Impacts and lessons learned from the rural water borne disease control project, Swaziland : a ten - year retrospective

Project training and TA improved the performance of involved Government of Swaziland (GOS) agencies -- the Rural Water Supply Board (RWSB) and the Ministry of Health"s (MOH) Health Inspectorate and Health Education Unit (HEU). The RWSB became very productive in constructing water supply systems, the Bilharzia Control Unit was reinforced, and the HEU gained a stronger place within the MOH; these improvements appear sustainable. The impact on broader institutional capabilities, coordination, and sector planning has been less, though informal coordination between MOH and RWSB at the field level remains strong. The absence of functioning information systems severely constrains the ability of the RWSB and the MOH to monitor and plan their activities; project assistance in this area was a conspicuous failure. Initiatives such as health communication and community development paved the way for continuing effective GO/USAID collaboration in these areas. In its single most visible impact, the project provided plentiful potable water for domestic use to an estimated 52,000 rural Swazis in 52 communities through 529 water taps. Although it was not possible to document decreases in diarrhea and schistosomiasis, the 1988 Swaziland Family Health Survey indicated that rural families with access to piped water systems have lower diarrhea rates than those without, and health personnel have observed a definite decrease in childhood diarrhea. On the sanitation side, at least 1,400 ventilated improved pit latrines, and probably many more, were constructed with project support. Had the 1982 KAP survey been repeated, it probably would have confirmed that health-related behavior has improved in rural Swaziland. Health messages are widely disseminated, and people generally appreciate the importance of clean water, especially for drinking; when prevailed upon to build latrines, they come to like and use them. There is little evidence, however, that they try to prevent schistosomiasis by avoiding contaminated water. Seeing that systems generally fail mainly because of a lack of community involvement, the project shifted from centralized construction of water supply and sanitation (WS&S) systems to an emphasis on community organization, training, and financial commitment. While the impact of community participation on sustainability has yet to be fully demonstrated, the project communities do have adequate funds, trained community members, and an organizational structure sufficient to handle everyday maintenance. The RWSB has applied the project"s community participation approach to WS&S systems funded by other donors. Several lessons were learned. (1) Community-based WS&S improvements, when supported by public health education and services, can benefit a significant number of people at relatively low cost. (2) Community organization pays off, particularly when community investments of money and effort are required. Sustainable WS&S services depend on consumer demand as reflected in willingness to make a commitment of time and money. (3) Community motivation to build latrines is increased when latrine construction is a prerequisite for the start-up of WS&S systems. (4) Project designers should identify usable, management-oriented indicators to help implementors and evaluators assess progress; indicators used before and after the project should be comparable. (5) The priority of a long-term advisor in the final phase of his/her tour of duty should be to establish local institutional mechanisms and capacity and to phase out direct implementation and coordination roles. When the role of a technical advisor is much broader than that of the counterpart who is expected to replace him/her, the chances of successful replacement and sustainability are diminished.