As part of Oxfam’s cholera response in Juba, South Sudan, teams of public health volunteers have been teaching affected communities about the importance of keeping themselves and their environment clean. May 2014. Kieran Doherty/Oxfam.

How humanitarian effectiveness reviews impact our WASH programming

Methodology, Research, Water, Sanitation and Hygiene (WASH)

How Oxfam is using monitoring and evaluation to improve programming on water, sanitation and hygiene in Zimbabwe and beyond. By Katie Whitehouse (Global Urban WASH & Markets Advisor, Oxfam) and Parvin Ngala (WASH & Markets Project Manager, Oxfam Zimbabwe).

As part of Oxfam’s cholera response in Juba, South Sudan, teams of public health volunteers have been teaching affected communities about the importance of keeping themselves and their environment clean. May 2014. Kieran Doherty/Oxfam.

As part of Oxfam’s cholera response in Juba, South Sudan, teams of public health
volunteers have been teaching affected communities about the importance of keeping
themselves and their environment clean. May 2014. Credit: Kieran Doherty/Oxfam.

A key challenge for the sector is translating monitoring and evaluation activities into programme change in the future. The recent publication of WASH Interventions in Disease Outbreak Response (2017) has served to inform programming design, implementation and monitoring of household water treatment (HWT) distributions in Harare, Zimbabwe. It seeks to influence other complementary programming on hygiene promotion, water quality monitoring and borehole maintenance. The programmes were implemented in 2017 in response to a typhoid outbreak in the city.

Advocating changes to conventional WASH interventions for waterborne disease outbreaks
Oxfam had recently conducted a Pre-Crisis Market Analysis (2016) in 6 areas of Harare. Advocating changes to conventional WASH interventions for waterborne disease outbreaks based on the analysis, these also promoted better preparedness and contingency planning for responses. The WASH Interventions in Disease Outbreak Response report served to support Oxfam’s advocacy for the changes in the programming. It built internal commitment to programme structure change by guiding global and country technical staff on programme issues and potential areas for improvement. It also advocated for further research on effectiveness on certain types of interventions where it was lacking but previously assumed as effective.

What are important WASH programme design and implementation characteristics in disease outbreaks? Key findings from the report:

  1. The simplicity supported our decision to choose one type of HWT for distribution to reduce confusion of dosage and messaging.
  2. The timing supported discussions for advocating for better preparedness and use of HWT distributions for risk reduction rather than just response.
  3. The engagement in the community built upon our participatory pre-crisis market analysis and rationale to engage local traders in HWT distribution given the viability of the market in Harare to do so.
  4. Linking relief, rehabilitation and development is supporting discussions on the effect of temporary HWT distributions in responses and timing of water supply chlorination responses with the effectiveness of uptake and use both during outbreaks but outside of outbreak periods too.

The perceptions of HWT reported in the Effectiveness Review matched the outputs of the Oxfam pre-crisis market analysis, which did extensive community level engagement to understand needs and preferences.

Given the lack of good quality evidence of effectiveness, the Zimbabwe team are trying to start incorporating better monitoring and evaluation based on the report. This also supports a key evidence gap for the Global WASH Cluster on the effectiveness of market-based programming for WASH interventions too. Key additions are:

  • Attempts to correlate interventions, suspected and actual cases of typhoid
  • Greater base of quantitative evidence to support qualitative studies
  • Ambition to publish outputs of evaluation to increase quality of evaluation activities
  • Surveys to understand what factors are influencing uptake of HWT in different areas and by different socio-economic groups. These surveys will help to combat the difference in uptake levels, and increase the ability to assess the effectiveness of different approaches, together with the introduction of randomised control testing in future HWT activities should the opportunity arise.
  • Survey to understand if HWT is actually being used in household and correctly through randomised water quality testing
  • Attempts to conduct comparative analysis of the different WASH interventions on HWT trialled compared to traditional approaches which includes cost-efficiency and cost-effectiveness analysis

Conducting the above will be a challenge given new frameworks to conduct such monitoring are in early stages of development, but the ambition is promising. It ensures extensive economic analysis extends not only past understanding the intervention cost, but also the wider local economic benefits of the market. For short-term interventions monitoring these economic impacts will require evaluations some months after the intervention. Zimbabwe is also trialling longer-term risk reduction and resilience programmes aiming to promote increased demand for household water treatment outside of high-risk seasons. Such a programme will require both continuity in delivery and evaluation.

…the ambition is promising. It ensures extensive economic analysis extends not only past understanding the intervention cost, but also the wider local economic benefits of the market.
Oxfam Zimbabwe are in a unique position with the funding provided by OFDA on a project exploring pre-crisis market analysis for WASH. We can conduct research such as this in a crisis and post-crisis setting, which as the review states is often difficult to do. However, without the review these programmes would not have had such a strong evidence basis to promote and resource the changes to the programmes we have implemented. Oxfam and the lead author of the review collaborated recently on a new academic discussion paper published by the BEAM Exchange, Increasing the uptake of household water treatment products: A behavioural, market-based approach with implications for humanitarian interventions and development programming.

The WASH Interventions in Disease Outbreak Response report will also be a key document referenced at the upcoming UNICEF/Oxfam Joint Cholera Initiative event in Harare this week , where a sub-regional support network for cholera preparedness and response from the five cholera prone and high-risk countries are expected to gather (Angola, Malawi, Mozambique, Zambia and Zimbabwe). Here the work in Zimbabwe (with learning to be published on Oxfam Policy and Practice later this year) will also be showcased and there is the hope to continue advocating for adoption of good learning and innovations in future programming.

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