Tesfanesh Eba is a 6th grade student at Lideta Limat school in Addis Ababa. “Previously, both male and female students used the toilets,” she says, indicating two rows of latrines, located in the same place. “The boys used the ones on the left and the girls used the ones on the right.” The girls, however, still weren’t that comfortable, particularly when they were menstruating—so uncomfortable, in fact, that many stayed at home for several days a month, missing school.
The building of new toilets and Menstrual Hygiene Management (MHM) spaces under a multi-sectoral Water Sanitation and Hygiene (WaSH) program supported by the World Bank and seven other development partners in Ethiopia, has made girls feel more comfortable and skip school less often. In Phase II of the One WaSH National Program-Consolidated WaSH Account (One WaSH-CWA) a good 1,074 schools installed a full WaSH package (out of a target of 1,453) and 227 new MHM rooms have been built (since the start of the program in 2019), improving school attendance, especially among girls.
In earlier years, the World Bank focused on the design of projects, primarily the infrastructure needed to aid menstrual health and hygiene. Today, the focus goes deeper, with the integration and institutionalization of learning in the school curriculum and more effort to address menstrual stigma and norms.
One WaSH CWA, which channels donor funding through Ethiopia’s ministries of finance, water and energy, health and education, is due to run to 2025, before entering another ten-year, multi-billion-dollar, multi-phased approach, for which the Ethiopian government is seeking $1.5 billion. “Other schools can learn a lot from this school,” says Tesfanesh. “They can learn that girls are given a big place and they can also learn about how to keep their hygiene. I’m not saying that boys should not be given priority, but female students face challenges.”
Still more needed
Poor menstrual hygiene poses serious health risks, such as reproductive and urinary tract infections that can lead to infertility or complications giving birth. Washing one’s hands after changing your menstrual products can prevent infections such as Hepatitis B and thrush. But about 39% of schools in Ethiopia are still without sanitation facilities and 76% without access to an improved water supply.
One WaSH financing supports the construction, expansion, and rehabilitation of water supplies and the building of latrines, handwashing sinks and taps (faucets), and MHM rooms. Rahel Abdella, a 7th grade student, says the facilities were also built for students with disabilities, providing them separate washrooms and more space. “What you see here is the cleaning room, this is the room for the disabled, and that one is the changing room. Everything has been sorted out for us.”
The budget extends to encouraging school gender and WaSH clubs. “Our teacher taught us about menstrual hygiene and then I signed my friends up to join the club,” says Tesfanesh. “Each of us played a role in teaching students who didn’t have awareness about the issue. We celebrate world Menstrual Hygiene Day every year and raise awareness to male and female students.”
The Second Ethiopia Urban Water Supply and Sanitation Project is part of the broader One WaSh National Program (OWNP), Ethiopia’s main instrument for universal access to integrate WaSH in rural and urban settings. Its objective is to increase people’s access to safely managed water, sanitation, and hygiene services and to strengthen Ethiopia’s capacity for water resources management and service delivery. It has five components—rural, urban, institutional (schools and health facilities), drought hotspots, and institutional strengthening and program management at Ethiopia's Ministry of Water and Energy and respective Regional Water Bureaus.
A study supported by the Global Water Security and Sanitation Partnership (GWSP) shows the link between inadequate access to clean water and proper sanitation and more than 60% of communicable diseases in Ethiopia. Only 8% of the country’s large population of 123.4 million (2022) has handwashing facilities with soap and water. Issues like surface water pollution—stemming from rapid population growth, urbanization, industrialization, and inadequate waste management— compound the problem. In 2017, water-related diseases were a leading cause of death, second only to undernutrition. A 2019 WHO update on the burden of disease related to diarrhea, estimated that for Ethiopia, death and Disability Adjusted Life Years (DALYs) attributable to inadequate wash service is estimated to be 46 percent for an improved community water source, 46 percent for improved on-site sanitation, 29 percent for handwashing with soap, 79 percent for combined basic WASH.
GWSP, an action-oriented think tank for the water sector, is building on the World Bank’s work by providing technical assistance and contributing to the design and implementation of the Bank’s lending operations to help fast track Ethiopia’s One WaSH national program.