Post on 05-Mar-2018
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Republic of Ghana
Ministry of Local Government and Rural Development
NATIONAL STRATEGY FOR HOUSEHOLD
WATER TREATMENT AND SAFE STORAGE
SCALE-UP MODEL
May, 2014
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TABLE OF CONTENTS
TABLE OF CONTENTS ........................................................................................................................................... 2
ACKNOWLEDGEMENTS ....................................................................................................................................... 3
EXECUTIVE SUMMARY ......................................................................................................................................... 5
1 BACKGROUND ............................................................................................................................................... 6
2 OVERVIEW OF NATIONAL HWTS STRATEGY ..................................................................................... 7
2.1 GOALS AND OBJECTIVES.............................................................................................................................. 7
2.2 SPECIFIC OBJECTIVES ................................................................................................................................... 7
3 OVERVIEW OF THE SCALE UP MODEL................................................................................................... 8
3.1 KEY ELEMENTS OF THE IMPLEMENTATION MODEL ................................................................................... 8 3.1.1 Behaviour-First Approach ....................................................................................................................... 8 3.1.2 Public Private Partnerships ..................................................................................................................... 8 3.1.3 Commercial/Business Approach .............................................................................................................. 9
3.2 GEOGRAPHICAL FOCUS OF IMPLEMENTATION MODEL ............................................................................. 9
3.3 IMPLEMENTATION ARRANGEMENTS ........................................................................................................ 10
3.4 WORK PLAN .............................................................................................................................................. 11
3.5 ADVOCACY STRATEGY .............................................................................................................................. 11
4 INSTITUTIONAL ARRANGEMENTS FOR IMPLEMENTATION MODEL .................................... 12
5 M&E FRAMEWORK FOR IMPLEMENTATION MODEL .................................................................... 13
5.1 MONITORING FRAMEWORK ...................................................................................................................... 13
5.2 EVALUATION FRAMEWORK ....................................................................................................................... 13 5.2.1 Indicators ............................................................................................................................................... 13 5.2.2 Frequency .............................................................................................................................................. 14
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ACKNOWLEDGEMENTS
The Ghana Government through the Ministry of Local Government and Rural
Development is grateful to all organizations and individuals who contributed in diverse
ways to the preparation of this strategy document.
The ministry is grateful to the United Nations Children’s Fund (UNICEF) for funding
the project. We acknowledge the Consultants, Marion Kyomuhendo - for providing the
original assessment and initial drafts of the Household Water Treatment and Safe
Storage (HWTS) Strategy; and Stephen Ntow - for the technical inputs during the
validation workshop and final revision of the HWTS Strategy.
The HWTS Technical Working Group members who guided the process of developing
this strategy included Patricia Buah of the Water Directorate (WD) of the Ministry of
Water Resources, Works and Housing (MWRWH) and Kweku Quansah of the
Environmental Health and Sanitation Directorate (EHSD) of the Ministry of Local
Government and Rural Development (MLGRD) who co-chaired the Technical Working
Group; Ebenezer Aidoo and Odartei Lamptey of Precision DX, Araba Sam Annan of
Vestagaard Frandsen, Joyce Maku Appiah and Theodora Adomako-Adjei of the
Community Water and Sanitation Agency (CWSA), Vida Nyenku of EHSD/MLGRD,
Basilia Nanbigne and Ben Arthur of the Coalition of Non-Governmental Organizations
in Water and Sanitation (CONIWAS), Adam Thomas and Samuel Amoako-Mensah of
UNICEF Ghana.
We are also grateful to Mr. David Duncan, Chief of WASH, UNICEF Ghana and Naa
Lenason Demedeme, Ag. Director, Environmental Health and Sanitation Directorate
(EHSD) of the Ministry of Local Government and Rural Development (MLGRD) for
their administrative and technical support.
We are also grateful to the International Network on Household Water Treatment and
Safe Storage (INHWTS) for guidance and direction, especially to the co-hosts Mr.
Michael Akyeamfo Forson (WASH Specialist, UNICEF HQ, USA) and Dr. Margaret
Montgomery (Technical Officer, WHO, Geneva), and Ryan Rowe (Communication
Specialist of the Network) for their advice and providing the required ‘international’
touch to this document, and the WASH Section of UNICEF HQ and WHO HQ for the
technical and administrative support.
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The final version of the national Household Water Treatment and Safe Storage (HWTS)
Strategy documents were put together by Harold Esseku and Joseph Ampadu-Boakye
of Rapha Development Consult. We are grateful to them for collating and putting
together all the comments and suggestions made by various stakeholders to come up
with the three documents comprising the Household Water Treatment and Safe Storage
(HWTS) Strategy for Ghana together with a Scale-Up Model and a Private Sector
Participation Framework.
The three documents are namely:
National Strategy for Household Water Treatment and Safe Storage (HWTS)
National Strategy for HWTS - Scale-Up Model
National Strategy for HWTS - Private Sector Participation Framework.
This document is the National Strategy for HWTS - Scale-Up Model.
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EXECUTIVE SUMMARY
The Ghana Government has launched a National Household Water Treatment and Safe
Storage (HWTS) Strategy which is aimed increasing knowledge, awareness and practice
of HWTS. The purpose is to reduce water related diseases and contribute to achieving
health for all by 2025. The strategy is anchored around seven (7) thematic areas and an
implementation model that adopts a three-pronged approach into scaling up HWTS
nationwide i.e. behaviour-first approach, public private partnership approach and
commercial/business approach.
This country plan defines the step by step approach for rolling out the implementation
model and addressing the overall strategic actions in the National HWTS Strategy.
Implementation of the plan is estimated to cost GHC 2.2million and will span the
period 2014 - 2025. The Government of Ghana will prepare a detailed financing plan
which will among others, review the costing of the strategy and clearly define financing
options including leveraging private sector financing initiatives.
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1 BACKGROUND
Household Water Treatment and Safe Storage (HWTS) significantly reduces the burden
of diarrhoeal and other related diseases which impacts positively on the health status of
people especially children. Regretably, only one (1) out of 10 households in Ghana
treats water before drinking. Only 17% of households that fetch drinking water from
unimproved sources treat their water before drinking. The concomitant effect is the
high prevalence of water related diseases. Contaminated drinking water contributes to
an estimated 10,000 deaths annually from diarrhoeal diseases and diarrhoea is the
fourth leading cause of child deaths in Ghana 1 . To address this challenge, the
Government of Ghana, working in partnership with its Development Partners has
launched a HWTS Strategy. The strategy defines the framework for implementing
HWTS in Ghana.
1 http://www.apromiserenewed.org/Dashboard.html
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2 OVERVIEW OF NATIONAL HWTS STRATEGY
2.1 Goals and Objectives
The goal of this strategy is to contribute to achieving improved health for all by 2025.
This goal will be achieved by pursuing sustainable and effective promotion and
adoption of HWTS as a behaviour and through the use of appropriate technologies that
make drinking water safe at the point of use.
2.2 Specific Objectives
By 2015,
90% of population in the five most vulnerable regions (Upper East, Upper West,
Northern, Central and Volta) are aware of HWTS;
70% of the targeted population have adequate knowledge about the use and
benefit of HWTS in reducing WASH related diseases.
35% of populations in the five most vulnerable regions (Upper East, Upper West,
Northern, Central and Volta) practice safe HWTS methods consistent with their
environment and circumstances.
By 2020,
90% of population in the five most vulnerable regions (Upper East, Upper West,
Northern, Central and Volta) and two most populous regions (Greater Accra and
Ashanti regions) are aware of HWTS;
70% of the entire population of seven regions have adequate knowledge about
the use and benefit of HWTS in reducing WASH related diseases;
50% of populations in the five most vulnerable regions (Upper East, Upper West,
Northern, Central and Volta) and two most populous regions (Greater Accra and
Ashanti regions) practice safe HWTS methods consistent with their environment
and circumstances.
By 2025,
100% of population in all regions including three remaining regions (Eastern,
Brong-Ahafo, Western regions) are aware of HWTS;
90% of the entire population have adequate knowledge about the use and benefit
of HWTS in reducing WASH related diseases;
75% of entire population consistently practice safe HWTS methods consistent
with their environment and circumstances.
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3 OVERVIEW OF THE SCALE UP MODEL
The scale up model defines the key elements of the model, geographical focus,
advocacy strategy and modalities for implementation, monitoring and evaluation.
3.1 Key Elements of the Implementation Model
The model for operationalizing the national strategy on household water treatment and
safe storage is anchored around three (3) interdependent approaches: (i) ’behaviour-
first’ approach (ii) public private partnership; and (iii) commercial/business approach.
These approaches are currently being used for Safe Excreta Disposal (SED) and Hand-
washing with soap (HWWS) interventions. HWTS implementation will dovetail within
and build on these and other related strategies and national policies currently being
implemented in Ghana in an integrated approach rather than a stand-alone programme.
3.1.1 Behaviour-First Approach
This focuses on improving behaviour and attitudes for water treatment and safe
storage.
Establish baseline of behaviour and practice of households, groups and
communities.
Establish knowledge base within households and communities on:
o Water Quality and water-borne diseases, especially diarrhoeal diseases
o Drinking water treatment and safe storage
Assess pre-feasibility of various technologies. Assessment may be done along
broad categories such as filtration systems, chemical treatment, including
chlorine disinfection systems and coagulation/flocculation and UV- Treatment.
Promote HWTS at community level, using Behaviour Change Communication
techniques and campaigns to create demand for technologies.
Identify community level champions to further promote and reinforce the
behaviour. These would include health institutions and school based structures.
3.1.2 Public Private Partnerships
This will focus on leveraging the potential of the private sector to partner with public
sector institutions to develop and roll out innovative programmes to improve HWTS
uptake. Proposed actions include the following:
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Linking households and communities with the private sector to support the
behaviour change initiatives with appropriate and sustainable HWTS
technologies including after-sales support;
Introducing viable financing products including micro-credit and other credit
schemes (e.g. HTWS products purchase on flexible re-payment terms), through
e.g. credit unions and local co-operatives.
It is expected that these partnerships will catalyse effective demand for HWTS.
3.1.3 Commercial/Business Approach
This will focus on creating the enabling environment to support private sector business
initiatives in HWTS with an economic proposition – full cost recovery and potential
profitability. This will involve:
Encouraging the private sector to develop and market HWTS products through
advertisement and interactive sessions with communities and households to
demonstrate the efficacy of their products, basic operation and maintenance, and
after-sales services and support.
The potential profitability also creates an incentive for more companies to enter the
HWTS market. These companies may compete for market share by reducing prices,
improving the quality of their products, developing innovative technologies, and
heavily promoting their products. This is expected to engender public interest in HWTS
products. With more companies manufacturing HWTS products, it may also be easier
to improve production and extend distribution and access across varied geographic
areas and market segments.
3.2 Geographical Focus of Implementation Model
The strategy will be rolled out across all ten (10) regions in Ghana across three main phases:
Phase 1 (2014-2015) - the model will be implemented in the five regions of Ghana
- Central, Upper West, Upper East, Northern and Volta regions. The
implementation will combine the behaviour-first and public private partnerships
approaches;
Phase II (2016-2020) – this phase will build on lessons from best practice from
Phase I; sustain existing interventions in the 5 regions (Phase I) and introduce a
mix of all three approaches in the Greater Accra and Ashanti regions;
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Phase III (2021-2025) – this phase will sustain interventions in the 7 regions
(Phase I and Phase II) and further extend implementation to the two remaining
regions – Eastern and Brong-Ahafo.
In implementing the model, priority will be given to communities using the under
listed criterion:
ODF Communities
Communities with > 50 latrine coverage
Communities requiring emergency interventions, based on risk of endemic
diseases or epidemic.
3.3 Implementation Arrangements
Within the framework of Ghana’s decentralisation programme, the National Water
Policy and Environmental Sanitation Policy, the scale up model will be implemented
across three levels i.e. national, regional and district level. The roles of relevant
stakeholders in the implementation process have been clearly defined in the national
strategy. Given the increasing role of District Assemblies in the implementation of
Government policies and programmes, they are expected to lead implementation in
their respective areas of jurisdiction and will carry out the following:
Mainstream HWTS strategy into their existing District Water and Sanitation
Plans (DWSPs), District Environmental Sanitation Strategy and Action Plans
(DESSAPs) and medium term development plans (MTDPs);
Engage EHSD-MLGRD and relevant institutions to provide adequate training for
district level staff (notably Environmental Health Officers and Community
Development Officers) to HWTS strategy including monitoring and follow up
support mechanism at the district level;
Establishing and providing adequate resources for District and Area Council
level teams comprising EHAs and Community Development extension staff to
promote HWTS;
Ensuring District and Area Council level teams provide required training for
existing community level structures on HWTS including monitoring;
Managing performance based contracts with CSOs (including NGOs/private
sector) on HWTS promotion (where necessary).
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3.4 Work Plan
A work plan on programme activities for implementing the HWTS strategy is presented
in Exhibit 1.
3.5 Advocacy Strategy
Strong government commitment and leadership in implementing this strategy is critical
for its success. Beyond playing expected roles as spelt out in this strategy, the
Government of Ghana, through the Ministry of Local Government and Rural
Development will ensure that all Regional Ministers and District Chief Executives lead
advocacy in getting all stakeholders at the regional and district levels to play their
expected roles in implementation of this model.
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4 INSTITUTIONAL ARRANGEMENTS FOR IMPLEMENTATION MODEL
The roles and responsibilities of all stakeholders in the implementation of this action
plan and scaling up model has been defined in the national HWTS strategy (see Exhibit
1). The NESPoCC and National Technical Working Group will provide the platform for
coordinating the implementation of activities by all relevant stakeholders. In addition,
existing sector learning platforms, including the National Sanitation Conference, Ghana
Water Forum, Mole Conference and National Level Learning Alliance Platform
(NNLAP) will continue to serve as a platform for sharing lessons on best practices and
for coordinating implementation of activities to minimise overlaps and promote
synergy.
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5 M&E FRAMEWORK FOR IMPLEMENTATION MODEL
It is envisaged that a detailed monitoring and evaluation plan will be developed to
track progress in the implementation of the HWTS strategy. Notwithstanding the
development of this plan, the following arrangements have been proposed to effectively
track progress in the implementation of the HWTS strategy.
5.1 Monitoring Framework
Within the framework of guidelines issued by NDPC for monitoring of sector activities,
the Environmental Health and Sanitation Directorate of the Ministry of Local
Government and Rural Development, working through its network of regional
departments and district environmental health units will track and report on the
implementation of specific activities within their respective areas of jurisdiction. The
EHSD-MLGRD will provide report on progress in implementation of the HWTS
strategy as part of quarterly and annual reports on its activities. Copies of these reports
will be submitted to the Policy, Planning, Budgeting, Monitoring and Evaluation
Directorate (PPBMED) of MLGRD for onward submission to NDPC.
5.2 Evaluation Framework
5.2.1 Indicators
Implementation of the HWTS model and strategy is expected to achieve the objectives
of the HWTS strategy (see section 2.2) and impact on the following indicators:
Knowledge of HWTS
Awareness of HWTS
Practice of HWTS
Accordingly, the following indicators will be assessed at the national, regional and
district levels:
A. Practice - Treatment and Safe Storage (practicing households should score 50% of
total score – comply for one of two criteria)
Number or % of households self-reporting treated water that are confirmed
(through observation or further interaction on specific methods used) to be
treating drinking water.
Number or % of households storing water safely:
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o Storing water in securely covered vessel
o Using designated vessel within household for collection of water from
general storage
o Storing water in vessel out of reach of animals and infants
B. Knowledge and awareness (practicing households should score 75% of total score –
comply for at least three of four criteria, including criteria 3&4)
Number or % of households that think neighbours/others in the community
treat and store drinking water safely.
Number or percentage of households reporting that they have received
training/ have been covered in promotion on HWTS
Number or % of households that can link water hygiene to reduction in
diarrhoeal diseases
Number or % of households that can name at least one effective HWTS
technology
Through periodic surveys carried out by the Ghana Statistical Service including the
Multiple Indicator Cluster Survey and Ghana Demographic and Health Survey, the
EHSD-MLGRD will track and report on progress towards achieving the objectives of
the HWTS strategy. Where necessary, EHSD -MLGRD will commission surveys to
collect relevant data to assess the impact of the HWTS strategy.
5.2.2 Frequency
Monitoring and evaluation of the implementation model will be anchored around
existing sector monitoring and evaluation framework notably DIMES and MINTESA.
These platforms are expected to provide timely (monthly) updates on progress towards
achieving the objectives of the HWTS strategy.
In the interim, the EHSD-MLGRD will rely on data from existing surveys commissioned
by the Ghana Statistical Service and report on the performance indicators annually.
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Exhibit 1 Institutional Arrangements – HWTS Scale up Model
Regional Level
District Level
Area Council Level
Community Level
Planning & Co-
ordination Implementation
Procurement BC –based Promotion Hardware including
after sales O&M M&E
A/C Teams
Districts
Teams
Participation in PPPs
Procurement of NGOs, Private
Sector organisation and
participation in PPPs
Follow up dialogues and sensitisation
through CBHVs/ WATSANs/ WSDBs
and Natural/ opinion Leaders
Carry out evidence-based promotion
campaigns
Capacity Building of District and Area
Council level staff for effective
implementation and O&M
Functionality inventory and reporting
to initiate repair/ replacement
through CBHVs/ WATSANs/ WSDBs
Assessment of technologies – Efficacy
(WQ –spot checks) and mainly O&M
audits
Monitor activities of
implementing NGOs and
private sector
organisations including
weekly assessments
Monitor activities of
implementing NGOs, private
sector and Area Council level
extension staff including weekly
to monthly assessment of
Monitor and validate performance at
District level, and quarterly to semi-
annual assessment of outcomes and
periodic impact evaluations and
clearing house for district level data
NGOs
National Level
Private Sector
Technical Working Group.
Env. Health & San.
Com. Water & San,
Assessment of technologies –
Efficacy of (WQ) and O&M
Technical support to Area Council Staff
to carry out evidence-based
promotion campaigns
Regional
Teams
Quality Assurance of Procurement of
NGOs, Private Sector organisation and
PPP process, and NGOs. Capacity
Building of District level for
procurement and contract
Zoning for implementation
and allocation of lots for
strategy implementation
Knowledge management and input for
strategy review, & District performance
management including awards and
District performance benchmarking,
and assessment of functionality /
performance of PPPs,
Community Action
Planning
Behaviour and practice
monitoring
Review of policy & strategies & formulation of PPP, Knowledge Management Framework
Technical studies and Appraisal of
technologies
Overall Policy/ strategy facilitation, target
setting and implementation (including
reporting)
Overall country level periodic monitoring of
outcomes and impacts Overall Programme Performance Management
Technical assistance to District level on
technology assessments through CWSA
Carry out evidence-based promotion
campaigns
Technology transfer, modification and
user education and after-sales services
Technology transfer, modification and user
education and after-sales services
Carry out evidence-based promotion
campaigns (through Pos where
Monitor weekly assessments outputs,
outcomes – behaviours and practices, as part
of implementation and related/ programme
evaluations (may involve CONIWAS)
Review of Feasibility Assessments d performance of technologies
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