The true costs of participatory sanitation: Evidence from community-led total sanitation studies in Ghana and Ethiopia

Evidence on sanitation and hygiene program costs is used for many purposes. The few studies that report costs use top-down costing methods that are inaccurate and inappropriate. Community-led total sanitation (CLTS) is a participatory behavior-change approach that presents difficulties for cost analysis. We used implementation tracking and bottom-up, activity-based costing to assess the process, program costs, and local investments for four CLTS interventions in Ghana and Ethiopia. Data collection included implementation checklists, surveys, and financial records review. Financial costs and value-of-time spent on CLTS by different actors were assessed. Results are disaggregated by intervention, cost category, actor, geographic area, and project month. The average household size was 4.0 people in Ghana, and 5.8 people in Ethiopia. The program cost of CLTS was $30.34–$81.56 per household targeted in Ghana, and $14.15–$19.21 in Ethiopia. Most program costs were from training for three of four interventions. Local investments ranged from $7.93–$22.36 per household targeted in Ghana, and $2.35–$3.41 in Ethiopia. This is the first study to present comprehensive, disaggregated costs of a sanitation and hygiene behavior-change intervention. The findings can be used to inform policy and finance decisions, plan program scale-up, perform cost-effectiveness and benefit studies, and compare different interventions. The costing method is applicable to other public health behavior-change programs

Building capacity for water, sanitation, and hygiene programming: Training evaluation theory applied to CLTS management training in Kenya

Training and capacity building are long established critical components of global water, sanitation, and hygiene (WaSH) policies, strategies, and programs. Expanding capacity building support for WaSH in developing countries is one of the targets of the Sustainable Development Goals. There are many training evaluation methods and tools available. However, training evaluations in WaSH have been infrequent, have often not utilized these methods and tools, and have lacked rigor. We developed a conceptual framework for evaluating training in WaSH by reviewing and adapting concepts from literature. Our framework includes three target outcomes: learning, individual performance, and improved programming; and two sets of influences: trainee and context factors. We applied the framework to evaluate a seven-month community-led total sanitation (CLTS) management training program delivered to 42 government officials in Kenya from September 2013 to May 2014. Trainees were given a pre-training questionnaire and were interviewed at two weeks and seven months after initial training. We qualitatively analyzed the data using our conceptual framework. The training program resulted in trainees learning the CLTS process and new skills, and improving their individual performance through application of advocacy, partnership, and supervision soft skills. The link from trainees' performance to improved programming was constrained by resource limitations and pre-existing rigidity of trainees’ organizations. Training-over-time enhanced outcomes and enabled trainees to overcome constraints in their work. Training in soft skills is relevant to managing public health programs beyond WaSH. We make recommendations on how training programs can be targeted and adapted to improve outcomes. Our conceptual framework can be used as a tool both for planning and evaluating training programs in WaSH

Some lessons learned from engaging in WaSH participatory action research in Melanesian informal settlements

In Melanesian countries there has been a large flux of people from rural to urban and peri-urban areas, resulting an in increased number living in informal settlements. These settlements often lack connections to mains water and sewerage lines and formal solid waste collection. Our project used a participatory action research (PAR) approach to work in partnership with informal settlement communities and enabling actors to achieve the self-determined WaSH conditions which participants felt would improve the well-being of those living in informal settlements. Because the PAR approach encourages reflection and adaptation, we learned lessons that were incorporated into the design of ongoing and future processes, and this paper presents five such lessons which we judge to be of practical use for WaSH enabling actors

Investigating Multiple Household Water Sources and Uses with a Computer-Assisted Personal Interviewing (CAPI) Survey

The investigation of multiple sources in household water management is considered overly complicated and time consuming using paper and pen interviewing (PAPI). We assess the advantages of computer-assisted personal interviewing (CAPI) in Pacific Island Countries (PICs). We adapted an existing PAPI survey on multiple water sources and expanded it to incorporate location of water use and the impacts of extreme weather events using SurveyCTO on Android tablets. We then compared the efficiency and accuracy of data collection using the PAPI version (n = 44) with the CAPI version (n = 291), including interview duration, error rate and trends in interview duration with enumerator experience. CAPI surveys facilitated high-quality data collection and were an average of 15.2 min faster than PAPI. CAPI survey duration decreased by 0.55% per survey delivered (p < 0.0001), whilst embedded skip patterns and answer lists lowered data entry error rates, relative to PAPI (p < 0.0001). Large-scale household surveys commonly used in global monitoring and evaluation do not differentiate multiple water sources and uses. CAPI equips water researchers with a quick and reliable tool to address these knowledge gaps and advance our understanding of development research priorities

Achieving Development Outcomes by Building Practical Authority in WASH Participatory Collectives in Melanesia

The strength of the ‘enabling environment’ for development is often considered to be one of the key elements in whether development initiatives fail or succeed. Attempts to strengthen the enabling environment have resulted in a series of checklists and frameworks that imagine it largely to be fixed, static, and separated from ‘beneficiaries’. In the Water, Sanitation, and Hygiene (WASH) sector, there is a preoccupation with fostering an optimal enabling environment that will result naturally in ‘ideal’ and formalised user participation, which will in turn lead to universal access to water and sanitation. In this paper, we challenge this simplistic and linear view of an enabling environment that is perpetuated by checklists and frameworks. We conducted a three-and-a-half-year transdisciplinary participatory action research (PAR) project which sought to foster WASH solutions in impoverished informal settlements in Fiji, Solomon Islands and Vanuatu. In a critical reflection on this project, we analyse the ways in which we both perpetuated problematic checklists and worked collaboratively with our participants to reimagine the enabling environment. We show how individuals challenged the expert-beneficiary dichotomy as they built ‘practical authority’ from their peers through taking action. Our study demonstrates that conceptualising the enabling environment as a dynamic ecology of actors, relationships and processes that includes the users of WASH as active participants was essential to supporting progress towards universal WASH access. We argue that working within the politics of development rather than seeking to render problems as technical was crucial to fostering WASH improvements that were determined by residents themselves and supported by stakeholders. Such an inclusive approach is essential to fully leveraging the co-productive possibilities of participation. If development practitioners and scholars are to achieve development outcomes in an equitable and participatory manner, they must shift their conceptualisation of the enabling environment as being a checklist of things ‘out there’ to one where they work to find their place within an ecology of participatory collectives

Addressing WaSH challenges in Pacific Island Countries: A participatory marketing systems mapping approach to empower informal settlement community action

Addressing complex and challenging issues entails access to credible systems information in the form of systems maps or diagrams. The purpose of our paper is to describe a participatory action research (PAR) systems mapping activity that was undertaken by an urban informal settlement community in a small Pacific Island Country. A total of 19 households participated in a systems mapping activity to map a household-level water or sanitation system. The individual household systems maps and related data were then used to construct a de-identified aggregated water, sanitation and hygiene (WaSH) marketing systems map (and accompanying narratives) for the informal settlement. We present the marketing systems map, which delineated a series of marketing exchanges, and report on how the map assisted the community to address a number of expressed needs. We conclude by suggesting that systems mapping is a valuable activity that communities could undertake to generate credible systems information to inform and empower collective planning and actions

Community management does not equate to participation: fostering community participation in rural water supplies

Community management has remained the dominant paradigm for managing rural water supplies in sub-Saharan Africa. There is a widespread perception that community participation principles are inherently embedded in the community management model. In this paper, we analyze how an international nongovernmental organization engages rural communities in their rural water projects, and the ways in which community members are able to participate in the management and governance of their water supplies. Qualitative data were collected in 18 study communities – six each in Ghana, Kenya, and Zambia – through interviews, focus group discussions, and participatory mapping with community and water committee members. We argue that community management does not inherently lead to broader community participation, but rather that fostering community participation requires intentionality. We recommend implementers use collaborative planning processes and explicitly engage with intra-community diversity and inequalities in order to facilitate the opportunity for all community members to meaningfully participate in decision-making. Collaborative planning with diverse groups will also allow community members to realize their rights to transparency and accountability once community management structures are in place

Weighted Banach spaces of harmonic functions

“The final publication is available at Springer via http://dx.doi.org/10.1007/s13398-012-0109-z."We study Banach spaces of harmonic functions on open sets of or endowed with weighted supremum norms. We investigate the harmonic associated weight defined naturally as the analogue of the holomorphic associated weight introduced by Bierstedt, Bonet, and Taskinen and we compare them. We study composition operators with holomorphic symbol between weighted Banach spaces of pluriharmonic functions characterizing the continuity, the compactness and the essential norm of composition operators among these spaces in terms of associated weights.The research of the first author was partially supported by MEC and FEDER Project MTM2010-15200 and by GV project ACOMP/2012/090.Jorda Mora, E.; Zarco García, AM. (2014). Weighted Banach spaces of harmonic functions. Revista de la Real Academia de Ciencias Exactas, Fisicas y Naturales. Serie A. Matematicas. 108(2):405-418. https://doi.org/10.1007/s13398-012-0109-zS4054181082Axler, S., Bourdon, P., Ramey, W.: Harmonic Function Theory, 2nd edn. Springer, Berlin (2001)Bierstedt, K.D., Bonet, J., Galbis, A.: Weighted spaces of holomorphic functions on balanced domains. Mich. Math. J. 40(2), 271–297 (1993)Bierstedt, K.D., Bonet, J., Taskinen, J.: Associated weights and spaces of holomorphic functions. Stud. Math. 127(2), 137–168 (1998)Bierstedt, K.D., Summers, W.H.: Biduals of weighted Banach spaces of analytic functions. J. Aust. Math. Soc. Ser. A 54(1), 70–79 (1993)Bonet, J., Domański, P., Lindström, M.: Essential norm and weak compactness of composition operators on weighted Banach spaces of analytic functions. Can. Math. Bull. 42(2), 139–148 (1999)Bonet, J., Domański, P., Lindström, M.: Weakly compact composition operators on weighted vector-valued Banach spaces of analytic mappings. Ann. Acad. Sci. Fenn. Math. Ser. A I 26, 233–248 (2001)Bonet, J., Domański, P., Lindström, M., Taskinen, J.: Composition operators between weighted Banach spaces of analytic functions. J. Aust. Math. Soc. Ser. A 64, 101–118 (1998)Bonet, J., Friz, M., Jordá, E.: Composition operators between weighted inductive limits of spaces of holomorphic functions. Publ. Math. Debr. Ser. A 67, 333–348 (2005)Boyd, C., Rueda, P.: The v-boundary of weighted spaces of holomorphic functions. Ann. Acad. Sci. Fenn. Math. 30, 337–352 (2005)Boyd, C., Rueda, P.: Complete weights and v-peak points of spaces of weighted holomorphic functions. Isr. J. Math. 155, 57–80 (2006)Boyd, C., Rueda, P.: Isometries of weighted spaces of harmonic functions. Potential Anal. 29(1), 37–48 (2008)Carando, D., Sevilla-Peris, P.: Spectra of weighted algebras of holomorphic functions. Math. Z. 263, 887–902 (2009)Contreras, M.D., Hernández-Díaz, G.: Weighted composition operators in weighted Banach spaces of analytic functions. J. Aust. Math. Soc. Ser. A 69(1), 41–60 (2000)García, D., Maestre, M., Rueda, P.: Weighted spaces of holomorphic functions on Banach spaces. Stud. Math. 138(1), 1–24 (2000)García, D., Maestre, M., Sevilla-Peris, P.: Composition operators between weighted spaces of holomorphic functions on Banach spaces. Ann. Acad. Sci. Fenn. Math. 29, 81–98 (2004)Gunning, R., Rossi, H.: Analytic Functions of Several Complex Variables. AMS Chelsea Publishing, Providence (2009)Hoffman, K.: Banach Spaces of Analytic Functions. Prentice-Hall, Englewood Cliffs (1962)Krantz, S.G.: Function Theory of Several Complex Variables. AMS, Providence (2001)Lusky, W.: On weighted spaces of harmonic and holomorphic functions. J. Lond. Math. Soc. 51, 309–320 (1995)Lusky, W.: On the isomorphism classes of weighted spaces of harmonic and holomorphic functions. Stud. Math. 175(1), 19–45 (2006)Meise, R., Vogt, D.: Introduction to Functional Analysis. Oxford University Press, Oxford (1997)Montes-Rodríguez, A.: Weight composition operators on weighted Banach spaces of analytic functions. J. Lond. Math. Soc. 61(2), 872–884 (2000)Ng, K.F.: On a theorem of Diximier. Math. Scand. 29, 279–280 (1972)Rudin, W.: Real and Complex Analysis. MacGraw-Hill, NY (1970)Rudin, W.: Functional analysis. In: International series in pure and applied mathematics, 2nd edn. McGraw-Hill, Inc., New York (1991)Shields, A.L., Williams, D.L.: Bounded projections, duality and multipliers in spaces of harmonic functions. J. Reine Angew. Math. 299(300), 256–279 (1978)Shields, A.L., Williams, D.L.: Bounded projections and the growth of harmonic conjugates in the unit disc. Mich. Math. J. 29, 3–25 (1982)Zheng, L.: The essential norms and spectra of composition operators on $$H^\infty$$ . Pac. J. Math. 203(2), 503–510 (2002

Geographical inequalities in drinking water in the Solomon Islands

Sustainable Development Goal 6.1 seeks to “by 2030, achieve universal and equitable access to safe and affordable drinking water”, which is challenging particularly in Small Island Developing States (SIDS) and Pacific Island Countries (PIC). We report drinking water sources and services in the Solomon Islands and examine geographical inequalities. Based on two quantitative baseline datasets of n = 1,598 rural and n = 1,068 urban households, we analyzed different drinking water variables (source type, collection time, amount, use, perceived quality, storage, treatment) and a composite index, drinking water service level. We stratified data by urban and rural areas and by province, mapped, and contextualized them. There are substantive rural–urban drinking water inequalities in the Solomon Islands. Overall, urban households are more likely to: use improved drinking water sources, need less time to collect water, collect more water, store their water more safely, treat water prior to consumption, perceive their water quality as better and have an at least basic drinking water service than rural households. There are also provincial and center-periphery inequalities in drinking water access, with more centrally located provinces using piped water supplies and more distant and remote provinces using rainwater and surface water as their primary source. There are also inter-national inequalities. Out of all PICs, the Solomon Islands have among the lowest access to basic drinking water services: 92% of urban and 55% of rural households. Of all SIDS, PICs are least serviced. This study shows that drinking water inequality is a critical issue, and highlights that all identified dimensions of inequality - rural–urban, provincial, center-periphery and inter-national - need to be explicitly recognized and addressed and included in pro-equity monitoring, policy and programming efforts by the Solomon Islands Government and stakeholders to reduce inequalities as per the Agenda 2030

Additional Saturday rehabilitation improves functional independence and quality of life and reduces length of stay: a randomised controlled trial

Background Many inpatients receive little or no rehabilitation on weekends. Our aim was to determine what effect providing additional Saturday rehabilitation during inpatient rehabilitation had on functional independence, quality of life and length of stay compared to 5 days per week of rehabilitation.MethodsThis was a multicenter, single-blind (assessors) randomized controlled trial with concealed allocation and 12-month follow-up conducted in two publically funded metropolitan inpatient rehabilitation facilities in Melbourne, Australia. Patients were eligible if they were adults (aged &ge;18 years) admitted for rehabilitation for any orthopedic, neurological or other disabling conditions excluding those admitted for slow stream rehabilitation/geriatric evaluation and management. Participants were randomly allocated to usual care Monday to Friday rehabilitation (control) or to Monday to Saturday rehabilitation (intervention). The additional Saturday rehabilitation comprised physiotherapy and occupational therapy. The primary outcomes were functional independence (functional independence measure (FIM); measured on an 18 to 126 point scale), health-related quality of life (EQ-5D utility index; measured on a 0 to 1 scale, and EQ-5D visual analog scale; measured on a 0 to 100 scale), and patient length of stay. Outcome measures were assessed on admission, discharge (primary endpoint), and at 6 and 12 months post discharge.ResultsWe randomly assigned 996 adults (mean (SD) age 74 (13) years) to Monday to Saturday rehabilitation (n&thinsp;=&thinsp;496) or usual care Monday to Friday rehabilitation (n&thinsp;=&thinsp;500). Relative to admission scores, intervention group participants had higher functional independence (mean difference (MD) 2.3, 95% confidence interval (CI) 0.5 to 4.1, P&thinsp;=&thinsp;0.01) and health-related quality of life (MD 0.04, 95% CI 0.01 to 0.07, P&thinsp;=&thinsp;0.009) on discharge and may have had a shorter length of stay by 2 days (95% CI 0 to 4, P&thinsp;=&thinsp;0.1) when compared to control group participants. Intervention group participants were 17% more likely to have achieved a clinically significant change in functional independence of 22 FIM points or more (risk ratio (RR) 1.17, 95% CI 1.03 to 1.34) and 18% more likely to have achieved a clinically significant change in health-related quality of life (RR 1.18, 95% CI 1.04 to 1.34) on discharge compared to the control group. There was some maintenance of effect for functional independence and health-related quality of life at 6-month follow-up but not at 12-month follow-up. There was no difference in the number of adverse events between the groups (incidence rate ratio&thinsp;=&thinsp;0.81, 95% CI 0.61 to 1.08).ConclusionsProviding an additional day of rehabilitation improved functional independence and health-related quality of life at discharge and may have reduced length of stay for patients receiving inpatient rehabilitation.&nbsp;</p