Primary SDG Focus
Secondary SDG Focus
How was your primary SDG focus identified and prioritized in the company’s value chain?
In Tanzania over 81,000 infants and nearly 114,000 children under-five die annually, while approximately 8,000 mothers die each year during childbirth (UNICEF, 2017). These sobering statistics make it strikingly apparent that reproductive, maternal, newborn and child health (RMNCH) must be a development priority in Tanzania.
However, the RMNCH indicators do not tell the whole story. A more comprehensive analysis of clean water, sanitation and hygiene (WASH) services in Tanzania reveal that only 65% of healthcare facilities (HCFs) have access to clean water and only 35% have access to basic hygiene services (UNICEF, WHO, 2019).
Together, the statistics make it overwhelmingly clear; improved RMNCH will not be achieved without prioritizing equitable access to WASH.
As such, SDG6 was identified as the focus of our Tanzania: Deliver Life program. By working to provide WASH services at 12 HCFs in the Geita and Nyang’wale districts, we are directly contributing towards achieving universal and equitable access to safe and affordable drinking water, as well as adequate and equitable sanitation and hygiene by 2030.
SDG6 is embedded in our mission – to transform the lives of the poorest and most marginalized people by improving access to WASH – and prioritized in all the work we do. At the highest level, our commitment to advancing SDG6 is reflected in our strategic plan, and this commitment is reflected in the work plans of each WaterAid team member. From contractors working in Tanzania to our CEO in Canada, each member is invested in advancing our mission and working towards SDG6.
How was your primary SDG integrated and anchored throughout your business?
Our Tanzania: Deliver Life program is part of the Canada-Africa Initiative to Address Maternal, Newborn and Child Mortality (CAIA-MNCM) that is being carried out by a consortium of Canadian organizations. As a member of this four-year (2016-2020), $4.4 million-dollar program supported by Global Affairs Canada (GAC), we are contributing to reducing maternal, neonatal and child mortality in Tanzania.
Despite the CAIA-MNCM being centered on RMNCH outcomes (SDG3), we have integrated and anchored SDG6 in all aspects of our programming, as we know that clean water, decent toilets and good hygiene underpin maternal, neonatal and child health. For example, without clean water, midwives and nurses are unable to wash their hands between deliveries, sterilize tools or clean delivery rooms. As a result, the risk of bacterial infections, such as maternal and newborn sepsis, is high and can be fatal.
Anchoring SDG6 at the forefront of our work as part of the CAIA-MNCM ensures WASH is prioritized and integrated into Tanzania’s wider development priorities and contributes to accelerating change in sectors such as education, health and agriculture, as well as promoting economic development and climate resilience.
Did you employ any innovative approaches in your efforts to implement the goal?
We employ a variety of innovative approaches in the implementation of our program and in the advancement of SDG6:
- We use population mapping to predict future populations and WASH demands in the communities where we work. This forward-thinking project design ensures WASH services are sustainable, especially given the high fertility rate and rapidly growing communities in Tanzania. Moreover, this data is used as evidence for strategic advocacy within the government and to facilitate cross- sectoral coordination.
- We use sustainable technologies (i.e. solar mechanized rainwater harvesting systems) to ensure a clean, reliable supply of water in the face of the intermittent power and severe drought that often plague the districts. We are aiding communities to develop climate resilience; ensuring WASH for all, even in the face of climate change.
- We use innovative methods of promoting sanitation and hygiene behavior change using locally-centred radio campaigns, particularly targeting mothers and children.
We build our WASH systems in such a way that they can be scaled up by the local, district and/or national governments. For example, in some sites where the source of water is reliable, we are working with governments to provide water to not only health facilities, but also to schools and communities. By sharing our expertise and building our WASH systems with the capacity to expand, we are enhancing the sustainability of WASH services, promoting both community and government involvement in WASH and catalyzing national action to advance SDG6. In doing so, we are also advancing SDG17.
Were any partnerships leveraged or created?
First, through our CAIA-MNCM consortium partnership we are leveraging our partners’ complementary knowledge, expertise and resources. For example, at the 12 targeted HCFs we are taking the lead on WASH infrastructure improvements and the training of healthcare workers, while our partner Amref is focusing on health systems strengthening and nutrition activities. This partnership allows us to use WASH programming to tackle the interconnected SDGs more effectively.
Second, in each step of the program we have partnered with government officials at the national, regional and district levels, as well as community-based organizations in Tanzania. The design of the program was informed by consultations with and close involvement of these various key stakeholders to align with traditional approaches. Involvement of government, local partners and key influencers remains crucial to our work as it helps to ensure engagement with the project, and it enhances governance, accountability and capacity to support quality RMNCH and WASH services after our program has ended.
Third, working with our partners has allowed us to influence policy and practice in order to bring about large-scale and sustainable change to WASH services and RMNCH, and ultimately to advance SDG6. For example, by working with Ministry of Health, UNICEF and our local community partners, we helped develop and launch the National WASH in HCFs Guidelines (2017). Leveraging this partnership to advance advocacy and policy work has increased the profile of WASH in HCFs in Tanzania’s National Development Agenda, with the government recently committing to ensuring 1,000 HCFs have WASH by 2021.
What communications strategy did you employ to share the initiative with your stakeholders?
The SDG Compass highlights the importance of strategic alignment of our mission with the SDGs. Aligning our mission with SDG6 allows us to be more effective in our communication about our program and our commitment to sustainable development on a global scale. At the local level, we strategically aligned our project with the Government of Tanzania’s Big Result Now Strategy and Objective 4 of Tanzania’s Water and Sanitation Sector Development Programme II, allowing us to be more effective in our communication of this project to the local communities, increasing community engagement.
The CAIA-MNCM communication strategy was developed to aid in effective communication of the program in the Canadian context. As a CAIA-MNCM member, our communication focuses on public advocacy, raising the profile of the program and recognizing the financial contribution of GAC. Additionally, by communicating our progress towards our KPIs, our financial results and our program impacts, we are increasing our transparency and accountability. Our communication methods include the use of social media, annual reports, newsletters/blogs and media coverage. Leveraging this partnership allows us to expand our reach at home and in Tanzania.
This year, a partnership with broadcast journalist Alannah Campbell led to the creation of an award-winning radio documentary, The Water Carriers. Focusing on Tanzania, this piece highlights how WASH is a critical pathway to empowering women and girls. In doing so, it emphasizes how WASH programs are in line with Canada’s Feminist International Assistance Policy and help to advance SDG5, in addition to SDG6.
How were KPIs and the levels of success outlined and defined?
Our program uses a Results-Based Management framework, with the Logic Model representing the blueprint for program implementation, and the Performance Measurement Framework serving as the key reference point for the design of the Monitoring and Evaluation (M&E) system.
We use two types of KPIs in the Performance Measurement Framework – process indicators and outcome indicators – however all our KPIs stem from our mission to reduce maternal & child mortality in the Geita and Nyang’wale districts of Tanzania. Process indicators are used to monitor program outputs and were chosen based on activities to be implemented. Outcome indicators are for assessing health outcomes and are conventional. Outcome indicators were drawn from list of common indicators provided by GAC, as well as from the WHO list of indicators.
For us, success is measured against the KPIs falling under our 9 Immediate Outcomes, three Intermediate Outcomes, one Ultimate Outcome. Program activities falling under Intermediate Outcome 1100 are geared towards improving the supply of health services; while program activities falling under Intermediate Outcome 1200 are geared towards empowering communities to increase demand for quality health services.
How were reporting and monitoring conceptualized and undertaken?
Our consortium partner SickKids Centre for Global Health leads the development and deployment of the program’s rigorous M&E strategy. This effective monitoring strategy produces high quality data that allows for informed decision making, as well as the sharing of results and lessons learned in order to inform the sector and provide evidence to influence policy. Moreover, this monitoring ensures accountability and enables robust reporting on program results to partners, local stakeholders and donors.
Capacity building for local monitoring is also central to our work in order to ensure sustainable WASH services after our program is completed. We have done this by supporting the Ministry of Health in the delivery of a National Sanitation Management Information System seminar with WASH and health sector actors, including health officers from the Geita and Nyang’hwale districts. Additionally, we have trained partners and health officers on WASH data collection and management using of the National Sanitation Management Information System.
Our program uses multi-step reporting. We (WaterAid Canada) ensure quality and comprehensiveness of reporting from WaterAid Tanzania before reporting progress on or towards outcomes to Amref Canada, who then reports on behalf of the consortium to GAC. This includes semi-annual reports on outcomes, as well as quarterly finance and construction reports.
What were some key lessons learned?
Setback: Unforeseen construction delays at two HCFs.
Lesson learned: Coordination among stakeholders and adaptability are needed to reach target outcomes when faced with unforeseen circumstances. When the government shared with us their updated plans to upgrade the Nyarugusu dispensary to become a Health Clinic, this required us to adapt our designs in order to accommodate the larger WASH demands of a larger facility. By having district staff, particularly the district engineers, involved at all stages of the program, we were able to effectively coordinate and adapt our plans in order to meet our targets, despite the increased demands for WASH.
Setback: Resistance to cooperation from village and district-level leaders.
Lesson learned: For effective policy and practice work, we must engage and cooperate with leaders at all levels of government. This involves engaging with local leaders to make them aware of WASH issues in order to obtain their support for the program and to help sustain the WASH services after the program ends. To foster cooperation, we learned that organizing a Key Project Implementation Team with cross-sector expertise, including key players in Community Development, Health, Education and Water, is incredibly beneficial.
Setback: At three sites where borehole pumps were connected to the electricity grid for power, the amperage was found to be insufficient to lift water from the underground aquifers.
Lesson learned: To overcome this challenge, we turned to innovative methods of power generation, installing solar panels to provide a reliable electricity source and an uninterrupted water supply to the HCFs.
What were the key impacts and results?
Key impacts and results of our work include:
- The rehabilitation and construction of WASH services and biomedical waste facilities at 12 HCFs.
- This infrastructure advances SDG6 by providing clean water as well as adequate and equitable sanitation and hygiene. To date, clean water is flowing at 9 of 12 HCFs, reaching approximately 500,000 people.
- This investment in WASH yields high returns by vastly improving the quality of RMNCH care, decreasing the rate of patient return and increasing healthcare staff retention.
- The training and capacity building of community members, village healthcare workers, as well as school staff and students.
- To date, we have trained 344 village health workers on RMNCH and best practices in WASH. Our reach is multiplied as the health workers teach community members how to construct tippy taps and share hygiene education messages (read stories from our work, attached). Additionally, we have trained 1906 community members in WASH behaviour change, greatly exceeding our target of 653 people. These trainings catalyze participation of the local communities in improving WASH and RMNCH to ensure lasting change.
- We have established WASH clubs and have conducted workshops on menstrual hygiene management and hygiene best practices at 12 schools, reaching 278 students, as well as their teachers and school management. Hygiene education helps reduce the spread of disease and gives girls the skills they need to manage their menstruation safely and with dignity. This training helps keep students, especially girls, healthy and in school, advancing SDG4.
- The Water Carriers Documentary
- Canada-Africa Initiative to Address Maternal, Newborn and Child Mortality (CAIA-MNCM) Project in Tanzania
- WASH: A Pathway to Realizing Gender Equality and the Empowerment of Women and Girls
- Improving WASH in Health Care Facilities in Tanzania
- National WASH in Health Care Facility Guidelines Tanzania
- WaterAid Canada Annual Report 2017/2018
- Select social media posts