USAID IWASH PROJECT: Community-Led Total Sanitation Component

USAID IWASH PROJECT: Community-Led Total Sanitation Component

Open Defecation Status, Community-Led Total Sanitation and Ebola Virus Disease (EVD) in Voinjama and Kolahun Health Districts, Lofa County, Liberia (2014)
Executive Summary

Global Communities, formerly CHF International, implemented the five-year USAID-funded Improved Water, Sanitation and Hygiene (IWASH) program in three counties in Liberia from February 2010 to April 2015. Global Communities concentrated WASH program activities in portions of Liberia’s most densely populated, non-urban counties, specifically Lofa, Bong and Nimba counties. In addition to supporting households and communities with improved access to suitable water and sanitation services, IWASH engaged heavily in capacity building with multiple Government of Liberia entities, focusing on strengthening County Health Teams (CHTs) to improve the enabling environment for WASH, while enlisting substantive participation from relevant ministries, including the Ministry of Health and Social Welfare (MoHSW) and the Ministry of Public Works (MPW).
In collaboration with the Liberian Ministry of Health and Social Welfare (MoHSW) at both national and county levels, IWASH implemented Community-Led Total Sanitation (CLTS), an internationally-recognized approach to improving sustainable access to sanitation and safe hygiene practices. CLTS “triggers” community disgust toward open defecation practices and subsequently raises community awareness about how feces in the environment can impact health and livelihoods. CLTS identifies Natural Leaders (NLs), community members who encourage their communities to achieve Open Defecation Free (ODF) status, as verified by the Liberian government. Once triggering was initiated, communities were actively monitored by IWASH staff. At the onset of the Ebola Virus Disease (EVD) outbreak in Liberia (March 2014), 284 of 350 triggered communities (81%) had been verified as ODF. During the Ebola crisis, Global Communities continued to trigger more communities. At the close of IWASH Global Communities had triggered 370 communities, 310 of which were verified ODF.
EVD first entered Lofa County from Guinea through Foya district in March 2014 and spread quickly across the county into other IWASH program areas. The Lofa County Health Team reported a total of 928 reported EVD cases – of which 422 were confirmed cases (206 male/216 female) – and 648 deaths in Lofa County alone.1 As the rate of Ebola transmissions began to decline, and as communities regained some stability, informal word-of-mouth observations and reports from IWASH communities, County Health Team officials and Global Communities’ staff consistently pointed to an absence of Ebola infections in communities where IWASH had implemented CLTS programming, and specifically, in communities that had achieved Open Defecation Free (ODF) status.
In order to confirm unofficial reports, and to identify any critical links between CLTS and the ODF process and reduced Ebola transmission, Global Communities commissioned a research study in January 2015 in two of the six health districts in Lofa County where IWASH was implemented (Voinjama and Kolahun) and where 98 out of 115 IWASH communities had achieved ODF status. The research also examined the broad impact of Ebola on IWASH communities in Lofa County and whether any correlation could be demonstrated between IWASH interventions and EVD preparedness or prevention.
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