Health care facilities are meant to be places where people go to seek treatment for illness, not where they are at risk of contracting one. Yet, millions across the globe face an increased risk of infection if they seek treatment at health care facilities because of the lack of safe and improved WASH (water, sanitation, and hygiene). Many of these facilities are breeding grounds for infectious diseases and thus pose a major barrier to the overall health of individuals and positive health care treatment outcomes.
These problems have become even more evident over the past year as developing nations continue to battle the COVID-19 pandemic. WASH services are needed more than ever to protect patients and health care workers.
Recently, UNICEF, the World Health Organization, large development organizations, and national governments have made it a top priority to improve WASH in health care settings by doing a global assessment and making a plan of action to fix this atrocity.
A severe lack of safe water, sanitation, hygiene, waste management, and environmental cleaning in health care facilities across most low- and middle-income countries poses a huge threat to the health of patients, visitors, health care workers, and especially newborns and their mothers. According to recent reports from UNICEF and the WHO, an estimated 896 million people use health facilities with no water service, and another 1.5 billion use facilities with no sanitation service.
There are major issues worldwide with WASH in health care facilities in low- and middle-income countries, and in the Rorya District, Tanzania, where Maji Safi Group is already working to tackle WASH issues in many different sectors, the problem is huge.
The following specific WASH issues were found during a recent study done in Tanzania amongst 96 health care facilities:
Access to Clean Water
Access to consistent, clean, and improved water sources remains an issue throughout Tanzania for many health care facilities. Though most facilities in this study (81%) have access to an improved water source, others are still relying on water from rivers and shallow wells, which can cause major health issues. Only 51% reported that they have access to water most days, with other facilities receiving water only some days of the week or even only seasonally. Only 23% of the facilities receive water that is treated at the source, and hardly any have a system in place to regularly monitor the quality of the water they are using. The lack of clean water places these facilities at a much higher risk of contamination and the spread of water-borne and infectious diseases.
Lack of Sanitation
In these health care facilities, it is also very common to find significant plumbing issues with drain systems in sinks, showers, and toilets. Cleaning is often very infrequent, and some facilities have floors that are not cleanable. It was reported that only half of the toilets/latrines observed were free from foul odors and sufficiently clean for use.
Hand Washing and Hygiene
Another major barrier to hygiene in these facilities is the poor quality of hand-washing stations and a lack of sufficient materials to use. One in four health care rooms did not offer hand washing at the point of care at all, and the stations found were some of the most unclean and poorly maintained parts of the facility. Only 56% of hand-washing stations in consultation rooms had water available, and only 51% had soap. This is a major hindrance to clean, safe health care. If workers are not able to clean their hands properly, there is always an increased risk for bacteria and viruses to spread.
Unsafe Waste Management
In many facilities, there were major gaps and deficiencies related to sorting, collecting, storing, and disposing of health care waste products. This can be extremely harmful to patients, visitors, and health care workers. The lack of proper management of waste is often the result of poor training and supervision.
Lack of Environmental Cleaning
In many facilities, the overall environment was not clean and kept to a proper standard to ensure safety. Cleaning systems and practices were not in place to make sure that surfaces were cleaned, sanitized, and sterilized properly. Tanzanian HCFs lack specific standards for cleanliness, leaving those in charge with no guidelines or minimum standards to abide by. Latrines are often blocked, bathtubs are clogged and/or not regularly cleaned, and water systems often leak or are broken. Standards must be put in place to regulate cleanliness in these facilities.
Maternal and Neonatal Care
One of the primary areas where WASH issues are rampant is in maternal and newborn care. Each year, more than one million deaths are related to unclean births, including 26% of neonatal deaths and 11% of maternal mortality.
The overall cleanliness of labor and delivery rooms and the availability of proper hand-washing stations and sanitation practices are essential to the health and well-being of newborn babies and their mothers. Without them, there is a much higher risk for infant mortality and/or illness in the mother or baby.
Education & Health Care Workers
Much of the problem with WASH in health care facilities stems from a major lack of education and training for health care workers. There are no education requirements in Tanzania for health care attendants, and many do not receive proper training on the importance of WASH.
Patients are not educated about proper hygiene either. The study found that only 33.5% of the respondents were informed of essential hygiene behaviors upon arrival at the health care facility.
While there is a huge gap in education, many health care workers are aware that they are at great risk for infection because of unsafe WASH practices – 86% of auxiliary workers reported their concern about common infections, such as HIV and tuberculosis, being passed at their facilities, and 41% of workers said they often lacked proper personal protective equipment (PPE).
One of Maji Safi Group’s primary goals this year is to join the global movement towards improving WASH in health care facilities to complement our community-based education model.
Practical potential ways for improvement:
- Perform a baseline assessment in more than 20 health care facilities (HCFs) in the Rorya District.
- Partner with the District Medical Office and the Shirati KMT District Designated Hospital to create a 5-year plan for improving WASH in HCFs.
- Implement a WASH Facility Improvement Team (FIT) model with partnering HCFs and provide capacity building and infrastructural improvements.
- Advocate for the improvement of WASH in HCFs in the Rorya District and recruit partners from the private and public sectors.
- Monitor and evaluate the effectiveness of our interventions and share our learnings with other district and regional governments.
Over the past decade, Maji Safi Group has proven the tremendous power of interactive, community-driven education in combatting diseases and promoting healthy lifestyles. In 2021 and beyond, we hope to be on the frontline of educating communities about WASH through the HCFs we partner with.
The UN Secretary General, Antonio Guterres, said this: “Water, sanitation and hygiene services in health facilities are the most basic requirements of infection prevention and control, and of quality care. They are fundamental to respecting the dignity and human rights of every person who seeks health care and of health workers themselves. I call on people everywhere to support action for WASH in all health care facilities.”
Let’s continue to do our part.
Sources and further reading:
2016 Report PDF
In 2015, the UN set the Sustainable Development Goal of having safely managed water, sanitation, and hygiene (WASH) worldwide by 2030.
This hope has brought the direct need for these improvements to the forefront. Some two billion people have since gained access to improved water and sanitation sources. But the work to eliminate WASH issues is far from over – 700 hundred million people still do not have access to improved water sources, 2.5 billion do not use improved sanitation facilities, and 1 billion people still practice open defecation.
Poor WASH impacts children in unique ways and specifically affects child mortality rates. Children are especially susceptible to health issues from unimproved water sources because of their developing body systems – digestive, respiratory, lymphatic, etc. Their survival rates from disease are also much lower when basic sanitation and hygiene resources are compromised. Worldwide, 6,000 children die of water-related diseases every day.
The evidence to support a connection between child health outcomes and WASH conditions has often been limited and inconsistent, but recently, the development world has made a push to reexamine this relationship. The findings indicate that people with access to safe water and proper sanitation facilities have much lower risks of child mortality and diarrhea. Historically, the most profound data has been linked to the way poor WASH impacts diarrhea-based diseases among children.
WASH and Diarrheal Episodes
Children living in rural places plagued by WASH issues experience an average of four to eight diarrheal episodes per year between birth and age two. This suggests that they are exposed to a great number of pathogens during their first two years of life. Diarrhea globally accounts for 1.4 million child deaths per year. The World Health Organization suggests that 58% of these deaths are linked to unsafe water supply, poor sanitation, and lack of hygiene.
Children are at high risk of being exposed to these dangerous pathogens in public play areas as child play often occurs where soil and surface water have been infected with pathogens that cause serious health issues when ingested. Human feces is also a major contributor to soil-transmitted bacteria that cause diarrhea and other similar issues in young children. With the continual practice of open defecation in many communities, there are rich opportunities for children to ingest fecal bacteria, which leads to illness and possibly death. Data indicate that safer fecal disposal reduces childhood diarrhea occurrences by 37%. There is much needed work to do in ending open defecation and installing proper latrines and toilets for people to use in these communities.
WASH and Child Health Care
Another focus area in WASH that would improve overall child health and reduce mortality rates is improved sanitation in healthcare facilities. Having clean water and proper sanitation in delivery rooms and during health services for mothers and babies would help reduce childhood mortality. Fundamental hygiene during labor and delivery, such as cleaning hands and surfaces, reduces the risk of infections and death up to 25%.
There is a great need in Tanzania’s healthcare facilities for more WASH education. Workers must be taught the importance of proper WASH practices, and we must work to ensure the proper equipment is available for them to use.
Improving and Saving Lives
In order for children to thrive physically and cognitively in their communities, there must be better WASH practices. Fundamental education on things like handwashing, food preparation, and proper waste disposal saves and improves lives. For example, handwashing with soap can reduce diarrheal diseases by 42 to 47 percent.
Every year, close to 11 million children die worldwide before their 5th birthday primarily from preventable diseases, and another 300 million suffer from illnesses caused by WASH issues. Maji Safi Group’s mission is to help these numbers drastically decrease in rural Tanzania. Would you join us in saving and improving the lives of these children?
This graphic illustrates how the occurrence of frequent diarrhea negatively affects a child’s physical growth. The top curve is that of a child who has access to proper WASH and nutrition. The bottom curve illustrates how a child’s growth is reduced every time the child has diarrhea, and over time, the growth is significantly lower than it should have been. This graphic only illustrates how poor WASH impacts physical growth, but reduced cognitive development is of equal concern.
It was 1968 when I started my period, and I was only 12. At that point in time, menstruation and sexuality were not surrounded by total silence in my rural corner of Denmark, but our mothers were not exactly chirping out information about budding teenage sexual desires and menstrual cycles. Menstrual hygiene management was focused on educational factors, however, many of that occurred beyond the household. We read books, heard about it from older sisters, girl-chatted among peers, and felt the vibes from the feminists who were burning bras, going to nudist island camps with their sisters, and championing the flower-power attitude towards sex. But without a doubt, the schools deserve most of the credit for educating us and keeping us safe from teenage pregnancies.
In Denmark, schools are not only meant to ensure academic qualifications, but they also play an important ‘civilizing role’ in that they are expected to provide the opportunity for all children to grow up as harmonious, happy, and genuine people for whom it is natural to consider other people’s welfare (Laura Gilliam and Eva Gulløv, Making children ‘social’: Civilising institutions in the Danish welfare state, Human Figuration, Feb. 2014). Source
Part of this paradigm is giving all students a profound knowledge of their bodies, respectful sexual relations, reproductive justice, STIs, contraceptives, and yes, basic information on vital menstrual hygiene management. Feeling a little bit awkward and mighty curious, we started sex education in sixth grade, and it was made very clear that teenage pregnancies reflected utmost stupidity and irresponsible behavior as we now had the knowledge to avoid them. I think my generation of teenagers – boys and girls – was the first to have the privilege of being empowered to control our own reproductive lives and understand the intricacies of desire, consent, and sexuality – the first generation of teenagers that was not told to abstain from having sex, but instead enjoy it responsibly, so our young lives, careers and dreams for the future would not be derailed by unwanted pregnancies or emotionally scarring abortions. Instead, we would be part of building a strong self, strong family, strong community, and a strong country.
DEFINITION: Teenage pregnancy or teenage childbearing is when a girl aged 15-19 is pregnant with her first child or gives birth.
Denmark’s sex education curriculum and even menstrual hygiene management are now among the most progressive in the world, so much so that the sixth week of the school year is dedicated entirely to all things sex and relationships. ‘Sex week’ — a play on the Danish homonym for ‘six’ and ‘sex’ — provides progressive and ambitious sex education to hundreds of thousands of young people. It is run by Sex & Samfund (Sex & Society), a non-profit dedicated to improving sex education in Denmark. And it works! Source.
This graph clearly shows how drastically the number of teenage births (Teenagefødsler) has decreased since 1973, and the teenage pregnancy and abortion rates are very low as well compared to most other places, including the US and many European countries.
In 2017, only 474 children were born to teenage mothers in Denmark. The number of teenage pregnancies was, however, higher as some teenage girls chose abortion. In addition, the morning-after pill and pregnancy tests are available for over-the-counter purchase and very instrumental for early discovery of and prevention of pregnancy.
In the US, the birth rate has fallen dramatically over time as well.
In 2017, the CDC reported that a total of 194,377 babies were born to women aged 15–19 years, for a birth rate of 18.8 per 1,000 women in this age group. This is another record low for U.S. teens and a drop of 7% from 2016. Birth rates fell 10% for women aged 15–17 years and 6% for women aged 18–19 years.
The situation is very different in Tanzania. It has the 17th highest adolescent fertility rate in Africa, and according to the United Nations Fund for Population Activities, teenage pregnancy has increased 4% since 2010. In 2016, statistics showed that one in four teenage girls aged 15-19 had begun childbearing. In the Mara Region, where Maji Safi Group works, teenage childbearing is at a whopping 37%. Source
The many drivers and consequences of teenage pregnancy seem to be hopelessly intertwined protagonists in a vicious cycle, and their relevance to Tanzania seems taken straight out of a textbook: low education attainment, poverty (often resulting in transactional sex/prostitution), limited economic opportunities, gender inequality, male-dominated social norms, child marriage, and a dire lack of youth-friendly sexual and reproductive health services. It is also a huge problem in Tanzania that teenage mothers are not allowed to reenter the school system after giving birth.
When Maji Safi Group started working in Shirati in the Mara Region of Tanzania in 2012, menstruation was a taboo subject, and the access to female hygiene products and appropriate school bathrooms was so limited that menstruation contributed greatly to school absences and girls failing to succeed in school. We have helped change that!
Thanks to funding from private donors and grants from Beyond Our Borders and Dining for Women, we have built a nationally recognized Menstrual Hygiene Management (MHM) program that has taught thousands of girls about their bodies, puberty, menstruation, healthy relationships, etc., given them access to feminine hygiene products (pads, tampons and menstrual cups), and enabled them to look to our Community Health Educators as mentors with whom they can freely discuss and celebrate being young women.
Maji Safi Group’s approach is echoed in Tara Culp-Ressler’s suggestions of five simple strategies to reduce teen pregnancies:
1. Teach teenagers comprehensive sex education from middle school up.
2. Target messages to both teen boys and teen girls.
3. Involve the whole community.
4. Make contraceptives (especially condoms) widely available.
5. Encourage mentoring to create open discussion of sexuality and contraception.
This blog post is brought to you by Mekala Pavlin, a graduate student in Social Work at the Silberman School of Social Work in New York City, and Spencer Dirk, an undergraduate student in Public Health at Austin College in Sherman, TX. Mekala and Spencer were part of our 2019 cohort of practicum students from the US who spent a couple of months working with the MSG staff in the Rorya District. To learn more about our practicum program, please follow this link.
Mambo! As we are sitting on the porch of Maji Safi Group’s office on our second to last day here in Shirati, today’s cool and gloomy weather reflects our sadness about leaving on Friday. Shirati and Maji Safi Group are truly special, and from the day we arrived, we were welcomed into the Maji Safi family, immediately feeling comfortable and cared for.
As we reminisce, our thoughts go back to one of our first days in Shirati. Although still fighting back some jetlag, we were to spend the entire day with the Outreach Program. We had no idea where we were going, but we were happy to be invited and start our time here, so we hopped into the Land Cruiser, and off we went. Two hours later, we found ourselves in Guchuma. Our first stop was the local government office, where the Community Health Educators (CHEs) asked for permission to teach the local residents about WASH-related issues and diseases. The local representatives were welcoming and gave their hearty approval for the outreach initiative. Somehow, it was already lunch time. At a restaurant, we had one of our first traditional meals, consisting of ugali and fried fish. We absolutely loved the food and enjoyed chatting with the CHEs while we ate.
Then the work began. We were paired with two CHEs who approached a group of men sitting outside a butcher shop. We were amazed by the confidence the CHEs had as they started discussing cholera with the group. We were equally stunned by how happily we were welcomed and how engaged the men were. They asked thoughtful questions and genuinely appreciated the knowledge they were receiving from the CHEs. After the conversation, most of the men even purchased WaterGuard (chlorine tablets) for treating their home water supply.
Next, we approached a large group of women who were selling tomatoes, cabbage and potatoes at the local market. Community Health Educator Judith Mbache started discussing urinary tract infections (UTIs) and fungal diseases with the women. We were impressed with her ability to instantly command the attention of the crowd and how she used humor mixed with personal experience to connect with her audience. Again, we were amazed by how responsive the crowd was to this sensitive subject. They asked great questions and were eager to learn more. We kept thinking how differently people in the US would have responded if stopped for a conversation of this nature on the street or at a market.
As the day wrapped up, and we waited for the other CHEs to finish, we shopped with Judith and Rosa for sugarcane, sardines and school supplies. As jetlag really hit, and we were dozing off during the car ride back to the office, the car unexpectedly broke down. We found seats on the side of the road under some papaya trees while waiting for a replacement part, chatting with Rosa for the better part of an hour. Considered how long we have been here, it’s interesting how much we can recall from our first days – it speaks to the incredibly memorable experiences we’ve had.
We both came into our practicum experience very interested in MSG’s Female Hygiene Program and curriculum. After expressing our interest in this area, Max and Dorothy explained that MSG had the opportunity to expand the Female Hygiene Program to six schools in the Serengeti Region. As part of this venture, baseline surveys were needed for female student participants, parents, community members, teachers, and male students. The surveys we wrote focused on assessing the knowledge these groups already had of menstrual hygiene management (MHM) and investigating methods to reduce both stigma and schoolgirl absenteeism related to menstruation. In order to write these four surveys for the five different target groups, we had to conduct in-depth research. We explored a variety of sources, many from world organizations such as UNICEF and Save the Children as well as smaller non-profit organizations in East Africa and other regions of the world. The volume of information available was large and took days to sort through. Once we had become familiar with published research on menstrual hygiene management, we immediately started drafting our own survey questions.
As the Serengeti Project includes giving out various menstrual products to female students, we realized that MSG could benefit from a comprehensive menstrual product pamphlet, describing all the different options women in the region may come across or use. This was a fun and interesting project that challenged us in many ways. Since we were already familiar with many of the products, it surprised us that it was so challenging to write step-by-step instructions for products that seemed so commonplace. We hope this how-to guide will help women navigate their monthly period more easily in the future.
Our time in Shirati with Maji Safi Group has been invaluable, and working on a project in an area that was unfamiliar to us taught us humility, the importance of relying on other people, and to think more deeply about our intentions. We will definitely miss buying passionfruit at the Monday market, the children that greet us screaming every morning as we walk to work, the endless chapatti (flatbread) and samosas we have had for dinner, the beautiful sunsets from Oboke Hill, and most of all the MSG staff’s friendly faces!
Erna Maj was born and raised in Denmark and immigrated to the US in 1978. She received her undergraduate degree in American Studies from City University of New York and her master’s degree from the University of Colorado in Linguistics and Teaching English to Students of Other Languages (TESOL). After raising three sons and working as a language teacher and translator for 20 years, Erna now volunteers her time to serve as Maji Safi Group’s Fundraising and Outreach Coordinator and Board Chair. Erna runs our Young Global Citizen Program and visits Maji Safi Group’s on-the-ground program annually.
Back in 2013, when Maji Safi Group was in its infancy, I thought I would help its young co-founders, Bruce Maj Pelz and Max Perel-Slater, by raising a bit of money, so I looked for dots that it made sense to connect.
During my first visit to Shirati in 2012, I volunteered at Tina’s Education Center every morning. I soon learned that the children had little to no exposure to art activities, so in cooperation with a couple of teachers, I started an after-school group where the children did art projects. The story of The Very Hungry Caterpillar became the first environmental print ever to hang on the classroom walls. At least temporarily! The building had no windowpanes, so there was so much dust on the walls that we had trouble getting the tape to stick. Every morning when I set foot on school grounds, students would come running to tell me that the pictures had fallen down – again! Even duct tape was not strong enough to make those pictures stick.
Fortunately, the idea stuck! This very informal group turned into Maji Safi Group’s After School Program where we teach proper WASH behaviors and disease prevention through art, singing, dancing, games, puzzles, word searches, etc. The After School Program now teaches roughly 2,000 students a year, and the knowledge the children gain makes it back into their homes.
The dots I connected was getting youngsters in the Boulder area to do projects with Maji Safi Group that would teach them about global issues, social responsibility, empathy, and helping others through personal effort and simultaneously raise money for Maji Safi Group’s After School Program.
Whittier International Elementary School became our testing ground for this idea when we ran our first Maji Safi Read-a-thon there in 2013. Read-a-thons are a win-win situation where participants improve their own reading skills and raise funds from sponsors who pay them for reading books. But the idea did not stop there! We started working with students in the leadership class at Casey Middle School on a regular basis; last year, Heatherwood Elementary jumped on the read-a-thon wagon; and this spring, water walks in three Boulder area schools helped raise money for Maji Safi Group’s very first Solar Powered Water Distribution Point (SPWDP) in Shirati.
In addition, board member and kindergarten teacher Alison Adams and retired teacher/librarian Diane Wagner have been instrumental to developing online resources for schools to use around World Water Day (March 22) and Global Handwashing Day (Oct. 15). This fall, we will add an equivalent resource for World Toilet Day (Nov. 19). These resources were created in line with the Boulder Valley School District’s academic curriculum and standards and offer an abundance of information and activity suggestions.
A project with our young global citizens typically starts with a class- or school-wide presentation where the students learn what life is like for a kid their age in Shirati, about the work Maji Safi Group does, and the project in question. Subsequently, information goes home (in English or Spanish) to all families along with the presentation in PDF format, so families can discuss the project with their children. This stage is a wonderful outreach opportunity for MSG as many families learn about Maji Safi Group, and once the students reach out to neighbors, grandparents, family friends, etc., the information reaches many corners of the US.
This spring, our Young Global Citizen Program blossomed like never before. Students, teachers, principals, parents and generous sponsors came together to learn about the WASH situation in the Mara Region and support our work.
The Whittier Read-a-thon
Founded in 1882, Whittier International Elementary School is a historic landmark and filled with traditions. It has been an IB World School since 2003, and along will all IB programs, it aims to:
Develop internationally minded people who, recognizing their common humanity and share guardianship of the planet, help to create a better and more peaceful world.
The 2019 Maji Safi Read-a-thon was the seventh annual at Whittier, so although young, another tradition has been established. Inspired by student council members again this year, 32 students read 450 books to improve their own reading skills and help the children in Tanzania. A huge number of Whittier students can tell you that ‘Maji Safi’ means ‘clean water’ in Swahili, and as the numbers show, Whittier has some amazingly dedicated readers:
Most books read: 75 (kindergarten student)
Most pages read:
6,092 pages/25 books (2nd grader)
5,518 pages/13 books (4th grader)
5,498 pages/25 books (2nd grader)
The Heatherwood Read-a-thon
With strong support from student council members and second-grade teacher Nicole Martini, Maji Safi Group ran its second read-a-thon at Heatherwood Elementary where the students are also directly encouraged to care about their world:
Heatherwood Elementary’s mission is to educate students to be respectful, responsible citizens who persevere through challenges and who proudly and peacefully contribute, both intellectually and emotionally, to make the world a better place.
Every time I drove east this winter/spring to join a 7:15 a.m. student council meeting, I appreciated the students’ commitment and their early-morning smiles. There they were, eager to take down the information they were taking out to the classrooms about the read-a-thon, making posters to promote participation, and asking good questions about our work and the kids in Shirati. It was obvious that they took their young role in making the world a better place seriously, and so did the 54 readers who read 550 books.
Most books read: 30 (1st grader)
Most pages read:
6,045 pages/11 books (5th grader)
3,844 pages/20 books (3rd grader)
3,394 pages/13 books (5th grader)
Casey Middle School
Maji Safi Group’s relationship with the leadership class at Casey Middle School started back in 2013 when four eight-grade girls organized our very first water walk for their Global Improvement Project. Casey’s mission speaks to students taking interest in the world beyond Boulder:
Casey inspires students to be creative and critical thinkers.
Our students become engaged lifelong learners who are compassionate
and connected to our diverse, multilingual community and global society.
Over the years, Casey students have done a variety of projects with Maji Safi Group, including raising money for piloting Arborloo Toilets. This spring, they revived the wonderful idea of organizing a Maji Safi Water Walk. The enthusiasm came from six students who studied the WASH crisis, organized the event, and used posters and Casey TV to persuade 34 fellow students to stay after school on May 1 to rally around bringing clean water to a remote and impoverished community in rural Tanzania. Thanks to the Beleza Coffee Bar, we were able to fill recycled bottles that the 40 students carried around a half-mile loop on campus. Around and around they went for a total of 117 miles! Fatigue set in, but the smiles stayed big, and fortunately, the water from up above held off until we were done.
The Watershed School
This spring was the first time Maji Safi Group had the pleasure of collaborating with the Watershed School – a small private school in central Boulder. The school only has 100 students, grades 6-12. Their mission goes well with Maji Safi Group’s work:
To spark adventure and wonder, foster inquiry and community, and build the character and ability of students to take on the world’s greatest challenges.
Their students study real-world problems, travel and have logged thousands of service hours in locations that include the Silicon Valley, the Mexican-American border, the Pine Ridge Indian Reservation, Guatemala, and along the Front Range.
On April 11, the 6th and 7th graders – 28 of them and two teachers – set out to do a water walk to raise awareness in the Boulder community and money for Maji Safi Group’s water point in Shirati. Carrying gallon-sized bottles or buckets with water, they walked five miles. Along the way, they stopped to educate passersby at the Pearl Street Mall and the CU Campus where the annual Conference on World Affairs offered a perfect setting to raise awareness. The well-rehearsed elevator speeches they had created were effective and their enthusiasm contagious for the Boulder community to see.
The Flagstaff Academy
The Flagstaff Academy was, thanks to kindergarten teacher Alison Adams, another new partner this spring. Here, we were also working with students who are learning to care about the world community and helping others:
Our mission is to develop students who are equipped to be well-rounded, ethical leaders in the world community with a foundation based on science and technology.
On April 26, three kindergarten classes set out to carry gallon-sized water bottles a mile around campus. For a kindergarten kid, a gallon of water is a challenge, so they enlisted buddies from two 5th grade classes to help when those little arms and legs got tired. Ninety-nine students participated, and even Fuego the Dragon came out to enjoy the sunshine and help out. Fun was had by all – because helping others feels so good!
A huge thank you to all of our young global citizens who care about the wondrous world they live in!
We applaud and thank everybody who chose to be, or support, our young global citizens this spring – who chose to show empathy for kids half way around the globe and through personal effort, help them learn how to stay healthy and gain access to clean water. The students’ enthusiasm and fundraising vigor were impressive:
Whittier International Elementary students raised $1,720 from personal sponsors.
Heatherwood Elementary students raised $2,050 from personal sponsors.
Watershed School students raised $2,610 from personal sponsors.
Flagstaff Academy students raised $560 from personal sponsors.
Casey Middle School students raised $1,760 from personal sponsors.
In addition, community sponsors honored the Whittier readers with $2 a book, Casey alumni donated $270, and an anonymous sponsor pitched in with $5 per mile walked, $1 per book read by Heatherwood students, and a 100% match of all donations brought in by students from personal sponsors.
Grand total: $21,000!
Our Young Global Citizens’ smiles were big and their sense of accomplishment huge. They were not unsung-heroes! In their classrooms and at school-wide assemblies, they received much deserved recognition from their peers; from Maji Safi Group, they received stickers, wristbands, pins and thank you cards; from Ben & Jerry’s and Lindsay’s Boulder Deli, they received coupons for free ice cream; from Audrey Jane’s Pizza Garage, they received delicious slices of pizza; and from their sponsors, they received support for their efforts to help Maji Safi Group’s beneficiaries in Tanzania lead healthier lives.
To learn more about our Young Global Citizen Program, please contact email@example.com
It was Maji Safi Group’s pleasure to provide a one-week Menstrual Hygiene Management (MHM) seminar to our partners in the Rorya District to expand awareness and education about this vital subject in the Lake Zone of Tanzania. A very big thank you to our two wonderful facilitators, Water Supply and Sanitation Collaborative Council (WSSCC) trainer Ms. Dhahia Mbaga (East Africa WASH specialist and MHM trainer) and Mr. Steven Kiberiti (career health promotion specialist and national MHM trainer)!
Menstrual Health Management (MHM) is now debated worldwide, including in countries like Tanzania, as an important aspect of public health, as a basic human right, and as a development issue. While the Millennium Development Goals (MDGs) did not make any reference to MHM, the Sustainable Development Goals (SDGs) do so – at least indirectly – under Goal 3 (Good Health and Well-being); Goal 4 (Quality Education); Goal 5 (Gender Equality); Goal 6 (Clean water and Sanitation); Goal 8 (Decent Work and Economic Growth); Goal 10 (Reducing Inequalities); Goal 11 (Sustainable Cities and Communities); Goal 12 (Responsible Consumption and Production); and Goal 17 (Partnering for Goals). The United Republic of Tanzania (URT) is one of the countries that agreed to the implementation of the SDG development agenda in September 2015 and prioritized it in terms of gender equality strategies and the improvement of access to basic human services under the National Five-Year Development Plan (2016/2017–2020/2021). MHM is a crosscutting issue that involves a number of sectors in the development agenda, especially water, sanitation, environment, education, health, industry, information and communication. If the service provisions are improved in all sectors aforementioned, menstruating women and girls will have access to clean menstrual hygiene materials, access to private and convenient toilet facilities with water and soap for cleaning their bodies, access to washing and drying their reusable pads discreetly, and access to disposing of used menstrual products safely in designated containers. In addition, the existence of good healthcare facilities with competent health professionals will ensure that menstruating women with complications are served appropriately to guarantee their well-being and good health outcomes.
Despite tremendous MHM work done in Tanzania by MHM stakeholders, including development partners on training, continued advocacy work with policy makers, open dialogue to abandon certain socio-cultural norms that discriminate against adolescent girls and women during menstruation, information sharing, and exchange on progress made so far on MHM in this country, there are still challenges in terms of reaching all peripheral regions in Tanzania, especially the Mara Region. It is for this reasons that Maji Safi Group (MSG) in the Rorya District of the Mara Region, a member of the Tanzania MHM Stakeholders Coalition Group, requested two consultants, Dhahia R. Mbaga, WASH specialist and Senior MHM Trainer, and Stephen Kiberiti, Health Promotion Specialist and MHM Trainer, to facilitate an MHM Trainers of Trainers (ToT) workshop for its staff and their working partners to support the implementation of the new MHM program in the Rorya District. The training focused on a holistic MHM approach with three main components: Breaking the silence, managing menstruation hygienically, and finding solutions to safely reusing and disposing of feminine hygiene products.
The training took place in Shirati, Tanzania, April 1-5, 2019. It brought together 66 participants (21 men and 45 women) from the Rorya District Council, Department of Health, Education and Community Development Office, teachers from secondary and primary schools, health workers from hospitals in Shirati, local entrepreneurs from the private sector, staff from Maji Safi Group (MSG), and other non-government organizations working in partnership with MSG in the Rorya District.
The new cohort of 66 National MHM Trainers of Trainers (ToT) joins two other groups that were trained from 2017 to 2018 with funding from the Water Supply Sanitation and Collaborative Council. Involved were: representatives from NGOs and CSOs, the education sector, the health sector, the water sector, members of parliament, participants from higher learning and research institutions, the private sector, media, and people living with disabilities. It is expected that the trained MHM ToTs will pass on the training obtained to their respective workplaces, i.e. districts, wards, neighborhoods, health centers, schools, faith-based organizations and congregations, local entrepreneur groups, youth groups in Shirati, and individual households.
The MHM ToT training objectives were:
- to create a cohort of trainers with knowledge and skills on inclusive WASH and MHM, who in turn will train others in workplaces, districts, wards, neighborhoods, and health centers as well as teachers, students, and peers;
- to gain knowledge and skills to address the challenges on Menstrual Health Management based on different training modules presented and visual aids used for training;
- to provide the opportunity for participants to bring positive changes, equity and non-discrimination to access to water, sanitation and hand washing to promote menstrual health management in the community;
- to support the Government of Tanzania with the implementation of National Health Policy, National WASH guidelines and other policies with strong links to MHM to ensure safe, sustainable and inclusive sanitation and hygiene for women, men, girls, boys and vulnerable groups; and to support government and partners in providing sustainable, inclusive MHM education with consideration of equity and non-discrimination to vulnerable and marginalized groups by changing mind sets at the national level.
Lessons Learned from the Training
The lessons learned from the MHM ToT Training were:
- The training was organized around a three-pronged approach: breaking the silence, safe and hygienic management, and the safe and hygienic disposal and reuse of feminine hygiene products. It was key to address the dignity of both women and girls and secure positive health outcomes in the Rorya District.
- The strategic step of engaging male participants was crucial for breaking the silence as fathers and brothers in the society need to understand that menstruating women and girls have needs that require additional resources to allow for hygienic management, access to menstrual products, and sanitation facilities that can accommodate female needs during menstruation.
- The strategic engagement of both male and female youths in the training was a step further in the Rorya District in terms of creating change agents on breaking the silence on menstruation and seeing it as a natural process, similar to wet dreams for adolescent boys, and therefore supporting adolescent girls during menstruation.
- Lack of appropriate information on menstrual management to adolescent girls prior to menstruation and delegation of parenting to aunties and grandmothers do not promote an enabling environment for girls to be open about menstruation.
- It is important to address gender inequalities in water and sanitation to ensure access to water services and user-friendly sanitation designs that can accommodate all age groups, are inclusive to people with disabilities, and can fulfil the needs of menstruating women and girls.
- Descriptions of first menstruation experiences shared during the training were associated with feelings of embarrassment, discomfort, shame and confusion, and they were characterized by pre-conceived notions of menstruation by peers and socio-cultural beliefs. We envision that with appropriate menstrual hygiene management education – both before and after the onset of menstruation – adolescent girls will change their perception of menstruation.
- Menstruation is still surrounded by myths, taboos, silence and secrecy across various cultures in Tanzania, especially Luo, Haya, Hehe, Kerewe, Simbiti, Kurya, Chaga and Sukuma, so there is a need to demystify those menstruation-related myths and taboos that compromise the dignity, well-being and safety of women and girls.
- During the training, it was noted that menstruating women and girls make diverse choices of menstrual products, including commercial products. However, the traditional reusable pads are widely used, so with support from Maji Safi Group, there could be a good business opportunity for a trained female entrepreneur group to make reusable pads that are safe for menstruating women and girls.
- It is important for Maji Safi Group to keep strengthening the collaboration with the District Council to mainstream Menstrual Health Management in district development plans and spread further training to other departments in the district, wards, schools, workplaces, institutions and among out-of-school youths.
- Evaluation carried out at the end of the training revealed that the Menstrual Hygiene Management Lab was the best tool and most liked by participants. In lieu of that, MSG could consider purchasing a mobile MHM Lab Tent that could be set up during Global Water Week, Toilet Day, MHM Day, national events, workshops, conferences, community meetings and market days. The MHM Lab could engage a large number of participants in a short period of time and provide an opportunity to transform menstruation issues from shame to pride.
Brynn Berry and Jessica Gannon are both master-level students from the Brown School of Social Work at Washington University in St. Louis, an MSG partner since 2013. Jonathan Berry is a graduate of the Mortenson Center for Engineering for Developing Communities at CU at Boulder. Jonathan is providing technical support for the Arborloo Toilet grant Maji Safi Group received from Friends of Tanzania. Brynn and Jessica have contributed greatly to the artistic aspect of MSG’s work with spreading awareness about preventing disease and adopting healthy WASH habits.
My name is Brynn Berry. My friend Jessica and I have been working in Shirati since August and have the privilege of working with Maji Safi Group (MSG) until the end of December. My husband, Jonathan, has also been able to join as a volunteer for MSG’s Arborloo toilet project.
Most of my work at Maji Safi Group consists of editing, curriculum design, and various art projects. However, before elaborating on my work, let me introduce you to someone much more talented than me.
MSG currently employs a local Tanzanian artist named Jacky. Jacky is a brilliant illustrator, succeeding to capture the culture and vision of the community in his work while providing a visual platform for the dissemination of WASH education. Jacky’s work decorates the Maji Safi office, local hospitals, and primary and secondary schools in the area.
MSG aims to complete six more murals before the end of the year. Jessica and I are assisting in the creation of one mural at the local Katuru Secondary School. The mural will serve as a learning tool for students and community members passing by. I also plan to assist Jacky in the planning stages of the creation of additional murals.
The planning process for mural design is structured to allow a variety of stakeholders to voice their ideas. This participatory approach allows for bottom-up inspiration.
Step 1: MSG’s Community Health Educators (CHEs) provide a list of suggested images/values to be painted.
Step 2: Jacky or I create a sketch of what a mural could look like based on the CHE suggestions.
Step 3: Artists invite MSG staff to interpret the mural. This stage reveals any changes that need to be made. This stage was particularly valuable to me as it highlighted several cultural differences that were revealed in my artwork. For example, a common menstrual care product used in Shirati is kitamba (cloth in Swahili) which needs to be included in female hygiene education.
Step 4: Artists edit and revise drawings.
Step 5: CHEs label and narrate mural in Swahili.
Step 6: MSG presents the sketch to school/hospital administrators and choose a wall for the mural.
Step 7: Artist, mainly Jacky gets to work.
In addition to mural design, I am busy creating educational booklets that will be used for menstrual hygiene management programming. Maji Safi Group is excited to announce that we have received a grant from Dining for Women, a global giving circle that funds grassroots organizations, to introduce menstrual cups (kikombe cha hedhi) to the Mara region. Menstrual cups will be purchased from a local Tanzanian distributor, and booklets will be given to girls receiving the cups. My work involves content development for the booklets and graphic design work to illustrate the pages.
The design process is fun and exciting. It demands a conscious effort to create culturally appropriate images and communicate WASH education in the best way possible.
Thank you for your incredible support and interest in our work here at Maji Safi Group.
Naomi Chang is currently getting her Master in Environmental Engineering at the University of Colorado at Boulder. At CU, Naomi is part of the Mortenson Center in Engineering for Developing Communities, and unlike most students in her program, she wholeheartedly believes in the importance of hygiene education. This is largely due to experiences from living abroad during her service in the Peace Corps from 2014 until 2016. Our common interests led Naomi to MSG for her summer practicum experience. Naomi also received a Boren Fellowship to improve her already seasoned Swahili skills by working with MSG’s staff on a daily basis.
Tanzania holds a special place in my heart. I spent two years in a rural village in central Tanzania as a math and science teacher, creating bonds with students, teachers, and other community members. So, when I was given the opportunity to come back to Tanzania and work with Maji Safi Group, I immediately jumped at the offer. As the time came closer to my arrival in Shirati, I became more and more nervous ̶ afraid that my previous experience was unique, and I wouldn’t be able to connect with the people of Shirati like I did with those in my old village. I was so wrong!
I immediately felt welcome in the Maji Safi family, with several Community Health Educators (CHEs) treating me like a daughter and others like a sister. Not only were they welcoming, they were dedicated and passionate about their work. I was able to participate in almost all the programs offered by MSG, watching firsthand as the CHEs took the time to fully explain waterborne diseases and their symptoms, how to prevent transmission, and how to filter and treat water.
At one primary school, the topic for the week was menstrual hygiene management (MHM). I was curious to see how the CHEs would approach this sensitive topic, because I know it can be an uncomfortable topic for many. To my surprise and delight, the CHEs were able to create a safe space for girls and boys to openly discuss the topic of menstruation, while injecting humor into the subject. Boys and girls were called on to respond to questions and to demonstrate how to attach sanitary pads to underwear. This education is integral to normalizing menstruation for future generations.
MSG also has a great relationship with a school for children who are speaking/hearing impaired. The CHEs have adapted their lessons to better teach these students, and some CHEs are learning sign language to further facilitate the transfer of knowledge. In a country where people with disabilities face stigma, it is great to see that MSG has provided the opportunity for community members to interact and create relationships with them.
I also remember walking to Lake Victoria and getting lost on my way back. Thankfully, a young lady was walking to the Lake and offered to take me to the main road. While we were walking, she asked if I had swum in the Lake. I responded by saying I was afraid of getting bilharzia. She smiled and then launched into the symptoms and transmission of this disease. Shocked, I asked her how she knew all of this and she replied, “Maji Safi!” To me, this was further proof of the excellent outreach and educational programs that Maji Safi Group provides. To see that a random person was able to correctly tell me the symptoms and transmission of bilharzia shocked me and points to the efficacy of Maji Safi Group.
It is impossible for me to paint the full picture of the dedication and passion of each of the CHEs at Maji Safi Group, but my experience working with them for three months was an excellent reminder of why I chose to pursue a career in international development.
Yinran Huang completed her practicum field work for her MSW at Washington University in St. Louis with Maji Safi Group this summer. Yinran was born and raised in China where she received a Bachelor of Marketing and Management from the Shanghai University of International Business and Economics in 2014. After working for several years with different marketing companies in China, Yinran decided that she wanted to focus on social work and began her MSW in 2016. MSG enjoyed welcoming her to Tanzania, and we are excited to bring you her blog reflecting on her experience.
Have you ever wondered how MSG helps normal households gain access to safe drinking water, proper sanitation and hygiene in an affordable way? Well, here come the answers. With the partnership of AfriPads and Population Services International (PSI), MSG has introduced several cost-effective products for program participants and local communities, including WaterGuard, water filters, reusable sanitary pads, and Arborloo toilets (see our previous blog for more information).
In Shirati, lacking financial resources is one of the key barriers to implementing good WASH practices within household settings. Many people still drink untreated water and rely on crude, improvised materials to manage their menstruation because they cannot afford or access proper WASH products. Now, normal households in Shirati have more choices for getting clean water, cheaper sanitation solutions, and female hygiene products.
Let’s begin with water. In Shirati, accessing drinking water can be costly and time-consuming. Surface water sources, such as ponds, rivers and Lake Victoria, are usually free but unimproved/unprotected and often far from dwellings. Groundwater, on the other hand, is a much safer but a more expensive choice due to the cost of drilling the well. So, most people fetch water from surface water sources every day, and the most common way of purifying water is boiling. However, the sustainability of this method is questionable as the cost of firewood/charcoal/gas is high, and people must wait for the water to boil and cool down before use. Thus, WaterGuard and water filters offer normal households a more convenient alternative for water treatment.
WaterGuard is a chlorine water treatment tablet provided by Population Services International (PSI), Tanzania, and one of MGS’s recommended water treatment methods in Shirati. The chlorine tablets offer an alternative to boiling water. Chlorine is released when a tablet is dissolved to disinfect the water and prevent water-related diseases. Each tablet can treat up to 20 liters of water, which will satisfy a typical household’s minimum daily requirements for clean drinking water. Two tablets are needed if the water is very dirty. After adding the tablet, the water must sit for 30 minutes. WaterGuard is sold either by the strip with 10 individually sealed tablets (500 TSH = $0.25) or in boxes with 12 strips (6,000 TSH = $3). Thus, flexible purchasing choices allow consumers to access safe drinking water with minimal disposable cash on their hands, and WaterGuard is more time- and cost-effective than having to gather firewood or buy charcoal.
Ceramics Water Filters
The Maji Salama Ceramic Water Filter is manufactured and distributed by Safe Water Ceramics of East Africa (SWCEA). The Maji Salama filter tested at a 99.99% microbiological effectiveness rate with a life of at least five years, according to SWCEA’s official website. The clay filter is placed in a food-grade plastic storage bucket with a spigot at the bottom for dispensing the filtered water. With a rate of 1 to 3 liters per hour, depending upon the volume of water in the filter, a single filter can provide enough safe drinking water for up to 6 people. In MSG’s office, several water filters provide a safe, reliable, and convenient drinking water resource for all staff members and program participants.
Female Hygiene Education and AfriPads
MSG noticed that the poor hygiene situation in Shirati is exacerbated by a lack of knowledge about menstruation and the use of poor solutions, like rags, instead of proper feminine hygiene products. In response, MSG’s Female Hygiene Program promotes proper menstrual hygiene management (MHM) education through culturally sensitive communication. The program is active in several primary and secondary schools in the Rorya District, and a small group seminar is held every Saturday afternoon at the MSG office. The classes give adolescent girls the opportunity to discuss female hygiene-related experiences and ask questions in a safe and supportive environment.
By educating adolescents, MSG plays an essential role in also educating adults and the community in general. Children and adolescents serve as agents for change because they take the knowledge and good practices learned from MSG’s Community Health Educators back home. Hygiene education is thus transferred from MSG’s programs to families and communities where many have no other access to formal education about hygiene and sanitation.
Maji Safi Group partners with AfriPads and introduces their reusable sanitary pads in the Female Hygiene Program as an alternative to disposable pads with at least two comparative advantages: affordability and waste reduction. AfriPads is a cost-effective and environmentally friendly choice. With proper care, the AfriPads can last at least 12 months. Instead of using 195 disposable pads, only four reusable sanitary pads can satisfy a girl’s needs for a whole year and thus help her save a significant amount of money.
Given the massive cost associated with healthcare, disease burdens, loss of productivity and labor capital, investing in WASH-related products will not only result in a large range of economic and social benefits but also be more cost-effective in the long run. MSG’s dedicated work gives people easy and affordable access to WASH supplies, resulting in healthier families and communities.