Transformation for Health in Rural Ethiopia

August 11, 2015


Building improved latrines cuts down on the number of communicable diseases spread by unhealthy sanitation practices in rural villages in Ethiopia.

  • The Ethiopian government has an ambitious plan to end exposure to communicable diseases caused by improper sanitation and hygiene practices in rural areas
  • Through the Water and Sanitation Program, a multi-donor partnership administered by the World Bank, the government has been able to reach more people
  • The program has helped to improve sanitation and hygiene, sparked behavioral change and made villages and woredas safer and healthier for its residents

KURT BAHIR, August 11, 2015 – Kefale Demelash, a local carpenter, built a two-room latrine for use in the Kurt Bahir village where he lives. Inspired by a diarrhea outbreak not long ago, he built one side for women and the other for men. He also built smaller pits for children that were much safer than the traditional ones, and encouraged children to start using latrines.

Demelash’s latrine, which meets international standards for an improved sanitation, encouraged other members of the community to upgrade their latrines. With his help, Kurt Bahir now has 126 improved pit latrines, decreasing the risk for communicable diseases spread by unsafe sanitation habits.

Demelash was recently trained as a village coordinator through the government’s Health Extension Program (HEP), which trains and deploys health extension workers to promote positive health practices in rural areas throughout the country. Through the Water and Sanitation Program (WSP), a five-year-multi donor partnership administered by the World Bank, the government is scaling up its capacity, improving sanitation and hygiene services and increasing access by the poor in 104 selected districts in Amhara, Oromia SNNP and Tigray regional states.

Sanitation and hygiene problems have exposed the rural population of Ethiopia to many kinds of communicable diseases. In its Universal Access Plan (UAP), the Ethiopian government has put an ambitious target to achieve 100% sanitation coverage at national level to address this problem. The WSP is supporting the government as it aims to reach its goal.

Under the program, more than 1,782 trainers and implementers educated more than 7 million people on positive sanitation practices though a community-led Total Sanitation and Hygiene  (CLTSH) approach.

“The training equipped professionals at different levels with the required facilitation skill to mobilize the community to discuss on the sanitation status and agree on collective action to improve their Sanitation and Hygiene situations,” said Kebede Faris, World Bank task team leader for the program. “This has led to an increase in the coverage of sanitation and hygiene, behavioral change, and increased the number of Open Defecation Free (ODF) villages and kebeles in supported woredas.”

Mecha Woreda is among the 104 learning woredas reached, located in Amhara Regional State. Following the training in Mecha, woreda representatives designed an expansion strategy using innovators and model households, broadening village-level improvements until the village became ODF. Through experience sharing, improvements then expanded to the kebele level. Using this expansion strategy, the woredas have been transformed into healthy living environments.

Before the project implementation, open defecation was a challenge throughout the woreda. Now, 52% of the kebeles in the woreda are open defecation free.

“The result of Mecha is one good model brought through this capacity-building support,” said Mulusew Lijalem, Health Promotion and Disease Prevention Core Process Owner in the Amhara Regional Health Bureau.

Medebayzana is another woreda where the program has been implemented. After the training, woreda representatives were able to develop a plan and quickly mobilize the community. To reach all villages within a short period, the woreda initiated a local savings mechanism where the prize money was awarded to the best innovator, performer or implementer of an improved sanitation project. This prompted others to compete for the prize.

Tiberih Tsegaye, who lives in Limat Kebele, Meresa Limat Budin, Adikibdet Village, was honored for her construction of an improved latrine with a shower. Her new latrine also inspired her neighbors to construct improved latrines.

The project and competition have helped Medebayzana to increase the percentage of open defecation-free villages from zero to 50%, with plans to double it to 100%.

“Currently ODF is taken at all levels as strong indicator to monitor sanitation and hygiene program achievements,” said Kiflom Fisseha, deputy head of the Woreda Health Office. “The support provided through this capacity building program was critical to achieve more than 50% ODF status in the Woreda.”

In Mecha and Medebayzana woredas, more than 55,000 households now have improved latrines, and communities have also started applying the sanitation lessons they learned in their daily lives, such as keeping their homes, compounds and communities clean, making themselves safer and healthier.