WASH for Health Project FY18 Annual Report

WASH FOR HEALTH PROJECT ANNUAL REPORT October 1, 2017 to September 30, 2018

Submission Date: October, 2018

Agreement Number: AID-641-A-15-00005

Submitted to: AOR Name: Emmanuel Odotei

Submitted by: Alberto Wilde, Chief of Party

Global Communities #63 Tripoli Street, East Legon, Tel: +233 302 522568, +233 025 4404 Email: [email protected]

This document was produced for review by the United States Agency for International Development/

WASH for Health Project FY18 Annual Report ACTIVITY INFORMATION

Activity Title Water, Sanitation and Hygiene for Health

Agreement Number AID-641-A-15-00005 Name of Prime Implementing Global Communities Partner The Manoff Group Obooman Rural Action Program Community Management for Sustainable Development (COMDEV) Savana Integrated Rural Development Aid (SIRDA) EDSAM Social Network Adsen Consult Links Centre for Sustainable Development Jaksally Youth Group Beza-Lel Water and Agro Services Ltd/Hope for new Generation (HFNG) Services EE&E Construction Keldem Ltd. Hydronomics Ltd. Joisssam Ltd. Bizgeo Ltd. Medeboa Ltd. EAK Sir Charles Dougan Company Ltd. Benghazi Development Company Ltd. Sebb-Say Company Ltd. Jonakot Construction Ltd. Name(s) of Asamoah Construction and Electrical Works Nakwab Trading Subcontractor(s)/Subawardee(s) Enterprise Ltd. Three J’s Construction Ltd. Taurus Emporium Company Ltd. Philbek Enterprise Ltd. Bremmed Company Ltd. Country Services Ltd. Ayidiki Water and Sanitation Organization (AWSO) Rural Development Network (RUDNET) Type Company Limited

Activity Start Date February 06, 2015 Activity End Date February 05, 2020 Reporting Period October 1, 2017 – September 30, 2018

DISCLAIMER The author’s views expressed in this publication do not necessarily reflect the views of the United States Agency for International Development or the United States Government.

WASH for Health Project FY18 Annual Report ACRONYMS AND ABBREVIATIONS ...... ii 1. EXECUTIVE SUMMARY ...... 4 1.1. Activity Description ...... 5 1.2. Summary of Key Accomplishments during Reporting Period ...... 8 1.3. Summary of Major Challenges and Lessons Learned ...... 9 2. ACTIVITY PROGRESS ...... 9 2.1. Measurable Results to Date ...... 15 2.2. Progress Narrative ...... 16 2.3. Trends and Deviations ...... 17 3. CROSS-CUTTING ISSUES ...... 20 3.1. Gender Equality and Female Empowerment ...... 20 3.2. Local Capacity Development ...... 20 3.3. Science, Technology, and Innovation ...... 21 3.4. Public Private Partnerships (PPP) ...... 22 3.5. Environmental Compliance ...... 22 4. STAKEHOLDER COLLABORATION ...... 22 4.1. Collaboration and/or Knowledge Sharing with Other USAID Activities ...... 22 4.2. Collaboration and Coordination with Other Key Stakeholders ...... 23 5. LESSONS LEARNED ...... 23 5.1. Challenges and Relevant Solutions to Activity Implementation ...... 23 5.2 Adaptive Learning...... 24 6. SUSTAINABILITY ...... 24 7. AGREEMENT MODIFICATIONS ...... 25 8. ACTIVITIES PLANNED FOR NEXT YEAR ...... 26 APPENDICES ...... 27 I. Performance Data Table (PDT) ...... 27 II. Success Stories and Press Coverage ...... 30 III. Financial Information ...... 32 IV. Activity Oversight & Technical Assistance Support ...... 33 V. M&E Issues ...... 39 VI. Management and Administrative Issues ...... 42 VII. Follow-Up Actions ...... 42 VIII. Map of Project Activity Sites/ Facilities by District ...... 43 IX. CLTS Updates Extract...... 45 X. List of Schools Receiving Institutional Latrines ...... 47 XII. List of FY2017 Small Grant Projects ...... 54 XIV. Digni-Loo Installation Guide ...... 56 XV. Cholera Prevention Campaign...... 57 XVI. Photos ...... 59

WASH FOR HEALTH PROJECT FY18 ANNUAL REPORT i ACRONYMS AND ABBREVIATIONS

AOR Agreement Officer’s Representative AWSO Ayidiki Water and Sanitation Organization BCC Behavior Change Communication CDO Community Development Officer CHPS Community-Based Health Planning and Services CLTS Community-Led Total Sanitation COMDEV Community Management for Sustainable Development CSO Civil Society Organization CWSA Community Water and Sanitation Agency DA District Assembly DICCS District Interagency Coordinating Committee on Sanitation DQA Data Quality Assessment DWST District Water and Sanitation Team EAWAG Swiss Federal Institute of Aquatic Science and Technology ESDM Environmentally Sound Design and Management EHA Environmental Health Assistant EHO Environmental Health Officer EHSD Environmental Health and Sanitation Directorate EMMP Environmental Mitigation and Monitoring Plan FY16 Fiscal Year 2016 FY17 Fiscal Year 2017 GAMA Greater Accra Metropolitan Area Sanitation and Water Project GDA Global Development Alliance GHACEM Ghacem Limited GIS Geographic Information Systems GOG GSA Ghana Standards Authority GWCL Ghana Water Company Limited HPNO Health, Population and Nutrition Office IE&C Information, Education, and Communication KVIP Ventilated and Improved Pit LNGO Local Non-Governmental Organization LOP Life of Project M&E Monitoring and Evaluation MHM Menstrual Hygiene Management MIS Management Information System MOH Ministry of Health MOU Memorandum of Understanding MSWR Ministry of Sanitation and Water Resources NADMO National Disaster Management Organization NGO Non-Governmental Organization NLs Natural Leaders ODF Open Defecation Free PDT Performance Data Table PPP Public Private Partnership RI Rotary International RICCS Regional Interagency Coordinating Committee on Sanitation

WASH FOR HEALTH PROJECT FY18 ANNUAL REPORT ii RING Resiliency in Northern Ghana RUDNET Rural Development Network Ghana SBCC Social Behavior Change Communication SG Fund Small Grant Fund SHEP School Health Education Program SIRDA Savana Integrated Rural Development Aid SOP Standard Operating Procedure SPRING Strengthening Partnerships, Results, and Innovations in Nutrition Globally STMA Sekondi-Takoradi Metropolitan Assembly TA Technical Assistance TAF Technology Applicability Framework UNICEF United Nations International Children’s Emergency Fund USAID United States Agency for International Development USG United States Government WADA Water and Development Alliance WASH Water, Sanitation and Hygiene WHI Water Health International WHO World Health Organization WSMT Water and Sanitation Management Team

WASH FOR HEALTH PROJECT FY18 ANNUAL REPORT iii 1. EXECUTIVE SUMMARY

The WASH for Health Project, a five-year project awarded to Global Communities in February 2015, has concluded its third full year of implementation with major successes chalked. The goal of the project is to accelerate sustainable improvement in water and sanitation access and improve hygiene behaviors in target districts in Ghana. During FY18, WASH for Health worked in 23 districts throughout the five- targeted regions (Greater Accra, Northern, Volta, Central, and Western Regions). To begin with, WASH for Health’s community-led total sanitation (CLTS) approach continued to promote rural sanitation delivery in all project communities. As usual, the project worked with previously identified and trained Natural Leaders, CLTS Field Staff, Environmental Health Assistants (EHA), and local NGOs (LNGO) to implement CLTS and provide technical support. This year, 346 new communities were triggered in the fiscal year and 5,884 new household latrines were installed - exceeding the annual target by 1,084 latrines. In total, the project has supported the construction of 13,952 household latrines, which has provided access to basic sanitation facilities for approximately 111,616 people, with approximately 47,072 people gaining access in FY18 alone. WASH for Health also successfully augmented community water supplies, providing 20 boreholes to communities, three boreholes to Community Based Health Planning and Services (CHPS) compounds and seven boreholes for schools. Water quality tests were conducted and Water and Sanitation Management Teams (WSMTs) in the beneficiary communities were trained on facility maintenance and management. WASH for Health continued to collaborate with and engage stakeholders and partners in both the private and public sectors. Collaboration with district and regional government ministries is key to sustainable results, and WASH for Health worked closely with ministry officials on a variety of activities, including the process for declaring communities Open Defecation Free (ODF). As done in the past, WASH for Health supported the District Interagency Coordinating Committee on Sanitation (DICCS) and Regional Interagency Coordinating Committee on Sanitation (RICCS) to carry out their assessment visits. A total of 376 communities were declared ODF by RICCS in FY18, bringing the total number of communities declared ODF to 632. Promotion of key hygiene behaviors continued through field visits and mass media via radio spots in project districts. Additionally, as part of SBCC activities for FY18, key hygiene behaviors were expanded to include the integration of Nutrition into the WASH activities of primary and secondary caregivers of children under 2 years (CU2). Two main exploratory research- Collective Active Trials (CATs) and Trials of Improved Practices (TIPs) went into the additional component, NuWASH to ascertain the practicability of certain proper hygiene behaviors among nursing mothers and their supporters. Plans are underway to incorporate the outcome of the research into the existing BCC messages for promotion in FY19. Collaboration with government partners continued in FY18 with the Ministry of Sanitation and Water Resources (MSWR) and other WASH actors assisting the development and launch of the pro-poor guidelines titled “Guidelines For Targeting The Poor And Vulnerable For Basic Sanitation Services In Ghana” on 20th June, 2018. The document has since been distributed nationwide with various workshops held to further empower implementers on its use. WASH for Health continued to maintain existing partnerships and pursued more this FY. In collaboration with Unilever Ghana Foundation, the construction of 10 institutional washrooms with hand washing facilities has been completed in selected schools in , which are yet to be branded. Partnership activities also continued with Rotary International, Ghacem, Duraplast and more, and new partnerships are under development with Be Girl, Caterpillar, and Diageo. Our partnership with Duraplast has also seen the improvement of the Digni-Loo to include a detachable plastic seat.

WASH FOR HEALTH PROJECT FY18 4 ANNUAL REPORT Additionally, WASH for Health played an important part in cholera prevention activities in and Accra. Strategic cholera prevention education campaigns were conducted throughout the year. WASH for Health also completed the construction of 48 institutional latrines, exceeding the FY18 target by 18. Lastly, the Small Grant Program continued to accept applications from Civil Society Organizations (CSO) and community-based organizations. In FY18, over 50 project proposals were received; eight of which were selected for funding. Projects included activities to construct tippy-taps at schools, install borehole hand pumps, rehabilitate institutional latrines and install rainwater harvesting systems. All projects were completed within the year. Despite the challenges faced in FY18, the WASH for Health project made significant marks in all six components. FY19 seems promising since lessons learnt from this year and past years will be used as stepping stones to meet and exceed more targets.

1.1. Activity Description

The WASH for Health project was developed in response to the health effects of inadequate or nonexistent WASH services for people across Ghana. Health effects are more profound in some regions than in others. Districts in the Northern, Central, Western, and Volta Regions were poorly served in terms of potable water coverage, averaging about 65% according to the rural water supply coverage statistics published by the CWSA. Regarding sanitation, virtually all regions were faring very poorly, though poor sanitation was more pronounced in the Northern, Upper East, and Upper West Regions with nearly 75%1 of all households lacking access to basic sanitation and practicing open defecation. It is, therefore, unsurprising that water and sanitation-related diseases were the top outpatient issues at healthcare centers in these areas. The scourge of cholera in recent years has been devastating, taking the lives of over 240 people, and infecting almost 30,000 Ghanaians between 2014 and 2015 in eight regions2. Cholera can be prevented by the use of basic improved sanitation facilities, the provision and use of safe drinking water, and good hygiene practices. The goals of the WASH for Health project are to accelerate sustainable improvement in water and sanitation access and to improve hygiene behaviors in target districts. These goals will be achieved through six mutually reinforcing objectives (components), which are listed below: 1. Increased use of improved household sanitation; 2. Improved community water supply services; 3. Improved sector governance and policies; 4. Expanded key hygiene behaviors;

1 GSS (2013), 2010 PHC Report, page 391. 2 http://reliefweb.int/report/ghana/situation-report-cholera-outbreak-ghana-20-september-2015-week-38 accessed 11th January 2016; http://reliefweb.int/report/ghana/situation;http://reliefweb.int/report/ghana/situation-report-cholera-outbreak- ghana-30-august-2015-week-35report-cholera-outbreak-ghana-30-august-2015-week-35.

WASH FOR HEALTH PROJECT FY18 5 ANNUAL REPORT

5. Leveraged public private partnership (PPP) investment to magnify the impact of United States Government (USG) funding; and 6. Improved water supply and sanitation infrastructure for schools and health facilities. Global Communities is the lead organization responsible for project management and administration, as well as for the implementation of water and sanitation infrastructure development, and CLTS implementation. The Manoff Group, a sub-recipient on the project, is responsible for promoting Social Behavior Change Communication (SBCC), which is mainstreamed throughout the above-listed project components. Other project partners include Rotary International (RI) a USAID Global Development Alliance (GDA) partner. Rotary International is extending project activities into a sixth region () and is working with the CWSA as a consultant/implementing partner. WASH for Health will match one to one funding in the already selected areas across six regions for Water and Sanitation projects with Rotary. WASH for Health engaged LNGOs as sub-recipients to support community mobilization, sensitization, household latrine promotion and hygiene education promotion for the WADA project. Water and Sanitation Management Team (WSMT) formation and training were done by project field staff. The project is also being implemented in collaboration with other USAID-funded projects. These projects are the USAID Systems for Health project, the Resiliency in Northern Ghana (RING) project, Communicate for Health, the Evaluate for Health and the People for Health. The six objectives of the project were translated into components as action areas, with particular activities detailed out in the project implementation plan. Though activities are currently being implemented in five regions (Volta, Central, Western, Northern, and Greater Accra) the degree and amount of activity is varied depending on any other previously existing interventions (i.e. existing water and sanitation coverage, prevailing health issues or interventions or other related projects present in the communities). WASH for Health worked in the Eastern Region in this FY to complement implementation of partnership activities with Rotary International. The planned activities and expected results, as well as the outputs realized from the various components are presented below. Component One: Increased Use of Improved Household Sanitation WASH for Health proposes a comprehensive approach that lays the foundation for effective, demand- led CLTS by building strategic alliances with local government counterparts, improving CLTS facilitation skills, and developing an efficient sanitation market that offers low-cost technologies for toilet construction and financing options before triggering demand for toilet acquisition. Over the life of the project, 10,100 household toilets are expected to be constructed in project communities, including toilets that the poorest of the poor have support to build.

WASH FOR HEALTH PROJECT FY18 6 ANNUAL REPORT Component Two: Improved Community Water Supply Services To maximize the outcomes of our health indicators and to create a sustainable impact on project deliverables, water supply activities will be implemented alongside sanitation activities. Sanitation and increased access to water supply complement each other by reinforcing the outcome of improved health. The availability and proper use of safe water and basic sanitation eventually protect water sources from contamination that results from poor hygiene practices, like open defecation. Improvements in water supply services promote good hygiene practices, as water is made available for bathing and handwashing. Community water supply interventions are planned in collaboration with local government institutions and stakeholders including the regional CWSA, the District Water and Sanitation Team (DWST) of the District Assemblies (DAs), and other relevant organizations. DWSTs and CWSAs handle long-term support to WSMTs. Both the DWST and the WSMTs will provide oversight, and their involvement in all aspects of WASH for Health interventions will promote national-level recognition of the CWSA and the DWST as service authorities and community resources in the future. By the end of project implementation, the following targets for water supply facilities are expected to be achieved: • 180 machine-drilled boreholes fitted with hand pumps; • 50 existing, non-functional boreholes rehabilitated; and • One small town water supply system developed. Component Three: Improved Sector Governance and Policies Using participatory approaches to rural and peri-urban WASH planning and implementation, the WASH for Health project seeks to strengthen Ghana’s WASH sector governance and policies through the delivery of successful programs derived directly from existing policies. The CLTS approach adopted for rural sanitation delivery derives from the National Rural Sanitation Model and Strategy, while the project’s BCC strategy will borrow from the Urban WASH BCC Strategy for Ghana. Each of these approaches conforms to the National Community Water and Sanitation Program and strategies for WASH delivery in Ghana. WASH for Health also aims to create a WASH environment at the community level by building the capacity of communities and community-based organizations to identify local water and sanitation needs and properly manage WASH resources. The project will form and train WSMTs and build the DWSTs’ capacities to monitor project implementation and conduct post-project monitoring for sustainable WASH services. WASH for Health will also extend support to the line ministries: the Ministry of Sanitation and Water Resources, the Ministry of Health and its allied agencies in policy 3 formulation, review, and dissemination (if it is deemed necessary). Component Four: Expanded Key Hygiene Behaviors By considering the local context in which a change takes place, Global Communities’ approach to communication for social and behavior change helps our projects achieve lasting impact. The specific behavior change goals established by the WASH for Health team help guide the implementation and leading decisions of all project components. WASH for Health works closely with statutory government entities like the CWSA and the Environmental Health and Sanitation Directorate (EHSD) within the Ministry of Sanitation and Water Resources, and with projects like Communicate for Health, Systems for Health, and RING so that the project’s behavior change strategy reinforces and extends that of these other projects.

3 The newly elected administration in Ghana has eliminated the Ministry of Water Resources, Works and Housing and the ministry of Local Government and Rural Development. The new ministry is the Ministry of Sanitation and Water Resources.

WASH FOR HEALTH PROJECT FY18 7 ANNUAL REPORT

Component Five: Leveraged PPP Investments to Magnify the Impact of USG Funding Global Communities anticipates that facilitating partnerships between state and non-state actors, especially the private sector, will unlock synergies that will complement and extend the span of WASH interventions to promote good health. Under this component, WASH for Health partners with Rotary International and Coca-Cola—both USAID GDA partners—and expects to work with one more GDA to support WASH interventions in selected communities in the six regions by the end of the project. Component Six: Improved Water Supply and Sanitation Infrastructure for Schools and Health Facilities Providing water and sanitation infrastructure in schools and health facilities has immediate positive impact on the health of patients, healthcare workers, students, and teachers, all while reinforcing the CLTS process and WASH for Health hygiene messaging. This component addresses an issue revealed by a World Health Organization (WHO) 20144 report indicating that neglect of WASH in schools and healthcare facilities undermines a country’s capacity to prevent and respond to disease outbreaks. Beneficiary schools and health centers will be selected in close coordination with USAID, other USAID-funded projects, and government institutions. Conforming to national policies on institutional toilet facility delivery, WASH for Health will provide both disability-friendly and gender sensitive toilet facilities. Toilets will have separate entrances for men and women, as well as a changing room for women to ensure privacy during menstruation. All the institutional toilet facilities will have handwashing facilities in the form of rainwater harvesting tanks with water taps and wash basins, Veronica buckets, or other appropriate technologies, depending on the availability of water resources and drainage capacity. By the end of the project, the following are expected to be achieved under this component: • Provision of 40 institutional water supply facilities; and • Provision of 190 institutional toilets.

1.2. Summary of Key Accomplishments during Reporting Period

The following have been accomplished during FY18: • 346 new communities were triggered for CLTS activities, with 1,026 communities triggered to date. • 376 communities reached ODF status, with a total of 713 communities in the ODF continuum5. Of the total, 632 communities are certified ODF by RICCS to date. • 5,884 household latrines were completed in the year, providing additional 47072 people access to safe sanitation facilities. A total of 13,952 latrines have been completed to date. • 20 out of 41 successful community boreholes drilled are fitted with hand pumps and safe for use providing potable water to over 6,000 people. 5 out of 7 boreholes have been mechanized; three for CHPS Compounds and two for schools. An additional five boreholes have been fitted with hand pumps for schools. • 48 institutional latrines were constructed in the reporting year • 470 handwashing facilities were supplied to beneficiary schools, including some schools that received toilet facilities last year. • A total of 196 teachers and PTA or School Management Committee (SMC) representatives of the beneficiary schools were taken through toilet user education to ensure the toilet facilities are used hygienically and sustainably. • 289 people trained at the community level to capably operate and maintain the water facilities provided for the communities. The people trained are all members of 41 WSMTs formed within the period of reporting.

WASH FOR HEALTH PROJECT FY18 8 ANNUAL REPORT • District Interagency Coordination Committee on Sanitation (DICCS) continued to function, carrying out assessment visits to confer ODF status on communities that meet the set criteria for declaration. • 1,375 girls were given menstrual hygiene education and supported with Be Girl panties and smart cycles from 20 basic schools. 438 boys were also educated on menstruation. They were also provided with some MHM reading materials. • A research was also conducted as part of the pilot of the Be Girl products to among others ascertain the impact of menstruation on girl's attendance to school, their level of concentration during menstruations and also what perception boys had on menstruation • Support was also given to the Ministry of Sanitation and Water Resources to develop a guideline document aimed at providing some guidelines for sector players to use to provide support for the poor and vulnerable for basic sanitation services in Ghana. • 111 MMDA key sanitation staff and stakeholders were trained on how to use the Pro-poor guidelines to enable them to use it appropriately in their respective areas. A total of 135 copies were also presented to the MMDAs. • All eight projects under the FY18 Small Grants Program have been completed in Volta, Western and Central Regions.

4 http://www.who.int/water_sanitation_health/publications/glaas_report_2014/en/ accessed 18-09-2015. 5 ODF is defined as ODF self-assessment, ODF Basic by DICCs and ODF certification by DICCS.

WASH FOR HEALTH PROJECT FY18 9 ANNUAL REPORT

1.3. Summary of Major Challenges and Lessons Learned

Much of the year has been largely successful; it also saw seasonal and perennial implementation challenges. The perennial challenges include those related to hydrological and geological conditions like soil formations, groundwater availability and quality and how they impact implementation. The seasonal challenges include, but are not limited to socio-cultural practices and economic conditions prevailing in communities. As a result, implementation approached were altered and this yielded significant results by the team, cementing the decision to continue direct implementation unless significant evidence arises to the contrary. In Q3 and Q4, due to seasonal rainfall, some household latrines constructed in the Northern and Volta regions, as part of the project, were affected. The heavy rains rendered some roads unmotorable impeding easy movement among project communities for activities.

2. ACTIVITY PROGRESS

Component One: Increased Use of Improved Household Sanitation With the objective of increasing the use of improved household sanitation facilities, WASH for Health continued using the three-pronged approach to sanitation promotion with CLTS. This strategy involves a) capacity building and training of trainers for triggering and post-triggering activities, b) triggering communities, and c) sanitation marketing using innovative approaches. Capacity building and training The project built the capacities of Natural Leaders (NLs) in project communities to support post- triggering activities in project communities to get them ODF. These NLs were taken through a three- day training to support latrine construction, community clean-ups, community self-assessment all aimed at getting communities ODF.

The capacity of CLTS field officers were also built on simple technologies of household latrines construction and the installation of the Digni-Loo to help the uptake of latrine construction in project communities. The officers were also taken through the process of identifying the poor and vulnerable latrines to benefit latrine support.

Triggering The WASH for Health CLTS Field Staff continued the direct implementation of CLTS in the project communities with support from District Assemblies, Environmental Health and Sanitation and Community Development staff. In collaboration with 156 Environmental Health Unit staff and close to 5,000 Natural Leaders, the project is working in 676 communities, supporting them as they work through the CLTS process of triggering,

WASH FOR HEALTH PROJECT FY18 10 ANNUAL REPORT

post-triggering and re-triggering activities. Details of CLTS activities disaggregated at the regional level is presented below with a summary table provided in Appendix IX. Through WASH for Health’s activities implemented in FY18, a total of 346 new communities were entered this fiscal year, 346 communities were triggered with 345 in the post-triggering phase. The project supported the construction of 5884 household latrines for a cumulative LOP total of 13,952 household latrines constructed, providing improved sanitation to approximately 111616 people. An additional 3,274 latrines are under construction between the substructure and the superstructure phases. Additionally, to date 590 communities reached various stages of ODF: 216 communities passed self- assessment, 90 communities reached ODF Basic, 28 communities were certified ODF by DICCS, and a total of 256 communities have been certified ODF by RICCS. ODF celebrations were held in the Volta, Northern and Greater Accra Regions as a platform to celebrate the achievements of the ODF communities, reinforce Government commitment, and further trigger other communities. Each ODF community received certificates of achievements and other sanitation working tools. Some outstanding field facilitators were also given awards to serve as a motivation for them and for their colleagues. At each celebration, senior government officials and community members from throughout the districts were in attendance.

Sanitation Marketing The third leg of the approach involves making it easy for residents of project communities to construct the latrines of their choice using locally available materials and inputs that ensure the basic latrines are safe. The project continued to promote three primary latrine technologies in target communities using the posters developed earlier in the project and distributed to CLTS Field Officers, Environmental Health Assistants, Latrine Artisans and Natural Leaders. Additionally, partnerships with private sector companies to channel latrine construction materials such as cement and vent pipes through existing distribution depots to project communities remained in place throughout the year. These materials/inputs help stabilize pits and provide ventilation for household latrines. CLTS field officers monitored the purchase and use of these inputs for latrine construction purposes. Additionally, Digni-Loo continued to penetrate gradually the sanitation market in project regions as households, communities and their leaders are buying into the Digni-Loo idea. 560 were produced, while 296 were distributed to entrepreneurs in WASH for Health project regions, to be sold to various households and communities; other interested agencies and individuals in FY18. At the end of FY18, 264 were yet to be distributed or purchased. A new model with a seat, to cater to the needs of the vulnerable, is yet to roll out in FY 19. Bill & Melinda Gates-Funded CLTS Research Findings from the mid-term evaluation of some selected communities conducted in Quarter 3 of FY17 have yet to be shared with WASH for Health. WASH for Health collaborated with The Swiss Federal Institute of Aquatic Science and Technology (EAWAG) to support their research on the impact of CLTS. Component Two: Improved Community Water Supply Services Throughout the fiscal year, WASH for Health conducted post-construction monitoring of the 85 boreholes constructed in FY17. The facilities were within the defect liability period for the first half of the fiscal year; users reported no major issues, and communities utilized the boreholes to access clean and safe water. WASH for Health drilled an additional 54 boreholes in FY18. Of these, 12 were dry or had marginal yield and were not constructed. 41 boreholes were successful, and of them 20 are fitted with hand pumps

WASH FOR HEALTH PROJECT FY18 11 ANNUAL REPORT and are in use at WASH for Health project communities at the end of the Fiscal Year. A total of 179 boreholes have now been constructed with 158 for communities. See Appendix XI for a list of boreholes. Additionally, a BCC Officer on the project conducted trainings of WSMTs in communities where boreholes were drilled and yielded water. These trainings will ensure the appropriate use and management of the boreholes and will ensure sustainability of the facilities. During the implementation year, a consultant conducted feasibility and hydrogeological studies in Tuna community, in the Sawla Tuna Kalba District, . Tuna is one of the water stressed communities in the Northern Region. There were several attempts in the past by other projects to provide them with water, but none of them could find high yielding boreholes. The consultant carried out detailed hydrogeological studies and sited over 10 potential points to be drilled. Later six drilling attempts were made, and two high yielding boreholes were found (160L/M & 140L/M). Based on the yields of these two boreholes, the consultant designed the water system for the community to serve 8,000 people, which it is made up of the construction of 100m3 elevated storage tank, 13km length of transmission and distribution pipe network, 11 stand pipes (taps for communal use), WSMT office, pump house and incorporated solar power system to power the submersible borehole pump. The construction is ongoing, and the completion date is schedule for March 31, 2019. Component Three: Improved Sector Governance and Policies WASH for Health in collaboration with the Ministry of Sanitation and Water Resources and other sector players successfully developed and launched the pro-poor policy, Guidelines for Targeting The Poor And Vulnerable For Basic Sanitation Services In Ghana on 20th June 2018. Copies of the document has since been distributed throughout the country and workshops held in various regions to build the capacity of implementers. Component Four: Expanded Key Hygiene Behaviors Significant and innovative strides were made in BCC in FY18, most notably the introduction of a novel component, NuWASH (Nutrition in WASH). From Q3, existing research work, resources and lessons learned from WASH and Nutrition programs in Ghana and other countries were reviewed to determine the viability of the two programs merged into one. The outcome of the literature review led to the profiling of nutrition-sensitive WASH behaviors and shared findings with relevant stakeholders for their perspectives.

A Formative Research was conducted in Q4, in four (Western, Northern, Greater Accra and Volta) regions, to ascertain context within which behaviors occur, the supporting and inhibiting factors, primary and supporting actors and trials of the improved practices (TIPs). The research was analyzed by using the Think I BIG (Behavioral Integration Guidance) analysis tool to develop Behavior Profiles and established the logical pathways to improve each of the seven prioritized NuWASH behaviors namely: • Safely dispose animal feces daily • Wash the hands of your children under two years before they eat • Wash your hands before preparing and serving food • Breastfeed your child exclusively for six months after birth • Wash and safely store eating and cooking utensils • Cover prepared food • Provide a clean mat for your child under two years to eat on Based on the analysis a NuWASH, a Behavior Change Strategy was drafted to cover all needed elements- Enabling Environment; Infrastructure, Products and Services; and Demand and Use, under which Communication falls.

From the behavior profiles and Behavior Change Strategy, a Behavior Change Communication plan will be drawn out in Q1 of FY19 to facilitate the uptake of the NuWASH behaviors namely; ▪ Mothers exclusively breastfeed for the first 6 months

WASH FOR HEALTH PROJECT FY18 12 ANNUAL REPORT ▪ Caregivers create a clean space for their children to eat and play ▪ Caregivers handle their children’s food safely ▪ Caregivers wash their hands before handling children’s food and wash children’s hands before they eat The previous WASH Behavior Change Strategy was revised in the last quarter and the remaining Enabling Environment; Systems, Products and Services; and Demand and Use issues were also addressed. The radio spots produced in various local languages in FY17 are still airing in most project districts.

Cholera Response Cholera prevention activities that commenced in the during the fourth quarter of FY17, continued till the end of FY18 Q1, whilst activities in some cholera prone communities in the took place during the last quarter of FY18. Activities in the Cape-Coast metropolis which span from 31st August to 31st December 2017, targeted households, festival grounds or gatherings, beaches, health facilities, soccer activities, food venders, churches, mosques and market centers including butchers. To achieve this objective, 41 volunteers were mobilized comprised of Environmental Health Officers and Ghana Red Cross staff. The volunteers were grouped into eight, comprising of five members and three coordinators to oversee planned activities. The groups was tasked to educate the populace on cholera preventive measures, distribute behavior change communication materials (BCC) and paste some of the posters at all vantage points, including public toilets, bathhouses, lorry stations and hospitals.

In the Greater Accra region, cholera prevention exercises took place in cholera prone communities in , Ga South, and Asedu-kete municipalities. Various activities were carried out to ensure an effective cholera prevention exercise in the communities, spanning from the 25th June to 11th August, 2018. The following activities were embarked on: house-to-house Aqua-tab distribution (water purification tablets), cholera sensitization, distribution of Behavior Change Communication (BCC) materials, disinfection of major drains, public bathhouses and latrines, dump sites, markets and slaughter houses. Global Communities organized these planned cholera prevention activities as part of the USAID- funded WASH for Health Project to curb any cholera outbreak in the region.

A total of 106 volunteers were mobilized for this exercise. Out of that number, 92 of them were drawn from Red Cross and Environmental Health to assist with the distribution of 256,000 strips of ten Aqua- tabs to households and 14 volunteers comprising Environmental Health Officers, Sanitation Guards and Red Cross Volunteers were engaged in the disinfection exercise. These activities have led to zero cholera cases recorded in the aforementioned districts. See appendix XIV for more details.

Global Communities continues to conduct awareness raising activities in order to educate the public on cholera and to prevent another outbreak from occurring. Menstrual Hygiene Management As a means to support underprivileged girls who find it very difficult to access menstrual pads during their menstruation, Global Communities in partnership with the Ghana education Service through a MHM program supported a total of 1,375 basic school girls with Be Girl panties (reusable menstrual panties and towels) and a menstruation tracking device known as a smart cycle. Apart from the girls, 438 boys from the basic schools were also educated on what menstruation is. The core objective was to help demystify some of the myths associated with menstruation in their communities. These myths have always had a negative impact on especially the girl who mostly will absent themselves from school during menstruation.

WASH FOR HEALTH PROJECT FY18 13 ANNUAL REPORT Component Five: Leveraged PPP Investments to Magnify the Impact of USG Funding Coca-Cola Water and Development Alliance (WADA) The seven institutional latrines in the five schools were continually monitored throughout FY18 and all were reported to be functional. Rotary International As part of matching the investments to be made by Rotary International under the partnership, Global Communities agreed to provide water and sanitation infrastructure and implement software activities in 13 districts that overlap with Rotary’s program areas. However, in early FY17, following discussions with CWSA, Rotary International’s implementing partner in Ghana, Global Communities requested approval from USAID to enable CWSA to implement the remaining software components of the partnership in 49 communities. Global Communities obtained clearance from USAID to establish a contract with CWSA in early FY18. So far, 131 institutional latrines have been constructed out of which Global Communities constructed 80. Additionally, 32 water sources have been provided so far, 28 of which were supplied by Global communities under WASH for Health. 74 out of 93 institutions have, since the inception of the partnership, received facility user/SHEP trainings. Finally, WASH committees from 52 of 90 communities have been trained.

Other Partnerships Global Communities maintained several additional partnerships throughout the Fiscal Year. Together with Unilever Ghana Foundation, WASH for Health constructed ten and refurbished one institutional latrines in the Tema Metropolis. As of the end of FY18, construction works were completed on the new hygiene stations, yet to be branded by Unilever. Once they are branded according to Unilever Foundation’s specification, they will be commissioned. Additional partnership activities continued throughout the year, and the Collaboration with Ghacem continued to supply cement at reduced prices to CLTS beneficiary communities. While collaboration with Duraplast Ghana Ltd. continued to supply vent pipes at reduced price to our beneficiaries for the construction of hygienic household latrines and to support the improvement, production, sale and delivery of the Digni-Loo. Furthermore, Global Communities’ partnership with Diageo led to the commencement of the Small Town Water Supply system in Tuna in Q4 of FY18. Another partnership with Be Girl, a U.S. based company that produces menstrual hygiene products, successfully piloted the Be Girl panties and cycles to pupils in 20 schools located in four (Volta, Northern, Greater Accra and Western) project regions. Component Six: Improved Water Supply and Sanitation Infrastructure for Schools and Health Facilities WASH for Health successfully constructed 48 institutional latrines (38 for project schools, and 10 constructed or refurbished through the Unilever partnerships). WASH for Health technical staff conducted monitoring visits throughout the construction process. The project worked closely with the Regional SHEP coordinators to ensure Government-led hygiene trainings are conducted at beneficiary schools. Additionally, 470 Veronica Buckets were provided to beneficiary schools to promote healthy handwashing habits. See Appendices VI and X for a list and map of the construction locations. WASH for Health also drilled and constructed 10 boreholes for CHPS Compounds and Schools. Three boreholes were given to CHPS and they are all mechanized and are providing potable water to the facilities. The remaining seven were given to schools with two mechanized. WASH for Health Small Grants Scheme In FY17, the Small Grant Program Handbook was updated and disseminated to WASH for Health Staff. A new review process, which required an initial Regional level review of applications and a subsequent

WASH FOR HEALTH PROJECT FY18 14 ANNUAL REPORT Accra-based review, was instituted. In FY18, Global Communities received over 20 applications in the first two quarters, and funded eight small grant projects in the Volta, Central and Western Regions in Q3. The Grant and Contracts officer made an introductory overview presentation to all recipients. Almost all projects were completed by the conclusion of the fiscal year. Applications will continue to be received on a rolling basis and the next tranche of funds for the program will be disbursed in FY19. (See Appendix XII for complete list of recipients)

WASH FOR HEALTH PROJECT FY18 15 ANNUAL REPORT 2.1. Measurable Results to Date Objective 1: Increased use of improved household sanitation WASH for Health continued to use CLTS to sensitize households on the dangers of open defecation and the need to construct and use basic, safe household latrines. The project, through its field staff, continues to provide technical support and monitor latrine construction so each latrine meets basic safety standards and can be classified as improved latrines. In FY18, 5,884 household latrines were completed, bringing the project total to 13,952, which is 138 percent of the LOP target. These latrines have facilitated access to improved sanitation for a total of 47,072 people. Of 1,026 communities triggered, 1,030 are engaged in post-triggering activities (including latrine construction). Out of the triggered communities, 426 are in the Northern Region, 84 are in Greater Accra, 118 are in the , 98 are in the and 89 are in the Central Region. A total of 732 communities are in the ODF Continuum: 78 have reached ODF Basic, 22 have been declared ODF by DICCS and 632 certified full ODF by RICCS. A total of 4,999 Natural Leaders ODF communities have been identified and trained to help implement CLTS in their communities and support adjoining Self communities as local champions. A Assessment network of the trained Natural 32% ODF BASIC Leaders is being formed to foster knowledge sharing and learning 1030 ODF by DICCS among them in CLTS activities. commuinities

60% ODF by RICCS

5% 3%

Objective 2: Improved community water supply services In FY18, 20 community boreholes were completed, benefitting over 6,000 people. Though 41 boreholes were successful in total, only 20 out of 41 were fitted with hand pumps as of the end of FY18 due to the availability of Ghana Modified India Mark II hand pump. Results for FY18 takes the total number of community boreholes to 158. The project is also in the process of constructing a small-town water system in STK district. When complete the facility will provide potable water access to an estimated 8,000 people. Objective 3: Improved sector governance and policies A key milestone achieved in FY18 was the development of a policy document to improve the rural sanitation model, that is, “Guidelines for Targeting the Poor and Vulnerable for Basic Sanitation Services in Ghana”. In collaboration with the Ministry of Sanitation and Water Resources, this document was developed to provide direction to stakeholders in the sanitation sector on how to fairly and properly provide support of diverse nature to the poor without comprising the objective of CLTS. The document was launched on 20th June 2018 and has been disseminated in selected project districts for implementation as a way to pilot-test the guidelines. Objective 4: Expanded key hygiene behaviors Following the development and roll out of the BCC communication package on water treatment, hand washing and safe disposal of human feces in FY17, results in FY 18 indicate that

WASH FOR HEALTH PROJECT FY18 16 ANNUAL REPORT ➢ 42,236 (Out of a target of 32816) people practice handwashing • 87% of people wash the hands before eating • 97% wash their hands after defecation ➢ 67% of households (of a target of 60%) have hand washing stations used by all households ➢ 25% of households (of a target of 20%) boil their water before drinking water The key activity for FY18 was the integration of nutrition into WASH actions (NuWASH). As part of the process, the priority behaviors identified under NuWASH have been tested and agreed upon among stakeholders. The team is the process of developing communication materials to promote these behaviors. Objective 5: Leveraged PPP Investment to Magnify the Impact of USG Funding In FY18 all partnerships continued as expected and, in some cases, improved. The airing of cholera messages on GBC continued. In the year under review, the messaging extended to radio with other BCC messages including safe storage and treatment of water, construction and maintenance of latrines and hand washing facilities, safe disposal of children’s feces among others. The supply of vent pipes and cement from Duraplast and Ghacem respectively continued in all districts. A key highlight for the year was the extension of the Unilever partnership to 10 additional schools as well as the identification of a new partner (Zenith Bank) to support the construction of the Tuna water system.

Objective 6: Improved water supply and sanitation infrastructure for schools and health facilities WASH for Health collaborated with Unilever Ghana Foundation to construct 10 and refurbish one institutional latrine in the Tema and communities. Additionally, 38 institutional latrines were completed taking the total number of institutional latrines constructed for the year to 48. 16 boreholes were successfully drilled with 10 fully installed for schools and health facilities.

2.2. Progress Narrative

The WASH for Health project achieved significant milestones in FY18. There has been a significant increase in the number of communities that have achieved ODF certification by the RICCS. This achievement indicates a level of sustained success resulting from consistent CLTS implementation in target communities. This is most notable in the Adaklu district of the Volta Region where one community was declared sanitized by the RICCS, which is the first of its kind since the inception of CLTS in the Region. This is widely acknowledged by other WASH sector stakeholders as an important accomplishment. Moreover, the project has witnessed massive achievement in the construction of household latrines, achieving 91 percent of the LOP target by the end of the third full year of implementation. This year also saw significant progress in innovation and the expansion of the SBCC to include, Nutrition in WASH (NuWASH), as well as effective cholera response and prevention activities in parts of the Cape-Coast Metropolitan Assembly and Parts of Greater Accra region. No new cases were reported throughout the year.

Global Communities gained Patent Right of Digni-Loo, which has in Q4 undergone a facelift, with an attachment of a seat to cater for the vulnerable in rural communities. Global Communities in collaboration with the Ministry of Sanitation and Water Resources, and other sector players successfully launched the “pro-poor” policy that will support the Government of Ghana with the provision of sanitation options to the most marginalized populations throughout the country. It is entitled Guidelines for Targeting the Poor and Vulnerable for Basic Sanitation Services in Ghana. This effort was underway in the latter half of the fiscal year and will continue into FY19.

WASH FOR HEALTH PROJECT FY18 17 ANNUAL REPORT 2.3. Trends and Deviations

Number of People Gaining Access to Basic Sanitation Service as a Result of USG Assistance With an annual target of 38,400 people to gain access to sanitation in FY18, the project ended the year providing access to basic sanitation to 47,072 people; this result is 22% over the target and was achieved with the construction of 5,884 latrines. The result follows the trend over previous fiscal years where the project overachieved its annual target. The overachievement of this fiscal year’s target was a result of the benefit the project is seeing from switching mainly to direct implementation as against relying on LNGOs. Also, as the project expands to new project communities, continues education and monitoring in old communities, the number of new beneficiaries increases. Below is a chart depicting how the project performed over the past year.

FY18 access to sanitation 18000 16000 14000 12000 10000 8000 6000 4000 2000 0 QTR 1 QTR 2 QTR 3 QTR 4

Results Target

Number of People Receiving Improved Service Quality from Improved Drinking Water Sources WASH for health has postponed activities to be measured by this indicator to FY19.

Number of Communities Certified as “Open Defecation Free” as a Result of USG Assistance Through household latrine construction and natural leader training, FY18 saw WASH for Health assist 376 communities to be certified Open Defecation Free. A result, which is 208% of the annual target of 180. Mostly achieved through strategies set out by the project at the beginning of the fiscal year. Smaller communities were prioritized during the community selection stage, because small less populated communities are quicker in attaining ODF than the larger communities. The relatively densely populated communities were divided into zones and each zone certified separately. These steps are what contributed to the project overachieving the FY18 target.

WASH FOR HEALTH PROJECT FY18 18 ANNUAL REPORT In all, results for FY18 takes the ODF Results from Q1 to Q4 total number of ODF communities to 632.

376

236

27

78

35

FY18 Total QTR 4 QTR 3 QTR 2 QTR 1

Number of Individuals Trained to Implement Improved Water and Sanitation Methods 1,253 volunteers were trained as natural leaders in FY18. These are motivated community members who influence their peers’ behavior during CLTS and support their community’s efforts to become ODF. The target for this indicator was 900, but this was over achieved because the project had to include some over 15 self-triggered communities that were otherwise not included in the annual target. This led to the project training more natural leaders than planned.

Percent of Households in Target Areas Practicing Correct Use of Recommended Household Water Treatment Technologies With the launch of the BCC materials, WASH for Health conducted an assessment to collect data on this indicator. Results of the survey showed that 25.81 of households were using the recommended water treatment method of boiling. The results of the indicator are slightly above the FY18 target of 25%.

Percent of Households with Soap and Water at Hand Washing Stations Commonly Used by Household Members. All households under the WASH for Health project have been educated to construct basic hand washing facilities close to a latrine and/or close to the cooking area. This practice encourages hand washing after defecation and before handling food. This indicator seeks to measure the percentage of households that are applying the practice of handwashing in their homes. For this fiscal year, 60% of households were expected to practice this behavior, however results indicate that at the time of year-end monitoring visits 67.38% of households have a “commonly used” handwashing station, equipped with soap and water.

Number of Basic Sanitation Facilities Provided in Institutional Settings as a Result of USG Assistance During FY18, WASH for Health provided a total of 48 institutional latrines to schools exceeding the FY18 target of 30. This was due to additional funding received from Unilever under the GDA to construct institutional latrine facilities for schools in Tema and Ashaiman communities.

WASH FOR HEALTH PROJECT FY18 19 ANNUAL REPORT Indicators with Results Within 10% of Target The following indicators had results within 10 percent of the expected target and do not require a deviation narrative. • Number of people gaining access to safely managed sanitation as a result of USG assistance • Number of people gaining access to basic drinking water services as a result of USG assistance • Number of people practicing handwashing with soap under running water • Number of institutional settings gaining access to basic drinking water as a result of USG assistance.

3. CROSS-CUTTING ISSUES

3.1. Gender Equality and Female Empowerment

The WASH for Health project, as conceptualized and implemented, is cognizant of gender issues and mainstreams gender into all activities. Culturally, are more often responsible for ensuring that their households have water, and for teaching children hygiene practices. Because most of WASH for Health’s communities are patriarchal, the project ensures a minimum of 60% female participation in all Water Sanitation and Management Teams (WSMT), which is based on CWSA’s minimum requirements. This quota for female participation in WSMTs enables women to participate in decision-making concerning WASH facilities and services in their communities. All WASH for Health CLTS Field Officers implementing CLTS work guarantee female membership when working with communities to establish WSMTs. As a communal activity, CLTS requires and ensures the participation of all sections of society, including people in leadership positions, women, men, and children. Therefore, the CLTS approach enables all genders to participate in their community’s progress toward ODF status. Furthermore, project activities in no way reduce the amount of power held by one gender, and in no way restrict beneficiaries’ access to services or resources based on their gender. Equal opportunity to benefit from project activities is given to all community members; WSMT participant lists are recorded and shared with WASH for Health staff to certify the gender quota is met. In FY17, WASH for Health began to identify an additional need among female students within schools where institutional latrines had been constructed. Menstrual Hygiene Management (MHM) among female students poses a significant challenge, often causing them to be absent or drop out entirely from school. Though increased access to improved sanitation facilities has proved beneficial for menstruating female students at school, Global Communities identified an opportunity to broaden the impact of these facilities by specifically addressing MHM through a pilot project implemented in partnership with BeGirl. Through the partnership project, Global Communities provided two BeGirl products (the BeGirl hygienic sanitary product, and a user-friendly Smart Cycle tool to help girls understand their monthly cycle) 1,378 students in 11 schools across four Regions. A baseline and end line survey were also conducted as part of the pilot program. The results clearly showed that if girls have access to MHM, it goes a long way to improve school attendance and also improves concentration levels during class hours. Additionally, the results with the boys’ survey also showed that, when boys have the right knowledge on menstruation, they feel very comfortable around girls. Padmore Street School located in the Tema Metropolis of the Greater Accra Region was used as a control school. In this school, girls were provided with only menstrual Hygiene education. The essence was to compare the outcome with one of the schools were pupils received both education and Be Girl products. Although there was some improvement in the school's attendance etc. as a result of the education, comparatively, it was on the low side compared to those who had both education and MHM materials (See appendix XIII for additional information). There are plans to reach 2,500 girls in the next fiscal year with Be Girl products especially in rural areas. Approximately 1,000 boys will also be given some education on menstruation

WASH FOR HEALTH PROJECT FY18 20 ANNUAL REPORT as well.

3.2. Local Capacity Development

WASH for Health builds on the local knowledge of Natural Leaders to emphasize its message of safe sanitation. WASH for Health technical staff have now identified approximately 5,000 Natural Leaders for training, networking and utilization in CLTS activities. WASH for Health also builds the capacity of the District Assembly officials (Environmental Health Officers, Community Development Officers, etc.) so they can implement WASH and CLTS activities in their districts. The project also trains WSMTs in order to reinforce their ability to operate and maintain WASH infrastructure in the communities, mainly boreholes. Additionally, through WASH for Health’s sub-grant award mechanism, the Project supports the growth and capacity of local organizations by enhancing their management, logistical and technical experiences. WASH for Health also supported officials, local volunteers and district/municipal officials during the cholera outbreak in early FY17. Sustained and intense training while providing support for the teams and volunteers on the ground helped equip them with enough BCC/IE&C materials to ensure they can facilitate widespread cholera prevention awareness. Lastly, to maximize the introduction of the Digni-Loo latrine to the Ghanaian sanitation market, WASH for Health is working with entrepreneurs in project communities to build their capacity to be distributors of the plastic slab.

3.3. Science, Technology, and Innovation

WASH for Health’s innovation activities IN FY18 was minimal but significant. Final patent materials to patent the slab in the United States and in the Western and Southern Regions of Africa were approved earlier in FY18. The production of the molds for the new Digni-Loo with detachable seats, closed the year on a good note. (See appendix XV for photograph)

3.4. Public Private Partnerships (PPP)

As described in Section 2 (Activity Progress) above, WASH for Health continues to partner with several private sector organizations, including Duraplast Ghana Ltd. which has supported the production of vent pipes and the Digni-Loo. Additional partnerships implemented in FY18 include collaboration with Ghacem, Unilever Ghana Foundation, Rotary International, Diageo, BeGirl and Ghana Broadcasting Corporation. Partnership discussions are currently underway with Mantrac Ghana Limited.

3.5. Environmental Compliance

To ensure sustainability of facilities, it has become necessary for the Project to incorporate Environmentally Sound Design and Management (ESDM) into all components of WASH project implementation. In the design of each water supply and sanitation facility, project engineers accounted for the types of materials required, in order to minimize the potential negative impact of their construction on the environment. The Project also incorporated the current and anticipated future use of the immediate surroundings into the facility designs. This approach ensures that the structures will be able withstand changes in the environment. In accordance with the project’s Environmental Mitigation and Monitoring Plan (EMMP), environmental compliance assessments were completed for institutional latrine and borehole sites as reported in previous quarters. The WASH for Health Environmental Officer conducted regular visits to project sites to ensure all construction activities are in compliance with the CFR.216. In accordance with CFR.216 and WASH For Health Water Quality Assurance Plan, all the water facilities constructed in Quarter 2 and Quarter 3

WASH FOR HEALTH PROJECT FY18 21 ANNUAL REPORT were sampled and results were send to Centre for Scientific and Industrial Research laboratory for both Physiochemical and Bacteriological analyses.

4. STAKEHOLDER COLLABORATION

4.1. Collaboration and/or Knowledge Sharing with Other USAID Activities

Throughout FY17, WASH for Health regularly and actively participated in USAID health program implementing partners Chief of Party meetings, while also contributing to the Knowledge Management Platform. These meetings are held every quarter and are hosted by the USAID Systems for Health project. The WASH for Health project is also part of the USAID Health, Population and Nutrition Office (HPNO) Monitoring and Evaluation Community of Practice where all USAID health partners, including Systems for Health, Communicate for Health, RING, DELIVER, and Vector Works, meet to learn and share knowledge on Monitoring and Evaluation (M&E), Knowledge Management, and Geographic Information Systems (GIS). Meetings are held every quarter, and are hosted by Evaluate for Health, which is the USAID partner solely responsible for M&E technical support on all USAID health programs. Out in the field, especially in the Northern Region where USAID RING, and WASH for Health intersect, extensive collaboration continued, especially in the training of and partnership with EHAs, EHOs, and Natural Leaders who undertake CLTS activities like triggering in shared districts.

Additionally, WASH for Health collaborated closely with Systems for Health to provide eight boreholes to CHPS compounds.

4.2. Collaboration and Coordination with Other Key Stakeholders

WASH for Health continues to work in collaboration with the sector ministries and agencies on sector policies and activities, and at the local level with DAs, in CLTS facilitation. This collaboration has extended to international agencies such as UNICEF, WHO, International Red Cross/Red Cross Ghana cholera response activities. The private sector and LNGOs also serve as partners when implementing activities under other components of the project and the unique partnership with Duraplast Ghana Ltd., remains ongoing. Lastly, collaboration with Diageo continues into FY19 until the completion of the Tuna water system.

5. LESSONS LEARNED

5.1. Challenges and Relevant Solutions to Activity Implementation

In FY17 WASH for Health assessed performance of the LNGO partners implementing CLTS activities in select regions. Based on analysis of results, WASH for Health determined that more impact and greater results will be achieved through direct implementation; the Project will not renew sub-grants with any LNGOs for CLTS activities in the coming year and will implement CLTS in select communities through WASH for Health staff. WASH for Health also identified that in several instances, the LNGOs provided cement materials to communities as incentive for participation in the CLTS process. This was compounded by challenges with other WASH organizations that may also be working in neighboring communities that provide subsidized sanitation facilities to households. This has posed a challenge as the Project begins direct implementation in neighboring communities, which may expect subsidized

WASH FOR HEALTH PROJECT FY18 22 ANNUAL REPORT materials. WASH for Health is working closely with community members to reinforce the CLTS process and adjust expectations within communities. Challenges with loose soil, collapsing pits, lack of motivation or capacity among some communities remained ongoing. Additionally, as described in Section 1.3 above, WASH for Health’s borehole construction, while on target, produced several holes with water quality issues. WASH for Health worked closely with contractors to ensure that all water pumped through wet boreholes is safe and clean. Any holes where water has unacceptable amounts of arsenic and fluoride have been capped, while any holes with bacteria or iron will be treated. For holes that were capped, WASH for Health will work with the communities to identify alternative methods for water access. The rainy season has lasted for several months throughout the country and caused some delays in the CLTS process. As a result, WASH for Health focused on training EHAs and Artisans in order to support them in their efforts to help communities become ODF. This approach undergirded WASH for Health’s ongoing efforts in existing communities and avoided efforts to trigger new communities when the rains would pose a challenge to household latrine construction, rather than begin triggering new communities when the rains pose a challenge. As the rains subside and the new Fiscal Year begins, WASH for Health will augment entering new communities.

5.2 Adaptive Learning WASH for Health identified that certain communities and districts, achievement of ODF occurs at a higher rate when the CLTS process is facilitated directly by WASH for Health staff, rather than through an LNGO that receives a sub-grant to implement activities. As a result, WASH for Health transitioned all CLTS activities from LNGOs to WASH for Health staff, ensuring direct implementation. The project expects positive results due to this change.

6. SUSTAINABILITY

Sanitation Provision From inception, WASH for Health has built on local knowledge and structures, working with local government staff, LNGOs, Natural Leaders, and Latrine Artisans to drive household sanitation facility construction and ownership, and to improve sanitation behaviors through CLTS. This approach ensures that local capacities are developed to continue CLTS activities even after project completion. Following assessment of LNGO performance in the implementation of CLTS activities. Global Communities determined that a more sustainable and impactful approach is to implement CLTS directly; the project no longer uses LNGOs. Water Supply The provision of publicly-owned facilities and services works in tandem with facility-user education. The formation and training of facility management committees, small town Water and Sanitation Management Teams, and the identification of caretakers ensures the optimal use and proper management of boreholes. Further, Area/Pump Mechanics have been trained in borehole repairs to help sustain water infrastructure under the project. These mechanics have been given a basic set of tools and

WASH FOR HEALTH PROJECT FY18 23 ANNUAL REPORT have been linked to the District Water and Sanitation Teams and for spare parts suppliers in their districts. This same approach is being utilized as the boreholes are drilled. BCC Collaboration with the Environmental Health Unit and Natural Leaders on BCC campaigns is a means toward strengthening and sustaining local knowledge of hygiene behaviors. In schools, activities with school health coordinators and school health clubs have increasingly improved hygiene practices among schoolchildren who act as change agents both in school and at home. WASH for Health implements BCC education at schools and throughout all project activities in order to ensure that all infrastructure provided to institutions, or any household latrines constructed through CLTS, is long lasting and improves the health and wellbeing of the beneficiaries. Additionally, with the introduction and rollout of the BCC Package, Ghanaian officials and their partners will have improved tools to implement sound BCC messaging throughout the country.

7. AGREEMENT MODIFICATIONS We received the Award Modification # 4 that increases our award ceiling by USD 700,000. The revised award necessitated revision in key project target as follows:

Item Previous Target New Target

Household latrines 10,100 14,100

ODF communities 640 700

People benefitting from 60,100 112,800 improved sanitation

WASH FOR HEALTH PROJECT FY18 QUARTER REPORT 1

8. ACTIVITIES PLANNED FOR NEXT YEAR

WASH for Health project activities are well founded and continue to be successful. As the project enters FY19, the following activities are planned (see FY19 Work Plan for more details): Component 1: Increase Use of Improved Household Sanitation: • Train CLTS Regional and District facilitators to implement demand-led CLTS; • Train NLs to support CLTS implementation in project communities. • Increase access to improved sanitation products and services; • Continue introduction of Digni-Loo into sanitation market in select districts. • Support the poor and vulnerable in ODF communities with Digni-Loos. • DICCS/RICCS to conduct community verification and certification Component 2: Improve Community Water Supply Services: • Complete outstanding boreholes to be repaired • Form and train WSMTs; • Construct Small Town Water System • Rehabilitate broken boreholes and hand pumps Component 3: Improve sector governance and policies: • Strengthen local governance and management; • Support broad engagement with the WASH sector; • Support WASH sector programs and activities; and • Support selected WASH sector policy reforms Component 4: Expand Key Hygiene Behaviors: • Finalize and produce NuWASH BCC Strategy and communication plan. • Conduct training and refresher trainings in the use of updated BCC materials for new and old users respectively. • Improve integration of WASH, Maternal and Child Health, and nutrition services. • Continue to promote and distribute BCC materials for use at community and district levels. • Continue to support less privileged girls with Be Girl products and provide menstrual education as well to both girls and boys. Component 5: Leverage PPPs to magnify the impact of USG investments: • Continue partnership with Rotary International and Unilever Ghana Foundation, and other partners (Diageo) to deliver WASH facilities to communities and schools; • Continue to collaborate with partners to supply affordable household latrine construction (cement, plastic latrine slab, etc.); • Continue partnership with Unilever for branding of institutional latrines in Tema schools. Component 6: Improve Water supply and Sanitation infrastructure for Schools and Health Facilities: • Construct 5 institutional latrines to schools and CHPS; and Provide 12 boreholes for schools and CHPS. Cholera Prevention Activities Digni-Loo • Increase production of new models to meet demands • Disinfection of flooded project communities in • Work with entrepreneurs in project communities/districts to the Northern Regions. facilitate purchase and distribution of Digni-Loos; • Respond to Cholera related issues when • Rigorously promote and feature Digni-Loo broadly; necessary. • Participate in USAID study on Pro-Poor Sanitation models.

WASH FOR HEALTH PROJECT FY18 QUARTER REPORT 2 APPENDICES

I. Performance Data Table (PDT)

FY 18

4th Qtr

Indicator

Baseline Baseline

Total FY 15 15 FY Total

ACHIEVED

LOP TARGET LOP

LOPRESULTS

PERCENTAGE PERCENTAGE

FY 16 TARGET 16 FY TARGET 17 FY TARGET 18 FY

FY 16 RESULTS FY 17 RESULTS FY 18 RESULTS FY

Target Achieved Achieved OBJECTIVE 1:INCREASE USE OF IMPROVED HOUSEHOLD SANITATION FACILITIES Number of people gaining access to a basic sanitation service as a result of 2707 0 4032 10096 32256 54448 9221 12096 38400 47072 112800 111616 99% USG assistance. male 0 0 1976 4947 15805 26680 4518 5927 18816 23065 55272 54692 99% female 0 0 2056 5148 16451 27768 4703 6169 19584 24007 57528 56924 99% Number of people gaining access to safely managed sanitation service as a 0 0 0 0 1500 1425 0 0 825 690 2250 2115 94% result of USG assistance. male 735 696 0 0 404 333 1102 1029 93% female 765 729 0 0 421 356 1148 1085 95% Number of individuals trained to implement improved water and sanitation 0 0 0 1702 798 2044 0 0 900 1253 2500 4999 200% methods Number of communities certified as “Open defecation free” (ODF) as a result 0 0 34 66 269 190 67 217 180 357 700 613 88% of USG assistance Number of basic household latrines constructed 0 330 1262 4032 6806 428 1512 4800 5884 14100 13952 99% 356 Number of safely managed latrines installed 0 100 95 0 0 55 55 150 150 100% OBJECTIVE 2: IMPROVED COMMUNITY WATER SUPPLY SERVICES Number of people gaining access to basic drinking water services as a result 9680 0 19500 18300 21600 23100 29400 4500 30900 6000 66000 47400 72% of USG assistance. Male 0 9555 8967 10,584 11319 14406 2205 12348 2970 32340 23256 72% Female 0 9945 9333 11,016 11781 14994 2295 12852 3030 33660 24144 72% Number of people in target areas with first-time access to improved drinking 0 0 0 0 20,520 23100 11400 4500 12900 6000 42930 29100 68% water supply as a result of USG assistance male 0 0 0 0 10,055 11319 5814 2205 6,321 2970 21465 14289 67% female 0 0 0 0 10,465 11781 5586 2295 6,579 3030 21036 14811 70% Number of people receiving improved service quality from existing improved 0 0 975 — 1080 — 0 0 15000 0 4770 — 0% drinking water sources male 0 0 478 0 529 0 0 0 1470 0 2337 0 0% 0 0 497 0 551 0 0 0 1530 0 2433 0 0% female

WASH FOR HEALTH PROJECT FY17 ANNUAL REPORT 3 Percent of households in target areas practicing correct use of recommended 14% 0 0 0 20 0 20 0 20 25.81 40 25.81 65% household water treatment technologies Litres of Drinking water disinfected with USG supported point of use 0 0 0 5208000 0 7200000 0 5,740,000 0 6,640,000 0 19048000 n/a treatment products Number of community boreholes installed 0 0 65 61 83 77 49 15 80 20 220 158 72% OBJECTIVE 3: IMPROVE SECTOR GOVERNANCE AND POLICIES Number of New policies, laws, agreements and regulations implemented that promote access to improved WATSAN 0 0 0 0 1 0 0 0 1 1 1 1 100%

OBJECTIVE 4: EXPAND KEY HYGIENE BEHAVIOURS Number of people practicing handwashing with soap under running water 8563 0 0 0 19,353 15664 0 7732 32,816 42236 48480 57900 119% Percent of households with soap and water at a hand washing station commonly used by all family members 0% 0 0 0 50 73 0 0 60 67.38 80 67.38 84%

OBJECTIVE 5: LEVERAGE PUBLIC/PRIVATE PARTNERSHIPS TO MAGNIFY THE IMPACT OF USG INVESTMENT Number of MOUs signed with organization for new GDA or similar 0 0 1 1 2 1 0 0 0 1 3 300% partnership 1

0 5 0 0 0 0 0 0 5 6 120% Number of GDAs or similar partnerships formed 5 Value of new funding mobilized to the water and sanitation sectors as a result of USG assistance 0 - 500,311. 0 611704.5 0 0 0 50,000.00 1,600,000 117% 1,877,836 5 Number of wash projects completed with alliance support 0 - 0 133 10 10 0 76 0 176 n/a - OBJECTIVE 6: IMPROVE WATER SUPPLY AND SANITATION INFRASTRUCTURE FOR SCHOOLS AND HEALTH FACILITIES Number of basic sanitation facilities provided in institutional settings as a 0 0 90 100 100 122 13 21 30 48 190 271 143% result of USG assistance. School Facilities 0 0 80 90 100 122 13 21 30 48 180 261 145% Health Facilities 0 0 10 10 0 0 0 0 0 0 10 10 100% Number of institutional settings gaining access to basic drinking water 0 0 0 0 5 13 14 7 17 10 40 23 58% services as a result of USG assistance. Schools 0 0 0 0 8 5 8 6 9 7 20 12 60%

CHPS 0 0 0 0 5 8 6 1 8 3 20 11 55%

WASH FOR HEALTH PROJECT FY17 ANNUAL REPORT 4 II. Success Stories and Press Coverage

Throughout FY18, there was no media coverage on WASH for Health and Global Communities.

A few success stories were published on the Global Communities Ghana website. The following links include all stories published on the Global Communities website and a documentary:

You Tube Documentary on the pro-poor policy https://www.youtube.com/watch?v=91z8JECJ2BI&t=8s

Global Communities Ghana website https://www.globalcommunities.org/node/38437 https://globalcommunitiesgh.org/index.php/in-the-news/featured-news/92-countdown-to-two-years-of-a- zero-cholera-accra https://globalcommunitiesgh.org/index.php/in-the-news/featured-news/93-central-region-s-fight-against- cholera-paying-off-no-cholera-case-in-two-years https://globalcommunitiesgh.org/index.php/in-the-news/featured-news/94-first-potable-water-reduces-the- occurrence-of-diarrhea-in-takuka

5 WASH FOR HEALTH PROJECT FY18 ANNUAL REPORT

III. Financial Information

The form 425 will be submitted separately.

6 WASH FOR HEALTH PROJECT FY18 ANNUAL REPORT IV. Activity Oversight & Technical Assistance Support

TABLE 1: MONITORING VISITS DURING REPORTING PERIOD

Monitoring Team Major observations and/or findings from site visits Date of Site Visit Site(s) visited Members / Individuals (Concise bullet points)

Andrews Ebo Mensah, WASH for Health • Promote the Small Grant Package Nov.28 – Dec 6. 2017 Districts in Western and Central Regions • Demonstration on the installation of Digni-Loo for Oct.10 – Oct. 13, Felix Amofa Ada West, Ada East, CLTS Field Officers, Support installation of Digni-Loos 2017 for the poor - successful Oct. 16 – Oct. 20, Felix Amofa South, • Demonstration on the installation of Digni-Loo for 2017 Nkwanta North, Krachi CLTS Field Officers, Support installation of Digni-Loos East for the poor - successful Amenfi West, Amenfi • Demonstration on the installation of Digni-Loo for Nov. 6- Nov. 10, 2017 Felix Amofa Central, Sefwi , CLTS Field Officers, Support installation of Digni-Loos Sefwi for the poor - successful James Obed Lomotey Adaklu, Krachi East, Re-orientation of District officers to use BCC Jan. 22 – Feb. 13, 2018 Nkwanta North and Communication Package Nkwanta South • Monitor CLTS activities in Project communities Martha Tia-Adjei Accra, Bole, Sawla • Menstrual Hygiene management training for basic school January 23rd-Feb. 6th girls and boys 2018 • Distribution of Be Girl products Martha Tia-Adjei Nkwanta North, • Menstrual Hygiene management training for basic school 30th Jan.-1st Feb.2018 Nkwanta South girls and boys • Distribution of Be Girl products Martin Sumbo Twifo Hemang Lower • Monitoring of CLTS activities in project communities Feb. 11 – Feb. 20, Denkyira District and 2018 Asikuma Odoben Brakwa March.20 – March 22. Felix Amofa Ada West and Ada East • Monitor CLTS activities in Project communities, 2018 Provided refresher for EHAs in Ada West Monitor CLTS activities in Project communities. Amenfi Central, Bodi March, 2018 Samuel Agyarko • Support distribution of Digni-Loos and ODF sign post and Wiawso to project communities April 15 – April 29, Edward Thompson • Community members indulge in feaco-oral practices Ada West 2018 Linda Yeboaa Amponsah Few community members practice basic hygiene behaviors

June 12 – June 14, Felix Amofa, Cape Coast • 25 persons trained on the installation of Digni-Loos 2018 Linda Yeboaa Amponsah James Lomotey • Codification of regional summaries of NuWASH June 21 – June 23, Asana Iddrisu Accra exploratory research into a single document 2018 Martin Sumbo • Drawing of plans for trial phase. Edward Thompson, June 26 – June 29, Linda Yeboaa Amponsah, • Participants were motivated and empowered to Shai Osudoku 2018 Rita Mantey, sustainably use the KVIPs provided to them with Theophilus Mensah support from Rotary International. July 15 – August 12, Edwards Thompson, Linda Ada West, Shai • NuWASH CAT and TIPS research 2018 Yeboaa Amponsah Osudoku • Data collection successful

7 WASH FOR HEALTH PROJECT FY18 ANNUAL REPORT Monitoring Team Major observations and/or findings from site visits Date of Site Visit Site(s) visited Members / Individuals (Concise bullet points)

Nkwanta South and • Monitor Small Grants projects in the districts. Andrews Ebo Mensah July 16 – July 19, 2018 Agotime Ziope Districts, Senam Amanda Ntow • Both awardees had completed their projects Volta Region Amenfi West, Amenfi • Monitor Small Grants projects in the districts Central, Sefwi Wiawso, Aug. 20 – Aug. 27, Andrews Ebo Mensah • Majority of the communities had fully completed their Sefwi Bodi, Asikuma- 2018 Senam Amanda Ntow projects Odoben-Brakwa Districts Aug. 27 – Aug. 30, • Follow up on Digni-loo sales Emefa Baidoo Bole 2018 Sewfi Wiawso, Bodi, • Training of staff on Propoor guidelines Sept.10 – Sept. 22, Martha Tia-Adjei Amenfi West, Amenfi • Supported in the identification and selection of FY19 2018 Central CLTS communities Sept. 10 – Sept. 12, Asikuma-Odoben- • Training of district CLTS implementers on the pro-poor CLTS- Felix Amofa 2018 Brakwa support guidelines

Sept.10 – Sept. 13, • Training of UNICEF entrepreneurs Emefa Baidoo Ho 2018

Sept. 16 – Sept. 20, Nkwanta North & • Training of district CLTS implementers on the pro-poor CLTS- Felix Amofa 2018 South, Krachi East support guidelines

Sept. 16 – Sept 23, M&E – James Lomotey & Nkwanta North & • Validation of FY19 communities 2018 Samuel Acquah Odoom South, Krachi East BCC – Edward Thompson, • Community selection and validation of communities for Sept. 16- Sept. 22, Asikuma-Odoben- Linda Yeboaa Amponsah, FY19 2018 Brakwa, Shai Osudoku Emmanuel Dziboe • Communities visited qualify for CLTS intervention

8 WASH FOR HEALTH PROJECT FY18 ANNUAL REPORT

TABLE 2: TECHNICAL ASSISTANCE (TA) PROVIDED DURING REPORTING PERIOD

Organization and/or person(s) Type of TA Purpose of TA Dates of TA who provided

Carol Garrison, Communications Write new success stories, train staff on success story writing and October 20-24, Specialist, Global Communities Field Visit photography and refresh some 2017 Headquarters communications materials Monique Coke Field Visit Support in the Be Girl pilot January 21st-28th programme ,2018

Peter Tyliszczak, Program Manager PM visited the WASH for Health July 3 – July 27, 2018 Field Visit (PM) team to assist Finance team.

Stephanie Dierichs-Garcia Field visit Workplace Harassment Training August 26 – August 31, 2018

TABLE 3: INTERNATIONAL TRAVEL Name of traveler(s) Purpose of Destination Travel dates international travel Samuel Acquah Odoom M&E Conference Amman, Jordan 12-17 November 2017 Edward Thompson International Social Bali, Indonesia April 11 – April 21, Behavior Change 2018 Communication (SBCC) Summit Nicholas Bah-Nguah Finance Conference Amman, Jordan June 24 – June 30, 2018

Joseph Baffo Finance Conference Amman, Jordan June 24 – June 30, 2018

V. M&E Issues

Indicator and/or Target Adjustments Minimal adjustment was made to the project indicators in FY18. Based on recommendations made by USAID, only one additional indicator was included in the existing component 5 (Leverage PPPs to magnify 9 WASH FOR HEALTH PROJECT FY18 ANNUAL REPORT the impact of USG investments) indicators.

10 WASH FOR HEALTH PROJECT FY18 ANNUAL REPORT

Modifications made: This PPP indicator under Objective 5 was added: • Value of new funding mobilized to the water and sanitation sectors as a result of USG assistance.

Data Quality No recommendation on Data Quality Assessment (DQA) available this FY. VI. Management and Administrative Issues

Staff Changes/Updates

For the period under review, there were four resignations from the WASH for Health team. Two of these were CLTS Field Agents while the other two were for the Grants/Contracts and Communications roles. The CLTS Field Agents who resigned were not replaced. However, three recruitment exercises were carried out to fill the Grants/Contracts and the Communications vacant positions, and to engage the services of a hydrogeologist. In November 2017, our Grants and Communications Specialist resigned for personal reasons and was subsequently replaced with two individuals to handle the Grants and Communications portfolios respectively. In October 2017, one of our Accounts Officers was appointed to handle the Grants and Contracts portfolio after being provided with training and grooming for this role. He continued in this role and was then promoted to Senior Grants and Contracts Officer in May 2018 – a position that he held until his resignation in September 2018. A Communications Officer who had previously worked as a Communications intern with us was hired in January 2018. She stayed with us until June 2018, using her last month on the job to train our newly recruited Communications Officer who is still at post. The hydrogeologist was employed in March 2018 and is still at post.

Budget Issues

Due to our good performance, we are burning the LOP funds much faster. It is likely that additional funds will be required for FY19 and FY20 to keep up with the same implementation rate.

Issues with Collaborators and Other Stakeholders None.

Other None

VII. Follow-Up Actions

A/COR comment/recommendation Date Action was taken from previous reporting period Brief Description of Follow- or is planned to be and/or relevant evaluation/research up Action Taken recommendation taken

NONE NONE NONE

11 WASH FOR HEALTH PROJECT FY18 ANNUAL REPORT VIII. Map of Project Activity Sites/ Facilities by District

FY8 Map of Project Communities, Districts, Regions

WASH FOR HEALTH PROJECT FY18 ANNUAL REPORT 43 Map of FY18 Project Facilities

WASH FOR HEALTH PROJECT FY18 ANNUAL REPORT 44 IX. CLTS Updates Extract INTERVENTIONS

COMMUNITY-LED TOTAL SANITATION ACTIVITIES HOUSEHOLD LATRINES

Under construction Completed

-

triggered

structure

-

triggered

- -

S/N DISTRICT

Communities Pre Triggered Post identified NLs Self Passed assessment ODF Declared DICCS by Basic by ODF Verified DICCS by ODF Certified RICCS Targeted HHLs Level Pit Sub Super structure Current Week Cummulative EHAs constructed HWF Soakaway constructed CENTRAL REGION 1 TWIFO ATI MOKWA *** 15 15 15 15 54 0 0 0 0 250 0 0 0 0 14 2 5 3 2 TWIFO HEMANG LOWER DENKYIRA 29 29 29 29 155 7 2 0 5 475 79 53 38 0 281 8 379 250 SUB TOTAL 44 44 44 44 209 7 2 0 5 725 79 53 38 0 295 10 384 253 3 ASIKUMA ODOBEN BRAKWA 47 47 47 47 244 23 6 1 26 667 100 80 22 0 316 14 339 296 4 ASSIN NORTH *** 29 27 27 27 126 5 1 1 0 250 96 20 7 0 119 9 112 58 5 UPPER DENKYIRA EAST *** 15 15 15 15 108 0 0 0 0 225 0 0 0 0 26 6 26 0 SUB TOTAL 91 89 89 89 478 28 7 2 26 1142 196 100 29 0 461 29 477 354 WESTERN REGION 6 AMENFI CENTRAL 37 37 37 37 203 10 0 0 21 385 85 82 55 0 269 12 268 232 7 AMENFI WEST 26 26 26 26 180 21 0 0 19 352 13 17 10 0 479 7 483 108 8 AMENFI EAST *** 10 10 9 8 69 2 0 0 0 180 0 0 0 0 28 2 23 5 SUB TOTAL 73 73 72 71 452 33 0 0 40 917 98 99 65 0 776 21 774 345 9 SEFWI WIAWSO 33 33 33 33 146 30 11 1 22 442 34 20 14 0 358 9 227 56 10 SEFWI BODI 46 46 46 46 187 27 9 0 34 667 72 33 17 0 456 14 342 142 11 *** 10 10 10 10 62 0 0 0 0 150 53 0 0 0 30 4 9 1 12 MPOHOR *** 10 10 9 9 40 0 0 0 0 150 17 0 0 0 11 4 0 0 SUB TOTAL 99 99 98 98 435 57 20 1 56 1409 176 53 31 0 855 31 578 199 VOLTA REGION 13 ADAKLU 25 25 25 25 107 22 5 1 18 394 24 12 38 0 133 7 123 22 14 AGOTIME 42 42 42 35 224 38 10 3 27 667 9 46 25 0 245 12 287 150 SUB TOTAL 67 67 67 60 331 60 15 4 45 1061 33 58 63 0 378 19 410 172 15(a) NKWANTA NORTH 13 13 13 13 78 12 0 0 9 250 121 3 47 0 124 2 93 90 16(a) NKWANTA SOUTH 15 15 15 15 56 7 0 0 7 250 127 16 42 0 218 2 202 80 SUB TOTAL 28 28 28 28 134 19 0 0 16 500 248 19 89 0 342 4 295 170 15(a) NKWANTA NORTH 41 41 41 41 215 27 2 3 26 667 108 101 92 0 626 14 584 435

WASH FOR HEALTH PROJECT FY18 45 ANNUAL REPORT INTERVENTIONS

COMMUNITY-LED TOTAL SANITATION ACTIVITIES HOUSEHOLD LATRINES

Under construction Completed

-

triggered

structure

-

triggered

- -

S/N DISTRICT

Communities Pre Triggered Post identified NLs Self Passed assessment ODF Declared DICCS by Basic by ODF Verified DICCS by ODF Certified RICCS Targeted HHLs Level Pit Sub Super structure Current Week Cummulative EHAs constructed HWF Soakaway constructed 16(a) NKWANTA SOUTH 46 46 46 46 279 36 2 4 31 667 52 70 283 0 787 15 644 254 17 KRACHI EAST 31 31 31 29 154 20 2 3 23 417 45 42 45 0 517 11 482 90 SUB TOTAL 118 118 118 116 648 83 6 10 80 1751 205 213 420 0 1930 40 1710 779 GREATER ACCRA 18 ADA EAST 38 38 38 38 310 17 8 2 18 475 44 54 159 0 282 10 241 0 19 ADA WEST *** 22 22 22 22 118 13 4 1 8 250 10 11 11 0 276 6 260 22 20 SHAI OSUDOKU 24 24 24 12 144 6 0 2 13 324 245 179 142 0 197 8 210 36 SUB TOTAL 84 84 84 72 572 36 12 5 39 1049 299 244 312 0 755 24 711 58 NORTHERN REGION 21(a) SAWLA TUNA KALBA 150 150 150 150 708 0 0 0 139 2250 249 197 154 0 2846 22 2891 3184 21(b) SAWLA TUNA KALBA (TUNA ZONE) 77 77 77 77 263 2 0 0 44 1185 356 168 253 0 1476 0 945 1071 22 WEST MAMPRUSI 47 47 47 47 294 11 3 0 22 705 81 222 304 0 1253 18 1288 228 23(a) BOLE 82 82 82 81 280 1 0 0 67 885 67 175 184 0 1462 20 1382 832 23(b) BOLE (BAMBOI ZONE) 70 70 70 70 195 0 13 0 53 1050 104 70 29 0 1123 2 974 643 SUB TOTAL 426 426 426 425 1740 14 16 0 325 6075 857 832 924 0 8160 62 7480 5958 GRAND TOTAL 1030 1028 1026 1003 4999 337 78 22 632 14629 2191 1671 1971 0 13952 240 12819 8288 *** Implementation was stopped in these districts effective May 2017

WASH FOR HEALTH PROJECT FY18 46 ANNUAL REPORT

X. List of Schools Receiving Institutional Latrines

Region District Community School Enrollment KVIP Type No. Allocated Contractor Ajumako Eyan Essiam HASOWODZE Hasowodze DA Basic Schools 224 4-seat KVIP 1

Ajumako Eyan Essiam KROMAIM Kromaim DA Basic Schools 230 4-seat KVIP 1

Ajumako Eyan Essiam SOLOMON Solomon DA Basic Schools 315 4-seat KVIP 1 Ajumako Eyan Essiam KOKOBENG Kokobeng Presby Basic Schools 420 3-seat KVIP 2 Ajumako Eyan Essiam KOKOBENG Kokobeng DA Basic Schools 395 4-seat KVIP 1 EAK Ent. Ltd.

Ajumako Eyan Essiam Etsi Abeka Etsi Abeka Basic School 427 3-seat KVIP 2 Ajumako Eyan Essiam Ampia Ajumako Ampia-Ajumako DA/Methodist Basic 763 4-seat KVIP 2 Ajumako Eyan Essiam Brofoyedru Brofoyedru Basic School 379 4-seat KVIP 1

Upper Denkyira East Kyekyewere Kyekyewere Methodist Basic School 400 3-seat KVIP 2

Upper Denkyira East Kyekyewere Kyekyewere African Faith Basic School 200 4-seat KVIP 1 Upper Denkyira East Buabin Camp Buabin Camp Basic School 163 4-seat KVIP 1

Central Upper Denkyira East Gyampo Gyampo M/A Primary School 104 4-seat KVIP 1 Sir Charles Upper Denkyira East Ntontom Ntontom Methodist Basic School 200 4-seat KVIP 1 Doughan Co. Ltd. Upper Denkyira East Zion No 2 Zion No 2 M/A Basic School 250 4-seat KVIP 1 Upper Denkyira East Amoafo Amoafo Basic School 250 4-seat KVIP 1 Upper Denkyira East Akyenekrom Akyenekrom MA Basic School 206 4-seat KVIP 1 Assin North Kadadwene Kadadwne M/A Primary School 111 4-seat KVIP 1

Nkranfuom M/A Primary School 67 4-seat KVIP Assin North Nkranfeuom 1 Assin North Sabinae Sabina M/A Primary School 274 4-seat KVIP 1 Ancient Assin North Wawasee Wawase M/A Primary (Nyame Nnae) 226 4-seat KVIP 1 Mariner Assin North Juaso M/A Primary School 221 4-seat KVIP 1 Assin North Breku Breku M/A Nimkyiso Primary 106 4-seat KVIP 1 Nkwanta South Ashiabre Ashiabre DA Primary 717 4-seat KVIP 2 Links Drilling Nkwanta South Bungna Bungna DA Primary 346 4-seat KVIP 1 and Volta Nkwanta South Blackie Blackie Junction DA Primary 102 4-seat KVIP 1

WASH FOR HEALTH PROJECT FY18 47 ANNUAL REPORT

Region District Community School Enrollment KVIP Type No. Allocated Contractor Nkwanta South Abotareye Abotareye DA Primary 209 4-seat KVIP 1 Construction Ltd. Nkwanta South Nyambong Nyambong DA Primary 290 4-seat KVIP 1 Nkwanta South Kanyita kanyita DA Primary 266 4-seat KVIP 1 Nkwanta South Kofi Akura Kofi Akura D/A Primary School 219 4-seat KVIP 1 Nkwanta South Ofosu Ofosu D/A JHS 215 4-seat KVIP 1 Nkwanta South Tutukpene Tutukpene D/A Primary School 232 4-seat KVIP 1 Krachi East Bawa Bawa Akura DA Primary 174 4-seat KVIP 1

200 4-seat KVIP Krachi East Kpelema Kpelema Shamsiya E/A Primary 1 Krachi East Ataki Ataki Hope for life Presby Primary 183 4-seat KVIP 1 Benghazy Dev. Krachi East Dambai Holy Rosary Primary 1050 4-seat KVIP 2 Comp. Ltd. Krachi East Dambai Dambai Holy Rosary Kindergatten 330 4-seat KVIP 1 Krachi East Kwame Akura Kwame Akura DA JHS 106 4-seat KVIP 1 Ada West Sege Presby Primary #2 260 4-seat KVIP 1

483 3-seat KVIP Ada West Sege Sege Presby Primary&JHS#1 2 Ada West Sege Sege Community JHS 268 4-seat KVIP 1 Jonakot Const. Ada West Amate-Koni Amate-Koni DA Primary 101 4-seat KVIP 1 Ltd. 108 4-seat KVIP Ada West Nuhalenya Nuhalenya DA Primary 1 Ada West Ayisah Ayisah Community Primary 132 4-seat KVIP 1 Greater Ada West Sorkope Sorkope DA Primary & JHS 165 4-seat KVIP 1 Accra Shai Osudoku Agbuviekpong Agbuviekpong DA Primary 220 4-seat KVIP 1

Kongo D/A Basic School 265 4-seat KVIP Shai Osudoku Kongo 1 New Jerusalem D/A Basic School 135 4-seat KVIP Shai Osudoku New Jerusalem 1 Phibek Ent. Ltd. Dodowa Newtown D/A Basic School (A Shai Osudoku 1198 4-seat KVIP 2 Newtown & B) Shai Osudoku Manya Jopanya Manya Jopanya Basic School 217 4-seat KVIP 1 Western Mpohor Mpohor Mpohor Methodist JHS 220 4-seat KVIP 1 Taurus Mpohor Mpohor Mpohor DA JHS 180 4-seat KVIP 1 Emporium Ltd.

WASH FOR HEALTH PROJECT FY18 48 ANNUAL REPORT

Region District Community School Enrollment KVIP Type No. Allocated Contractor Mpohor Manso Manso St. John's Methodist Basic & JHS 283 4-seat KVIP 1 Angu Anglican Primary/All Saints 222 4-seat KVIP Mpohor Angu Anglican KG & Primary 1 Adum Dominase St. James Anglican 139 4-seat KVIP Mpohor Adum Dominase Primary 1 Sefwi Akontombra Kabiesue Kabiesue Basic Primary and JHS 291 4-seat KVIP 1 Sefwi Akontombra Adukwesi krom Adukwesikrom Primary 200 4-seat KVIP 1 Sefwi Akontombra Bosumpim Bosumpim D/A Primary 349 4-seat KVIP 1 Three Js Const. Sefwi Akontombra Krobo mankyia Krobo mankyia D/A primary 175 4-seat KVIP 1 Ltd. Sefwi Akontombra Agyemangkrom Agyemangkrom D/A primary and JHS 273 4-seat KVIP 1 Sefwi Akontombra Domi-Asante Domi-Asante krom catholic school 390 4-seat KVIP 1 Amenfi East Tieku Agave Tieku Agave D/A primary 106 4-seat KVIP 1

Amenfi East Wantram Wantram D/A primary 296 4-seat KVIP 1

Amenfi East Mamieso Mamieso D/A primary 131 4-seat KVIP 1 Sebb-Say Amenfi East Nsuaem No. 2 Nsuaem No.2 RC Primary/JHS 406 3-seat KVIP 2 Comp. Ltd. Amenfi East Domeabra Domeabra D/A Primary JHS 554 4-seat KVIP 2 Amenfi East Appiakrom Appiahkrom D/A Primary/JHS 458 3-seat KVIP 2 Bodi Benumsuo Benumsuo D/A Primary 233 4-seat KVIP 1 Bodi Krayawkrom Krayawkrom D/A Primary 321 3-seat KVIP 2 Bremmed Bodi Denchemoase Denchemoasue R/C JHS 252 4-seat KVIP 1 Comp. Ltd. Bodi Denchemoase Denchemoasue R/C Primary 334 3-seat KVIP 2 Sawla-Tuna-Kalba Tuna St Paul Pri & JHS 298 4-seat KVIP 1

188 4-seat KVIP Sawla-Tuna-Kalba Tuna St Peters Pri 1 120 4-seat KVIP Sawla-Tuna-Kalba Napala Napala JHS 1 Nakwab Sawla-Tuna-Kalba Soma Soma RC Pri & JHS 499 3-seat KVIP 2 Trading Ent.

197 4-seat KVIP Ltd. Sawla-Tuna-Kalba Kong Kong DA Pri 1 Sawla-Tuna-Kalba Sanyeri Sanyeri Pri & JHS 332 4-seat KVIP 1 124 4-seat KVIP Northern Sawla-Tuna-Kalba Kponju Kponju Pri 1

WASH FOR HEALTH PROJECT FY18 49 ANNUAL REPORT

Region District Community School Enrollment KVIP Type No. Allocated Contractor Sawla-Tuna-Kalba Daboyiri Daboyiri DA Primary 156 4-seat KVIP 1 Sawla-Tuna-Kalba Nahari Nahari DA Primary 231 4-seat KVIP 1 Bole Mandari Madari D/A Primary 287 4-seat KVIP 1

Bole Signye Kura Signye Kura D/A Primary 137 4-seat KVIP 1 Asamoah Bole Maluwe Maluwe E/A JHS 137 4-seat KVIP 1 Const. and Bole Bole St Kizito R/C Pri B 444 3-seat KVIP 2 Elect. Works Bole Bamboi Bamboi D/A JHS 180 4-seat KVIP 1 Bole Kurabaso Kurabaso Primary 618 4-seat KVIP 2 Bole Bale Bale Methodist Primary/KG 874 4-seat KVIP 2 Keldem Eng. Bole Jama Jama D/A KG/ Primary 605 4-seat KVIP 2 Comp. Ltd. Bole Bole Bole EA KG/Primary 478 3-seat KVIP 2

WASH FOR HEALTH PROJECT FY18 50 ANNUAL REPORT XI. Boreholes Provided to Communities and Institutions Communities WASH for HEALTH COMMUNITIES TO BENEFIT FROM W4H BOREHOLE FACILITIES (RI Inclusive)

PROJECT # REGION DISTRICT COMMUNITY YEAR BOREHOLE STATUS No. Nkansah (Woman no good) FY16 1 Simpa FY16 1 4 Gyaman FY16 1 Akokofe FY16 1 Domeabra FY17 1 Amenfi West Tanna FY17 1 Adoboakrom FY17 1 Sika Nti No. 3 FY17 1 7 Kamaboi FY17 1 Ehuntem FY17 1 Nkwantanum FY17 1 Manukrom FY17 1 Jerusalem FY17 1 Amenfi Central Nkwantanan FY17 1 5 Pramso FY17 1 Yaw Sarbeng FY17 1 Bawdie Krobofum FY17 1 Bawdie Mansiso – New Completed Western and Amenfi East Town FY17 1 handed over 4 Bawdie Kwaku-Adu FY17 1 Dikoto Town FY17 1 Alavanyo FY16 1 Tordzero FY16 1 Timothykrom FY16 1 7 Attaboka FY16 1 Aferewa FY16 2 Kama FY16 1 Asou Yeboah FY17 1 Sefwi Bodi Ankaase FY17 1 3 Lasiskrom FY17 1 Gyidi FY18 1 Dokukrom FY18 1 Anokokrom FY18 1 5 Ativorkrom FY18 1 Kwasibikrom FY18 1 Sefwi Wiawso Laweakrom FY16 1

WASH FOR HEALTH PROJECT FY18 ANNUAL REPORT 51 Aboaonidua FY16 1 Bedii FY16 1

Kessekrom FY16 2 Anhwiamu FY16 1 Brekuline FY16 1 12 Kwamebou FY16 1 Krobomu FY16 1 Amankwahkrom FY16 1 Gyampokrom FY16 1 Larbikrom FY16 1 Amangoase FY17 1 1 Subea FY18 1 Fiakyekrom FY18 1 Suhenso FY18 1 BH Drilled 5 Anglo FY18 1 Gyampo 81 FY18 1 Manukrom FY17 1 Completed and handed Akontombra over 5 Aseikrom FY17 2 handed over Yawkrom FY17 2 SUBTOTAL 58 Kushiegu FY16 1 Chikoyiha FY16 1 4 Andando FY16 1 Bechindo FY16 1 Completed Salugu FY16 1 and Kofiyiri FY16 1 handed over Daboya No.2 FY16 1 5 West Mamprusi Chama FY16 1 Sagadugu FY16 1 Banjam Kurikinyaang FY18 1 1 Northern Zanguga FY18 1 Handpump Sagadugu-Akolbilafongu FY18 1 installed 4 East Mamprusi Takuka FY18 1 Boayini-Bimofongu FY18 1 Samniboma 2 FY16 1 1 Kamintayiri FY17 1 Kalefayiri FY17 1 Seripe Gonjaline FY17 1 Bole 20 Babator FY17 2 Gbilimpe FY17 1 Yaro Kura/Benyunkun FY17 1 WASH FOR HEALTH PROJECT FY18 ANNUAL REPORT 52 Gbampe FY17 1 Completed and Bampewa (Bamboi) FY17 1 handed over Chibrinyoa Bamboi FY17 1 Koeteyiri FY17 1 Daboyiri #2 FY17 1 Kpenayiri FY17 1 Daboyiri #1 FY17 1 Mamadu kura FY17 1 Semariyiri FY17 1 Dendeyiri FY17 1 Nokoryiri FY17 1 Jesiyiri/Doli FY17 1 Goli FY17 1 Nybokura FY18 1 Tampurukura FY18 1 Dorlanakura FY18 1 Laaryouryiri (Konjuma) FY18 1 7 Davaniyiri (Tinga) FY18 1 Gbongbong No.2B FY18 1 Agric Nkwanta (Bamboi) FY18 1 Kunkrumpe FY16 1 Sogoroyiri FY16 1 Jorbiyiri FY16 1 Di-Eriyiri FY16 1 Jembe FY16 1 Blema No.1 FY16 1 11 Blema No.2 FY16 1 Nakpala FY16 1 Dorkuyiri FY16 1 Gindabo FY16 1 Bagbeyiri FY16 1 Sawla Tuna Kalba Sey-Guyiri FY18 1 Tensonyiri No. 2 FY18 1 Kulwon No. 2 FY18 1 Uro-Mekar FY18 1 7 Malkayiri No. 2 FY18 1 Poaraduri FY18 1 Honeyiri FY18 1 Damiyiri FY17 1 Danivaari RS FY17 1 Gbelulpie FY17 1 15 Pinvuror FY17 1 Loteyiri FY17 1

WASH FOR HEALTH PROJECT FY18 ANNUAL REPORT 53 Korle No.1 FY17 1 Nasoyiri FY17 1 Nabena FY17 1 Completed Saanuoyiri FY17 1 and Simidayiri FY17 1 handed over Dandapre FY17 1 Ongoli FY17 1 Nayanyama FY17 1 Morkpee (Gonsi) FY17 1 Sitiepuo FY17 1 SUBTOTAL 75 Agbonjo Akura FY16 2 Binandimdo FY16 1 Bladjai FY16 1 Bongodo FY16 1 Damako FY16 1 Degengam 1 FY16 1 12 Kitare_bh 1 FY16 1 Konjado FY16 1 Tenglento Bapleldo FY16 1 Waja Akura FY16 1 Nijudo FY16 1 Nkanchina #2 FY17 1 Completed Kpandai Konkomba Chief and area FY17 1 handed over Konjakura (near Bintim) FY17 1 Binadim FY17 1 8 Wiae Chabo FY17 1 Volta Takoradi #1 FY17 1 Takoradi #2 FY17 1 Balai Konkombaline FY17 1 Dadoto FY17 1 Krachi East 2 Ayrefie FY17 1 Hondo Akura FY16 1 3 Gbosike FY16 2 Jagrido FY17 1 Kanjo Tinjanse FY17 1 Nkwanta North 4 Binakab No. 1 FY17 1 Binakab No. 2 FY17 1 Majimaji FY18 1 BH Drilled 2 Wui FY18 1 Dankope FY17 1 Completed Nkwanta South Agou Junction FY17 1 and 5 Yadjakrom FY17 1 handed over WASH FOR HEALTH PROJECT FY18 ANNUAL REPORT 54 Basari Akura FY17 1 Otolli Junction FY17 1 Lege #1 FY18 1 Papaye FY18 1 Mangoase FY18 1 BH Drilled 5 Kente FY18 1 Ato-Plans FY18 1 SUBTOTAL 41 Hasowodze FY18 1 Wornanso FY18 1 Central Ajumako Enyan 1 BH Drilled 5 Region Essiam Esupafie FY18 Mmofrafadwen FY18 1 Ofabir FY18 1 SUBTOTAL 5

TOTAL 179

FY16 59 FY17 79 FY18 41

INSTITUTIONS BENEFITTING FROM W4H BOREHOLE FACILITIES

PROJECT # REGION DISTRICT COMMUNITY SOURCE YEAR BOREHOLE STATUS Nyamegyeaso CHPS W4H FY18 1 Western Sefwi Wiawso BH Drilled Anyinabrim Health Centre W4H FY18 1 SUBTOTAL 2 Douli CHPS S4H FY17 1 Konjuma CHPS S4H FY17 1 BH Drilled and 1 handed over Bole Bole Girls Model JHS W4H FY18 Sapka CHPS W4H FY18 1 BH Drilled, not 1 Northern Bole NMTC W4H FY18 mechanised Kunfusi Health Centre W4H FY18 1 Sawla-Tuna- Sawla SHS W4H FY18 1 BH Drilled and Kalba Gindabor Health Centre W4H FY18 1 handed over

Gbegu CHPS S4H FY17 1 SUBTOTAL 9

Volta Nkwanta North Kabonwule CHPS S4H FY17 1

WASH FOR HEALTH PROJECT FY18 ANNUAL REPORT 55 Jumbo No.2 CHPS S4H FY17 1 BH Drilled and Portripor CHPS S4H FY17 1 handed over Kofi-Akura D/A Primary RI FY18 1 Nkwanta South Brewaniase D/A B W4H FY18 1 BH Drilled Nkwansec D/A Primary RI FY18 1 Ashiabre D/A Primary RI FY18 1 SUBTOTAL 7

Etsi Fawomanyo 1 JHS RI FY18 Ajumako-Eyan- Central Ampia-Ajumako BH drilled Essiam RI 1 DA/Methodist Basic FY18 Eyiakro Primary School RI FY18 1 SUBTOTAL 3

TOTAL

PROJECT YEAR TOTAL TYPE OF INSTITUTION HEALTH FACILITIES EDUCATIONAL FACILITIES FY17 6 6 0

FY18 15 5 10

WASH FOR HEALTH PROJECT FY18 ANNUAL REPORT 56

XII. List of FY2018 Small Grant Projects

Organization Project Number Location Project Name Status Name

Amenfi Central, Latrine Construction Project completed Akyerekyere W4H-SGP-ACHPS-18-01 Western Region for the CHPS CHPS Compound Manso Amenfi Amenfi Central, Latrine Construction Project completed W4H-SGP-MAHC-18-02 Health Centre Western Region for the health centre Project completed Construction of Asuohyiam D/A W4H-SGP-ADBS-18-03 Asuohyiam , Latrine for the Basic School Amenfi West, school Western Region Sefwi Wiaso, On-going. Western Region The school modified the project at their cost. Lack of Naana Biney Latrine for the regular internal W4H-SGP-NBPS-18-04 Primary School school funds has caused the delay. They will be monitored till project is complete.

Sefwi Bodi, Extension of Water Project completed Awudome Western Region Facility (Borehole) W4H-SGP-AC-18-05 Community to other areas within Sefwi Awudome Breman Assikuma Odoben Project Anhwiam – Brakwa, Central Repairing of Pipe for completed. W4H-SGP-BAA-18-06 Agave Region the Community Community Nkwanta South, Practical Project completed Volta Region Demonstrations Tehayon W4H-SGP-TF-18-07 (Tippy Tap and Foundation Hand Washing) in Schools Agotime –Ziope Promotion of Project completed District, Volta Sustainable Centre for Region Handwashing Integrated Behaviors and W4H-SGP-CIED-18-08 Development & (The project is Practices in Basic Education being implemented Schools in the in Agortime-Ziope Agortime-Ziope District) District Breman Anibre Project almost Nye, Assikuma complete. Hand Odoben Brakwa, pump of the Breman Anibre Repairing of Pipe for W4H-SGP-BAN-18-09 Central Region second water Nye the Community facility purchased but yet to be fitted.

WASH FOR HEALTH PROJECT FY17 ANNUAL REPORT 55 XIII. BeGirl Interventions

Region District School Girls Boys Parents Greater Accra Tema Klangon 228 46 78 Tema Manhean TMA 95 0 81 Tema Manhean Presby 155 0 Sub total 478 46 159 Volta Nkwanta North Abuyanya 89 46 50 Nkwanta South Abrewankor 59 44 35 Nkwanta South Ashiabre 25 28 39 Krachi East KwameAkura 22 35 Krachi East Ataki Hope for Life 6 0 Krachi East Kplema Shamsiya E/A Primary 10 0 Krachi East Bawa Akura 7 0

Krachi East Dambai Roman Catholic School 51 12 0 Sub total 269 165 124 Western Takoradi Apowa 120 0 85 Takoradi Tanokrom 37 20 7 Takoradi Anaji 157 20 84 Sub total 314 40 176 Northern Sawla Tuna Kalba St.Paul's 38 36 28 Bole Kurabaso 81 30 16 Sawla Tuna Kalba Sanyari primary & JHS 40 30 20 Sawla Tuna Kalba Nyoli JHS 41 30 10 Bole E/A Primary &JHS 56 30 0 Bole Bale 58 31 44 Sub total 314 187 118 Grand Total 1375 438 594

BeGirl piloted schools

WASH FOR HEALTH PROJECT FY17 ANNUAL REPORT 55 WASH FOR HEALTH PROJECT FY17 ANNUAL REPORT 55 XIV. Cholera Prevention Campaign

FY18 Cholera Disinfection

Greater Accra Cape-Coast Cape-Coast (25th June - Metropolis (28th - Metropolis (16th- 11th Aug., Facility 30th Nov. 2017) 20th April, 2018) 2018) Public Toilet 61 71 29 Drains 70 49 119 Container site 32 51 - Communal Dumpsites - - 23 Refuse dump 42 35 - Public Bathrooms 13 11 28 Markets 1 16 9 Fish market - - 2 Abatoir 1 - 2 Total 220 233 212

WASH FOR HEALTH PROJECT FY17 ANNUAL REPORT 57

XV. Photos

Pro-Poor Guidelines Launch

WASH FOR HEALTH PROJECT FY18 ANNUAL REPORT 59

NuWASH Activities

Collective Active Trials (CAT) session Trials in Improved Practices (TIPS) session

Household Observation Community Walk

WASH FOR HEALTH PROJECT FY18 ANNUAL REPORT 60 Activities: Tuna Water System and Unilever Ghana Foundation Hygiene Stations construction

Tuna Water System construction works Unilever Ghana Foundation Institutional Latrines

WASH FOR HEALTH PROJECT FY18 ANNUAL REPORT 61

Partnership Activities: Duraplast, BeGirl

Digni-Loo with detachable seat Distribution of BeGirl products and Menstrual Hygiene sensitization

WASH FOR HEALTH PROJECT FY18 ANNUAL REPORT 62

FY18 Cholera Preventive Activities in Greater Accra Region

WASH FOR HEALTH PROJECT FY17 ANNUAL REPORT 63

FY 18 Small Grant Projects

Repaired borehole at Breman-Agave 2-seater latrine at Manso Amenfi Health Center 2-seater latrine at Akyekyere CHPs compound

Handwashing sensitization and distribution of Veronica Buckets at Handwashing sensitization and tippy-tap construction Nkwanta South District at Agotime-Ziope District WASH FOR HEALTH PROJECT FY17 ANNUAL REPORT 64