Context and Community Profile:
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
is one of the components of CARE Kenya's Nyanza Household Livelihood Program (Dak
Project Coverage and location:
target communities are located in Western Kenya around Lake Victoria, in the three
districts of Rachuonyo, Homa Bay and Subain Nyanza province.
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.
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.
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.
Detailed Narrative description of NHW project
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.
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.
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
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
· Safe water storage, preferably in plastic containers
with narrow mouths and spigot
· Behavior change resulting from hygiene
education and social marketing
The Study matrix:
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
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.
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.
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:
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.
group B: * WASEH villages in which well construction is possible|
randomly selected from each of 3 districts
* Each village is given access
to safe water system in phase 1 of the project
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.
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
dosages of chlorine for various water storage vessels has been established viz.
for new clay pot, old clay pot and plastic container.
Project Implementation strategies:
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.
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.
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.
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.
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
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.