Chimanimani and Chipinge Emergency and Early Recovery WASH Program (CCEER)

Chimanimani and Chipinge Emergency and Early Recovery WASH program (CCEER)

BASELINE SURVEY

12 SEPTEMBER 2019

Contents Executive Summary ...... 5 1. Introduction ...... 6 1.1 Background ...... 6 1.2 Baseline Survey Objective: ...... 7 2 .0 Baseline Survey Methodology: ...... 7 2.1 Quantitative data – HH Interviews...... 7 2.2 Qualitative Data including secondary data ...... 8 2.3 Study Limitations ...... 8 3.0 Survey Findings ...... 8 3.1 Demographics and Socio-economic status of Households ...... 8 3.1.1. Respondents Profile ...... 8 3.1.2 Households Profile ...... 8 3.1.3. How can this background information be used to guide program participants? ...... 9 3.2 WATER SUPPLY ...... 9 3.2.1 Access to safe water sources ...... 9 3.2.2 Distance travelled to a Close Water source...... 10 3.2.3 Knowledge and perception on drinking water by source ...... 11 3.2.5 Challenges resulting in water supply shortages in the district: ...... 11 3.2.6 How can water shortages challenges be addressed? ...... 12 3.2.7 Community Water maintenance ...... 12 3.2.8 Underground water studies ...... 12 3.3 SANITATION ...... 13 3.3.1. Open defecation ...... 13 3.3.2. Sanitation Facilities ...... 13 3.4 Hygiene ...... 15 3.4.1 VHW and CHC Functions: ...... 15 3.4.2 Hygiene enabling environment ...... 15 3.4.3. Hand washing practices and behaviour ...... 16 3.4.4 Health Hygiene Information Sources ...... 16 3.4.5. PHHE Information ...... 16 3.5 Waterborne Diseases ...... 17 3.6 Program expectations ...... 18 4. Conclusions and Recommendations: ...... 18 4.1 Conclusion ...... 18

4.2 Recommendations ...... 18 4.2.1. Water Supply and Access ...... 18 4.2.2 Child Health related to Water and Sanitation and Hygiene ...... 19 4.2.3. Promote environmental awareness and hygiene ...... 19 4.2.4 Sanitation ...... 19 4.2.4 Cross cutting issues ...... 20

ACRONYMS CCEER Chimanimani and Chipinge Emergency and Early Recovery WASH program DDF District Development Fund DWSSC District Water and Sanitation Sub-Committee’s EHTs Environmental Health Technicians), FGD Focus Group Discussion HH Household M&E Monitoring and Evaluation MoHCC Ministry of Health and Child Care NGOs Non-Governmental Organizations NFI Non-Food Items UNICEF United Nations Children’s Education Fund UNHCR United Nations High Commission for Refugees UNOCHA United Nations Office for the Coordination of Humanitarian Affairs PWSCC Provincial Water and Sanitation Sub-Committee’s RDC Rural District Council SPSS Statistical Package for the Social Sciences VHWs Village Health Workers VIDCOs Village Development Committees WASH Water, Sanitation and Hygiene WHO World Health Organization WPC Water Point Committee RWIMS Rural WASH Information Management System ZINWA Zimbabwe National Water Authority

Executive Summary In the Manicaland Province, eastern side of Zimbabwe, the devastating effect of cyclone Idai resulted in 270,000 people being affected through injury and loss of life, damage to homes, schools, health centres, road infrastructure, utilities and other facilities. Mercy Corps, an international development organisation, with funding from OFDA responded to the crisis by implementing the Chimanimani and Chipinge Emergency and Early Recovery WASH (CCEER) program. The project intervention aims to build on the immediate life-saving efforts of Mercy Corps and other actors in the province by working to reduce morbidity and mortality rates linked to waterborne diseases among the cyclone-affected populations. This will be achieved by restoring community water supplies, supporting reconstruction of household sanitation facilities, and promoting essential hygiene messages among the population to prevent further disease transmission in a high-risk environment in the 2 districts. In September 2019, a baseline survey to provide an information base on gaps, opportunities and needs of the affected households in Chimanimani and Chipinge was commissioned. The baseline provides information base against which to monitor and assess the WASH project activity’s progress and effectiveness during implementation and after the activity is completed. The baseline provides data upon which projects’ progress on generation of outputs, contribution to Mercy Corps outcomes and impacts is assessed. The study focused on water access, supply, and quality; as well as hygiene and sanitation practices in these districts. This study complemented other rapid assessments that have been previously done in the districts. Significant numbers of HHs in the two districts relied on water from the springs and evidence gathered in this study reveals that 50.3% of the springs in Chipinge and 36% in Chimanimani were silted or washed away by the floods while a sizeable number where contaminated by the floods. This left over 70% of the HHs in the wards 8, 9 and 14 (Chipinge) and 16 and 21(Chimanimani) are in dire need of water access for safe drinking and for domestic use. The study further reveals that over 60% of the HHs in the targeted wards consumed water from unsafe water sources (river water, unprotected wells and springs) exposing them to the risk of water borne diseases. The RDCs reported that distances travelled to access water, as a result, increased by 30% with over 65% HHs reporting that they spent more than 30mins fetching water for the HH. This has result in excessive cuts in HH water use limiting most HHs to using less than the recommended Sphere standards of 7.5 to 15 litres/person/day. It is reported that 98% and 70% of the sanitation facilities in Chipinge and Chimanimani, respectively, were destroyed by the cyclone resulting in very poor sanitation coverage (below 8%) in the district. 29% of the respondents interviewed stated they did not have a functional toilet in their homestead, resulting in the use of the bush system (open defecation) or alternatively use of neighbours toilets. The majority of HH who stated access to a functional toilet meant temporary pit latrines built from local resources. While locals had most of their WASH facilities destroyed by the cyclone, PHHE education was lacking as exhibited by poor health hygiene knowledge, practices and behaviours explored by this study. Local stakeholders interviewed stated that the rehabilitation of the springs and toilets was crucial and urgent, matched with the software PHHE to stimulate good health hygiene practices, behaviours and also knowledge. Chimanimani and Chipinge development stakeholders expressed high hopes for the CCEER project as the interventions of the project seeks to tackle were a priority in the 2 districts.

1. Introduction 1.1 Background On the night of March 15th, Cyclone Idai made landfall in Zimbabwe with devastating results for the Chimanimani, Mutare, and Chipinge districts of Manicaland Province. As a consequence of the cyclone, the Chisengu weather station recorded rainfall levels of 407 mm, the Mukandi station recorded 203 mm, and the surrounding districts: Nyanga, Rusape, Zaka, Buhera, Wedza, Marondera, and Chisumbanje, also registered unprecedented rainfall totals. According to the United Nations Office for the Coordination of Humanitarian Affairs (UNOCHA), rainfall levels in Chimanimani and Chipinge exceeded all previous records from the past three decades. The strong winds and heavy rains led to flash floods, landslides and mudslides, resulting in many deaths and the destruction of infrastructure including houses, bridges, schools and utility lines. According to a United Nations High Commission for Refugees (UNHCR) report of 12 April 2019, 344 deaths, 175 injuries and 257 missing people were reported with 270,000 people affected by the cyclone across Zimbabwe. On the evening of March 16th, the President of Zimbabwe, Emmerson Mnangagwa, declared a state of disaster. Water Supply: Populations in the target wards depend on natural springs as their primary source of water. Extensive damage to these springs and their associated reticulation systems occurred as a result of the Cyclone. According to the Rural WASH Information Management System (RWIMS), in Chipinge Wards 8, 9 and 14, a total of 91 springs out of 177 springs that were serving the local population of 5,630 households (28,150 people) were contaminated and silted during the cyclone. Only 85 out of 177 springs remain functional, however, these are mostly unprotected. In Chimanimani, 72 springs out of the 207 community springs were affected by the cyclone leaving a total of 135 to serve the 5,616 households in the area (28,080 individuals). Sanitation: In Chipinge wards 8, 9 and 14, Mercy Corps’ needs verification assessment confirmed the RWIMS findings that indicate 208 out of 350 household sanitation facilities were damaged translating to 59% of sanitation facilities that existed prior to the cyclone. In Chimanimani (ward 16 and 21) 750 sanitation facilities out of 1,185 were destroyed, translating to 63% of the facilities. All assessments indicate widespread damage to sanitation infrastructure at household level in the target wards. This has led to an increase in the practice of open defecation (OD) reported, typically around households, carrying with it the increased risk of feacal contamination of household water and food preparation areas. Hygiene Promotion: Knowledge and application of hygiene practices among households in target areas varied, but was generally low. This was also evidenced by the lack of handwashing facilities in most of the households that were visited during the assessments thus expressing the need for hygiene promotion in the target communities. Of the households that Mercy Corps’ visited as part of the needs verification in Chimanimani in April 2019, none of the households had handwashing facilities in place and there was evidence of inadequate handwashing practice at critical times. The majority of those who reported washing hands at critical times only use water without soap due to limited accessibility and affordability. With a significant number of the local population having lost possessions in the disaster, access to safe water collection and storage containers has been restricted; more than 80% of households are using buckets without lids for water collection and storage in the home. These containers expose the water to contamination during transportation and storage. The Mercy Corps’ verification exercise indicated that the affected communities in Chipinge do not have access to health education information sharing forums. In terms of menstrual hygiene management, more than 90% of women engaged indicated using old clothing material for this important hygiene task. Before the cyclone, about 50% of these women used proper sanitary pads for menstrual hygiene management. However, infrastructure damage affecting the road network in the two districts, particularly Chipinge, where major roads are still being repaired, has led to restricted availability of these menstrual hygiene materials, pushing prices beyond the reach of most local communities whose livelihoods were also

destroyed in the cyclone. Cyclone induced price increases have been further compounded by general price increases across the country due to the deteriorating economic conditions. 1.2 Baseline Survey Objective: To provide an information base on gaps, opportunities and needs of the affected households in Chimanimani and Chipinge districts. The baseline provides information base against which to monitor and assess the WASH project activity’s progress and effectiveness during implementation and after the activity is completed. The baseline provides data upon which projects’ progress on generation of outputs, contribution to Mercy Corps outcomes and impacts is assessed. The current assessment of the water and sanitation situation in target districts also assist in directing and designing program activities. The baseline information will inform or attribute change/impact as a result of the interventions.

2 .0 Baseline Survey Methodology: This baseline is based on the humanitarian needs identified by Mercy Corps’ own needs assessments and the Provincial Water and Sanitation Sub-Committee’s (PWSCC) detailed WASH assessment for Chimanimani and Chipinge, as well as information from relevant coordination bodies (notably the WASH Cluster that Mercy Corps co-chairs) and the Rural WASH Information Management System (RWIMS). The PWSSC carried out a rapid WASH needs assessment across the province in the aftermath of Cyclone Idai. To complement previous studies and need for project specific baseline data, a mixed methodology (qualitative and quantitative) was adopted. A HH survey tool was prepared and pretested to determine household water supply, sanitation and health hygiene gauging practices, behaviours and knowledge. (Refer to Annex 1 for the HH Survey Questionnaire.) The other tools used were Focus Group Discussions (FGD) from the 2 districts and stakeholder key informant interviews with RDC, DDF and MOHCC cadres. Interview questions were prepared prior to all interviews.

2.1 Quantitative data – HH Interviews A total of 521 HHs, with each at least 105HHs targeted in each ward, were surveyed in this baseline in the districts (Chipinge and Chimanimani). The HH survey had three specific areas of investigation Water supply, Sanitation and Hygiene Promotion. A total of 10 (5 males and 5 females) Enumerators were trained and deployed to the targeted districts to administer the HH Survey. They were also oriented on the CCEER project, its objectives, targeted beneficiaries and key activities. The study Enumerators were recruited based on their intellect, knowledge of fieldwork, and previous experience. The group was provided with a one-day training in which the survey questionnaires were pre-tested in Ward 8 in Chipinge and modified accordingly. Local government representatives and stakeholders were informed of the survey during the project inception meeting held in the districts and provided their consent to conduct the survey. a. The HHs for the baseline survey were sampled using cluster sampling. The 5 project wards were purposefully sampled, and villages in each ward were randomly sampled. At village level, the households were randomly sampled using the random walk method. b. The baseline HH quantitative data was collected, standardized and encoded in a Statistical Package for Social Sciences (SPSS) computer program. The design of the system and interpretation of the results were conducted by the Mercy Corps M&E Team who cleaned and analysed the data. In-depth data analysis was carried out particularly disaggregating data by gender, age, location, and a number of other factors to further understand current project location dynamics related to water and sanitation.

2.2 Qualitative Data including secondary data The study collected primary data from interviews, KII and FGD and also utilised secondary sources that included a comprehensive Literature Review particularly the related to previous studies and data from PWSSC and DWSSC-led assessments. The project proposals, previous assessments of Cyclone Idai in the two districts were consulted and reviewed. Six key informants from the RDC, DDF and MOHCC were interviewed for this baseline study

2.3 Study Limitations  Ultimately the baseline had to sample HHs due to limiting factors such as time and budget thus it was not possible to undertake a full census of all households to develop baseline information for Indicators like No of HHs with clean latrines, No of HHs with access to improved water sources. The survey had to ensure the highest sampling size possible, randomisation of selected HHs and equitable representation of different HHs characteristics e.g. sex, geographical area  Some HH became very expectant during the interviews such that some responses were biased especially those that inquired about the socio economic status and presence of facilities. This was minimised by triangulating data with other sources and also informing the respondents on the need to be objective. Secondary sources like the RWMIS was also used to verify information.  Some critical key informants were not available for interviews as some were out of the districts on duty. HH call backs and following up on certain respondents was limited due to resource constraints.

3.0 Survey Findings

3.1 Demographics and Socio-economic status of Households 3.1.1. Respondents Profile A total of 521 respondents were selected for the survey so that a minimum response of 500 households could be achieved, based on a 5% margin of error. The baseline respondents constituted of 64.7% (337) female respondents and 35.3% (184) male respondents. Thirty-seven point three percent (37.3%) of the respondents were household heads, while 43.8% were the spouses of the household heads. The remaining percentage, 18.8% were relatives of the household head. The baseline participants’ ages ranged from 19 years to above 50 years with 26.7% aged between 19 and 30 years, 26% aged between 31 and 40years, 19% were aged between 41 and 50 years and 25.4% were aged above 50 years. An insignificant number of respondents (2.9%) were aged 18 years and below. Thirty- three point two percent (33.2%) of the respondents were educated up to primary level while 43% were educated up to secondary level. A notable percentage of 18.2 % respondents had no schooling and the remaining small proportion had vocational and tertiary education. 3.1.2 Households Profile Heads of households among the respondents were mostly men (62%) while female headed HH constituted 38% of the respondents surveyed. The majority of the household’s heads in the survey were married at 72.2% while 18.1% were widowed and the remaining proportion were either single, separated or divorced. Polygamous households were in existence in the target area i.e. 10% of the households had more than 1 wife. A significant number of household heads did not go to school i.e. 21.6% of the households, 43.4% were educated up to secondary level, 28.9% went up to primary level and the residual was either vocational or tertiary level.

Generally, households were in good health, with 77.3% of the surveyed HH indicating that they were in good health. Fifteen percent (15%) of the HH were chronically ill and some were suffering from either diabetes or TB. Three point five percent (3.5%) of the HHs had a family member who was mentally ill and 4.3% of the HHs indicated that they had family members living with disability. The most common form of disability took the form of crippled leg or legs while few cases were either blind, partially blind or crippled arms. Total population surveyed is 3520 from the 521 HH. The minimum family size was 1 and the maximum was 27 family members. The average family size for the surveyed HH was 6.75. Fig 1 shows the distribution of age and sex for the surveyed population. The greater proportion of the population is composed of children at 53.9% of the population while the working group was 35.1%. A notable number of the surveyed households, 41.6% depended on farming for their livelihoods, while 29.5% survived from casual labour. Petty trade was also visible with 17.1% of the HHs indicating that they depended on the trade for survival. The residual surveyed HHs made their living on either paid labour, cross border trading or remittances. The average income was reported to be ZW$141.61 per month for those who revealed their income platforms. Fig 2, shows the socio-economic status indicators for the households.

Figure 1 Surveyed HH population distribution by age and sex

Households in the survey tended to depend on solar energy rather than grid electricity for lights. Nearly 57.1% and 53.7% for Chimanimani and Chipinge districts, respectively, depended on solar in the evening for charging their mobile devices. Access to radio and television was below 50 % for both districts, but the access to a mobile phone was high at 91.4% in Chimanimani and 84.6% in Chipinge. Above 50% of the surveyed HHs owned livestock. The poultry was the most popular category of small livestock being owned. A few households owned livestock like cows, goats, donkeys, rabbits etc.

Figure 2 Socio economic status of HH

3.1.3. How can this background information be used to guide program participants? Vulnerable groups in society included households headed by widowed mothers, people living with disability, children and the elderly. These vulnerable groups of people will have difficulties in meeting some of the project demands that includes digging and brick moulding for toilet construction thus they will need assistance. The current livelihood options available for the community is affected by unpredictable climate change and harsh economic conditions, This reality should be considered for the sanitation intervention that the project requirements do not further exacerbates their vulnerability status.

3.2 WATER SUPPLY 3.2.1 Access to safe water sources As a consequence of the Cyclone Idai, 50.3% and 36% of the springs in Chipinge and Chimanimani were silted or washed away by the floods. This put a strain on the water supply system in the district with most HHs resorting to using contaminated water flowing in the streams as well as sand abstraction points for their drinking water. These unprotected sources are shared with wild and domestic animals and as result get contaminated. Accordingly there has been 60% reduction in water

usage due to strain on accessing safe drinking water and for other uses. In Chipinge 85 of out the 177 springs were functional while Chimanimani had 135 out of the 207 springs functional.

Table 1 water sources by functionality according to RWRMS database District Ward Number No of Springs Functional Functionality Chipinge 8 81 38 47% 9 70 36 51% 14 31 17 55% Chimanimani 16 110 85 77% 21 97 50 52% In Chipinge district there are 1742 water points constituting of protected and unprotected springs and wells and boreholes, most of which are institutional. Over 40% of these water points are springs (556). The upper Northern side of the district is a host to over 60% of the springs while the lower Southern part has more boreholes than springs. Chimanimani showed the same trend with more springs than boreholes in the district. Over 70% of the springs in both districts are seasonal. The FGDs revealed that the community sometimes drinks from unsafe water from the river, since most springs were washed away by the cyclone. Ward 9, Chipinge and wards 16 and 21, Chimanimani HHs harnessed water using pipes to a central place within the village or household for easy access. During the dry season, some HHs dig wells along river beds when their water sources dry. According to the HH survey only 9.1% and 21.5% respondents from Chimanimani and Chipinge respectively drink water for safe sources (boreholes, protected springs and wells). Over 45% of the HHs utilised water from the unprotected springs, 20% of the HHs accessed water from unprotected well. RWIMS database showed an increasing number of HHs were accessing unsafe water sources since the Cyclone. In the same vein, 76% of the HHs also used these water sources for other purposes such as bathing, hand washing and cleaning. Over 80% of the HHs used less than 100litres of water per day in Chipinge and Chimanimani, consequently cutting down on drinking water to far less than the recommended Sphere standards of 7.5 to 15 litres/person/day. The cut down on water use was necessitated by scarcity, long distances to water sources coupled with hitches in purification, transportation and storage. The bulk of this water is adeptly used for drinking, washing and cooking (70%) with the left over used for other purposes that includes animal watering and gardening. Figure 3 Water source by district It is worrying to note that despite 90% of the HHs using water from unsafe sources, 60% of these HHs were of the opinion that their sources were safe to drink. Of the 40% who thought their sources were not safe, 70% said that they treated their water for drinking with the mainstream (80%) using chlorine product for treatment while the other 20% boiled their water for treatment. 3.2.2 Distance travelled to a Close Water source Generally, over 27% of the respondents travelled over 500m to access drinking water, thus going above the Sphere standards in the maximum distance travelled to access water. Over 51% said they travelled between 100m and 500m to access water. It is important to note that these water sources tended to be the easily accessible sources that were overly not safe for drinking. There were no significant differences noted between the 2 districts with regards to distances travelled to access water. The RDC reports that distances travelled to access water increased since Cyclone Idai by an average of 33% in both Districts. Related to this, 70% of the surveyed HHs spend over 30mins in a round trip to access water against the Sphere’s standard 15minutes maximum time. Time spent fetching water in these districts is aggravated by the steep terrain in the mostly mountainous areas. Only 7% of the respondents reported having access to water within their homestead. Notwithstanding the long distances travelled in fetching water, the baseline survey further revealed that fetching and transporting Figure 4 Distance travelled to a close water source

water was entirely the responsibility of adult women (84%) with only 7% of the adult men and female children (7%) taking up this responsibility. The situation however, was different for child-headed HHs were the child head was entirely responsible for fetching and carrying water. It is also interesting to note that the role of children with regards to this chore increased among female headed HHs than in male headed HHs. Coupled with this responsibility is the transportation of water over the rough steep terrain which is carried on the back or head (84%). Much time was spent in accessing water in both districts. Above 89% of the respondents reported that, as part of their chores, they fetched water twice or more in a day (fig 5). Despite the above challenges, 68% of the respondents said they did not face any challenges in fetching water, the majority of whom probably constituted those that fetched water within their homestead. Those that said they face challenges sited long distances to access water, sharing of water sources with animals, poor water quality (leaves, worms, animal waste), terrain being steep and slippery, dry spells reducing water tables and floods that wash away springs as some of the challenges that they faced in accessing water. A majority of 69% of the respondents reported that their water was palatable with 31% asserting that their water either was smelly, had rusty particles particularly borehole water and/or had presence of suspended particles. 3.2.3 Knowledge and perception on drinking water by source A crosstab to gauge perception and knowledge of HHs on drinking water by water source accessed, worryingly revealed that respondents who accessed water from unsafe sources (91% in Chimanimani and 79.1% in Chipinge) perceived they Figure 5 frequency of fetching water in a day water sources to be safe for drinking. The respondents sourced water from unprotected springs and well, open surface and river water. Some of the respondents (over 77%) were aware of the diseases caused by drinking unsafe water. Respondents mentioned diarrhoea, cholera and dysentery as some of the common diseases that were caused by drinking contaminated water. Although 77% of the respondents interviewed stated that they did not experience any water disruptions in the past 2months, their water sources were mainly unprotected springs, rivers and wells. 3.2.5 Challenges resulting in water supply shortages in the district:  Over 90 of the springs collapsed in the district due to Cyclone Idai. Moreover some the springs were affected by the seasonal rainfall thus becoming dry and silted during the dry seasons.

Figure 6 Perception on drinking water by source  Over 78% (according to DDF estimates) of the springs found in the districts were not protected.  Long distances, prevalent mostly in Chipinge where wards 8, 9 and 14 in Chipinge are resettlement farms, No water infrastructure was provided for the newly resettled families.

 Most of the boreholes in the districts broke down due to rusting, wear and tear, and poor material used in erecting boreholes. This was further exacerbated by the shortage of boreholes parts, lack of repair and maintenance skills, and lack of resources to procure spare parts and pay for the erection of new water points.  Low yields in some areas resulting in water points drying early. The average yield in Chipinge and Chimanimani is at 61%.  Most of the water points were facing high stress due to overuse. An average 66 HHs used one water point in the districts.

 Seasonality of rains- rainfall is received during the summer season and most of it is inadequate to sustain use throughout the year. According to the KII, 17% of the water points are affected by seasonality.  Non-functional water management committees to maintain of water points in most wards.  Water quality testing not conducted thus most HHs accessing water of poor quality.

3.2.6 How can water shortages challenges be addressed?  Rehabilitate boreholes in the district to supplement the collapsed water springs.  Protect the perennial and high yielding springs and make the water safe for drinking.  Capacitate the WPC in repair and maintenance skills, promote local ownership of the community goods.  Conduct water point mapping and reallocate certain number of HHs per a water point to reduce water stress at each water point.  Provide piped water augmented with solar powered pumps.  Support the community with livelihoods and income generating activities to generate money for erecting water points, purchase tools for repair and maintenance.  Support the DDF who have the capacity to drill new water points to drill new boreholes and rehabilitate broken ones.  Use of aquatabs and the practice of boiling water in the community, an effective way to render water free from pathogenic organisms.

3.2.7 Community Water maintenance Village Pump Minders (VPM) Although Chipinge District had 61 VPMs in the district, the majority were not equipped to carry out their functions due to lack of training and tools. According to the data provided, Wards 8 and 14 do not have any trained VPM while Ward 9 has only one VPM. Africa Ahead conducted trainings for the VPMs in the wards 2 and 12. It is imperative to tape on the progress made and probably replicate the trainings to cover wards 8, 9 and 14. HHs and Key Informants interviewed revealed that the WPC were mainly responsible for maintaining and attending to breakdowns of the water sources, however in Chipinge people trained in WPC excluded the critical water extension cadres, the EHTs and VHWs. While the DWSSC was said to be functional, they were recommended to capacitate critical cadres (Enumerators, Key Informants and VPS). The DDF is proactive in the districts with regards to sitting and drilling boreholes. Improvements can be made in coordinating their progress and reporting it. “DDF drills the boreholes and go, we, as stakeholders need to know where so that WPC Enumerator can track the water point use and management” said the DEHO. The DDF is responsible for sitting, drilling and repairing of boreholes, train Pump mechanics and to chair the DWSSC. 3.2.8 Underground water studies No underground water studies were done in both districts in the past 2years. According to the DEHO, such studies were crucial in ensuring underwater water management however they have not been done either due to non-prioritisation of such, lack of resources, innovation and skills and/or because the local cadres were not aware of such studies. Underground water studies are needed in the districts to complement knowledge of how water supply can be improved and managed in the districts.

3.3 SANITATION According to the MOHCC, both districts have low sanitation coverage following the devastating Cyclone Idai which flooded and destroyed most of the sanitation facilities where 98% and 70% of the sanitation facilities were destroyed in Chipinge and Chimanimani respectively (Cyclone Response Emergency Rapid Assessment, May 2019). Chimanimani has sanitation coverage of 7.3% with over 67% of the toilets in the district affected by the cyclone. Chipinge trails in the same low range with sanitation coverage of 3%, and over 50.3% of the toilets affected by the cyclone. Ward 16 in Chimanimani has the highest number of functional toilets (342) while the rest of the wards had less than 100 functional sanitation facilities-Rural WASH Management Information Systems. (RWIMS). It must be noted that qualitative studies have tended to produce exaggerated data with information falsified in light of anticipated benefits (donor dependency syndrome).

Figure 7 Sanitation Coverage: Chimanimani and Chipinge

Twenty-nine (29%) of the respondents stated that they currently did not have a functional toilet at their household with a significant number (79%) saying that their structure was lost due to the Cyclone. The greater proportion of the community claimed to have functional latrines at 79%. On probing further, it was found that most of the so-called functional toilets were make-shift substandard toilets.

Table 2 Do you currently have a functional toilet at your HH? Do you currently have a functional Chimanimani Chipinge Total toilet at your HH? (%) (%) (%) Yes 72 70 71 No 28 30 29

3.3.1. Open defecation It was worrying to note that that of the 29% who did not have a toilet, 63% opted for Open defecation (OD) while the smaller portion used their neighbours’ facility. OD practices was similar among the two districts.

3.3.2. Sanitation Facilities Queried about the type of toilet facility that most HH members used, the pit latrine emerged as the most used type of toilet in both districts with 47% and 64% of the respondents using the facility respectively followed by the bush method which is most commonly used by 18% of HHs. Qualitative studies (FGD) also revealed that most HHs in the community used the temporary pit latrine for sanitation as exhibited by 60% of the FGD respondents in Chipinge and 50% in Chimanimani saying they used the temporary pit latrine. 20% said they used the bush (OD) since the standard BVIP is costly to construct.

Table 3 Sanitation facilities according to Focus group discussions District Wards BVIP Open defecation Temporary pit latrines

Chipinge 8 2.5% 5% 92.5%

9 10% 10% 80%

Chimanimani 14 30% 10% 60%

Figure 8 common sanitation facilities found in the surveyed HH

16 30% 20% 50%

*Data for ward 21 was missing Queried on whether women and girls felt safe using the latrine at night, 68% and 43% of the survey respondents in Chipinge and Chimanimani, respectively, perceive that women and girls do not feel safe at all. (Table 4) Some the reasons given included a lack of privacy since the structure had openings, rape in cases where the structure is distant from the homestead, and also the structure collapsing.

Table 4 Do women and girls feel safe using the latrine at night? Do women and girls feel safe using the Chimanimani Chipinge Average latrine at night (%) (%) (%) Yes 57.2 32.0 42.3 No 42.8 68.0 57.3

3.4 Hygiene

3.4.1 VHW and CHC Functions: The Village Health Workers were said to be active in almost all wards in both districts. They conduct homes visits once a month or once in two months including testing for malaria, facilitating and monitoring HH hygiene matters encouraging hand washing with soap at critical times, boiling of drinking water and construction of latrines. VHWs were also said to be the responsible agents in disseminating PHHE information in the districts. In Chipinge, it was reported that 267 CHCs were established in the past, and 70% were said to be functional. In Chimanimani, the existence of CHCs was only indicated for 2 areas, Tamandai and Machowiro A, in village 11, Tamandai, there are 5 CHCs, and the participant who mentioned this indicated that her club, Kubatana Health Club, has a membership of 10 and meets once a week. A major snag faced in both districts was on the prioritisation of sanitation at household level “You see from way back, it was the government and NGOs who advocated and sponsored people to build toilets, now people see this as an NGO/Govt thing. They developed a strong donor syndrome, you will note that some households can do it on their own but it is not a priority, in fact they do not see it as theirs but an NGO/Govt responsibility” said the Chipinge DEHO. Government heavily subsided sanitation facilities while donors build them for free thus people developed high donor dependence syndrome. The RDC for Chipinge pointed out that wards 8, 9 and 14 had heavily moist soils which does not provide rigid ground to withstand a normal toilet thus it tends to collapse. The RDC recommended that the project build extra strong structures that can withstand perennially moisture environment with light roofing material to avoid collapsing of the structure. Besides the above challenge, lack of resources remain the major factor hindering building of sanitation facilities while a small number of HHs said they did not see the need for having one. 3.4.2 Hygiene enabling environment Enumerators independently inspected the availability of a hand washing facilities at each HH that was selected for this study, 68% of the HHs in Chipinge and 57% in Chimanimani, did not have a hand washing facility near the latrine. This was attributed to lack of knowledge, poor hygiene practices and absence of a sanitary facility where normally the hand washing facility is sited. There was a positive correlation between HHs which did not practice constant hand washing before handling food with those without hand washing facilities at their homesteads. Of those HHs with hand washing facilities, 70% did not have water present in their facility suggesting inconsistent hygiene practices. 80% of the same HHs (with a hand washing facility) did not have soap (detergent) for washing hands. Generally, health hygiene was better in Chimanimani with over 70% of the HHs observed with a clean latrine over Chipinge which has slightly above 50% HHs with a clean latrine. It was pleasing to note that 70% of the HHs in Chimanimani and 60% in Chipinge had a functional refuse pit. According to the MOHCC data sources, not all HHs in Chipinge has a health hygiene enabling facility. A previous study (source Figure 9 Availability of Handwashing facility unspecified) revealed that over 95% of the HHs in wards 8, 9 and 14 had pot racks however those with refuse pits were below 40%. In this study 64.3% of the surveyed HH had functional pot racks while 64.5% of the HH had the recommended closed and clean drinking water containers.

3.4.3. Hand washing practices and behaviour Hand washing practices, behavioural patterns and knowledge was tested in this study. Respondents were asked to state when they should wash their hands, it was pleasing to note that 87% of the respondents said that hand washing is necessary before eating, while 78% said it was important to wash hands after using the toilet. Only 35% said it was important to wash hands before feeding a child- these were probably breastfeeding mothers. 54% said washing hands before handling food was important and 30% of the respondents picked the importance of washing hands after changing a child nappy and after cleaning the toilet, again these respondents who picked this activity where mostly female. The majority of males tended to highlight the need to wash hands when handling food, before eating and after toilet use while females picked other activities. On average 60% of the respondents across the 2 districts said they always wash their hands before cooking or handling food, 84% said to always wash hands after using the toilet. An analysis of a small sample of 10 completed HHs tools revealed that those that said to always “wash hands before eating and handling food had previously picked the option “before handling food” and “wash hands after using the toilet” on the above question. Although hand washing practice in both districts was not very high as evidenced by the proxy indicator of the existence of a facility, over 45% of the respondents said they use water and soap to wash their hands. 42% in Chimanimani and 32% in Chipinge said they use water only, 16% said they used other detergents that may include ash. The most common way of washing hands was the run to waste Figure 10 Critical times of Handwashing as mentioned by respondents method at 64%. 24% of the respondents mentioned use of a bowl shared by at least 2 people and 16% said they use a bowl used by only one person. 3.4.4 Health Hygiene Information Sources Other than the Figure 11 what do you normally use to wash your hands? Radio and TV, the Key Informant said that the EHTs were the most common source of PHHE information dissemination in the villages. Radio and TV used to be dominant, however the excessive power cuts have rendered these media unreliable and not functional most of the time. Health centres were also major PHHE information hubs for the people where announcements and IEC material were distributed however a negligible number (less than 8%) of HHs in both districts had IEC material on PHHE. 3.4.5. PHHE Information There was pronounced PHHE information gaps in the districts with over 73% of the respondents stating that they have not participated in any hygiene promotion activities in the past 12months. Considering that 65% of the survey respondents were females, who had the burden of water and hygiene responsibilities, it was worrying to note that less and less information was filtering to them. The remaining 27% said they received PHHE information from organisations that included GOAL, TSURO Trust, Africa Ahead, CARE International, Mercy Corps, Red Cross, Nutrition Action, Plan International, Save the Children, IRC, OXFAM and UNICEF and the VHWs. Table 5 shows that the bulk of respondents (66%) from the 2 districts (72% in Chimanimani, 61% in Chipinge) prefer to receive most of their health information through word of mouth. They have trusted the traditional oral dissemination of information maybe because it is more interactive than other media and also quite a number of household heads indicated that they did not go to school.

Table 5 Which media do you prefer to get most health and hygiene information? Preferred media Chimanimani (%) Chipinge (%) Total (%)

Figure 12 Health and Hygiene information platforms

Word of mouth 72.4 61.4 65.8 Newspaper 1.0 1.3 1.2 Posters and pamphlets 9.5 7.7 8.4 Local radio 1.0 2.6 1.9 Combination of media platforms 15.2 27.0 22.3

According to the HHs level sources, Community Health Workers is the most common source of health information and /or education of health and prevention of diseases in both districts. An average of 78% of the respondents interviewed said that they did not belong to a Health Club. The bulk of the respondents were from Chipinge (84%). It was, however, encouraging to note that the majority (93%) of the respondents’ religion does not bar them from using the hospital or clinic when they fall sick. The other 7% probably belongs to the Apostolic sect which was highlighted in the FGD conducted in Chipinge ward 9. Again several studies have also established this. 3.5 Waterborne Diseases According to the MOHCC officials, dysentery and diarrhoea were the most common water and sanitation diseases in both Chimanimani and Chipinge communities with Chipinge wards 9 and 14 with relatively higher cases than other wards. Cholera cases were last reported in 2011 in Chipinge. Water and sanitation diseases, especially diarrhoea is often contracted through polluted water or from poor hygiene, these diseases are more prevalent during the rainy season in the 2 districts and are mainly caused by poor hand washing practices and eating unwashed wild fruits. Although the diseases affected everyone, the MOHCC stated that the most affected victims were the children who are under 5 years of age. The average maximum distances travelled to access Health services ranged from 35km in Ward 8 to 14km in Ward 14 to 15km in Ward 9 and finally 7km in Ward 14. An increase in disease cases was reported after Cyclone Idai although the statistics were not readily available.

Table 6 . Did anyone in your family had diarrhoea in the last 2 weeks? Did anyone in your family had Chimanimani Chipinge diarrhoea in the last 2wks (%) (%) Yes 26.2% 22.2%

No 73.8% 77.8%

23.8% of the respondents interviewed said someone in their HH had diarrhoea in the past 2 weeks. This could be related to the unsafe water sources used by most of these HHs and eating fruit before washing and poor hand washing practises. In response to how they dealt with the illness, 46.6 % of the respondents who had cases of diarrhoea said they reacted by preparing ORS while 33.1% said they took the patient to hospital or clinic. Reported Cholera cases were negligible at 2.5% in both districts. It is important to note that only HH in Chimanimani mentioned these cases. Over 62% of the interviewed respondents stated that the nearest health facility was less than 5kms. 28% of the respondents in Chipinge said they travelled between 5km and 10km to access health services with a negligible 4% travelling above 10km. In Chimanimani nearly 27% of the respondents said the nearest Health facility was more than 10km away. The MOHCC said they coordinated the “Zero open defecation” campaigns in all district wards in the past 6 months. The campaign Table 7 How far is the nearest health facility? carried messages on the need to

constantly use toilets for sanitation, the need to build sanitary facilities, handwashing and health hygiene. Attendance to these campaigns was high with over 100 people attending, mainly women. However contrary to the above, HHs interviewed said none of their HH members attended a WASH related celebration event which points to the fact that these campaigns might have not yet been conducted in the project area wards. The President of Zimbabwe also implemented the Clean-up campaign in most urban sites. This has been cascaded to the ward level in the rural areas however attendance was an average of only10 people per event. 3.6 Program expectations Interviewed HHs said they are looking forward to benefiting through assistance in latrine construction, borehole drilling, borehole spares, NFIs, erection of water tanks, provision of sanitary wear, hygiene education knowledge, improved health, to receive water guard and aquatabs, and protection of water sources. Quotable quotes with regards to what Mercy Corps should take note in implementing the CCEER project: “The project must focus on scaling up and reaching to all needy people in the District other than erecting a few boreholes and toilets and then you go, We want to see Impact, I would rather recommend you work on just one ward, do the best there, change lives than being all over without much changing” “We expect to see impact, real tangible changes, including improved health hygiene in the villages, from the Mercy Corps WASH project, there has been a lot of activity here by NGOs, I like this project because we will see toilets, rehabilitated water points, not just messages and meetings”

4. Conclusions and Recommendations:

4.1 Conclusion The study concludes that target areas have a very low water and sanitation coverage with a greater majority of the HH drinking water from unprotected springs and making use of temporary latrines. Although the study noted gaps in hygiene knowledge and inconsistent behaviours, there exists opportunities in improving this as the stakeholders and communities are eager. This study revealed that some communities have to transport water for more than 30 minutes by foot. Alternatively, the project can provide wheelbarrows or other water transport means along with additional water containers to those communities. The EHTs and VHWs are a resource for influencing change among the different HHs in the target villages and wards. Thus the planned project, whose interventions, according to key discussions from this survey, are relevant will go a long way in assisting communities to have access to improved water supply sources and sanitation facilities.

4.2 Recommendations 4.2.1. Water Supply and Access  Coordinate with key stakeholders (Government, water and sanitation sub-committees, the Chimanimani and Chipinge communities) to increase access and supply of clean and safe drinking water by rehabilitating the water sources and adding new ones where distances to functional water sources are very long.

 Identification of springs that need protection need to be done earlier before the rainy season to avoid investing in seasonal sources.  Protection of spring sources needs thorough involvement of stakeholders particularly local leaders, as the community attach a lot of traditional and culturally practices to natural water sources.  Some households have already harnessed uphill springs through pipes. The same can be done for other HH and shared standpipes can be installed in reasonable distances.  Distribute water purifiers (aquatabs) to communities with unsafe drinking sources and vulnerable HHs combined with education on proper usage. Educate the HHs concerning the use of water purifiers through a number of campaigns reinforcing the message.  Build sustainability by involving the communities in project activities and ensure adequate monitoring with regular feedback from the communities.  It is imperative to integrate and mainstream gender and disability in the project by educating HHs and key stakeholders on gender disparities related to water access and supply.  Underground water studies are important in harnessing this information on improving water and sanitation in the communities, Mercy Corps is recommended to coordinate with appropriate government water departments concerning water quality testing of key water sites used by HHs, carry out underground water studies and utilise the results in strategizing for a sustainable water management in both districts in the future.  Investigate the possibility of funding water storage during the dry season.  Strengthen the coordination meetings and report progress on the districts.

4.2.2 Child Health related to Water and Sanitation and Hygiene The study indicated that very few HHs received hygiene messaging thus MC and stakeholders must promote hygiene awareness through informal sessions with mothers at surveyed HH homes with a focus on methods of water treatment, hand-washing, and child & mother hygiene, and causes of cholera, diarrhoea and dysentery. The VHWs emerged as the most common agents in communicating WASH and PHHE information at village level, there is need to train, support and strengthen the functions of VHWs in the districts. The project can determine appropriate contents for hygiene kits and distribute hygiene kits combined with hygiene campaigns targeting women. Health information should also include water and sanitation related disease prevention, treatment and management. 4.2.3. Promote environmental awareness and hygiene Conduct awareness raising campaigns about safe water transport, storage and handling at household and community levels. Sound hygiene practices and environmental preservation issues should also be addressed through a variety of awareness raising activities targeting a wide audience especially women (who do the majority of water fetching, transportation and handling) and children (who have knowledge gaps, most affected by water and sanitation diseases). Coordinated efforts on the part of the Water Authority, Health Authority and humanitarian community will be required to address this issue. Coordinating with other NGOs already working in the same areas would be necessary to avoid duplication of efforts, but rather strengthening on what is already established. As indicated earlier, ward 9 in Chipinge seem to have quite a number of established health clubs facilitated by AfricaAhead. MC will have to put more effort in ward 8 and 14, which indicated a gap in this area. 4.2.4 Sanitation Although the project will target the most vulnerable HHs for latrine construction, the study also recommends that other HHs, which have already shown interest by digging pits and provision of bricks before the project was initiated could also be assisted as a way of promoting early recovery self-efforts

in communities. Areas where sand was captured after the Cyclone can also be identified as sources of locally available materials to ease provision of sand for latrine constructions in the target areas. 4.2.4 Cross cutting issues  Mainstreaming of disability and Gender issues in the planning and designing of response programs.  Future funding activities to include livelihood activities: training on income generation activities and/or input for small business activities, for the sustainability of schools WASH and PHHE interventions.

REFRENCES 1. Mercy Corps Cyclone Response Emergency Rapid Assessment, May 2019 2. RWMS Database 3. CEER Project Proposal

ANNEX I

Chimanimani and Chipinge Emergency and Early Recovery WASH program (CCEER) WASH BASELINE HOUSEHOLD QUESTIONNAIRE QUESTIONNAIRE IDENTIFICATION

INTERVIEWER NUMBER

PARTICIPANT HOUSEHOLD NUMBER- 4 digits

INTERVIEW DATE (day/month/year)

Instructions

This interview should be started only once informed verbal consent has been obtained from the participant. Please read all information as it is written.

Please mark an X in the box that corresponds to the reply by the participant. Note that some questions have multiple responses possible. Please mark an X in the box next to each reply. Do not read the list of possible responses to the participant, unless noted in the instructions for a specific question. If someone replies “I don’t know” this should be the only response indicated. For the “Other” responses, mark an X in the box and then write the response on the line provided. Please record participant’s comments as directly and carefully as possible. At this time, mark start time of interview below and then proceed with the interview.

Start time: __ __ . __ __ INTRODUCTION: My name is______I am an Enumerator working for Mercy Corps conducting the WASH baseline survey. I would like to ask for your responses to a number of questions I have here. Your responses will be confidential, no one will be able to identify you as the respondent of this survey. You are free to refuse to participate in this interview and should you choose to you can answer in any language you are comfortable with. This interview will approximately take….minutes .Do you agree to participate? Thank you again for agreeing to participate in our study.

DEMOGRAPHICS CODES 1 District 1=Chimanimani

2=Chipinge 2 Ward 3 Name of village 4 Respondent 1= household head 2= wife 3= relative to household head 5 Age 1=<18, 2=19-30, 3 =31-40, 4=41-50 5=51 yrs+ 6 Sex 1= Male 2=Female 7 Education level completed 1=No schooling 2=Primary 3= Secondary 4= Tertiary 5=Other Household information (Household head) 8 Age 1=<18, 2=19-30, 3 =31-40, 4=41-50 5=51 yrs+ 9 Sex 1= Male 2=Female 10 Education level completed 1=No schooling 2=Primary 3= Secondary 4= Tertiary 5=Other 11 Marital status 1 Married, 2=Widowed, 3= Divorced, 4=Single 5=Separated 12 Number of wives/husbands 13 Health Status 1= Chronically ill 2=Disabled 3=Mentally ill 4=None 14 State form of disability

15 Total number in Household 0-5yrs M F 6-12yrs M F 13-17yrs M F 18-50yrs M F 51-65yrs M F >65yrs M F Total

No Question Response

Socio-economic status

16 What is the main source of household income? 1=Cross border trader 2=Farmer 3=Petty trade (Fishing, Weaving, Firewood selling etc.) 4= Paid labour 5=Casual labour 6=Remittance 7=Other:______

17 What is your usual income per MONTH from ALL sources? Amount RTGs)______18 Does your household have: No Yes a) Electricity ZESA (1) (2) b) Electricity Solar (1) (2) c) A radio (1) (2) d) A television (1) (2) e) A mobile telephone (1) (2)

19 Does your household own any livestock? No (1) Yes (2) 20 How many of the following animals does your household own? Animal Number Cows/bulls Donkeys/Horses/Mules Goats Chickens/poultry Ducks Other, list the animals

Water Supply 21 What is the main source of DRINKING WATER for 1=Borehole members of your household? 2=Protected well (Do not prompt or read answers) 3=Unprotected well 4=Protected Spring 5= Unprotected Spring 6=Surface Water 0pen(River/dam/ pond) 7= River water (mifuku) 7.Other (specify) 22. Do you use water from this source for other uses like Yes (1) bathing, handwashing etc.? No (2) If YES, skip next Question 23. What is the main source of water used by your 1=Borehole household for OTHER PURPOSES, such as Bathing, 2=Protected well hand washing and cleaning? 3=Unprotected well

(Do not prompt or read answers) 4=Protected Spring 5= Unprotected Spring 6= Open Surface Water (River/dam/ pond) 7= River water (mifuku) 7.Other (specify) 24. How many litres of water do you use per day for All Quantity (liters) ______your household needs? 25. What is the purpose of water/use of water? tick all that 1=Household use-drinking, washing, cooking apply 2=Animals 3=Garden 4=Other, specify ______26. In your opinion, is your water safe to drink? No (1) Yes (2) 27. Do you treat your water to make it safer to drink? No (1) Yes (2)

28. If No, give reasons 29. If yes, How do you treat your water for safe drinking? 1=boil 2=use water-guard

3=use aquatabs 4=strain it with a cloth 5=other (specify 30. How far is the main water point from your household? 1=within 100m 2=100m and less than 500m 3=more than 500m 4=within yard/dwelling 31. How much do you take to go and fetch water from 1= less than 10mins home and back including waiting time at the water 2= 10 – 30mins source? 3= more than 30mins 4= within yard/dwelling 32. Who usually collects drinking water for your 1=Adult women (age 15+ years) household? 2=Adult man (age 15+ years) 3=Female child (under 15) 4=Male child (under 15) 5=If inside dwelling/yard, not applicable 6=Other:______

33. How is drinking water transported from the source to 1=Carry water on back or head the household? (mainly) 2=Bicycle 3=Using domestic animals 4=Piped into dwelling/yard 5=Wheelbarrow 6=Other:______34. How many times does this person travel to the water 1=Once a day source within a day in order to collect water? 2=Twice a day 3=Thrice a day 4=More than 3 times a day 5=Other:______35. Are there any challenges you are encountering as far as water supply is concerned? If Yes can you outline them.

…………………………………………………………………………………………………… …………………………………………………………………………………………………… …………………………………………………………………………………………………… …………………………………………………………………………………………………… 36. Is your water palatable? 1=Yes 2=No

37. If response to above question is No, give reasons. Tick 1=Smells all that apply 2=Rusty 3=Has suspended particles 4= Other:______38. Can drinking water cause illness? Yes (1) No (2) 39. What disease are caused by unsafe drinking water? tick 1=dysentery all that apply 2= diarrheal 3=malaria 4=bilharzias 5= Cholera 6=other 40. Did your household experience interruptions in the Yes (1) drinking water supply from the main source during the No (2) last two months? 41. Describe the patterns in the interruptions of drinking water supply from the main source

………………………………………………………………………………………………………………… ………………………………………………………………………………………………………………… ………………………………………………………………………………………………………………… 42. Where do you get water when your usual supply is interrupted? ………………………………………………………………………………………………………………… ………………………………………………………………………………………………………………… ………………………………………………………………………………………………………… 43. Who maintains the source? 1)water point committee 2)village pump minder 3)Water point committee and village pump minder 4)Water point users 5)Other- 44. Who attends to breakdowns on the water source? 1)water point committee 2)village pump minder 3)Water point committee and village pump minder 4)Other 45. Are they trained? 1)Yes 2)No 3) don’t know 46. Do they have tool kits that they use for maintenance of 1)yes the water source? 2)No 3)don’t know 47. Where do they get their spares from? 48. Do you pay for maintaining the source for drinking Yes (1) water? No (2) 49. If yes how much do you pay per month? Amount:______50. If no reasons for not paying 51. What happens if you do not pay the maintenance fees?

52. How much would you be willing to pay per month for maintaining the source? Amount:______53. What improvements would you water for your water supply situation? …………………………………………………………………………………………………… …………………………………………………………………………………………………… …………………………………………………………………………………………………… …………………………………………………………………………………………………… …………………………………………………………………………………………………… …………………………………………………………………………………………………… Household sanitation Now I would like to ask you some questions specifically about sanitation

54. Do you currently have a functional toilet at your 1=Yes 2=No household? If No Go to Q55-56

55. If no, why? 1=can’t afford 2= it is not important 3=it collapsed 4=other specify 56. How do you dispose fecal waste at your household 1=use my neighbor’s toilet 2=use the bush 3= other specify 57. What kind of toilet facility do members of your household 1=Pit latrine/temporary latrine usually use? 2=Cat method 3.=Flush toilet 4=BVIP latrine 5.=Upgradable BVIP 6.=Ecological sanitation toilet 58. When was the latrine constructed? 1=sometime this year before cyclone 2= sometime this year after cyclone 3=more than 1 year ago 59. How many households use this toilet facility? (Enter 99 if unknown or not sure) 60. How far is the toilet facility from the main dwelling? < 5 meters (1) 5 – 10 meters (2) 11-15 meters (3) >15 meters (4) Other:______(5) 61. Do women and girls feel safe to use the latrine at night? Yes (1) No (2) 62. Does the toilet provide privacy observe Yes (1) No (2) 63. Do you share toilet with all family members Yes (1) No (2) 64. If No, give reasons 65. Is everyone in the household PRESENTLY able to use Yes (1) the toilet easily and conveniently, unassisted? If the No (2) answer is No please answer question 66 66. Why are some members of your household not able to use the toilet easily and conveniently, unassisted? Hygiene Now I would like to ask you some questions specifically about hygiene

67. Have you or any of your HH member(s) participated in 1= Yes hygiene promotion activities in the past 12 months? 2=No 68. Who or which organisation facilitated the activities? 69. Where do you get health information or education on 1=Local schools health and prevention of diseases? (mainly) 2=Local hospital/clinic 3=Community health workers 4=Church 5=Local authority 6=Local radio 7=Television 8=Councilor 9=Any other:______70. Which media do you prefer to get most health 1=Word of mouth information 2=Newspaper 3=Posters and pamphlets 4=Local radio 5=Television 6=Councilor 7=Any other:______71. Do you or any of your family members belong to any 1=Yes 2=No health club group? 72. Does your religion encourage treatment at the hospital 1=Yes 2=No or clinic when you fall sick? 73. Please mention all the occasions when it is important to 1=Before eating wash your hands 2=Before breastfeeding /feeding a child 3=Before cooking /preparing food 4=After defecation/toilet use 5=After cleaning a child that has defecated/changing child’s nappy, 6= After cleaning toilet or potty 7=Don’t know 8=Other:___ 74. When do you wash your hands? Complete the table below.

Always Occasionally Never

After changing nappies/ assisting a child with the toilet.

Before eating

Before cooking or handling food

After toilet use

75. What do you normally use to wash your hands? 1=Water only, 2=Water with soap, 3=Water with detergent/ash, 4=Other…. 76. How do you normally wash your hands? 1=In a bowl used by one person 2=In a bowl, shared by at least two people 3=Run to waste 77. Has anyone in your family had diarrhoea (more than 3 Yes (1) stools a day) in the last 2 weeks? No (2)

78. If yes what did you do? 1=Prepared ORS 2=Consulted faith healers

3=Went to hospital/clinic 4=Consulted traditional healers 5=Did nothing 79. Has any member of your household been infected with Yes (1) cholera in the last 12 months? No (2) 80. If yes what did you do? 1=Prepared ORS 2=Consulted faith healers 3=Went to hospital/clinic 4=Consulted traditional healers 5=Did nothing 81. How far is the nearest health facility? 82. Have you ever participated in a WASH related Yes celebration event No 83. If yes, identify one 84. If a WASH project was to come to your area how do ……………………………………… you think you would benefit? ……………………………………… ……………………………… Observation 85. Is there a hand washing facility near the latrine? (observe) 1=Yes 2=No

86. Is water present at the handwashing facility? ( observe) 1= Yes 2= No 87. Is soap/ash(detergent) available for handwashing at the facility? ( observe)

1=None available

2=Soap of any sort

3=Soap substitute

88. Is the latrine clean ( no smears of fecal matter on floor or wall) 1= Yes 2= No

89. Is there a functional pot rack in the HH yard ( observe ) 1= Yes 2= No

90. Is there a functional refuse pit (observe) 1= Yes 2= No

91. Drinking water container 1=closed and clean 2= closed and dirty 3= open container 4= no water in HH

92. Is there IEC material around ( stickers, flier or poster) 1=yes 2=no

CLOSING: Thank you for taking part in this survey. The information you shared will be very helpful. Please remember that all of the information you shared will be kept private and confidential. Thank you once again for talking with me.

End time: __ __ . __ __

ANNEX II

BASELINE STUDY: Focus Group Discussion Tool – Community

1. What is the main sources of drinking water for the village/ward? -What is the average distance travelled to access the water in the ward? -What are the alternative sources of drinking water in the ward? - What particular challenges are they facing? 2. Are there any challenges that the community is currently facing in terms of: - Water supply in the village/ward (functionality -access to improved water source -distance to water sources 3. How many of you drink water that is tested? If, Yes who does the testing?-Are results for water quality analysis shared with you? 4. Who maintains the water point? -Is she or he trained? -does he or she have the tools? -is there a water point committee? -is it functional? -do you pay anything for its maintenance? - How much is contributed? -Do all water users contribute -What happens to those who do not contribute? -What is the number of tool kits in the ward? How many pump mechanics are trained and are active in the village/ward? 5. Do you have any active VHWs in the village/ward? Does the local leadership participate in PHHE? If yes what is their role? What is the common media where you receive PHHE information or messages in the villages/ward? 6. Are there any active CHCs in the village/ward? -How many are they? What is the average membership for the groups? -How often do they meet? -What is their role in the community? 7. What is the most common sanitation facility in use by households in the community? How many families have latrine? And how many families do not have latrine? -How much did you pay for the construction of such a facility? -How do people in your village maintain their latrine? - For households that do not have latrines, what are the reasons why they do not have latrines? What do they use? -What are the main sanitation challenges currently being faced by households in the community? -How do you overcome some of the mentioned challenges? 8. Comment on the number of households with and without BVIPs, are they functional? 9. Comment on the presence of handwashing facilities at HH level near sanitation facilities. If they are present, are households making use of the facilities? What are the challenges? How many families have handwashing habits? And how many families do not have hand-washing habits? Why do we hand wash? When should we hand wash and with what? 10. What is the prevalence of diarrheal diseases in the community? (Who is mostly affected (age range), which areas are affected). 11. Are Health facilities accessible to the community? Probe distances 12. What are the common water and sanitation related diseases that affect the village/ward? What is the community doing about these diseases? 13. Does the community participate in WASH annual commemoration events like Global Handwashing Day, Toilet Day, and Menstrual Hygiene Day? If yes, which activities are done?

ANNEX III CCEER BASELINE STUDY KEY INFORMANT TOOL RDC/ DEHO/ DWSSC chair-DDF

Water supply 1. What is the number of water points in each of the villages in project wards? Functional/ Non Functional? What are the causes of break down?

Ward Number No of Water Points Functional/Non-Functional

2. How many households have access to improved water sources? 3. What are the challenges faced by most HH in accessing water in the district and how they can be overcome? 4. What are the average distances travelled to access water in the wards one way? Ward Number Longest distance travelled Shortest distance travelled

List the Wards/villages with least access to safe water 5. Does the wards have Village pump mechanics? How many were trained? Trained and are active in each of the villages of the wards mentioned: Do they have tool kits? What is the number of tool kits per village/ward? 6. Comment of the functionality of WPCs, their roles Comment on the Role of DWSSC in access to water Comment on the Role of DDF in the WASH project? 7. Has there been a study carried out to assess underground water? If yes, do we have documentation of the study? If yes, is there any documentation towards such a study? If not, reasons for not prioritizing underground water studies?

Hygiene 8. Are there functional CHCs in the villages? Evidence of functionality, How many? Which is the common media channel used for PHHE information dissemination in the villages? Comment on the existence of hygiene enabling facilities in the project areas

Sanitation 9. What is the sanitation coverage in the wards? Which is the village with least sanitation coverage? What challenges are faced in access to sanitation in the ward?

Diarrheal Diseases Trends 10. What are the common water and sanitation related diseases that affect the communities? 11. What is the prevalence of diarrheal diseases in the community? Who is mostly affected? Age groups? How many diarrheal (dysentery) cases have been reported since January 2018 disaggregated by month? Which areas are mostly affected by diarrheal diseases? Month No of cases Comment

12. Are there any WASH commemorations events that you facilitate for the community? Which ones? How many people are reached out to by these events?

Event No of people reached

13. For WASH projects to be a success what are some of the best practices which you think Mercy Corps should consider as they embark on this project? 14. What are your expectations from the WASH programme?