WASH

East Meets West’s Output-Based Aid (OBA) programs work closely with local partners to help increase sanitation adoption and access to clean water among people in poor, rural areas of Cambodia, Laos, and Vietnam.

Output-Based Aid has increasingly been recognized as a key financing mechanism to expand access to basic services for the poor and to ensure sustainability. Unlike traditional financing, where payment is made prior to implementation, OBA provides payment based on results after implementation. The donor and service provider agree on a pre-determined payment to ensure service delivery and cost efficiency. The service provider mobilizes private funds to pre-finance investment.

The aim of our sanitation OBA initiatives is to reduce the practice of open defecation for improved individual and community health. We combine stakeholder incentives, community education, and assistance in securing financing to enable poor families to buy and install sanitary household latrines.

The aim of our water supply OBA initiatives is to ensure household service provision that is high-quality and sustainable. We construct new water systems, as well as rehabilitate and extend existing systems, to enable “last mile” delivery.

Lack of access to clean water is a problem for too many people around the globe – one that has enormous negative impacts on their health, productivity, safety, and finances. According to the World Health Organization, at least 1.8 billion people use a drinking-water source contaminated with feces. Contaminated drinking water can transmit a host of diseases—including diarrhea, cholera, dysentery, typhoid, and polio—that typically lead to losses in productivity and necessitate medical treatment that poor populations can ill afford. Worse yet, contaminated water can be a killer: it is estimated to cause half a million diarrheal deaths each year.

East Meets West has been constructing, rehabilitating, and expanding rural water supply and treatments systems since 1995. The majority are piped village water systems with metered household connections; a smaller number are school-based water systems. In all cases, the systems provide poor, mostly rural areas with a lasting source of clean water to promote individual and community health.

Our piped village water systems are designed, implemented, and maintained with maximum community involvement. Residents contribute labor to dig the pipe trenches, purchase their own house connections for water, and pay for water consumption. Water managers selected from each community collect fees for water usage, operate and maintain the systems, and provide feedback to the East Meets West’s water team. Upon project completion, East Meets West transfers ownership and management responsibilities to government, private or community operators. This approach increases the long-term success of each water project.

• 6,615 household water connections in four provinces (Son La, Ha Nam, Nghe An, An Giang) in Vietnam as of December 2019

• 4 manuals with instructions and methodology to formulate full cost recovery tariff and guidance on the approval procedure

• 3 dissemination workshops at national and regional levels

• 2 water kiosks and 20 membrane filters were installed in Chieng Mai Commune, Son La delivering approximately 30,000 liters per day, providing 4,700 local residents with safe drinking water

Despite significant improvements in rural water supply, Vietnam still faces considerable challenges in “reaching the last mile” i.e., providing the poorest quintile of the population with access to clean water and sanitation. Connection costs, technical and financial sustainability issues are among the reasons for limited coverage and low-quality services.

Research in Vietnam shows that the local private sector can deliver efficient water supply service, and be adaptive to new technologies, as well as deliver high quality services in the right contexts. However, current legal conditions and preferential policies on private enterprise are unclear or only partially implemented.

With funding from the Australian government (DFAT), the Private Sector Development in Rural Water Supply Sector project (2016-2020) used government funding to leverage maximum private sector investment while ensuring sustainable and equitable services in Vietnam’s rural water supply sector. While maximizing social welfare for households, the project supported the financial sustainability of private enterprises’ business operations. The results from the project are being used to advocate for regulatory reforms and encourage government buy-in to transparent bidding processes and innovative financing mechanism. The project outcomes also call for appropriate safeguards and service standards, which are critically needed to ensure public health and safety.

When challenging weather conditions such as destructive flooding and powerful storms contaminate surface and ground water, families are forced to drink unclear water, which sickens children and hurts communities. Without proper sanitation and medical treatment, waterborne illnesses such as intestinal worms can devastate a community. Children readily spread the parasites to each other, and the toll from missing school for weeks or even months causes long-term damage to the outcomes of whole villages.

East Meets West’s WASH in Schools program installs water filtration systems and handwashing basins and latrines for kindergartens, primary schools and secondary schools in rural and mountainous areas where daily living conditions of pupils and teachers are very difficult. The program also aims to raise awareness for school hygiene, conducting a behavior change campaign promoting handwashing.

Each water purification system we install delivers drinking water for 400 to 850 students using well-established reverse osmosis and ultraviolet (UV) technologies. As part of the installation of handwashing facilities, we also work with local departments of education to teach students about environmental cleanliness and personal hygiene.

Menstruation is considered taboo in many cultures. A lack of understanding on menstrual beliefs and practices in the local context creates gender biases and inclusion issues in sanitation where people who menstruate (women, girls, non-binary, intersex and transgender people) are left behind in safe access and service.

As part of East Meets West’s Women-led Output-Based Aid project in Cambodia, funded by Australia’s Department of Foreign Affairs and Trade (DFAT), national consultants on menstrual health and hygiene (MHH) have used educational sessions to reach and start conversations with community women and leaders about their hygiene and sanitation needs. Additionally, specific training sessions have been held for commune leaders who now have the capacity to independently conduct MHH education sessions in their own communes.

Government buy-in has allowed for the expansion of this initiative to different districts and communes in Prey Veng and Kampong Chhnang provinces, with thousands of community members participating in the menstrual health and hygiene and nutrition training sessions. Furthermore, commune partners have been able to mobilize their commune funds, with coordination and facilitation from East Meets West, to continue providing MHH training sessions to other communities in these districts. These results underline the feasibility of incorporating and scaling up menstrual health and hygiene initiatives in sanitation programming.

The very first integrated fecal sludge management project in Vietnam is being constructed in Ben Tre province, in the Mekong Delta region of Vietnam. Since 2017, Ben Tre’s provincial government and the Women’s Union have shown their commitment to participate and carry out the Fecal Sludge Management project activities in Ben Tre city.

With the support of the Bill & Melinda Gates Foundation, the project is currently in its the final stage of constructing a fecal sludge treatment plant in Ben Tre city. After three months of trial operation and testing, the plant will be handed over to Ben Tre city government and officially operated by the end of 2020. This treatment plant construction was co-financed by both Ben Tre provincial government and Gates Foundation.

From 2020, with funding from Water for Women Fund, a programme of the Australia’s Department for Foreign Affairs and Trade (DFAT), East Meets West will continue to provide technical support to implement an integrated city-wide fecal sludge management pilot in Ben Tre city. This pilot project will benefit over 600,000 people by solving environmental issues relating to fecal sludge emptied from over 100,000 septic tanks built for the last decade in this city.

• 905,000 Preschool and school-aged children received deworming treatment

• 9,000 Health workers and community leaders trained to deliver hygiene education

• 2,600 Schools received teacher training on administering deworming medication

East Meets West’s deworming program was a three-year, school-based deworming initiative that integrated sanitation and hygiene education to reduce reinfection rates among at-risk children in Vietnam. With funding from philanthropic organization Dubai Cares, the program targeted four rural provinces that have poor sanitation coverage and high rates of soil transmitted helminths (STH) infection. STH (more commonly known as intestinal worms) causes health problems in children that can negatively affect school attendance and ultimately lead to poor life outcomes.

The program provided deworming medication to an estimated 905,000 preschool and school-age children from over 2,600 kindergartens and primary schools. Teachers and community health workers were trained to administer the medicine to their students at school, ensuring a cost-effective and scalable approach.

The provision of deworming medication was complemented by the program’s focus on increasing awareness. The Deworming initiative trained 10,000 individuals across its program locations – teachers, health workers, and local Vietnam Women’s Union members — to deliver education in their communities on improving personal hygiene, reducing the practice of open defecation, and eliminating unsafe soil fertilization practices. Building community awareness about the factors that contribute to infection was key to reducing reinfection rates and increasing program sustainability.

Collaboration was key to the success of the Deworming initiative at all levels. On the ground, the program leveraged the existing infrastructure of schools, teachers, health workers, and local civic groups to implement its activities. In partnership with the nonprofit Evidence Action and the Vietnam Health Environment Management Agency, we generated evidence of the impact of an integrated approach and will advocate with government partners for adoption of an integrated national policy to control STH.

Together with the provision of deworming medicine to at-risk children, a cross-sector approach that addresses these multiple environmental factors was needed to minimize the risk of re-infection and promote sustainable health outcomes.

East Meets West is partnering with the Australian Water Association to pilot innovative technology in installing new community water kiosks in Vietnam. These kiosks are being managed as sustainable businesses by local women as part of the women-led water, sanitation, and hygiene program (WOBA).

Innovative features of the community water kiosks include: 1) new filtration technology (a web-based tool to help communities manage human health risks from water quality), and 2) introduction of competitive bidding amongst current private operators to extend services to rural and remote areas.

In 2020, East Meets West collaborated with the Women’s Union and Provincial Center for Rural Water Supply and Sanitation to install its first brackish water filtration kiosk, providing water to 6,000 households affected by the drought and saltwater intrusion in Ben Tre, Vietnam.