OXFAM GB WASH IN-DEPTH ASSESSMENT · Based on the assessment recommendation, Oxfam designed an EFSL...

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OXFAM GB WASH IN-DEPTH ASSESSMENT HODEIDAH GOVERNORATE YEMEN

AUGUST AND SEPTEMBER 2012 PUBLIC HEALTH TEAM OF HODEIDAH


TABLE OF CONTENTS

Topic # Topics Page #

01 Abbreviation 3

02 Executive Summery 4

03 Background 6

04 Objective of the Assessment 7

05 Methodology of the Assessment 7

06 Village Distribution per District 7

07 Team Composition for Assessment 8

08 Findings of the Assessment 9

8.1 Overview of the Health Status 9

8.2 Water 9

8.2.1 Summary findings of water supply situation in three districts 12

8.3 Excreta Disposal 13

8.4 Hygiene 14

8.4.1 Summary findings of sanitation and hygiene situation in three districts 16

8.5 Water Quality Analysis 17

8.6 Technical Information of the Assessed Water Supply Source 18

09 Possible Challenges/ Limitations 19

10 Recommendations 20

10.1 Summary Recommendations-Water 20

10.2 Summary Recommendations-Sanitation and Hygiene 22

11 How We could do Differently 22

12 Project Management Arrangement 23

13 Annexes (List) 24

14 References 25


ABBREVIATIONS

RTI: RESPIRATORY INFECTION

O&M: OPERATION AND MAINTENANCE

NTU: NEPHELOMETRIC TURBIDITY UNIT

EFSL: EMERGENCY FOOD SECURITY AND LIVELIHOOD

HP: HYGIENE PROMOTION

PHP: PUBLIC HEALTH PROMOTER

PHE: PUBLIC HEALTH ENGINEER

PHP-TL: PUBLIC HEALTH PROMOTER-TEAM LEADER

PHE: PUBLIC HEALTH ENGINEER-TEAM LEADER

HSP: HUMANITARIAN SUPPORT PERSONNEL

MEAL: MONITORING EVALUATION AND LEARNING

WASH: WATER SANITATION AND HYGIENE

PH: PUBLIC HEALTH

PH TEAM: PUBLIC HEALTH TEAM

BH: BORE HOLE

DW: DUG WELL

FGD: FOCUSS GROUP DISCUSSION

U5: UNDER 5

M: METRE

HDW: HAND DUG WELL

RCC: REINFORCED CONCRETE CEMENT

YR: YEMENI RIEL

M: MILLION

KM: KILOMETRE

MIN: MINUTE

WP: WATER POINT

KG: KILOGRAM

ORS: ORAL REHYDRATION SOLUTION

SSS: SALT SUGAR SOLUTION

NGO: NON GOVERNMENT ORGANIZATION

INGO: INTERNATIONAL NON GOVERNMENT ORGANIZATION

NFI: NON FOOD ITEM

GARWSP: GERERAL AUTHORITY FOR RURAL WATER SUPPLY SANITATION PROJECT

LAB: LABORATORY

UDL: URINE DIVERSION LATRINE

AWD: ACUTE WATERY DIARRHOEA

WWD: WORLD WATER DAY

GHWD: GLOBAL HAND WASHING DAY

BoQ: BILL of QUANTITY

CLTS: COMMUNITY LED TOTAL SANITATION

DIA: DIAMETER


EXECUTIVE SUMMERY The assessment results revealed that the Malaria, Diarrhoea, RTI and Skin Diseases are the most common and major diseases in the villages which has greater impact to its health status, morbidity and mortality. It is also proved its lack of the knowledges, means (facilities) and practices within the village communities. Though each & every village having minimum one or two water supply schemes for domestic and irrigation purposes, but the major concern regarding reliability in terms of quantity & quality, functionality, O&M and acceptability of the water. It is revealed that majority water supply schemes were not functioning round the year and producing much less water during summer. Results showed that all the wells (being used as borehole) are reinforced with RCC rings/ stones but it is not protected properly e.g. appropriate cover, sanitary platform and raised side wall are not built, therefore the water of the wells are exposed to further contamination, flooded/ inundated during heavy rain and exposed to threat to people/ children/ livestock. It is observed that some of the villages having water source management committee some are not but their competencies & skill to perform O&M work are questionable. Assessment results showed that more than five water storage containers are available with each & every families but the quality (most of them are damaged/ broken/ dirty) and cleanliness is the major concern. Majority of village community cover their water storage containers at all the time but cleanliness of the lid is the concern. Water filtration and or treatment at household level are not the common practice in these villages, whoever does using only cloth as filtration media. No evidence for using any other means of filtration and or treatment technology. Assessment results showed that especially young children (boys and girls) are responsible to collect water, have to walk distance and spend most of their time to meet their family needs. As they travel distance, essentially the protection issue arise, results shows that 79% of them are feel safe during collection of water remaining 21% not. But hidden number could be more to unsafe. It is also revealed that most of the young girls and women are the vulnerable groups. The assessment results revealed that open defecation at nearby bushes or open fields are the most common practice while limited number of families in each village are using latrines but the question whether these are safe or un-safe. Results showed that most of the latrines are being used for multipurposes e.g. defecation, bathing and washing (especially for women). Latrines are being constructed adapting the concept of ‘urine diversion latrine’, but safe disposal of urine and cleansing water are questionable. Community have the adequate knowledge and skill for building latrines but affordability and materials is their concern. Assessment results strongly showed that the shared or communal latrine is not acceptable, village community prefer to have absolutely individual family latrine. Results revealed (also visible) that the disposal of children faeces is one of the major concern for public health risk, most of the village community just dispose them here & there.


The hygiene situation in most of the villages is critical as there are no systematic and regular hygiene

awareness activities. It is revealed that people are aware and have knowledge at certain extend but

do not practice due to lack of effective awareness and access to facilities. Assessment results

showed that the community have good level of understanding around diseases transmission route.

Solid waste management is another major concern in all the villages, majority of the community in rural villages disposing them in nearby open space or pile-up them surrounding their courtyard as privacy wall. Results revealed that the village community people are aware regarding handwashing at critical moments but they do not practice due to unavailability of facilities and means. It is also revealed that mojority of the village community wash their hands only with water at critical moments (even after defecation). It is showed that significant number of village community wash fruits before eat though quality of water is questionable. Assessment results showed that most of the women in the village community use old cloth/ rags during meanstruation period while some of them use nothing. Literacy rate in general around 30% who are mostly men, women are much less compare to men, it may due to the cultural barrier (restriction of less mobility or given less priority to girls compare to boys). Assessment results shows that four different types of health promotion media exist in the village community. Among them radio is the most common & popular, besides television, local folk songs, printed posters & leaflets are used as media. Village community said that voluntary work is acceptable but they prefer to have women volunteers more compare to men. Assessment results showed that there are different types of activities exist to protect themselves from vector-born risk. Among them chemical spray is the most common practice; nets, burning local plants and other means are also practiced. In order to prevent themselves, majority village community people are asking for nets. According to them, children and women are the most affected group. Field test results showed that the pH of the drinking water is perfect ranging 6.8 – 7.4. The turbidity test resultes showed mosty <5 NTU, few <10 NTU and only one >300 NTU. None of the test results showed the presence of chlorine (at sources or household storage). Physical observation revealed that water are highly acceptable and no presence/ visible of colour, odor/ smell, iron and salinity. Lab test results showed (waiting for getting test results from lab) ......................


BACKGROUND Hodeida governorate is one of the five food insecure governorate in Yemen, in July 2011 Oxfam carried out rapid EFSL assessment in five districts of the governorate, Al Hawk, Al Sukhnah, Bayt Al Faqiah, Al Garrahi and Hays. Assessment recommended immediate cash injection to the poor communities in order to contribute in reduction of food shortage at household level and midterm/ long term water resources management1. Based on the assessment recommendation, Oxfam designed an EFSL Cash Transfer along with Hygiene Promotion (HP) activities for nine districts and has been implementing the project since January 2012. Following recommendations, PH team of Oxfam Hodeidah taken its initiative for conducting in-depth/ comprehensive WASH assessment in three districts (Al-Sukhnah, Hays and Bayt Al Faqiah) where scale-up project activites (EFSL and WASH) is anticipating to implement in near future. This assessment activity not only present us clear and specific information about the WASH situation also help us to design context specific appropriate WASH programmes in future. HP component of the project was mainly giving hygiene messages in three different (sitting) 20 minute long sessions held in 30 clusters followed by volunteers visiting communities at household level. In such short HP intervention can be raised awareness on some aspects of hygiene such as hand washing; in general it is hard to have the desired effect on any change on the hygienic way of life at household level on the communities. At later stage to improve the outcome of HP component more hygiene promotion campaigns in specific areas and villages was carried out. One of the field visit (Nega Bazezew Legesse, PHE Advisor, in June 2012) observation found that the WASH gap is very evident. Not all water sources are functional, and some that are partially functional, the water quality is questionable. Borehole water source in general is not supplying water round the year and not to the overhead tank; instead water is pumped into open concrete tank from where the communities collect water through siphon pipes. Ingress of contaminant to the water source is evident, and this is compounded by the poor water storage and handling at households level. It was also clear that more than 50% of the households in the villages do not have latrines and exercise open field defecation. There is significant gap in the availability of appropriate sanitation facility and water supply for all. Based on these findings, he recommended for scale-up projects focusing more on WASH activities but better integrated with EFSL.

1 EFSL Rapid assessment report July 2011


OBJECTIVE OF THE ASSESSMENT The prime objectives of the WASH assessment are, to:

Be familiar with the present situation regarding WASH facilities including community knowledge and practices.

Generate evidence based information which helps to develop and design context specific appropriate future WASH programming for the most vulnerable communities.

Support the PH Team to plan and fine-tune the WASH activities and methodologies for upcoming scale-up projects even ongoing recovery projects.

METHODOLOGY OF THE ASSESSMENT Assessment has been carried out following methodologies, theese are –

Review secondary reports and ongoing projects proposals.

Develop FGD checklist and close ended questainnaires which include sharing among PH team colleagues, management, field test, update based on feedback & field test, and finally translate into Arabic.

Conduct WASH assessment in 17 villages under three districts; village (each) level assessment comprised of five major activities, such as -

o FGD with male group conducted by two male PH staff; o Close ended questionnaire with female group conducted by two female PH staff; o Together physical observation walk around the village along with community people to

visit existing water supply & sanitation facilities, practices etc; o Collect detail information regarding water supply sources in a separate format. o Conduct water quality test for existing water supply source with three parameters e.g.

pH, Chlorine and Turbidity using field test kit.

Collect water samples from water supply sources and transport them to Hodeidah University Lab (same day) in order to perform microbiological and chemical tests.

Preserve collected information in the computer using Sphinx software for close ended questionnaires (quantitative) and Excel for FGD (qualitative).

VILLAGES DISTRIBUTION PER DISTRICT WASH assessment has been carried out in the following villages –

Name of district # of village Days spent per district

Al Suknah 4 4, 11 and 15 August 2012 (3-days)

Hays 8 12 – 14 August and 26 – 29 August 2012 (7-days)

Bayt Al Faqiah 5 1 – 5 September 2012 (5-days)

Total 17

The graph [above] shows the village distribution for the assessment per district. 47% villages have been selected in Hays while 29% in Bayt Al Faqiah and 24% in Al Sukhnah.

Hay

s

Bayt Al Faqiah

Al Sukhnah


Water samples collected from water supply sources to perform water quality test at Hodeidah University Lab from the following villages –

Name of district # of village/ # of sources Days spent per district

Al Sukhnah 3 12 September 2012

Hays 5 10 and 11 September 2012

Bayt Al Faqiah 3 8 and 9 September 2012

Total 11

The graph [left] shows the village distribution for the water quality test per district. 46% villages have been taken for Hays while 27% for Bayt Al Faqiah and 27% for Al Sukhnah.

The assessment has been conducted in the villages where both ESFL and hygiene promotion activities are implementing under recovery phase, and WASH integrated with EFSL scale-up projects are intending to implement in near future. Villages were selected randamly with thorough discussion with PH & EFSL Team as well as Management based in Hodeidah. [see detail in annex-3] TEAM COMPOSITION FOR ASSESSMENT The assessment team compraised with the following personnel –

1-PHP Officer (National, Male)

1-PHP Officer (National, Female)

1-PHE Officer (National, Female)

1-HSP PHE (Global, Male) Supprt team:

1-PHP Officer (Global, Female)

1-MEAL Officer (National, Male)

1-Translator (National, Male) Beside this, received excellent management, logistic and administrative support from relevent personnel.


FINDINGS OF THE ASSESSMENT The assessment has been conducted in 17 villages under three districts (Al Sukhnah, Bayt Al Faqiah and Hays) of Hodeidah governorate. Assessment has been focussed especially on WASH and linking to malnutrition due to non availability of adequate & safe WASH facilities, knowledge and practices. Entire assessment results have been segregated into six categories, such as – 1. Health Status (covering most common illness, currently suffering illness related to water &

excreta born), 2. Water (covering water quantity, quality, access and use) 3. Excreta Disposal (covering excreta disposal options, excreta disposal practices & preferences and

solid waste disposal), 4. Hygiene (covering health & hygiene practices, public health promotion & community

mobilisation, vector-borne disease & control and malaria control), 5. Water quality testing both at field and lab (covering physical, microbiological and chemical) 6. Detail technical information of each & every water supply source located in 17 assessed villages, For these purposes, assessment team use field tested structural FGD checklists and close ended questionnaires. [see detail in annex-5 and 6] OVERVIEW OF THE HEALTH STATUS The assessment results revealed that Malaria, Diarrhoea, RTI and Skin diseases are the most common and major diseases in the villages. People are currently suffering with these diseases as well. Due to seasonal variation especially during winter, fever, caugh are added with these. Community mentioned that there are cases of mortality in past due to suffering with malaria, diarrhoea and malnutrition. Children U5, elderly women and elderly men are the most affected by these. Ranking of the diseases (accordning to the community) considering both morbidity and mortality – 1. Malaria, Diarrhoea and RTI 2. Skin Diseases Moreover, one of the common and major effect has been observed in village community level that suffering with ‘Malnutrition’. Children, women and elderly are the most affected groups. It is almost certain that this effect due to inadequate & diversified food intake and inadequate & inapprorpiate WASH facilities. Especially the people suffering with all or one illness led them to undernourishment. The health status of all assessed villages in three districts are the same. WATER (water quantity, quality, access and use) In general four different types of water supply sources exist in the villages, these are –

Most common: Dug-well (DW) [dia 1.5-2M, depth 25-100M] attached with submersible pump and engine through power transmission belt or shaft. Water then pumped to the protected (sometime open storage tank, sometimes just raised reservoir tank, sometimes in the irrigation channel) overhead reservoir tank and distributed to the household level through pipe network. Sometimes water pumped and pushed directly to the distribution pipe network. In some cases, there is no overhead tank and no pipe network; people have to travel to the water source for collecting water.

Few regular boreholes found where metal well pipes & filters lowered into the aquifer and attached with submersible pump and engine.

HDWs using bucket (made out of rubber motor inner tube), ropes and pulley to draw water.

HDWs using just bucket and ropes to extract water.


Four inches dia metal pipe being used as well pipe which lowered into the dug-well for all cases. Some of the water sources are functioning very well, some are partially and some are completely non-functional, while majority were producing less water (yield) during dry season. Wells are reinforced with RCC rings/ stones but 95% wells are not protected properly e.g. appropriate cover/lid, sanitary platform and raised side protection wall are not built, therefore the water of the well is exposed to further contamination, flooded/ inundated during heavy rains and exposed to life threat to people/ children. [see detail in annex-1].

Chart [left] shows that 57% wells are functioning properly while 21% partially and 21% non-functioning or damaged.

Reason for non-functioning: chart [left] shows that more than

29% wells are not functioning due to motor/ engine while 21% due to dug well/ borehole, 14% due to distribution network and remaining 7% for other

reasons. The cost: chart [right] shows that 71% of the complete construction cost for the water supply sources are more than a million (YR) [it goes upto even 15M] and remaining 28% are 500,000 – 1M (YR).

Availability of water: chart [left] shows that 36% village community get water 2-4 hrs in a day while 21% only 1-2 days in a week and remaining 6-12 hrs/day or 3-5 days in a week. Pay for the wat

er/hh/month: chart [right] shows that 36% village community pay 1000-2000 (YR) while 36% may not pay anything, 21% less than 1000 (YR) and 7% more than 3000 (YR).

Alternative option: chart [left] shows 64% village community believe that dug-well/ open well could be the alternative option while 28% believe that new well with ropes & pulley or (others) repairing/ renovation of existing well, 7% for new well with mechanised pump and remaining 21% believe rainwater.

Reliability of current water source: chart [right] shows 50% water sources providing water round the year while 21% only during winter, 14% during winter & rainy season and


remaining 14% only rainy season or others (unknown).

Water acceptability (taste): chart [left] shows 79% water sources providing users acceptable water while 21% not. Assessment found that water with high turbid but still it is acceptable by the community because they do not have other alternative options.

Water filtration at point of consumption: assessment results found that 50% community perform filtering water before drink and 50% do nothing. chart [right] shows 43% community use simple cloth filter while 14% prefer boiling, 14% candle filter or others and remaining do not do anything. Distance of water point, collection time and queing time: assessment results pointed out that majority village community having somekind of water supply network systems, or open dug well nearby, it is therefore in response to distance of the water piont from dwelling, majority replied less than 500M. But often they travel distance ranging from 1-4KM to collect water and spending significant amount of time when there is no water in the supply network or dug well dried up (due to unavailability of water in the well or non functioning of engine/ pump). As a results especially young children (boys and girls) have to spend most of their time to collect water to meet their family needs. As they travel distance, essentially the protection issue arise, results shows that 79% of them feel safe during collection of water remaining 21% not. But hidden number could be more to unsafe. It is also revealed that most of the young girls and women are the vulnarable groups.

chart [left] shows that 86% water sources distance from dwelling are less than 500m while 7% are 500-800m and remaining 7% more than 1,000m. Chart [right] shows the queuing time, it is revealed that 36% community have to

wait less than 30 min to get water while 14% 30-45 min and 50% have to wait more than 60 min. chart [left] shows walking time. It is revealed that 64% village comminuty people have to walk 15 min to collect water while 21% 30 min and remaining 14% more than 60 min. Type of containers is available to each household for the collection and storage of water: assessment results

shows that majority households having plastic jerrycane for this purposes while plastic containers is also available especially to store water; besides claypot, plastic bucket are also available. It is revealed that most of the households having atleast more than three containers for the collection


and storing water though quality of the containers are questionable. Though 85% households shared that they have seperate containers for storing drinking water but it is observed during physical visit that most of them are common containers. 50% villages community siad that they clean water containers every time when they collect water while more than 28% said onece in a day. Majority village community clean their containers only with water while more than 21% with sand and more than 22% with ash or clay. Majority village community expressed that they carry water on their head while donkey is also very common and remaining by push cart or motor cycle/ car.

WP Management and O&M of the water source: assessment results found [chart left] that 43% water sources are managed & repaired by management committee while 42% volunteer technicians or (others) relatives, 14% hired/ paid technicians but never get support from government.

Assessment results show that the water handling at the point of consumption is poor. It is also found that the significant numbers of population in the villages are depend on unprotected drinking water sources (which is not safe for the users), and their children especially U5 are at the higher risk of water & excreta born diseases which lead to malnutrition/ underweight compare to their age. Summary findings of water supply situation in three districts:

Sector Al Sukhnah Hays Bayt Al Faqiah

Water All assessed water sources are the same type e.g. well attached with submersible pump and engine through power transmission shaft and also similar type of distribution system e.g. water pumped to the protected overhead reservoir tank and distributed to the household level through pipe network.

All observed water sources are functioning well but producing less water during draught season.

The engine condition

38% [five of thirteen] assessed water sources are attached with submersible pump and engine through power transmission belt while 23% [three] with shaft and 38% [five] with rope, pulley & bucket (simple open dug well).

Five water supply sources are connected to overhead reservoir tank while one direct to the distribution network, one to the irrigation channel and remaining simple open dug-well using rope, bucket & pulley.

No dedicated ropes & bucket being used to extract water from well, therefore not only collected water also water in the well is exposed to further contamination.

Alternatively, motor inner

60% [three of five] assessed water sources are the similar type e.g. well attached with submersible pump and engine through power transmission shaft.

One well using bucket (made out of rubber motor inner tube), rope & pulley to draw water from well.

One village having nothing, community have to walk 1-1.5km to collect water from privately own water source.

Wells of all assessed water sources are reinforced with rcc


of 50% assessed water sources are in good condition while remaining 50% are not as they are so old.

Wells of all assessed water sources are reinforced with rcc rings/ stones and pump attached with metal pipe.

It is found that all wells are not protected properly e.g. appropriate cover, sanitary platform and raised side wall are not built, therefore the water of the well is exposed to further contamination and exposed to life threat to people/ children.

tube being used as bucket to draw water from well which is not safe for public health.

Only 8% [one] water source is functioning very well and remaining 92% are partially with fewer yields during draught season.

Static water tables with majority wells are so deep and required 4-8 people to draw a bucket [8-10L] of water.

Wells of all assessed water sources are reinforced with rcc rings/ stones and pump attached with metal pipe.

It is found that all wells are not protected properly e.g. appropriate cover, sanitary platform and raised side wall are not built, therefore the water of the well is exposed to further contamination and exposed to life threat to people/ children.

33% [three of nine] distribution networks are damaged badly.

rings/ stones.

It is found that all wells are not protected e.g. appropriate cover, sanitary platform and raised side wall are not built, therefore the water of the well is exposed to further contamination and exposed to threat to people/ children.

Wells are functioning partially and low yields while one with high turbid water.

Three of five distribution network are damaged.

[see detail in annex-2] Summing up the table above, the water supply situation in BAYT AL FAQIAH district is the worst while HAYS second and AL SUKHNAH is in better condition compare to other two. Beside, overall O&M condition of the water sources are extremely poor or not there due to lack of functional & skill management committees. EXCRETA DISPOSAL Open defecation at nearby bushes or open field, use safe latrines at their courtyard and un-safe latrines are the most common practices in the villages. The latrines exist in the villages are simple direct drop and off-set pit latrines. No re-inforcement materials are used with pit while locally available materials especially mud or blocks (cement, sand and gravel) are mostly used for the construction of privacy wall. Most of the latrines’ superstructur are without roof while very few of them with roof. In gerneral, the pit size are 1.5-2M dia and 3-4M depth, and the superstructure size varies house to house. Most of the latrines are used for multipurposes e.g. defecation, bathing and washing (especially for women). Majority latrines are constructed adapting the concept of ‘urine diversion latrine’ e.g. urine and cleansing water are diverted outside of the pit. But these are not disposing in a safe mannar, e.g. urine and cleansing water are running through the floor of the latrine which could be a high health risk.


Assessment results show that 71% households having somekind of latrine facilities (but safe or un-safe is questionable) while 29% don’t. 79% of these latrines are simple pit latrine. 43% village community said that the latrines they have it is suffient for all group of people residing in the village and remaining 57% said no which lead more than 57% village community to go for open defecation. Mostly women are using latrine while men prefer to go for open field or bushes. Most of cases women (65%) are responsible for maintaining/ cleaning the latrine. It is observed that most of the latrines (58%) are used, clean and maintained. 93% village community shared that they are familier to construct latrine while only 7% said they hired people from distance. The complete constrcution cost of a latrine are varies village to village. Chart [right] shows that 29% latrine construction cost is around 50,000 (YR) while 57% latrine cost is 50,000-100,000 and 14% latrine cost more than 100,000 (YR). 86% village community shared that only superstructure materials are available locally other materials have to buy from distance. 100% village communiy said (also observed during visit) that they have sufficient/ adequate space to construct latrines. Defecation practice: assessment result shows that 36% village community use latrine and remaining 64% village community people go for open field/ bushes/ designated area during day/ night. 100% village community people expressed that it is certainly pose a threat to public health for all and the physical safety of women and children. 100% village community people strongly expressed that the use of communal or shared latrine is not acceptable. Half (50%) of interviewed village community people said that they use shoes during latrine use or defecation in field. Disposal of children faeces: assessment results shows that 79% of children faeces are through here & there and remaining whether dispose off in the latrine or buried. This practice certainly pose to significant level of public health risk especially for the children and the person who dealt with (women). Solid waste disposal practice: 93% village community shared that current practice of houehold solid waste likely to cause a public health risk. Majority (93%) village community said that each household produce less than 5kg of waste/day. Most of the waste (65%) in the villages just through here & there and remaining whether dispose off in a designated place, sorrounding to their houehold courtyard or compost or burn up. 79% respondent of the villages community said that these can be collected and disposed off in a designated pit. For medical facilities, only 29% of villages have a small medical facilities (pharmacy) who hardly produce clinical waste. They also shared that there is no collection and disposal system as these waste are not significant in volume. Drainage: more than 93% village community expressed that there is no drainage problem. HYGIENE (HEALTH & HYGIENE PRACTICE) The hygiene situation in most of the villages is critical as there are no systematic and regular hygiene awareness activities. It is revealed that people are aware and have knowledge at certain extend but do not practice due to lack of effective awareness and access to facilities. Solid waste management is one of the major concerns in all the villages, majority of the community in rural villages dispose solid waste in nearby open space or pile-up them surrounding their courtyard as privacy wall.


Assessment results reveal the need for comprehensive, systemic and continuous community

awareness/ mobilisation activities on these aspects in order to reduce the public health risk.

Understanding of disease transmission and public health risks: assessment results shows that the community have good level of understanding around diseases transmission route. According to them, through flies and mosquito is the top, water and food is the second, poultry/ livestock and hand is third. Mothers do when their children have diarrhoea: assessment results shows that 86% mothers give medicine to their children when they suffer from diarrhoea and only 14% mothers give them ORS/ SSS. Inaddition, 79% mothers do not know about ORS or home made solution and remaining 21% know about it. Level of awareness around hand washing practice: results revealed that 71% village community people are aware but do not practice and only 29% are aware and practice. In addition, 86% said that soap or other cleansing materials are not available while only 14% said these are available. It is also revealed that mojority of the village community wash their hand only with water at critical moments (even after defecation), with water & ash stood second, with water & sand third and remaining with somekind of detergent (soap or powder). Significant number (93%) of village community people wash their food/ fruits before eating and remaining (7%) do not. Women manage issues related to menstruation: assessment results shows that most of the women in the village community use old cloth/ rags during meanstruation period while next mejority women use nothing and few % of women use sanitary pads. 71% village community women said that appropriate materials are not available locally and remaining 29% said these are available.

Chart [left] shows that 57% community village women wash these cloth in a latrine while 7% at water source/ tap stand and remaining 36% other places. In addition, chart [below] shows that 86% village community women dry these cloth under the sun after washing while 7% in a dark place and remaning 7% other places.

Literacy level among the population:

Chart [left] shows the literacy rate of the village community people. It is revealed that 71% of the village people are less than 30% literate while 21% are 30-50%, only 7% are

50-70% and none more than 70%. Health promotion media - available and accessible to the population: assessment results shows that four different types of health promotion media available in the village community. Among them


radio is the most common & popular, television is the second media, local folk media is the third and printed posters & leaflets are fourth media. Government/ NGOs initiatives for the promotion of public health are not the common activities; around 57% community said there are some activities while remaining 43% said none. Concept of voluntary (unpaid) work: 86% village community said that this concept is acceptable but they prefer to have women volunteers (86%) and remaning said could be the men. Some also said that in each villages man and woman volunteers should be identified, trained and eqquiped. How do people protect themselves from vector-borne risks: assessment results shows that there are different types of activities that community people do to protect themselves from vector-born risk. Among them chemical spray is the most common practice; nets, burning local plants and other means are also common. According to them, children are the most affected group, women are the second and then men. Livestock: every villages community have their own livestock and keeping them at same courtyard that they live. Therefore, the question is how people handle or dispose of animal dung. The assessment results shows that ‘through here & there’ is the most common practice while ‘composting’ is the second option and ‘disposing in a designated pit’ is the third. Vector control program: community says that there are vector control programme activities are exist (64% says) in the villages conducted by government/ NGO at limited scale remaining (36% village community says no. According to them, chemical sprays is the most common activities and distribution of mosquito nets being distributed just once much earlier with limited number/ family. In order to prevent them, majority village community people are asking for nets, few said only information would be useful and some are expecting chemical sprays. Majority village community people mentioned that 2-5 person have been died last year, some says 5-7 people and some says more than 7. According to them children are the most affected group while elderly are the second, women are the third and men is the least. Cover food and water containers all the time: 93% villages community people says that they cover food and water containers all the time but cleanliness is questionable and remaining 7% do not cover or cover but may not all time. Summary findings of sanitation and hygiene situation in three districts:


Sanitati

on and

Hygiene

Majority of assessed village communities having their own latrine (mostly pit latrine and some of them are with septic tank) but not hygienic.

Open defecation is also the common practice.

The condition of water collection and storage

33% [three of nine] village community people having significant number of latrine, 22% [two] village having nothing and remaining 44% village community have certain number but majority are not in hygienic condition.

Open defecation is also

60% [three of five] village communities are so needy and majority families do not have any latrine.

Open defecation is the common practices.

The condition of water collection and storage containers


containers observed so poor (mostly damages/ broken/ dirty.

Found significant lack of hygiene practices though have adequate knowledge.

Solid waste disposal and management systems are not in place.

the common practice.

The condition of water collection and storage containers observed so poor (mostly damages/ broken/ dirty.

Significant lacks of hygiene practices are found though community have adequate knowledge.


observed so poor (mostly damages/ broken/ dirty.

Significant lacks of hygiene practices are found though community have adequate knowledge.


[see detail in annex-2] Abstract of the table above revealed that the sanitation situation in BAYT AL FAQIAH district is the worst while HAYS second and AL SUKHNAH is in better condition compare to other two. Alternatively, hygiene situations (practice level) in all three districts are extremely critical which include hand washing, safe disposal of children faeces & solid waste, protection from vector born risk, menstruation management etc. WATER QUALITY ANALYSIS Water quality test is one of the major pomponent of this assessment. Water quality test has been performed at two levels; 1. test water samples right at the source located in villages using field test kits with parameters of

pH, chlorine and turbidity. Along with these, physical observation for colour, odor/ smell, iron, salty etc have also been performed for each source.

1. collect water samples from selected sources of selected villages and send them to Hodeidah University Lab for conducting microbiological (total coliform, faecal coliform and e-coli), and chemical test (floride, sulphide, nitrate, chloride, calcium, magnesium, sodium, potasium). At field level, tests have been done only for sources while at lab four water samples are collected from three different places these are –

o Two samples from source, one for microbiological and one for chemical test o One sample is collected from reservoir tank or tap stand only for microbiological test o One sample is collected from household storage container (point of consumption) only

for microbiological test Field test results are giving us the primary understanding regarding physical water quality status of the sources while lab test results are giving us the microbiological contamination status of water chain (source to point of consumption) as well as chemical contamination information for source. These information and analysis help us to design and implement appropriately of future WASH programmes. Field test: field test has been conducted in nine different villages with nine diffrent water supply sources. test results shows [table below] that the pH is perfect with all water sources, it is ranging 7.0 – 7.4 mostly, one test result shows 6.8. The turbidity test resultes shows mosty <5 NTU, one <10 NTU and only one >300 NTU. None of the test results shows the presence of chlorine. Physical observation revealed that water are highly acceptable by users and no presence/ visible of colour, odor/ smell, iron and salinity.


Summary of water quality field test results in three districts are mentioned below:

village district pH turbidity (NTU)

Al mahraq Hays 7.4 <5

Al anab Hays 7.2 <5

Al saraq Hays 7.2 <5

Zawbal Hays 7.2 >10

Al jamba'iah Bayt Al Faqiah 7.2 <5

Al dhbeerteen Bayt Al Faqiah 7.0 <5

Basaabias Bayt Al Faqiah 7.2 >300

Al maraazga Bayt Al Faqiah 7.4 <5

Al'abbasi Bayt Al Faqiah 6.8 <5

Lab test results showed (waiting for getting test results from lab) ...................... TECHNICAL INFORMATION ON WATER SUPPLY SOURCES LOCATED IN 17 VILLAGES Assessment team collect the detail information for each & every existing water supply source which include general information, information regarding structure of well (borehole, dug-well etc), information on pump/ engine and information about water quality. Team use a seperate format for this purpose. [see detail annex-1].


POSSIBLE CHALLENGES/ LIMITATIONS Needs: assessment revealed that there are huge needs for WASH facilities especially repairing/ renovation of existing water facilities, sanitation facilities, WASH NFI Kits, Mosquito nets and household water filtration systems (simple cloth filter or local water filters). Installation of new water supply sources/ scheme(s): assessment found that there is in-need to construct new water supply sources/ scheme(s) in some of the selected villages. Women participation: active and equitable women participation in the project cycles along with men could be a challenge. Access to information: ease access for obtaining accurate and authentic information from government line departments as well as other agencies might be challenges. Access to field: due to wide spreading of the village location as well as political unrest and security could be the hindrance of the project staff for smooth implementation and monitoring of project activities. Community contribution: communities may not able to contribute (cash or kind) for the construction of WASH facilities as our target would be to reach most vulnerable families. Conflict within villagers: if our strategy do not support for blanket coverage of the particular village for the provision of WASH facilities, which might create conflict within the villagers and may lead for unexpected delay the implementation of project activities. Capacity and competencies of the PH Team: as of today here in Hodeidah no comprehensive WASH project, only mass HP awareness component at limited scale has been implementing along with EFSL cash injection activity, it is therefore the question around the capacity, competencies and ways of working of the existing PH Team to implement future comprehensive WASH projects. Funding for inclusive WASH projects: till of today, Hodeidah Oxfam does not have funding for exclusive WASH projects or does not have WASH projects integrated with EFSL.


RECOMMENDATION Rehabilitation/ renovation of existing water supply systems to improve water quality & quantity and to prevent the threat of live. This activity may include repairing/ replacing the engine, pump, borehole sources/ pumping & distribution main and network. It could also include cleaning/ sanitising wells, excavate wells deeper, construction of proper protective cover, sanitary platform and raised protection side wall. Provision of pulleys, dedicated bucket & ropes could be another work to be performed. These activities could be done jointly with GARWSP and village committee to perform the assessment of the particular water supply scheme physically, prepare list of materials required, prepare estimated cost for the required materials, identify materials which could be supplied/ provided by GARWSP and which materials need to be procured, perform the necessary work by selected/ GARWSP’s technician. Construction of new protected wells could be considered for the communities with extreme water scarcity, most needed and vulnerable. This could be done jointly with GARWSP and community in a cash or kind sharing basis. Surface Water harvesting which include the construction of subsurface dams to increase the availability of water on shallow wells. This will be in line with the need to look at the water resources management in Yemen that will contribute to prevent water depletion in the country. This could be done with active involvement of community in a cash or kind contribution basis. Small scale piloting and scale up the appropriate and locally available household water filtration/ treatment technologies. Cloth filtration technology could be promoted at mass scale as this practice/ technique already exists. Provision of water storage and collection containers/ jerry canes could be considered to distribute among most vulnerable and needy families. In that case minimum two containers could be considered. Activation/ formation of water supply system management committees including training & refresher on O&M, record keeping, monitoring etc. Water quality testing, monitoring and surveillance activities should be considered at source and point of use level throughout the project intervention period. Cross verification test could be performed at lab (probably 5% of the total tests done by field test kits). District wise prime recommendation for water:


Water Wells need to be digging out deeper so that wells could produce adequate water round the year.

Few engines need to be replaced as these are become so old and not functioning properly.

Appropriate cover, sanitary platform and raised side wall has to be

Dedicated ropes and bucket could be promoted/ provided to extract water from well.

Avoid to use motor inner tube and promote regular heavy metal bucket to draw water from well.

Wells need to be

Dedicated ropes and bucket could be promoted/ provided to extract water from well.

Avoid to use motor inner tube and promote regular heavy metal bucket to draw water from well.

Wells need to be digging out deeper so


built with all wells. digging out deeper so that well could produce adequate water round the year.

Appropriate cover, sanitary platform and raised side wall has to be built with all wells.

Damaged distribution network need to be assessed for future repairing/ renovation.

New hand dug wells could be explored in few villages.

that well could produce adequate water round the year.

Appropriate cover, sanitary platform and raised side wall has to be built with all wells.

Damaged distribution network need to be assessed for future repairing/ renovation.

New hand dug wells could be explored in few villages.

To ensure sustainability (functionality) of the water supply sources necessary measures should be taken regarding –

Formation/ activation of management committees

Capacity building activities (training and refresher) in order to enhance their skill and capacity on O&M.

Promotion of safe excreta disposal would be the major thrust to reduce or eliminate open defecation. Individual household latrine should be promoted as shared latrine is not acceptable. To do this however, facilitate community for the construction/ rehabilitation of context specific, user-friendly improved (existing UDL concept but improved) latrines along with hand washing devices, bathing/ washing facilities. [see detail in annex-9]. This could be done with active involvement of community in a cash or kind contribution basis. Community led latrine construction approach could be followed and triggering tools could be adapted for igniting/ mobilizing the community. Provision of standard hygiene kit, latrine cleaning kit, mosquito nets (minimum two/family) could also be considered to distribute among most vulnerable families. [see detail in annex-10] Promotion of safe solid waste disposal management could be another drive to reduce vector born diseases. The activity could include – collection, separation, disposal in a designated pit (inorganic) and compost (organic). Community led solid waste disposal management approach could be followed and regular village cleaning campaign activities could be adapted for mobilizing the community. Provision of solid waste management kits could be considered to kick-up this activity. Context specific and culturally acceptable hygiene promotion activities could be planned which links to nutrition, AWD prevention, hygiene and environmental sanitation. It could be done at community and household level. Following activities could be considered to include (it will depend on the context, size & duration of the project) –

Link to malnutrition: promotion of food hygiene, dietary diversity, vector control, malaria protection etc.

Safe drinking water: promotion of safe management of potable water (water chain e.g. source to the point of consumption) and O&M of water facilities.

Safe excreta management: promotion of proper use, maintenance and future O&M of sanitation facilities.

Hygiene: promotion of personal hygiene (hand wash, menstrual management etc.), targeted households and neighbourhood, hygiene fair, competition, folk song etc. Regular hygiene


promotional activities through issue based courtyard session, house to house visits, etc with active participation of community.

Waste management/ clean-up campaign: promotion of solid waste, open defecation, solid and other waste clean-up campaign, throughout the villages.

Awareness activities for disease transmission routes and prevention.

Accountability: project information, transparency, complain/ feedback mechanism, community monitoring etc dissemination board.

Selection and training & refresher of volunteers at village level

Formation of village committee, training & refresher

Observation of global events (e.g. WWD, GHWD etc.)

Along with PHPs, villages level volunteers could be identified (preferably more women), trained and equipped in order to assist PHPs to perform above mentioned activities at community level. As the sanitation situation in Bayt Al Faqiah is worst compare to other two districts, it is therefore strongly recommending for giving highest priority to intervene future WASH project. No specific district wise recommendations are given for hygiene promotion as the situation of all three districts nearly the same. HOW WE COULD DO DIFFERENTLY Partner led implementation approach (Partnership approach) should be adapted for future WASH programming, sooner would be beneficial. Prior to inception of the project activities at field, clear and specific implementation strategies, guidelines, tools, design, drawing & BoQs etc should be developed with active involvement of project personnel. ‘Community led implementation approach’ could be followed to implement WASH projects throughout the project cycle. Example- Oxfam could provide technical assistance and materials for the repairing/ renovation/ construction of WASH facilities, and community could do all related work to complete. This will ensure community ownership and sustainability of the project. CLTS approach (may be only Triggering tools) could be adapted based on local culture/ context to implement WASH activities. Village based committees could be activated/ formed (enhance capacity and skills) having specific responsibilities to support Oxfam voluntarily for the identification of beneficiaries, resolving of any unexpected conflict, site selection, procurement, ensuring community participation, monitoring and feedback. Project could focus for improving the efficiency and efficacy of the existing water supply infrastructure (as first priority) rather new, thus community would able to know what to do while it is non-function. Prior to perform these activities, proper joint (community, Oxfam and GARWSP) assessment (technical and financial) should be done through physical observation of targeted water supply sources. Water supply source management committees could be activated/ formed for each source, provide adequate required tools and provide hands on training/ refresher to enhance their capacity and skills for future O&M.


Proper initiative could be taken for establishing effective linkages of these committees (Village and WP management), so that they would able to contact to the right place on right time to full-fill their future needs. Global best practices could be adapted during implementation of WASH projects considering geophysical, social and cultural dynamic. [Eco-sanitation, handpumps, protected drinking water ponds, Bio-gas digester etc. Accountability which including its four dimensions e.g. Transparency, Feedback, Participation and Monitoring & Evaluation should be ensured during implementation of future and ongoing programmes. Exist strategies should be in place during developing and designing of future programmes. This strategies should also be shared among sector actors e.g. community, partners, staff, government line departments, donors and INGOs. Along with project staff, community monitoring system/ approach could be considered in order to assess project progress and their level of changes. Specific attention could be given to include women in project cycles including project activities, decision making, technology choice, site selection and design interventions for inclusion. Oxfam aims to increase equitable participation of gender in project cycles. In the implementation phase, Oxfam aim to enhance equitable roles for both children, adolescent, women, elderly and men, and that aim to 50% of field volunteers are women. A learning sharing meetings/ workshop/ seminars could be organized at the end of each project to share its learning and best practices among stakeholders. PROJECT MANAGEMENT ARRANGEMENT It is strongly recommended that A senior, competent and adequate skill (both managerial and technical) PH personnel (Global PHP or PHE) with adequate AUTHORITY to manage PH Team should be in place. She/ he should play the leadership role to oversee the PH Team (as PH Coordinator) and report to PM but certainly have the freedom and authority in decision making. It is also recommended that under PH Lead personnel (PH Coordinator), only national level PHPs and PHEs should be deployed for future WASH programming. The proposed structure could be (depend on programme size and duration) –

1-PH Coordinator (C2 or C1 Global)

1-PHP-TL and 1-PHE TL (National, D1),

PHEs and PHPs (National, D2),

PHP and PHE Assistants (national, E1)

Volunteers at villages level The Global PH Coordinator should be deployed for certain period of time and should be replaced by Senior C2 level National staff.


ANNEXURES 1. DETAIL INFORMATION REGARDING WATER SOURCES – VILLAGES WISE 2. WASH SITUATION DISTRICT WISE 3. LIST OF THE VILLAGES THAT ASSESSMENT PERFORMED 4. MAP OF AL-HODEIDAH 5. FGD CHECJLIST 6. CLOSE ENDED QUESTIONNAIRE 7. CASE STORY ‘KILLING WELL’ 8. CASE STORY ‘BEHIND THE SCREEN’ 9. IMPROVED LATRINE DESIGN (PROPOSED) 10. WASH STANDARD NFI KITs 11. PHOTOGRAPHS OF WASH SITUATION IN ASSESSED VILLAGES


REFERENCES 1. Rapid WASH Assessment report 01.07.12; Nega Bazezew Legesse, PHE Advisor, in June 2012 2. Oxfam Rapid WASH Baseline Survey, PH Team, January 2012 3. Eco-sanitation, handpumps, protected drinking water ponds, Bio-gas digester etc.

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