Ministry of Health
Programme Coordinating Mechanism:
Co-chaired by the World Bank Water and Sanitation Programme and UNICEF
The Ethiopia Sanitation and Hygiene Improvement Programme (ESHIP) is integrated into the Government of Ethiopia’s Health Extension Programme, aimed at providing universal access to essential health care services for the country’s rural population. ESHIP aims to scale up sanitation and hygiene improvement across rural communities, health facilities, public spaces and schools. In line with the Government’s decentralized health service delivery system, the programme works in 40 woredas (districts) across four regions. Implementing Partners are comprised of 44 government health offices at the regional and woreda level.
In 2016, ESHIP completed and shared various evaluations, studies and surveys related to its strategies, operations and outcomes. This included an independent outcome evaluation of Ethiopia’s sanitation and hygiene improvement programme in regions supported by ESHIP and UNICEF. The study underscores the significant progress made on collective behavior change and the effectiveness of Community-Led Total Sanitation and Hygiene (CLTSH). It also provides a range of recommendations, including improving post-ODF follow-up, implementation quality, data collection and coordinating mechanisms.
As a result of these assessment activities, ESHIP stakeholders began designing an extension of the programme beyond 2017. The extension phase is aimed at continuing ESHIP’s work to align with and support the achievement of the Sustainable Development Goals and 2015-2020 Health Sector Transformation Plan (HSTP).
Other highlights during the year included strengthening the Programme Coordinating Mechanism with new members and strengthening monitoring, reporting and learning activities through Implementing Partner review meetings, exchanges with other GSF-supported programmes and thematic workshops covering equality, rapid appraisal of CLTS and household water treatment and safe storage.
During the year, five woredas, with a population of over 637,000 people, were certified ODF. This achievement contributes to a cumulative total of 3.3 million people living in ODF environments and 1.1 million people with access to improved toilets under the ESHIP programme. In addition, the ESHIP collaborated with WaterAid to produce a documentary film on the programme’s impact.
Drought and the acute watery diarrhoea outbreaks affected programme activities in some woredas covered by ESHIP, shifting the Government’s focus to these issues. However, since the programme’s activities are part of a larger package of health services offered to communities through the Federal Ministry of Health, the programme was able to integrate its behaviour change work into government response and relief activities. Other challenges faced included budget constraints and the absence of national guidelines and technology options for the disabled at the household level. The Ministry of Health and its government and civil society partners have since developed a manual for addressing the needs of the disabled.
Learning and innovation
ESHIP travelled to Uganda for an exchange mission with the GSF-supported Uganda Sanitation Fund, where they learned more about pre- and post-ODF approaches, including Follow-up MANDONA and Institutional Triggering. Following the exchange, the programme began a transformative process of piloting new CLTS follow-up activities in various kebeles. Implementing Partners also facilitated inter-kebele learning and sharing involving health actors, teachers and local governments.
ESHIPs activities are part of an innovative government programme that includes a package of health services offered to communities. As part of this package, Sub-grantees facilitate
CLTS and train village-based Health Extension Workers (HEWs) in the approach. The HEWs then train grassroots women leaders who make up the ‘Health Development Army’. ESHIP therefore strengthens the overall delivery of health services.
In 2016, community-led innovations promoted by the programme included using plastic bottles and bamboo to build vent pipes for latrines; using buckets and sticks to construct accessible latrines for the disabled; using radios and USB flash drives to disseminate sanitation and hygiene messages in school WASH clubs; installing drainage pipes at the bottom of seepage pits to water and grow trees and fruits; and developing manually controlled shower heads.
Implementing Partners have trained school WASH club members in preparing menstrual pads from local materials. They have also actively engaged religious leaders and held competitions among women’s groups to mobilize communities to end open defecation and construct toilets, including for poorest community members.
As the first phase of the programme ends, ESHIP will work to transform hundreds of kebeles into primary and secondary ODF environments. The programme will also work to transform at least two kebeles per woreda into model communities exemplifying secondary ODF status. Plans are also in place to enable over a dozen woredas to achieve ODF status. ESHIP will also continue to explore programme extension plans with stakeholders.
GSF workshops support programmes to monitor progress towards and beyond Open Defecation Free status.
10 principles for ensuring that disadvantaged people benefit effectively from sanitation programmes and processes
Study confirms that disadvantaged groups have benefited from Global Sanitation Fund (GSF)-supported programmes, but more proactive attention is needed