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Published: March 21, 2023

Building better toilets, safer water, and healthier communities

Safe water and sanitation are the most basic of human needs–and are essential to good health. Yet around the world, billions of people lack access to clean water, the ability to wash their hands, or a working toilet. In Kenya, nearly 10 million people drink from contaminated water sources, 5 million people do not have access to a toilet, and just one-fourth of households have soap and water to wash their hands at home.

That’s why water, sanitation, and hygiene (referred to as WASH) are integral to our community-led health model. With the right training and skills, community groups can transform WASH outcomes for their neighbors. They provide information to their communities on the importance of WASH, including handwashing, latrine use, and clean water. Alongside community health workers (CHWs), they also organize action days, during which community members come together to build latrines and handwashing stations and to rehabilitate water sources.

Christine Adhiambo, a member of the WASH committee in North Kamagambo, remembers why she got involved. “Cholera and other waterborne illnesses were common at the time,” she says. “I joined the WASH committee soon after it was founded in 2016 because I wanted to help lessen the disease burden.” After a training from Lwala, the WASH committee began to build awareness among community members on the importance of using a latrine, and they taught their neighbors to treat water with chlorine to prevent illness. They also worked with CHWs to identify households in need of a latrine, or schools and clinics in need of handwashing stations. “As WASH committee members, we lead by example,” Christine says. “We have our own rubbish pits and latrines, and we treat our drinking water.”

Improving access to WASH is also about combating inequity. People living with HIV and other immunocompromised populations are more susceptible to malaria, diarrhea, and other illnesses– meaning access to WASH is of utmost importance in staying healthy. People living with disabilities also face significant challenges in accessing WASH independently, hygienically, and with dignity.

To ensure they are not left behind, Lwala includes vulnerable populations in our WASH work as leaders. Thomas Omollo, for example, led an HIV support group in 2015 when he first heard about ongoing WASH work. He was initially hesitant to get involved because he worried that he and members of the group might have to disclose their HIV status. But after attending a training on WASH, he quickly became a champion–and he helped his village become one of the first communities to reach Open Defecation Free status. “WASH has helped so many people living with HIV to live healthier lives–and it’s also improved my community as a whole,” he says.

Because of the work of WASH committees and local leaders like Thomas and Christine, 3,500 new latrines and nearly 10,000 handwashing stations have been built in Lwala-supported communities. This means the majority of households have the WASH tools they need to keep their families healthy–85% of households now have a functional latrine, a handwashing station, and the ability to treat their drinking water, up from 35% in 2016.

Over the past few years, communities have broadened their mission. “We are moving past the goal of just the presence of latrines in households–we are also focused on their quality so they last longer and are more accessible,” says Peter Nyasita, a community health committee (CHC) member in North Kamagambo. Lwala began working with community groups on pit lining, which uses trapezoidal cement blocks to reinforce the holes dug for latrines. This prevents soil from collapsing or washing away, especially during the rainy season. WASH committees organize demonstration days, where they train local artisans to make and install the trapezoidal blocks. Peter is a key player in his community–a stone mason by profession, he is a natural teacher and mentor for many artisans. Once trained, artisans are contracted to install the pit lining. “We all feel motivated in our work because we are called on by our community,” says Peter.

“We are moving past the goal of just the presence of latrines in households–we are also focused on their quality so they last longer and are more accessible,”
- Peter Nyasita, a community health committee (CHC) member in North Kamagambo.

In addition to pit lining, WASH committees also work with artisans to install SATO stools, a toilet-like device that sits atop latrine holes. These stools make latrines more accessible for anyone who needs more support–like some pregnant women, older people, and people living with disabilities. Through WASH committee leadership, artisan training, and community action days, Lwalasupported communities have improved nearly 1,700 latrines.

For a woman named Teresa, access to WASH has transformed her daily life. A medical condition caused Teresa to lose the use of her legs, but she quickly learned to move around with her hands. This was a challenge when it came to using the bathroom, however, so her CHW flagged this for the local WASH committee. They mobilized neighbors and resources to build a latrine for Teresa, outfitted for her needs, as well as a handwashing station. Lwala staff also connected Teresa with our partner Village Enterprise, which focuses on income generating activities. She now sells cooking oil from her home. “Today I feel stronger and more confident in my skills,” Teresa says. “I learned that my disability is not an inability.”

In Rongo Subcounty, Lwala has a big vision for WASH access–to solve the sanitation and water crisis for the entire population of 125,000. We recently worked with Vanderbilt University to complete a water quality assessment in Rongo, collecting samples from 93 different water sources. We found the presence of bacteria like E. coli in 98% of water sources, and dangerous levels of nitrates in 25%. We also found that many households were not treating water correctly.

In response, we mobilized WASH committees and CHWs to encourage the use of water filters, which CHWs sell for a reduced cost–resulting in the highest number of water filter purchases ever in December. CHWs also recommended alternative water sources for pregnant women and children, who are most at risk. In the longer term, we are exploring larger scale water initiatives, such as piped river water. And at Rongo Subcounty Hospital, we recently rehabilitated a borehole, which now provides water for the facility. This project took place alongside the opening of Rongo’s first operating theater, for which clean water is critical.

As Lwala expands into other subcounties in Migori, our integrated WASH programming is reaching new communities. CHWs remain key allies in identifying households in need, and CHCs are being trained to incorporate WASH into their health improvement initiatives. At the center, is the motivation of leaders like Christine: “I love seeing my community clean. Together, we make sure no one is left behind.”

“I love seeing my community clean. Together, we make sure no one is left behind.”
- Christine Adhiambo, WASH committee member

Agency, health, and wholeness of life.

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