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CARE Kenya: Dak Achana Program
CCHI Project Profile


Country: Kenya, East Africa
Project name: Nyanza Healthy Water Project
Program name: CARE Kenya: Nyanza Household Livelihood Security Program (Dak Achana)
Donor & TimelineWoodruff Foundation, USA: Period: Oct.1, 1999 to Aug.31,2001 (i.e. .22 months funding period)
Project budget USDCCHI portion : US$ 250,000 In-Kind (CARE -WASEH): US$ 1,199,990 Total : US$ 1,399,990
Project GoalTo improve household water quality and decrease diarrheal diseases in a population lacking potable water.; hence enable increased biological utilization of food for a "supergoal" of improved child nutrition.
Professional staff provided by associated firm:2 CDC Scientific Advisors & 2 CCHI coordinators based in Atlanta.
Staff involved directly in project implementationNHW staff (5) - Project Officer, Marketing Specialist and 3 field OfficersWASEH shared staff - Project Manager, Training Officer (1) & Field staffs (3)Program shared staff - Program coordinator plus M & E Officer
Project contact personsProject Manager: Philip Makutsa,
email: [email protected]
Western Regional Coordinator: Dr. Adam Koons,
email: [email protected]
Funding Agency:Woodruff Foundation, USA



A. Context and Community Profile:

A1. Introduction:
The Nyanza Healthy Water Project is a fairly new project in CARE Kenya and is being implemented under the auspices of CARE - Centers for Disease Control and Prevention (CDC) Health Initiative (CCHI). The project complements an on-going CARE Kenya's USAID-funded Water, Sanitation and Education for Health (WASEH) Project, and is an applied research cum development project within the rural context.

WASEH is one of the components of CARE Kenya's Nyanza Household Livelihood Program (Dak Achana).

A2. Project Coverage and location:
The target communities are located in Western Kenya around Lake Victoria, in the three districts of Rachuonyo, Homa Bay and Subain Nyanza province.


A3. Profile of the communities
These districts have an estimated population of 575,294 with annual growth rate of 3.0%. The main livelihood systems are subsistence farming, petty trading, agricultural wage labor and small-scale commercial fishing.

Rural-to-urban migration, along with the breakup of households due to deaths and divorce, has resulted in approximately 35% of rural household being headed by women. These female-headed households constitute (53%) of all households living in absolute poverty, nationally. In two of the districts, the target population is of rural-rural migrants, whose settlements dates back as far as 1950s.

A4. Interventions and selection criteria
The Nyanza Household Livelihood Security Program is a multi-sectoral set of projects, targeting mainly food, health and nutrition securities. The program is designed based on a livelihood security assessment conducted by CARE-Kenya in 1996 and 1999. These assessments found constraints to livelihood security, including 34% access to safe drinking water, 47% incidence of diarrhea among children, poor sanitation, poor nutritional standards, high prevalence of STD/HIV/AIDs, low food production and lack of credit facilities.

B. Detailed Narrative description of NHW project

B1. Project Overview:
The NHW project is basically an applied research cum development project. The project goal is to improve the quality of drinking water at household level and reduce diarrhea incidences in the target population, particularly in children below 5 years.

The project seeks to accomplish three objectives:
i. Motivate the communities to adopt and use the safe water system.
ii. Determine the impact of the intervention on health, in terms of reduced diarrhea incidences, improved nutrition and ultimately reduced child mortality rate.
iii. Develop a social marketing strategy that would promote a wider utilization
of the safe water system.

B2 Technology
This household-based water quality intervention, commonly referred to as safe water system, and was developed by the Centers for Disease Control and Prevention (CDC) and Pan America Health Organization/World Health Organization (PAHO/WHO) for control and prevention of diarrhea diseases caused by bacterial infections.

The intervention employs technologies appropriate for the developing world, which comprises of the following key components:
· Filtration of contaminated water using cotton cloth
· Treatment of contaminated water using Sodium Hypochlorite
· Safe water storage, preferably in plastic containers with narrow mouths and spigot
· Behavior change resulting from hygiene education and social marketing


C. The Study matrix:

C1. Research Design
The project uses a quasi -experimental design. The nature of the implementation of the safe water system does not permit experimental design because the disinfectant solution and storage containers will be promoted and offered for sale on a village- basis. As such, the Nyanza Healthy Water Project is basically an applied research project

The purpose of the study is to determine whether households in the WASEH project areas utilizing the safe water system are able to improve the quality of stored drinking water and reduce the incidence of diarrheal diseases in children under 5 years.

The study covers a total of 1620 households in 18 villages, and the implementation is being done in all the 71 villages where Dak Achana is implementing WASEH project and two villages where TASK projects is being implemented.

The study in the selected villages involves, monitoring of chlorine adherence at the households, consumer research and active diarrhea surveillance. This study has three intervention groups which are as follows:

Intervention group A: * WASEH villages in which well construction is not possible
* Two randomly selected from each of 3 districts.
* Each village is given access to safe water system in phase 1 of the Project.

Intervention group B: * WASEH villages in which well construction is possible
* Two randomly selected from each of 3 districts
* Each village is given access to safe water system in phase 1 of the project


C2 Formative and Consumer Research
These have been conducted to gauge the communities' acceptability of the safe water system, willingness to buy the inputs, affordability and preferred distribution system. Communication channels and decision making were also explored. Further qualitative consumer research was conducted to identify a locally acceptable name, logo, promotional slogan and preferred label design of the chemical. A sustainable input supply and distribution system (chlorine and storage vessels) has been designed. For production of the inputs, CARE has contracted the services of the private sector.

C3 Chlorine Demand Standardization of various water storage vessels was conducted to determine the amount of chlorine needed in 20 liters of river, dam (earth pan) and lake water. These vessels included old and new clay pots as well as a plastic container.

Thus dosages of chlorine for various water storage vessels has been established viz. for new clay pot, old clay pot and plastic container.


D. Project Implementation strategies:

D1. Community mobilization
The Nyanza Healthy Water Project covers the same 71 villages with a target population of 51,183; currently being covered by WASEH. The project is using functional community structures, which have been facilitated by WASEH and put in place. The 3 Locational Management Committees (LMCs), 6 Sub-Locational Management Committees (SLMCs ) ,71 Village Management Committees (VMCs) are charged with the responsibility of co-ordinating the implementation of the project activities.

D2. Input Supply System
The project has established linkages with the private sector which is a commercial bleach manufacturer produces branded Sodium Hypochlorite (Klorin) and transports to the project site.

A sustainable system of distribution of inputs (chlorine and storage vessels) using the local institutions has been designed and established to facilitate easy accessibility by the communitymembers. Distribution of the chemical and the water storage vessels is through the local community institutions and the VHPs. Reasonable price margins are offered to create incentives and motivation to VHPs.

D3. Hygiene Education
A total of 520 Village Health Promoters (VHPs) have received training using a curriculum jointly developed by WASEH and Nyanza Healthy Water Projects. The VHPs will conduct Hygiene education to the communities, particularly on safe water handling and storage and prevention and control of diarrhea.

D4. Water Quality Testing
Water sampling and quality analysis will be conducted to determine the bactericidal effect of chlorine in water during rainy and dry seasons. Samples of water from the 1,620 households will be collected and tested for Escherichia coli and other coliforms in the laboratory. Chlorine adherence monitoring will also be carried out to monitor adoption rate of chlorine in households. Chlorine levels will also be checked at the household level.

D5. Monitoring of Health Effects
Diarrhea surveillance will be conducted in 360 households (22% of the target) to determine the health effect of the intervention on diarrhea incidences in the villages. The surveillance will run for 8 weeks per season (before the rains and after the rains).

E. Social marketing techniques
Upon the conclusion of this research/study in August 2001, Phase II of the project will commence immediately. This will entail launching and wider dissemination of the modified safe water technology based on the experiences and lessons learned.


Centers for Disease Control and Prevention
National Center for Infectious Diseases
Division of Bacterial and Mycotic Diseases
Foodborne and Diarrheal Diseases Branch


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