KWAHO - Kenya Water for Health Organisation

KWAHO 1991 Evaluation Report

Original location: http://www.lboro.ac.uk/departments/cv/wedc/garnet/allcasewateraid4.html

The following summarises an evaluation carried out by independent consultants in April 1991 of work undertaken in Kenya by WaterAid

By Eric Abitbol

Evaluations Methodology
An evaluation was conducted in Kenya to assess the achievements of WaterAid's association with the Kenya Water for Health Organisation (KWAHO). The project stemming from this partnership has assisted village communities in obtaining nearby sources of clean water and receiving health education throughout Kenya.

The full evaluation team comprised Brian M U Bennell, B.Sc., F.I.C.E., Civil Engineer, Team leader, Anders Karlsson, M.B.A., Socio-economist, Brian Mathew, M.A., Water Engineer and Social Development Specialist, James W V Murage, B.Sc., Water Engineer and Justus Siboe, M.Sc., Sociologist. The team, two from WaterAid and two nominated by KWAHO, spent about ten days visiting projects throughout Kenya from April 2, 1991. Management aspects of the evaluation were examined at a different time by Management Economist Anders Karlsson, funded by SIDA (also asked to participate in the evaluation).

The team visited eight projects covering the full range of WaterAid supported activities: peri urban development, sanitation, pumped water supplies, gravity schemes, shallow tube wells, and rainwater harvesting. They undertook field trips to the Lake Region and to Tharaka, two regions which exemplify the major lines of KWAHO activities: direct support to projects, and support in the field of social mobilisation as a discrete input within the framework of an established project organisation. Excellent written background information was provided at each site by the respective programme officers.

Several days were then spent near Mombasa and in Nairobi report writing. A draft summary of the report was discussed at a meeting with KWAHO, chaired by Mr Aremo, Chairman of KWAHO, on April 17. The team dispersed the following day.

Process and Progress
WaterAid's partner in Kenya, KWAHO, is an indigenous NGO formed in 1982 under the auspices of the National Council of Women in Kenya. KWAHO operates in close co-operation with the Ministries of Water Development, Health, and Culture and Social Services as well as other Kenyan NGOs. KWAHO projects are selected by a Programmes Committee of the governing board. They are generally located in deprived areas where available water is very scarce and distant and where infant mortality is high.

From at least 1983-1991, WaterAid has been collaborating with KWAHO on water development projects, beginning with the provision of a Technical Advisor (water engineer) to the Kenyan organisation. This relationship was formalised in a Memorandum of Understanding in 1988, on the premise "that a majority of Kenyans should have safe drinking water at a reasonable distance by the year 2000." In addition to providing the project hardware costs for the programme, WaterAid has provided funds required for head office and field staff, vehicles and running expenses.

WaterAid has played an important role in the development of health and hygiene education components of the programme. Positive effects have been felt throughout project regions of Kenya which have experienced significant improvements in the health and hygiene of residents and their communities. One exception has been to the supply of clean water and effective sanitation, health and hygiene education to the island of Mfangano on Lake Victoria, where infant mortality is the highest in Kenya due to pollution around the shores.

It is evident that WaterAid, by its steady financial and technical support, has played a significant role in KWAHO's development. The team strongly supports the continuation of WaterAid's association with KWAHO. The relationship is beneficial to both organisations and to the communities which are served by the projects.

Water and Technology
WaterAid has provided the services of a full-time water engineer for seven years preceding this evaluation. Technical support provided by WaterAid has enabled KWAHO to introduce appropriate technology in the implementation of their projects, notably the use of a hand-operated drilling rig (The Vonder Rig), the construction of ferrocement water tanks, the construction of appropriate latrine slabs, and the manufacture of sisal cement roofing tiles.

Peri Urban Project - Kibera, Nairobi
KWAHO co-ordinates the water supply inputs to this project which includes the construction of 14 public water kiosks. These include an elevated galvanised steel water tank with a capacity of nine cubic metres, connected to the main Nairobi system through a water meter. The tanks regulate the intermittent nature of the mains supply.

Rainwater harvesting-Kibwezi project
This project includes the provision of guttering and the construction of rainwater storage tanks at 46 schools in the area. The purpose of the programme is to provide sufficient water throughout the year for the pupils, both for drinking and for cooking their midday meal. The work is carried out under KWAHO supervision with the assistance of parents who excavate the pit in which the ground tank is cast, and provide sand for its lining. At the time of evaluation, this installation had been completed in 27 schools, of which 10 incorporated ferro-cement tanks above ground with a capacity of 30 cubic metres and 17 are below ground with a capacity of 75 cubic metres. It is possible that low lift pumps installed in certain schools may not be suitable, in that they are mounted at about 45 degrees to the vertical.

Mfangano Island Project
Shallow wells constructed on Mfangano Island were intended to respond to endemic cholera, dysentery, diarrhoea and billharzia found in the Lake water from which inhabitants draw their supplies. To provide sources of safe water for inhabitants who tend to cluster around the lake shore, a trial programme for the construction of ten shallow wells has been carried out but with very limited success. In almost all cases, the water was saline and unacceptable to villagers.

Kochongo-Kakola Project
Shallow tubewells using a Vonder hand-operated drilling and equipped with an Afridev handpump have been installed in Kochongo-Kakola, covering 61 villages. After a slow start, 23 such wells have been completed of which 17 are working satisfactorily. The remaining were fitted with pumps which were not correctly manufactured and have been returned. A further 38 are drilled and are awaiting pumps and the completion of pump stands. It is planned that a total of 90 wells and pumps will be completed during this phase of the project. A more recent agreement has also been entered into with UNICEF for the construction of a further 140 water points. Finance will be provided approximately two thirds by UNICEF and one third by WaterAid.

Ngusuria Project
In Ngusuria, villagers have laid 12 km of 50 mm diameter GS pipe to supply three villages from a spring and impoundment high up on the side of the escarpment surrounding the area. Service mains, storage tanks and break pressure tanks have also been installed serving some 25 stand pipes and private connections. The discharge from the spring often reduces to zero at the end of the dry season. In this event, supplies are provided from a deep, copious borehole in which an electro-submersible pump has been installed. This was unserviceable at the time of the visit. Arrangements to lift the pump and motor for repairs were being made.

Buguta Project
The Buguta project is located in the Taita-Taveta District near the Tanzanian border. The source of water supply for the villagers are two springs arising in the upper slopes of Kasigau mountain. A short main to a nearby village is supplied by the smaller of the two springs. The larger source is piped through 75 mm GS main about 18 kms to supply outlying villages. It terminates in an 80 cubic metre storage tank from whence smaller supply lines serve a number of villages where water kiosks have been installed. A total population of 10,000 is served by the system, together with about 5,000 cattle.

Subukia Project
Some WaterAid/KWAHO initiatives have been developed as pumped water supply schemes. Subukia's community is served from a deep borehole drilled and equipped by a farmer in colonial times with a Lister engine-powered generator and a submersible electric pump. WaterAid arranged for the overhaul of the original engine and provided a new submersible pump and switchgear. They also provided the pipes and fittings. A strong, enthusiastic water and sanitation committee organised the laying of the main pipeline to a 90 cubic metre capacity masonry storage tank and 8 kms of distribution mains servicing four kiosks.

With the exception of the Mfangano Island initiative, all KWAHO/WaterAid water technology projects have been very successful. Of particular note was the success of the Afridev pump which is easily taken apart and reassembled. This has been designed in Kenya, with international support in such a way that it can be serviced and maintained by village communities.

Recommendations
Towards improving the delivery of water and associated technical services in Kenya, it is recommended that WaterAid:

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Continue providing the services of its water engineer in an advisory and project monitoring role, to be extended over the full range of KWAHO activities;

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Consider a more robust semi-rotary pump on a trial basis in a small number of the next installations to be constructed in Kibwezi;

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Consider using Cansdale pumps on Mfangano Island, and closely monitor their performance; and;

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Arrange for additional pilot drillings to be made in Buguta, using a small diameter bore to find additional supplies. Advice from a senior hydrologist familiar with the region should be sought to select the sites.

Sanitation
Sanitation is at the forefront of KWAHO's efforts to improve public health. WaterAid funded projects in Kenya are involved in developing affordable, locally manufactured latrine components.

The evaluation team visited a large number of KWAHO/WaterAid constructed VIP latrines at schools where construction, siting and maintenance were generally good. In Kibwezi District, 27 of 46 installations at schools had been completed at the time of evaluation. Some schools have made a particular effort to keep their latrines clean with students directly involved, a practice which should be encouraged as part of the drive for health education in schools.

Community latrines were the most notable features of the Kibera and Buguta projects. Twenty-five double pit VIP latrines have been built and are being used and managed by their immediate communities in the Kibera Project. In Buguta, the seven women's committees had a laundry slab and bathroom cubicle built at their new water kiosks. These have also become a feature at some of the schemes in the Kwale project.

The conventional VIP latrine is too costly for most rural households in Kenya and the projects in Mfangano and Buguta were challenged in addressing the cost of long-term sustainability of component production. KWAHO has been seeking to address this problem by promoting intermediate technology building methods in these locations, with the assistance of the Intermediate Technology Development Group (ITDG - UK). Through the promotion of appropriate technology, both initiatives are bringing the essentials of basic sanitation at a cost of œ2, initially within the grasp of the ordinary household budget.

In the Kibera Latrine Evacuation Pilot Project, KWAHO was involved in providing management and software support, such as office running expenses, field staff salaries, community development and health education. This was part of a pilot project to test a latrine evacuation vehicle developed by the British Building Research Establishment and Manus Coffey Associates of Ireland, and provided by NORAD.

The entry point for this project was through a community development project which covered care for the elderly, family planning and support for women's groups. The latter are involved with the construction of community VIPs, community health education and community-run water kiosks. This formed the backdrop to an attempt to develop a self-sustaining method for the emptying of latrines in Kibera. Because there is little space for the construction of new latrines and little incentive for the majority of residents who are tenants to even build if the space were available, there is a need to extend the life of those latrines which are in use. The project now does this by emptying the latrines at a charge of Ksh150 per load.

Between July and December 1990, 607 loads were collected from 385 houses and 71 public latrines, an average of about three and a half trips per day. The population benefiting from this service over a two year cycle is estimated to be about 40,000. There is undoubtedly a very real need for this type of service in a high density shanty town. This project will provide a valuable model for further development.

Recommendations
Towards increasing access to improved sanitation, it is recommended that WaterAid:

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Promote the reinforcement with chicken wire of latrine slabs that are likely to be transported over rough road;

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Promote the building of correctly shaped covers to be fitted to both the vent hole and inlet to those latrines that do not have the full VIP type superstructure; and

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Develop a sustainable system for latrines to be emptied every two years or so.

Hygiene Education
The overall aim of KWAHO/WaterAid projects to improve the sanitation and environmental health of poor communities in Kenya is being achieved on a sustainable basis. This is being done not merely by implementing infrastructure improvements but also by means of community health education and community involvement. Thus it is raising the consciousness of people so that they comprehend the need for such improvements and then have the means, through self-help and appropriate technology to reach these new goals.

Using an adaptive approach, KWAHO developed a well conceived and executed health education programme. Target groups have ranged from women's committees, project community committees, project umbrella committees and ordinary community members, to schools and outpatient classes. The communities have been consulted and involved in this effort so that the projects do truly become community projects. KWAHO staff have acted as advisors and animators in the community rather than conduits for materials passed down from above.

A number of local women continue to be trained and employed as Water and Health Assistants (WAHAs). They remain in the village and conduct training sessions at regular intervals and are important pillars of the hygiene education component of the initiative.

On Mfangano Island, an intensive programme of health education and latrine development has been carried out. It is reported that the villagers are now beginning to accept the fact that the source of their ill health is the lake water. This is a major effect of the programme since the Island has a poor record for health and hygiene with respect to villagers' use of the lake.

Innovative training materials in the form of illustrated booklets in the main local language have been produced and circulated to village families. A major effort has been made to ensure that they are clear, understandable, enjoyable to read and perhaps most important of all, culture specific. The focus of the material is on basic home cleanliness, the causes of water washed and water-borne diseases, and hints on how to avoid them. They also address oral rehydration for people with diarrhoea and introduce the Ventilated Improved Pit (VIP) latrine and various alternative designs.

Ensuring relevance of the material, drawings and text are pre-tested up to three times in the target population before the final draft is sent for publication. It has been found that the books double as a reading aid since much of the population is literate or semi-literate and is constantly seeking reading material.

Health education material is used at several levels including schools, in general health education classes and in private homes. The objective is to reach as wide an audience as possible and to exploit the multiplier effect so that information is passed not only from project worker to community but from individual to individual, adult to adult, and child to child. KWAHO management enthusiastically supports this approach.

Recommendations
Towards expanding the reach and effectiveness of health and hygiene education in Kenya, it is recommended that:

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Training materials be produced and/or translated into diverse ethnic languages of Kenya where this has not been done.

Capacity-Building of Partners
As projects are completed successfully, communities are further motivated to launch new ones. This was quite clear in a number of projects visited during the evaluation. The sociological input is providing the necessary impetus for the emergence of a development process which is important for long-term sustainability.

As part of its 'software' package, KWAHO has provided all members of the community water point committees and the umbrella committees with leadership training throughout the project areas. It is estimated that more than 1,000 members have had this training. KWAHO has also made effective use of local leaders, educational tours and information handouts as part of its motivation strategy.

A new type of leadership, consisting mainly of women, is emerging as a result of these projects. There are numerous women leaders who, for the first time, are managing water points creating an added stock of leadership at the disposal of communities for the future. The programme has provided an opportunity for hundreds of women to broaden their knowledge in project management, nutrition and health and have gained the courage to take decisions and risks. It has been a good investment in human capital.

Recommendations
In an effort to contribute to partner and local community capacity-building, it is recommended that:

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The proposal to establish a KWAHO Training Institute to cater for the training of WAHAs is abandoned on the grounds that it would be too costly and tie KWAHO resources in an unproductive and inflexible way;

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Training modules for various training sessions are brought from existing training institutions based on specifications provided by KWAHO; and

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Adequate transport is provided to enable staff to supervise the project covering a very wide area.

Organisational Links
KWAHO occupies a unique position among NGOs in Kenya. It works in close collaboration with the Ministries of Water Development, Health, and Culture and Social Services with funding from various donor agencies coming either directly from or through the Ministries. The Ministries of Water Development and Culture and Social Services have representation on the KWAHO Board, providing inter-linkage at the policy level.

KWAHO management has responded to government's District Focus Strategy for rural development and works closely with respective ministry staff at the district level on a continuous basis through the Programme Officers. This ensures liaison not only in project execution but more importantly in project selection, by ensuring that projects accord with the District Development Committees' priorities.

Financial support is offered to KWAHO projects from WaterAid, the Danish Volunteer Service, the Institute of Cultural Affairs (ICA), the Housing Research Development Unit, UNICEF and Help the Aged. KWAHO co-ordinates these inputs.

There are at least five other NGOs operating in the Kibwezi district, namely ActionAid, CARE, AMREF and 2 Dioceses, Catholic and Protestant. The high concentration of NGOs may be due to the arid and semi-arid (ASAL) nature of the environment.

KWAHO's success in managing and executing projects, especially those involving the mobilisation of local communities is becoming known world-wide. The organisation has been invited to assist in organising a training seminar in Nigeria, funded by the UNDP.

Recommendations
Towards maximising the efforts of organisations working in the area, it is recommended that:

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WaterAid facilitate KWAHO's outreach and educative influence in the hope that aid agencies and international NGOs will invite KWAHO to share its experience with others in the field and region, and help with their projects in East Africa and the Global South more generally; and

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WaterAid and KWAHO desist from extending their participation in Kibwezi with the end of the current phase so as to avoid overlapping activities with other NGOs.

Community Management
The Evaluation Team studied KWAHO'S field operations in two areas: the Lake Region and Tharaka. These areas represent two distinct types of KWAHO operations. Activities in the Lake Region are directly managed by KWAHO, whereas KWAHO input at Tharaka is to provide social mobilisation support within a project where Government agencies provide their own specialised services. In the case of Tharaka, KWAHO's role is mainly that of a consultant.

At the time of evaluation, the Lake Region had only been established for slightly more than a month. The programme manager had been appointed and had access to supportive accounting staff. Generally, the Lake Region was well in control of activities and would be able to take on responsibilities as required within a decentralised organisation.

The Tharaka Area Programme constitutes a major effort to improve water and health standards in the Tharaka Division of Eastern Province. The programme forms part of Swedish assistance to the water sector. It is based on project organisation in which a number of agencies are represented. The project is run by a project manager from the Ministry of Water Development. At Tharaka, as at Kwale, KWAHO is not the leading implementing agent, but a provider of adequate sociological inputs as and when required. Experience from Tharaka shows that KWAHO had difficulties playing the role of consultant. Still. KWAHO's input is essential to the success of the project and KWAHO's participation is actively supported by the project management.

KWAHO's inputs in its water and sanitation programmes have been effective with respect to the provision of sociological inputs commonly referred to as 'software'. Their purpose is to ensure that once a project is completed, it is maintained by the community itself. The need for 'software' inputs responds to the increasing number of failing or abandoned water supply systems throughout the country and the increasing demand for new systems. These are all beyond the government's ability to manage.

KWAHO's 'software' package includes mobilisation and motivation of target groups, training and the direct involvement of beneficiaries in implementation of their projects. Existing women's groups have been used as entry points to communities. Since women are themselves traditionally water fetchers and cleaners of the homes, the response has been quite positive compared to other similar projects where the entire community is involved. Community meetings have been used for brainstorming sessions to enable target groups to clearly articulate problems and possible solutions. Communities have been persuaded to adopt realistic planning and all project areas have experienced the smooth implementation of activities. Specific leaderships courses have also been organised to mould local leadership, crucial to sustained development.

KWAHO has effectively mobilised village communities in the implementation of water supply and sanitation projects. Carefully planned strategies have been employed to involve communities at all stages of the project. This reflects a belief that communities' commitment to projects increases substantially with the level of participation. Efforts to mobilise local resources for the community's development are based on Kenya's tradition of 'harambee' (self-help).

Communities have participated in generating new ideas for project development through community group meetings and providing unskilled labour, skilled labour, and local materials such as sand and ballast. This substantial input might account for 50 percent of total project cost. The community maintains the project itself and most groups hold bank accounts.

Water and Sanitation Committees are generally in place and doing quite well. Group members are highly motivated in most cases. They have been trained in the repair of pumps and also make monthly contributions towards pump maintenance, more or less guaranteeing sustainability.

Village committees, almost exclusively led by women, now regard installations as their own. They are eagerly planning income generating activities, including sewing, tie-dying and working with bark cloth, to fill time formerly needed to fetch water from original sources. Women's water committees, established for each water point, range in number from 20 to 120 members. They organise the attendance at the kiosk to collect charges from customers who are limited to group members only. These charges meet the cost of bulk supplies. In most communities, the system appeared to be functioning very effectively.

Close co-ordination is maintained between the District Development Committees and KWAHO at all stages of project implementation though links vary somewhat between districts. The key committee at the implementation stage is the Umbrella Committee, which is the link between the KWAHO project officer, the local development committee and the village elders. The effectiveness of the Umbrella Committees has varied. In some areas, they may have outlived their usefulness, particularly when the projects have taken off.

Recommendations
Towards long-term community management of projects, it is recommended that:

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KWAHO take full professional and administrative responsibility for its inputs into the project;

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Efforts are made to respond to administrative, planning and development, communication and recruitment challenges facing KWAHO;

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KWAHO receive clear instructions and an improved delineation of responsibilities for initiatives;

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As efforts in Tharaka demonstrate that KWAHO has not yet defined a method to work in a 'consultant/contractor' capacity, contrary to its efforts elsewhere in Kenya, urgent measures are required to improve performance;

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Terms of reference and job descriptions for the sociological input are worked out by an external consultant in the case of KWAHO's future involvement in Tharaka, and formalised in a contract between KWAHO and the project;

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Support continues to be provided for diverse and complementary income-generating activities that may fall outside the strict definition of project guidelines; and

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The role and effectiveness of the Umbrella Committee be re-evaluated.

Programme Management
KWAHO's projects arise from a variety of sources such as the Ministry of Water Development, the Ministry of Health, NGOs such as the National Schools Feeding Council, women's self-help groups, UN agencies and bilateral aid organisations such as SIDA and GTZ. All projects have to be approved by the District Development Committees before being implemented and all project groups must be registered.

KWAHO's staff, the majority of whom have a sociological background, are perhaps the organisation's most valuable asset. Substantial progress has been made in the field of personnel management, such as the elaboration of "Terms and Conditions of Service".

As of January 1991, KWAHO was administratively decentralised, initially through the creation of regions (Coast, Central, Lake and ASAL), each one comprising a number of projects. There are two autonomous projects (Kwale and Tharaka). Other projects will remain under Head Office supervision. In a decentralised organisation, planning and reporting procedures are particularly crucial to management. KWAHO has made substantial progress in this field. KWAHO staff have been extensively involved in the decentralisation process and new policies have been firmly established within the organisation. Standardised planning/budgeting forms are matched with standardised reports on progress and financial performance.

KWAHO's decision to decentralise operations is strongly supported. In principle, far-reaching delegation to project level is appropriate: delegating responsibility and control of resources to those closest to the beneficiaries should increase staff commitment and contribute to improved performance. From a management perspective, it appears that delegation straight to the project level is not practical and different management options are being considered.

Overall, KWAHO's participation is essential to the project. The main problems are of an administrative and managerial character. In spite of the decentralised field organisation, the KWAHO management remained centralised at the time of the evaluation, creating an imbalance in the organisational structure. This could be solved by KWAHO if time and commitment were allocated to such a shift. The full evaluation provides an alternative form of organisation for KWAHO based on recommendations of the evaluation team.

KWAHO had not made a determined attempt to raise funds, thinking such attempts were not likely to be productive. It has however been successful in attracting help from international and national agencies who have employed KWAHO to manage and execute projects.

A study of KWAHO's financial system was undertaken by Cooper Lybrand, Nairobi. The study indicates that KWAHO's basic financial management was in order. Important improvements have been made in financial management, including the introduction of a system of advance payments to projects and regions. Control functions regarding bank reconciliation and fixed assets are weak areas, as is the recording of the utilisation of funds.

KWAHO's main donors have been SIDA and WaterAid, donating 38 percent and 58 percent respectively. The proportion of SIDA funding has declined since 1988 while that of WaterAid has increased during the same period. WaterAid was financing about 66 percent of KWAHO's professional staff at the time of evaluation. Since 1984, the Government has made a contribution in kind providing insfrastructure and support.

KWAHO is in the process of introducing and improving simplified planning and reporting procedures that will be linked to the process of fund disbursements as required by a decentralised organisation. A three-layer planning/reporting system is used: annual, quarterly and monthly documents are produced. Quarterly and monthly reports have been standardised and simplified and a basic structure for the annual reports has been issued.
Cost awareness among staff is presently low, at least in parts of the organisation. Decentralised financial responsibility within given budgets, combined with performance targets, appears to be the best way to introduce cost awareness and economic thinking among the staff. It can be assumed that further improvements will be made as a result of continuous dialogue between the field and headquarters.

KWAHO is one of the biggest and most experienced NGOs working in the water and health sector in Africa. On the basis of its professional standards, it should be able to consolidate its position and even expand, geographically and sector-wise.

Recommendations
Towards more effective management of the Kenya programme, it is recommended that:

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WaterAid consider the possible phasing out of SIDA and make concerted efforts to identify and evaluate possible project areas where there is a desperate need for improved water supply;

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Development and decentralisation of KWAHO and its administrative structures and systems be facilitated by WaterAid;

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Specialist assistance from local, Kenyan consultants is provided to complete the reorganisation of the management structure and advise on personnel matters;

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Authority and accountability are delegated to the regional level, which in turn would delegate to the project level, in a step-by-step process. Delegation could then be extended as project managers gain the experience in handling additional responsibilities;

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Efficiency and accuracy of KWAHO's financial management system (planning, accounting and auditing) is developed and pursued as required by a decentralised organisational structure;

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WaterAid continue financing staff at KWAHO directly engaged on WaterAid supported projects and continue financing Head Office and Programme Managers from a percentage of WaterAid's contribution;

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A quarterly financial audit be carried out by independent auditors; and

KWAHO improve its personnel management through the clear delineation of responsibilities and increased staff allocation, with special attention paid to Water and Health Assistants (WAHAs).

For more details, please contact:

Overseas Evaluations Manager
WaterAid
Prince Consort House
27-29 Albert Embankment
London SE1 7UB
United Kingdom

JeanMacGrory(at)WaterAid.org.uk
Facsimile: +44-171-793-4545
Telephone: +44-171-793-4500

Updated 03/03/03