Sustainable Sanitation Services
The Bill and Melinda Gates Foundation is an organization dedicated to fighting poverty, disease, and inequity around the world. It has been working to create a world where every person has the opportunity to live a healthy and productive life. In order to reach their goal, in 2021 alone, the Gates Foundation has been responsible for funding 2,051 grants and contributing a total of $6.7 billion of charitable support to build economies across the globe. With $653 million going to global growth and opportunity, the Gates Foundation has been a leader in improving water, hygiene and sustainable sanitation services globally.

Sustainable Sanitation

Since the main objective of a sanitation system is to provide a clean environment to people living in a community, promote better health and break the cycle of disease in the process. It is imperative that all societies have access to clean, filtered water and sewage systems. Sustainable sanitation is a sanitation system that is economically viable and institutionally appropriate. For example, sustainable sanitation measures should be both socio-culturally acceptable and easy to operate. It should also be low-cost and effective in mitigating disease and preserving the health of the community.

The Importance of Sanitation Services

The World Health Organization (WHO) has reported that “poor sanitation is linked to the transmission of diarrheal diseases.” As the spread of diseases like cholera, dysentery, typhoid and polio contributes to the spread of antimicrobial resistance, proper sanitation is crucial to the development of a community. Often linked to reducing the well-being and economic development of society, sustainable sanitation services are crucial to reducing poverty. However, improving and providing sustainable sanitation services can lead to many more benefits such as:

  • Reducing the spread of neglected tropical diseases.
  • Reducing the impact of malnutrition.
  • Promoting safety and empowering women and girls to employ safe feminine hygiene practices.
  • Promoting school attendance.
  • Encouraging the potential recovery of water and renewable energy.

However, WHO reported that in 2020, only 54% of the world’s population were using safely managed sanitation services and more than 1.7 billion people still don’t have access to basic sanitation services. Since roughly 830,000 people die every year due to the effects of poor hygiene and inadequate water sanitation in low/middle-income countries, it is important to take steps to mitigate the problem.

The Gates Foundation and Its Goals

The Gates Foundation has been working with government leaders and technologists to revolutionize sanitation standards and practices around the world. Their core initiatives include:

  • Promoting and creating policies and outlets for global governments to take in order to establish sustainable sanitation services.
  • Investing in the following priority demographics:
    • Low-Income populations
    • Racial and ethnic minorities
    • Women
    • Children and adolescents
    • Elderly
    • Individuals with special needs
  • Investing in the adoption of new technologies that can radically change the management of human waste in an affordable manner.
  • Conducting research to help the sanitation section develop data and evidence about what works and what does not.

The Four Focus Regions

The Gates Foundation recognizes that the implementation of sustainable sanitation services is most pertinent in sub-Saharan Africa and South Asia. Even in the sub-Saharan countries with the best water coverage rates, as much as 25% of people still lack adequate access to proper sanitation services. The Gates Foundation reports that governments are now beginning to acknowledge the need for more innovative sustainable sanitation solutions as the population of towns and cities begins to grow rapidly. The organization has been focusing on four complementary areas, which are as follows:

  1. Investing in transformative technologies and commercialization is key to making sustainable sanitation accessible. Since 2011, the Gates Foundation has been working to “reinvent the toilet,” by designing a low-cost toilet that does not need access to an electrical grid, water or a sewer system.
  2. The foundation works with local governments, organizations and partners to stimulate the market and community demands to improve urban sanitation conditions.
  3. It also works to improve government policy and advocacy regarding sustainable sanitation by setting guidelines and providing funding. These efforts particularly work to increase women’s participation in sanitation decision-making areas.
  4. Lastly, the Gates Foundation invests in more research to measure the effectiveness of various sanitation services in order to reach its goal of providing equitable and safely managed sustainable sanitation services for all people by 2030.

Goals for the Future

Because poor sanitation is responsible for so many health complications, the Gates Foundation recognizes the importance of expanding access to clean water and providing sustainable sanitation. Solving sanitation challenges in the developing world will require new technologies that are both reliable and cost-effective. It is therefore crucial to invest in proper sanitation to lift poverty-stricken nations.

– Opal Vitharana
Photo: Flickr

Sanitation in Angola
According to USAID, “nearly half the population of Angola (49.3%) lacks access to clean drinking water and (54.7%) of households do not have access to adequate sanitation facilities.” As a result, many Angolans face a high risk of exposure to waterborne illnesses, further burdening the nation’s existing health care infrastructure, worsening malnutrition and negatively impacting the economy.

Moreover, the southern regions of Angola are currently experiencing a prolonged drought, which has gravely impacted the nation’s health, sanitation, water access and also education services. More than 1.2 million Angolans face water scarcity due to the drought. In the Cunene province, the drought has caused “serious disruptions” to school access for nearly 70% of students.

Impacts on Public Health

The lack of access to sanitation and clean water has had devastating consequences for public health and children are the most vulnerable demographic. In Angola, half of the children under 5 are anemic, while another third are estimated to have stunted growth and one-fifth are underweight.

Diarrheal diseases that originate from contaminated drinking water, including cholera, are a leading cause of death in Angola. In 2018, UNICEF reported 1,038 suspected cases of cholera and 17 deaths in the Angolan cities of Uige, Cabina and Luanda.

The World Bank’s Plans to Improve Angola’s Water Quality

Despite the scale of this issue, agencies like the World Bank are taking important measures alongside Angola’s government to improve water quality, in hopes of achieving universal access to WASH services by 2030. Between 2013 and 2016, Angola’s government created 16 provincial water and sanitation utilities aimed at improving water access in urban areas by utilizing independent service providers. In May 2021, Angola’s Ministry of Energy and Water launched a new reform program for the WASH sector.

The World Bank, through this reform program, is evaluating the progress of the Ministry’s working groups, looking at five key opportunities for improvement. These indicators include the significant population growth in Angola that has slowed WASH sector progress, the high rate of susceptibility by poor and malnourished children to WASH-related diarrheal diseases and mortality, the ways in which Angola can invest more effectively in the WASH sector, insufficient institutional and bureaucratic resources to achieve success and inadequate data on the effectiveness of WASH sector improvements.

UNICEF’s Efforts to Aid Angola

In addition, UNICEF is leading an initiative to support Angola by establishing child-centered hubs, known as “safe havens” that support vulnerable communities by concentrating integrated health, sanitation and water services within the same communities. Projections have indicated that these interventions will assist an estimated 341,565 children.

These efforts, which the U.N. Central Emergency Response Fund (CERF) funded, also encompass a supply of 30 5,000-liter water tanks that will end up in drought-affected communities in Cunene province. These tanks will reduce the distances community members travel to acquire water.

UNICEF’s initiative will assist 96,000 women in regions that the nation’s severe drought affected, and projections have stated that 135,000 people will receive WASH sector assistance. Additionally, the initiative will see a shipment of around 12 tonnes of therapeutic milk (used to treat severe acute malnutrition in children) and tablets for water purification delivered to the Cunene and Huila provinces. This relief package is a critical step forward in reducing malnutrition in Angola.

Looking Towards a Brighter Future

The efforts to improve access to water and sanitation in Angola will have transformative effects on not only public health but also education and economic development. Having access to clean water and adequate sanitation greatly reduces children’s risk of contracting waterborne illnesses, allowing them to stay in school. Improving hygiene and sanitation in Angolan communities and schools will spur greater social development, and in turn, reduce poverty.

– Oliver De Jonghe
Photo: Flickr

Water Scarcity
Multiple factors can cause water scarcity including “collapsed infrastructure, distribution systems, contamination, conflict, poor management of water resources, climate change and human interference” according to UNICEF. Water scarcity is common even in well-developed countries. Water scarcity limits access to clean water used for basic hygiene, cooking and cleaning.

The lack of water resources affects hospitals, homes, restaurants, schools and sewage systems. Additionally, water scarcity takes a toll on the economy because of its high value. However, it affects women and children more than anything. Women and children are the sole providers of water and often walk miles to retrieve it. Therefore, children are spending countless hours outside of school, exposing them to unsafe places and exploitation.

UN-Water Summary Progress Report July 2021

The U.N.-Water Summary Progress Report category of drinking water in 2020 stated that 26% of the global population or 2 billion people, did not have access to clean drinking water services. The sanitation category reported that 3.6 billion people or 46% of the global population lacked sanitation services with 494 million people openly defecating in 2020. Furthermore, 2.3 billion people lacked access to a handwashing system with soap and water in 2020. One final note from the hygiene category detailed that 44% of global wastewater did not receive adequate treatment in 2020.

The 2021 U.N.-Water Summary report also mentioned that there is inadequate research on the safety of our groundwater coming from lakes, rivers, streams, etc. Global water-use efficiency has only improved by 10% since 2015. The water stress category outlined that 2.3 billion people live in water-stressed areas in 2020. In the 2020 integrated-water management category, U.N.-Water detailed how 107 countries are not on track to have achieved sustainable water sources by 2030. From 2015 to 2019, there was only a 9% increase in international cooperation with 14 out of 109 countries participating in water and sanitation decision-making.

UNICEF Water Scarcity Key Facts

  • At least one month every year, 4 billion people, two-thirds of the world’s population, experience severe water scarcity.
  • In countries where water supply is deficient, 2 billion people may experience water shortages.
  • As soon as 2025, half of the global population could potentially reside in areas experiencing water scarcity.
  • In 2030, a proposed 7 million people could face displacement from water scarcity.

UNICEF Water Scarcity Response

While there are many reasons for water shortages, UNICEF is working to provide new technology that reaches countries where people are experiencing water scarcity in seven ways. As a first glance, UNICEF is working to identify new water resources through remote sensing, geographical surveys and field investigations. Also, UNICEF is striving to produce efficient water sources that “reduce water leakage and contamination promoting wastewater reuse for agriculture to protect groundwater.”

Furthermore, UNICEF is planning for future water scarcity needs. For instance, UNICEF is expanding technologies to support water sources that can withstand our changing climate. With this in mind, UNICEF is educating schools and communities on water scarcity. On a larger scale, UNICEF is preparing for “national water needs” for domestic, health and sanitation use. Lastly, UNICEF is “supporting the WASH sector” through creating online programs, technical guidance and manuals to improve standards for accessing water.

Organizations Helping People Reach Clean Water

Due to social and cultural inequality, women and children bear the brunt of water-borne illnesses. Hence, the reason organizations similar to The Water Project and exist. The Water Project has been providing access to clean water to remote villages located in sub-Saharan Africa since 2006. As of May 2022, The Water Project has reached 714,350 people with a 96% water flow status.

For the past 30 years, the founders of, Gary White and Matt Damon, have been offering financial solutions to the global water scarcity issue. It all began in 1990 when Gary White started helping Latin communities impacted by water scarcity. Later in 2003, their WaterCredit Initiative launched which enables to financially assist places affected by water scarcity. In 2009, Matt Damon joined the team as a co-founder. So far, reported having improved 45 million lives across 17 countries with access to clean water.

Looking Ahead

Thanks to the organizations and the dedication of U.N.-Water and UNICEF, water scarcity is becoming less of an issue. Hopefully, this issue will reduce, so that women and children may experience safety, good health and education without having to walk miles for water.

Kaley Anderson
Photo: Flickr

Sanitation in Taraba“The importance of water, sanitation and hygiene has been emphasized by the COVID-19 pandemic,” said Stephen Haykin, USAID mission director, at the online signing of a memorandum of understanding (MoU) between USAID and Taraba State on May 21, 2020. The MoU lays out commitments to improve water and sanitation in Taraba, a small state in Northern Nigeria. In a nation where out of more than 203 million Nigerians, 130 million did not have access to basic sanitation in 2020, it is no surprise that sanitation remains a constant discussion among policymakers. However, Taraba grapples with severe sanitation issues — sanitation in Taraba is far worse than in most other Nigerian states. The signing of the State Water Sanitation and Hygiene bill in Taraba on December 19, 2019, brings hope for improvements.

Sanitation in Taraba

To put this issue into perspective, according to a 2020 journal article, Taraba has an open defecation rate of 52.5%, much higher than the national average rate of 37%. The state’s sanitary facilities and services, such as “safe, sanitary disposal of human waste, hand washing and water supply facilities,” are basically non-existent. In a state where roughly nine in 10 people earn less than 90 cents per day, this comes as no surprise.

Aside from that, due to the state’s landscape, wastewater, human feces and other waste materials collect in shallow borehole fields. This leaves Taraba’s people exposed to contamination by germs and chemicals, which can give rise to potentially fatal waterborne illnesses, such as cholera and typhoid.

Not only does the extensive poverty throughout the region worsen the effects of poor sanitation as most are unable to afford medical attention, but the lack of education due to poverty results in poor sanitary practices. Across the most impoverished northern states of Nigeria, on average, only 57% of children attend school, resulting in roughly 8 million out-of-school children as of 2020.

Past Efforts

Along with the State Water Sanitation and Hygiene bill, which aimed to improve the state’s access and use of clean water, in 2019, Governor Darius Ishaku of Taraba urged his people to “engage in proper disposal of solid waste” and “cleaning of teeth and bathing at least once a day,” among other improved sanitation and hygiene practices.  Additionally, up to 2009, the state had imposed a Sanitation Day every month to encourage citizens to engage in sanitary practices and clean-ups. Although this mandate is no longer in effect, the African Development Bank Group says it was “well adopted.”

State Environmental Day

This year, in 2022, the International Technical & Engineering Co. Limited (ITEC LTD), an NGO established in 1981 as a servicing company, appealed to the Taraba State Government to impose a State Environmental Day monthly. The request came after four days of environmental courses, intending to teach locals appropriate waste management and sanitary practices to celebrate this year’s World Environmental Day.

The State Environmental Day aims to set aside time for citizens of the state to take part in clean-ups to address some of the environmental problems Taraba faces. ITEC LTD believes that this will help Taraba engage in the three Rs of waste management: Reduce, reuse and recycle — crucial steps for preserving the environment.

Similar regulations, and clean-ups in general, prove to be effective at addressing environmental concerns, according to multiple studies. It is difficult to note the positives that have come from the COVID-19 pandemic, however, policy changes, such as the potential introduction of Taraba State Environmental Day, indicate that the pandemic has prompted nations to place a renewed focus on environmental issues.

– Lena Maassen
Photo: Flickr

Amsha Africa Foundation
The Amsha Africa Foundation is a nonprofit organization that focuses on improving the living conditions “in African slums and villages.” The organization accomplishes this “by supplying these communities with clean water, food, medical aid, hygiene kits and mosquito nets.” In addition, the program also runs literacy and agricultural education programs while prioritizing housing and sanitation. By reconstructing schools and providing these facilities with resources, the Amsha Africa Foundation prioritizes education as a pathway out of poverty. The organization provides this assistance to several disadvantaged communities in several African countries.

The Founding of Amsha Africa Foundation

In 2008, Tony Abuta began the Amsha Africa Foundation. Now residing in the United States, Abuta grew up in Kenya, which is where he found his passion for helping the people of Africa. In an interview with The Borgen Project, Tony Abuta stated, “I needed to do something about [poverty in Africa], especially after moving to the U.S. and making many return visits to Kenya and other [developing] countries.”

After realizing his privileges in the United States, Abuta knew he needed to help the less fortunate. This led to the start of the Amsha Africa Foundation in early 2008. Abuta worked with his mom and sister to start the groundwork in Kenya, which meant teaming up with community groups, local authorities and other nonprofit organizations. On the organization’s website, Abuta recalled that “In May 2008, Amsha Africa Foundation implemented the Nairobi Slums Project that promoted free medical checkups, tree planting, environmental cleanup, training workshops geared to teach the local community about self-help programs, free testing for STDs, eye and dental problems.”

WASH and Child Protection Programs

The Amsha Africa Foundation has several programs to help those living in poverty. One of these programs is its Water, Sanitation and Hygiene (WASH) program. The organization works with community-based groups to provide access to safe water. Currently, the WASH program is building a runoff harvesting system. This would allow a simply constructed water pan to collect rain that falls on roads, bushes or fields. This project includes building water pans to collect water for livestock watering as well as building a plastic-lined underground tank that would provide a space to store water.

Amsha Africa Foundation also works with partner organizations to “stop child abuse and neglect” through its Child Abuse Prevention program. This program provides “free legal services” to African children enduring abuse. The organization also gives “support [to] children who are forced to work for their survival” and partners with local schools to develop “income-generating activities to support children under situations that would lead to neglect and dropouts.” It has supported a minimum of 100 children who have no option but to work in order to survive and has developed child protection teams in rural areas.

Pen Pal Program

The Amsha Africa Foundation also has a “Dear Friend” pen pal program, which allows children from Kenya and the U.S. the opportunity to create relationships. Abuta said that “This project’s aim is to preserve the art of letter writing for our generation’s children, teaching them to communicate well through the written word. At the moment, we have had 275 children participate in this program.”

U.S. children can participate in this program by having an adult email Katie Burke, the special programs director, at [email protected] with the child’s name, age and gender. Burke will then match the child in the U.S. to a child in Kenya.

One of Amsha Africa Foundation’s health care-focused programs is the Eyeglasses Distribution program, which partners with local communities and the nonprofit Eyes on Africa to provide cost-free eyeglasses to those who do not have access to vision care.

Accomplishments and Successes

Amsha Africa Foundation boasts a number of success stories within its many programs. The Child Abuse Prevention program now has a group of 20 lawyers who offer free legal services to children facing abuse and neglect. The lawyers have given cost-free legal services to assist with 42 cases and are currently working on 120 legal cases.

The organization has also implemented aquaponics in rural Kenya as a part of an Eco-Education program. Abuta stated that “We have set up 38 aquaponics systems across Kenya and trained [more than] 235 individuals on sustainable agriculture. These aquaponics systems have provided these communities with a new source of income and sustainable and nutritious food supply.”

When asked about the success of the Amsha Africa Foundation, Abuta cited the success story of the Eyeglasses Distribution program. Abuta said that “Every year, we partner with Eyes on Africa to provide eyeglasses at no cost to Africans through distribution in communities with no access to vision care. At the moment, we have distributed [more than] 23,000 eyeglasses throughout East and Central Africa.”

Through the ongoing efforts of the Amsha Africa Foundation, impoverished Africans can live a better quality of life while becoming empowered with the tools to break cycles of poverty.

– Sierrah Martin
Photo: Flickr

Slovak Republic Foreign Aid
According to the World Bank, the Republic of Moldova oversaw a reduction of extreme poverty in 2011 from 7% to a rate of 3.1% in 2013. Although the Republic of Moldova has made remarkable progress in reducing extreme poverty, the republic remains one of the poorest countries in Europe. However, the Slovak Republic’s foreign aid is helping communities in Moldova garner clean drinking water and more.

About the Republic of Moldova

The problems facing the Republic of Moldova in reducing poverty include a domestic economy that is highly dependent on agriculture and remittances, a severe drought in 2020 that obstructed agricultural production and the COVID-19 pandemic. Alongside the problems, Russia’s recent invasion of Ukraine has put further strain on Moldova’s administrative capacity as the country is quickly approaching a point in which Moldova can no longer safely accept more refugees. The Republic of Moldova’s Prime Minister Natalia Gavrilita asked the U.S. on March 6, 2022, to send more humanitarian aid assistance in response to  Moldova taking in more than 120,000 displaced people as a consequence of the war in Ukraine.

According to the United Nations 2020 Voluntary National Review on the Republic of Moldova, the country is working towards clean water access for the population. The road towards clean water for Moldova requires addressing the insufficient investment in the management of wastewater. It will also require renewed efforts in water resource management. The problems remain in part due to the lack of institutional reforms and how 54% of the drinking water samples do not meet the sanitary and chemical norms for drinking water quality.

The Republic of Moldova has increased its population’s access to water sources by 9%, to 82.1% at the end of 2018. Furthermore, the proportion of the rural population with access to water supply sources leaped from 56.9% in 2014 to 71.2% in 2018. One can credit this achievement in ensuring access to water sources for the Moldovan people to the continuing combined efforts of the Republic of Moldova, the Slovak Republic and the United States.

A Brief History

The Slovak Republic’s foreign aid programs warrant attention because this government recently joined the fight in eradicating poverty in developing countries. The Slovak Republic initially implemented its foreign aid programs in 2007 with the establishment of the Slovak Agency for International Development Cooperation. The commitments of the programs were expanded upon when the Slovak Republic joined the Development Assistance Committee of the OECD in 2013.

Slovak Republic’s Foreign Aid Today

The scope of the foreign aid programs varies. The Slovak Agency for International Development Cooperation (SAIDC) lists three ‘Programme Countries’ including Georgia, Kenya and Moldova. The government also has several ‘Partner Regions’ in which the cooperation provides foreign aid assistance including Eastern sub-Saharan Africa, the Middle East and the Western Balkans.

In 2020, the Slovak Republic provided $140 million in foreign aid, which represents 0.14% of the 2020 gross national income (GNI). This is a marked increase in foreign aid spending for the country. It places the country as the 26th largest Development Assistance Committee country when comparing the official development assistance it provides to its GNI.

To understand the work that the Slovak Republic’s foreign aid is doing, it is important to take a look at the programs the Slovak Republic is implementing in the Republic of Moldova. The problems that the Republic of Moldova is facing range from a stalemated conflict to complex political, economic and social developments, as well as emigration causing social problems, particularly in rural areas.

Additionally, the problems have compounded due to what SlovakAID deems as development challenges including most of the working-age population going abroad to work, long-term problems with the quality of water resources and drinking water supply, inefficient waste management, the existence of environmental burdens and weak development of the business community. Several of the problems facing the Republic of Moldova today result from inadequate infrastructure, especially water supply and treatment infrastructure which consequently further strains the agricultural sector of the economy.

Goals of SlovakAID in the Republic of Moldova

The three objectives of SlovakAID in Moldova encompass sharing Slovakia’s transition experience supporting a democratic stable Moldova, improving the quality of life and health of citizens via sustainable water management and improving the performance of the business sector.

How is the Slovak Republic Addressing These Problems?

The Slovak Republic employs a range of developmental tools varying from the provision of grants and financial contributions provided by the embassies of the Slovak Republic, Sharing Slovak Expertise programme activities, projects for the deployment of volunteers and expert volunteers, government scholarships and financial contributions.

Progress Towards Prosperity

SlovakAID is leading a project that seeks to improve the quality of life for people in the Ialoveni municipality in Moldova through improving access to clean drinking water and raising awareness about water management. SlovakAID initially started this project in January 2020 with a deadline of March 2022. SlovakAID’s project will support the provision of quality water and sanitation infrastructure, which includes the rehabilitation of 1,035 meters (3,395 feet) of the water connection system to ensure access to reliable drinking water. SlovakAID is also raising awareness regarding water management and environmental responsibility through education campaigns.

The Slovak Republic and its foreign aid recipients have already seen success in similar programs it has completed. In September 2021, the Slovak Republic, in collaboration with Shingala Azad NGO, successfully installed two water wells and a water reservoir that now supplies sufficient water to the people living in the municipalities of Shekhka and Hasan Ava in Iraq. This program’s success was due in part to educational programs raising awareness on water management similar to how SlovakAID is running in the Ialoveni municipality in the Republic of Moldova.

Exciting Developments in Development

According to USAID Administrator Samantha Powers, the Slovak Republic is a foreign aid success story in its own right, joining the EU in 2004 and becoming an international development donor after receiving USAID support between 1990 and 2000. On February 3, 2022, Administrator Samantha Powers and Minister of Foreign and European Affairs of the Slovak Republic Ivan Korčok held a meeting and signed a new Memorandum of Understanding (MOU).

This memorandum calls for an additional three years of collaboration between SlovakAID and USAID. Through the previous MOU the Slovak Republic and USAID jointly supported community development in Moldova, enabling North Macedonia to continue making progress in its path towards joining the European Union and helping those without housing in Belgrade access clean water, sanitation and essential health care.

With this new MOU implemented, the Slovak Republic alongside USAID has renewed its continued commitment to eradicating extreme poverty around the world. Investment in the Slovak Republic via U.S. foreign aid and USAID has shown continued returns on investment. The Slovak Republic has since affirmed its place in the fight against global poverty as the country recently became the 26th highest donor of foreign aid on a GNI per capita basis. Among other returns on investment, the Slovak Republic has been able to branch out its developmental efforts in the neighboring Republic of Moldova and assist far from home in municipalities in Iraq. The Slovak Republic has made great leaps in foreign assistance, but there is much more progress that needs to occur, hence the new MOU is an exciting development for further development.

Chester Lankford
Photo: Flickr

CARE is a nonprofit international organization that has worked for 75 years to create better lives for the underprivileged. In 2020, CARE implemented 1,300 projects that reached 90 million people across 100 countries. The organization’s work focuses on women and girls because it believes that poverty will not undergo eradication until all people have equal rights and opportunities. Two CARE programs in Africa are helping reduce poverty in several different ways.

About Water+

CARE uses many different approaches to help countries all around the world. One approach is Water+, which focuses on using water to alleviate contributing factors of poverty. This program links water to more than just hand-washing and clean drinking water. In order to make the most significant impact possible, it focuses on the connections between water and many other systems, including agriculture, education and nutrition.

In 2013, 14 studies occurred in low-income countries on water, sanitation and hygiene (WASH) interventions that found that WASH interventions improved the height-for-age scores in children below the age of 5 years old. This is significant because malnutrition is the surface cause for stunted growth. However, by improving access to water, sanitation and hygiene, the nutrition of the children improved. The direct link between nutrition, hygiene and poverty means that CARE’s Water+ programs are effectively able to alleviate many contributing factors of poverty.

Water+ puts in extra effort to ensure that the water services it provides receive proper maintenance and financing once they are in place so that they will be sustainable. In 2019, CARE’s Water+ approach has directly impacted 8 million people throughout 56 countries. Here is information about two CARE programs in Africa working to improve circumstances regarding poverty and clean water.


In sub-Saharan Africa, women have limited access to land, water and education, yet they make up 50% of the workforce and are responsible for a large portion of agricultural labor. She’s SMART impacts poverty in Africa by working with female farmers in Mali, Malawi and Ghana, helping them grow more food by using Water Smart Agriculture (WaSA). Women farmers in Mali restored around 225 acres of land to productivity using techniques they learned from the WaSA project.

Women are also receiving encouragement to use CARE’s Village Savings and Loan model because having savings allows them to borrow money for any needs they might have. The Village Savings and Loan Associations (VSLAs) are currently part of a 12-year strategy to support 65 million people as they form groups by 2030. The savings groups usually contain 15 to 25 people that meet up to “save their money in a safe space, access small loans, and obtain emergency insurance.”

Overall, women in Mali report that they retrieve water for their fields half as often since implementing the WaSA techniques and they saw an increase of 18% in their annual income. In Malawi, the women saw a 27% increase in their income, while Ghana saw a 27% decrease in the costs of production. Thanks to She’s SMART, 36,000 women across these three countries have learned to grow and prepare healthy vegetables, and how to use wastewater to reduce the amount of labor for water collection.

CARE’s Nutrition and Hygiene Project

Each year, malnutrition is responsible for almost 50% of child deaths globally. Therefore, it is important to improve sanitation and provide access to clean drinking water in order to prevent communicable diseases that can lead to malnutrition. The CARE Nutrition and Hygiene project lessens the impact of poverty in Africa by improving the nutrition and health of pregnant women and children under the age of 2 years old in Mali by implementing nutrition, water, sanitation, hygiene (WASH) and agricultural interventions. The project takes multiple approaches including helping farmers to produce more nutritious foods, improving the treatment of malnutrition and educating communities on healthy nutrition.

As of August 2019, 48,364 children under the age of 5 years old had improved their nutritional status, 277,838 people had access to an improved sanitation facility, more than 180 communities received open defecation free certification and 9,000 farmers had applied new management or technology practices and increased their food security. At the end of the program interventions in 2019, the project reached 173,000 children under the age of 2 years old, along with 68,300 pregnant and lactating women and 17,500 farmers and their households. There was also a 70% decrease in the prevalence of underweight children.

The Good News

These two CARE programs in Africa were both successful and made an impact on many lives. Past programs also include Glarciares+ which worked to help communities better adapt to changing weather in Peru, and the School Water, Sanitation, and Hygiene plus Community Impact (SWASH+) which focused on “increasing the scale, impact, and sustainability of school water, sanitation, and hygiene (SWASH) programming in Kenya.” Currently, CARE is implementing Rural Access to New Opportunities in WASH (RANO-WASH) which aims to “create solutions for sustainable and equitable water, sanitation, and hygiene (WASH) systems so people can live healthier lives and preserve the environment” in rural parts of Madagascar. With continued efforts, CARE will have a positive impact on communities by focusing on water, sanitation and hygiene programs to alleviate poverty for years to come.

Trystin Baker
Photo: Flickr

Open Defecation in Nigeria
In 2000, the number of people worldwide who practiced open defecation was around 1.3 billion, and in the span of 17 years, the number went down to 670 million people. This was nearly a 50% decrease, according to World Bank. However, the number of people still defecating in the open remains high and the problem needs addressing, which is why countries, such as Nigeria, are tackling the issue head-on. Here is some information about how some are attempting to eliminate open defecation in Nigeria.

About Open Defecation

Open defecation involves a person “passing excreta in open-air locations instead of in hygienic, covered locations,” and can be detrimental to populations due to its potential to cause health problems. The countries with higher rates of open defecation have the highest numbers of malnutrition, poverty and deaths of children 5 years or younger. Open defecation can harm and negatively affect the health of countries’ populations through the contamination of drinking water and the spread of contagious diseases such as cholera, diarrhea and dysentery. Children become most vulnerable to such diseases, and with the elimination of open defecation, the number of premature deaths will also decrease, according to an article from the World Health Organization (WHO).

Nigeria’s Challenge with Open Defecation

An estimated 50 million Nigerians still defecate in the open. Despite its population of about 200 million people, it surpasses India’s numbers, whose population is 1.3 billion people, meaning that the proportion of Nigerians openly defecating is much larger than that of India. Though linked with poverty and poor sanitary facilities, the practice also happens in tertiary institutions as well as in rural areas. Not even one-third of Nigeria has access to basic sanitation, and the numbers have only grown since 2015. With these numbers come the consequences. Poor sanitation, poor education, premature deaths and economic loss affect the country as well.

Solutions for Open Defecation in Nigeria

Despite the high statistics regarding open defecation in Nigeria, the country is attempting to tackle the problem. Nigeria has made progress toward improving sanitation through its “Clean Nigeria: Use the Toilet” campaign. This national campaign aims to completely rid the country of open defecation by 2025 through the encouragement of hygiene behavior in 47 million Nigerians.

Parts of Nigeria, such as the Cross River State, which refers to the Southeastern region, have made progress within the country after becoming the first open defecation-free local government area. Since its introduction in 2019, the campaign has also seen success through the support it received from UNICEF in 2021.

Mission Goals

The goals of the campaign are the following:

  • Political Commitment — Help fund and allocate funds for the campaign in conjunction with political support.
  • Media Support — Gain support from the media to raise awareness of basic hygiene and sanitation.
  • Proper Funding — Increase support for sanitation in underdeveloped areas.
  • Collaboration with Local Groups — Local and civil society organizations join the campaign.
  • Hygiene Awareness Promoted Through Businesses — Work with businesses and corporations to bring awareness through branding and promotion.

With proper support and funding along with collaboration with organizations and media, the “Clean Nigeria: Use the Toilet” campaign can work toward the shared goal of eliminating open defecation in Nigeria — and maybe beyond.

– Michelle Sheen
Photo: Flickr

Flaxseed Oil
Around 689 million people, or 9.2% of the global population, currently live in poverty with less than $1.90 a day. In 2017, Global Citizen reported that “at least half of the world’s population did not have access to essential health care.” Global connections between health care and poverty are distinctly universal, even in the United States. A study by the Institute for Research on Poverty further indicates that practically 70% of the U.S.’s uninsured experience poverty or are on the brink of poverty. Consequently, poverty and low-income status have links to a variety of negative health consequences due to poor sanitation, such as shorter life expectancy. One way to improve sanitation in areas with high poverty is to use flaxseed oil.

Poverty and Sanitation

Research shows that 673 million people continue to defecate in public, such as in city gutters, behind bushes or in open bodies of water; the impacts of poor sanitation are severely detrimental. Poor sanitation exacerbates stunting and contributes to the spread of diseases like cholera, diarrhea, dysentery, hepatitis A, typhoid and polio. This issue is causing diseases such as intestinal worms, schistosomiasis and trachoma. Predictions have determined that poor sanitation causes 432,000 diarrheal deaths per year. Factoring in deaths from all of these diseases, countless people die every year in connection to poor sanitation.

A National Center for Biotechnology Information study found that there is a relationship between sanitation and types of floors. High levels of bacteria such as E. coli are more common in houses with dirt floors in comparison to houses with concrete floors. Proper floors and resources are a solution to this issue; however, concrete is expensive which means it’s hard for the poor to access it. This is where flaxseed oil comes in.

Flaxseed-Supported Floors

After Gayatri Datar traveled to Rwanda with her classmates from Stanford University, she wanted to address the prevalence of dirt floors as around 75% of the population had dirt floors, making people susceptible to certain illnesses. Datar partnered with Zuzow, one of her former classmates, and together they created “a flaxseed oil that, when poured over an earthen floor, dries to form a plastic-like, waterproof and sustainable resin that glues the surface together. The flaxseed is currently imported from India, but EarthEnable [Datar’s organization] is planning to harvest it in Kenya to keep the entire project more local.”

This flaxseed oil is a cheap and effective alternative to concrete floors. The flaxseed oil sealant costs between $2 and $5 per square meter, or around $50 per house, and residents pay it in either one sum or in six monthly installments. The cost is less than the $162 cost of the concrete floors used in Piso Firme, one of the first floor-replacement operations in Mexico.

Connecting Solutions

TECHO – a nonprofit organization – has been doing something very similar. It has “built one-room houses with hard floors, insulated pinewood walls and tin roofs for almost 130,000 families in Latin America since 1997.” All of this together has resulted in a “big drop in childhood incidence of diarrhea in these homes, down 27% or double the improvement Gertler measured for Mexican children whose dirt floors were replaced with concrete.”

Though simple, identifying contributing factors to poverty and poor health can be a meaningful step to increase the quality of life for millions. While EarthEnable and TECHO continue their work, they quite literally work to establish a stronger foundation for those experiencing certain forms of poverty.

– Noya Stessel
Photo: Flickr

Global hepatitis eliminationHepatitis-related illnesses kill someone every 30 seconds. While many strains have treatments, the disease is incredibly prevalent. About 354 million people have hepatitis B or C and around 80% are unable to receive the appropriate care. The illness appears all over the world, as 116 million have it in the Western Pacific Region, 81 million in Africa, 60 million in the Eastern Mediterranean Region, 18 million in South-East Asia, 14 million in Europe and 5 million in the Americas. Global hepatitis elimination is possible with additional steps and education. However, as of right now, hepatitis is clearly very significant across the globe.

What is Hepatitis?

Hepatitis is inflammation of the liver often from infection or liver damage. While acute hepatitis often does not have symptoms, some symptoms can occur including:

  • Muscle and joint pain
  • High temperature
  • Fatigue
  • Loss of appetite
  • Dark urine
  • Pale, grey fecal matter
  • Itchy skin
  • Jaundice

Types of Hepatitis

There are five prominent types of hepatitis:

  1. Hepatitis A: Caused by the hepatitis A virus, people usually catch it when consuming food or drink contaminated with the fecal matter of an affected person. It is more common in places with poor sanitation and typically passes within a few months but could potentially be life-threatening. While there is no specific treatment, professionals recommend vaccination if a person is at “high risk of infection” or traveling to an area where it is more prevalent.
  2. Hepatitis B: Caused by the hepatitis B virus, hepatitis B spreads through “the blood of an infected person.” Hepatitis B is very common globally and typically spreads from an “infected pregnant woman to her babies or [through] child-to-child contact.” Sometimes it spreads through injecting drugs or unprotected sex but that is fairly rare. This strain is significant in southeast Asia and sub-Saharan Africa. Most adults who get it recover in a couple of months, however, children often develop a long-term infection that can lead to cirrhosis and liver cancer. A vaccine exists for hepatitis B.
  3. Hepatitis C: The hepatitis C virus causes this strain and is fairly common globally. Typically, the virus spreads through blood-to-blood contact with an infected person, so sharing needles is significant. Since many do not have symptoms, most people may not know they are sick without testing. One in four people is able to fight off the infection, however, it will stay in others for years. Chronic hepatitis C could cause cirrhosis and liver failure.
  4. Hepatitis D: Caused by the hepatitis D virus, this strain only affects those with hepatitis B. Spread through blood-to-blood or sexual contact, it is prevalent in Europe, the Middle East, Africa and South America.
  5. Hepatitis E: Caused by the hepatitis E virus, people usually catch it by eating raw or undercooked pork, venison, shellfish or offal. Typically, it is a “mild and short-term infection that does not require any treatment,” but people with a weakened immune system may be more at risk.

Other forms include alcoholic hepatitis, which occurs when a person drinks large amounts of alcohol. There is also autoimmune hepatitis, which is rare and occurs when “the immune system attacks and damages the liver.” A medication to reduce inflammation is available. Global hepatitis elimination needs to focus on all strains but especially B and C.

Methods of Reduction

By 2030, diagnostic tests, awareness campaigns, testing and vaccines could prevent 4.5 million deaths in low and middle-income countries. Currently, only 42% of children receive the birth dose of the hepatitis B vaccine. Nevertheless, global hepatitis elimination is very possible. A daily medication taken for 8-12 weeks cures most with hepatitis C and medications for hepatitis B are available. Both hepatitis A and B are preventable with safe and effective vaccines. Vaccinating more children would significantly reduce cases and be a major step towards global hepatitis elimination.

Additionally, since hepatitis A and E both spread mostly in areas with poor sanitation, improvements in sanitation could drastically reduce infections. Testing is another important step as many do not know they have it. In 2019, the World Health Organization (WHO) “estimated that only 10% of people with hepatitis B and 21% of people with hepatitis C worldwide knew they were infected. Of these, 22% and 62% had received treatment, respectively.”

Goals for 2030

The World Health Assembly called for the near or total elimination of viral hepatitis by 2030. This would entail:

  • A 90% reduction in new cases of hepatitis B and C
  • A 65% reduction in deaths
  • Treatment for 80% who have the illness

The Global Immunization Strategic Framework has laid out how to achieve global hepatitis elimination. Goals include strengthening vaccination services, helping improve access to testing and improving the response to outbreaks. Safe vaccines for hepatitis A and B already exist, so improving access to them is important. However, the World Health Organization (WHO) has estimated that only 10% of people with hepatitis B and 21% with hepatitis C know they are sick. That means that improvements in both testing and education are vital first steps before improving vaccination rates. Therefore, global hepatitis elimination is possible with increased testing and vaccination rates.

– Alex Alfano
Photo: Flickr