The ‘Ethiopia Sanitation and Hygiene Improvement Programme’ (ESHIP), with the Federal Ministry of Health (FMOH) serving as GSF Executing Agency (EA), aims to scale up sanitation and hygiene improvement across rural communities to help achieve national WASH goals. The programme is also now contributing to the newly adopted Sustainable Development Goals (SDGs). ESHIP Sub-grantees are government health offices at the regional and woreda (district) level. The programme works in 40 woredas across the Amhara, Oromia, Southern Nations, Nationalities, and Peoples’ (SNNPR) and Tigray regions.
In 2015, ESHIP made significant efforts to strengthen programme management, implementation of activities, reporting, and results. This included revising the workplan, allowing for a no-cost programme extension from mid-2015 to mid-2016. In addition to strengthening activities, the programme will use the extension period to consolidate learning and prepare for further expansion, to align its work with the SDGs and the national Health Sector Transformation Plan (HSTP). The HSTP is the first phase of Ethiopia’s 20-year health sector strategy to achieve universal coverage.
During the past year, ESHIP collaborated with various entities to carry out evaluations, studies and surveys related to its strategies, operations and outcomes. These entities include Addis Ababa University’s School of Public Health, the BDS Center for Development Research, UNICEF and the independent consultancy firm IOD PARC. Evaluation results are expected to be finalized in 2016.
As part of the information revolution strategy within the Health Sector Transformation Plan, the Federal Ministry of Health and regional governments are working to strengthen their monitoring and evaluation systems. These ongoing improvements and national, sector-wide processes include re-verification of ESHIP’s previously reported results. Consequently, cumulative results reported in June 2015 have been revised, and these adjustments are reflected in the dashboard presented in this Progress Report. The GSF will continue to support FMOH efforts at ensuring data quality.
Cumulative results reported from the start of the programme until December 2015 include over 2.8 million people living in ODF environments, 2.9 million accessing handwashing facilities and over 994,000 with improved toilets.
The extended rainy season, floods and drought affected programme activities in a number of woredas covered by ESHIP. In drought-affected woredas, Sub-grantee staff were redeployed by the Government to support relief efforts, such as the distribution of food, thus decreasing their availability to implement ESHIP activities. Other challenges that continue to be addressed include: data collection and reporting; the lack of appropriate and affordable sanitation technologies in communities prone to extensive weather hazards; ‘slippage’ in some woredas due to the amount of time it takes to empty or replace filled latrines; and the low CLTS implementation capacity in some woredas.
Learning and innovation
E-SHIP’s activities are part of a package of health services offered to communities through the Federal Ministry of Health. As part of this package, 40 Sub-grantee health offices facilitate CLTS and train village-based Health Extension Workers (HEWs) in the approach. The HEWs subsequently train women leaders who make up the ‘Health Development Army’. Through this systematic training, ESHIP helps strengthen the overall delivery of health services, going beyond sanitation and hygiene.
In 2015, community-led innovations promoted by the programme included using plastic bottles and bamboo to build vent pipes for latrines; using faecal sludge for biogas production; and promoting the development of ‘equbs’, which are informal savings and credit schemes that can help finance sanitation improvement. In one woreda, ESHIP facilitators supported disabled women to construct and use their own latrines, which inspired other community members and woredas to replicate the practice.
ESHIP has observed that regular follow-up and the involvement of strong leaders, including school and religious officials and elders, is of paramount significance to achieving programme goals.
ESHIP will continue to build on its strong sanitation and hygiene gains and boost learning and sharing activities. This will include a visit to the GSF-supported programme in Uganda in early 2016, which is similar in structure. The two programmes will share best practices, common challenges and different strategies for delivering large-scale CLTS through government structures. Plans for continuing ESHIP beyond 2016 are in development.
When WASH practitioners understand the patterns and causes of slippage, they can devise innovative strategies to avoid it.
Global Sanitation Fund programmes are designed to incorporate gender considerations and equity dimensions.
Monitoring slippage should go beyond the numbers to truly understand behaviour change and community dynamics.