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Improving water, sanitation and hygiene in Tanzania

Approximately 80% of Tanzania’s poor live in rural areas. Their access to water, sanitation and hygiene (WASH) facilities is very low. In 2012, only 12% of all Tanzanians had access to these services (7.5% in rural areas and 20.5% in urban areas). As a consequence women and children have to walk hours a day to fetch water and many people fall ill, suffering from diarrhoea, malaria, typhoid and worm and skin diseases.

The Tabora region is one of the poorest regions of Tanzania. There are no proper roads, so local farmers cannot bring their produce to market. There are no permanent water sources, rivers or lakes, lead-ing to a shortage of water during the dry season. Nevertheless,

Tabora is a major producer of tobacco because the dry climate is excellent for growing the crop.Together with Tabora Development Foundation Trust (TDFT), Simavi worked on a WASH project in 30 rural communities in the Tabora region to improve people’s health, environmental and economic conditions by providing safe water, ef-fective sanitation and improved hygiene practices. Between 2008 and 2013 we focused on improving access to latrines, changing people’s behaviour to use latrines, dispose of faeces safely, wash their hands with soap, and to store and handle drinking water safely. To assess the impact and sustainabil-ity of this project, we conducted desk research and a survey in one of the communities, Usimba, where no other NGOs have been working.

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Improving water, sanitation and hygiene in Tanzania Simavi’s approach

The projectAt the beginning of the project we mobilised community members to establish Water Committees and we provided training to these groups. The Water Committees are responsible for the management and maintenance of the water supply systems and for hygiene promotion and mobilisation in the community. Besides the Water Committee, other community representatives, such as the village executive officer and schoolteachers who provide child-to-child education, were trained. We hired engineers to construct water pumps and the associated boreholes and to train community members on the technical aspects of maintaining these hand pumps. The Water Committees organised, in agreement with the village executive officer and the sub-leaders, awareness raising meetings within the community on the importance of WASH and positive hygiene behaviour. Those meetings are still organised every three months and include, among other things, training in hand washin

WaterTwo years after the closure of the project a striking difference is notable: all water points in Usimba are currently functioning, in contrast to the wider Kaliua district (in which Usimba is situated) and the rest of Tanzania where only 50% are in working order. The hand pumps, with the associated boreholes and wells, give local people immediate access to clean water. Previously,

people sometimes had to walk hours a day to fetch water. The current situation means people in Usimba have to walk less and so have more time to work in the fields, sell produce and make bricks to build houses.

SanitationIn the absence of latrines, most people disposed of their faeces close to their house or in the bushes nearby. Latrine coverage in Usimba, particularly improved latrines, is now higher compared to the rest of the country. Since the start of the project, 52.9% of households in Usimba have built improved latrines, compared to 24% in the rest of the country. Just over 44% of the people in Usimba are still using open pits, compared to 69% elsewhere.

Hygiene behaviourOpen defecation is socially accepted in many parts of Tanzania. However, in Usimba this has completely changed as a result of the project and the active involvement of the community and officials. There is a stigma on people who do not practise good hygiene.

Most people have changed their health behaviour because they understand how hygiene affects their health. However, having knowledge and understanding the context does not automatically lead to behavioural change: people need to be willing to change as well.

The five health principles the project taught were:1. Food hygiene: wash hands before and

after eating; keep food in a clean and safe environment

2. Water hygiene: keep water in a safe condition

3. Personal hygiene: wash hands and take baths

4. Domestic hygiene: keep house and household clean

5. Environmental hygiene: keep surroundings clean

“What has changed the most for me and my family is that our living standard is improved. We can get clean water nearby, we spend less time on getting water. Because of this I can spend more time on selling tomatoes at the market place. I earn more money; with this money I can buy textbooks for my children so they can do well in school now.”

“We did construct an improved latrine, we are still working on it. We want a good latrine because we know now that the use of a good latrine can prevent diseases [such] as UTI [urinary tract infections]”.

“One farmer who lives nearby has 80 cows and sells the milk in our community. He never attended an awareness raising meeting, he does not have a latrine and is said not to be hygienic. People in Usimba talk about him. We do not want to buy his milk anymore, because he doesn’t use a latrine and doesn’t act hygienically,” said a Usimba resident.

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Improving water, sanitation and hygiene in Tanzania Impact of our work

According to a project survey in 2008, hand washing by households before eating was 70% and only 10% after defecation. Today 98% of household members wash their hands with soap before eating and about 96% wash their hands with soap after defecation

“I see changes in the behaviour of the community. When I walk around in Usimba I see clean households, children are well dressed, people eat more healthily and there is less malnutrition. This was different before,” said the chairperson of Usimba

Thanks to these changes people are in better health, mainly through a decrease in diarrhoea. The chairperson of Usimba said, “I see a decrease in diseases, especially diarrhoea, also for children. People are in better health because they have access to safe water, they use the latrine and practise other forms of good hygiene. They can now do their business and work without any problems.”

Locally, health is understood as a feeling of the body. “Health is when I wake up and feel strong or able to work,” said one member of the community. The way people experience their health improved, scoring an average of 2.2 on a scale of 5. According to one villager: “Our health is improved. Before having a latrine we defecated in the bush. The rain and the flies took our faeces into the field

where vegetables grow and into our homes”. Another villager said, “Before we couldn’t wash ourselves regularly. Now it is easy to get water, so we wash more often. We feel cleaner and therefore healthier. We have seen a decrease in skin diseases in our family because of this reason as well.”

Even though most people in Usimba are very satisfied with the new situation, they do have one major complaint – the number of hand pumps is too low, resulting in queues at busy hours. But the majority realises that, “all the traditional wells we were using in the past dried up due to the absence of rain. The pump is available and will always give me water.”

SustainabilityAs explained above, two years after the project ended, all services are still functioning, managed and maintained well, and used by the people. The Water Committee and the village executive officer in Usimba are still organising an awareness raising meeting every three months. According to the officer, around 60% of the community members of Usimba attends an awareness raising meeting at least once a year. People’s health is continuing to improve. Because they are spending less time fetching water, they can do more work and they are earning more money, so their livelihoods will improve. Children are more attentive in school and they generally feel cleaner and better about themselves.

Who

How much

When

Cycle of the effect of improved WASH

Tabora Development Foundation Trust (TDFT)

€382,451

2008–2010; 2011–2013.

BETTER LIVING STANDARD (better and more meals, better health, more healthy cattle, better education, better WASH facilities)

LESS WALKING DISTANCE/ LESS ILLNESS (because of the WASH project)

(at the field/ at the market)

MORE SPARE TIME

MORE TIME TO WORK

RAISE IN EARNINGS

01

0203

04

05

“Before we couldn’t wash ourselves often, now it is easy to get water so we wash more often. We feel more clean and therefore more healthy. We see a decrease in skin diseases in our family because of this reason as well.”

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We are working towards basic health for all

Health is the first step out of poverty

About Simavi Simavi is an international non-profit organisation working towards a world in which basic health is accessible to all. Our goal is to structurally improve the basic health of 10 million people in marginalised communities in Africa and Asia by 2020. By doing so, we enable them to build a better existence and break the cycle of poverty.

Our experience over the past ninety years has shown us thatinvesting in water, sanitation and hygiene (WASH) and in sexual and reproductive health and rights (SRHR) is vital for people to be able to lead a healthy life. Therefore we concentrate our efforts in these two areas.

Theory of ChangeAll our programmes are based on three integrated pillars:1. Empower communities to demand quality services and to

practice healthy behaviour;2. Create a supportive, enabling environment in which all

stakeholders are aware of their roles and responsibilities, work together and can be held accountable;

3. Ensure that people use affordable, suitable and sustainable WASH and SRHR services. This is the core of our Theory of Change – it’s designed to ensure that everyone involved, from community to governmental level, works together towards realising sustainable improvement of basic health.

In the many years Simavi has been active, we’ve built up an extensive network of reliable and capable local partners and gathered a deep understanding of the religious, ethical and cultural sensitivities within every community we work with. This is crucial to realise sustainable change.

We know how to build the capacity of local partners to make sure that the community’s demands are voiced to regional, national and international influential stakeholders, according the law, legislation and regulation of the countries we work in.

We’ve established extensive local and international networks in WASH, SHRH and beyond. We believe that the interaction between these different stakeholders is crucial to learn from each other and to make sure that expertise and experience of our local partners are shared at international WASH and SRHR conferences, as this enables the southern voice in the international debate. In this way we create new synergies and partnerships within our networks, bringing together partners whose expertise complements each other with one goal: to facilitate more people enjoying basic health.