Municipal Service Project (MSP)

This is the web site of the Municipal Services Project (MSP), which has been running since 2000 and has now entered its third phase (2008-2013). Phase III of MSP is an inter-sectoral and inter-regional study that systematically explores ‘alternatives to privatisation’ in service delivery, with a thematic focus on health, water/sanitation and electricity and a regional focus on sub-Saharan Africa, Latin America and Asia.

MSP partners include universities, labour unions, NGOs, social movements and activists from South Africa, Ghana, Zimbabwe, Bolivia, El Salvador, Canada, UK and The Netherlands. MSP is coordinated by the Institute for Social and Economic Research, Rhodes University, South Africa and the Southern African Research Centre, Queen’s University, Canada. The MSP is funded in large part by the International Development Research Centre (IDRC), and in particular the Governance, Equity and Health (GEH) programme

The MSP web site includes all project publications since the start in 2000 and links to related research, publications and web sites. A discussion forum, and lists of events and multimedia are being developed.

Gates Foundation awards $10.9 million to study impacts of sanitation on diseases

Researchers at the University of California, Berkeley, have received a five-year, $10.9 million grant from the Bill & Melinda Gates Foundation to evaluate several interventions to combat diarrheal disease in developing countries.

Dr. Jack Colford

Dr. Jack Colford, professor of epidemiology at UC Berkeley’s School of Public Health, will coordinate the project, working with the International Centre for Diarrhoeal Disease Research, Bangladesh (ICDDR,B) and Innovations for Poverty Action (IPA).

An estimated 2.2 million children under the age of 5 die from diarrheal diseases each year, according to the World Health Organization. Most of these diseases are thought to be preventable with improvements in sanitation, water quality and hygiene.

Due to the high cost of developing and maintaining large infrastructure projects, such as networked water, there is now a movement toward simpler, alternative methods to improve health in rural areas. However, there is almost no evidence that allows direct comparison of the health benefits or cost effectiveness of these simpler interventions, such as improved latrines, household water treatment and hand washing with soap.

The goal of the new project is to determine how sanitation interventions, delivered alone or as part of combined intervention packages, impact child health and well-being. In addition to improved sanitation, the intervention packages will include drinking water improvements and hand washing solutions. The results have the potential to influence how billions of dollars are directed towards long-term improvements in health and economic outcomes for millions of children each year, said Colford.

“Increasingly, foundations, governments, the World Bank and development agencies such as the MCC (Millennium Challenge Corporation) are demanding evidence of effectiveness when awarding development funds,” said Colford. “Right now, it is unknown whether single interventions are as cost effective as combinations of these interventions. This grant will fund the first large-scale, randomized impact evaluation designed to gather rigorous evidence about this question.”

The study will test the impact of these sanitation, water and hygiene interventions using a large-scale, randomized impact evaluation in Bangladesh and Kenya. These two countries are representative of the two regions that account for the majority of the world’s gastrointestinal disease burden: Southeast Asia and sub-Saharan Africa. The researchers expect to enroll a total of 23,000 children in the trials, which will be monitored by several institutional review boards.

Of the $10.9 million, about $7.9 million will be subcontracted out to the two field sites. Dr. Stephen Luby, head of the Programme on Infectious Diseases and Vaccine Sciences with ICDDR,B, and Michael Kremer, Ph.D., a research affiliate with IPA, will lead the trials in Bangladesh and Kenya, respectively. They will be joined by a team of experts from various disciplines, including public health, economics, behavioral change, nutrition, cognitive development and tropical enteropathy.

Source: Linda Anderberg, UC Berkely News, 05 Nov 2009

Intermittent slow sand filtration for preventing diarrhoea among children in Kenyan households using unimproved water sources

Intermittent slow sand filtration for preventing diarrhoea among children in Kenyan households using unimproved water sources: randomized controlled trial
doi:10.1111/j.1365-3156.2009.02381.x
Published Online: 4 Sep 2009

Sangya-Sangam K. Tiwari 1 , Wolf-Peter Schmidt 2 , Jeannie Darby 1 , Z. G. Kariuki 3 and Marion W. Jenkins 1
1 Department of Civil and Environmental Engineering, University of California, Davis, CA, USA
2 Department of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London, UK
3 Ministry of Health, Nakuru District, Nakuru, Kenya

Objective Measure effectiveness of intermittent slow sand filtration for reducing child diarrhoea among households using unimproved water sources in rural Kenya.

Methods A randomized controlled trail was conducted among populations meeting a high-risk profile for child diarrhoea from drinking river water in the River Njoro watershed. Intervention households (30) were provided the concrete BioSand Filter and instructed on filter use and maintenance. Control households (29) continued normal practices. Longitudinal monthly monitoring of diarrhoea (seven-day daily prevalence recall) and of influent, effluent, and drinking water quality for fecal coliform was conducted for 6 months.

Results Intervention households had better drinking water quality than control households (fecal coliform geometric mean, 30.0 CFU vs. 89.0 CFU/100 ml, P < 0.001) and reported significantly fewer diarrhoea days (86 days over 626 child-weeks) compared to controls (203 days over 558 child-weeks) among children up to 15 (age-adjusted RR 0.46; 95 % CI = 0.22, 0.96). Greater child diarrhoea reduction due to the intervention (age-adjusted RR 0.23, 95 % CI = 0.10, 0.51) was observed among the sub-group using unimproved water sources all of the time.

Conclusion Intermittent slow sand filtration, a non-commercial technology, produces similar observed effects on child diarrhoea as commercial POU products, adding to the range of effective options for poor populations (chlorination, ceramic filtration, solar disinfection, flocculation/disinfection).

Determinants of handwashing practices in Kenya: the role of media exposure, poverty and infrastructure

Determinants of handwashing practices in Kenya: the role of media exposure, poverty and infrastructure
Tropical medicine & international health
Published Online: 30 Sep 2009
doi:10.1111/j.1365-3156.2009.02404.x

Wolf-Peter Schmidt 1 , Robert Aunger 1 , Yolande Coombes 2 , Peninnah Mukiri Maina 3 , Carol Nkatha Matiko 3 , Adam Biran 1 and Val Curtis 1
1 Department of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London, UK
2 Water and Sanitation Program, World Bank, Nairobi, Kenya
3 Steadman Group Kenya, Riverside Drive Riverside, Nairobi, Kenya

E-mail: wolf-peter.schmidt [at] lshtm.ac.uk

Background To explore how structural constraints such as lack of reliable water supply, sanitation, educational and other socio-economic factors limit the adoption of better hygiene.

Methods In preparation for the Kenya National Handwashing Campaign, we conducted a nationwide cross sectional survey in 800 households with two components: (i) direct structured observation of hygiene practices at key junctures (food handling, cleaning a child after defaecation, toilet use), followed by (ii) a structured interview addressing potential socio-economic, water access and behavioural determinants of handwashing.

Results We observed a total of 5182 critical opportunities for handwashing, and handwashing with soap at 25% of these. Handwashing with soap was more often practised after faecal contact (32%) than in connection with food handling (15%). In univariate and multivariate analysis, water access, level of education, media exposure and media ownership were associated with handwashing with soap. Only households with very poor access to water and sanitation, and with the lowest levels of education and media exposure, washed their hands markedly less than the majority of the households.

Conclusion The results underscore that structural constraints can limit hygiene practices in the very disadvantaged sections of a population, thus jeopardizing the potential success of hygiene promotion campaigns in those most at risk of disease. Nevertheless, the strong association of handwashing with media ownership and exposure supports the view that mass media can play a role in hygiene promotion.

Quantifying the burden of disease associated with inadequate provision of water and sanitation in selected sub-Saharan refugee camps

Cronin, A.A. … [et al.] (2009). Quantifying the burden of disease associated with inadequate provision of water and sanitation in selected sub-Saharan refugee camps. Journal of water and health ; vol. 7, no. 4 ; p. 557-68. DOI: 10.2166/wh.2009.089

A WHO methodology is used for the first time to estimate the burden of disease directly associated with incomplete water and sanitation provision in refugee camps in sub-Saharan African countries. In refugee camps of seven countries, containing just fewer than 1 million people in 2005, there were 132,000 cases of diarrhoea and over 280,000 reported cases of malaria attributable to incomplete water and sanitation provision. In the period from 2005 to 2007 1,400 deaths were estimated to be directly attributable to incomplete water and sanitation alone in refugee camps in Ethiopia, Kenya and Tanzania. A comparison with national morbidity estimates from WHO shows that although diarrhoea estimates in the camps are often higher, mortality estimates are generally much lower, which may reflect on more ready access to medical aid within refugee camps. Despite the many limitations, these estimates highlight the burden of disease connected to incomplete water and sanitation provision in refugee settings and can assist resource managers to identify camps requiring specific interventions. Additionally the results reinforce the importance of increasing dialogue between the water, sanitation and health sectors and underline the fact that efforts to reduce refugee morbidity would be greatly enhanced by strengthening water and sanitation provision

Contact: Aidan A. Cronin, Public Health and HIV Section, United Nations High Commissioner for Refugees, Switzerland, E-mail: aacronin [at] gmail.com.

Using water and sanitation as an entry point to fight poverty and respond to HIV/AIDS

Manase, G., Nkuna, Z. and Ngorima,E. (2009). Using water and sanitation as an entry point to fight poverty and respond to HIV/AIDS : the case of Isulabasha Small Medium Enterprise. Physics and chemistry of the earth, Parts A/B/C. Available online 11 July 2009. DOI: 10.1016/j.pce.2009.07.007.

Author abstract: South Africa is faced by a number of challenges that include low water and sanitation coverage in rural and peri-urban areas, high unemployment and increasing inequality between the rich and the poor as indicated by a Gini coefficient of 0.77; the second highest inequality in the world after Brazil. The situation is compounded by high HIV prevalence with South Africa having the largest HIV infection in the world. This case study demonstrates how water and sanitation is used as an entry point to address these major challenges and to empower communities. The project has two main components: the Small Medium Enterprise (SME) that trades in water and sanitation facilities and a community garden that ensure food security and nutrition for people living with HIV/AIDS. Income generated through these activities is ploughed back into the community through construction of sanitation facilities, maintenance of water pipes and paying school fees for orphans. In addition to creating employment, the project has also empowered the community to mobilize and address other challenges such as gender, child abuse and crime. The case study identifies weaknesses with projects designed solely to provide domestic drinking water and sanitation and calls for an integrated approach that uses water and sanitation as an entry point to unlock opportunities and empower the targeted communities.

Contact: Dr. Gift Manase, Council for Industrial and Scientific Research (CSIR), South Africa, gmanase [at] csir.co.za

Networking Event in the Field of Water Management and Sanitation for Europe – Africa – EECA, Vienna, Austria, 16–17 September 2009

The aim of the two-day event is to initiate competitive research project proposals in the field of water management, sanitation and sludge treatment for the upcoming calls of the EU Framework Programme for Research (FP7) in the field of Environment. Following the joint Africa-EU strategy (2007) the European Union launches a cross thematic ‘Africa call’ with 63 million Euros available for funding.

Read more

Uganda: Water is Life Programme to start PhD research in 2010

‘Water is Life: Amazzi Bulamu’ (2007-2011) is a large multi-disciplinary project comprising a partnership of Irish Higher Education Institutions, Makerere University in Uganda and various NGOs.

The Irish Institutes involved are Dundalk Institute of Technology, NUI Maynooth, Dublin City University, Trinity College Dublin, Dublin Institute of Technology Bolton St., The Royal College of Surgeons in Ireland, University College Dublin and Queens University Belfast.

The goal of the partnership, in support of the Government of Ireland’s development goals, is: to build research capacity in Ireland and Africa and to conduct research that supports sustainable water resource management as a catalyst for sustainable economic and social development in rural Uganda.

The project is funded under the Programme for Strategic Cooperation between Irish Aid and Higher-Education and Research Institutes (2007-2011) and is led by Dundalk Institute of Technology.

On 1st January 2010, in collaboration with Makerere University, PhD research will start on the following eight projects:

The eight research projects are:

• Sourcing and distribution of sustainable groundwater supplies for rural water supply;
• Sustainable pump technologies;
• Rainwater harvesting and other appropriate safe water storage mechanisms;
• Solar disinfection of drinking water;
• Water and water management needs: social and health impacts on women and their children;
• Adaptation of water management to climate change;
• The social impact of gendering water resource management;
• Understanding cooperation and conflict in local water governance or Participation and governance in water management systems.

Read more

Schistosomiasis: no funding, more worms in Mali

After a donor-funded national schistosomiasis control programme in Mali ended in 1992, the organ-destroying worm disease that affects about 200 million people worldwide (World Health Organization) rebounded within 12 years, according to a recently published medical study.

The disease can damage the bladder, ureters, kidneys, liver, spleen and intestines.

Even though endemic communities in Mali received intensive treatment and health education on schistosomiasis from 1982-1992, the infection was still as widespread nationwide in 2004 as earlier decades, according to researchers.

Despite the 10-year programme, study leader Archie Clements from Australia’s The University of Queensland said control needs to be delivered even longer – “over a very long time period” – to have a lasting impact.

Since Malian government funding for schistosomiasis ended in 1998, the disease received little attention until the Bill & Melinda Gates Foundation-funded Schistosomiasis Control Initiative started in 2004.

Source: IRIN, 08 May 2009

Estimating the impact on health of poor reliability of drinking water interventions in developing countries

Hunter, P.R., Zmirou-Navier, D. and Hartemann, P. (2009). Estimating the impact on health of poor reliability of drinking water interventions in developing countries. Science of the total environment ; vol. 407, no. 8 ; p. 2621-2624. DOI: 10.1016/j.scitotenv.2009.01.018.

Abstract

Recent evidence suggests that many improved drinking water supplies suffer from poor reliability. This study investigates what impact poor reliability may have on achieving health improvement targets. A Quantitative Microbiological Risk Assessment was conducted of the impact of interruptions in water supplies that forced people to revert to drinking raw water. Data from the literature were used to construct models on three waterborne pathogens common in Africa: Rotavirus, Cryptosporidium and Enterotoxigenic E. coli. Risk of infection by the target pathogens is substantially greater on days that people revert to raw water consumption. Over the course of a few days raw water consumption, the annual health benefits attributed to consumption of water from an improved supply will be almost all lost. Furthermore, risk of illness on days drinking raw water will fall substantially on very young children who have the highest risk of death following infection. Agencies responsible for implementing improved drinking water provision will not make meaningful contributions to public health targets if those systems are subject to poor reliability. Funders of water quality interventions in developing countries should put more effort into auditing whether interventions are sustainable and whether the health benefits are being achieved.

Contact: Prof. Paul R. Hunter, School of Medicine, Health Policy and Practice, University of East Anglia, Norwich, UK, Paul.Hunter@uea.ac.uk