all households visited knew how to use filter correctly. Only two households did not know all steps. One had been in hospital during training and one was a very old lady who said she had forgotten

Many did not use the clips, Some problems with using the cleaning sponge, some were using soap, some were not gentle ( PLASTEC to check change of design. In some places the water was coming very slowly, filter found dirty, some were washing every day and not when the water is coming out slowly.

Valuation of the results of Hygiene and Sanitation training

No feaces noticed in the village environment in the villages covered. This was contrasted with one of the villages not covered where feaces were strewn along paths and around houses.

All houses had leaky tins. Most households including children reported washing hands at appropriate periods and also dish rack available in all households. Most households could answer questions on key hygiene and sanitation correctly and knew why they needed to use the filters

55 of the 60 households, 91 %, visited had adopted hygiene and sanitation practices in just 3 months. This is remarkable when seen against the convention of hygiene and sanitation promotion that “ change take time” A theoretical basis of this project should be better established so that it is easier to replicate

Distribution of the filters assessed

Filters well distributed. Important that TOT have small stocks. Some families had tap water had filters, and some ladies did not have access tap water.

Assessment of partnerships with women groups in promoting hygiene and sanitation as well as distributing the filters.

Good participation by women, women felt in charge of the projects and the changes.

Strategy of using women was very successful. Women gave practical examples of the impact of poor water quality in their lives. Women were proud of the changes they have made in their house

Determination of future programming strategies

Add monitoring, add evaluation trips

The Impact of the training. Hand washing even for children is now being practiced by 95 % of the households visited

A demonstration on how to clean the filters in shown during the evaluation

A delicate exercise. Clean the filters without damaging was the most important component of maintenance

Community members in discussion on the filters

Text box 2: Remarks of the use and maintenance of the filters by Merja

1. Sponge could be thicker and smaller (5x5 cm) in order for better cleaning; with the current sponge some had difficulties to clean the membrane.

2. Tube-end cork was not (in use) in all Emergency kits (some people clean the filter

by placing the filter and tube end into a bucket and dirty water gets into the tube if the cork is not there). Extra corks, pump, and tube-end with cork could be added to the kit. These were easily lost in some families. 3. Addition should be made to the instructions: Clean the filter at the same level or

above the raw water container. 4. One or two people had the raw water container 1-meter higher than the filter in a

bucket on the ground when air developed inside the membrane. People could damage the membrane if air gathers inside and it also decreases the flow rate when starting the filtering after cleaning.

5. After training and distributing the filters the TOTs should do an evaluation visit

shortly (1 week) afterwards to families to find out that the users have learned everything and are following the instructions. At the same time they could interview the rest of the family for back and their experience on the use.

4. CONSTRAINTS

1) Turkana district is vast and villages are scattered over long distances.

2) There is a general water scarcity in the district. It is obviously difficult to promote

filters in an environment where water is hard to come by.

3) Poverty in the distinct is very high and future sustainability of the filters should

address the cost element.

4) There are economic and technological constraints in construction of toilet

facilities.

5. CONCLUSIONS

1) The project has realized desired results and has proved effective in promoting

hygiene and sanitation.

2) It was noted that the filters are easy to use for both parents and children. In

addition they are light and easy to carry, a factor that makes them suitable for

nomadic families.

3) It can be concluded that women groups are an effective entry points to

communities following the positive results of the exercise.

4) It can be concluded that the donated filters have been put into good use and

accepted by the communities

5) There was now a demand for latrines generated by the hygiene and sanitation

promotion. But communities need assistance in developing various low cost or

no cost solutions.

Text Box 3: Quotes from the users

1. After filtering the taste is very good, better than boiled water. Color is clear, no more sand in drinking water.

2. Diarrhea and typhoid cases were gone after starting to use filters. 3. Filter is easy to use and clean. We love it. People in remote rural areas need

the filters desperately. Where can we get more filters? 4. Direct benefits to families, user friendly, people understand the efficiency of

water filters (bacteria removal, reduced sickness, improved health), many people were reached by this kind of training (see previous reports from Unicef)

5. Spare filter could be added with spare parts already to the first kit delivered in the future.

6. People were hoping that the local shops could sell the filters and spare parts.

6. RECOMMENDATIONS

1. It is recommended that due to the demand generated UNICEF should take the

project ot scale in Turkana. This will cover an additional 50,000 filters. The same

model should be used but add the following elements:

( a) Spare filters to be given to the women groups for replacement at a fee

whenever a household requires it.

(b) A plan for eventual commercialization of the filters. A well thought out and

soft landing three-phase exit strategy needs to be put in place. Phase one

may entail free distribution of the 50,000 filters, phase two may entail

subsidy while the last phase may entail the sale at cost recovery price

when complete behavioral change has been achieved.

( c) Development of low cost or no cost sanitation solutions

2. The suppliers should be encouraged to ensure there is local availability of the

filters in the markets so that those who can afford can procure them.

3. The suppliers should come up with modified filters to improve cleaning without

damaging the delicate components of the filters.

4. UNICEF should work with other partners and Government and arrange for

exchange visits for the community members so that they may learn from other

communities.

5. The District Steering Forum should get involved in the intervention to give it the

necessary support for lasting success.

6. The local schools should be equipped with water filters and UNICEF should

initiate arrangements to have them supported with the help of donors.

7. LESSONS LEARNT

Hygiene and sanitation can be promoted within a short time if the right methodology and

model is applied.