Ecological sanitation - Implementation, opportunities and challenges in Chikwawa

Ecological sanitation (EcoSan) in not a new technology but rather a recognition that human excreta is a valuable natural resource (not a waste to be disposed of), containing plant nutrients which after containment and sanitization can be recycled in agriculture to enhance food production, with minimal risk of pollution of the environment and with minimal threat to human health. Various organizations are implementing EcoSan technologies in Malawi. Chikwawa is a rural district that is currently implementing EcoSan initiatives with resources from the Scotland Chikwawa Health Initiative and the US Ambassador’s Self Help Fund. The benefits from EcoSan are clear. For example, EcoSan systems help reduce the risk of spreading diseases by containing and treating human excreta before collecting it; minimising surface and groundwater contamination and recylcing the nutrients found in excreta and returning them to soil to enhance food production. However, EcoSan poses some challenges in its implementation such as a correct utilization, acceptability and sustainability of the concept

Gap Analysis of Environmental Health Research in Malawi : Report to the National Commission of Science and Technology

The aim of this consultancy was to assess the current gaps in research for the environmental health sector in Malawi, and to recommend research priorities and an effective action plan to address these gap

Interactional co-design and co-production through shared dialogue workshops

In 2017 660 million people remain without sustainable access to safe drinking water [1]. The majority of these are in rural areas with little hope in the foreseeable future of access to distributed treated water systems. Solar water disinfection (SODIS) is a household water treatment using solar energy to inactivate pathogens in water stored in transparent containers placed in direct sunlight. SODIS is used by approximately 5 million people in developing countries daily [2], but uptake is slowing. The WATERSPOUTT project aims to increase user uptake of SODIS by designing, piloting and manufacturing technologies including solar jerry cans and solar-ceramic filtration. These are being designed in a multi-disciplinary collaboration between designers, engineers, health and social scientists and end users in Europe and Africa. This is achieved through co-design activities, context analysis and stakeholder dialogue workshops which aim to ensure that product designs meet both the technical and social needs of the more than 100 million potential end users in Africa. Examples of student design work highlight the importance of this shared dialogue and changes in design thinking that are evolving through the co-design approach. Through producing designs which are readily accepted and widely adopted in the case study communities, this paper addresses issues relevant to the topics of social issues in design education and new design education paradigms. It also addresses the wider theme of building community: design education for a sustainable future by showing how transdisciplinary approaches can ensure community engagement and design adoption

Scotland Chikwawa Health Initiative - improving health from community to hospital

The Scotland Chikwawa Health Initiative is a three year programme funded by the Scottish Executive International Development Fund which aims to achieve measurable reductions in major causes of disease and death in four villages within the Chikwawa District of Malawi alongside improving the hospital environment for the good of both staff and patients. The initiative has developed a holistic approach to health improvements through the provision of infrastructure at both health facilities and within communities, and training of government personnel and community volunteers. Specific areas targeted have included water and sanitation, maternal health, and communicable disease control with provision of training and materials to facilitate interventions and health education. At the end of the second year the programme has already seen reductions in diarrhoeal disease (30% overall in target communities), improved access to safe water, an increase in the uptake of growth monitoring and immunisations in children under the age of five years (15% increase since training volunteers), improved safe delivery of babies within the community (245 babies delivered safely in target communities with 25 referred due to complications) and increased community health activity (training and integration of village health committees, water point committees, traditional birthing attendants and health surveillance assistants). The programme hopes to act as a model for the District to follow in other communities to achieve it’s obligations under the Malawi Ministry of Health Essential Health Package

Assessment of implementation of the health management information system at the district level in southern Malawi

Background Despite Malawi’s introduction of a health management information system (HMIS) in 1999, the country’s health sector still lacks accurate, reliable, complete, consistent and timely health data to inform effective planning and resource management.Methods A cross-sectional survey was conducted wherein qualitative and quantitative data were collected through in-depth interviews, document review, and focus group discussions. Study participants comprised 10 HMIS officers and 10 district health managers from 10 districts in the Southern Region of Malawi. The study was conducted from March to April 2012. Quantitative data were analysed using Microsoft Excel and qualitative data were summarised and analysed using thematic analysis.Results The study established that, based on the Ministry of Health’s minimum requirements, 1 out of 10 HMIS officers was qualified for the post. The HMIS officers stated that HMIS data collectors from the district hospital, health facilities, and the community included medical assistants, nurse–midwives, statistical clerks, and health surveillance assistants. Challenges with the system included inadequate resources, knowledge gaps, inadequacy of staff, and lack of training and refresher courses, which collectively contribute to unreliable information and therefore poorly informed decision-making, according to the respondents. The HMIS officers further commented that missing values arose from incomplete registers and data gaps. Furthermore, improper comprehension of some terms by health surveillance assistants (HSAs) and statistical clerks led to incorrectly recorded data.Conclusions The inadequate qualifications among the diverse group of data collectors, along with the varying availability and utilisation different data collection tools, contributed to data inaccuracies. Nevertheless, HMIS was useful for the development of District Implementation Plans (DIPs) and planning for other projects. To reduce data inconsistencies, HMIS indicators should be revised and data collection tools should be harmonised

Social capital insights from healthy settings needs assessment in Malawi

Despite global health improvements, substantial challenges in social determinants of health and poverty remain in rural communities in low-income countries. Public health theorists suggest that communities with high social capital are less vulnerable to such challenges and more likely to participate in community development. This research examines levels of social capital amongst rural communities in southern Malawi through data gathered as part of a participatory needs assessment for a Healthy Settings project, and discusses the potential benefits of having access to such data before project implementation. Social capital data was collected during 108 focus group discussions in 18 communities (split by gender, age, status) by adapting an existing mixed methods measurement tool, the Schutte tool. Five indicators were measured: sense of belonging, friendship, reliance, ability to work together and influence. Mean results showed all 18 communities had medium-high levels of social capital. Means from each group in the 18 communities highlighted the lowest social capital among the youth groups and the highest with the leaders. A more detailed breakdown highlighted that all groups had a strong sense of belonging to the community, while youth and women had lower social capital levels in terms of influence over local decisions and ability to rely on other community members. Incorporating social capital tools into community health needs assessments in low-income settings provides a valuable overview of community dynamics before project implementation, and Monitoring & Evaluation indicators which allow changes in social capital to be measured at different stages of the project

Engaging Participants in Community-Based Research

These reports outline the process, policy brief and outputs for guidance to support good practice in community based health research in Malawi. Documents are supported and endorsed by the National Commission for Science and Technolog

A transdisciplinary co-design and behaviour change approach to introducing sodis to rural communities in Malawi

Despite the increasing volume of evidence demonstrating the efficacy of solar water disinfection (SODIS) as a household water treatment technology, there still appear to be significant barriers to uptake in developing countries. SODIS potential is often treated with skepticism both in terms of effective treatment, and the safety of plastics used. As such it is often dismissed in preference for more accepted technologies such as ceramic filters and dose chlorination. We report formative findings of the WaterSPOUTT (Water – Sustainable Point Of Use Treatment Technology ) project (www.WATERSPOUTT.eu), carried out at the Centre for Water, Sanitation, Health And Appropriate Technology Development Centre (WASHTED) at the University of Malawi – Polytechnic from June 2016 – September 2018. The outputs of this formative stage will lead to the piloting of a SODIS system for 12 months (November 2018 – October 2019) in Chikwawa District, Southern Malawi. This posterhighlights activities pertaining to co-design process between the transdisciplinary research team, and potential end users. The process sought to ensure that the design is, socially accepted, locally adapted, and can be effectively operated and managed during field trials. We present results to date

A Transdisciplinary Methodology for Introducing Solar Water Disinfection to Rural Communities in Malawi-Formative Research Findings

Despite the increasing volume of evidence demonstrating the efficacy of solar water disinfection (SODIS) as a household water treatment technology, there still appear to be significant barriers to uptake in developing countries. The potential of SODIS is often treated with skepticism in terms of effective treatment, volume, and safety, and is dismissed in preference for more accepted technologies such as ceramic filters and dose chlorination. As part of WATERSPOUTT (EU H2020 688928), our study used a transdisciplinary methodology to cocreate an innovative SODIS system in rural Malawi. The formative work focused on the design of 1) an appropriate and acceptable system and 2) a context-specific intervention delivery program using a behavior-centered design. Initial research identified specific water needs and challenges, which were discussed along with a cocreation process with potential end users, through a series of shared dialogue workshops (SDWs). Specifications from end users outlined a desire for higher volume systems (20 L) that were “familiar” and could be manufactured locally. Development of the “SODIS bucket” was then undertaken by design experts and local manufacturers, with input from end users and subject to controlled testing to ensure efficacy and safety. Concurrent data were collated using questionnaires (n = 777 households), water point mapping (n = 121), water quality testing (n = 46), and behavior change modeling (n = 100 households). These identified specific contextual issues (hydrogeology, water access, gender roles, social capital, and socioeconomic status), and behavioral determinants (normative, ability, and self-regulation factors) that informed the development and delivery mechanism for the implementation toolkit. Integr Environ Assess Manag 2020;16:871–884

Researcher's Guide to Good Practice in Community Health Research

The Centre of Water, Sanitation, Hygiene and Appropriate Technology Develoment (WASHTED) at the University of Malawi Polytechnic has been conducting research in Chikwawa for many years. Our encounters with community members and district authorities during research revealed the need for researchers, district officials and community members to meet and discuss issues surrounding good research practice