Running head: WATER SANITATION IN LIBERIA

Global Health Culminating Project: Water Sanitation in Liberia

Bobbie Chahal, Rita Chikrallah, Yelena Ivaschenko, Laura Johnson, Harpreet Kaur, Nikiesha
Thomas
California State University, Stanislaus School of Nursing

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Executive Summary
According to the United Nations Secretary General, Water is not only a basic necessity,
it is a human right (Ban Ki-moon, 2010). The people of Liberia are deprived of this basic
human right. They lack access to clean drinking water and sanitary practices (Kimani-Murage &
Ngindu, 2007). The lack of clean water and adequate sanitation frequently puts the population at
risk for water-borne diseases such as cholera (Waves for Water, 2012). In fact, 1 in 5 deaths in
Liberia are correlated with water and sanitation problems (Waves for Water, 2012). There are
many organizations that are working in Africa to implement water, sanitation and hygiene
programs. For example FACE Africa reports helping 12,000 people access clean water, serving
25 communities so far, and saving the residents of the communities a total of 200,000 hours to
use towards productivity instead of transporting water (Face Africa, n.d.).
This proposed program targets the problem by collaborating with the people of Monrovia
about current sanitary practices, knowledge, attitudes, and beliefs. The program works in
collaboration with the villagers to build the Photovoltaic solar powered water purification
machine (PVSPWM), which is a solar water-purifying machine (Forstmeier, Feichter, & Mayer,
2008). The installment of the water filtration system, pumps, and water pipes will allow villagers
to have easier access to clean water. In addition, the program holds classes that teach villagers
about sanitary practices and effects of contaminated water on their community and health.
By 2020 the expected outcomes of the program are an increase in number of Liberians
who have access to clean, safe drinking water from 75% to 85%, a decrease in the number of
waterborne illnesses in Monrovia by 5% by 2020, and lastly, a decrease in the number of
Monrovian children under 5 who die by from waterborne diarrheal diseases from 1000 to 750, a
decrease of 25% by the year 2020.
Background
Even though water remains the main source of life, about one quarter of Liberias
population (approximately one million people) lack access to safe water (WaterAid, 2013). Since

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the end of a long-fought civil water in 2003, the country still struggles with corruption,
unemployment, and poor services. About 80% of the population does not have access to adequate
toileting facilities. Consequently, more than 1,000 children die annually in Liberia due to the lack
of safe water and improper sanitation (WaterAid, 2013).
According to information submitted to World Health Organization (WHO) and UNICEF
Joint Monitoring Program from the Liberian Government, 8 percent of the households in urban
areas have piped water and 88 percent have access to an improved water source (Boley, 2012,
Measuring process, para. 1). In an interview, the managing director of the Liberia Water and
Sewer Corporation, Nortu Jappah, and President Ellen Johnson Sirleaf, stated that a water main
along Somalia Drive was recently opened to aid the neighborhood, as the area was missing piped
water for over two decades. However, after the interview, the author could only locate one tap
after hours of search. Moreover, the owner of the tap mentioned that it only ran once after the
civil war (Boley, 2012).
As of 2008, the government had established a Poverty Reduction Strategy (PRS) to
monitor Liberias developmental progress (Boley, 2012). Along with other goals, it aimed to
double access to clean water in four years time. However, a final assessment report published in
2011 showed that only seven out of 22 goals were accomplished. Furthermore, only two of these
would directly profit the population through physical projects. Despite having other sources of
water such as hand pumps and wells across the country, the majority of these do not supply
adequate amounts to meet the needs of the Liberian people (Boley, 2012).
By 2013, the government had prohibited adults from excreting wastes alongside the
beach; though children are allowed to continue this practice (Marcelo, 2013). In 2011, three
public latrines were made, and six more were in progress. However, for the 50, 000 individuals
of West Point, Monrovia, less than a dozen public latrines are available. Therefore,
contamination of the water resources leads to epidemics such as cholera (Marcelo, 2013). Even

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among the displaced camp residents, diarrheal diseases are responsible for 40% of deaths, with
80% of these appearing in children younger than 2 years of age (Doocy & Burnham, 2006).
Besides inadequate sanitation, other sources of infection included polluted water sources,
contamination of water during transport and storage, shared water containers and cooking pots,
scarcity of soap and contaminated foods (Doocy & Burnham, 2006).
Literature Review
There has been much research about macro-level indicators of water and sanitation
improvements, like gross national product (GNP). Njoh and Akiwumi (2011) investigated microlevel indicators, particularly access to improved water and sanitation facilities in African cities,
to find that cities that were colonized longer had better access to improved water and sanitation
facilities in comparison to cities with shorter colonization time. However, the outcome of
colonization varies by country and there is some controversy about the link. Some scholars argue
that Africa has improved with the help of colonialism, while others argue that colonialism
marginalizes Africa by making countries dependent on foreign aid. Previous attempts at
improving access to water and their implications for future efforts are discussed. In the early
twentieth century, governance policies aimed to win the hearts and minds of natives in all
districts. To provide urban infrastructure during colonization, experts were employed to work
with the natives and gather input from the labor force. In many cases, natives took part in
projects by financing parts of it or providing staff or other resources. There is still a great deficit
in water and sanitation, but Liberia is blessed with abundant, but unequally distributed water
resources, ranking 15th internationally. The continent has many natives who have shown their
willingness to help through communal labor and the study suggests that future projects use the
labor work force available as active participants in developing and maintaining programs.
Slum dwellers in Africa live with inadequate clean water and sewerage (Kimani-Murage
& Ngindu, 2007). Overcrowding results in little distance from the pit latrines and the nearby

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wells, causing bacteria to migrate between them and easily contaminate the water. This study
assessed the sanitary practices of Kenyans living in an urban slum and evaluated the fecal
contamination of their primary domestic water sources. The cross-sectional study of 192
participants from a Kenyan slum collected 40 samples of water from shallow wells, deep wells,
and taps. The shallow well samples had 100% coliform bacteria, with 97% of the samples
containing thermotolerant coliforms. Deep wells were 75% positive for coliform bacteria, with
two out of the four having thermotolerant coliforms. The five tap samples were negative for total
coliforms and thermotolerant coliforms. Thermotolerant positive water samples suggest fecal
contamination and the study suggests that the source of contamination is the close distance
between water sources and pit latrines. Runoff water after rain may also be a source of
contamination as 30% of the children use open fields for excrement. There is a high chance of
pathogens being in the fecal contaminated water and as a result, the well water in the slum of
Langas, Kenya may not be safe to drink. Treatment of the water in communities and households
and changes in sanitary practices are recommended. Another solution is to provide regulated tap
water to the community in Langas, Kenya and other slums in Kenya where tap water is not
available. This evidence is relevant as Kenyan slums are comparable to the environment in
Monrovia, Liberia.
Morbidity and mortality caused by waterborne diseases is a widespread occurrence that is
largely preventable (Doocy& Burnham, 2006). "Point-of-use water treatment and diarrhoea
reduction in the emergency context: an effectiveness trial in Liberia" by Doocy and Burnham
(2006) addresses the issue of communicable diseases through water contamination.
Communicable diseases are a main concern in disaster-affected populations that live in camp
settings. Diarrheal diseases have accounted for more than 40% of deaths among these residents.
There are some limitations in current water treatments with only few products capable of treating

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turbid water. A 12-week treatment using a point-of-use water treatment with a flocculant
disinfectant among 400 households in camps in Liberia revealed an improvement in water
storage. It revealed a reduced diarrhea incidence by 90% and prevalence by 83% in the treatment
group, compared with control households with improved water storage alone. Adequate
sanitation and water supply in quantity and quality is the primary mean for diarrhea reduction.
Johnson, Hokanson, Zhang, Czupinski and Tang (2008) assess the economic likelihood of
providing water purification technologies in rural areas of developing regions including
Mozambique, Africa; Sichuan, China; Madhya Pradesh, India; and Honduras, Central America.
These regions were selected based on economic, demographic, and environmental variables. In
addition, the article considers the social and political factors impacting the market entrance
strategy. To support the findings, the article analyzed the social, economic, and governmental
data using academic journals, textbooks, special topic books, and databases. Furthermore, an
analysis was conducted for water purification technologies, the disinfection contribution, primary
use, affordability, and appropriateness of each technology. Findings suggest Sichuan, China as a
possible candidate for water purification technologies due to its large population density leading
to growing market and increasing household income and favorable policies encouraging foreign
investment. On the contrary, Mozambique, Africa is discouraged as a potential business target
because of unpredictable income sources indicating insecure cash flow and weak revenue source
for the process and unreliable statistical data providing hurdles for the investors to make
informed business decisions. Therefore, in order for these regions to gain access to clean water,
changes need to occur in social and cultural standards.
Mellor, Smith, Learmonth, Netshandama, and Dillingham (2012) report the development
of an agent-based model to study and accurately capture the essential parts and elements of
communities and their water contamination chain. Inadequate access to potable water and

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sanitation is the primary contributor to over two million annual deaths globally as well as the
cause of numerous negative effects (e.g. child growth stunting), both caused by early childhood
diarrhea (ECD). Many studies have examined the causes and prevention of ECD related to
limited access of quality household water, revealing a complex system involved in this epidemic.
Studies often approach interventions in isolation, failing to grasp the complex nature of the chain
of water and sanitation. The elements examined in the study were behaviors involved in water
collection, treatment frequency, and biofilm buildup in water storage containers, source water
quality, and water container types.
To develop quantitative understanding of the contamination of the chain involved in
water acquisition and storage, which ultimately leads to ECD the study focused on the
transmission of coliform bacteria, but this model can be applied or generalized to other
pathogens (Mellor et al., 2012). The information used was acquired from 50 households in the
target area, which found household water quality variability monthly as well as higher levels of
coliform bacteria in household water compared to water at the source. Higher levels of coliform
bacteria were found in the storage containers, on tools used to scoop water and on participants
hands. Significant bacteria regrowth was found in stored water containers, and was a significant
contributor to household bacteria levels, except in containers that had narrow necks and were
generally cleaner. The study also determined that a childs ECD risk could decrease by up to 43%
if they practice optimal hand-washing, approximately 32 times a day. A childs risk for ECD
lowers each time they wash their hands when optimal hand washing is not feasible. The four
major characteristics evaluated were boiling frequency, collection interval, municipal tap water
quality, and container biofilm quality. The best water quality was reached by those who had both
a cleaner source as well as participated in frequent water boiling and who had less container
biofilm achieved through frequent container cleaning. However, large ECD reductions were seen

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in only a few cases. ECD cases were much lower when all households boiled their water every
day compared to those who did not. There were also fewer ECD cases when families had lower
biofilm buildup levels. Despite improvements seen in overall water quality, the frequency of
water collection and quality of municipal tap had little impact on mean ECD cases. The results of
this study indicate that while individual interventions can reduce ECD risk, intervention
combinations reduce ECD risk significantly more.
There exist state of the art water purification technologies can convert almost any source
of water into drinkable water (Forstmeier, Feichter, & Mayer, 2008). But the technologies require
energy, mainly in the form of electricity. About 1/3 of the worlds population is not connected to
an electrical grid, including many areas in Liberia. So the water problem can also be seen as an
energy problem. Photovoltaic (PV) powered water purification is an opportunity to solve this
issue, providing both potable water and minigrids that provide electricity. Dry, warm regions are
best for PV because there is a high irradiation and large water shortage. PV is good for the
environment because it offers a small distortion on nature with no noise or exhaust gas emission
during operation. It is hard to give one cost figure, as most cost factors are strongly site
dependent. Calculations show that on a good site with high solar irradiation, the cost of water can
be as low as 1/desalinated water. Running costs for solar powered water purification tends to be
far lower because no money is spent for fuel or electricity. The transport distance will influence
the availability and price of the cost of water. The initial investments may be high, but the end
result will far outweigh this. Government incentives can further reduce the cost. PV powered
water purification seems to be one of the solutions in areas with high sun radiation.
Program Goals and Objectives
The primary objective of this proposal is to increase access to potable water in Monrovia,
Liberia. By the end of the first year of the program, the percentage of Liberians with access to
potable drinking water will be raised from 75% to 85%. The primary means of achieving this

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goal will be the implementation of photo-voltaic solar water purifying pumps as a primary source
of potable water. One of these pumps is able to provide a small farm or village with clean water
(Forstmeier et al., 2008). Access to a clean water source is the first step to providing the target
population with clean water. Education must also be provided concerning proper handling,
storage and preparation of water for drinking. Workshops and campaigns will include curriculum
aimed educating the people of Monrovia. Curriculum will also emphasize proper storage of the
clean water collected from the solar pumps, which according to evidence based research involves
clean , narrow-neck containers and boiling of water before consumption after it has been stored
(Mellor, Smith, Learmonth, Netshandama, and Dillingham , 2012). More frequent collection of
clean water is also supported by evidence, and distribution schedules will also be addressed by
the program in order to prevent heavy traffic or conflict concerning water distribution and
collection at the pumps. By 2015, the project aims to educate the community about sanitary
practices and the difference between clean and contaminated water. Citizens should understand
the idea of water contamination in their current water sources. They should also understand the
function and purpose of PVSWPM's and engage in the practice of acquiring clean water for
drinking and cooking from solar-filtered pumps. Refer to Appendix A for details.
The second goal of our proposal is to decrease the total number of waterborne illnesses
by 5% by the year 2020. Providing primary access to potable water is the first means of
achieving this objective. Based on a thorough review of literature, waterborne illness is further
prevented by ensuring proper storage of water prior to use and water preparation prior to
consumption. Mellor, Smith, Learmonth, Netshandama, and Dillingham (2012) determined that
proper cleaning of water storage containers and reduced biofilm build up as well as the use of
narrow necked containers resulted in higher water quality and reduced the presence of pathogens
in stored drinking water. The target practice this second goal aims to change is for citizens to use

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clean, narrow-necked storage containers for the clean water they acquire from the PVSPWMs
and understand the importance of clean storage containers and boiling stored water. They will
also understand the role of feces contaminated water in the spread of water-borne diseases and no
longer accept the practice of open defecation.
The last goal of this proposal is to decrease the rate of death in children caused by early
childhood diarrheal illnesses due to waterborne pathogens by 5% by the year 2020. As
mentioned, focus on reducing the amount of pathogens in drinking water is the primary means of
decreasing the rate of ECD caused by water-borne pathogens. Mellor, Smith, Learmonth,
Netshandama, and Dillingham (2012) also reported a significant 43 % reduction in the incidence
of early childhood diarrhea when children performed optimal hand hygiene. Though the number
of time optimal hand washing required was 32 times per day, each occurrence of hand washing
throughout the day reduces a childs risk for ECD (Mellor, Smith, Learmonth, Netshandama, and
Dillingham, 2012). Based on this evidence, hand washing will be an emphasized in project
curriculum and education. Mothers, caretakers, and children will ideally understand the role of
hand hygiene in preventing diarrhea and engage in optimal hand hygiene. The project also aims
to change the attitude of the acceptance of children engaging in open defecation. As these
changes are anticipated to take up to 5 years for optimal results, the program also includes
educating mothers and caretakers about diarrhea in young children. A final objective of the
program is to increase the mothers knowledge and practice concerning diarrhea and the proper
use of oral rehydration salts to treat diarrhea.
Technical Approach
The anticipated program includes various factors which will be implemented over a one
year span. In order to reach the goals listed in Appendix B, the program will include a
comprehensive assessment of the community, baseline studies, establishment of rapports with
stakeholders and city leaders, teaching sanitary techniques to the villagers, and implementation

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of the solar filtration systems, or PVSPWMs.

Technical Approach Goal 1
In order to achieve the first goal of increasing the percentage of Liberians with access to
clean water, goal, and assessment is the first step. During the first month of the project, baseline
studies will involve searching current literature regarding water sanitation and accessibility in
Liberia. In addition, assessment of the current water resources and taps in the area are essential to
base the planning of the system locations. In order to engage the community and view villagers
as assets for this project, it is important to get their opinion and feedback and work with them to
improve water access. Establishing communication is essential; therefore, using media,
specifically the radio, will be beneficial to spread the word about the project and get more people
involved. In addition to specialized trainers and solar system experts, villagers can be part of the
project as labor to prepare the land for implementation of the system. Since they are the main
beneficiary of this project, it is important to have them involved. After preparing the location and
setting up the solar system, a maintenance team will be formed to guard the system. Also, visual
demonstration to the villagers will be implemented by experts in this domain. Further workshops
will be available throughout the year for reinforcement and encouragement. Once the system is
in place, the water will be tested for safety. All the assessments will be completed within the first
month whereas preparation of the land and setting up the systems will take around three months.
Continuous evaluation will be performed throughout the year, but mainly in the last quarter.
It is important that the villagers understand the importance of clean water and sanitary
practices. Therefore, focusing on providing knowledge about sanitary practices, the difference
between clean and contaminated water, the idea of contamination in their current water sources,
and the function and purpose of the solar system implemented is crucial to get them involved and
to maintain their participation. This will be achieved by weekly workshops.
In sum, the baseline tasks to complete involve purchasing the solar systems, arranging for

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transportation, developing workshops for staff education, briefing, and assignments, distributing
containment cleaning supplies and containers, and developing mass media campaigns by locating
major radio stations.
Technical Approach Goal 2
By 2020, the program plants to reduce the number of contaminated water ingestion
related diseases in Monrovia, Liberia, by 5 percent. In order to do so, some crucial research,
planning, implementation and evaluation needs to take place. First, a team of researchers will
check hospital rates regarding water related diseases. Then, the team will head to the targeted
community of Monrovia, Liberia to research the activities in the community that contaminate the
water sources such as open defecation, using water from the same source that animals might
bathe and defecate in, and humans wash clothes in. Also, the researchers will check for runoff
water sources that might bring additional contamination via bacteria from feces. Additionally, the
team will assess what the villagers are currently doing as far as daily sanitary practices. An
important part of the researchers work is to find out the changes the community wants to see so
that the program takes into consideration the targeted communities needs while planning and
implementing the program. By taking what the community wants into consideration, the program
is transformed into a more realistic and community-oriented program rather that the community
can accept rather than a foreign organization the community cannot trust and work with.
Second, the research team will partner with established leaders of the community,
volunteers, and radio stations in order to plan workshops that will teach the community about
hygiene and sanitation promotion. Once these workshops are planned, radio stations and
community leaders will broadcast the upcoming learning events to the villagers.
The next step to achieve the programs goal is to implement the educational workshops.
These workshops will be led by a team of community leaders, research experts, volunteers, and
radio stations. The radio stations will play a part by broadcasting hygiene and sanitation

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promoting educational segments amongst their usual programs. The participants of the
workshops will be asked to give their feedback in how the programs team can better teach these
workshops. In order to help the community realize why clean water is so important, there will be
an activity that will demonstrate that even water that looks clean can contain feces. The
community will be taught effective hand washing techniques and at what occasions they must
wash their hands. These workshops will be held three times a week by the program educators
that will work with the community leaders, radio stations, volunteers, and research experts.
Lastly, the effectiveness of these workshops will be assessed by assessing the rates of
deaths occurring as a result of water contaminated related diseases by obtaining the data from
hospitals. The water the community members use will also be tested regularly to assess the
maintenance by the community of the filtered water. Changes in sanitary practices will also be
assessed by the research teams. By the year 2020, the program hopes to have reduced the number
of contaminated water ingestion related diseases in Monrovia, Liberia, by 5 percent
Technical Approach Goal 3
Reaching the third goal of the project, decreasing the number of children in Monrovia
who die from diarrhea caused by water-borne pathogens from 1000 to 750, a reduction of 25%.
Contributing to this goal initially is providing the people of Monrovia with a source of clean,
potable water using the photo-voltaic solar powered water machines as well as providing them
with the materials and education to store and prepare water in a way that does not promote
pathogenic contamination of stored water. Diarrhea is especially deadly for children under 5 in
developing countries. In order to reach the target of young children and their hygiene practices,
focus will be placed on educating mothers and caretakers in the community as well as children
themselves. Studies have shown that in communities such as Monrovia, up to a 47% reduction in
diarrhea can occur when proper hand washing using water and soap is introduced into a
community (Curtis and Cairncross, 2003). An intensive hand-hygiene campaign will be

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developed and implemented in Monrovia. Using mass media as was used in the other program
goals, hand hygiene and the emphasis in the need to wash hands after defecating will be a focus
of the campaign. The CDC has published instructions for Tippy Tappy, a very simple hand
washing station using plastic bottles and minimal cost supplies that can be connected to a water
supply, such as one of our photo-voltaic water machines, or a smaller source of stored clean
water, with soap attached, that can serve as a hand washing station next to latrines or designated
defecation areas (2010). In addition distributing the supplies for hand washing stations in public
areas, hand washing supplies will always be distributed to mothers and families in Monrovia
after they have received hand-washing instruction and demonstrated they can properly wash their
hands.
While the act of public open defecation has been considerably decreased among adults, it
is still common practice in Monrovia for children to be permitted to defecate in public, especially
in beaches. The program will address sanitation and eliminating open defecation in general in the
community of Monrovia. In order to focus of reducing the high rate of fatal diarrhea in children,
education and action must be made to ensure children are also made to defecate in designated
areas or latrines. Open defecation in general is dangerous particularly to younger children as they
are closer to the ground and have less knowledge of the danger of feces. Mothers, caretakers, and
children will be educated about the danger in contact with feces or in contact with dirt or water
that has been contaminated with feces.
While clean water and improved sanitation and hygiene is preventative measure to
diarrhea, the continued occurrence of diarrhea must also be addressed as practices and attitudes
concerning hand hygiene and sanitation may not be changed immediately and may take
continued exposure to the program. Prior studies conducted in the comparable setting of GuineaBissau, revealed that the majority mothers who children were suffering from diarrhea had

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sufficient knowledge and understanding of oral rehydration salts (ORS) and their use yet only
58% of the children in the homes surveyed were treated with ORS, and in many of the cases
when ORS were given the amount given was insufficient (Sodemann, Jakobsen, Molbak,
Martins, & Abby, 1999). In addition to community outreach and education programs to educate
mothers and caretakers about the signs ad symptoms of diarrhea and how to treat diarrhea with
ORS, an emphasis will be placed on ensuring mothers and caretakers can properly mix and
administer ORS to children when needed. ORS will be acquired and distributed to the
community in conjunction with campaigns concerning the recognition and home treatment of
diarrhea in young children.
Monitoring and Evaluation
Monitoring and evaluation are very important in developmental projects because it
assesses if progress is being made in line with project expectations. Monitoring is the ongoing
collection and analysis of information and data that shows if progress is being made towards
achieving the projects established goals. Evaluation is an overall assessment that looks at the
long term impact of a project and reveals what worked, what did not work, and what needs to be
done in order to improve future projects (Energy Saving Trust, 2014).
The main goal is to decrease the number of Liberians who do not have access to clean,
safe drinking water from 25% to 15%. Another goal is to decrease the number of waterborne
illnesses by 5% by 2020, and the last goal is to decrease the number of children under 5 who die
by from waterborne diarrheal diseases by 5% by the year 2020. Sanitation is a major factor that
plays a role in water contamination. In order to increase sustainable water, promotion of
sanitation services and hygiene practices needs to occur. The first step in promotion is to get the
villagers to see that their current hygiene and sanitation practices are not ideal.
In regions in Africa, such as Liberia open defecation is a norm. But villagers dont
realize the health implications that come with the practice. A standard activity for all villages will

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be implemented. Villagers are asked to walk through their communities to observe their
sanitation facilities and hygiene practices such as hand washing and open defecation. Then a
volunteer will hand everyone a cup of water and ask them to take a drink from it. After everyone
takes a sip, a second volunteer will go around and drop feces in the cup and again ask everyone
to take a sip. The goal of this activity is to increase the villagers knowledge and change their
behavior.
Another standard evaluation is to have volunteers go into each new village and collect
initial data on the number of people living in the villages, the number of home or community
bathrooms/ latrine facilities, community hand washing facilities, and also the number of water
pumps in villages. Then data on the number of children 5 years and younger and people over 5
years who had diarrhea in the last month will be gathered. Next the number of deaths from
waterborne diarrheal diseases within the past year will be collected. This information will be
found at the local level from hospital and lab records. It will also be obtained from the CDC and
WHO websites. This will give baseline numbers to compare against. Once villages in need of
improved sanitation facilities and hygiene behaviors are identified educational workshops will be
put into place.
Each workshop will have an attendance sheet for villagers to sign in on every time they
attend a workshop. The attendance records will be analyzed at the end of every month to see if
there has been an increase in the number of villagers attending. Villages will be taught that open
defecation is not ideal because fecal matter can contaminate many sources such as water, fruits,
vegetable, inanimate objects which ultimately end up in their mouths. The villagers will learn the
number of people who develop and die from waterborne illnesses. Then teachers would
demonstrate proper hand washing techniques. The participants will be taught how to properly
wash their hands and at what times they should wash their hands such as before eating or after

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using the bathroom. The participants will need to demonstrate back the proper techniques in
order to ensure effective learning. Once they show the teachers that they can properly wash their
hands they will be given a certificate of completion. Volunteers will also conduct weekly home
visits to observe when and how villagers are washing their hands. The villagers will be taught
about the importance of having separate areas for hand washing, defecating, and bathing. An
incentive will be to have a village wide ceremony when they become defecation free areas.
They would get a plaque which can be hung in the village square stating the government
recognizes the village as defecation free. This recognition would give the village a sense of
pride and empowerment which could create a domino effect for other communities. A video
about photovoltaic powered water sanitation and how the process works would be shown. At the
end of the video poll would be taken to see how many villagers are interested in having a
photovoltaic powered water pump installed. Another poll would be taken to see how many
villagers would be interested in learning how to maintain the pumps. Once these programs are
implemented they the data will be reassessed to see if any improvements in the villages
sanitation and hygiene practices.
Follow-up will be conducted monthly for all the targeted villages. There should be an
increase in the number if communal and personal hand washing stations and latrines. There
should also be an increase in the number of solar powered sanitation water pumps. Monthly
follow-up will also include the number of new cases of diarrheal illnesses and deaths. Every
three months the findings will be given to all the key stakeholders. Every year all the data will be
analyzed to see if any of the impacts have been met. The data will be compared against that of
the CDC, WHO, and UNICEF websites. If improvements have not been made such as in
villagers sanitation or hygiene practices then volunteers will go back into those villages and
provide refresher courses. Volunteers can also think about setting up hygiene fairs. The

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monitoring and evaluation should show increased cleanliness in safety in Liberians drinking
water.

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References
Boley, F. (2012). In Liberia, Political Battles Center on Water Access. PBS Newshour: The
Rundown. Retrieved from http://www.pbs.org/newshour/rundown/in-liberia-politicalbattles-center-on-water-access/
Center for Disease Control. (2010). Tippy Tappy. Retrieved from: www.cdc.gov/safewater/
publications_pages/tippy-tap.pdf
Curtis, V. and Cairncross, S. (2003). Effect of washing hands with soap on diarrhoea risk in the
community, a systemic review. The Lancet: Infectious Diseases, Volume 3, May 2003
Doocy, S., & Burnham, G. (2006). Pointofuse water treatment and diarrhoea reduction in the
emergency context: An effectiveness trial in liberia. Tropical Medicine & International
Health, 11(10), 1542-1552. Johnson, D. ,Hokanson, D. , Zhang, Q. , Czupinski, K. , &
Tang, J. (2008). Feasibility of water purification technology in rural areas of developing
countries. Journal of Environmental Management, 88(3), 416-427.
Energy Saving Trust (2014). How to monitor and evaluate your community project.
http://www.energysavingtrust.org.uk/Communities/Support-and-guidance/Howto-guides/How-to-monitor-and-evaluate-your-community-project
Face Africa. (n.d.) Our projects. Face Africa. Retrieved from http://faceafrica.org/our-projects/
Forstmeier, M., Feichter, W., & Mayer, O. (2008). Photovoltaic powered water purification
challenges and opportunities. Desalination, 221(1-3), 2328.doi:10.1016/j.desal.2007.04.063
Johnson, D. , Hokanson, D. , Zhang, Q. , Czupinski, K. , & Tang, J. (2008). Feasibility of water
purification technology in rural areas of developing countries. Journal of Environmental
Management, 88(3), 416-427.
Kimani-Murage, E. & Ngindu, A. (2007). Quality of water the slum dwellers use: The case of a
kenyan slum. Journal of Urban Health, 84(6), 829-838.
Ki-moon, Ban. (2010). Secretary general: 22 september, 2010. United Nations. Retrieved from
http://www.un.org/News/Press/docs/2010/sgsm13126.doc.htm
Marcelo, P. (2013, August 11). Rebuilding Liberia: Clean water and sanitation still serious
challenges in Monrovia's slums. The Providence Journal. Retrieved from

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http://www.providencejournal.com/breaking-news/content/20130811-rebuilding-liberiaclean-water-and-sanitation-still-serious-challenges-in-monrovia-s-slums.ece
Mellor, J. E., Smith, J. A., Learmonth, G. P., Netshandama, V. O., & Dillingham, R. A. (2012).
Modeling the Complexities of Water, Hygiene, and Health in Limpopo Province, South
Africa. Environmental Science & Technology, 46(24), 13512-13520.
doi:10.1021/es3038966
Njoh, A. J., &Akiwumi, F. A. (2011). The impact of colonization on access to improved water
and sanitation facilities in African cities. Cities 28(5), 452460.doi:10.1016/j.cities.2011.04.005
Sodemann, M., Jakobsen, M.S., Molbak, K., Martins, C., Aaby, P. (1999). Management of
childhood diarrhea and use of oral rehydration salts in a suburban West African
community. American Journal of Tropical Medicine and Hygiene. 60(1):167-71.
WaterAid. (2013). Where we work: Liberia. Retrieved from http://www.wateraid.org/where-wework/page/liberia
Waves for Water. (2012) Project Liberia. Retrieved from http://www.wavesforwater.org/
project/Project-Liberia
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http://www.wavesforwater.org/project/Project-Liberia

Planning+Support
Inputs

Causal Pathway Logic Model

P
lan This Way
Program Activites/Outputs

Activites/Outputs

Activities

Activities

Outputs

Outputs

Effects
Knowledge/Attit
udes

Practices

Impact

WATER SANITATION IN LIBERIA

Evidence

Grant Writing

concerning

and

21
By 2015, the

Citizens

By the

community will

of

end of the

be more

Monrovia

first year

knowledgeable

, Liberia

of the

about sanitary

will

program,

practices and the

acquire

the

difference

clean

percentag

between clean

drinking

e of

and contaminated

water for

Liberians

water. Citizens

solar-

without

will understand

powered

access to

the idea of water

filtered

potable

contamination in

pumps

drinking

their current

and

water will

water sources.

ingest

be

Citizens will

only

decreased

understand the

clean,

from 75%

function and

potable

to 85%.

purpose of

water.

Operate/Maint
current

Acquisition
Purchase

rates of

of Funds,

ain
Build and

PVSWPM's
illness and

Contact

PVSWPM's,
place

, arrange for
access to

shareholder/

Provide
PVSWPM's

transport.
potable

security for

meet with the

pumps

water

solar system

assessed

company.

Designatio
n of target
community

Establish

Distribute

schedules

water and

for

containers -

Workshops

distribution,

monitor

for staff

determine

schedule and

education,

capacities of

oversee water

briefing,

pumps and

collection/dist

and

amount of

ribution

assignments

water to be

Hire and
Orient
Program Staff

rationed
during

PVSWPM's and

Identificati

Evidence

Narrow

distribution
Distribute

on of

supporting

neck

Containers

drinking and

stakeholder

narrow necks

containers

for

cooking from

s and target

containers

and

Collection

solar-filtered

beneficiari

and clean

containment

es and

containment

cleaning

contributor

procedures is

supplies are

studied,

acquired for

presented to

distribution

stakeholders,
and funding

acquire water for

pumps.

WATER SANITATION IN LIBERIA

22

for containers
is acquired.
Baseline
studies:
Water access,
Continue
currents
Community
KAP's of
meetings,
target
Necessary

Educate
Developme

population,
funding

workshops,
target

nt of target
current

determined

and use
population

KAP's,
occurrence of

and

members of
about water

establish
diarrhea and

acquisition

community as
contaminati

target
other

of funding

teachers
on and need

problem
illnesses,

is initiated

(women) to
for potable

areas
current

further
water
continue

presence of
community
other aid
education
programs and
access to
Profession

resources
Evidence

Developme

Radio/Mass

Continue

al

based

nt of mass

Media

campaigns/res

companies

material for

media

Campaigns

pond to

consulted

campaigns

campaigns

Initiated

inquiries/eval

presented to

and location

uate

stakeholders

of major

effectiveness

and funding

radio

for mass

stations,

media

commercial

campaigns is

time

acquired.

acquired,
campaigns

WATER SANITATION IN LIBERIA

23

initiated

Designatio
n of team
members
and
staffing
acquired
Team

Evidence

Developme

Mass Media

Citizens are

Citizens will

Citizens

By 2020,

education

based

nt of mass

Campaigns,

exposed to

be taught to

of

there will

material for

media

Community

campaigns for

use clean,

Monrovia

be a

campaigns

campaigns

Outreach

clean water,

narrow-necked

will

reduction

presented to

and location

Programs,

promoting

storage

properly

in the

stakeholders

of major

Focus on

PVSWPM's,

containers for

collect

number

and funding

radio

Education

proper water

storing potable

and store

of

for mass

stations,

of mothers

storage and

water acquired

potable

contamin

media

commercial

and women

preparation.

from

water, as

ated

campaigns is

time

and their

Emphasis is

PVSWPM's,

well as

water

acquired.

acquired,

involvement

placed on

and understand

engage in

ingestion

campaigns

all

education of

the importance

water

related

are

implemente

women as

of clean

boiling of

diseases

reviewed by

d in target

primary water

storage

water that

in

team.

communitie

acquirers and

containers and

has been

Monrovia

food preparers.

boiling stored

stored.

, Liberia

water.

by 5

WATER SANITATION IN LIBERIA

24

Logistics

Review of

Design of

Defecation

Citizens are

Citizens of

By 2020,

for team

baseline

defecation

Clean Up,

shown

Monrovia will

citizens

determined

studies

plan to

Designation

designated

understand the

of

concentrating

promote

of

defecation areas

role of

Monrovia

on sanitation

sanitation

Defecation

and agree to

contaminated

will

and

and

Areas,

designate areas,

water in the

engage in

defecation.

decrease

Education

as well as are

spread of

more

Evidence for

contact with

about Feces

involved in

water-borne

sanitary

new

feces and

and Water

demonstrations

diseases and its

practices,

defecation

water

Contaminati

on water

relationship

such as

program

contaminati

on

contamination

with open

separate

found and

on

Curriculum

and fecal

defecation and

areas for

presented to

developed

Developme

transmission of

importance of

bathing,

team.

and

nt

pathogens.

avoiding

toileting,

presented to

contact with

and

team.

feces.

drinking.
The
communit
y will no
longer
engage in
open
defecatio
n and will
establish
safe areas
for
defecatio
n far from
water
sources.

percent.

WATER SANITATION IN LIBERIA

25

Continued
developmen
Current

t of hand

review of

hygiene

knowledge

education,

and exposure

team

Collection

Citizens are

Designatio

to hand

assigned

and

given hand-

n of team

hygiene

and

Acquisition

washing

members

knowledge

prepared for

of Hand

materials and

and

determined

implementat

Hygiene

are able to

staffing

and

ion, and

Materials

demonstrate

acquired

curriculum

funding for

and

proper hand

for hand

hand

Education

washing.

hygiene

hygiene

campaign is

materials

developed

and

Citizens will

Citizens

understand the

will

importance of

engage in

hand washing

optimal

the relationship

hand

with illness.

washing

They will take

and

charge over

minimize

their health and

contact

feel

with

empowered

feces.

program is
determined
Profession
al
healthcare
experts
contracted
Materials

Funding of

Program

Workshops

Education

Mothers and

Mothers

Decrease

for

PVSPWM's

Implementa

for team to

provided to

caretakers will

and

the

demonstrat

tion of

learn

mothers and

understand

caretakers

number

ions

PVSPWM's

curriculum

caretakers about

need for clean,

will have

of

to provide

for teaching

water

potable water

access to

Monrovia

access to

to mothers

contamination

and understand

PVSPW

n children

clean water.

and

and relationship

the occurrence

M's and

under 5

caretakers,

to diarrheal

of water-borne

provide

who die

demonstrati

illness. Mothers

pathogens in

potable

by from

WATER SANITATION IN LIBERIA

26

ons will be

will be given

developed

access to

and given,

PVSPWM's and

access to

taught about

PVSPWMs

proper storage

established

and preparation

and

of water. Use of

encouraged

PVSPWM's.

stored water.

water to

waterbor

children

ne

under 5

diarrheal

for

diseases

drinking

by from

and

1000 to

cooking.

500 by

They will

the year

engage in

2020.

proper

(This is a

storage,

50%

boiling,

reduction

and

; optimal

serving of

goal
would be

Materials

Development

Team

Hand

Children and

Children will

water.
Children

for hand

of hand

members

hygiene

mothers will be

learn the

will

hygiene

hygiene

will learn

campaign

shown how to

importance of

engage in

campaign

and be able

will be

properly wash

proper hand

optimal,

based on

to

implemente

hands and

washing and

proper

evidence.

demonstrate

d directed at

supplied with

know how to

hand

Funding and

hand

children

hand washing

properly wash

washing.

acquisition of

hygiene

under 5,

materials.

hands.

hand hygiene

practices

with

materials:

relative to

emphasis on

soaps,

area and

mother and

buckets,

their

caretaker

etcetera

supplies and

education.

available
resources.

eliminati
on of
death
from
diarrheal
diseases.)

WATER SANITATION IN LIBERIA

27
Open

Developme

defecatio

nt of mass
media

Through

n will no

campaigns and

longer be

Education
campaigns
Evidence

community
and mass

and location
based

education:
media

of major
material for

mothers will be

radio

taught about

stations,
Workshops

defecation and

commercial

its relationship

time

to diarrheal

acquired,

illness and water

campaigns

in
feces with

contamination.
will be

initiated,
campaigns.

take place
contact with

defecation

media

n will
defecation and

child open

for mass

Defecatio
childrens open

practice of

and funding

children.
between

the current

stakeholders

adults nor
relationship

focusing on

presented to

, for
understand the

campaigns

campaigns

permitted
Mothers will

designate
diarrheal

They will be
implemente

community

d areas.
illness.

shown

Contact

outreach

designated

with

education

defecation areas.

feces will

d.

developed.
Equipment

be

Evidence

Acquisition

Distribution

Community

Mothers will

avoided.
Mothers

based

of

of

outreach

be taught about

will treat

material for

rehydration

rehydration

programs and

the signs,

children

funding of

salts and

salts and

education given

symptoms, and

experienc

rehydration

healthcare

education of

to mothers of

dangers of

ing

salts

professional

signs and

children under

diarrheal

diarrhea

s to

symptoms

5, rehydration

disease in

with

establish

of diarrhea

salts provided.

children under

properly

treatment

education

5 and be

prepared

guidelines

provided t

provided with

and

for

outreach

rehydration

mixed

campaign

teams and

salts as well as

rehydrati

and

mass media

taught to

on salts

WATER SANITATION IN LIBERIA

educational

28
campaigns.

and

Proper

recognize

preparation

severe

of

symptom
correctly

outreach

rehydration

s and
prepare them.

programs.

salts learned

seek

and

treatment

demonstrate

when

d.

possible.

Regulation
s, licensure
requiremen
ts
Implement This Way
Target Population Defined:

Stakeholders/Partners Identified
Businesses: if the private
The solar system company
Water Aid Charity
Villagers/Liberians: improved
health, decrease global disease,

Monrovia, Liberia, with focus on educating

mothers and women and establishing their
involvement in the community and in the
project

make time spent on walking

long distances useful for
education, work, or family.

sector invests in these new

technologies, then the
community will have bought
into these changes and more
likely to help/be involved
Environment: building these

Government: more time for

water purification machines
school and work will help the
will not harm the
government; healthier residents
environment
will help govt.

WATER SANITATION IN LIBERIA

29