To read the full evaluation report, please click here.
Background
The Millennium Water Alliance (MWA) has been implementing the five-year Sustainable WASH Project (SWP) in Ethiopia to strengthen water supply, sanitation, and hygiene (WASH) services in schools, health facilities, and communities, contributing directly to Ethiopia’s One WASH National Program and the Conrad N. Hilton Foundation’s Safe Water Initiative 2025 strategy. Acting as a central hub, MWA has coordinated partners’ activities in the Amhara Region and supported the expansion of improved WASH services.
In August 2024, PATH conducted the endline evaluation of WASH services in 26 selected health facilities across Dera, Farta, and North Mecha Woredas. This evaluation focused on assessing the quality, functionality, and improvements in WASH services, particularly for facilities implementing the Clean Clinic Model (CCM). The findings highlight progress achieved since baseline and midline assessments while emphasizing the challenges faced due to Ethiopia’s ongoing conflict and climate change impacts.
Key Findings
Water: At endline, 50% of SWP facilities met the Joint Monitoring Program (JMP) basic water service level, with 92% of these being CCM facilities. However, only 5% of facilities showed improvement in water service levels since baseline.
Sanitation: Nineteen percent of facilities achieved JMP basic sanitation service levels, with 23% showing improvement since baseline. However, some facilities experienced service declines, particularly in Dera Woreda.
Hand Hygiene: Fifteen percent of facilities met the JMP basic hand hygiene level, with 32% demonstrating improvement from baseline. Functioning hand hygiene stations were present at 75% of points of care in 31% of facilities.
Healthcare Waste Management: Fourteen percent of facilities met JMP basic waste management standards, improving from 5% at baseline.
Environmental Cleaning: Two facilities met JMP basic environmental cleaning levels at endline, though baseline data were unavailable for comparison.
Energy and Environment: While 88% of facilities had access to electricity, 87% of these facilities faced energy insufficiencies for meeting all operational demands.
Impact on Clean Clinic Model (CCM): Facilities implementing the CCM generally outperformed non-CCM facilities in water, sanitation, hand hygiene, and environmental cleaning according to JMP standards, but significant gaps remain, particularly in healthcare waste management where CCM facilities showed no clear advantage.
Conclusions
The endline evaluation shows steady progress in achieving basic WASH service levels, particularly in water, sanitation, hand hygiene, and waste management. However, challenges persist, including service declines in some facilities, limited budgets, and inadequate systems for operation and maintenance. External factors such as ongoing conflict and climate change further exacerbate these issues, highlighting the fragility of progress.
Recommendations
Data for Action: Continue using WASH FIT and CCM to guide quality improvement strategies, enhance funding approaches, and track progress. A data dashboard can facilitate real-time trend analysis and decision-making.
Costing Toolkit Development: Develop comprehensive costing estimates for capital and operational expenses needed to achieve and sustain basic WASH services, serving as a tool for advocacy and resource allocation.
Risk Assessment and Mitigation: Integrate climate change and antimicrobial resistance considerations into planning to ensure sustainable WASH services in the face of emerging risks.
This report underscores the importance of sustained efforts, collaboration, and innovation to overcome challenges and build resilient WASH systems in Ethiopia.
To read the full evaluation report, please click here.
