Health is one of the most critical parts of the Sustainable Development Goals to which all governments and agencies across the globe have committed to achieving by 2030. Women and girls are an important part of health programs and services, as they are not just consumers of services but also a part of service delivery. Health programs have been built on universal principles and frameworks, with the aim of reaching the maximum number of individuals. But sometimes these programs are more focused on reproduction and maternal health, including service delivery, and neglect to include women and girls as individuals, or acknowledge their personal agency. This critical aspect should be an integral part of ideating, planning, policy-making, programming and implementation. Continue Reading
This past Sunday, I was reflecting on my incredible experience of being a mother. I have two wonderful kids who fill my heart with joy and my house with pop songs and stinky soccer cleats. However, giving birth to these kiddos was not so easy. In fact, one took 39 hours to be born, and with the other, I experienced post-partum hemorrhaging.
As hard as childbirth was, I also recognize my privileged circumstances living in Seattle as a white woman. I had both a doula and a midwife, and I gave birth in a hospital with extensive support. Such support is frequently absent for women in developing countries, and indeed also for many women of color in the U.S. And without quality care, the consequences can be dire. The World Health Organization estimates that 830 women globally die every day in childbirth or from preventable complications related to pregnancy. Every single day.
At Global Washington this month we are shining the spotlight on one aspect of childbirth that is often overlooked. A birth attendant is often the most critical person in preventing maternal and newborn death, and yet she is also often the least supported caregiver, and frequently faces the brunt of emotional or physical abuse. The contributions of birth attendants – the nurses, midwives and Aunties all over the world – are critical to achieving the Sustainable Development Goal of reducing maternal and newborn deaths globally.
Fortunately, there are organizations right here in Washington state helping to increase the number of skilled birth attendants and supporting their work. In this month’s newsletter you’ll learn about how PATH collaborates with clinical providers to develop tools and technologies that can make their jobs easier, and also makes sure they have systems in place to continue to improve the quality of care. In addition, we spotlight the amazing career journey of Heidi Breeze-Harris, co-founder of One By One, and the current executive director of PRONTO International.
Furthermore, I hope you can join me and our event partner, the Washington Global Health Alliance (WGHA), for an event on May 22 on the role of birth attendants in improving maternal and newborn health. We’ll hear from experts at PRONTO International, Health Alliance International, Worldwide Fistula Fund, and the Kati Collective.
This issue campaign was inspired by the upcoming Women Deliver conference in Vancouver, B.C., which will explore gender equality and the health, rights, and wellbeing of girls and women. We’ll continue to bring you context related to maternal health over the next several weeks. I hope you will join in the conversation.
Investing in Birth Attendants Reduces Maternal Mortality and Improves Overall Care
By Joanne Lu
In this PRONTO simulation, Dr. Leah cares for a new mother and baby immediately following birth. Simulation is an important way for providers to practice patient-centered, respectful maternity care. Photo provided by PRONTO International.
Every woman deserves to give birth safely and with dignity. Yet sadly, maternal death during childbirth is not yet a thing of the past. Despite immense progress between 1990 and 2015 that nearly halved the global maternal mortality rate, the World Health Organization (WHO) estimates that about 830 women around the world still die every day from preventable causes related to pregnancy and childbirth. By 2030, the international community aims to reduce maternal mortality by 68 percent. But achieving that will require a concerted push to not only improve skilled delivery for mothers around the world but also build their trust through respectful care.
Safe birth environments require many functioning systems to work together. A single missing element can be dangerous, even fatal, for mothers and their babies. These elements include timely transportation, safe blood for transfusion, clean water and, perhaps most importantly, skilled birth attendants.
According to the UN Children’s Fund (UNICEF) and WHO, the presence of a skilled birth attendant – whether a medical doctor, nurse or midwife – can reduce the risk of death or stillbirth from delivery-related complications by about 20 percent. Yet only 78 percent of births in the world occur with assistance from a skilled birth attendant. In West and Central Africa, the coverage is a mere 56 percent. Without trained attendants who can recognize and respond to deadly complications such as hemorrhage or sepsis, about three-quarters of all maternal deaths occur during delivery and in the immediate postpartum period.
That’s why organizations like Maternity Foundation are developing training resources for skilled birth attendants in low- and middle-income countries. Over the last six years, Maternity Foundation, Copenhagen University and University of Southern Denmark have refined the “Safe Delivery App” as a training tool and job aid that is being used in over 40 countries. Primarily based on WHO guidelines, the app includes easy-to-understand clinical modules, essential practical procedures, action cards for emergencies and a comprehensive drug list. A randomized controlled trial in Ethiopia as well as case studies in other countries have shown that usage of the app has not only resulted in a marked increase in health workers’ skills and knowledge, but also in their confidence, especially in managing complications.
Training is one crucial aspect of improving maternal and neonatal care, but increasingly, the conversation is turning toward the well-being of the birth attendants themselves. According to Heidi Breeze-Harris, executive director of PRONTO International, birth attendants – particularly midwives and nurses, who are mostly women – are often the worst paid and worst treated of care providers.
When birth attendants are overworked, underpaid, traumatized by seeing too many deaths and treated horribly by doctors, patients’ families and others, they in turn take out their frustration on patients, says Sadaf Khan, a Senior Program Officer at PATH’s Maternal, Newborn, Child Health and Nutrition program. Sometimes it’s discrimination; other times constraints, slapping or abuse.
Recognizing this systemic problem, PRONTO and PATH work to elevate the status of care providers. PRONTO’s programs focus on the provider team as a whole and try to break down hierarchies that can interfere with quality care. Their training program gives birth attendants the chance to learn in lower risk environments, and simulations in which the provider plays the role of the mother help foster empathy. Other scenarios teach them not to lash out at patients and to ask for support when they need it.
Breeze-Harris recounts one birth simulation when the midwife called on a driver in the hall to help. It didn’t take long for the midwife to realize that she didn’t have to take care of 30 women on her own. Even if they weren’t technical hands, there were many ways to get hands there to help her.
“We help them find a way to manage what’s real for them,” Breeze-Harris says. “We meet them where they are, not where the algorithm says they should be.”
Famous for its innovative health technologies, PATH also works closely with providers to design and develop low-cost, effective, and easy-to-use devices according to the providers’ needs, wants and specifications. These include devices pre-filled with drugs that allow a single provider to administer the medication to multiple patients more quickly, or low-cost uterine balloon tamponades that help control hemorrhage.
But beyond just a safe and respectful delivery, global health experts are now promoting an even more holistic approach to maternal care. In 2016, the WHO released guidelines for a positive pregnancy experience to “ensure not only a healthy pregnancy for mother and baby, but also an effective transition to positive labor and childbirth and ultimately to a positive experience of motherhood.” The guidelines include recommendations on nutrition, malaria, HIV and even intimate partner violence.
Along those lines, PATH is working in communities through health education, preventative care, and a curriculum designed by mothers themselves to help women know their maternal rights and decide which procedures to undergo.
When women are empowered to speak up for themselves and providers are empowered to provide quality care, the outcomes can be dramatic. Positive experiences build trust, and word-of-mouth accounts can increase the number of women who seek care at facilities with skilled providers throughout their pregnancies – even their lifetimes. Of course, to achieve these outcomes, there must be continuous support with resources, training and accountability. But turning our focus to the wellbeing of mothers and those providing their care is the first step toward sustainable progress.
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The following Global Washington members are working to improve maternal and newborn health through a variety of interventions.
Adara’s work in maternal, newborn and child health is primarily focused on strengthening services in central Uganda by supporting holistic program development, and undertaking high impact interventions and training. Adara does this to enhance health services and contribute to ending the preventable deaths of women, children, adolescents, and in particular, newborns. Adara partners with Kiwoko Hospital to help women deliver their babies safely, help newborn babies needing specialized care in the neonatal intensive care unit (NICU), provide community outreach services and health promotion, and train village health workers and clinicians from the local district health system. The Kiwoko Hospital NICU is considered a center of excellence in maternal and newborn health in East Africa.
Construction for Change believes maternal and child outcomes are inextricably tied to a community’s ability to access quality healthcare services. CfC seeks to increase access to healthcare by offering construction management expertise to organizations who need a new or improved building to increase their impact in the community. CfC’s healthcare initiative, the 30/30 Project, has specifically targeted maternal and child programs through the construction of four maternity wards and 18 rural health clinics around the world. These facilities have logged over 250,000 patient visits, including over 65,000 by children under 5 years old. The facilities also offer comprehensive prenatal care, with over 15,000 prenatal visits having taken place in the buildings over the past four years. Positive maternal and child outcomes have a reverberating effect throughout a community and access to a building where quality services can be obtained is central to CfC’s mission.
For 30+ years, HAI has worked to strengthen service delivery within, and expand access to, public sector MCH services. HAI considers the full system in which birth attendants operate and works to reduce barriers at each level. In Timor-Leste, HAI’s Liga Inan program has connected 47,000+ mothers nationwide to government midwives using mobile phone technology. Liga Inan empowers Timorese mothers to make informed decisions about their perinatal care in consultation with trained midwives. In Côte d’Ivoire, HAI has played a key role to integrate HIV, STI, and antenatal care services in 200+ health facilities, building birth attendant skills to provide specialized, comprehensive care to at-risk mothers and infants. In Mozambique, HAI is developing new ways for health providers and managers to use data to identify coverage gaps and implement localized, informed adaptations that respond to the specific needs of the families they serve.
In places where the needs are greatest — places of conflict and disaster — mothers and children are at even higher risk of disease and death. Medical Teams International provides prenatal check-ups, helps mothers give birth in clinics, and performs emergency C-sections to save the lives of mothers and babies. Once babies are born, the organization’s staff provide vaccines and treatments for pneumonia, malaria, and diarrhea. They also check for malnutrition and distribute supplemental food. Empowering women to keep their families healthy and safe is at the heart of what Medical Teams International does.
From Guatemala to Niger to Tajikistan, Mercy Corps has worked for years to combat child mortality through improving access to medical care and educational resources for new mothers. In Tajikistan, over 70% of the population lives in remote areas with limited access to medical care. In order to improve maternal and newborn health, Mercy Corps has trained over 1,200 local community members in over 600 communities to host community classes on pregnancy risks, childbirth and childhood nutrition. The classes have been attended by both new mothers and their mothers-in-law, as they hold significant influence over young women in most Tajikistan villages. Following the community trainings, mothers were 67% more likely to acknowledge danger signs during their pregnancy and visit their local health clinic. New mothers were also more likely to breastfeed exclusively, when prior to the trainings newborns and toddlers would have been given formula, sweet tea or biscuits crumbled in water.
Improving maternal, newborn, and child health is central to PATH’s mission and work around the world. PATH’s Maternal, Newborn, Child Health & Nutrition (MNCHN) program takes a health-systems oriented, multi-sector approach to strengthening the continuum of care for women, children, families, and communities. The MNCHN program provides core technical support and expertise to enable communities to survive and thrive by focusing on three broad, intersecting areas of work: strengthening maternal and newborn care; expanding nutrition policies, programs, and innovation; and integrating early childhood development into the broader MNCHN environment.
Since 2001, Planned Parenthood of the Great Northwest and the Hawaiian Islands (PPGNHI) Global Programs has worked to improve access to sexual and reproductive health education and services in low resource settings, including family planning. Family planning is integral to maternal health; access to contraception has been associated with reductions in maternal mortality and can improve maternal and child health outcomes by delaying or spacing pregnancies. Recently, the PPGNHI Global Programs team partnered with the Módulo Anexo Materno Infantil (MAMI) in the Dominican Republic to improve maternal and child health and sexual and reproductive health outcomes through a digital support network for adolescent mothers, supported by funding from Grand Challenges Canada (through the Government of Canada). Through WhatsApp groups, they share educational messages and provide a forum with the aim of increased use of post-partum family planning, increased attendance at well-child and vaccination appointments, and increased social support measures.
The name “PRONTO” evokes a necessary urgency – birth attendants typically have fewer than five minutes to diagnose and deliver solutions to life-threatening emergencies affecting mothers and babies during childbirth. PRONTO International conducts simulation-based training designed for healthcare provider teams in limited-resource settings. PRONTO’s mission is to provide locally-owned, sustainable training that improves the capacity of frontline providers to save the lives of mothers and babies. More than 5,000 providers have been trained in ten countries, including nurses, traditional midwives, doctors and other providers who care for women and infants during labor and delivery. In addition, there are now more than 150 PRONTO trainers and PRONTO master trainers in Mexico, Guatemala, Kenya, Uganda, India, and the United States.
Working in 157 programmatic countries, UNICEF supports governments and communities in scaling up maternal, newborn, and child healthcare services. UNICEF provides vaccines to roughly 45% of the world’s children, and works with community healthcare workers to promote breastfeeding. In 2017, over 25 million live births were delivered in facilities supported by UNICEF, and $665 million was invested in nutrition programs, helping treat 4 million children for severe acute malnutrition in 67 countries. Since 2011, UNICEF and partners have helped eliminate maternal and neonatal tetanus from an additional 26 countries through the Eliminate Project, averting an estimated 24,000 newborn deaths annually.
World Vision’s maternal, newborn and child health (MNCH) programs work predominantly in the communities hardest hit by injustices, recognizing that the health of mothers and children cannot be separated, and that providing newborns with optimal nutrition and access to essential care promotes a basic human right. World Vision establishes community health committees, mother support groups, and “peer mothers” who help with breastfeeding and early infant nutrition. Through World Vision’s interventions, more than 220,000 community health workers have been trained and are now equipped to focus on prevention, providing key messages at the household level as well as essential care to new mothers and infants.
Worldwide Fistula Fund protects and restores the health and dignity of the world’s most vulnerable women by preventing and treating devastating childbirth injuries. The organization seeks to improve global women’s reproductive health and the safety of childbirth by improving the capacity of low-resource countries to meet women’s health care needs. WFF works to identify women who need fistula treatment and then provides life-changing surgeries, performed by expert fistula surgeons. Recovery and support includes post-op care, safe places to heal, meals, and integrated physical therapy. WFF supports advocacy and support groups through counseling and connecting survivors to local mentoring groups. Women are encouraged to participate in education and vocational skills training in literacy and health. WFF also funds training for community members in fistula awareness. In Ethiopia, WFF offers an enhanced OB-GYN residency training program and a specialized Urogynecology Fellowship training program.
For PATH, innovative tools depend on supportive systems for success
By Joanne Lu
Since its founding in 1977, PATH has become a giant in global health technology. With 1,600 employees working in 70 countries, PATH estimates that its innovations touch the lives of more than 150 million people each year. PATH works with a range of stakeholders and partners including, but not limited to, industry, governments, research institutions, and academia to address some of the world’s most pressing health problems, including those affecting mothers and newborns
About six years ago, the organization began to reevaluate how its work can transform entire systems. Instead of focusing strictly on technologies for individual projects, PATH has adopted a multidisciplinary “platform-based approach” that brings together the expertise of its teams across multiple countries and disciplines in order to research, design, scale up, and advocate for systemic innovations that make prevention and treatment more affordable, accessible and effective.
“Technologies are a very powerful piece of the armamentarium, but they’re just one piece,” says Sadaf Khan, a senior program officer with PATH’s Maternal, Newborn, Child Health & Nutrition Program.
Health workers in Ghana learn to use the blood collection drape to measure post-partum blood loss. Photo: PATH/Patience Cofie.
Khan, a physician originally from Pakistan, has spent the last eight years at PATH, primarily working on maternal health, but also on areas that intersect with her expertise, such as drug and device development and maternal immunization. She also looks at the potential of antenatal and postpartum care as platforms that can introduce women to a whole range of other health services for the rest of their and their children’s lives. These include nutrition, immunization, family planning and sexually transmitted infections, and malaria prevention and control.
“Everything PATH does in some way touches upon the lives of women and children,” Khan says.
And yet, Khan says they have found that their technology innovations achieve their transformative potential only when providers and patients in low- and middle-income country settings receive systems support they need.
“You can have these wonderful technologies, but if you have providers who are not trained in their use, or who are unsure of their ability to use them, there’s only so much good a tool can do by itself. Systems need to be built around the people who are providing those services, and they need to address the needs of the people – the women – who are receiving those services.”
Part of the solution is making sure that providers are being trained in up-to-date best practices and guidelines and that there’s a structure within which they can bring up issues that arise. But tools also need to be developed with the providers’ needs in mind.
For example, Khan notes that according to the World Health Organization, 99 percent of maternal deaths occur in low-resource settings, primarily in South Asia and sub-Saharan Africa. One of the most common causes of maternal death is postpartum hemorrhage. Severe postpartum hemorrhage can kill a mother in less than two hours. Oxytocin is the recommended drug of choice for preventing and treating it. Yet, according to Khan, it’s an underutilized intervention.
So, PATH asked, what are the barriers to the use of oxytocin for postpartum hemorrhage prevention? And how can it be used more widely? This issue was approached from a technology and systems lens. PATH’s technology solution was a simplified pre-filled device. That way, when there is only one birth attendant for several patients – as is often the case in low-resource settings – the birth attendant can administer it quickly. Additionally, the device is so simple that even health workers with fairly low levels of expertise can learn to use it quickly and easily.
Women in Uganda wait for their turn to see a provider at a health facility. Photo: PATH MediaBank
Second, PATH asked, what is the quality of the drug? Khan says they found in PATH’s work in Ghana and India, even when women were receiving oxytocin, the drug, especially when procured from private pharmacies, had very low levels of the active ingredient. Building an evidence base around quality and storage conditions has been key to addressing a systemic problem. This has included advocacy around procurement of quality oxytocin, as well as potential systems solutions, including exploring the integration of oxytocin into alternate cold chains, such as those for vaccines.
Third, PATH looked at the current practices, both from the provider perspective and from the community perspective. She says that while oxytocin may be underused for prevention, there’s often significant misuse to induce and augment labor, as providers respond to the demands of the patient’s family in certain settings. To address this challenge, PATH focused on training providers to optimize the drug’s appropriate use and to prevent misuse, as well as developing communication messages intended for families to minimize the misuse of the drug.
Armed with a bundle of evidence, PATH then approached policy makers in specific geographies to provide support and information for the development of a postpartum hemorrhage policy that addresses issues along the prevention-management continuum and looks at all the issues around providers’ skills, the availability of tools, and community demands. Working collaboratively with the policy makers, PATH aims to ensure that not only are changes made where needed but that all information is available to all providers.
PATH works closely with providers in developing tools that can improve care. For example, in cases where hemorrhaging is not managed by first line treatments, traditionally manual pressure is applied to stop the bleeding. But again, given workflows and patient load, manual pressure is not always a viable option.
For bleeding that is non-responsive to initial treatments or where these may be unavailable, the use of uterine balloon tamponades (UBT) can prove lifesaving, reducing blood loss and the need for risky and costly surgical interventions and blood transfusions. The UBTs available to providers in a developed country setting are effective but often too expensive for low resource settings. In these settings, it was observed that providers were rigging up their own UBTs with available items, such as catheters, condoms, and syringes. While certainly an ingenious solution, these approaches take time to assemble.
A prototype of the Sinapi uterine balloon tamponade (UBT) inflated with water. Photo credit: PATH/Patrick McKern.
Taking these needs into consideration, PATH has worked with providers, developers and researchers to develop an inexpensive all-in-one, pre-assembled UBT with all the design features that the providers themselves wanted. It’s a fully assembled system that can begin working in less than one minute, and the estimated cost is a fraction of the cost of UBTs used in the U.S. PATH estimates that an affordable UBT could save up to 6,500 lives annually and avert almost 11,000 surgeries just in sub-Saharan Africa alone. The Innovation Countdown 2030 report estimates that widespread use of the UBT could save the lives of 169,000 women by 2030.
Empowering providers with the appropriate tools, trainings and support makes a monumental difference in the care that is delivered. As one provider told Khan, “It’s very frustrating to me to not know whether the skill set that I have is even up-to-date. Now I feel full confidence in my ability to deliver these services. I feel empowered, and I feel my attitude and my interactions with my patients have improved and changed for the better.” The quality of care from a confident and well-equipped provider also shapes women’s perceptions of care. It can affect whether a woman will continue to seek care for herself, as well as how and when she will take her children to a health care provider and whether she will encourage others in her community to do the same.
That’s why Khan says PATH is focused on moving forward with not just providers’ needs in mind, but with a women-centric approach.
“Much of the new global guidance coming out is recognizing that we need to move beyond thinking only vis-a-vis health outcomes – which are undoubtedly critical – to the experience of pregnancy and childbirth as a positive experience that is empowering for women.”
Through its work with communities, PATH is integrating ways to keep women informed as partners in the process of tackling maternal mortality.
A community-led behavior change strategy in India uses digital video technology. Photo: PATH/Kiersten Israel-Ballard.
“There is an understanding that even if a woman receives services that are technically sound but she leaves with an overall negative experience of her childbirth experience due to lack of other dimensions of quality, we as providers have failed that woman,” says Khan. “For me, addressing these is the next step to accelerating progress.”
Heidi Breeze-Harris, executive director of PRONTO International
By Angelia Miranda
For Heidi Breeze-Harris, working in the global health sector may not have been an obvious path, but in retrospect, it makes sense. Thanks to the trips that she and her mother saved up for every summer, and growing up with a diverse extended family, Breeze-Harris has always had a strong connection to the international sector. “Because I started traveling to pretty out of the way places when I was young, I was comfortable in those settings,” she says.
But what she saw within those settings didn’t always make sense.
One of the greatest influences in her life, her grandfather, instilled in her a lesson as a child. “He taught me that there is nobody lesser than me, and nobody better. We are all the same level of human.” Breeze-Harris internalized his words, but the inequality and injustice she saw during her travels made her wonder how they could be true when reality looked so different.
“My grandfather instilled this belief and then I went into the world.” As a 5-year-old child in Lima, she recalls asking herself, “How do I get to eat breakfast and these other children my age don’t. Why can’t they have what I have? And is it wrong that I do?”
Upon finishing college with a degree in anthropology and Asian studies, Breeze-Harris considered looking for international work. “I also loved, and love art and I thought what better time to experiment with work in the arts than when I am young and have little to lose.” A conceptual artist, she has embraced music, acting, sculpting, photography, and painting. In fact, her first job was with local glass sculptor and artist, Dale Chihuly. “I started as a receptionist with Dale and worked my way up,” she says.
With long hours and dedication, within six months Breeze-Harris became Chihuly’s book designer and museum liaison, and she worked with the installation design teams in the studio. After six years, she shifted her focus from art to urban design in service to community development.
After working as an urban designer for low-income communities, Breeze-Harris received a fellowship in 2003 to work with immigrant communities in Kobe, Japan, who had been displaced and disenfranchised after the Hanshin Awaji earthquake. It was after returning from Japan that she first heard about the medical condition, fistula.
Obstetric fistula is a childbirth injury caused most often by women experiencing obstructed labor without access to timely medical care. In obstructed labor the baby’s head puts pressure on the mother’s birth canal, which if left unrelieved can result in a stillborn baby and the mother with a hole in her bladder or rectum. An estimated 2 million women worldwide suffer from fistula. Because women with fistula can leak urine and and/or feces chronically, they often face ostracism, isolation, shame, and a heightened risk of death.
Breeze-Harris was herself one month pregnant when she began learning about fistula. It went from being a topic completely unknown to her to suddenly showing up in her life three times in one week. “I think that’s a sign that something’s worth paying attention to,” she said. And so she did.
Together with her friend, Katya Matanovic, she co-founded the organization, One By One, to work with women in East Africa and implement a holistic approach to fistula treatment and prevention. She learned more about fistula and its impact on girls and women in low-income countries. In an ironic twist, her own pregnancy took a turn for the worse, and Breeze-Harris almost died from obstructed labor.
“Because I lived in the U.S.,” she explained, “I was able to have a cesarean section in time.” Once again, the questions raised by her grandfather’s lessons seemed to apply; only this time the difference between her and others like her was access to life-saving resources.
Breeze-Harris never intended to start an organization like One By One. As a new mother, she fully expected to hand the project off to the UN Foundation. “I had my own child,” she points out. But the UN Foundation gave One By One a startup grant and encouraged them to keep going.
After 11 years, she left One By One, in need of a chance to recharge. But the work she started continued on. In 2018, she watched with pride as One By One merged with the Worldwide Fistula Fund, a Global Washington member. “I am so thrilled the work continues. That’s what’s happening, and it is happening in an even bigger and better way than either organization would have been able to do alone.”
On the flipside, the team One By One helped to build in Kenya now operates and functions as its own NGO. “The leadership is theirs,” she affirmed. Looking back at all that One By One has accomplished since she left, she says, “To say I’m proud is a weird way to put it—I’m humbled that I was able to connect and work alongside incredible leaders who made all of this happen. This work is led by fistula survivors there. That is how it should be.”
Heidi Breeze-Harris (center) in Migori County, Kenya, with midwives who have just undergone a week of PRONTO training and are receiving their certificates of completion. Photo provided by PRONTO International.
Breeze-Harris continues her work in global and maternal health as the current executive director of PRONTO International, an organization that provides innovative low-cost obstetric training to clinical providers in resource-limited settings around the world.
The philosophy that PRONTO International embodies is the idea that clinicians are not separate from mothers and babies—rather, they are an essential part of the childbirth process and the “mother-baby-provider” triad. As such, the organization focuses on offering clinical providers the emotional, psychological, and technical support they need not only for the safety of mothers and children, but also for their own well-being, because confident providers save lives.
When asked about her confidence in the global community’s ability to accomplish the Sustainable Development Goals relating to global health by 2030, she expressed a general sense of optimism. At the same time, she cautioned that the global community must not forget all those encompassed by the term “global.” For instance, the United States is the only developed nation where rates of maternal death are increasing, especially in populations of women of color.
“It is important that we highlight the relationship between our healthcare system, racism and pregnancy outcomes,” she said.
While PRONTO International works in low-resource areas across the globe, it also sells birth simulation kits to American providers and universities. PRONTOPacks™ allow clinicians in any setting to simulate birth in a highly realistic and innovative, yet sustainable, low-tech and low-cost manner.
In pursuing innovative ways to train birth attendants, from offering PRONTOPacks™ to developing curriculum and training plans in collaboration with local governments, PRONTO International aims to develop practitioner skills in-country, while ultimately placing the responsibility of continuing the programs with the countries themselves. “Our goal has to be to make it sustainable within country budgets and staffing systems.”
Tracing a path from the office of an artist to the forefront of innovative organizations in global health and maternal care was certainly never the plan. But if there is one thing Breeze-Harris illustrates, it is following her passion wherever it may lead.
Today, Heidi Breeze-Harris brings her creativity to the role of changing the very inequality and injustice that she witnessed in the world as a child. By ensuring that future mothers can get what they need, regardless of where or who they are, she helps to make her grandfather’s words a reality: nobody less, and nobody better.
Please welcome our newest Global Washington members. Take a moment to familiarize yourself with their work and consider opportunities for support and collaboration!
One Equal Heart Foundation
One Equal Heart is a Seattle-based nonprofit that collaborates with indigenous leaders to honor and nurture sustainable agriculture, equitable communities and traditional knowledge. oneequalheart.org
SG Foundation
SG Foundation trustees and staff collectively strive to serve God and the poor by relieving suffering and improving the quality of life in communities and for the individuals in those communities both locally and around the world. sgfoundation.org
YWCA SEATTLE | KING | SNOHOMISH
YWCA is on a mission to eliminate racism and empower women. ywcaworks.org
As a 2019 GiveBIG marketing partner, Global Washington is thrilled to highlight our non-profit members that are participating in this year’s one-day online fundraising event. All of our members have a strong presence in Washington state and are working to improve lives in developing countries. Please consider supporting their work (and ours!) by making a donation today.
Stamford, Conn. – May 3, 2019 – Americares India is preparing to deliver medicine and relief supplies to assist survivors of India’s worst cyclone in decades.
Cyclone Fani made landfall in Odisha Friday morning local time with wind gusts over 120 mph—the equivalent of a Category 3 hurricane. More than 1 million people evacuated India’s east coast as the storm approached, taking refuge from the heavy rains and punishing winds in more than 800 emergency shelters.
Americares is planning to deliver medicine and relief supplies to Odisha this weekend, including tarps, water cans and water purification tablets for up to 3,000 families. Americares India, based in Mumbai, also has medical teams on stand-by, ready to provide primary care services and treatment for minor injuries. Continue Reading
Through the Task Force program, students in the Jackson School of International Studies tackle critical policy challenges — and set their career paths in motion.
A country is in the midst of a brutal conflict.
The capital city has become a battlefield, and residents are caught in the chaos. Food is scarce, and every bed in the understaffed hospital is full. Public utilities were cut off months ago, so there’s no running water, electricity or garbage collection.
As a foreign aid worker, you’re trying to get basic supplies to civilians. It’s work that involves more than simple logistics: Will you need armed protection to reach people safely? If you do, will some groups see you as a threat? And should you even be doing this if the government in power doesn’t want your country’s help?
At the Henry M. Jackson School of International Studies, students grapple with questions like these as part of the Donald C. Hellmann Task Force Program. By giving undergraduates the chance to address real-world crises, Task Force — the capstone project for all international studies majors — immerses them in culture, politics, economics and human rights.
It has also created a pipeline for the next generation of global leaders, which is more crucial now than ever. Read More
Beginning in December 2018, Kids in Need of Defense (KIND) conducted a series of visits to different points along the United States-Mexico border to learn about conditions and challenges experienced by unaccompanied children seeking protection and access to United States ports of entry. Following KIND’s initial trip to Tijuana in December 2018, the organization published The Protection Gauntlet, in which it reported concerns that unaccompanied children in Tijuana were being systematically prevented from accessing the San Ysidro port and therefore protection in the United States. This report provides an update to The Protection Gauntlet and explains the danger and the challenges that unaccompanied children currently face in Tijuana and other parts of the U.S.-Mexico border.
By Angelia Miranda
(With contributions from Sheila Panyam)
Kristen Dailey, GlobalWA Executive Director, gives open remarks for a panel on ending child marriage, co-hosted by GlobalWA and the Seattle International Foundation. Panelists (L to R) include Thea Handelman, Board Member, Women’s Justice Initiative – Guatemala; Perla Vázquez, Deputy Program Director, Seattle International Foundation, Central America and Mexico Youth Fund (CAMY); Eric Sype, Community Engagement Fellow, UNICEF USA; and Cathy Herholdt, Senior Communications Director, World Concern. Photo credit: Andie Long/GlobalWA.
Of all the women and girls alive today, 650 million were married before the age of 18. For some, it happened when they were much, much younger. Child marriage, or early marriage, is a practice that is more widespread—and more complex—than one might think. Perpetuated by gender inequities, lack of access to education and resources, and social norms, child marriage is a critical issue that presents severe consequences for the millions of girls still at risk. The UN has identified the elimination of child marriage by 2030 as one of the Sustainable Development Goal targets. According to Kristen Dailey, Executive Director of Global Washington, in order to reach that target the global community needs to work 12 times faster. Continue Reading
Stamford, Conn. – April 22, 2019 – Americares is delivering more than 4 tons of critical medicine and medical supplies to treat patients and protect health workers fighting the deadly Ebola epidemic in the Democratic Republic of the Congo.
Since August 2018, more than 1,300 cases and 870 deaths have been reported according to the Ministry of Health, making this the second-largest and second-deadliest Ebola outbreak on record. Political unrest and violence against health workers in the North Kivu and Ituri provinces have made it difficult to monitor the spread of the virus, resulting in a continued increase in cases.
“Thousands of lives are at stake,” said Americares Director of Emergency Response Brian Scheel. “Health workers offer the best hope for containing the spread of the disease, and this shipment will provide the tools they need to protect themselves and care for patients.” Continue Reading
By Cyndie Berg, Director of Business Development, Splash
11 year old Kidist uses the water station at her school in Addis Ababa. Photo credit: Gavin Gough for Splash.
In March, Splash’s Seattle office hosted two of its leaders from Ethiopia: Dawit Alemishet, Country Director, and Kelbessa Wordofa, Director for Project WISE (WASH-in-Schools for Everyone). They were in town to meet with colleagues planning the launch of Project WISE (WASH-in-Schools for Everyone), an initiative to reach every government school in Addis Ababa, Ethiopia, and Kolkata, India, with WASH infrastructure (water storage, filtration systems, drinking and handwashing stations, and improved toilet facilities), as well as behavior change programs for children and adults, and strengthened menstrual health services for girls aged 10 and above.
Splash has reached 79 schools serving 78,000 children in Addis Ababa, and 194 schools serving 55,985 children in Kolkata. Through Project WISE, the organization expects to reach approximately 1,600 schools serving one million children by 2023.
Splash’s efforts will benefit even more children like Kidist, a fifth-grader who is 11 years old. Kidist is very pleased about the improvements that Splash has made at her school. She especially loves the different colored drinking and handwashing stations and is attracted to wash her hands and drink from them. Continue Reading
Water is an essential element for survival, yet efforts to ensure that everyone has access to this precious resource have faced an uphill battle. According to UNICEF, 30 to 50 percent of water, sanitation, and hygiene (WASH) project fail after two to five years. In the business community, “failing forward” is often considered a sign of progress – companies make mistakes, they learn from them, and they find ways to improve. In global development, however, we often avoid acknowledging mistakes, in part due to fear of alienating donors.
In order to accomplish the seemingly impossible – such as ensuring clean water for everyone on the planet – we must be willing to innovate and try new approaches. In the process, despite our best efforts there is always the potential for failure.
This month we’re focused on learning from failure when it comes to clean water projects. Yet the same could be said of any other global development sector – healthcare, education, agriculture, human rights, etc. The more open and transparent we can be about what’s working and not working, the faster we can course-correct and have the greatest impact.
We call our members “Goalmakers” for a reason. With the UN Sustainable Development Goals in our sights, we have dedicated the next decade to helping our members accelerate progress toward a better and more sustainable future for everyone.
In this month’s newsletter you will read about an inspiring Goalmaker, Water1st’s Director of International Programs, Kirk Anderson, who has devoted his career to ensuring people have reliable access to clean water year-round. You’ll also read about WaterAid’s comprehensive approach to helping communities advocate for and implement self-sustaining water infrastructure. I also hope you’ll join us on April 25th for Failing Fast Forward, an in-depth conversation on this topic with our members: MSR Global Health, Splash, Water1st, and WaterAid.
Failing Fast Forward: Learning to Build Water Systems that Last
By Joanne Lu
Photo Credit: @R_Tee via Twenty20
For decades, we’ve heard that access to clean water changes everything. Not only does it improve the health of entire communities, it also gives women freedom to earn an income and children time to go to school, when they don’t have to spend hours walking miles every day just to gather water. That’s why global progress has been rightly celebrated: Between 2000 and 2015, 1.6 billion people gained access to clean water for the first time.
But according to the UN Children’s Fund (UNICEF), as much as 30 to 50 percent of water, sanitation and hygiene (WASH) projects fail after just two to five years, leaving recipients of the new wells, toilets or other projects back where they started – even worse off sometimes. This has led to calls for the WASH sector to be more upfront about failures and understanding what went wrong. Without learning from mistakes, we will miss the mark on Sustainable Development Goal 6: to ensure the availability and sustainable management of water and sanitation for all.
There are many reasons why water projects fail. But Kirk Anderson, director of international programs at Water1st, says the failure rate is not unique to the WASH sector. In fact, he says that most development efforts suffer problems with sustainability, simply because of the nature of aid.
In a market system, when buyers do not purchase faulty, poor or unwanted products, manufacturers quickly get the message that they need to either improve their product or go out of business. But in a donor system, the users are not the buyers. Therefore, unless the buyers (development organizations, in this case) are regularly asking the users for feedback – and the users are willing to give honest feedback about the gift they received – buyers often continue to fund and implement faulty, poor or unwanted programs.
Pit latrines are a great example of this. For countries like India that are making a strong push to eliminate defecation in open spaces, installing a pit latrine is a cheap and easy way to mark off another community as having access to sanitation. But pit latrines can smell so bad that many sit unused after just a few months. And once a pit latrine is full, who’s going to empty it?
Similarly, some clean water projects are simply insufficient. Water1st’s Founder and Executive Director Marla Smith-Nilson once wrote about how she visited the site of a sealed spring-water catchment chamber in Ethiopia that was supposed to be an “improved water source.” Yes, the catchment was a good way to protect the clean spring water, but the spring itself didn’t provide enough water throughout the year for the community. In additional, the water point wasn’t conveniently located for everyone in the community, which meant that some people still had to walk hours to get there. Then, they had to wait in line for several more hours, because the water trickled so slowly.
On the other hand, rain catchment systems – like the ones Hands for Peacemaking Foundation is installing in Guatemala – collect enough water during the rainy seasons to last households and communities throughout the dry seasons, without them having to walk hours to access it.
To make collected water safe for drinking, some organizations like Friendly Water for the World are teaching groups of people how to make Biosand Water Filters and set up businesses to sell them. The filters are essentially large buckets filled with layers of “specially selected and washed sand and gravel” that remove pathogens and suspended solids. Microorganisms in the sand can remove up to 99 percent of the pathogens. Up to 95 percent of dirt and metals and 100 percent of worms are also removed during the slow filtration process, according to Friendly Water for the World. The technology comes from the Centre for Affordable Water and Sanitation Technology (CAWST), a Canadian non-profit and licensed engineering firm. According to Friendly Water for the World, the greatest challenge is not the technology itself, but the social dimension – introducing the approach to communities and encouraging them to use it consistently.
The high failure rate of water projects is also often attributed to a lack of monitoring. The World Bank has estimated that less than 5 percent of water projects are visited after they’re constructed, and less than 1 percent are monitored long-term. This means that most organizations are unaware – or willfully ignorant – when a project breaks or sits unused. Many water systems are feats of engineering that need to be properly maintained, yet in many cases, no one has been trained on how to maintain the system, or spare parts are not readily available to fix it.
That’s why WaterAid, Water1st and others have centered their strategies on local sustainability. With strong input from local partners, these organizations first tackle the technical sustainability of their projects: Is the system easy to use and maintain? Can the technology be used anywhere in the world? Are the spare parts affordable and available locally?
Then, they also set up the local communities to keep the projects running. WaterAid works closely with local governments, as befits its belief that ultimately, it is the responsibility of governments to ensure that all of their citizens have access to water and sanitation services. Beneficiaries also contribute financially or in other ways at the start of projects to instill a sense of ownership.
In the case of Water1st, not only does the organization train communities on the technical aspects of independently maintaining the new water systems, but it also helps communities institutionalize payment of water fees. According to Water1st, when a project is owned and operated by the beneficiaries, they are motivated to keep it running. Water1st also routinely follows up on its projects to make sure they’re not only functioning but that other sociological issues – like hierarchies or conflicts within the community – are not derailing their success.
For years now, the business sector and self-help books have preached the concept of “failing forward” – that failure is inevitable, and ignoring it will precipitate bigger problems down the road, while learning from failure will propel us toward success and innovation. Unfortunately, the WASH sector – and international development as a whole – has been slow to embrace this mindset, mostly because of the risk that donors will pull funding if they admit failure.
But some organizations are starting to realize there is no alternative route to success. BRAC and Canada’s Engineers Without Borders are hoping to push the entire industry forward by publishing their mistakes in annual “failure reports.” At one point, Water1st, along with a host of other organizations, also developed a “Water for Life rating” that independently rated WASH programs on their long-term sustainability. Although the rating system didn’t take off – likely because organizations perceived it as a risk – Water1st believes it still has potential to propel WASH programs forward if donors were willing to support organizations that go through the process. Those that received a high score could be awarded a grant to keep doing what they’re doing, while those that scored poorly would be given financial support to fix the problems.
With 2030 fast approaching as the “deadline” for the Sustainable Development Goals, the WASH sector doesn’t have time to continue pushing its sustainability issues out of sight. Failing forward is the only way to “ensure the availability and sustainable management of water and sanitation for all.”
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Friendly Water for the World
Founded in 2010, Friendly Water for the World is a dynamic, rapidly growing, 501(c)(3) non-profit organization based in Olympia, WA. Its mission is to expand global access to low-cost clean water technologies and information about health and sanitation through knowledge-sharing, training, applied research, community-building, peacemaking, and efforts at sustainability. The organization empowers communities abroad to take care of their own clean water needs, even as it empowers people in the U.S. to make a real difference. Friendly Water for the World currently works in 15 countries, and has assisted more than 190 marginalized and oppressed rural communities – including widows with HIV, people with albinism, survivors of war-time rape, victims of domestic violence and sexual assault, indigenous tribes, and unemployed youth – ensure their own safe drinking water while becoming employed in the process. http://www.friendlywater.net/
Hands for Peacemaking Foundation
Many villages that populate the mountainous areas of NW Guatemala are continually faced with a daily struggle to obtain water for survival. Since most village locations were based on available land, and not by the availability of natural resources, they often lack basic water resources. Many water sources have dried up due to the over-harvesting of trees to be used for firewood – an example of the domino effect that one resource has on another. Hands for Peacemaking Foundation (HFPF) has partnered with villages to install water storage tanks. These simple but effective means to collect water during the rainy season are coupled with water filters to meet the basic needs. The resulting water system doesn’t replace a well or spring, but it does provide emergency water that can mean life or death for villagers. HFPF has included the introduction of forest management in its training and education of villages after the installation of catchment systems. To date, the organization has installed 448 water catchment systems and 226 water filters in 17 villages. http://www.handsforpeacemaking.org/
Mercy Corps
Mercy Corps helps people around the world get clean water by providing water during emergencies, building wells to reduce long treks (often made by vulnerable girls and women), repairing damaged water infrastructure and helping construct reservoirs to ensure communities have access to clean water in the future. In Zimbabwe, Mercy Corps restored a community’s water infrastructure to provide clean and safe water for over 43,000 people. In turn, this also significantly reduced the distance girls had to travel to collect drinking water for their families from 2500m to 80m. During emergencies, access to clean water plays a vital role in preventing disease outbreaks and other water-borne illnesses. In response to the ongoing humanitarian crisis in the Democratic Republic of Congo where three quarters of the population lack access to clean water, Mercy Corps has provided over 600,000 displaced people with safe drinking water to help keep their families healthy and prevent disease. In 2018, Mercy Corps connected more than 3 million people to clean water and hygiene and sanitation facilities during emergencies across the globe. https://www.mercycorps.org/
MSR Global Health
MSR is a leading innovator and manufacturer of low-cost, field-proven products that improve access to basic human needs for people around the globe. With 50 years of technical engineering and manufacturing expertise, MSR is developing technologies that increase access to vital needs such as clean water, sanitation, and hygiene. https://www.msrglobalhealth.com
Path From Poverty
Path From Poverty transforms lives and communities by working with rural women’s savings groups in eastern Kenya. Launched in 2000, the organization now comprises 52 groups with over 1,100 members. It provides training in leadership, group governance, small business development, finance management and community service that supports women to launch their individual or group income-generating projects and to pool group savings and purchase 10,000-liter rainwater catchment tanks. To show its support and encouragement for their hard work, Path From Poverty also sends eight “gift” water tanks each month to needy women. In 2018, Path From Poverty installed 191 rainwater tanks that now provide clean, safe water to over 2,000 women, their families, and neighbors. https://pathfrompoverty.org/
Splash
Splash is a nonprofit organization that designs child-focused water, sanitation, hygiene (WASH), and menstrual health solutions for governments in some of the world’s biggest, low-resource cities. Through Project WISE (WASH-in-Schools for Everyone), Splash aims to reach every school in Addis Ababa, Ethiopia, and Kolkata, India, with WASH infrastructure, behavior change programs, and strengthened menstrual health services, benefiting one million children by 2023. Splash’s approach to WASH includes high-quality water filtration systems, durable drinking and hand washing stations, improved toilets, teacher training, and hygiene education to ensure that kids learn healthy habits. This is accomplished through government partnership, supply chain development, local leadership, and other systems-strengthening activities. To date, Splash has completed over 1,700 projects at child-serving institutions, including schools, hospitals, shelters and orphanages. Splash reaches over 430,000 children a day in eight countries (China, Cambodia, Bangladesh, Ethiopia, India, Nepal, Thailand, and Vietnam). http://splash.org/
Water1st International
Water1st prides itself on funding sustainable water projects that involve local communities, local women, as well as a consistent funding stream. Since its founding in 2005, Water1st has provided clean water to over 188,000 people. While its projects focus on providing easy access to clean water, the organization also ensures that projects integrate toilets and hygiene education. Water1st’s success centers on robust program evaluation of each of its funded projects to ensure that deliverables are effective and community needs are met. http://www.water1st.org/
WaterAid
WaterAid is working to make clean water, decent toilets and good hygiene normal for everyone, everywhere within a generation. As the leading international clean water nonprofit, WaterAid works in 28 countries to change the lives of the poorest and most marginalized people. Since 1981, WaterAid has reached 26.4 million people with clean water and 26.3 million people with decent toilets. http://www.wateraid.org/us
World Vision
World Vision is the leading NGO provider of clean drinking water, reaching one new person every 30 seconds. Focusing on the rural, ultra-poor, combining access to clean water with sanitation and hygiene interventions and engaging communities in sustainability efforts, World Vision and its partners are committed to expanding their reach to one new person every 10 seconds with clean water and sanitation by 2020. With the use of right-sized equipment, appropriate water sources, manual drilling, mechanized wells with solar pumps and over 500 WASH professionals who live and work in the communities where they lead efforts, nearly 80 percent of World Vision wells continue to function at a high level after 20 years. http://www.worldvision.org/our-impact/clean-water
Molia Abdallah, 47, fills a bucket of water at the solar-powered water scheme being constructed in Chicoma, Nampula Province, Mozambique. Photo Credit: WaterAid/Chileshe Chanda
In most parts of the U.S., we don’t think twice about turning on the faucet or hopping in the shower. With infrastructure in place, it’s incredibly easy to forget that public utilities, engineering, and coordination enable access to fresh water for millions of Americans every day. But this kind of infrastructure is expensive to build and maintain, especially in parts of the world where governments are just beginning to prioritize water for their people.
Worldwide, 844 million people do not have access to clean water, UNICEF estimates. WaterAid, a global nonprofit is working to change this.
Established in 1981 by members of the U.K. water industry, WaterAid works to close the gap globally on access to clean drinking water, sanitation, and hygiene (referred to as “WASH” for short). The organization is now bringing water resources to communities in 28 countries, on three different continents.
“The emphasis was really on water supply in the early days, then coming on to sanitation and how to do that effectively, and now hygiene is a big focus, so it’s an integrated approach,” said Vincent Casey, WaterAid senior manager for water, sanitation and hygiene.
Access to clean water, sanitation, and hygiene is crucial not only for daily life but also for health. Every two minutes, diarrhea caused by dirty water or poor toilets kills a child under five years old. Casey says this is why WaterAid also focuses on toilets and hygiene practices in the communities where it works. Clean water alone does not impact the disease burden that exposed human waste can have on a community.
WaterAid has staff in 34 countries, including those where advocacy and fundraising work happen, like in the U.S. and the U.K.
WaterAid Burkina Faso’s Regional Learning Center Coordinator, Lucien Damiba, removes a water monitoring device from a borehole. Photo Credit: WaterAid/Andrew McConnell
A large part of the WaterAid model is ensuring that local and national governments recognize the crucial needs of their people for access to clean water. Casey said WaterAid works at all levels of government, from local communities to national policymakers.
“We work a lot with districts or local governments, so operation-wise not only the delivery of WASH but how you keep those benefits in place,” Casey said.
In other words, helping create national or district-level policies is important, but not sufficient. WaterAid also works with other NGOs and education and health advocacy organizations to ensure that they are including education about handwashing, good hygiene and sanitation practices. Each in-country WaterAid team works to influence policy, and sometimes directly implements water initiatives, as well.
Back in the 1990s, WaterAid helped introduce gravity-fed water schemes for large communities with thousands of people to get water. In each case, the organization created a structure to govern the new utilities. Casey used WaterAid’s work in Ethiopia, which began in the 1990s, as an example. After a management arrangement for a local water utility is recognized by the national government, this type of multi-village model can become a reality.
“That’s literally all the villages nominating someone to a board, and that board appointing an executive board to run the scheme, and then that executive board contracts mechanics and people who do financial management and revenue collection,” Casey said.
WaterAid evaluated these types of management models in Ethiopia over several decades, and the most recent evaluation from 2018 shows that they are still performing really well, Casey said. Such large-scale gravity-fed water schemes usually supply water from higher ground springs to lower ground areas. There are no pumps or complex equipment to maintain, making it an easier model to establish.
Mesay Garedew of Oromia, Ethiopia, was one of the most actively involved community members during the development of springs that channel water into the town’s distribution system using the natural force of gravity. Photo Credit: WaterAid/Behailu Shiferaw
Not all of the countries where WaterAid works can support these types of models, especially in rural areas where water is difficult to access underground, or may be contaminated with arsenic or high salinity. In these places, financial stability and investment are necessary. This is where political advocacy comes in.
“You have to be working to push government to take up its responsibility to ensure that everyone has access to these basic things. Governments are responsible for making sure that happens,” Casey said. “(In some countries) they’re not doing it and not delivering on it, and they need to. That needs a push not only from civil society but from individuals themselves, to demand better services.”
Part of WaterAid’s work is connecting water utilities and private companies with community water associations established in the countries where they work. These relationships are not just for financial support, but also to share best practices for sustainability of services.
“A good utility has to be able to have good cost recovery, a good billing system, and good revenue collection processes,” Casey said.
Those partnerships also support new water associations with challenges like reducing water lost due to infrastructure and figuring out how to improve efficiency.
While WaterAid helps find financing and investment for local utilities in the countries where it works, the organization also encourages governments to invest even more. Casey said leveraging government investment has worked in some countries, including Ethiopia.
At its best, WaterAid’s model enables the nonprofit to leave a country entirely. Casey said this is how the process is supposed to work if the job is done correctly. The key, he said, is establishing water utilities as professionalized services.
“It’s not just about building infrastructure, training a few people then walking away; it has to be a formal management model, which is legally recognized in the country and supported nationally,” he said. “And the problem is with a lack of resources, there may be legally recognized management models, but they’re not supported. So, they rely on various donor initiatives to provide the backup support to subsidize major maintenance.”
Ultimately and ideally, WaterAid wants to create a sustainable model for delivering water to communities with reliable funding sources before it leaves. Casey said the current challenge is in places where communities do have access to WASH, but suffer from very poor levels of service.
“People may have access on paper or be within proximity of a water supply installation, but the level of service provided isn’t necessarily very high,” he said. “It’s like a hidden crisis of poor service, poor water quality, long periods of service outage, long periods of service breakdown. It’s not simply a problem of lack of access—it’s beyond that.”
WaterAid has US offices in New York and Washington, D.C., with remote-based staff throughout the country, including in Seattle.
Kirk Anderson, Director of International Programs, Water1st
By Allegra Abramo
Chittagong, Bangladesh (2016) – Kirk Anderson poses with Israh Jahan, a young girl whose family lives in a low-income area in the city without access to clean water. Water1st worked with a local partner organization to help her family and neighbors construct this water system. Photo provided by Kirk Anderson.
As a young Peace Corps volunteer in Lesotho, Southern Africa, Kirk Anderson was hitchhiking to the capital when a United Nations truck stopped to give him a lift. He climbed in and found himself chatting with the undersecretary of health for Sub-Saharan Africa.
“What’s the most important health problem to address in this area?” he asked her.
She quickly replied, “It’s nice to have an easy question once in a while.” If every community had water, she told Anderson, 80 percent of her job would be done for her.
Her response matched Anderson’s experience as a middle school teacher in the country. When his community ran out of water in the dry season, kids didn’t come to school because they were waiting at the spring to fill a cup with water so they could make breakfast.
“Lack of access to water is really holding my community back,” Anderson realized.
Yet most water projects he’d seen had failed, in large part because governments and funders installed pipes and pumps, and then walked away — leaving neither the human capital nor financial resources to ensure they remained viable.
A decade and half later, when Anderson was working on salmon recovery for King County, he still wasn’t sure how development projects could be more effective than those he’d witnessed. Then his wife took him to a talk by Marla Smith-Nilson, who would go on to found Water1st. Smith-Nilson spoke about the importance of working through local partners who understand the subtleties of their cultures and communities.
“Oh my gosh,” Anderson thought. “That’s the thing that’s been missing from the projects I’ve seen.”
Anderson joined the fledgling Water1st, first as board chair and then as director of international programs. His wife, Jennifer Norling, was also an early supporter and today is Water1st’s director of development and communications. The organization provides ongoing funding and support to partner organizations that build and maintain water infrastructure in countries across Central America, South Asia and Africa.
“We call our projects technologically simple, sociologically complex,” Anderson says. “You need a local partner organization to tackle all those complex social issues.”
Communities are also motivated to keep the water flowing because they get a high-value service: Instead of a central hand-pump, projects include household water taps.
Families pay a monthly fee for the water they use. That ensures there’s money on hand to rapidly make repairs and hire plumbers and other experts when needed. Increasingly, projects are incorporating household meters to allocate the costs of operating the water system fairly and to encourage good management of an incredibly valuable shared resource.
Consistent funding from Water1st means organizations can retain staff and continue to build their expertise, Anderson explains. It also allows them to translate lessons learned into improvements. In Honduras, for example, the partner organization agreed to add meters only after five years of working with Water1st; now all new projects in the country have meters.
The 14-year-old organization has also learned from its failures. In Ethiopia, Water1st initially funded an organization to put in community water points. But those aren’t selling much water, Anderson said, indicating that people are using it only for cooking and drinking, and not to improve their hygiene.
A community tap is what Anderson calls a “marginal improvement.” While it provides a source of clean water, people still must waste time traveling and waiting in line. Moreover, once people have to travel more than about 100 meters, water use — and with it, hygiene — falls dramatically.
“I don’t want my mom walking 100 meters and carrying water back to her house every morning, so that she can cook, drink, clean the house,” Anderson says. “That would be a problem for me, so why would I build a problem for someone else?
Instead of wasting money on marginal improvements, Anderson argues, invest in real solutions from the start.
Water systems that reach all the way into people’s homes are a cost-effective solution, Anderson says. They allow families to install flush toilets instead of latrines that attract disease-spreading flies. They also encourage people to bathe frequently, which is especially important in places where people have frequent contact with livestock, soil and sick children.
If you build solutions that people love, they will keep them going, Anderson says. “Because they remember what it was like to carry water, so not carrying water, that’s a big motivator. They remember what it was like to have a latrine, so keeping your toilet working, that’s a big deal.”
Lesson learned: In Ethiopia, Water1st is now working with its local partner to install household taps.
Anderson says he’s astonished how hard people will work to build effective solutions. He recalls spending a day helping dig a trench for a pipeline in Honduras. “I imagine looking 5 miles down the road to where the community is, and looking at how little I accomplished in one day, and thinking, ‘Are we going to complete this in my lifetime?’”
Yet “they don’t give up,” Anderson says. “If you are willing to work that hard, I’ll invest in that.”
Introducing Project WISE (WASH-in-Schools for Everyone)
By Cyndie Berg, Director of Business Development, Splash
11 year old Kidist uses the water station at her school in Addis Ababa. Photo credit: Gavin Gough for Splash.
In March, Splash’s Seattle office hosted two of its leaders from Ethiopia: Dawit Alemishet, Country Director, and Kelbessa Wordofa, Director for Project WISE (WASH-in-Schools for Everyone). They were in town to meet with colleagues planning the launch of Project WISE (WASH-in-Schools for Everyone), an initiative to reach every government school in Addis Ababa, Ethiopia, and Kolkata, India, with WASH infrastructure (water storage, filtration systems, drinking and handwashing stations, and improved toilet facilities), as well as behavior change programs for children and adults, and strengthened menstrual health services for girls aged 10 and above.
Splash has reached 79 schools serving 78,000 children in Addis Ababa, and 194 schools serving 55,985 children in Kolkata. Through Project WISE, the organization expects to reach approximately 1,600 schools serving one million children by 2023.
Splash’s efforts will benefit even more children like Kidist, a fifth-grader who is 11 years old. Kidist is very pleased about the improvements that Splash has made at her school. She especially loves the different colored drinking and handwashing stations and is attracted to wash her hands and drink from them.
In the past, she and her brothers used to bring water from home, but it was never enough to last all day. As Kidist explained, they couldn’t bring a very big bottle of water, since her parents don’t have access to water in their home and needed to source water from the neighborhood tap. Sometimes her brothers finished their water before lunch, and she would share her own half-liter bottle with them.
Thanks to Splash, Kidist and her brothers and all the other students can access clean water at school all day long.
Please welcome our newest Global Washington members. Take a moment to familiarize yourself with their work and consider opportunities for support and collaboration!
Heifer International
Heifer’s mission is to work with communities to end hunger and poverty and to care for the earth. heifer.org
Don’t miss your chance to attract new donors to support your organization. The deadline to register for GiveBIG is Friday March 29. By that day you also need to have paid your registration fees or you will not be able to participate. GiveBIG raised $16,500,000 last year. It is easy to register and once you are registered you can participate for free in the GiveBIG fundraising trainings with Ariel Glassman from Ostara. 501 Commons is also providing Fundraising Accelerator to help you mount a successful campaign. Every two weeks 501 Commons will send you specific actions you can take to prepare for GiveBIG.
Mark Your Calendar
April 19: Last day for profile changes
April 23: Early Giving begins
April 28: Seattle Times Giving Guide published
May 7: Early Giving ends
May 8: GiveBIG!
If you have questions or need assistance contact 501 Commons by phone at 1-833-962-3615 or by email at givebig@501commons.org
For Heidi Breeze-Harris, working in the global health sector may not have been an obvious path, but in retrospect, it makes sense. Thanks to the trips that she and her mother saved up for every summer, and growing up with a diverse extended family, Breeze-Harris has always had a strong connection to the international sector. “Because I started traveling to pretty out of the way places when I was young, I was comfortable in those settings,” she says.
Americares is planning to deliver medicine and relief supplies to Odisha this weekend, including tarps, water cans and water purification tablets for up to 3,000 families. Americares India, based in Mumbai, also has medical teams on stand-by, ready to provide primary care services and treatment for minor injuries. 
