February 18, 2020

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Poverty, Access, Malnutrition & Hygiene: Pursuing an Integrated Solution for the Millennium Development Goals

780 million people in the world lack access to a safe drinking water source and more than 1.8 billion people don’t have improved toilets.


By Sonia Ehrlich Sachs, Director of Health, Millennium Villages Project, Earth Institute and Joyce Chen, WASH Program Manager, Millennium Villages Project

Today, through the Millennium Villages Project (MVP), close to 500,000 people in poor rural communities throughout sub-Saharan Africa are demonstrating how, with modest financial investment, they can achieve all eight Millennium Development Goals (MDGs) by 2015 and become active participants in the global economy.

Of the MDGs, four are directly concerned with improving health, aiming to reduce child mortality, maternal mortality, malnutrition, HIV/AIDS, TB, malaria, and other diseases. Diarrhea is a leading cause of childhood illness and major contributor to child mortality. Preventing and treating diarrhea requires a multi-disciplinary approach necessitating infrastructure installations as well as education and behavior change, and, of course, a functioning health system.

The MVP is developing an integrated approach to improving access to safe drinking water, access to toilets and addressing education about personal hygiene. Striving for sustainable solutions to this multi-pronged challenge require public-private partnerships such as the ones we have with Unilever and GlaxoSmithKline.

This integrated approach to development started in 2005 and includes working with rural communities on improving agriculture, education, infrastructure, business development and health simultaneously. The MVP’s intensive monitoring and evaluation system studies how the integrated model creates and benefits from synergy of diverse but simultaneous interventions; communities reap health benefits from interventions beyond the traditional health care system.

For example, improving roads and having ambulances reachable by cell phones improve health outcomes by providing emergency transport; new cell phone towers and cell phones give Community Health Workers (CHWs) the support they need to provide better home-based care and give CHW managers a way to supervise and monitor the CHWs; increased crop yield and biodiversity lead to better-nourished children and adults.

Likewise, concurrent interventions in water, sanitation and hygiene (WASH) are important for children in rwandapreventing transmission of infectious diseases and improving health outcomes. That is why the MVP is gearing up to have a distinct WASH program to learn and measure how a comprehensive and robust program, alongside investments in other key sectors, can contribute to reducing child mortality and to improving health outcomes.

The Global WASH Picture

In the developed world, clean piped water and flush toilets are commonplace and taken for granted. Yet, 780 million people in the world lack access to a safe drinking water source and more than 1.8 billion people don’t have improved toilets. Although the UN declared in 2010 that “equitable access to safe drinking water and sanitation” is a human rights obligation, sanitation remains the most off-track MDG target. At the current rate of progress, the sanitation target for sub-Saharan Africa would not be met for another 200 years!

Although not a glamorous topic, sanitation must be addressed; it is a matter of human dignity, privacy, and health equity, not to mention life-and-death. Infectious diseases related to unsafe water and lack of sanitation kill more than 2.4 million people each year, mostly children under the age of five.

Unglamorous but Fatal

Diarrhea and pneumonia - two diseases that are closely associated with poor hygiene, unsafe drinking water and inadequate sanitation - kill more than 2 million children under 5 each year. If everyone practiced good sanitation and hygiene behaviors, it is estimated that up to 1.8 million children’s lives would be saved each year in averted diarrhea and pneumonia. Handwashing with soap after defecation and prior to eating is especially critical for preventing transmission of disease-inducing pathogens.

In fact, one study found that hygiene promotion is the single most cost-effective intervention related to high-burden diseases in low- and middle- income countries; for every US$1,000 spent, hygiene promotion saves 298 disability-adjusted life years. By reducing the incidence of diarrhea by 42-48 percent, handwashing with soap prevents the loss of nutrients in young children, thereby reducing handwashingmalnutrition, which causes delays in physical growth and cognitive development, and increases vulnerability to other diseases.

Developing a Comprehensive WASH Model for Rural sub-Saharan Africa

As we laid out above, the MVP’s holistic approach to WASH involves both infrastructure and behavior change interventions; building supply and demand for WASH services and commodities is essential to sustaining healthy WASH practices in the long run. Even with vast improvements in access to improved water points, water can become contaminated during collection, transport, handling and storage.

Likewise, access to latrines does not guarantee hygienic sanitation practices.

During the first five years, the MVP focused on expanding households’ access to safe water and sanitation -- to build the infrastructure needed to successfully practice safe hygiene and handwashing with soap. The proportion of MV households using an improved water source has increased substantially and now, more community members drink clean water and have the means to wash their hands, which has been shown to reduce the spread of infectious diseases.

Taking advantage of the integrated approach, MVP specialists in health, education, infrastructure, and business development coordinate and collaborate across sectors to reduce fragmentation in what is a truly crosscutting issue. While the MVP’s infrastructure team expands access to water and sanitation infrastructure, health professionals educate and model healthy sanitation and hygiene practices. During routine home visits, community health workers counsel household members on handwashing with soap, safe stool disposal, oral hygiene, household water treatment and food hygiene.

In schools, WASH specialists collaborate with education and health coordinators to develop teaching materials, train teachers and school management committee members on behavior change communication, and work with district education officials on incorporating WASH into school curricula. unilever handwashing daySchool health and hygiene clubs help maintain school WASH facilities and promote key messages through the creative arts and local competitions.

Ensuring that there is adequate supply of water and sanitation commodities to meet increased demand is also crucial. This is where an intersection of business development and WASH involving building a supply chain for water treatment technologies and latrine construction materials becomes critical.

Corporate Sustainability: Can the Private Sector Become the Strongest Link?

But MVP is not just about solving a social problem.

It also aims to help communities become self-sustainable by enhancing knowledge, capacity, and promoting local ownership.

Using CommCare, an algorithm-driven smart phone application carried by Community Health Workers, health managers have real-time data collected at households, which allows for rapid problem solving and more efficient operations and management.  Local and national advocacy events, e.g., Global Handwashing Day celebrations, are organized in close collaboration with government officials, civil society partners and community leaders. These achievements would not be possible without our partnerships with host governments, foundations, corporations, international organizations, and NGOs.

These multi-stakeholder cooperations facilitate the exchange of information, resources and technical expertise; by taking advantage of each partner’s strengths, better and broader solutions can be achieved. Combined with the government’s ability to influence policy, civil society’s programming expertise, and research institutions’ scientific findings, the private sector can play a key role in saving the lives of millions of children.

Join the Millennium Villages Project and Unilever in celebrating the 5th annual Global Handwashing Day this October 15th. Take a pledge on Facebook or join the conversation on Twitter at #IWashMyHands.


About the Authors:

Dr. Sonia Ehrlich Sachs is a pediatrician, an endocrinologist and public health specialist. She received a BA from Harvard University, an MD from the University of Maryland Medical School, and an MPH from Harvard School of Public Health. Dr. Sachs practiced medicine for over 20 years, 14 of which she spent at the Harvard University Health Services in Cambridge, Massachusetts. In 2004 she joined the Earth Institute, Columbia University, and became the Director of Health for the Millennium Villages Project, overseeing all health related interventions and research.

Joyce Chen is the Water, Sanitation and Hygiene Program Manager for the Millennium Villages Project. She has a dual Master of International Affairs and Master of Science in Social Work from Columbia University. Prior to joining the Earth Institute, Joyce worked with many international and domestic non-profit organizations and served as a Peace Corps Volunteer in Ukraine.  


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