GROWTH THROUGH NUTRITION

INNOVATIVE APPROACH, SUSTAINABLE IMPACT

In response to the U.S. Agency for International Development (USAID) request for applications (RFA), Feed the Future Ethiopia Growth through Nutrition Activity (GTN) led by Save the Children (SC) and implemented in partnership with the Government of Ethiopia (GoE) has started in September 2016. GTN is a six-year (2016–2021) multi-sector nutrition and Water, Sanitation, and Hygiene (WASH) project which aims to improve the nutritional status of women, young children, and adolescents in Ethiopia. The project works with the Ministries of Agriculture; Health; Water, Irrigation, and Energy; and Education at all levels to strengthen institutional capacity and influence policy to improve nutrition. Save the Children leads the implementation of the project in collaboration with six international and five local partners.

The project goal is to improve nutrition and significantly reduce stunting by the joint implementation of multi-level, evidence-based interventions in livelihood and agriculture; social and behavior change communications; quality improvement of nutrition services; improved water, sanitation, and hygiene; and multi-sector coordination and sectoral capacity including pre-service education support. Cross-cutting elements of the project include rigorous monitoring and evaluation, consideration of gender issues, and convergence and layering with other partners.

PSI’s role in GTN is to increase rural customers’ demand for, and access to, affordable quality WASH products and services, particularly improved sanitation, through private sector engagement and to advise on private sector engagement to strengthen WASH, nutrition, and agricultural markets.

CONTEXT IN ETHIOPIA

Improved sanitation coverage of the country was very minimal before 2015, despite the effort of the government and other sanitation stakeholders. Those efforts resulted in major reductions in open defecation rates from 2000 to 2016, from 82 percent to 32 percent (DHS 2000 & 2016). However, many of the adopted latrines did not meet international standards for “improved” latrines. According to the 2016 Demographic and Health Survey (DHS) report, only 6.3 percent of Ethiopian households had the access to improved latrines.

PSI, by learning from those situations, proposed using a pure marketing approach through existing private sector partners. There was pressure from the Federal Ministry of Health (FMOH) at the beginning to use small and medium enterprises (SME) instead of the existing private sector partners. But PSI argued that using SME’s would limit the accessibility of WASH products for the target community and would hurt the sustainability of the intervention beyond the project period based on the experience from the preceding multi-sectoral nutrition project, ENGINE.

PSI proposed, designed, and implemented a market-based sanitation approach to enhance the coverage of improved sanitation in the GtN implementation woredas. The approach aligns with both the Government of Ethiopia’s (GOE) and USAID’s increasing emphasis on engagement with the private sector to effectively deliver sanitation services. The aim of involving the private sector in the WASH business was to make the intervention sustainable beyond the project implementation period since private sector actors are working for their income and community.

PSI has been implementing the WASH business component from GtN activity to make improved sanitation accessible to 100,000 people in the life of the project (LOP) period. The approach was promotion and demand creation of different sanitation products by developing marketing strategy; increased access for low-cost high-quality sanitation products by establishing an effective supply chain, providing the required capacity building training, and improving the enabling environment for WASH products’ marketing.

RECOMMENDATIONS

• To make the WASH business sustainable beyond the project period, it should be designed in a market-based approach using private sector engagement. In designing the market-based WASH products and services, the following three pillars should be up to standard and target the customers:

o First, Demand Creation through promotions with an appealing value proposition, tools, and approach

o The Second pillar is the supply side should have

an effective supply chain system,

various high-quality low-cost product and services options and

trained supply chain actors

o The Third pillar is creating an enabling environment to implement the WASH business

• Follow-on Nutrition and WASH projects should have budget for sanitation loans for business partners and consumers and room for sanitation subsides in a targeted and smart approach for the most vulnerable households.
• The budget assigned for WASH business in similar projects should align with the number of woredas where sanitation marketing will be implemented (focus on quality rather than quantity). A dedicated logistics service should be available.
• The health extension workers (HEWs)should be trained on the new sales approach.
• Advocate for consumable goods and drug shops because selling construction materials in shops with other WASH products is not effective.
• The government must increase the demand for improved sanitation in the country and improve some of the factors that make it harder for businesses to thrive in Ethiopia such as lack of intellectual property rights and protection, unwieldy business start-up requirements, lack of financing for enterprises, and consumers, high tariffs and taxes, the difficulty of repatriating profit, and limited access to foreign exchange currency.
• To reach the whole community in improved sanitation, there should be room for a smart and targeted subsidy approach to reach the poorest of the poor. Otherwise, the disease cycle related to sanitation and hygiene will continue.

Results and Lessons Learned

The GtN project’s marketing approach for WASH products and services through existing private sector business partners was very effective and successful. Through this approach, GTN has facilitated the sale of more than 20,000 sanitation products of varying types, over the life of the project. Most of the business partners working with the project are now selling WASH products in more effective and systematic ways. They have increased the type and quantity of products they offer, [inset 1 or 2 more examples of how they are selling more effectively]. Most importantly, they plan to continue running their WASH business after the end of the GTN project period. This ensures that the WASH business intervention will continue to yield results beyond the project period. The GtN WASH businesses have brought real change in the health, financial status, and everyday lives of communities across Ethiopia. It has been so successful that the Ministry of Health has revised its “Market Based Sanitation Guideline” to fully support our approach. GTN has distributed the guideline and training manual to each GtN WASH business implementation woredas and zones for them to use these valuable documents in implementing their WASH businesses.

Conclusion

PSI created access to improved sanitation for more than 96,000 people through the life of the project, which improved the nutritional status of women, young children, and adolescents and reduced stunting. This impact was achieved by establishing a sustainable supply chain for WASH products; helping local businesses adopt and sell 13 different types of WASH products and services; improving the enabling environment for WASH business, and developing and implementing new and innovative demand creation strategies. PSI recommends that the WASH business be expanded during the follow-on project by incorporating some of the major recommendations indicated above. This will make the WASH products and services more accessible to the target communities and make the intervention sustainable beyond the project period.