Why I support Global Handwashing Day

Addise Amado is Water and Sanitation Manager for one of Tearfund’s partner organizations, Kale Heywet Church, Ethiopia. He is currently completing a Master’s degree in water and environment management in the UK before returning home.

In the UK hand-washing is a perfectly normal thing to do. There’s nothing remarkable about seeing someone wash their hands. However, in many rural communities in Ethiopia, like the one I grew up in, washing your hands is not the norm. The normal thing to do, the accepted thing, is to defecate in the open because there isn’t a toilet, and not to wash your hands afterward.

So why the difference between these two countries? I believe that education is a huge part of the answer. Without knowledge, without understanding the impacts on health, habits won’t change.

Teaching someone to wash their hands sounds a simple enough task, but trying to change behaviour patterns or habits is always challenging. The need for hand-washing can be clearly demonstrated – washing your hands with soap and water reduces the risk of diarrhoeal diseases by nearly 40%. But although communities in Ethiopia know first-hand how destructive these diseases can be, they may not realise the connection with hand-washing.

People need to know the critical moments for hand-washing (e.g., after going to the toilet, before handling food, after cleaning babies’ bottoms) and understand why it is important. You need soap and water. When I was a child soap was something that we saved for clothes, it wouldn’t be ‘wasted’ on hands. People also need to dry their hands; wet hands are a perfect breeding ground for germs.

But why should anyone listen to people from outside their village, just because we claim that this is a better way to live? The approach that we use within Kale Heywet Church is to involve the community at every stage.

Community groups are created, they assess current practices and analyse what needs to change. Then they are the ones to work out solutions and implement them. Our role is to support and facilitate this process. And to provide the expertise needed, like with hygiene promotion.

But this process, village by village, takes time, and without follow-up and encouragement people can easily slip back into their old habits, even if they know they shouldn’t. For example, I conducted some research into hand-washing in one village: 60% of inhabitants said that they washed their hands with soap after going to the toilet; observations showed that only 10% of them actually did so.

For me, one of the best things about working in hygiene, sanitation and water is the way the community can get involved. Empowering a community to see the solutions to the problems they face doesn’t have to be finance intensive as they are supported to carry out the analysis, problem-solving and implementation themselves. They can take control of the situation.

Seeing the health benefits that come from improved hygiene is immensely rewarding, but so too is seeing members of a community take on leadership roles in their hygiene, sanitation and water projects.

The situation is improving across Ethiopia. Kale Keywet Church works in 23 districts across four regions of the country. However, greater advocacy and resources are needed if the simple, life-saving message of hand-washing is to reach every person. Global Handwashing Day may not mean much in the UK, but for millions of poor communities around the world it is a day that draws attention to the ongoing need for investment in this critical field.

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Some good news about loos in the news?

Horaay! Some good news in the news… maybe… at least in theory anyway. According to this BBC article here India’s Supreme Court has given the central and state governments six months to ensure that all schools have proper toilets and drinking water. This follows on from a court order made last year that toilets, especially for girls, should be built in all schools.

The fact that the importance of this issue has been recognised at such a high level is definitely news to be welcomed – and the BBC article points out that around 10% of schools in India lack drinking water facilities, 40% lack a functional communal toilet and another 40% lack separate facilities for girls.

This is part of a wider sanitation crisis in India, with two thirds of the population not having access to improved sanitation facilities and just over half carrying out open defecation (JMP 2012). With a population of over a billion people living in India – the importance of addressing water and sanitation in India is unquestionable.

It is not just in India where the lack of proper water, sanitation and hygiene (WASH) facilities in schools is an issue – more than half of all primary schools in the developing countries do not have adequate water facilities and nearly two thirds lack adequate sanitation (UNICEF 2010). While it is encouraging that the BBC ran with this story, perhaps what is lacking is recognition of the significance – both within India and globally – aspects of which I attempt to summarise below;

(c) Will Boase Photography

Impact on education

  • Diarrhoea is one of the top global killers in the world and 88% is caused by poor WASH (WHO 2008). Each year children lose 272 million school days due to diarrhoea (UNICEF 2010).
  • 93% of the 181 million school-aged children in sub Saharan Africa suffer nematode (worm) infections. Nematode infections impact physical growth and impact intellectual development.  This is wholly attributable to poor WASH (Hotez & Kameth 2009).

Impact on girls

  • About 50% of girls in sub-Saharan Africa who drop out of primary school do so because of poor water and sanitation facilities (UN 2006).
  • Girls in particular need privacy and the impacts of poor WASH on girls are especially detrimental once girls hit puberty: absenteeism can reach 10-20% of school time due to lack of WASH facilities at schools when girls are menstruating (UNICEF 2010). One study found over half of girls interviewed had missed school at least once while on their period with lack of privacy being cited as the number one cause (WaterAid 2009).

What must happen now?

The Supreme Court should be applauded for this move and for both prioritising and bringing attention to this issue. However we must not forget that there is a big step from ordering toilets to be built and actually seeing it happen – I hope that it does happen, and that it happens well. Building toilets in themselves will not have the desired impact unless the following points are considered and accounted for;

  • Hygiene promotion is alongside the implementation of these facilities.
  • The facilities are well maintained, and that soap is always available. An evaluation conducted in India showed soap was used by only 2% or less of children when washing their hands – thus severely cutting their effectiveness as use of soap has an enormous impact on reducing the presence of pathogens (UNICEF 2010).
  • Involve the communities in this process –the families of the children, the teachers and the local authorities as this can have multiplier effects when people respond to improve hygiene and sanitation within their homes as well.
  • The toilets are not isolated far away from the protective environment of the school – a study in South Africa revealed more than 30% of the girls attending school had been raped at school – many of those in the school toilets (UNICEF 2010).

Finally the health sector needs to have a key role in this process and work closely with the education authorities. They must play a key role in advocating for effective and adequate WASH facilities in schools and holding the government into account – in 2008 the Lancet stated wrote ‘the shamefully weak presence of the health sector in advocating for improved access to water and sanitation is incomprehensible and completely short-sighted’.

I will watch with interest over the next six months to see what the outcome will be – and hope that this decree does have an immense impact – on the education, dignity, safety and quality of life of children in India. 

Mission impossible? How can WASH services contribute to peace and stability?

Conflict and fragility are holding back development efforts and the poorest and most vulnerable people are at the sharp end of the impact.

Despite the current investment of 30% of all international aid into ‘conflict-affected and fragile states’ (CAFS), not one has achieved a single MDG. Development progress and results are being achieved, but not at the scale and pace needed and are hampered by insecurity and weak governance, to name but two.

But there is renewed interest and energy to tackle this. A New Deal for Engagement in Fragile States was launched last year by the G7+, whereby many countries classed as CAFS are seeking to work in partnership to “reform and reinvent a new paradigm for international engagement”. DFID’s practice paper ‘Building Peaceful States and Societies’ outlines the desire to tackle conflict and fragility head on through development efforts, to include peace-building and state-building in a mutually reinforcing manner.

All great stuff, but what does this mean in practice?

I’ve been thinking about the implications for addressing conflict through the delivery of basic services, such as access to clean water and basic sanitation. To what extent and in what ways can peace and state building be improved through increasing access to water and sanitation? To find out Tearfund teamed up with ODI to carry out research in eastern DRC and South Sudan, with the help of DFID funding and advisory input from conflict specialists SaferWorld. The reports will be available at the end of the year, but I shared some initial reflections at Stockholm’s World Water Week recently and do so below:

We need to be realistic but aspirational. The causes of conflict in both countries are complex and contributions from organisations such as Tearfund to the peace efforts will be minimal at a macro level. But opportunities do exist at the local level and these small efforts, across sectors and combined with other non-state actors, are vital for maximising peace building and state building efforts.

But there would be significant implications for the way we work -such as the skill set of our staff, the time frames we work within and the modality of WASH service delivery used – and donors need to be prepared to support this new way of working

Building the state means tackling visibility. In one project area in DRC, for example, Tearfund was seen as the visible service provider, while the government was not regarded as having the capacity or legitimacy to provide services.  Although Tearfund aligns its work with government priorities and helps to build the capacity of local government officials, in efforts not to create parallel systems, communities can still take a very different view. As one respondent shared ‘Who is the government. Who are they? I have never seen them. They have not brought the schools or clinics to the village.’

ImageThis research also touched on another common debate – how to improve the transition between relief and development work and raises the question at what stage is it appropriate to bring in peace and state building elements? However, in reality the relief/development dichotomy is often an unhelpful distinction. It’s rarely about agencies exiting once the relief efforts have been met and new development agencies coming in – we’re often the same agencies. The relief-development relationship is rarely, if ever, linear. It can be cyclical and a bit messy and as NGOs we need to be able to be more flexible and blend and mix approaches appropriately.

Flushing money down the toilet?

So Bill Gates has actually been flushing his money down the toilet – as the BBC reports here! In between addressing malaria, TB and other killer diseases, Mr Gates has been trying to re-invent the toilet – an endeavour that has received a good deal of media coverage recently, with good reasons too.

The current flush toilet doesn’t make a lot of sense –about 10 litres of drinking water are used when flushing a toilet and then the waste has to be filtered out. This is followed by the challenge to then clean up the water again to a quality that can be drunk – or flushed down the loo once more…

The competition stipulated that designs did not require running water and was especially aimed at countries where piped water to that volume is a constant challenge. The entries to the competition were quite something – with the winner being a solar-powered toilet that can generate hydrogen gas and electricity.

Sanitation, or lack of it, is a problem faced by over a third of the world’s population. The statistics about the lack of sanitation in the world are both well rehearsed and shocking – 2.5 billion people lack access to a basic toilet and around 4000 children everyday die as a result of poor sanitation from diarrhoea.

It’s easy to forget the human story behind every statistic but I was strongly reminded on my recent trip to Ethiopia. I met 30 year old Aeylech Tomas who lives in village, Kisho, about 300km south of Addis Ababa. She talked about the fears she experiences everytime she has to go to the toilet – ‘I am always afraid that someone might see me. If the boys or men see us they might attack or rape us. I feel sad; this is not a good life.’

I am pleased to see that in between reporting on the various toilet inventions the The Gates Foundation have highlighted the health impacts of the sanitation crisis and I hope that some positive public awareness comes from this. For people like Aeylech, it is not necessarily a toilet producing hydrogen gas and electricity she needs, but somewhere safe and clean that will provide her with dignity. Let’s hope that out of this competition, positive public awareness is raised and that ultimately, lives like Aeylech’s can be radically transformed.

Why dialogue on diarrhoea?

‘Oh Stephanie NO, not while we’re eating our dinner!’

This is how the conversation usually goes when my parents make the mistake of asking me how my job is going over a family meal. I have become so used to discussing this subject, I forget that for most people it is perhaps more of an unrefined issue – certainly not a suitable topic of conversation during a meal at least.

But it IS a subject that we need to talk about – in fact we need to ensure lots of people talk about it. Rather than being embarrassed to discuss this over dinner we need to be embarrassed that in the twenty-first century diarrhoea is allowed to prevail as one of the top child killers in the world.

In fact we should be horrified.

Horrified that each year hundreds of thousands of children die from diarrhoea when we know how to prevent it and we know how to treat it. In 2009 UNICEF and the WHO laid this out in a 7-point plan – that brings together both the treatment (rehydration solution, Zinc) and prevention (water, sanitation, hygiene, vaccines and exclusive breastfeeding).

As straightforward as it sounds, to prevent people from getting it and give treatment once they have it, when it comes to policies and – most importantly implementing those policies – it is often challenging. Countries need to coordinate effectively between and within government departments responsible for water, sanitation, hygiene, and health. Dialogue and, most importantly, action is needed to overcome these barriers.

This is why Tearfund and PATH gave their new report the title ‘Diarrhoea Dialogues: from policies to progress’.

The report examines how three high-burden countries are addressing diarrhoea –Mali, Ethiopia and Zambia. It analyses both the opportunities and challenges in diarrhoea control. It concludes with recommendations that the international community need to shout about this issue and catalyse political will to give this issue the priority it deserves. Countries also need to review their policies and improve coordination.

When UNICEF and WHO re-launch their 7-point plan in March 2013, we need to ensure that it doesn’t simply get lost or put on a shelf, but it turns into action.

If we want to see lives saved and this avoidable suffering stopped we need to make a noise about this issue… even if it does make for an uncomfortable dinner time conversation.

Guest Post: What They Expect When They Are Expecting

A new rom-com about pregnancy, birth and babies is about to hit our cinema screens: What To Expect When You’re Expecting. It won’t be everyone’s cup of tea, but it looks to do well in the chick-flick charts.

The film focuses on the journey of five American couples. The same journey of pregnancy and birth that is followed by millions of women around the world each year. I say ‘same’. Actually, the reality is that what expectant mothers can expect in pregnancy, birth and motherhood differs enormously depending on where in the world they themselves happen to have been born.

My daughter, Lydia, was born almost 18 months ago in a London hospital. During the pregnancy, I remember feeling extremely privileged at the number of routine antenatal appointments and scans I had. In my work with Tearfund, I’d met many women in developing countries who were pregnant or had young children. I knew most of them had experienced no such care.

In our antenatal classes my husband and I were encouraged to write a ‘birth plan’ outlining our wishes for the birth. Looking back, it’s interesting to reflect on what our birth plan did not include. There was no mention of things such as ‘clean water and soap for hand washing’, ‘hygienic and skilled care’ or ‘access to a toilet’. These were basic expectations – ones that giving birth in the UK, we took for granted. Most mothers in Southern Asia and sub-Saharan Africa give birth without skilled care and many are denied the basics of water, sanitation and hygiene, often with tragic consequences. Approximately 99% of all maternal deaths (about 1000 a day) occur in developing countries, and most are preventable. As many as 15% of them are caused by infections in the six weeks after childbirth, mainly due to unhygienic practices and poor infection control during labour and delivery (according to Tearfund’s Joining the Dots report).

Mari with her new baby Lydia in 2010

I won’t go into detail, but Lydia’s birth wasn’t straightforward. The ‘birth plan’ went out of the window and the whole process required a fair bit of medical intervention. After the birth, I was severely dehydrated. But I was placed on a drip and had unlimited access to clean drinking water. Lydia was moved to an incubator on a ‘High Dependency Baby Unit’ with suspected pneumonia. She was put on antibiotics, monitored and cared for in clean and hygienic surroundings. Thankfully, Lydia only stayed on the Unit for 36 hours and we were both out of hospital within a week. 17 months on, Lydia is thriving. Had she been born in a place without such care, it could have been a very different story.

And what about the differences in expectations for childhood around the globe? The statistic that stays in my head the most from my time at Tearfund is this: every day, 4000 children under the age of 5 die because of lack of access to clean water and basic sanitation. 4000 children, children like Lydia, every single day. That is outrageous.

Mari and Lydia happy and healthy in March this year

I want Lydia to grow up in a world where no woman dies due to preventable causes in pregnancy or childbirth and no child dies because they lack clean water or decent sanitation. There are 3 years left for governments to achieve the Millennium Development Goals. The Goals related to water and sanitation, maternal health and child health are some of the most off-track. Governments must recognise the links between these Goals, and act with unprecedented financial and political will to achieve them.

Is that too much to expect?

What to Expect When You’re Expecting comes out in UK cinemas next Friday, 23rd May.

Mari Williams worked in Tearfund’s policy and campaigns teams for 7 years. She now spends her time looking after her daughter Lydia and working as a freelance researcher and writer. 

Time for change – outcomes of the Ministerial meeting of Sanitation and Water for All

“A mother and child wait for you to return home” and put your commitments into action was the challenge from Liberian President Ellen Sirleaf Johnson to delegates at the Ministerial meeting of ‘Sanitation and Water for All’ (SWA) yesterday. She couldn’t be there in person but her word’s still carried the passion and authority she has for water and sanitation.

Friday 20th April was the 2nd Ministerial meeting of SWA, the global partnership that does what it says on the tin – working towards universal access for sanitation and water. Tearfund, alongside others, campaigned for the creation of this global partnership to increase the political and financial priority needed to deliver the basic right of access to water and sanitation for everyone. Since the partnership’s launch in 2010 it has grown in size and strength. Yesterday an unprecedented amount of finance, water/sanitation, health and development Ministers met from nearly 40 countries to demonstrate how they are committed to change and pushing sanitation and water higher up the global as well as national agenda’s.

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Ministers and other delegates commit to increasing access to water and sanitation at the High Level Meeting. Photo: WaterAid

After much anticipation and advocacy it was a day to celebrate and I was able to hear first hand the commitments made.  Donor governments stepped up to the bar and the UK government led the way by announcing it is doubling the amount of people it intends to reach with access to water and sanitation from 30 to 60 million people by 2015. Two new donor governments, the US and Australia, joined the partnership and called on other donor’s to do the same. The US also pledged $1million to SWA’s support to the most off-track countries.

A somewhat less ‘glitzy’ announcement but equally important came from Japan. They committed to improve the targeting of their funding to the people most in need. This was in response to the findings of a new report highlighting how globally, only 50% of aid for WASH goes to the countries most in need and only 26% on basic services. Japan is the largest bilateral donor for WASH and yet the majority of their funding is spent on larger infrastructure projects. So, if Japan does really does make a step change, it could make a huge difference to the most poor and vulnerable.

Developing country commitments included:

  • The Kenyan Minister for Water and Irrigation, Charity Ngilu, reflected that “the missing link in Africa is lack of access to water” and responded pledging that a further 20 million people would gain access to drinking water and sanitation by 2015.
  • Benin committed to increasing its budget allocations for 2013-2014 by 100% per year for basic sanitation
  • Burkina Faso promised to eradicate open defecation by 2015.

That’s just a snippet of the commitments. However, as with all such endeavours, there is never time to sit back and celebrate for too long. There were also some sobering reminders of why everyone had gathered. The Minister for Rural Rehabilitation and Development from Afghanistan was open about their shockingly low levels of sanitation coverage at only 5% of the population. The room went tangibly quieter as Nigerian Finance Minister, Ngozi Okonjo-Iweala, shared her personal story of contracting hook worm from poor sanitation in villages as a young lady and receiving life saving treatment years later.

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SWA Chair, John Kufour, is flanked by incoming UN Deputy Secretary General and moderator for the meeting, Ambassador Jan Eliasson, and Anthony Lake, Executive Director of UNICEF. Picture: WaterAid

Underlining President Johnson’s call at the beginning, ex Ghanian President and now Chair of SWA, John Kufour, reminded delegates “we’ll be judged by our actions and not our words”.  Truly appropriate words to sum up an historic occasion, and we’ll be working hard to ensure the commitments turn into action and the mother and child are no longer waiting.

Gavin Shuker MP guest blogs on World Water Day

ImageNext week I will travel with Tearfund to Zambia to witness firsthand the work Tearfund is doing on the ground to assist communities to access clean water.

As Shadow Minister for Water in the Department for Environment, Food and Rural Affairs it’s my job to consider water everyday. On a daily basis I try to hold our UK Government to account to ensure that we have access to safe uncontaminated water at an affordable price.

Tearfund also works everyday to help communities across the globe access better sanitation and clean drinking water, along with many other pursuits such as assisting farmers respond to threats from climate change.

Today, on World Water Day it is important for us all to take a step back and to recognise how lucky we in theUKare to have access to clean drinking water.

Couple this with the upcoming Rio+20 Summit being held in June, we have an incredible platform to raise water sanitation issues onto the global political agenda – and I urge our UK representatives to raise the issue of water infrastructure and sanitation at this forum.

We need an ambitious government that wants to lead the world on sustainable development, eradicating poverty and one that takes water and sanitation seriously.  With this in mind it is imperative that access to water and sanitation remains a priority for UK aid.

I agree with Tearfund, and believe that with a little bit of political ambition, DFID should increase its results in WASH in a way that reflects its equal priority compared with other basic services such as health and education.

I also urge the Secretary of State for International Development, Andrew Mitchell to make full use of the Sanitation and Water for All Partnership forum when it meets in April.

I look forward to my travels with Tearfund. I am sure I will able to return to Parliament and become a strong ambassador for the work they do every day across the globe.

Gavin Shuker is the Shadow Minister for Water and Waste at DEFRA and Tearfund supporter.  

MDG target on water met, but the devil is in the detail

At Tearfund we’ve been doing advocacy on water, sanitation and hygiene for nearly 15 years now, and ‘good news’ days are few and far between in terms of progress against the MDGs. However, today is one of those days.

The latest monitoring data was published today by WHO and UNICEF, reporting that the world has met the MDG target on water – to halve the proportion of people without access to safe water. This is definitely good news! Especially for the 2 billion people that have gained access between 1990 and 2010[1]. The fact that this was achieved 5 years ahead of the MDG deadline of 2015, is timely news; just ahead of World Water Day on 22nd March and a month later, the next high level meeting of the global partnership ‘‘Sanitation and Water for All’.

Yet, the devil is in the detail. Notwithstanding the fact that 783 million people are still without access to safe water – over 10% of the global population – the figures hide various disparities of progress across and within countries. For example, Sub-Saharan Africa accounts for more than 40% of the global population without access to improved drinking water.

However, with diarrhoea being the biggest cause of death among children in Africa– we must not forget that the twin target of reducing the proportion of people without access to sanitation is far from being met. Although off track globally, it’s in Africa where the statistics are most startling: at current rates of progress, sub Saharan Africa won’t meet the target on sanitation for another two centuries. I’m still astounded at how this can be the case in such ‘modern’ times.

When talking about the billions of people affected by lack of access to safe water and basic sanitation, it’s all too easy to forget the human impact and daily grind this means in practice. When in Haiti recently, I was reminded of the fast pace at which cholera can spread and the devastating death toll it leaves in its wake.  Indeed, as the WHO Director-General Dr. Margaret Chan has reflected “today, even with this exciting new progress, almost 10 per cent of all diseases are still linked to poor water, sanitation and hygiene.”

Whilst today has brought encouraging news of the MDG progress, this is no time to sit on our laurels – much work remains to be done. The ‘Sanitation and Water for All’ partnership mentioned above, aims to garner the much needed political and financial priority required so that everyone in the world has access to sanitation and water. It’s crucial that donors and developing countries alike step up to the mark and show the leadership, backed up with action, that’s required.


[1] There is a 2 year lag between data collection in 2010 and publishing the report

Prevention as well as cure: You want to stamp out tropical disease? Put clean water, sanitation and hygiene at the top of your ‘to do list’.

The Gates Foundation conference today: has sparked an increase in the debate on how to tackle tropical disease, with DFID announcing a five-fold increase in its aid for this area last week. There is no doubt that working with the pharmaceutical industry to increase investment in the treatment:and in some cases eradication, of diseases, such as trachoma and guinea worm which can deform, disable, blind and kill, will be a great step forward.

However, in the current climate: where “value for money” is the mantra, shouldn’t we also be ramping up investment in the measures that stop people from getting sick in the first place? Basic hygiene: proper toilets, an uncontaminated water supply and simple hand washing, can stop these diseases spreading and destroying communities. Every 20 seconds a child under five dies in the developing world from a preventable illness. Clean up the water, and you’re going to make a huge difference.

Working alongside other NGO’s, Tearfund helps to run one of the few health centres in Motot, South Sudan. It offers immunisation, but also explains how a change of hygiene habits can prevent diarrhoea and stop babies getting sick. Families learn that washing their hands with soap after going to the toilet, or before eating, prevents these diseases like bilharzia (which kills 200,000 in Africa each year) from spreading spreading. Latrines too, help to control the flies that carry Chlamydia between children’s faces.

And in Parwan, in central Afghanistan, a low tech solution; Bio-sand filters, are helping to rid stream water of bacteria and worms. One woman told of how this had made a huge difference in her life.

‘We always used to drink from streams and all our children had diarrhoea. This meant high medical bills, because we didn’t understand the problems; the filter is a huge gift as our children are now better’.

In some ways this is stating the obvious.  We all reach straight for the bottled water when in unfamiliar territory to reduce the risk of picking up diseases.  However, what is less obvious is why there appears to be a false divide between those working on medical solutions and those working on water and sanitation – with an imbalance in funding available as well.  At a community level, health workers definitely see these issues as all part of the same problem, so shouldn’t we try to be a bit more “joined up” at the global level as well? It’s a humanitarian priority, and makes economic sense too.

There is some good news. The Sanitation and Water for All Initiative may not be as well known at the Global Fund for AIDS, TB and Malaria, or other global health initiatives, but it is doing great work behind the scenes to catalyse action to improve access to safe water and sanitation worldwide.  Just last week, due to the work of Sanitation and Water for All, Liberian President Ellen Johnson Sirleaf signed a compact which sets out how her government, alongside international donors, will prioritise action in this vital area in the years ahead. This investment will do much to reduce tropical disease in the country as well.

How can we encourage more governments, and donors, to get behind this and do the same?

Of course it’s positive that the Bill and Melinda Gates’ Foundation, governments, NGO’S and the private sector are all talking about tropical disease prevention around the table today. My message to all of them:  everyone gains if the health sector works with the WASH (water, hygiene and sanitation) sector, and investment in both – both financial and political capital – is vital. Maybe when Gates is next in town, we could have a conference on this?