Haiti Assistance Program: Water and Sanitation Direct Implementation Project Project Review September 28, 2012

Ekaterina Noykhovich, M&E Analyst – Washington, DC Gonzalo de Jesus Aquino Lopez, Watsan Delegate – Panama City

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Contents Acknowledgements...................................................................................................................................... iii Acronym List ................................................................................................................................................ iv Executive Summary....................................................................................................................................... v 1: Appropriateness of Watsan Direct Implementation Project .................................................................... 1 1.1

Project Context ............................................................................................................................. 1

1.2

Project Design and Amendments ................................................................................................. 1

1.3

Relevance ...................................................................................................................................... 1

1.4

Effectiveness ................................................................................................................................. 4

1.4.1

Implementation .................................................................................................................... 4

1.4.2

Process .................................................................................................................................. 4

1.4.4

Management ......................................................................................................................... 6

1.4.5

Roles and Responsibilities ..................................................................................................... 6

1.5

Coordination ................................................................................................................................. 6

2: To Inform the Design of Future Projects................................................................................................... 7 2.1

Key Lessons Learned ..................................................................................................................... 7

2.1.1

Relevance .............................................................................................................................. 7

2.1.2

Effectiveness ......................................................................................................................... 8

2.1.3

Coordination ......................................................................................................................... 9

2.1

Recommendations/Next steps ................................................................................................... 10

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Acknowledgements The review team consisted of the Watsan Delegate Gonzalo de Jesus Aquino Lopez from American Red Cross based in Panama and the Monitoring and Evaluation (M&E) Analyst Ekaterina Noykhovich from American Red Cross National Headquarters (ARC NHQ). The review team would like to first and foremost, thank the beneficiaries of the Watsan DI project for their patience and welcoming the review team into their community. We would also like to thank Fidel Pena, Senior Watsan Delegate, who provided organization and logistics for all site visits and interviews, and adapted to schedule changes, as well as the Watsan engineers, Daphney Richemond, Community Mobilization Claudy Jean, and Watsan Project Officers, Jean Nathalie and Jean Renald Thomas for their support and engagement with the community. The review team would also like to thank the Haiti Delegation for making time for interviews, and to the NHQ M&E Advisor, Gregg Friedman and Watsan Advisor, Yohannes Hagos for their technical feedback and support throughout the process.

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Acronym List ARC BOQ CBHFA CBO CDC CFW CLTS DI DRR HAP HP IDP IFRC J/P-HRO LAMIKA LARRA MoH M&E MOU NCBIP NHQ O&M PaP PGC PNS PHAST TRP VIP WATSAN

American Red Cross Bill of Quantities Community Based Health and First Aid Community Base Organization Centers for Disease Control and Prevention Cash For Work Community Led Total Sanitation Direct Implementation Disaster Risk Reduction Haiti Assistance Program Hygiene Promotion Internally Displaced Person International Federation of the Red Cross and Crescent Societies J/P- Haitian Relief Organization Lavi Miyò Nan Katye pa’m Nan – A better life in my neighborhood Latin American Risk Reduction Activity Ministry of Health Monitoring and Evaluation Memorandum of Understanding North Community Based Integrated Program National Headquarters Operation and Maintenance Port au Prince Petionville Golf Club Participants National Societies Participatory Hygiene and Sanitation Transformation Tsunami Recovery Program Ventilated Improved Pit Water and Sanitation

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Executive Summary The Watsan Direct Implementation project developed out of the immediate response to the January 2010 earthquake in Haiti. American Red Cross, with a budget of about $0.5 billion USD, directed approximately $3 million for Watsan DI. The purpose of this review is to: 1) assess the degree to which the project was properly designed and implemented to meet needs of beneficiaries in targeted areas; and 2) inform design of future projects such as Lamika and North Community Based Integrated Program. The Watsan DI project was relevant to the immediate needs of beneficiaries in communities, schools and camps; however, it was neither efficient nor sustainable as the quality of hygiene promotion is severely lacking in all sites. Design and quality of Watsan facilities were good at schools and communities, but was poor in camps. Despite the original proposal, the Watsan DI project lacked a clear vision and strategy, leading to challenges and delays in contracts, procurement, finances. The project was as effective as possible, given these limitations. Implementation was limited as budget reductions occurred without clear communication, resulting in excess time spent redefining activities and reformulating the budget several times. The Watsan DI project coordinated internally with the DRR and health teams; however communication was limited within the rest of the delegation. The program design was aligned with the IFRC Strategic framework, and more so after the first amendment to concentrate efforts on permanent solutions in neighborhoods. Watsan DI coordinated with IFRC on water trucking, and support to DINEPA’s for Morne a Cabrit completion works. However, coordination and communication were limited in the WASH Cluster group, and a strong relationship with DINEPA needs to be built. The Watsan DI project coordinated with PNSs and organizations working on Watsan interventions on an as needed basis, such as with Spanish Red Cross, J/P-HRO, and IRC. Key lessons can be learned. To improve relevance, a robust design based on a sustainable approach with involvement of community members is necessary (e.g. IRC); additionally, the lack of appropriate baseline and monitoring tools led to serious implications in measuring project progress and impact. Effectiveness was hindered, by placing hygiene promotion under the health program, as opportunities were missed on technical trainings, and although the most important messages were included, the approach was not participatory and therefore ineffective. Procurement and contracts were slow at first, but once activities were clarified, a “Small Works Template” was developed, which improved processes. The Watsan DI project faced continuous financial problems due to the lack of communication between NHQ and the Delegation, and no correct process for monitoring project spending. Key recommendations include: 1) WatSan should be addressed as an integral program composed of software and hardware; 2) Water supply should include temporary or permanent solutions managed by beneficiaries unless networks are tapped to DINEPA; 3) Excreta disposal utilizing bio-digesters or septic tanks and infiltration fields; and scaling up public latrines at crowded areas; 4) Improve manuals and monitoring tools; 5) Improve accountability to beneficiaries by involving them in all project phases; 6) For project design, complete a risk assessment checklist and include safety standards within proposal; work through partners to increase impact; 7) Learn from the sustainable follow-up model as done in the Latin American Risk Reduction Activity; 8) Management restructure to designate a logistics person for Watsan activities within Operations team; and 9) Sphere standards are applicable for disaster-affected population, at this time.

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1: Appropriateness of Watsan Direct Implementation Project 1.1 Project Context The Watsan Direct Implementation (DI) Project was established after the earthquake in January 2010, following Health and DRR activities. American Red Cross in Haiti was operating on an approximate budget of $ 0.5 billion USD, funding mostly immediate responses at the time of the earthquake. An Emergency Watsan Delegate was present for 3 months from February 2010, and recommended that ARC could be most effective in Watsan if it made grants to partners, who were already ahead of ARC in terms of logistics and on the ground operations, and also through some form of direct implementation.

1.2 Project Design and Amendments Project Design and Proposal: The original proposal (Annex 2 and 3 for Logframe) had a one year implementation period from January 1, 2011 to December 31, 2011, and targeted 25 settlements where DRR and/or the Health program were already working. Since the onset of the HAP a Watsan delegate was designated to identify needs and define the WatSan operational framework. The Watsan interventions were clearly defined since the beginning mainly through grants to partners, with a small part to the direct implementation program in order to fill in the gaps not considered in the RFP such as WatSan services in IDP settlements or camps1. Staffing plans should correspond to this approach. Amendments: Due to changes in target population, such as movement out of camps and camp closures, and low expenditure level, two amendments were approved by NHQ. Amendment 1: On September 19, 2011 an amendment to reduce the camps from 25 to 10 and a no-cost extension of 6 months was approved. The reduction in number of camps was reduced to develop more long-term, sustainable interventions to be carried out in neighborhoods of camps, and to provide additional support to Watsan partners. Additional support to partners included procurement of materials, such as for cleaning latrines, construction of boreholes, and others. Amendment 2: On June 25, 2012 a second amendment for an additional three month no-cost extension and a reduction of approximately 50% of the overall budget from $3,005,794 to $1,545,012 was approved. The budget was drastically reduced to reflect the reallocation of funds to external partners: IRC for desludging and maintenance of latrines, and the American Refugee Committee for kiosk construction.

1.3 Relevance Throughout the evolution of the Watsan DI project, activities were conducted within camps, communities, public spaces, and schools. Water and sanitation interventions were relevant, but often they lacked significant oversight for sustainability and effectiveness, and at times lacked in project completion.

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The main Watsan interventions were implemented through Watsan and T-shelter partners

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Schools: The rehabilitation of latrines, water reserve, and construction of latrines, rainwater harvesting, and hand-washing stations were relevant to the needs of the schools. However, the impact of these interventions is sorely lacking. Three out of 4 schools visited lacked adequate hygiene promotion to have any change on behavior. For example, at Lycee Miron, the principal stated that there were not enough hygiene promotion sessions to have an effect on students, and that they need to be repeated more often and not just for one month, as was done at this school. Another school, Petit Jardin reports regular hygiene promotion sessions by ACF once a week for students and twice a week with parents, and also distributes hygiene kits. Hand-washing stations were reported to be useful, but often enough the students break the tap. Waste bins were provided to manage the trash in schools, but with no plan in place for trash collection; one school reported lost contact with the trash collection agency and now results to burning trash. Camps: ARC provided a range of services to camps, including water systems, water trucking, drainage, and the construction and desludging of latrines. The Watsan interventions provided were relevant to the needs of the community; however the majority of camps that ARC worked in, lacked key components to change behavior and increase sustainability. At Neptune camp, the water system provided by ARC is no longer there as it disappeared when the camp activities closed, as did the latrines and showers that were provided by the American Refugee Committee. At ASDE camp, approximately 8 latrines were provided by ARC, however community members report that they do not use latrines as they are dirty and some do not work. Additionally, ARC provided water trucking and 6 (1000 gallon each) water tanks for the committee to manage; however according to community members this has been privatized and they must pay 10 gourds2 per bucket of water. Hygiene promotion was conducted by World Vision, ACF, and ARC; yet, community members do not have water, soap, nor do they have working latrines – as there was one case of an “ARC flood” of waste from a latrine when it rained. Petionville Golf Club (PVGC), managed by J/P-HRO, is one of the largest settlements and has approximately 110-140 latrines, with special ones designated for children and individuals who are handicapped. ARC provided latrine desludging, hygiene promotion, and cleaning and maintenance through CFW. However, upon site visits, there was no water available to clean the latrines, but people still report using them. IRC Desludging: ARC funded the IRC project of desludging latrines in camps, on the condition that all desludging goes to the Morne a Cabrit treatment plant. Camp sites to work in were narrowed down through joint ARC-IRC assessments from a DINEPA list. When IRC enters a community they first bring the latrines to working order and desludge them, then they wait and monitor the camp situation to determine if it is worth it to put more efforts and resources into the latrines and community there. The latrines are either manually desludged or in-situ desludged; if manually, then the waste is taken in special drums to the Morne a Cabrit treatment plant. The three sites visited included St. Hillaire, Cite Gabrielle, and Acra 2. Of all the sites, Cite Gabrielle had the cleanest latrines, which could be attributed to IRC concept of placing locks on latrines. Each latrine is then managed by 3-4 families, and the sense of ownership seems to be the driving force in keeping latrines clean and functional; IRC also provides Watsanrelated incentives (boots, raincoat, flashlight, chlorine, etc.) to volunteers for cleaning latrines. 2

At the time of the writing, the currency exchange rate is approximately 1 USD per 43 gourdes (coinmill.com)

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Cash Transfer Services: CTS was involved to organize and provide Cash for Work opportunities to beneficiaries involved in the cleaning of latrines at camps. This component of the Watsan DI project was relevant to beneficiaries according to reports of the Senior Field Officer, and JP/HRO cited CFW. Several beneficiaries would use the income to pay back debts and/or start a small business. Beneficiaries reported that ARC was responding to a serious need by providing Cash for Work opportunities. Morne L’Hopital Community: ARC provided 20 rainwater harvesting systems and 50 latrines to this community located in semi-urban Carrefour Feuilles, with a population of about 250 persons. Prior to the project, the community members would either walk about 1 hour down the hilly landscape or try to get a ride with a truck to reach Port au Prince for water; sometimes the trip to bring water to the household would take at least half a day. Two of 4 families stated they use a combination of aquatabs and chlorine in the rainwater harvesting tank and drink directly from it, and another family uses a mixture of lemon, salt, and aquatabs. The rainwater harvesting system was relevant in this sense as it eased access to clean water for families; however some tanks were found to be empty due to the lack of rain. Additionally, only 20 of the 50 planned rainwater harvesting systems were built as some roofs were deemed unviable for such a system, and the Watsan DI budget was reduced. Latrines were stated to be beneficial to the community; however upon observation, all four latrines visited were very clean and appeared unused, and one of the latrines was being used as a storage facility for corn. Hygiene promotion sessions were conducted before project start and all four families stated that they are aware of appropriate hygiene behaviors, but it is unclear if they are practicing these behaviors. Marche Salomon: ARC built a new bathing and latrine block, as well as rehabilitated an existing latrine and bathing block located in the surrounding area of the market. The new facilities are well maintained and clean, while the rehabilitated ones are a little dirty. Both facilities are very smelly due to the lack of ventilation pipes. The latrine and bathing enclosure are maintained through a service cost of 5 gourds either for bathing or the use of latrine. The person in charge of collecting the service fees is also responsible for cleaning and ensures the provision of water supplied by the DINEPA´s distribution network. This payment for use system appears to keep the facilities in good condition. According to the operators, about 7 people per day use each latrine. The latrine and bathing enclosures are managed by the market administration. Morne a Cabrit: This is the wastewater treatment plant for DINEPA, with oversight provided by IFRC. The plant treats all desludging coming from PaP area, and has been an initiative of UNICEF, UNOPS, and DINEPA. A site visit was not possible at this time, as the facility staff has not been paid in the past 4 months and they are on strike. The Morne a Cabrit plant is relevant in that it is providing a space for treatment of latrine waste from camps; however, IRC reports that the treatment plant facing problems due to the large amount of garbage (plastics, diapers, etc.) thrown into latrine pits, leading to a solid waste problem at the plant. Apparently, a trench has been dug up to throw the solid waste in, but this is reported to be overflowing. Also, it should be noted that there is another wastewater treatment plant, Titanyen, funded by the Spanish Agency for International Development not too far from Morne a Cabrit – leading to the question of coordination with external actors.

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1.4 Effectiveness 1.4.1 Implementation The Watsan DI project changed in scope from the original proposal; therefore the activities were not implemented as planned. However, the Watsan DI project did respond to beneficiary needs, although without a clear strategic framework and the activities and sites in which ARC Watsan worked appear to be chosen through sites where Health and DRR already worked. Implementation could have improved if a clear plan was in place and communicated with all departments of the Delegation, which could have improved the contracts and procurement process as well. 1.4.2 Process Officially the program commenced on January 1, 2011 and aimed to provide WatSan services to settlements and camps identified by DRR and Health programs. The cholera outbreak by the end of 2010 impacted the project activities since no water trucking was provided due to the risk on providing unsafe water to the IDP camps. Delays in procurement and lack of contract templates obligated the WatSan program to look to the Federation as a service provider for the construction and desludging of tank latrines and the water trucking. 1.4.3 Timeline of Main Events January – March 2011: Project implementation is slow due to procurement issues. For example, the project aimed to provide 8,000 people (target) with access to WatSan facilities; however only 28 latrines were installed in 3 camps, estimating coverage of 2,800 IDPs. April – June 2011: Issues with procurement have been resolved with more efficient procedures in place. The Watsan Department used rolling Cash Advances for procurement of “as needed” construction items such as sand and gravel. Although this had previously caused significant delays with respect to construction, it also reflects no predefined clear targets for the implementation. The finance expenditure for the second quarter was only 5% of the forecasted amount. July – September 2011: Delays due to the nature of project activities and slow procurement were reported which motivated the submission to NHQ for approval of a template for simple works, which was expected to expedite the process of selection contractors. A template for drilling boreholes was also sent to NHQ. The first no-cost extension amendment was approved extending the project until June 2012 and reducing the target camps from 50 to 10. October – December 2011: The contract template for small contracts was approved in early January 2012. DINEPA requested support for the completion of the Morne a Cabrit wastewater treatment plant and for staffing the sanitation department. At this point, 21% of the budget has been expended, which is very low considering the project is expected to complete all activities in June 2012. January – March 2012: ARC is continuing to support 7 settlements in PaP providing basic services like maintenance and cleaning of latrines using Cash for Work procedures and services. Solid Waste collection has been done by Catholic Relief Services agreement via the “Solid Waste hotline” in support to ARC. It is planned to continue this kind of support until June this year. Program expenditure shows

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227% of variance due to the payment to IFRC for water trucking service. The second amendment was submitted at the field level during this period requesting more support to DINEPA sanitation department and financial support to complete the Morne a Cabrit wastewater treatment plant. The amendment was not approved as submitted and instead, a no-cost extension was approved until September 2012, with a budget reduction of approximately 50% in the following quarter. Budget reduction: Approximately $1 million was removed from the Watsan budget from NHQ HAP management during this period. Communication between NHQ HAP and the Delegation regarding this $1million reduction is unclear, as there were talks about budget reallocation but the Delegation was never consulted again before this decision was made by NHQ HAP. Based on interviews, the Delegation received unclear communication from NHQ regarding this, and it is unclear at what stage the documentation (IPAS) was completed. Watsan department was then tasked with developing a strategy with the remaining $500,000. Water kiosk challenges: Plans to build water kiosks fell through due to methodological gaps in the construction process. In the district of Debrosse, Canapé a system was designed to use a borehole for the water source, a water pump activated by a solar system, water filter to ensure water quality, and the water kiosk facility. The purchase of this equipment and construction of water kiosk were completed prior to the identification and digging of the borehole site. It was realized that the site considered for the borehole was not suitable for a water kiosk due to the existence of several latrines surrounding the site, which would contaminate the water table. April – June 2012: The Close-Out Plan, requesting a no-cost extension to complete activities was revised by Delegation Senior Management, and submitted to and approved by NHQ during this quarter. Main changes from the proposal indicate a 49% reduction of the original budget, with a reallocation to IRC for desludging, and American Refugee Committee for construction of water kiosks. July – September 2012: As planned the activities in camps has been closed down during this period, the support given to the last 6 settlements in PaP to provide basic services like maintenance and cleaning of latrines using Cash for Work procedures and services has come to its end. A communication campaign has been designed and conducted together with CTS Department to pass the message to the camp committees and also the camp inhabitants announcing the closing of the program. Morne L´Hopital was completed with 50 latrines and 20 rainwater harvesting household solutions. Plans to complete WatSan facilities in Arcahaie Cabaret, Daniel Fignole School, Ecole Communitaire Petit Gardin, and Lycee Jean Jacques have been done. Contracts and Logistics: Very small works such as WatSan facilities for schools and markets demanded important quantity of human resources in management, oversight and support services such as procurement and logistics. The needs were identified on a site by site basis and a procurement process had to be assumed for each work. After many delays in procurement and contracts, a “Small Works Template” was established (See Annex 4). After the contractor for labor was selected, the WatSan Engineer prepared the purchase request for the labor required of work, the list of contractors with their respective quotations, and the purchase request for the materials as per procedures according to the

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BOQ. The materials and labor were procured separately to ensure the quality of the delivered materials and avoid open biddings due where delays in procurement are possible. The labor contracts facilitated the employment of unskilled labor at the beneficiary settlement level. 1.4.4 Management The management of the Watsan department strayed from the original proposal (See Annex 5). Throughout the project, an additional team of one Watsan engineer and two project officers was hired to provide oversight on water-trucking for camps. In the beginning of the project, the contract of the Watsan Delegate initially responsible for direct implementation was terminated early due to his circumvention of policies and procedures for contracts and procurement. This occurred when cash advances were used to pay essentially contractors; however, NHQ did not allow a certain amount of money to be paid as a cash advance to one individual, who would then distribute it among the team. This forced the Delegation Senior Management to pay the workers for construction at the field level, at the expense of this delegate’s contract. Additionally, unclear communication between NHQ HAP Senior Management and the Delegation was reflected in the budget decisions. For example, Delegation Finance was not receiving IPASs as they came in, and HAP NHQ talked about potential reallocation of budgets or new project funding, but the Delegation would not hear from NHQ on whether these were finalized or not. Additionally, prior to new NHQ HAP management, there was not a correct ATS tracker listing projects approved, spending to date, and remaining balance. This led to confusion about the gaps in tracking Watsan DI funds, both at NHQ and in the Delegation, and also resulted in several budget scenarios to be developed by the current Senior Watsan Delegate. 1.4.5 Roles and Responsibilities Slow recruitment process was reported by WatSan since the beginning of the program. In the first quarter, only 2 WatSan Engineers positions were filled and the DI program delegate was not yet recruited during this period. Even though during the second quarter the recruitment process was more efficient, still one WatSan Engineer and two field officers were pending to complete the staff. A Watsan Delegate was hired to manage the Partnerships and DI project; then in May 2011 the current Watsan DI program delegate was recruited in May 2011.

1.5 Coordination IFRC Strategic Framework: It is important to highlight that the DI program design was aligned with the Federation strategic framework especially after the first amendment, where the purpose was to concentrate efforts on permanent solutions in neighborhoods (See Annex 6). The needs and situational analysis from the IFRC Strategic Framework include: drinking water, sanitation facilities, cholera plan of action, DINEPA MoU, and shelter solutions (details in Annex 6). IFRC Framework Strategic Objectives: Facilitate a responsible scale-down of non-sustainable emergency water and sanitation services and support the revitalization of neighborhoods through improved access to water and sanitation services for populations returning home within PaP and other earthquakeaffected areas where Federation shelter solutions are prioritized. This can be accomplished by leveraging: 1) community mobilization; 2) sense of ownership; and 3) access to public and private water and sanitation markets.

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DINEPA: There is weak coordination between ARC and DINEPA, although they have been minimally involved and informed of the Lamika project. Future meetings will be scheduled regarding the Lamika work and the NCBIP project as well. Coordination can be improved upon, since they are the water authority and also, to support their engagement with communities. Haitian Red Cross: Involvement in this project is limited to the participation of the HRC WATSAN coordinator in monitoring visits to the target spontaneous settlements. It is not expected that HRC will develop an implementation capacity for WATSAN as a result of this project. HRCS has prioritized CBHFA and has historical capacity in implementing PHAST. Prior to the earthquake, HRCS was the only Haitian organization capable of supporting DINEPA and NGOs’ requests for PHAST training of trainers. HRCS is interested in integrating water and sanitation software methodologies (e.g. PHAST, hygiene promotion, solid waste management, etc.). To date, integration of Movement water and sanitation software components has been limited. The Lamika and NCBIP programs open the opportunity to involve the NS in the implementation process which is aligned with the IFRC plans to build the NS WatSan capacity. IFRC: ARC coordinated with IFRC for providing water-trucking services, and supports to the DINEPA through the Morne a Cabrit treatment plant. From interviews, IFRC seems well placed to coordinate with DINEPA and other PNSs. IFRC is considering an “Umbrella MoU” that is broader, and could be used to coordinate between DINEPA and other PNSs. IFRC also seems best placed to coordinate with Haitian National Society, as HRNS showed interest in building a Watsan unit. Other PNS: The coordination with other PNSs was strictly needs-driven. For example, ARC took responsibility for some of the camps where Spanish Red Cross was providing WatSan services. WASH Cluster: Due to language constraints, the Senior Watsan Delegate did not attend the WASH cluster meetings; however, he was constantly informed by the IFRC WatSan coordinator about the main issues. Other organizations: ARC coordinated with other organizations working on Watsan interventions, based on needs. Funding was provided to IRC for desludging, and to American Refugee Committee for water kiosks. Coordination with IRC on desludging appears to be successful and sustainable.

2: To Inform the Design of Future Projects 2.1

Key Lessons Learned

The Watsan DI program review has identified the following lessons learned, and subsequent recommendations for future Watsan projects in Haiti, such as LAMIKA and the North Community Based Integration Program. 2.1.1 Relevance To improve the appropriateness of the project activities to targeted beneficiaries and sites, a clear project proposal must be designed that demonstrates a strategic and sustainable approach. Additionally, camp members are distrustful of committee members and their lack of involvement in

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project design is apparent when the water system has become privatized and facilities are inadequate and maintained. Monitoring and Evaluation: Watsan DI project has lacked detail and analysis in monitoring and evaluation. The lack of a methodologically sound baseline, despite a survey of 4 camps, had serious implications on a) definition of targets without baseline data in order to meet the sphere standards/WASH cluster indicators; b) measure of impact on the project’s objectives and outcomes; and c) establishment of a monitoring system to measure the progress of project’s activities. An initiative from the Senior WatSan Delegate to conduct a baseline using electronic devices was rejected due lack of appropriate sampling technique among other technical survey requirements. Future surveys initiated should be coordinated with the M&E department prior to any events taking place. 2.1.2 Effectiveness Hygiene Promotion (HP): Although programs integration has been well addressed since the onset of the Watsan direct implementation program, the decision to give the health program the responsibility to implement the HP component not only demands more coordination between both parties at different levels, but also dilutes the responsibility and impact due to the lack of coherence in the implementation of Watsan activities. It is important to highlight that software activities consist of a) hygiene promotion, b) training on management, operation and maintenance (O&M) of CBO/committees and c) training of plumbers on systems’ O&M. At the schools, the lack of HP follow-up is apparent where the Watsan facilities consist of dirty and smelly latrines, broken hand-washing taps, and unused waste bins. No follow-up has been provided and the Watsan program is considered as a strict infrastructure provider. With this approach, years of experience and efforts to prepare methodologies such as PHAST and CLTS are being missed. The health program has provided HP using one module aimed to spread key messages such as hand-washing, use of latrines, dental hygiene, and the management of food. Although the most important messages have been included, the approach has not been participatory and therefore ineffective. PHAST is a powerful tool that not only ensures improvement in knowledge, but also the commitment from participants through a process of recognition of the ,current practices, the analysis and reflection of the current situation, and a community plan in order to ensure behavior change. A combination of PHAST and CLTS might ensure sustainable hygiene behavior change. Integration: WatSan DI program started several months after DRR and health which gave the opportunity to integrate this program to these two components. The impact of this has been positive considering that one of the main purposes of both programs is to provide the community of micro mitigation-projects in order to reduce vulnerabilities on health. Contracts, Logistics, and Finance: Templates developed for pre-approved spending were helpful, and previously, all programs in Haiti had delays because no strong operations were in place. Delays must be resolved in procurement and payment of contractors for implementation to proceed. The TRP lessons learned for contracts and procurement has demonstrated that “Except for small projects, or where it will be extremely difficult or expensive to procure materials, direct implementation using community labor is unlikely to be cost-effective. Even then, employing small-scale local contractors is likely to be more

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efficient overall”3. The WatSan DI project used cash advances to hire local skilled and unskilled labor to implement the projects. In addition, the NHQ HAP management resisted TRP tools and lessons learned, citing that Haiti is different. Finance processes followed by NHQ HAP were unclear and communication was lacking regarding final budget reallocations or new project funding, between NHQ HAP and the Delegation. Financial procedures for project tracking and documentation of communication regarding budget changes need to be put in place prior to the next disaster that ARC responds to. Quality Control: Although the Cash Transfer Support Program has provided valuable systems and methodologies to ensure the involvement of beneficiaries for the operation and maintenance of the WatSan facilities using CFW, there is no a quality control monitoring system to ensure the quality of services provided by beneficiaries through this modality. The quality control monitoring system should provide linkages between support delivered to beneficiaries and the quality of service received from beneficiaries for their own benefit. Sustainability: Latrines at public buildings such as schools and markets show different levels of sustainability which is strongly related to the management of the facilities and the HP effectiveness. The installed facilities in Marche Salomon are being managed by the market administration collecting 5 gourds (0.12 USD) for the use of either the latrine or the bathing cabin. The incomes4 are about 10 USD/day for the small facility and 15 USD/day for the larger facility, enough to cover the desludging cost5 and the minimum wage6 of the facility. Using these figures the provision of sanitation facilities demonstrates sustainability taking into consideration that the facility caretaker is responsible not just for the collection of the service but also to ensure cleanliness and water supply for the facility. In comparison, sustainability at the school level is lacking. At Ecola Fortuna Guery, one guard is responsible for maintaining and cleaning the latrines, clearing the drainage channel, and the hand-washing stations, in addition to his regular duties. At that school, the latrine facilities were in the worst condition of all schools visited, the drainage channel was filled with trash and standing water, allowing for mosquito breeding and risk for malaria. The sustainability of Watsan interventions at Ecola Fortuna Guery is unlikely. 2.1.3 Coordination The pressure to provide latrines to the IDP camps within the WatSan Federation response team required the construction of tank latrines, which lack any excreta treatment. The tank latrines are a deposit which has to be emptied as soon as it is full, requiring the desludging of the excreta plus the water utilized to move the solids to allow the vacuum for later transportation to either a dump site or an excreta treatment plant. These types of latrines became a Federation standard and therefore accepted by all the PNS including ARC. This solution could be suitable just for a very short term, however, according to the Haiti camp coordination cluster7, “As of August 2012, an estimated 93,748 IDP households, or 369,353 3

TRP WatSan Meta-evaluation page 65 Calculated with an average of 7 users/day/latrine and 7 users/day/latrine/bathing-cabin and 6-9 latrines and 6-9 bathing cabin/facility. 5 1US/day (15,000 gourds/year) 6 Estimated at 1.66 USD/day 4

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Haiti CCCM available from: http://www.eshelter-cccmhaiti.info/jl/images/pdf/final_dtm_v2_report_aug_2012_english.pdf

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IDP individuals continue to reside in 541 IDP sites across the earthquake affected areas in Haiti”. The aforementioned figures suggest that the IDP sites, after two and a half years after the disaster, are far from disappearing as emergency shelters, indicating that the adopted solution through tank latrines is not a sustainable solution. Further efforts to provide this population with technical sustainable solutions should be addressed. The IFRC Strategic framework on the needs and situational analysis states that “Sanitation facilities were rarely, if ever, mentioned in interviews and do not appear to be a factor that encourages people to stay in camps; sanitation solutions (mostly raised, tank latrines) are not being maintained properly despite hygiene-promotion efforts”. On the other hand, water trucking was delivered using IFRC services from July 2011 to November 2011, aligned with the needs and situational analysis highlighted in the IFRC Strategic framework which states that “Drinking water is not a priority of camp residents and there is evidence that they purchase their drinking water (as they did before the earthquake); trucked water appears to be primarily used for hygiene and other domestic purposes” while the other point states that “The cholera plan of action calls for continued delivery of emergency water and sanitation in IDP camps and surrounding neighborhoods until November 2011; while drinking water is increasingly available via water kiosks and neighborhood water points, it is unclear what impact trucked water for hygiene purposes would have on cholera rates in camps if downscaled or stopped”.

2.1

Recommendations/Next steps

Integrality: WatSan should be addressed as an integral program composed by software and hardware. According to the Federation WatSan policy guidelines “the hardware (e.g. pumps, pipes) aspects of water and sanitation interventions are easier to implement compared to the software aspects. Hygiene promotion (hygiene education, community participation and management etc.) must be established parallel to, if not, before introducing the hardware. Hardware installations need to be sustainable for the community with the ability to maintain them leading to long-term ownership. This will ensure best possible community ownership, management and commitment. In emergencies minimum aspects of hygiene promotion need to be established. Give due consideration to the use of appropriate local technologies and cultural preferences for the sustainability of the work.” The TRP WatSan program implemented in Indonesia hygiene promotion using PHAST linked to O&M issues which facilitated not just the identification of problems related to health and waterborne diseases, but also the need to address the O&M issues and subsequent long term sustainability8. Water-supply: For flat areas in PaP it is expected that the water table is relatively high which might be well-planned to explode the underground water in order to install water supply systems either for water kiosks or distribution networks with household connections. Any solution could be complemented with rain water harvesting at the household level. Temporary or permanent water supply solutions should be managed by beneficiaries unless secondary and tertiary distribution networks are tapped to DINEPA networks and DINEPA is the service provider. For any of the water supply solutions a close coordination with DINEPA is essential in order to guarantee quick services.

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Indonesia Water, Sanitation and Health Promotion Project, TRP Final Evaluation, June 2010,Page 10

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Long-term sanitation solutions: For the future ARC programs including LAMIKA and NCNIP, even if the situation demands transitional solutions for excreta disposal, long term technical solutions should be provided in order to ensure efficiency for excreta disposal, to extend the desludging period as much as possible. Due to the poor sanitation practices before and after the earthquake and the lack of facilities for excreta disposal, any technical solution should be the product of analysis and involvement of beneficiaries who must be aware about what the real problem is in terms of public health and the link between the lack or misuse of WatSan facilities and waterborne diseases. Although PaP is a large city (more than 3 million people), no sewage systems have been installed, and the reason why efforts to provide basic sanitation infrastructure should address the very basic and functional solutions such as VIP latrines which are also suitable for rural and peri-urban areas. Household solutions are strongly recommended to set ownership and therefore best practices on operation and maintenance. Scale-up: Public latrines and bathing facilities located in crowded areas as markets have demonstrated high levels of sustainability, therefore this best practice should be replicated in order to ensure the provision of these essential services. The existing facilities in Marche Salomon are being maintained and managed by the market administration in an efficient way. Although water is provided in buckets for hand-washing, better solutions must be studied in order to provide both running water and soap. Also better technical solutions such as pour latrines9 and bio-digester as primary and secondary treatment and soak pits as tertiary treatment should be considered in order to ensure high quality in the provision of the service and low desludging cost. Additionally, increase infrastructure in the schools and market, in coordination with government and local authorities. Monitoring and Evaluation: Considering the importance of evaluation tools and involvement of ARC in recovery programs, guidelines with criteria for survey sample design and a standardized questionnaire for Watsan should be provided. Additionally, more time should be spent with program managers on establishing appropriate monitoring systems. Accountability to Beneficiaries: Beneficiary involvement in the process of preparation, monitoring and handover has proven to be more effective in setting ownership than financial or in kind contribution. Increase transparency and build model within the community to integrate them within the project; specifically involve entire community, not just committee members. For Lamika and NCBIP programs this approach should be part of the software component. Project Design and Coordination: Future projects should include a Risk Assessment checklist10 within the proposal, including mitigations for the stated risks, to improve efficiency of implementation. Safety standards for staff and contractors should also be included within project proposals. Increase impact of ARC work through partners when working with a large budget that cannot be effectively spent by one organization. Sustainable Follow-up Model and DRR: The ARC Latin America Risk Reduction Activity (LARRA) program has integrated WatSan into risk reduction projects using a sustainable follow-up model which was 9

Pour latrines need up to 5 liters of water per evacuation Already developed by ARC-ISD

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developed in Central America thanks to an cooperation agreement between the Center for Disease Control and Prevention from Atlanta (CDC) and ARC in order to apply follow-up activities to the Post Mitch ARC interventions. This model11 has proven effective in involving stakeholders in a process based on monitoring and evaluation tools. The model activities are a) stakeholder involvement, b) monitoring and evaluation and, c) accountability to beneficiaries. Involvement of beneficiaries in monitoring hygiene practices tend to fill in the gaps between knowledge and practice, which has been one of the main gaps identified during the Watsan DI program review. This approach could be suitable for the NCBIP program and further analysis should be conducted to define applicability in LAMIKA program, and applying this approach has potential to improve the projects’ sustainability. The LAMIKA and NCBIP programs also open the opportunity to develop a management model based on community participation, involvement and commitment of stakeholders (DINEPA, MoH, Municipality and NS) and integral approaches (programs) which might be replicated by other organizations supporting WatSan and other programs. Haitian Red Cross: Taking into account the IFRC plans to develop a Watsan unit into the NS, ARC should consider unifying efforts with IFRC in order to develop a Watsan strategy into the NS. In Central America, ARC is providing technical assistance to the NS on reporting, PHAST/CLTS, M&E, WatSan Technical designing (using computer software), and project management as part of a NS WatSan strategy facilitated by ARC. Management structure for NCBIP and Lamika: To ensure efficient processes and foster communication between the Watsan team and vital sections of the Delegation, it is recommended to have a Logistics person sit within and report to the Operations team, but be dedicated to supporting and prioritizing Watsan activities. Watsan Standards: To decrease the prevalence of diarrhea diseases, it is recommended that at least 80%12 of target population has adequate access to WatSan facilities and HP. Due to difficulties to collect water fees when the solution is through public services, household solutions are advised. However, taking into consideration the size of land constraints, the Sphere standards and indicators are applicable for the disaster affected population13.

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Ministry of Health (MoH), municipalities, water sector authorities and National Societies integrate the stakeholders supporting group which is activated when an early warning on health is launched. The beneficiaries monitor hygiene practices every semester and the MoH conducts evaluations every two years aimed to ensure opportune hygiene promotion refreshment or infrastructure rectification where needed based on the findings, either on hardware or software issues. 12

SPHERE standards Each latrine could then serve up to 20 persons and should be located at least 50 meters from the HH who is using the facility 13

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