Bowling, T, 2012 –– A tray full of money is not worth a mind full of knowledge: Taking outcomes to impacts - the art of integrating WASH and nutrition in resettled villages in the Lao PDR
Tari undertook her final project in Laos as a professional placement adopting the role of integrated WASH-Nutrition coordinator with the Theun-Hinboun Power Company (THPC). Her project targeted Nongxong, a village relocated as part of a hydropower expansion program, known as the Theun-Hinboun Expansion Project.
Tari’s work focused on how to improve village health and child and maternal nutrition rates. In Nongxong, these were not improving as rapidly as hoped, despite considerable investment in water supply and sanitation hardware plus additional support programs and services.
Key findings identified the need to focus on the gaps between outcomes (access to improved water and sanitation; increased income) and the impact of reduced under nutrition, anaemia and diarrhoea rates in project-affected villages. The principles of IWM were used to analyse these gaps, highlighting the important difference between safe water at point of supply and safe water at point of consumption, and the critical need to focus on the latter.
There is an increasing push towards CLTS (Community-led Total Sanitation) as a method of a non-subsidy approach to water, sanitation and health outcomes in the Lao PDR, one of the most impoverished countries in South East Asia. There is strong advocacy for non-subsidy approaches to WASH programs at both the national and international level, and understandably so. In many situations governments, local organisations or NGOs would be unable to fund such resource-intensive programs; partial subsidy of selected ‘pilot’ households has the potential to lead to community disharmony; and a non-subsidy approach has the added benefit of creating ownership over water and sanitation facilities.
The question facing Tari was: "What approach do you take when a company is obliged by its concession agreement to fully fund the installation of water supply and sanitation systems?"
Private companies, depending on where their funding comes from, have obligations and responsibilities towards ensuring that communities do not suffer any negative impacts as a result of resettlement or company activities, particularly for health and livelihoods. In many cases there is a national or international expectation that these organisations will provide for the impacted community’s needs, but how do you create ownership through a process of infrastructure provision that inherently takes ‘ownership’ out of the communities' hands?
Tari (front right) at a livelihoods demonstration day looking at different rice crops
Tari’s final semester project took place in the province of Bolikhamxay, approximately 4-6 hours (depending on your chosen form of transportation) from the capital city of Vientiane. CLTS was not an approach suited to this particular situation. THPC had provided the infrastructure, digging new bore wells and piping water to each individual household: water quality met the Lao government's standards for rural water supplies, every house had a toilet and incomes had increased; yet general health was not improving as expected in this particular village. Nutrition rates still lagged and preventable health problems persisted, particularly in poorer households. Ultimately, improvements in water supply and sanitation had not resulted in the expected impact of improvements in village and household health.
Through a recent (and ongoing) situation analysis carried out by members of the THPC Social and Environment Division, hygiene and behavioural norms surrounding sanitation and household water use were clearly identified as the dominant cause of contaminated water and food, with the obvious outcome of high levels of diarrhoea. Persistent diarrhoea critically reduces the body's ability to absorb nutrients, particularly in a rice-based diet, making any improvements in nutritional uptake of food obsolete if done in isolation from behavioural change associated with sanitation and household hygiene.
Tari (right) showing an SED staff member how to use the Delagua water testing kit
Having identified this, a new approach is being developed, tailored to the context of resettled villages that will integrate water supply, sanitation, household hygiene and water use, and environmental health and nutrition, applying the underlying concepts of the CLTS approach that seek to identify the emotive triggers best targeted to bring about behavioural change. This new approach will facilitate communities in understanding and identifying the risks to their health with a focus on WASH and nutrition, motivate individuals to drive change, and support communities in establishing what actions should be taken, by whom, and when.
The last three months of Tari’s time in Laos working on this project were exciting, somewhat confusing at times, very challenging, but overall, hopeful as she found herself in a company that realised this was not a one- or two-year project. Nor was it an issue that could be solved with infrastructure alone, but rather a community issue that revolved around behavioural norms, established over generations and not easily changed. Since Tari began working with THPC the company has adopted an integrated approach to WASH and nutrition with short- and long-term goals to complement infrastructure investment.
Following completion of the final project, THPC hired Tari as a consultant to coordinate implementation of the integrated WASH and nutrition approach.
All images courtesy of THPC - Jim Holmes