230 TOILET SLABS, AND COUNTING

BECOMING A FEMALE SANITATION ENTREPRENEUR AGAINST ALL ODDS

Have you even wondered why an elephant, a massive, powerful animal, can fall prey to a lion whose size is a tiny fraction of the elephant’s? That is the power of the lion’s attitude and determination. The following story is also a clear demonstration of the power of total commitment.

SEIZING THE OPPORTUNITY TO BECOME A SANITATION ENTREPRENEUR

Assefash Tadesse, 32-years-old, is an 8th grade dropout and a mother of five children. In her community, like many other Ethiopian communities, she has seen children getting sick and dying from diarrhea diseases. She knows that her family members and neighbors openly defecate in the surrounding forests, and rarely prioritize investing in a household toilet. With much green space surrounding her village, the need for capturing waste is not always understood by her neighbors, who are used to using the outdoors to relieve themselves.

She often heard people chatting and complaining about their lack of money, the limited supply of good quality and affordable products, and their lack of knowledge about construction as the key reasons why they failed to construct private and safe latrines. Though she was not a Health Extension Worker(HEW) and lacked any formal training, she had an entrepreneurial spirit. Where her neighbors saw barriers, she saw an opportunity. With training provided by the USAID Transform WASH project on sanitation marketing and business development at Yirgalem town in Ethiopia’s Southern Nations, Nationalities, and Peoples’ Region, she started manufacturing concrete slabs and fitting them with the low-cost, low-water requirement plastic toilet pan called the “Sato Pan”. She started her business in September 2019 after receiving a loan from the Omo Microfinance Institution with the support of project staff. She knew that embedding the Sato Pan in the slab would increase its price and that her potential customers were farmers who often lacked much disposable income. However, Assefash was not deterred after observing some households fixing Sato Pans on their mud floor and struggling to clean them. Therefore, despite the higher cost, she always encouraged families to upgrade their toilet to a SATO Pan in a slab because of the following key benefits:

     

      • Reduces odors from pits,

      • Prevents flies from entering or exiting the pits,

      • Is easy to clean.

    VILLAGE SAVING AND LOAN ASSOCIATION

    She also was aware of a savings and loan group being set up in her community. These were being organized by Plan International as part of the USAID Transform WASH project to help community members access affordable credit so they could invest in an improved sanitation facility. The Village Saving and Loan Association (VSLA) is a community-based platform where 15–25 household heads/members come together and save a little amount of money ranging from 5–20 birr as per their bylaws. The group is managed by a volunteer leader and get support from VSLAs facilitators who are responsible for screening, supporting the leaders, and linking members to local manufacturers. Even though all the VSLAs are established to provide easy access to loans for their members, the interest rate, payment period and loan sizes vary based on their bylaws.

    A TRUSTWORTHY PERSON

    Assefash volunteered to become the facilitator of the VSLA in her neighborhood, closely working with the group leaders and others to ensure better recordkeeping and planning. The leader and members recognized her commitment and members approved a loan to her in form of advance payment. This direct provision of individual member’s loan money greatly minimized possibilities for loan diversion. Once she received the advance payment from the VSLA, she started working on producing latrine slabs and delivering them to her customers who had ordered them and paid in advance. She stive to deliver them on time and provide the installation service herself. She only accepts full payment when the household was satisfied with both the quality of the product and her installation work.

     

    Assefash Tadesse

    Now nearly all the community members know Assefash and trust the quality of the products and services she provides. In just two months, Assefash sold 239 slabs embedded with Sato Pans. She has hired two employees (including her husband) to help keep up with the demand from households. She works with project-trained Sales Agents who promote her products (they receive a 30 Ethiopian Birr commission per sale — about 0.56 USD). Even though she has no written business plan, she intends to sell and install products in 4 kebeles (villages) during 2020 and wants to expand her business to other nearby Woredas (districts) in the coming years. She also wants to diversify her range of products to include both latrine superstructures and substructures.

    When asked if there was a potential conflict of interest by being both a sanitation business owner and the VSLA Facilitator (who benefits from the VSLA providing loans to households in order to purchase her products), she replied that, “…the VSLA was …organized to ensure improved toilets were installed in the community. I am trying to deliver on that promise. If the quality of the products had been poor, the customers would have rejected them. I am their neighbor and am always accessible to anyone.”

    As both the lion and Assefash demonstrate, with drive, passion and commitment, what may seem impossible can actually be achieved!

    USAID Transform WASH aims to improve water, sanitation, and hygiene (WASH) outcomes in Ethiopia by increasing market access to and sustained use of a broader spectrum of affordable WASH products and services, with a substantial focus on sanitation. Transform WASH achieves this by transforming the market for low-cost quality WASH products and services: stimulating demand at the community level, strengthening supply chains, and improving the enabling environment for a vibrant private market.

    USAID Transform WASH is a USAID-funded activity implemented by Population Services International in collaboration with SNV, Plan International, and IRC WASH. The consortium is working closely with government agencies, including the Ministry of Health, the Ministry of Water, Irrigation and Electricity, the One WASH National Program, and regional and sub-regional governments.

     
     

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    Safiya Ahmed, from Oromia region of Ethiopia, is seen immersed in transformative technical training on floor solutions and SATO pan installation

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    “The men we spoke to [while I was traveling to South Africa for a PrEP project with Maverick Collective by PSI] were not only decidedly open to the idea of taking a daily pill…many were willing to spread the word and encourage friends to get on PrEP too. We were able to uncover and support this new way forward because we had flexible funding to focus on truly understanding the community and the root barriers to PrEP adoption. This is the philanthropic funding model we need to effectively fight the HIV epidemic, and it’s beneficial for all sorts of social challenges.”

    – Anu Khosla, Member, Maverick Collective by PSI

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    — Martin Dale, Director, Digital Health and Monitoring, PSI

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    Building on our extensive private sector malaria surveillance work under the BMGF-funded GEMS project in the Greater Mekong Subregion, PSI implemented a case-based disease notification system using social media channels to overcome the limitations of paper-based and custom-built mobile reporting tools. These chatbots, accessible through popular social media platforms like Facebook Messenger and Viber, proved to be user-friendly and required minimal training, maintenance, and troubleshooting. The system was implemented in more than 550 clinics of the Sun Quality Health social franchise network as well as nearly 470 pharmacies. The captured information flows to a DHIS2 database used for real-time monitoring and analysis, enabling rapid detection of potential outbreaks. Local health authorities receive instant automated SMS notifications, enabling them to promptly perform case investigation and outbreak response.

    In 2022, private clinics reported 1,440 malaria cases through the social media chatbots, while community mobilizers working with 475 private providers and community-based malaria volunteers reported more than 5,500 cases, leading to the detection of two local malaria outbreaks. Local health authorities were instantly notified, allowing them to take action to contain these surges in malaria transmission. During the same time, pharmacies referred 1,630 presumptive tuberculosis cases for confirmatory testing – a third of which were diagnosed as tuberculosis and enrolled into treatment programs.

    Training health workers in Angola

    By: Anya Fedorova, Country Representative, PSI Angola  

    The shortage of skilled health workers is widely acknowledged as a significant barrier to achieving Universal Health Coverage. To address this challenge, PSI supported ministries of health to develop a digital ecosystem that brings together stewardship, learning, and performance management (SLPM). The ecosystem enhances training, data-driven decision-making, and the efficiency of healthcare delivery.

    Here’s what it looks like in practice.

    In July 2020, PSI Angola, alongside the Angolan digital innovation company Appy People, launched Kassai, an eLearning platform that targets public sector health workers in Angola. Through funding from USAID and the President’s Malaria Initiatve (PMI), Kassai features 16 courses in malaria, family planning, and maternal and child health – with plans to expand learning topic areas through funding from ExxonMobil Foundation and private sector companies. A partnership with UNITEL, the largest telecommunication provider in Angola, provides all public health providers in Angola free internet access to use Kassai.

    Kassai’s analytics system to follow learners’ success rate and to adjust the course content to learners’ performance and needs. Kassai analytics are integrated with DHIS2 – the Health Management Information System (HMIS) of Angolan MOH, to be able to link learners’ knowledge and performance with the health outcomes in the health facilities.  The analytics track learners’ performance by course and gives visibility by health provider, health facility, municipality, and province. Each course has pre-and post-evaluation tests to track progress of learning, too.

    By the end of 2022, there were 6,600 unique users on the Kassai platform and 31,000 course enrollments. PSI Angola’s partnership with UNITEL, the largest telecommunication provider in Angola, allows for free internet access to learn on the Kassai for all public health providers in Angola. Building on its success for malaria training, Kassai now also provides courses in family planning, COVID-19, and maternal and child health. This reduces training silos and provides cross-cutting benefits beyond a single disease.

    Implementing the SLPM digital ecosystem brings numerous benefits to health systems. It allows for more strategic and efficient workforce training and performance management, enabling ministries of health to track changes in health workers’ knowledge, quality of care, service utilization, and health outcomes in real time. The ecosystem also supports better stewardship of mixed health systems by facilitating engagement with the private sector, aligning training programs and standards of care, and integrating private sector data into national HMIS. Furthermore, it enables the integration of community health workers into the broader health system, maximizing their impact and contribution to improving health outcomes and strengthening primary healthcare.

    OUR COMMITMENTS

    WHISTLEBLOWER AND ANTI-RETALIATION

    PSI does not tolerate retaliation or adverse employment action of any kind against anyone who in good faith reports a suspected violation or misconduct under this policy, provides information to an external investigator, a law enforcement official or agency, or assists in the investigation of a suspected violation, even if a subsequent investigation determines that no violation occurred, provided the employee report is made in good faith and with reasonable belief in its accuracy.

    OUR COMMITMENTS

    Global Code of Business Conduct And Ethics

    PSI’s code sets out our basic expectations for conduct that is legal, honest, fair, transparent, ethical, honorable, and respectful. It is designed to guide the conduct of all PSI employees—regardless of location, function, or position—on ethical issues they face during the normal course of business. We also expect that our vendors, suppliers, and contractors will work ethically and honestly.

    OUR COMMITMENTS

    The Future of Work

    With overarching commitments to flexibility in our work, and greater wellbeing for our employees, we want to ensure PSI is positioned for success with a global and holistic view of talent. Under our new “work from (almost) anywhere,” or “WFAA” philosophy, we are making the necessary investments to be an employer of record in more than half of U.S. states, and consider the U.S. as one single labor market for salary purposes. Globally, we recognize the need to compete for talent everywhere; we maintain a talent center in Nairobi and a mini-hub in Abidjan. PSI also already works with our Dutch-based European partner, PSI Europe, and we’re creating a virtual talent center in the UK.

    OUR COMMITMENTS

    Meaningful Youth Engagement

    PSI is firmly committed to the meaningful engagement of young people in our work. As signatories of the Global Consensus Statement on Meaningful Adolescent & Youth Engagement, PSI affirms that young people have a fundamental right to actively and meaningfully engage in all matters that affect their lives. PSI’s commitments aim to serve and partner with diverse young people from 10-24 years, and we have prioritized ethics and integrity in our approach. Read more about our commitments to the three core principles of respect, justice and Do No Harm in the Commitment to Ethics in Youth-Powered Design. And read more about how we are bringing our words to action in our ICPD+25 commitment, Elevating Youth Voices, Building Youth Skills for Health Design.

    OUR COMMITMENTS

    Zero Tolerance for Modern-Day Slavery and Human Trafficking

    PSI works to ensure that its operations and supply chains are free from slavery and human trafficking. Read more about this commitment in our policy statement, endorsed by the PSI Board of Directors.

    OUR COMMITMENTS

    UNITED NATIONS GLOBAL COMPACT

    Since 2017, PSI has been a signatory to the United Nations Global Compact, a commitment to align strategies and operations with universal principles of human rights, labor, environment and anti-corruption. Read about PSI’s commitment to the UN Global Compact here.

    OUR COMMITMENTS

    Environmental Sustainability

    The health of PSI’s consumers is inextricably linked to the health of our planet. That’s why we’ve joined the Climate Accountability in Development as part of our commitment to reducing our greenhouse gas emissions by 30 percent by 2030. Read about our commitment to environmental sustainability.

    OUR COMMITMENTS

    Affirmative Action and Equal Employment Opportunity

    PSI does not discriminate against any employee or applicant for employment because of race, color, religion, sex, sexual orientation, gender identity, national origin, age, marital status, genetic information, disability, protected veteran status or any other classification protected by applicable federal, state or local law. Read our full affirmative action and equal employment opportunity policy here.

    OUR COMMITMENTS

    Zero Tolerance for Discrimination and Harassment

    PSI is committed to establishing and maintaining a work environment that fosters harmonious, productive working relationships and encourages mutual respect among team members. Read our policy against discrimination and harassment here.

    PSI is committed to serving all health consumers with respect, and strives for the highest standards of ethical behavior. PSI is dedicated to complying with the letter and spirit of all laws, regulations and contractual obligations to which it is subject, and to ensuring that all funds with which it is entrusted are used to achieve maximum impact on its programs. PSI provides exceptionally strong financial, operational and program management systems to ensure rigorous internal controls are in place to prevent and detect fraud, waste and abuse and ensure compliance with the highest standards. Essential to this commitment is protecting the safety and well-being of our program consumers, including the most vulnerable, such as women and children. PSI maintains zero tolerance for child abuse, sexual abuse, or exploitative acts or threats by our employees, consultants, volunteers or anyone associated with the delivery of our programs and services, and takes seriously all complaints of misconduct brought to our attention.

    OUR FOCUS

    Diversity and Inclusion

    PSI affirms its commitment to diversity and believes that when people feel respected and included they can be more honest, collaborative and successful. We believe that everyone deserves respect and equal treatment regardless of gender, race, ethnicity, age, disability, sexual orientation, gender identity, cultural background or religious beliefs. Read our commitment to diversity and inclusion here. Plus, we’ve signed the CREED Pledge for Racial and Ethnic Equity. Learn more.

    OUR COMMITMENTS

    Gender Equality

    PSI affirms gender equality is a universal human right and the achievement of it is essential to PSI’s mission. Read about our commitment to gender equality here.

    Cover

    01 #PeoplePowered

    02 Breaking Taboos

    03 Moving Care Closer to Consumers

    04 Innovating on Investments

    ICFP Q&A:
    Let's Talk About Sex

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