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Republic of Ghana

Ministry of Local Government and Rural Development

NATIONAL STRATEGY FOR HOUSEHOLD

WATER TREATMENT AND SAFE STORAGE

SCALE-UP MODEL

May, 2014

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TABLE OF CONTENTS

TABLE OF CONTENTS ........................................................................................................................................... 2

ACKNOWLEDGEMENTS ....................................................................................................................................... 3

EXECUTIVE SUMMARY ......................................................................................................................................... 5

1 BACKGROUND ............................................................................................................................................... 6

2 OVERVIEW OF NATIONAL HWTS STRATEGY ..................................................................................... 7

2.1 GOALS AND OBJECTIVES.............................................................................................................................. 7

2.2 SPECIFIC OBJECTIVES ................................................................................................................................... 7

3 OVERVIEW OF THE SCALE UP MODEL................................................................................................... 8

3.1 KEY ELEMENTS OF THE IMPLEMENTATION MODEL ................................................................................... 8 3.1.1 Behaviour-First Approach ....................................................................................................................... 8 3.1.2 Public Private Partnerships ..................................................................................................................... 8 3.1.3 Commercial/Business Approach .............................................................................................................. 9

3.2 GEOGRAPHICAL FOCUS OF IMPLEMENTATION MODEL ............................................................................. 9

3.3 IMPLEMENTATION ARRANGEMENTS ........................................................................................................ 10

3.4 WORK PLAN .............................................................................................................................................. 11

3.5 ADVOCACY STRATEGY .............................................................................................................................. 11

4 INSTITUTIONAL ARRANGEMENTS FOR IMPLEMENTATION MODEL .................................... 12

5 M&E FRAMEWORK FOR IMPLEMENTATION MODEL .................................................................... 13

5.1 MONITORING FRAMEWORK ...................................................................................................................... 13

5.2 EVALUATION FRAMEWORK ....................................................................................................................... 13 5.2.1 Indicators ............................................................................................................................................... 13 5.2.2 Frequency .............................................................................................................................................. 14

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ACKNOWLEDGEMENTS

The Ghana Government through the Ministry of Local Government and Rural

Development is grateful to all organizations and individuals who contributed in diverse

ways to the preparation of this strategy document.

The ministry is grateful to the United Nations Children’s Fund (UNICEF) for funding

the project. We acknowledge the Consultants, Marion Kyomuhendo - for providing the

original assessment and initial drafts of the Household Water Treatment and Safe

Storage (HWTS) Strategy; and Stephen Ntow - for the technical inputs during the

validation workshop and final revision of the HWTS Strategy.

The HWTS Technical Working Group members who guided the process of developing

this strategy included Patricia Buah of the Water Directorate (WD) of the Ministry of

Water Resources, Works and Housing (MWRWH) and Kweku Quansah of the

Environmental Health and Sanitation Directorate (EHSD) of the Ministry of Local

Government and Rural Development (MLGRD) who co-chaired the Technical Working

Group; Ebenezer Aidoo and Odartei Lamptey of Precision DX, Araba Sam Annan of

Vestagaard Frandsen, Joyce Maku Appiah and Theodora Adomako-Adjei of the

Community Water and Sanitation Agency (CWSA), Vida Nyenku of EHSD/MLGRD,

Basilia Nanbigne and Ben Arthur of the Coalition of Non-Governmental Organizations

in Water and Sanitation (CONIWAS), Adam Thomas and Samuel Amoako-Mensah of

UNICEF Ghana.

We are also grateful to Mr. David Duncan, Chief of WASH, UNICEF Ghana and Naa

Lenason Demedeme, Ag. Director, Environmental Health and Sanitation Directorate

(EHSD) of the Ministry of Local Government and Rural Development (MLGRD) for

their administrative and technical support.

We are also grateful to the International Network on Household Water Treatment and

Safe Storage (INHWTS) for guidance and direction, especially to the co-hosts Mr.

Michael Akyeamfo Forson (WASH Specialist, UNICEF HQ, USA) and Dr. Margaret

Montgomery (Technical Officer, WHO, Geneva), and Ryan Rowe (Communication

Specialist of the Network) for their advice and providing the required ‘international’

touch to this document, and the WASH Section of UNICEF HQ and WHO HQ for the

technical and administrative support.

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The final version of the national Household Water Treatment and Safe Storage (HWTS)

Strategy documents were put together by Harold Esseku and Joseph Ampadu-Boakye

of Rapha Development Consult. We are grateful to them for collating and putting

together all the comments and suggestions made by various stakeholders to come up

with the three documents comprising the Household Water Treatment and Safe Storage

(HWTS) Strategy for Ghana together with a Scale-Up Model and a Private Sector

Participation Framework.

The three documents are namely:

National Strategy for Household Water Treatment and Safe Storage (HWTS)

National Strategy for HWTS - Scale-Up Model

National Strategy for HWTS - Private Sector Participation Framework.

This document is the National Strategy for HWTS - Scale-Up Model.

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EXECUTIVE SUMMARY

The Ghana Government has launched a National Household Water Treatment and Safe

Storage (HWTS) Strategy which is aimed increasing knowledge, awareness and practice

of HWTS. The purpose is to reduce water related diseases and contribute to achieving

health for all by 2025. The strategy is anchored around seven (7) thematic areas and an

implementation model that adopts a three-pronged approach into scaling up HWTS

nationwide i.e. behaviour-first approach, public private partnership approach and

commercial/business approach.

This country plan defines the step by step approach for rolling out the implementation

model and addressing the overall strategic actions in the National HWTS Strategy.

Implementation of the plan is estimated to cost GHC 2.2million and will span the

period 2014 - 2025. The Government of Ghana will prepare a detailed financing plan

which will among others, review the costing of the strategy and clearly define financing

options including leveraging private sector financing initiatives.

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1 BACKGROUND

Household Water Treatment and Safe Storage (HWTS) significantly reduces the burden

of diarrhoeal and other related diseases which impacts positively on the health status of

people especially children. Regretably, only one (1) out of 10 households in Ghana

treats water before drinking. Only 17% of households that fetch drinking water from

unimproved sources treat their water before drinking. The concomitant effect is the

high prevalence of water related diseases. Contaminated drinking water contributes to

an estimated 10,000 deaths annually from diarrhoeal diseases and diarrhoea is the

fourth leading cause of child deaths in Ghana 1 . To address this challenge, the

Government of Ghana, working in partnership with its Development Partners has

launched a HWTS Strategy. The strategy defines the framework for implementing

HWTS in Ghana.

1 http://www.apromiserenewed.org/Dashboard.html

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2 OVERVIEW OF NATIONAL HWTS STRATEGY

2.1 Goals and Objectives

The goal of this strategy is to contribute to achieving improved health for all by 2025.

This goal will be achieved by pursuing sustainable and effective promotion and

adoption of HWTS as a behaviour and through the use of appropriate technologies that

make drinking water safe at the point of use.

2.2 Specific Objectives

By 2015,

90% of population in the five most vulnerable regions (Upper East, Upper West,

Northern, Central and Volta) are aware of HWTS;

70% of the targeted population have adequate knowledge about the use and

benefit of HWTS in reducing WASH related diseases.

35% of populations in the five most vulnerable regions (Upper East, Upper West,

Northern, Central and Volta) practice safe HWTS methods consistent with their

environment and circumstances.

By 2020,

90% of population in the five most vulnerable regions (Upper East, Upper West,

Northern, Central and Volta) and two most populous regions (Greater Accra and

Ashanti regions) are aware of HWTS;

70% of the entire population of seven regions have adequate knowledge about

the use and benefit of HWTS in reducing WASH related diseases;

50% of populations in the five most vulnerable regions (Upper East, Upper West,

Northern, Central and Volta) and two most populous regions (Greater Accra and

Ashanti regions) practice safe HWTS methods consistent with their environment

and circumstances.

By 2025,

100% of population in all regions including three remaining regions (Eastern,

Brong-Ahafo, Western regions) are aware of HWTS;

90% of the entire population have adequate knowledge about the use and benefit

of HWTS in reducing WASH related diseases;

75% of entire population consistently practice safe HWTS methods consistent

with their environment and circumstances.

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3 OVERVIEW OF THE SCALE UP MODEL

The scale up model defines the key elements of the model, geographical focus,

advocacy strategy and modalities for implementation, monitoring and evaluation.

3.1 Key Elements of the Implementation Model

The model for operationalizing the national strategy on household water treatment and

safe storage is anchored around three (3) interdependent approaches: (i) ’behaviour-

first’ approach (ii) public private partnership; and (iii) commercial/business approach.

These approaches are currently being used for Safe Excreta Disposal (SED) and Hand-

washing with soap (HWWS) interventions. HWTS implementation will dovetail within

and build on these and other related strategies and national policies currently being

implemented in Ghana in an integrated approach rather than a stand-alone programme.

3.1.1 Behaviour-First Approach

This focuses on improving behaviour and attitudes for water treatment and safe

storage.

Establish baseline of behaviour and practice of households, groups and

communities.

Establish knowledge base within households and communities on:

o Water Quality and water-borne diseases, especially diarrhoeal diseases

o Drinking water treatment and safe storage

Assess pre-feasibility of various technologies. Assessment may be done along

broad categories such as filtration systems, chemical treatment, including

chlorine disinfection systems and coagulation/flocculation and UV- Treatment.

Promote HWTS at community level, using Behaviour Change Communication

techniques and campaigns to create demand for technologies.

Identify community level champions to further promote and reinforce the

behaviour. These would include health institutions and school based structures.

3.1.2 Public Private Partnerships

This will focus on leveraging the potential of the private sector to partner with public

sector institutions to develop and roll out innovative programmes to improve HWTS

uptake. Proposed actions include the following:

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Linking households and communities with the private sector to support the

behaviour change initiatives with appropriate and sustainable HWTS

technologies including after-sales support;

Introducing viable financing products including micro-credit and other credit

schemes (e.g. HTWS products purchase on flexible re-payment terms), through

e.g. credit unions and local co-operatives.

It is expected that these partnerships will catalyse effective demand for HWTS.

3.1.3 Commercial/Business Approach

This will focus on creating the enabling environment to support private sector business

initiatives in HWTS with an economic proposition – full cost recovery and potential

profitability. This will involve:

Encouraging the private sector to develop and market HWTS products through

advertisement and interactive sessions with communities and households to

demonstrate the efficacy of their products, basic operation and maintenance, and

after-sales services and support.

The potential profitability also creates an incentive for more companies to enter the

HWTS market. These companies may compete for market share by reducing prices,

improving the quality of their products, developing innovative technologies, and

heavily promoting their products. This is expected to engender public interest in HWTS

products. With more companies manufacturing HWTS products, it may also be easier

to improve production and extend distribution and access across varied geographic

areas and market segments.

3.2 Geographical Focus of Implementation Model

The strategy will be rolled out across all ten (10) regions in Ghana across three main phases:

Phase 1 (2014-2015) - the model will be implemented in the five regions of Ghana

- Central, Upper West, Upper East, Northern and Volta regions. The

implementation will combine the behaviour-first and public private partnerships

approaches;

Phase II (2016-2020) – this phase will build on lessons from best practice from

Phase I; sustain existing interventions in the 5 regions (Phase I) and introduce a

mix of all three approaches in the Greater Accra and Ashanti regions;

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Phase III (2021-2025) – this phase will sustain interventions in the 7 regions

(Phase I and Phase II) and further extend implementation to the two remaining

regions – Eastern and Brong-Ahafo.

In implementing the model, priority will be given to communities using the under

listed criterion:

ODF Communities

Communities with > 50 latrine coverage

Communities requiring emergency interventions, based on risk of endemic

diseases or epidemic.

3.3 Implementation Arrangements

Within the framework of Ghana’s decentralisation programme, the National Water

Policy and Environmental Sanitation Policy, the scale up model will be implemented

across three levels i.e. national, regional and district level. The roles of relevant

stakeholders in the implementation process have been clearly defined in the national

strategy. Given the increasing role of District Assemblies in the implementation of

Government policies and programmes, they are expected to lead implementation in

their respective areas of jurisdiction and will carry out the following:

Mainstream HWTS strategy into their existing District Water and Sanitation

Plans (DWSPs), District Environmental Sanitation Strategy and Action Plans

(DESSAPs) and medium term development plans (MTDPs);

Engage EHSD-MLGRD and relevant institutions to provide adequate training for

district level staff (notably Environmental Health Officers and Community

Development Officers) to HWTS strategy including monitoring and follow up

support mechanism at the district level;

Establishing and providing adequate resources for District and Area Council

level teams comprising EHAs and Community Development extension staff to

promote HWTS;

Ensuring District and Area Council level teams provide required training for

existing community level structures on HWTS including monitoring;

Managing performance based contracts with CSOs (including NGOs/private

sector) on HWTS promotion (where necessary).

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3.4 Work Plan

A work plan on programme activities for implementing the HWTS strategy is presented

in Exhibit 1.

3.5 Advocacy Strategy

Strong government commitment and leadership in implementing this strategy is critical

for its success. Beyond playing expected roles as spelt out in this strategy, the

Government of Ghana, through the Ministry of Local Government and Rural

Development will ensure that all Regional Ministers and District Chief Executives lead

advocacy in getting all stakeholders at the regional and district levels to play their

expected roles in implementation of this model.

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4 INSTITUTIONAL ARRANGEMENTS FOR IMPLEMENTATION MODEL

The roles and responsibilities of all stakeholders in the implementation of this action

plan and scaling up model has been defined in the national HWTS strategy (see Exhibit

1). The NESPoCC and National Technical Working Group will provide the platform for

coordinating the implementation of activities by all relevant stakeholders. In addition,

existing sector learning platforms, including the National Sanitation Conference, Ghana

Water Forum, Mole Conference and National Level Learning Alliance Platform

(NNLAP) will continue to serve as a platform for sharing lessons on best practices and

for coordinating implementation of activities to minimise overlaps and promote

synergy.

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5 M&E FRAMEWORK FOR IMPLEMENTATION MODEL

It is envisaged that a detailed monitoring and evaluation plan will be developed to

track progress in the implementation of the HWTS strategy. Notwithstanding the

development of this plan, the following arrangements have been proposed to effectively

track progress in the implementation of the HWTS strategy.

5.1 Monitoring Framework

Within the framework of guidelines issued by NDPC for monitoring of sector activities,

the Environmental Health and Sanitation Directorate of the Ministry of Local

Government and Rural Development, working through its network of regional

departments and district environmental health units will track and report on the

implementation of specific activities within their respective areas of jurisdiction. The

EHSD-MLGRD will provide report on progress in implementation of the HWTS

strategy as part of quarterly and annual reports on its activities. Copies of these reports

will be submitted to the Policy, Planning, Budgeting, Monitoring and Evaluation

Directorate (PPBMED) of MLGRD for onward submission to NDPC.

5.2 Evaluation Framework

5.2.1 Indicators

Implementation of the HWTS model and strategy is expected to achieve the objectives

of the HWTS strategy (see section 2.2) and impact on the following indicators:

Knowledge of HWTS

Awareness of HWTS

Practice of HWTS

Accordingly, the following indicators will be assessed at the national, regional and

district levels:

A. Practice - Treatment and Safe Storage (practicing households should score 50% of

total score – comply for one of two criteria)

Number or % of households self-reporting treated water that are confirmed

(through observation or further interaction on specific methods used) to be

treating drinking water.

Number or % of households storing water safely:

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o Storing water in securely covered vessel

o Using designated vessel within household for collection of water from

general storage

o Storing water in vessel out of reach of animals and infants

B. Knowledge and awareness (practicing households should score 75% of total score –

comply for at least three of four criteria, including criteria 3&4)

Number or % of households that think neighbours/others in the community

treat and store drinking water safely.

Number or percentage of households reporting that they have received

training/ have been covered in promotion on HWTS

Number or % of households that can link water hygiene to reduction in

diarrhoeal diseases

Number or % of households that can name at least one effective HWTS

technology

Through periodic surveys carried out by the Ghana Statistical Service including the

Multiple Indicator Cluster Survey and Ghana Demographic and Health Survey, the

EHSD-MLGRD will track and report on progress towards achieving the objectives of

the HWTS strategy. Where necessary, EHSD -MLGRD will commission surveys to

collect relevant data to assess the impact of the HWTS strategy.

5.2.2 Frequency

Monitoring and evaluation of the implementation model will be anchored around

existing sector monitoring and evaluation framework notably DIMES and MINTESA.

These platforms are expected to provide timely (monthly) updates on progress towards

achieving the objectives of the HWTS strategy.

In the interim, the EHSD-MLGRD will rely on data from existing surveys commissioned

by the Ghana Statistical Service and report on the performance indicators annually.

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Exhibit 1 Institutional Arrangements – HWTS Scale up Model

Regional Level

District Level

Area Council Level

Community Level

Planning & Co-

ordination Implementation

Procurement BC –based Promotion Hardware including

after sales O&M M&E

A/C Teams

Districts

Teams

Participation in PPPs

Procurement of NGOs, Private

Sector organisation and

participation in PPPs

Follow up dialogues and sensitisation

through CBHVs/ WATSANs/ WSDBs

and Natural/ opinion Leaders

Carry out evidence-based promotion

campaigns

Capacity Building of District and Area

Council level staff for effective

implementation and O&M

Functionality inventory and reporting

to initiate repair/ replacement

through CBHVs/ WATSANs/ WSDBs

Assessment of technologies – Efficacy

(WQ –spot checks) and mainly O&M

audits

Monitor activities of

implementing NGOs and

private sector

organisations including

weekly assessments

Monitor activities of

implementing NGOs, private

sector and Area Council level

extension staff including weekly

to monthly assessment of

Monitor and validate performance at

District level, and quarterly to semi-

annual assessment of outcomes and

periodic impact evaluations and

clearing house for district level data

NGOs

National Level

Private Sector

Technical Working Group.

Env. Health & San.

Com. Water & San,

Assessment of technologies –

Efficacy of (WQ) and O&M

Technical support to Area Council Staff

to carry out evidence-based

promotion campaigns

Regional

Teams

Quality Assurance of Procurement of

NGOs, Private Sector organisation and

PPP process, and NGOs. Capacity

Building of District level for

procurement and contract

Zoning for implementation

and allocation of lots for

strategy implementation

Knowledge management and input for

strategy review, & District performance

management including awards and

District performance benchmarking,

and assessment of functionality /

performance of PPPs,

Community Action

Planning

Behaviour and practice

monitoring

Review of policy & strategies & formulation of PPP, Knowledge Management Framework

Technical studies and Appraisal of

technologies

Overall Policy/ strategy facilitation, target

setting and implementation (including

reporting)

Overall country level periodic monitoring of

outcomes and impacts Overall Programme Performance Management

Technical assistance to District level on

technology assessments through CWSA

Carry out evidence-based promotion

campaigns

Technology transfer, modification and

user education and after-sales services

Technology transfer, modification and user

education and after-sales services

Carry out evidence-based promotion

campaigns (through Pos where

Monitor weekly assessments outputs,

outcomes – behaviours and practices, as part

of implementation and related/ programme

evaluations (may involve CONIWAS)

Review of Feasibility Assessments d performance of technologies

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