Growing with safe water in Bolivia

The sun rises in the municipality of Tarabuco, province of Yamparaez, department of Chuquisaca, Bolivia. The dry air caresses the fields of potatoes, barley, and corn and brushes against some fruit trees that dot the valley with peaches, apples, and figs. Some peaceful sheep graze on its slopes, unaware that their wool will perhaps travel the world in spectacular Yampara textiles. José, who works at a small school in the area, walks through this landscape, carrying a container - for 3 km - to get water for breakfast for the children who will soon arrive for classes.

The fact is that the schools in the poorest areas of Tarabuco do not have water and especially in the dry season, long walks to get it become inevitable, at least what is essential for consumption. Children's hygiene and school cleanliness are luxuries that they cannot always afford. And these deficiencies, also present in many homes, impact health and education: it is common to see malnourished and “short” children. It is also no surprise that children fall asleep in class or fall behind in learning.

These types of challenges were the focus of “Growing with Safe Water”, a pilot project by CAF - development bank of Latin America and the Caribbean - implemented in 2022 in three municipalities of Bolivia: Tarabuco, Caripuyo and Entre Ríos, through the NGOs Andean Rural Health Council and Proyecto Esperanza, in coordination with the Technical Secretariat of the National Council of Food and Nutrition (CONAN) of Bolivia.

The project sought to prevent chronic childhood malnutrition (low height for age) through an intervention model based on training relevant social actors in the community to promote healthy practices in water, hygiene, health, nutrition and stimulation of the child development in children under 5 years of age (WASH plus nutrition), both at home and at school and in health facilities. And it was framed in the MIAGUA projects, with which Bolivia, and the financial support of CAF, since 2011 has brought water to approximately 2 million people in dispersed rural communities and peri-urban areas, and aims to reach another quarter of a million with “MIAGUA V”.

“Growing with Safe Water” included the development of a toolbox with teaching-learning materials to promote the practices necessary to combat child malnutrition in homes, health centers and educational units, with a focus on access and availability of safe water. Equipped with these materials, the project implementing team trained almost 100 trainers, who in turn trained almost a thousand people in the three target municipalities.

On the other hand, a series of follow-up, monitoring and evaluation instruments were developed, which sought to ensure that the implementation was of high quality.

An evaluation of the project implementation results showed a favorable reception of the materials by teachers and health personnel, and also suggests improvements in some key practices of families with respect to the pre-project situation. In particular, improvements were observed in personal hygiene practices, with a higher percentage of families using detergent to wash their hands (85% vs. 53%), and a higher percentage of mothers demonstrating knowledge of the key times to wash their hands.

Also, improvements were observed in household hygiene and sanitation practices, with more families keeping their bathrooms and latrines clean (65% versus 28% before the project), their yards free of organic and inorganic waste (45% versus 25% before the project ) and their garbage containers properly covered (52% versus 32%). In contrast, some practices related to safe water consumption (e.g., boiling water) and child feeding (e.g., exclusive breastfeeding up to 6 months) continued to have low adoption.

The evaluation also yields lessons to keep in mind when considering scaling the project. Among the most important, it is worth mentioning that the results may be affected if there are no means to implement the recommendations (for example, health facilities that do not work) or if there is no adequate budget (for example, to disseminate the materials developed). or sustain training over time).

Furthermore, it is necessary to highlight the importance of community support and commitment. Without a doubt, this is one of the key elements that must be addressed from the beginning, ideally from planning, including monitoring actions and analysis of results.

That is why scaling up to other municipalities requires detailed planning, including a sufficient budget to operationalize the project for at least one year, as well as greater integration with local health and education plans. It would also be important for the evaluation of the project for health centers to annually process relevant indicators to measure their impact, in particular the level of chronic childhood malnutrition in children under 5 years of age, the reduction of which is the ultimate objective of this intervention. However, this indicator requires a long time to be affected by interventions.

CAF, through its strategic action area “Water and Sanitation”, has contributed to expanding access to safe drinking water and sanitation in households in the region, which has helped to significantly reduce child mortality from diarrhea. “Growing with Safe Water” adds value to water provision programs for communities, particularly rural ones, as it allows entry into the home with WASH practices, strengthened with components of health and nutrition practices aimed at mothers, pregnant women and children. little ones. With projects such as “Growing with Safe Water” CAF honors its commitment to contribute to improving the health and education of Latin American and Caribbean children, through its fight against chronic childhood malnutrition.

For more information about CAF's action in water and sanitation and its impact in the region, visit: CAF Impact