Report | no. 360 Report | no. Impact evaluation of drinking water supply and sanitation interventions in rural Mozambique Since 2006, the UNICEF–Netherlands Partnership evaluation office. It found evidence of a large Programme for Water Supply and Sanitation has increase in the use of improved water sources been supporting Water Supply and Sanitation and in the ownership and use of latrines. Much of programmes in Mozambique. The largest the increase can be attributed to an innovative programme, the ‘One Million Initiative’ aims to approach to sanitation. However, water from bring improved sanitation and clean water to improved sources and even more importantly, over one million people in rural Mozambique. stored water, are not always safe to drink. An Half-way through the programme, a joint impact element of subsidy will continue to be needed to evaluation was carried out by IOB and UNICEF’s sustain facilities and services. More than Water Published by: Ministry of Foreign Affairs Impact evaluation of drinking water supply and sanitation interventions in rural Mozambique Policy and Operations Evaluation Department (IOB) P.O. box 20061 | 2500 eb The Hague | The Netherlands www.minbuza.nl/iob © Ministry of Foreign Affairs | October 2011| ISBN 978-90-5328-414-8 11Buz283729 | E This project was a product of a cooperation between: Impact evaluation of drinking water supply and sanitation interventions in rural Mozambique More than Water Mid-term impact evaluation: UNICEF – Government of The Netherlands Partnership for Water Supply, Sanitation and Hygiene ‘One Million Initiative’, Mozambique Impact evaluation of drinking water supply and sanitation interventions in rural Mozambique Preface Drinking water supply and basic sanitation has been a priority for the Netherlands’ development co-operation and for UNICEF for many years. Current attention is guided by the international consensus on the Millennium Development Goals (MDGs). MDG 7 includes the target to halve, by 2015, the proportion of people in 1990 without sustainable access to safe drinking water and basic sanitation. Since 2006 the Netherlands supports UNICEF programmes through the UNICEF- Netherlands Partnership Programme for Water Supply and Sanitation. The biggest programme is the UNICEF/Government of the Netherlands/ Government of Mozambique water supply, sanitation and hygiene promotion programme “One Million Initiative” in rural areas in the provinces Manica, Sofala and Tete. Mozambique is both for the Netherlands and for UNICEF a partner country to which for many years substantial support to water supply and sanitary facilities has been provided. The Policy and Operations Evaluation Department (IOB) of the Netherlands Ministry of Foreign Affairs and the UNICEF Evaluation Office, in close cooperation with UNICEF Mozambique, conducted a mid-term impact evaluation of the on-going programme. A follow up impact study is envisaged at the end of the programme in 2013. | 3 | The objective of the support to water supply and sanitary facilities goes beyond sustainable access to facilities: it aims to reduce the burden of water collection (typically a task for women and girls), improve health, raise school enrolment and attendance, improve livelihoods and, ultimately, reduce poverty. The for Mozambique innovative UNICEF Community Approach to Total Sanitation (CATS) made the study particularly interesting. Special attention is paid to drinking water quality at the source and at point of use and to linkages between water supply, sanitation and hygiene behaviour. In addition the report reviews some major challenges to reinforce sustainability. There is a worldwide consensus on the impacts of programmes for water supply and sanitary facilities; conventional evaluation studies do not, however, normally quantify these. The impact evaluation has used a combination of quantitative and qualitative methods and techniques. Through such an evaluation both Evaluation Departments wish to explore how the effects of these programs can be measured. For the Netherlands the study is the fifth in a series of impact evaluations of water supply and sanitation programs in different countries. Rita Tesselaar of IOB was overall responsible for the impact evaluation, in coordination with Samuel Bickel of the UNICEF Evaluation Office, and in close cooperation with Samuel Godfrey, head of programme at the UNICEF Mozambique Office and Mr. Americo Muianga, programme coordinator of the Directorate of Water, Government of Mozambique. The main research consultants for the study were Jan Willem Gunning and Chris Elbers, Professors of Development Economics at the VU University Amsterdam; Dr. Stephen Turner, senior consultant in Resource Development and Belis Matabire, national consultant in water supply and sanitation. The household, community and water point surveys were Preface implemented by the agency WE Consult, through the UNICEF Mozambique Office. The study benefited from information and comments on draft versions of the report received from the Directorate of Water, staff of the UNICEF Mozambique Office, Paul Eduards of UNICEF headquarters, Dr. Christine Sijbesma of the IRC International Water and Sanitation Centre, Antonie de Kemp and Henri Jorritsma of IOB, Dick van Ginhoven of the responsible policy department of the Netherlands Ministry of Foreign Affairs and Felix Hoogveld of the Netherlands Embassy in Maputo. Thanks are also due to all other infor- mants and last but certainly not least, all the respondents to the survey questionnaires and participants of group interviews. Special thanks are due to the water supply and sanitation team of the UNICEF Mozambique Office for their information, advice and support through- out the study. IOB and UNICEF Evaluation Office bear responsibility for the contents of the report. Prof. Dr. Ruerd Ruben Director IOB Colin Kirk Director UNICEF Evaluation Office | 4 | Impact evaluation of drinking water supply and sanitation interventions in rural Mozambique Contents Preface 3 Tables 7 Figures 9 Abbreviations 10 Main findings and issues 12 1 Background and methodology 22 1.1 Purpose and focus of the impact evaluation 23 1.2 Key evaluation questions 27 1.3 Methodology 29 1.4 Structure of the report 31 2 Problem and context 32 2.1 Demography and society 33 2.2 Natural environment 34 2.3 Economy and poverty 35 2.4 Health and nutrition 36 2.5 Water and sanitation policy and institutional context 38 | 5 | 2.6 External funding agencies’ policy and support to rural water and sanitation 41 2.7 Summary 43 3 The One Million Initiative, 2006-2013 46 3.1 Objectives 47 3.2 Approach and activities 48 3.3 Institutional strategy 57 3.4 Outputs to date 61 3.5 Costs 65 3.6 Summary 66 4 Impact analysis 70 4.1 Introduction 71 4.2 Data and Methodology 71 4.3 Water interventions of the One Million Initiative 74 4.4 Sanitation and hygiene - related interventions of the One Million Initiative 90 4.5 Health impact of the One Million Initiative 102 4.6 The One Million Initiative and Education 105 4.7 Summary 111 5 Sustainability assessment 114 5.1 Introduction 115 5.2 Policy and institutional arrangements 116 5.3 Institutional capacity 118 5.4 Other factors affecting sustainability 123 Contents 5.5 Monitoring 127 5.6 Summary 129 Annexes 134 Annex 1 Terms of reference 135 Annex 2 Estimating the number of newly realised water points under the One Million Initiative 152 Annex 3 Sampling design 155 Annex 4 References 163 | 6 | Impact evaluation of drinking water supply and sanitation interventions in rural Mozambique Tables Table 1 Manica, Sofala and Tete provinces: demographic data 33 Table 2 Poverty headcount, 1996-97, 2002-03 and 2008-09 36 Table 3 Selected health and nutrition indicators, 1997 and 2003 36 Table 4 Selected health and nutrition indicators, 2008 37 Table 5 Percentage of persons aged 15-49 testing HIV positive, Manica, Sofala and Tete, 2000 - 2007 37 Table 6 One Million Initiative ODF awards, 2008 and 2009-10 52 Table 7 New water points and beneficiaries, 2008 - 2010 62 Table 8 Number of new water points, estimated from survey data 63 Table 9 New latrines and beneficiaries, 2008 - 2010 63 Table 10 ODF communities, 2008 – 2010 64 Table 11 Communities planned for CATS evaluation, evaluated, declared ODF, 2010 64 Table 12 School water supplies and latrines, 2007 - 2010 65 Table 13 Budget of the One Million Initiative 65 Table 14 Improved water points in survey locations 76 Table 15 Access to improved water points 77 Table 16 Percentage of households using improved water sources as their main source of drinking water. 78 | 7 | Table 17 Households response to water point intervention (number of households) 78 Table 18 Change in use of improved water sources caused by change in availability of improved water sources and / or CATS intervention 79 Table 19 Payment mode for user charges for improved water sources 80 Table 20 Monthly payment according to water committee 81 Table 21 User charges 81 Table 22 Determinants of using improved sources of drinking water 82 Table 23 Changes in Water Quality at Source 84 Table 24 CFU Count at Source (2010) 84 Table 25 Water quality: subjective and objective 2010 85 Table 26 Perceived water quality determines switch to improved sources 85 Table 27 Water safety at point of use 86 Table 28 Trends in water consumption 87 Table 29 Water consumption and perceived water quality 88 Table 30 Water collection time 89 Table 31 Latrine Ownership and CATS intervention 90 Table 32 Open Defecation Practice and CATS intervention (changes 2008-2010. % points)