Water and sanitation aid to Afghanistan from Norway is not quite up to standards as a thorough review of several reports suggest. A major public health issue, open defecation, has not been combated adequately and the current efforts appear to be comparatively fruitless. The lack of follow-up studies and poor performances on hygiene education are major deficiencies in the Norwegian aid strategy that need to be addressed urgently before further steps are taken.
On May 21st the Norwegian government announced its plans to double the humanitarian aid volume to Afghanistan for the year 2016 in comparison to 2015. The 208mio NOK are supposed to significantly and sustainably improve the accessibility to food, water, shelter, health care and schooling, according to the Norwegian Government. The move was explained, by the fact that despite the discontinuation of the military operations, the country still faces severe lacks of basic amenities and will be in dire need of support for years to come.
On June 6th a commission appointed by Norway’s Ministry of Defence published a 200 page report evaluating the efficacy of Norwegian military and civilian aid from 2001 till 2014. The commission’s evaluation does not draw an all good picture for Norwegian efforts and it is therefore important, that the commission’s results are taken seriously and incorporated into the new strategies for Afghanistan.
Coinciding with these news comes that fact the Norwegian Ministry of Foreign Affairs has also decided that the Norwegian Church Aid (NCA) WASH programme will continue to be a key agent in providing access to clean drinking water. For the next three years the MFA agreed to giving a grant of 55mio NOK as a thematic contribution to water and sanitation within the NCA.
A report by NORAD stipulates that the main bulk of aid including the one earmarked for water went to the poorest and most vulnerable regions of Faryab, while remaining in reasonably safe zones of the country. The districts of Almar, Qaisar and Ghormach are mentioned as the main target districts all of which are considered rather poor within the Faryab province.
Drinking water, latrines and health education
Norway has allocated funds to different agencies all of which operated on relatively uniform principles. Firstly, the main target was to supply basic drinking water facilities, as the ongoing conflict since the late 70s has damaged the infrastructure to complete dysfunctionality and especially rural communities are left without any water supply. Mostly, basic hand-pumped wells, and filter systems for drinking water purification, were used to attain this goal. Secondly, on a much smaller scale the organizations were determined to install latrines in rural parts of the country to combat open defecation as it has become common practice and a major public health issue. Thirdly, education regarding the health benefits of personal hygiene was provided in order to make the target groups use the sanitation facilities regularly and correctly. To varying degrees a gender equality emphasizes was incorporated in the projects.
Building community wells in rural and otherwise very poorly equipped villages underscores the urgency with which water and sanitation facilities are needed. It was also taken notice of, that the in the past conflicts over access to water had triggered outbreaks of violence in local fights, working contrary to aim of pacifying Afghanistan. In order to avoid poor maintenance and power struggles over access to water all organizations consistently established community ownership schemes. No member of the community could make money of the water source, and maintenance plans and costs were shared, which apparently ensured that funds for it were less likely to disappear or poorly used.
Failed to combat open defecation
NORAD’s internal assessments criticise that the strategy to combat open defecation has not played out the way it was supposed to so far. First and foremost there is a lack of funds, which forced the implementing agencies, to build showcase latrines in scattered villages hoping that neighbouring villagers would attempt to construct similar structures in their own communities. This was not the case and a survey disclosing the reasons for the failure pointed out that extreme poverty and the subsequent lack of tools and material that was necessary to build a latrine were the predominant reason for why neighbouring communities did not build latrines of their own.
Difficult to implement hygiene routines
As pointed out above pivotal to this programme is the education of the target population, next to the provision of sanitary equipment, in order to permanently change their behaviour into using such equipment. Especially this behavioural change part has proven to be most difficult, as a plethora of reviews, reports and scholarly articles explain why communities often fail to make use of the equipment. The very core sense of hygiene is something so profound that it is hard to change. Reports suggest that communities that are told that they face risk of fatal diarrhoea if they fail to wash their hands before preparing and eating food, simply choose not to believe it based on their own experience of having survived with their current hygiene practice. Where latrines had been installed community members often chose to continue to defecate in the open because indoors defecation was considered dirty, and they are in discomfort with the odour if chlorine. Some surveys that included questions regarding this topic gave unreliable information, as the interviewees reported 98% that they were washing their hands more than eight times a day. This survey outcome suggests that such communities have heard about the importance of hand-washing and understood how important the matter for the implementing agencies was, but still chose not to follow the advice. NORAD’s report also states that Norwegian NGO support had at times been too confined to its thematic strategies, and unresponsive to the need of being flexible. It was pointed out that in order to achieve the thematic strategy NGO’s under the WASH programme had trained villagers without access to water, to wash their hands regularly.
Funds administered through NGOs
In contrast to a range of other aid recipient countries, the funds for Afghanistan are predominantly administered by NGOs or other organizations, but rarely given directly to a respective ministry. The biggest recipient; the Afghanistan Reconstruction Trust Fund (ARTF); a multilateral organisation operating under the World Bank used to receive earmarked support but since 2010 has the right to freely allocate the funds and thus spends 5% on water and sanitation. Next to ARTF, the Norwegian Church Aid (NCA) and the Danish Committee for Aid to Afghan Refugees (DACAAR) are key agents. The total financial commitment from Norway to water and sanitation in Afghanistan since 2001 amounts to 214 Mio NOK.
Between 2005 and 2011 the support through ARTF has helped building access to drinking water for 19% of Afghanistan’s household. As of 2014 approximately 46% of the households had access to clean drinking water. In connection with the other projects, such as the latrine building or education on germ spreading there have been over 10 Mio beneficiaries. It is important to note here, though, that while the amount of households with access to drinking water has risen significantly from 26% to 45% in Afghanistan overall, the commission’s report also states that in the Faryab region in which Norway has conducted its operations, the proportions has only risen up to 33% from 26% in 2007, indicating that Norway has performed comparatively worse at establishing access to drinking water.
An internal report states that the DACAAR mission had built 809 wells providing drinking water to 153.000 people, introduced a community based operation and maintenance system which performed 8500 inspections on water systems, installed 2950 bio sand filters for water purification, constructed 1420 latrines and helped distribute 21.300 hygiene kits as well as set up a water quality monitoring system.
While these achievements are formidable there are a range of issues that need attention. Support often wasn’t tied to a strategy or to specific targets by which an assessment board could measure how successful and sustainable Norwegian aid projects have been. An elaborate overall assessment is therefore hard to produce. Along the lines of this factor comes the second problem that no follow-up studies have been done, so the situation right now is not absolutely clear. The reasons for the failure to conduct follow-up studies is partially owed to the security situation in Afghanistan. With rapidly changing security situations it was impossible to visit the very rural communities in which the wells were built.
Education least effective
The multitude of reports surrounding the efficacy of Norwegian Aid to Afghanistan are the bedrock for an educated improved strategy. It is clear that the Faryab region is underperforming on water accessibility, thus a stronger emphasize is absolutely important. Consumption of contaminated water and otherwise poor hygiene are the main causes for diseases and, at times, fatal suffering. Through the use of well-seasoned NGOs funds were used relatively effectively and less prone to dwindle through corruption. The partner NGOs were however susceptible for being too inflexible in their operations in order to meet thematic goals. Aside from the short-comings regarding sustainability studies, the educational part of the WASH programme has been pointed out as least effective in numerous assessments of all organizations in Afghanistan, but also in other countries which currently receive assistance in the WASH sector. A re-tailoring of the approach by the implementing organizations should be considered. The use of sanitary facilities is completely jeopardised if the community refuses to use such facilities.