Toilets for All

Posted May 30, 2019

by John Sauer and Jennifer Marcy, Senior Technical Advisors for Water, Sanitation & Hygiene, PSI

Approximately 500 million people in Sub-Saharan Africa do not have access to a basic toilet, making them vulnerable to avoidable dangers like chronic disease, malnutrition and gender-based violence. We’re not doing enough to ensure they have access to the sanitation services they deserve. The World Bank predicts that at the current rate, it will take several hundred years to reach universal coverage of basic sanitation. In short, business-as- usual is not getting us there.

In an effort to reach the United Nations Sustainable Development Goal 6—availability and sustainable management of water and sanitation for all by 2030—PSI has partnered with Oxfam and Social Finance to create a global movement that will push forward progress for sanitation. This initiative aims to deliver sustained access to simple and affordable sanitation for 100 million people through the marketing, sales and installation of 20 million hygienic toilets.

This effort is built around three pillars of change: an approach built on inclusive markets, simple and affordable products and funding instruments that are fit-for-purpose. It will first be delivered in a small number of low-income countries, focusing on inclusive markets to ensure that consumers can access modern toilets at scale and pace.

This endeavor is complex, requiring upfront funding across donor communities. But with investment and cooperation across the development community, we aspire to deliver toilets for all.

This article appears in PSI’s Impact magazine, released in tandem with Women Deliver 2019, as part of an ongoing conversation about putting #PowerInHerHands.

Banner Image: ©PSI

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Digitalizing contraceptive counseling to reach rural women and girls in Ethiopia

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In a significant development, PSI Ethiopia has digitized the proven counseling messaging of Smart Start, expanding its reach to more adolescent girls, young women, and couples. This approach aligns with the priorities set by the Ethiopian Ministry of Health (MOH) and is made possible through funding from Global Affairs Canada. The interactive and engaging digital messaging has revolutionized counseling services, enabling clients to make informed and confident decisions regarding both their finances and contraceptive choices.

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For example, in Mali, access to formal health services remains challenging, with four in ten people living several miles from the nearest health center, all without reliable transportation or access. In 2009, the Ministry of Health adopted a community health strategy to reach this population. The U.S. President’s Malaria Initiative (PMI) Impact Malaria project, funded by USAID and led by PSI, supports the Ministry with CHW training and supervision to localize health services.

In 2022, 328 thousand malaria cases were recorded by CHWs); 6.5 thousand severe malaria cases were referred to health centers, according to the national health information system.

During that time, the PMI Impact Malaria project (IM) designed and supported two rounds of supportive supervision of 123 CHWs in their workplaces in the IM-supported regions of Kayes and Koulikoro. This included developing and digitizing a standardized supervision checklist; and developing a methodology for selecting which CHWs to visit. Once a long list of CHW sites had been determined as accessible to supervisors for a day trip (including security reasons), the supervisors telephoned the CHWs to check when they would be available to receive a visit [as being a CHW is not a full-time job, and certain times of the year they are busy with agricultural work (planting, harvesting) or supporting health campaigns like mosquito net distribution].

Supervisors directly observed how CHWs performed malaria rapid diagnostic tests (RDTs) and administered artemisinin-based combination therapy (ACT). They recorded CHW performance using the digitized checklist, interviewed community members, reviewed records, and provided on-the-spot coaching. They also interviewed the CHWs and tried to resolve challenges they expressed, including with resupply of commodities or equipment immediately or soon afterwards.

Beyond the observed interactions with patients, supervisors heard from community members that they were pleased that CHWs were able to provide essential malaria services in the community. And the data shows the impact.

In IM-supported areas of Mali, 36% of CHWs in the first round were competent in performing the RDT, which rose to 53% in the second. 24% of CHWs in the first round compared to 38% in the second were competent in the treatment of fever cases and pre-referral counseling. Between both rounds, availability of ACT increased from 80 percent to 90 percent.

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Taking a market-based approach to scale sanitation in Ethiopia

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Toilets for All

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Digitalizing contraceptive counseling to reach rural women and girls in Ethiopia

Building community health worker capacity to deliver malaria care

Taking a market-based approach to scale sanitation in Ethiopia

Promoting self-managed care like Self-testing and Self-Sampling

Using peer coaches to counter HIV stigma in South Africa

simplifying consumers’ journey to care in Vietnam

Engaging the private sector for disease surveillance in Myanmar

Training health workers in Angola

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