Hygiene and EH Strategy

The Federal Democratic Republic of Ethiopia
Ministry of Health
National Hygiene and Environmental Health

Strategy
Dec, 2016
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DECLARATION
Federal Democratic Republic of Ethiopia National Hygiene and Environmental Health
Strategy Implementing Sectors Declaration
We, the undersigned, representing the Government of the Federal Democratic Republic of
Ethiopia, in the WASH sector ,National Hygiene and Environmental Health Strategy
Coordination Body, fully recognize each Ministry’s mandate and pledge our commitment to
support the achievement of the targets laid out in this strategy document and will strive towards
equitable and sustainable multi sectoral actions towards the realization of optimal rural and
urban Hygiene and Environmental health status for all Ethiopian citizens.
We, as a government, shall work through enhanced strategic partnerships and integration to
prioritize the achievement of Rural, Urban and Institutional hygiene and Environmental health
implementation to bring better achievement for all Ethiopian as one of the most viable strategies
for achieving the Growth and Transformation Plan II for the attainment of positive livelihood.
Outcomes will be achieved through evidence based programming and responsiveness and the
promotion of accountability towards these results by each Ministry here undersigned.
Signatures:
H.E. Dr. Kebede Worku
State Minister of Health
________________________________
H.E Ato Admassu Nebebe

State Minister of Finance & Economy Cooperation
________________________________
H.E. Mr. Kare Chewicha

State Minister of Environment, Forestry and Climate Change
________________________________
H.E. Mr. Demese Shito

State Minister of Urban development and Housing
________________________________
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H.E. W/ro. Frenesh Mekuriya
State Minister of Water, Irrigation and Electricity
________________________________
H.E. Dr. Samuel Kifle

State Minister of Education
________________________________
H.E. W/ro Meaza G/Medhin

State Minister of Culture and Tourism
________________________________
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TABLE OF CONTENTS
Declaration ........................................................................................................................................... ii
Table of Contents ................................................................................................................................ iv
List of Tables ...................................................................................................................................... vii
List of Figures.................................................................................................................................... viii
Acknowledgement ............................................................................................................................... ix
Definition of terms/ Operational Definition .........................................................................................x
Acronyms .......................................................................................................................................... xiii
Executive summery ........................................................................................................................... xvi
PART I................................................................................................................................................. 1
1. Background ..................................................................................................................................... 1
2. Rationale ......................................................................................................................................... 3
3. Scope ............................................................................................................................................... 4
4. Situational Analysis ........................................................................................................................ 5
4.1. Status of HEH in Ethiopia ................................................................................................ 5

4.2. Health and economic effect of poor HEH Conditions ..................................................... 8
4.3. Emerging Hygiene and Environmental Health challenges .............................................. 9
4.4. SWOT Analysis.............................................................................................................. 10
5. Strategy Development Process...................................................................................................... 12
PART II ............................................................................................................................................. 13
Hygiene and Environmental Health Program Strategy ..................................................................... 13
1. Vision ........................................................................................................................................ 13
2. Mission...................................................................................................................................... 13
3. Core Values............................................................................................................................... 14
4. Guiding Principles..................................................................................................................... 14
5. Strategy Formulation................................................................................................................. 15
5.1. Strategic framework.................................................................................................... 15
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5.2. Goals ........................................................................................................................... 16
5.3. Strategic Objectives .................................................................................................... 16
6. Program Management/Implementation framework .................................................................. 20
6.1. Institutional Development .......................................................................................... 20
6.2. Capacity building ........................................................................................................ 21
6.3. Access to Basic HEH Facilities .................................................................................. 21
6.4. Cross cutting issues..................................................................................................... 24
6.4.1. Equity ...................................................................................................................... 24
6.4.2. Gender ..................................................................................................................... 26
6.4.3. Environment............................................................................................................ 26
6.4.4. Health and Safety .................................................................................................... 27
6.4.5. Private sector engagement ...................................................................................... 28
6.4.6. Community engagement and ownership................................................................. 29
6.4.7. Sustainability........................................................................................................... 31
6.5. Partnership, coordination integration and networking................................................ 32
6.6. Finance........................................................................................................................ 33
6.7. Monitoring, Evaluation, Learning and research ......................................................... 33
PART III ............................................................................................................................................ 34
Strategic Action Plan ......................................................................................................................... 34
1. Program Management Arrangements ....................................................................................... 34

1.1. HEH initiatives ............................................................................................................... 34
2. Strategic Solutions for Successful outcome.............................................................................. 35
2.1. Create or strengthen the enabling/ supportive environments ..................................... 35
2.2. Engage stakeholders at all level.................................................................................. 35
2.3. Capacity building ........................................................................................................ 36
2.4. SBCC and media support............................................................................................ 36
2.5. Develop personal skills ............................................................................................... 37
2.6. Strengthen community actions ................................................................................... 37
2.7. Strive to ensure sustainability and replicability .......................................................... 37
3. Strategic Action Steps and Milestones ..................................................................................... 39
1. Research, learning and sharing ................................................................................................. 50
2. Program coordination and planning .......................................................................................... 50
3. Resources .................................................................................................................................. 50
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3.1. Funding requirement................................................................................................... 50
3.2. Budget by each Strategic Initiatives ........................................................................... 51
3.3. Source of fund............................................................................................................. 54
4. Roles and Responsibilities of Government and Partner Organizations .................................... 54
5. Monitoring and Evaluation ........................................................................................................... 65
6. ANNEX......................................................................................................................................... 67
6.1. Annex 1: Strategic Result framework ............................................................................ 67

6.2. Annex 2: Key Critical Barrier Analysis ......................................................................... 73
7. BIbliography ................................................................................................................................. 79
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LIST OF TABLES
Table Description Page
No
1 Five year action plan for hygiene and environmental health, 2016 26
2 Stakeholders analysis for hygiene and environmental health, 2016 41
3 Monitoring and evaluation indicators for hygiene and environmental health 49
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LIST OF FIGURES
Fig. Description Page
No
1 Strategy development process for HEH strategy 11
2 Strategy development logical order Adopted from https://www.google.com.et 12
search=strategic actions (Accessed date on 20/11/2015.)
3 Conceptual strategic framework for Hygiene and Environmental Health Strategy 14
4 Program management components 18
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ACKNOWLEDGEMENT
The Federal Ministry of Health acknowledges the very valuable inputs from government sectors
(MoE, MoLSA, MOT, MOEFCC, MOCT, MOANR, MOI, MOE, MOUDHC, MOWIE, EPHI,
FMHACA, AAU/EWRMI); International and bilateral partner organizations (UNICEF, WHO,
WSP/WB ); Civil Society Organizations (Save the children, JSI, Plan International, SNV);
private sector (Citrus International PLC, Beshangari Purification, Tulip) and Associations
(EPHA and EHA) representatives and other stakeholders that gave their valuable time for the
development of this strategy during office level discussions, reviewing the draft document and
extending their valuable comments in writing and in person.
Special acknowledgment is due to WaterAid Ethiopia to its financial, material, technical
contributions and involvement to realize the strategy to this final stage.
Acknowledgement is due also to regional health bureaus, woredas visited, primary health care
units and staffs for their time candid discussion and honest information provided to the team
during their visit.
We acknowledged the contribution of community members organized in WHDA/ limat budins,
church leaders, HEWs, teachers and kebele leaders who provided valuable and honest
information on prevailing issues and challenges in their settings with confidence and truth.
Last but not least we appreciate the contribution made by the consultant Ato Kebede Faris who
had put his time, knowledge and experience in designing this Hygiene and Environmental Health
strategy.
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DEFINITION OF TERMS/ OPERATIONAL DEFINITION
 Basic latrine: defined by the Millennium Development Goals Task Force is “the lowest-cost option for
securing sustainable access to safe, hygienic and convenient facilities and services for excreta and sullage
disposal that provide privacy.”
 CLTSH: A community mobilization approach or a behavior change triggering tool that is administered
by trained and skilled facilitators to mobilize communities through self-realization resulting from fear,
disgust and shame which the tool is creating on individuals and communities to ultimately initiate a rapid
behavior change in constructing improved latrine with proper hand washing facilities.
 Community resource People : are prominent, respected, trusted and informal community leaders
permanently residing in community setting
 Community Empowerment: engaging communities to take the upper hand in recognizing their heartfelt
problems in hygiene and environmental health and plan for an intervention program using their
knowledge, skill, time and material resources for a sustainable health outcome, and take part in the
planning, implementation ,and monitoring and evaluation.
 Environmental Health: Environmental health addresses all the physical, chemical, and biological
factors external to a person, and all the related factors impacting behaviors. It encompasses the
assessment and control of those environmental factors that can potentially affect health. It is targeted
towards preventing disease and creating health-supportive environments (WHO 2016)
 Health: A state of complete physical, mental and social wellbeing and not merely the absence of disease
or infirmity. (WHO 1950)
 Health Development Army: is a network of women volunteers organized to promote health,
prevent disease through community participation and empowerment.

 Hygienic latrine: A hygienic latrine is essentially an improved latrine but one that is clean, cleanable and
odor free.
 Hygienic behavior: A behavior that manifested when people transform themselves to demand,
develop and sustain a hygienic and healthy environment for themselves by erecting barriers to
prevent the transmission of diseases primarily deriving from fecal contamination
 Household Water Treatment and Safe Storage: A water safety practice of treating water at
point of use and safe guarding clean water from contamination during storage and withdrawing
from storage
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 Improved latrine: A hygienic sanitation option for securing sustainable access to safe, hygienic,
sealed and convenient service for excreta disposal providing adequate and secured privacy,
protected from rain, built either on site or connected to sewer or septic tank while at the same
time ensuring a clean and healthful living environment
 Liquid Waste management: The proper containment and disposal of wastes generated at
household, industries, farms and institutions which may be hazardous or just sullage from
causing nuisance, infection, poisoning to people and animals
 Model community: A model community in the context of this strategy is that where all
residents in a community use clean toilets; wash hands and other personal hygiene practices;
have clean and cleanable house with separate bedrooms; have safe food and water storage;
vigilant management of insect vectors and rats and good management of solid and liquid waste
and the immediate housing environment.
 Sanitation: refers to the principles and practices relating to the proper collection, removal or disposal of
human excreta, household waste water and refuse to prevent adverse effect upon people and their
environment
 Sanitation marketing: Sanitation marketing is a social marketing approach which uses all marketing
principles of price, place and products which satisfy the sanitation requirements (needs and wants)
through a commercial exchange process Satisfying improved sanitation requirements (both demand and
supply) through social and commercial marketing process as opposed to a welfare package
 Solid organic waste management: The proper containment and disposal of solid organic waste
generated in household, farms, institutions and other processing industries from causing nuisance, animal
and insect breeding.
 Solid Inorganic waste management: The proper containment and disposal of inorganic solid waste
including hazardous, infectious and non-biodegradable waste from being health and environmental
hazards.
 Unimproved latrine: sometimes known as traditional latrines are the lowest-cost option considered at
the bottom of the sanitation ladder which is mostly open, un-cleanable, poor superstructure, unsafe, and
accessible to flies, domestic foul, and other animals.
 Universal Access Plan: The Universal Access Plan was drawn up by the Government of
Ethiopia to chart process and investment to the achievement of the national target of universal
access to improved water, sanitation and hygiene by 2012.
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 Ventilated Improved Pit Latrine (VIPL): A latrine system that is essentially an improved latrine
but having features of vent pipe, well-constructed superstructure and having cleanable floor and
secured door to provide the necessary privacy and security.
 Waste Water: Water that is wasted from leaking pipes and spillover from water drawing areas
such as water pumps or communal distribution sites usually forming ponds around the site
attracting animals, encouraging mosquito breeding or infiltrating to contaminate the water
source.
 Adequate sanitation: each of the following sanitation facility types is considered as adequate
sanitation
o facility is shared among no more than 5 families or 30 persons (whichever is fewer)
o A pit latrine with a superstructure, and a platform or squatting slab constructed of
durable, material.
o A variety of latrine types can fall under this category, including composting latrines,
pour-flush latrines, and VIPs., A toilet connected to a septic tank.
o A toilet connected to a sewer (small bore or conventional).
 Integrated solid waste management service: the strategic approach to sustainable management
of solid wastes covering all sources and all aspects, covering generation, segregation, transfer,
sorting, treatment, recovery and disposal in an integrated manner, with an emphasis on
maximizing resource use efficiency
 Hand washing at critical times: is the act of cleaning one's hands with or without the use of
water or another liquid, or with the use of soap for the purpose of removing soil, dirt, and/or
microorganisms at five critical times (before eating, before cooking, after using the latrine, after
cleaning, a baby or an adult's bottom or cleaning the pott, before and after taking care of a sick
person)
 Water safety plan: is a plan to ensure the safety of drinking water through the use of a
comprehensive risk assessment and risk management approach that encompasses all steps in
water supply from catchment to consumer.
 Complete WASH package: Availability of WASH services provide for water availability and
quality, presence of sanitation facilities and availability of soap and water for handwashing.
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ACRONYMS
AEA Agriculture Extension Agents

ARI Acute Respiratory Infection
CASH Clean and Safe Health Facility
CLTSH Community led Total sanitation and Hygiene
CRP Community Resource People
CSA Central Statistics Agency
EPHI Ethiopian Public Health Institute
ESI Economics of Sanitation
EWRM Ethiopian Water Resources Management Institute
FMHACA Food, Medicine and Health Care Administration and Control Authority
FSM Fecal Sludge Management
GDP Gross Domestic Product
GoE Government of Ethiopia
GTP Growth and Transformation Plan
HDAs Health Development Armies
HEH Hygiene and Environmental Health
HEP Health Extension program
HEWs Health Extension Workers
HPDP Health Promotion and Disease Prevention
HSDP Health Sector Development Plan
HSTP Health Sector Transformation Plan
HWTS Household water treatment and Safe Storage
IE Impact Evaluation
IEC Information, Education and Communication
IRT Integrated refresher Training
JMP Joint Monitoring program
M&E Monitoring and Evaluation
MDG Millennium Development Goal
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MOANR Ministry of Agriculture and Natural Resources
MOCT Ministry of Culture and Tourism
MoE Ministry of Education
MOEFCC Ministry of Environment, Forestry and Climate Change
MOI Ministry of Industry
MoLSA Ministry of Labor and Social Affairs
MOT Ministry of Transport
MoU Memorandum of Understanding
MOUDHC Ministry of Urban Development, Housing and Construction
MOWIE Ministry of Water, Irrigation and Electricity
NCD Non Communicable Disease
NTD Neglected Tropical Diseases
OD Open defecation
ODF Open Defecation Free
OWNP One WaSH national Program
PASDEP Plan for Accelerated and Sustained Development to End poverty
PHCU Primary Health Care Unit
SBCC Social, Behavior Change Communication
SDG Sustainable Development Goals
SLTS School led total; sanitation
SM Sanitation Marketing
SME Small and Micro Enterprise
STH Soil transmitted helminthes
TIP Trials of Improved Practice
UHEP Urban Health Extension Professionals
VIP Ventilated Improved Pit
WaSH Water, Sanitation and Hygiene
WaSHCO Water, Sanitation and Hygiene Committee
WDG Women Development Group
WHO World Health Organization
WIF WaSH Implementation Framework
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WSP Water Safety Plan
WWT Woreda WaSH Team
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EXECUTIVE SUMMERY
In Ethiopia, the Federal Ministry of Health of Ethiopia (FMOH) takes the primary responsibility for
hygiene and Environmental Health development. The Government of Ethiopia, with the support of its
development partners, has been committed to changing the country’s poor record in hygiene and
environmental health especially access to sanitation and hygiene practices. This commitment is well
demonstrated by the training of sanitarians/environmental health professionals; adapting, and
committing to international programs by the focus placed on achieving the relevant Millennium
Development Goal targets (2000-2015) and the Health Extension Program.
In order to take the rural health development forward the ministry has designed woreda transformation
as one of the HSTP agenda. Through this transformation it is hoped that services are rendered equitably
to the people. The Hygiene and Environmental Health strategy is designed for 5 years (2016-2020) to
support the HSTP plan taking into considerations the promising achievements as well as, drawbacks and
gaps of the past and with a pragmatic and innovative plan for 100% achievements in Hygiene and
environmental Health in the future
The strategy is developed after reviewing existing enabling environments such as policies, strategies,
guideline documents, national administrative reports and other national data and documents. Thorough
analysis was also made on the enabling environment, behavior analysis on the basic environmental
domains, SWOT and stakeholders. Moreover, field investigation on the seven domains using data
collection instruments was also conducted to document first hand and up-to-date information. The
documents reviewed, analysis made and data from the field indicate the availability of conducive
enabling environment, policy and organization; the need for more concerted effort to change the
hygiene and environmental health related conditions and disease burden; the need to involve and
empower communities through which strengthen the health extension program.
The learning done through the various processes was used to design the strategy framework, the vision
and strategic goals. The strategic goals designed include : empowering communities and community
resource people; enhance capacity building program; establish intervention and transformation program
based on local skills and resources; enhance behavior change communication through the expansion of
approximate behaviors; establish a bottom up and top down communication and feedback mechanism;
make hygiene and environmental health a viable program in the promotion of community health and
improve research and monitoring especially on behaviors, emerging environmental challenges
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The strategy will focus on improving human excreta disposal systems through the construction and
constant use of improved latrine; enhancing safe water use from source to the point of use; hygienic
practices including personal, oral and menstrual hygiene; food safety including storage, preservation and
protection from vermin; improvement of the living environment including vector control, indoor air
pollution and safe energy use and enhancing institutional (schools and health facilities) hygiene.
Health Extension Workers (HEWs) and Women Development Groups (WDG) will be supported by
local government including Woreda WaSH team (WWT), Woreda command post, PHCUs, Kebele
WaSH Team, and WaSHCOs. Federal, regional, zonal and woreda authorities shall have input mostly
revolving around onsite suportive supervision, giving feedback, capacity building, verifying open
defecation free (ODF) achievements, printing and distributing guidelines and manuals, posters,
billboards and other community mobilization support materials. Besides, in order to reinforce and give
the program a national flavor, a strong well planned review and reward program is also indicated to
igniting changes through mass engagment of communities or people and for benchmarking. Motivating
best performers, scale up of best practices and looking for context specific solutions will be employed
will be employed to bring the expected transformation in Hygiene and Envitonmental Health (HEH).
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PART I
1. BACKGROUND
Ethiopia with a population of more than 95million in nine regional States and two City Administrations
has an estimated land area of 1.1 million square kilometers making it the second most populous country
in Africa. In addition to its rich and unique religious and cultural history it has become better known
today as the fastest growing economy in the World. Over the last decade the Ethiopian economy has
expanded and registered an average GDP growth of 10.9%. The rural population in Ethiopia which is
estimated to be about 80% of the total population is primarily engaged in subsistence farming. The
government is making meaningful strides towards improving agriculture technology, to support better
income and food security for the rural population. In doing so, it is hoped that majority of the
Ethiopian population can break the vicious cycle of poverty, illiteracy and disease. It is theorized that
improvement in societal economy support sanitary and hygienic living. Comprehensive HEH work in
Ethiopia started on 1978 as a department in the ministry of health but established as a unit in 1906 under
the Ministry of Interior and since then the EH work has been disintegrated in many government ministry
structures living a system or a structure that can coordinate EH activities in the country (Abera K.2010)
.
The Government of Ethiopia, with the support of its development partners, has for many decades
committed in changing the country’s poor record in hygiene & environmental health especially access to
safe water, sanitation and hygiene development and behavior change practices. This commitment is
well demonstrated by the training of environmental health professionals; adapting, and committing to
international programs such as the Primary Health Care Initiative (1970–1980); the engagement in the
International Drinking Water Supply and Sanitation Decade (1980–1990), and by the focus placed on
achieving the relevant Millennium Development Goal target (2000-2015).
In early 2003, the government and partners agree to design a National Hygiene and Sanitation Strategy
(NHSS) to set out key principles and has served as an important first step to give sanitation the
prominence it deserves. Hereafter, in 2005 HSDP III (2005-2010) gave focus to community based
environmental health programs through the development and implementation of the Health Extension
program (HEP)
However, the progress of hygiene and sanitation work in the country was not satisfactory with regard to
many standards, for instance the low percent increase in improved latrine growth which is only 1.2%
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annually, with low improved latrine coverage which is 28%. These problems have contributed to the
existing child and maternal mortality rate, chronic malnutrition, increased environmental pollutions and
furthermore; has linkage with the economic and sustainable development of the country.
Currently the Health Sector Transformation Plan (HSTP) (2015-2020) is designed to realize the
universal health coverage by setting four transformation agendas; the Woreda Transformation, health
service quality and equity, Information revolution and creating caring, respectful and compassionate
health care professionals. Environmental Health is one of the program areas of the HSTP and other
Environmental health related strategies of the country.
This Hygiene and Environmental Health National strategy is designed taking into consideration all the
drawback and gaps of the past and with a pragmatic and innovative plan for transforming the HEH
conditions in the future.
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2. RATIONALE
The strategy is designed to address existing gaps and introduce innovative ideas to safeguard the
environment and the society. :
 The HEH programs implemented are mainly focused on sanitation and hand washing promotion.
 Lack and inadequate HEH structure and implementation capacity from federal to Woreda level
including health facilities.
 Improved latrine coverage in the last 25 years is only 28%. The average annual improved latrine
growth rate is sluggish (1.2% per year), with this pace it will take us another 25 years to reach to 51%,
unless a new thinking and effort is in-place.
 HEH activities are not planned implemented, monitored and evaluated as per the need due to lack of
environmental health personnel at right place, shortage of trained human resources with high staff
turnover.
 The existing hygiene and sanitation strategy does not address emerging problems related with
population pressure, unplanned and rapid urbanization, climate change, recorking public health
emergencies and development in all aspects of industrialization and agriculture technology
 Institutions are deprived of adequate supply of safe water and sanitation facilities exposing
beneficiaries and contribute to negative health outcomes, bad images and poor behavior.
 Weak integration and collaboration with in and /or among sectors on promotion, regulation and
research related with HEH programs.
 The Health Sector Transformation Plan (HSTP) as part of the Growth and Transformation Plan (GTP)
II is undertaking a robust rural and urban transformation program for which HEH strategy and action
plan will play fundamental role.
 A comprehensive and robust HEH monitoring and evaluation system shall be generated from
community level upwards to support evidence based planning, innovation, tactical change for better
and sustainable change.
 The commitment and leadership for the implementation of HEH is not as expected at different level
 Inadequate participation and partnership of different stakeholders and duplication of efforts between
different sectors
 Inadequate and inconsistent funding for HEH programs.
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3. SCOPE
The strategy addresses public health issues related to HEH components; behavioral, social, technical
and other related issues and conditions. Hence, the strategy will focus on strategizing to change the
prevailing HEH problems, as well as to address the emerging environmental health (EH) issues in
urban, rural, pastoralist and agrarian communities throughout the country by targeting households and
institutions in each HEH components: -
HEH Strategic components:
 Sanitation
 Personal hygiene
 Water quality
 Food hygiene
 Housing and institutional health
 Vector control
 Pollution
 Occupational health and safety
The basic premises of this national hygiene and environmental health strategy stands that household and
institutions are the sources of all pollutants that go into water, air or land. It is believed that focusing on
households and institutions at a community level and managing problems at the source will certainly
improve the environment and thereby the health of people.
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4. SITUATIONAL ANALYSIS
Official government reports and published researches made in Ethiopia and other similar countries were
reviewed to have an insight on HEH problems and solutions. The findings are summarized below to
clearly see the context.
4.1. Status of HEH in Ethiopia

Rural
According to Boydell (1987), around the MDG baseline, rural sanitation coverage in Ethiopia was only
1%; and another researcher in 2003 found that 87.5% of rural population in Ethiopia has no latrine and
the rest (10.2 %) have holes with no superstructure, 1.5% have improved pit latrine and 0.8% have VIP
latrines (World Bank. 2005)
A study conducted in 2011 on child feces disposal conditions in Ethiopia found that 69% reported that
shows the feces of their youngest child under three were not deposited into a toilet/latrine – i.e. that the
child feces were unsafely disposed (World bank and UNICEF 2014). A preliminary study by World
Bank (2012) on child feces disposal methods in Ethiopia also found statistically significant associations
between disposal of infant feces not into a latrine, and acute childhood diarrhea.
In 2003, prior to the full roll-out of the HEP, sanitation coverage was around 20%. After training and
mobilizing the Health Extension Workers (HEWs), a clear increase in sanitation coverage was realized
though most latrines were unimproved. According to FMoH’s fourth Health Sector Development report
(2010) both the unimproved and improved latrine coverage was 60% (56% rural and 88% urban).
However, the JMP report in 2015 showed that improved sanitation coverage is 28% and shared 14 %
and unimproved latrine 29%. Whereas EDHS (2016) report indicates that only 32.3% of the Ethiopian
population didn`t have latrine which shows a good improvement when we compare it from EDHS
(2011) report that is 45%.A global sustainable rural sanitation (SURS) study by Water and Sanitation
Program of the world Bank indicate that the improved latrine acceleration rate in 2013/14 for Ethiopia
was 1.2% per year predicting that it would be difficult for Ethiopia to meet the MDG goal by year 2015.
The study further stated that to reach to the MDG goal (51% ) coverage with improved sanitation at the
present 1.2% rate will take us 25 more years (until 2040).
EDHS 2016 result Reveals, overall 20 percent of households in Ethiopia have water on their premises,
77 percent in urban areas versus only 6 percent in rural areas. Forty-five percent of households spend 30
minutes or longer to obtain their drinking water, 53 percent in rural areas, as compared with only 13
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percent in urban households. In addition, EDHS 2016 report also shows that more than 9 in 10
households (91 percent) do not treat their drinking water; this is more common in rural than in urban
areas (92 percent versus 88 percent respectively). The most commonly used method of water treatment
is adding bleach or chlorine (3 percent). Overall, 7 percent of households use an appropriate treatment
method.
Working hard towards narrowing the existing regional, gender, rich-poor, differently-able disparities for
the WASH service need to be focused. Girls-friendly WASH services in schools could attract female
student’s enrolment, attendance, privacy and comfort during menstruation, which therefore could ensure
gender equity, equality and empowerment. WASH services in communities, similarly help women to
have more time for caring their offspring, and it can also ensure their equality and security.
According to the latest Ethiopian Welfare Monitoring Survey (CSA, 2011), the proportion of
households using a waste disposal vehicle/container for solid waste management was 38.8 percent
whereas the number of people who handle their solid waste locally, by dumping in a pit, throwing away
or burning, were estimated as 58.4 percent. The balance is made up of 2.9 percent being used as manure
and 0.6 percent defined as ‘other’.
Urban
As a result of fast urbanization and population increase, focusing on improving WASH service delivery
in urban areas is not only necessary but also urgent demand to be addressed. In many of the cities, towns
and peri-urban settlements in Ethiopia households live and raise their children in highly polluted
environments. Much of the pollution is caused by lack of awareness of hygienic behavior, poor access to
safe and improved latrines and poor management of existing facilities. As cities expand and populations
increase, the need for safe, sustainable and affordable sanitation systems becomes a matter of urgency to
prevent outbreaks of diarrhea, worms, skin and eye infections and devastating epidemics of typhoid and
cholera.
Sanitation coverage in urban residents as revealed by a study in 17 major urban communities was only
3% which has flush toilets and 49% with access to pit latrine. WHO/UNICEF (2001) reported that urban
sanitation coverage in Ethiopia in 1980 and 2000 was 24% and 33% respectively but the 2016 EDHS
report showed the sanitation coverage of urban dwellers were increased to 93.1% which means only
6.9% of the urban communities defecate openly.
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The 2016 EDHS report showed 40.5% of the Ethiopian urban population uses Pit latrine without
slab/open pit sanitation facility. In Addis Ababa (91.1%) use pit latrines where evacuation of fecal
sludge was considered a solution but, 85.4% are dissatisfied with the service and over 50% of the pits
were found to be overflowing
An estimated 90% of wastewater in cities in developing countries is discharged untreated directly into
rivers, lakes or the ocean (UNEP, 2010). Wastewater-related emissions of methane and nitrous oxide
could rise by 50% and 25%, respectively, between 1990 and 2020 (UNEP, 2010).Visits to 4 woreda
towns found in Amhara, Tigray and Afar and discussion with Woreda towns health offices in the
regions visited revealed that solid waste collection and management is very crude except one woreda
which has a recycling program, liquid waste is discharged in the environment or in open ditches. Open
ditches are full of waste including plastics, silt, dead animals etc. Fecal sludge management is absent.
Even if they manage to hire vacuum truck from other cities. The pumped out waste is dumped in the
open outside the town mostly in farms.
The problem of human waste disposal is acute and need very stringent and community based approach
as obviously past intervention were slow to achieve the desired target. Majority of the population are
still at lowest level of the sanitation ladder.
Urban sewer systems are limited to very few areas and are not fully functional. The collection of faecal
sludge is also reportedly lacking in most parts of the country. For example, sludge collection services
were available in only 11 of the 30 large towns and that small towns are further disadvantaged in that
little to no sludge collection services exist. Solid waste management systems, in particular the storage
and disposal systems are considered inadequate, unhygienic and have both health and environmental
consequences (ACIPH, 2014).
Pollution of the environment especially in developing countries such as Ethiopia has a ripple effect on
human health and social wellbeing due to a high rate of industrialization and urbanization combined
with low capacity to abate - and combat the health and social consequences of pollution. Environmental
pollution control is a multifaceted and diversified issue that demands for multi-stakeholder action and
policy intervention. The 24-hourly PM10 and 8-hr average of CO were below US-EPA permissible
levels, while the annual PM10 concentrations could exceed the guideline (Addis Ababa Administration,
et al, 2007). The other concluded, averaged concentrations of CO in both sampling periods were within
US-EPA and WHO limits, however, added there is a reasonable indication that these guidelines might
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be exceeded in the long run air pollution related environmental and health problems (Kume et al., 2010)
.The variation of BOD mg/l in a river affected by coffee processing plant effluent was found significant.
It ranges from 0.5 mg/l BOD in impacted to 1,900 mg/l BOD in impacted areas. On the other hand,
acidic pH (4.6–7.4) (4.5), high nitrate concentration 6.1–12.4 (6.8) and pollution resistant macro
invertebrates (16 times higher) was reported in impacted sites. Studies also identified the presence of
heavy metals bioaccumulation in edible fish in the rift valley lakes. Additional concern was raised about
the synergistic effects of all pesticides added.
In Ethiopia, the process of industrialization and mechanized farming are liable to complex occupational
health and safety problems which need timely attention and consideration before it leads to a major
public health consequences.
4.2. Health and economic effect of poor HEH Conditions

According to WHO (1997), 30% of the disease burden in Ethiopia is attributable to poor sanitation and
15% of total deaths are due to diarrhea. The MDG report (2010) clearly states that 23% of the causes of
under-five mortality in Ethiopia are due to diarrhea resulting from poor sanitation and hygiene. The recent Health
Sector Transformation Plan (HSTP) and the 2008/9 and 2009/10 Health and Health related Indicator also
indicated that diarrhea is the second biggest killer for under five children next to acute
respiratory infection. According to EDHS 2011, the wealth index, under five mortality rate and
education are correlated with wealth quintiles. The data indicate that the poorer societies are less
educated and mortality of under five children also increases with poverty. The costs of poor sanitation
are inequitably distributed with the highest economic burden falling disproportionately on the poorest.
The richest 20 per cent in sub-Saharan Africa are five times more likely to use improved facilities than
the poorest 20 per cent.( Achieving the MDGs with Equity, UNICEF 2015)
The study by World Bank 2013, established that malnutrition is not only due to lack of food but also the
result of environment risk factors such as poor sanitation and hygiene. However, the nutrition status in
Ethiopia is improving as indicated by three years result of the EDHS 2011. But still total removal or
control of the risk factors is the most important guarantee for a sustained child development
The effect of poor HEH in society is not only limited to health but also to an economic and welfare
dimension. Economics of Sanitation Initiative (ESI) desk review conducted by WSP/World Bank 2013 1 ,
indicates that poor sanitation costs Ethiopia Birr 13.5 billion each year, equivalent to about Birr 170 per
1 World bank 2013
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person per year or 2.1% of the national GDP. Yet, eliminating the bad practice would require only 6
million improved latrines to be built and used.
4.3. Emerging Hygiene and Environmental Health challenges

Indoor and outdoor air pollution
Most of the population in Ethiopia (83%) lives in rural villages where biomass fuel such as using of fire
wood and dung is the main source of energy. This energy source is also considered as the source of
indoor air pollution. The health effect caused by indoor air pollution due to biomass fuel is the most
unrecognized in Ethiopia although, the potential health effect of biomass smoke especially to eye
disease and respiratory problems has been well established by World Health Organizations (WHO).
The ambient air pollution problem sources are vehicles, industries, charcoal processing, solid waste
dumps, indoor biomass smoke etc. With industrialization, population growth, commercial agriculture
etc. and poor monitoring and control mechanism air pollutant emissions in Ethiopia will be eminent. A
study made by Kumie, 2010 after rigorous sampling using CO data logger of a total of 80 road side and
24 on-road daily traffic air samples during wet and dry seasons in 2007 and 2008, respectively, found
that a mean CO concentration of 5.4ppm. In general 15% of road side samples and all on-road samples
showed more than 50% of the 8hr. CO WHO guideline values.
Water Pollution
The sources of water pollution include agricultural overflows from irrigation schemes carry fertilizers
and chemicals; Solid and liquid wastes dumped or discharged in water source catchment areas, river
formations and drains and open defecation in water ways and depressions. And about 40-50% of urban
waste is dumped in unsuitable areas or let to pour into rivers that traverse the urban centers, wetlands
and ecosystems. Such in the case with “Tilku and Tinishu Akaki river” in the Awash basin which has
unacceptable levels of chemical oxygen demand, heavy metal and pesticides
Land pollution
Land pollution sources and types of pollutant includes solid waste especially plastic products, metals,
electronic wastes, feces, dead domestic and wild animals, chemicals, drugs, infectious wastes dumped
in an uncontrolled manner is a well-established fact. Regulating land pollution source is now a challenge
and may get worse with expansion of cities and population growth potentially creating squatter
settlements which may remain to be a worsening challenge unless it is regulated
Noise Pollution
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The problem of noise emanating from highly amplified music centers, advertisement from vehicles
mounted loud speakers, minarets and churches is being felt by institutions and individuals.
Noise measurement and coordinated control program should be one aspect of the environmental health
program in the future.
Looking at all the above pollution sources and absence of controlling mechanism, it can be concluded
that water sources in Ethiopia is threatened by pollutants. The rivers in Addis Ababa are already
considered dead as they no more support lives and this condition should not be the fate of other rivers
whose source passes through cities and towns.
4.4. SWOT Analysis

Strengths:
 Strong commitment of the leadership for equitable service and community level sanitation and hygiene
program to continuously adopt innovative and effective interventions in the attainment of HEH targets.
 Availability of some HEH program guidelines protocols, manuals directives and initiatives
 A functional HEH Task Force and TWGs that serves as a platform to coordinate and foster partnership,
as well as harmonize and align HEH interventions.
Weaknesses:
 Limited use of the enabling Environments such as existing WASH institution, program methodologies,
and technology options.
 Limited number of environmental health professionals at all level.
 Inadequate implementation capacity for HEH activities.at all level.
 Weak monitoring and evaluation systems, including limited indicators in the HMIS.
 Poor utilization of available resources
 Poor recording, and documentation as well as inconsistent reporting at all level.
 Insufficient evidence and use of formative assessments in the development and production of Hygiene
and environmental IEC/BCC materials.
 Inadequate sensitization and enforcement of existing public health laws and legal frameworks
 weak emergency communication capacity and system to address HEH emergencies
Opportunities:
 Favorable National Constitution and health policy guiding program focus and action
 Proclamations and policies related with HEH
 The Health Sector Transformation Plan
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 Decentralized government structure
 Public demand for sanitation and hygiene.
 National One WaSH Program with Consolidated donor fund and MOU among WASH sectors
 MOU by sector ministries to work together for WaSH Availability of WIF (WaSH Implementation
Framework)
 Presence of partners with good expertise and resource for WaSH
 The HEP and WDA.
 expansion of schools and increased literacy rate
 Increasing opportunities for public-private partnerships and small scale microenterprises to promote
Environmental health activities
 The community health platform, the HEP/HDAs, where about seven of the sixteen of HEP
packages are focused on HEH..
 Availability of supportive policies and strategies
Threats:
 Slow progress of WaSH coordination at all level
 Lack of coordination and collaboration among different stakeholders
 Scattered and overlapping mandates given to different sectors especially in urban areas
 Staff turnover resulting in loss of trained human power and institutional memory
 Emergency situations such as outbreaks and natural disasters.
 Climate change.
 Negative impact of industrialization, population pressure and, unplanned and rapid urbanization
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5. STRATEGY DEVELOPMENT PROCESS
Fig. 1: Strategy development process for HEH strategy
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PART II
HYGIENE AND ENVIRONMENTAL HEALTH PROGRAM STRATEGY
Fig. 2: strategy development logical order Adopted from https://www.google.com.et search=strategic actions
(Accessed date on 20/11/2015.)
The hygiene and Environmental health strategy follows a logical order starting from current situational
assessment to implementation planning and learning. Through this process we would know where we
are, where we want to go and how we reach to our goals.
1. Vision
‘’To see healthy, productive and prosperous Ethiopians “
2. Mission
To prevent disease, promote health, safety and wellbeing of Ethiopians through provision and
regulation of comprehensive HEH services and ensuring the highest possible quality in an equitable
manner.”
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3. Core Values
 Community first  Respect
 Integrity, loyalty, honesty  Be a role model
 Transparency, accountability,  Collaboration
 Confidentiality  Professionalism
 Impartiality  Change/Innovation
 Quality  Compassion
4. Guiding Principles
 Self-reliance
 Community ownership
 Universal HEH coverage
 Focus on community based approachclient centered quality HEH service
 Equity and inclusiveness
 Good governance
 Appropriate technology and innovation
 Participatory partnership
 High impact interventions
 Learning institution/system
 Professional ethics
 Continuous professional development
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5. Strategy Formulation
5.1. Strategic framework
The strategy consists of eight strategic domains and specific focus areas under each of the domains as
well as underpinning pillars (see annex 1).
Fig. 3: Sstrategic framework for HEH Strategy

The community based HEH activities are mainly focused on Health Extension hygiene and
environmental packages that is to be delivered at household and Kebele level, including local
institutions. These promotional package based activities are expected to be coordinated with woreda and
Kebele command post regulatory bodies for the health of the community.
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5.2. Goals
The ultimate goal of this strategy is to comprehensively implement key domains of the HEH through
community empowerment and institutional enhancement.
5.3. Strategic Objectives

The objectives of the strategy are designed to address national and global interest and targets. The strategic
objectives are grouped by headings for easy reference.
Objective 1: By 2020 achieve access to adequate and equitable sanitation for all.
Strategic initiatives:
 CLTSH/SLTSH
 Sanitation marketing
 liquid waste management service
 solid waste management service
 capacity building
 advocacy and social mobilization
 IUSH implementation
Objective 2: By 2020 promote basic hygiene behavior in order to control related communicable
diseases.
 CLTSH/SLTSH
 Hygiene education and promotion
 MHM implementation
 capacity building
 Advocacy, awareness and social mobilization
 Implement HEH communication guideline
 Capacity building
 School health promotion
Objective 3: By 2020 ensure safe water from the point of source to consumption.
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 Household water treatment and safe storage(HWTSS)
 water quality monitoring and surveillance
 introduce HWTSS technology options
 water safety plan promotion
 Advocacy awareness and social mobilization
Objective 4: By 2020 ensure WASH in all institutions.

 CASH
 Institutional WASH surveillance and regulation
 School wash
 SLTSH
 Institutional WASH facilities design standardization
 hazardous waste management
 promote institutionalization WASH in all institutions
Objective 5: By 2020 ensure food safety from farm to fork

 good hygienic ppractice implementation
 institutional food safety surveillance and regulation
 promote and follow good manufacturing practice implementation and food safety measures
 monitoring, surveillance and regulation of food products
Objective 6: By 2020 reduce vector borne diseases.

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 Environmental management
 Housing
 Vector and rodent control
 Personal hygiene
Objective 7: By 2020 ensure safe and conducive working environment in all institutions
 Promote occupational health and safety good practice
 Monitoring and regulation of occupational health and safety standards
 Promote and advocate occupational health and safety technology options
Objective 8: By 2020 enable abatement of generation and exposure to sources of pollution

 Waste management
 Enforce and support Environment management plan implementation
 Enforce and support institutions to mitigate and control of environmental pollution
 Implement and support health adaptation plan to climate change
 Monitor and regulate emission of pollutants
 Enforce and support national and international environmental pollution standards
 Promote and advocate environmental friendly technology options
Objective 9: By 2020 ensure community empowerment through organized and promotional

interventions
 Strengthen community platforms
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 HEP
 Strengthen partnership and collaboration
Objective 10: By 2020 enhance conducive and enabling working environment for HEH activities
 Strengthen coordination, integration and collaboration with in and /or among sectors
 Enhance networking and partnership
 Develop and advocate HEH structure at all levels
 Ensure and mobilize adequate resources
 Develop and put in action policy brief, guidelines, directives and manuals
 Strengthen Monitoring evaluation and research.
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6. Program Management/Implementation framework
The strategy have the following management components in order to develop the program, create access
and change to basic environmental health services, strengthen partnership and communication, capacity
building, resources, monitor and learn.
Fig 4: Program management components
6.1. Institutional Development

Putting in place an appropriate and enabling structure from federal to kebele level that can support the
implementation of the domains of the strategy is the first step. Filling the structure with appropriate
professionals with a focus to assist and capacitate communities to deliver HEH activities at household and
institutional levels is critical.
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6.2. Capacity building
Capacity building element will focus on putting in place skills through cascading of trainings, based on
manuals, protocols and guidelines which will address the HEH domains in this strategy. In addition to
cascading trainings, long term and short term on/off job trainings will be given to the professionals working
on HEH
6.3. Access to Basic HEH Facilities

Creating access to basic and equitable HEH facilities at community and institutional level to provide
affordable quality products (supply) and services. Facilitating production and marketing of appropriate and
effective products through different mechanisms, such as sanitation marketing centers, water utilities,
health facilities and other institutions.
6.3.1. PROMOTION
An effort ensuring community empowerment and social change, influencing appropriate behavioral change
and demand for use of environmental health facilities and products to happen through the application of
relevant promotional methodologies (CLTSH, WSP, HEP, IEC, SBCC). Sustained advocacy and social
mobilization efforts to be conducted.
Empower communities and make the households the center of planning, action and follow up for
sustainable HEH/sanitation behavior change. Perhaps, this may be the time to stop the top down approach
and replace it more to community centered approach to enhance local involvement, using local aspiration,
knowledge and skill and local motivation and action. Community empowerment is also made by the full
scale application of community based HDA and strong HEP implementation that make the community
empower by technical and feasible behavioral actions.
Focus on feasible behavior than jumping direct to ideal behavior. Environmental health/Sanitation
improvement program should address the problem incrementally basing the intervention program on do-
able actions rather than jump into the ideal behavior. Clean, safe, appropriate environmental
health/sanitation system can be developed using local skill and available local material at the beginning and
build up than to introduce a more expensive system which may be ideal progressive ly.
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Engaging political leaders: from federal, regional and local levels and influential people such as religious
leaders, WDGs, youth at the regional, woreda, kebele and community levels through a multi stakeholder
planning process
Catalyzing “the multiples”
 Using ulti-level (national, Regional, Zonal, Woreda, Kebele and Community levels) advocacy and
planning
 Engaging multi-sectoral partners (health, education, water, development partners’ youth, women,
private commercial),
 Employing Multi-communication channel (face-to-face, community events, religious institutions,
school curriculum, mass media, advocacy, IEC, mobile film shows, drama, soap opera, etc.)
1.3.2. Regulation and Legislation
There is limited public awareness and commitments on policy implementation and low commitment of
regional and local environmental affiliated government good regulation of HEH, and also requires
improving the enforcement capacity. Public urban and rural HEH sector actors, especially those at the
city/town level need to be aware of the existing regulations, its enforcement and follow up mechanisms.
Despite the fact that manufacturing industries across the country are found to be a major factor associated
with environmental pollution issues in towns in Ethiopia, there is hesitation on behalf of the government to
enforce existing regulation. This has to be addressed through negotiated agreements with individual and
staged mitigation, applying the polluter pays principle, backed by clear threat of penalty through legal
enforcement institutions.
Equally important, but not enforced, are the regulations developed by the Ministry of Health, Ministry of
Environment, Forestry and Climate Change, Ministry of Urban Development and Housing, and the Ministry
of Water, Irrigation and Electricity indicating that the owners of houses/institutions are required to invest in
improved HEH facilities and/or services and adopting improved HEH behaviors. To address these and
related challenges currently existing, the following actions are required:
 conduct mapping of the existing regulations on urban and Rural HEH and take action on the gaps and
overlaps within the existing regulations
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 agree on enforcement mechanisms and responsible institutions to enforce those regulations at the lower
level
 organize awareness creation events for urban and rural Hygiene and Environmental sector actors and for
the community on the existing regulations and enforcement mechanisms such as the polluter pays
principle
 Development and Enforcement of uniform regulatory guidelines and standards from the federal to
Kebele level.
 To regulate HEH activities at the community and institutions.
Food safety is a primary global concern. This subject is more pertinent as the society becomes more
commercialized and eating out becomes a norm. Increasing activity in the food industry due to economic
pressures is resulting in more people turning to food vending as a means of economic sustenance. Also the
growth of the tourism industry has placed greater demands for local cuisine. Government regulation and
supervision is important to ensure that standards are maintained throughout the food chain. Monitoring of
standards, conditions and supervision of food preparation is critical in ensuring the health of the nation.
The provision of an adequate supply of safe water is paramount public health importance and can never be
over emphasized; its impact on health is profound and is both direct and indirect. The direct impacts are
related to quality of water utilized, (in particular water, which is consumed,) and water reintroduced to the
environment through means of treatment processes (effluent). Thus surveillance is conducted to evaluate the
suitability of the water supplied to the public with the ability of implementing mitigation actions to alleviate
any potential hazard.
The compliance and monitoring Programme covers the following:
 Private (commercial/institutional) water supply systems
 Testing of municipal water supply
 Sanitary surveys of water systems
 Inspection & licensing of water trucks & bottled water plants
 Inspection and licensing of swimming pools
 Inspection of waste water plants
 Assessment & processing of development plan applications
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 Investigation of complaints
 Monitoring of recreational waters
 Solid waste monitoring
 Technical support in standards development for recreational water.
 Technical support in implementation of recreational water quality projects.
The expansion of international travel and trade has been cited as a primary cause for the global transmission
of emerging and reemerging infectious diseases. Recent epidemics of Ebola, SARS, Avian Influenza virus
infection, Norwalk virus and H1N1 virus infection across continents have taken a significant toll on humans
by way of death and disease and a severe economic cost impact as a result of their direct impact on the
productive sectors (e.g. tourism). As a result, there is a heightened awareness worldwide for Port Health
Surveillance Systems as a strategy for mitigating international threats to public health.
The impact of industrialization on the health and safety of workers and on the environment is one of the
subjects currently being studied throughout the United Nations, and specifically in the International Labor
Organization (ILO) and the World Health Organization (WHO). Although this impact varies greatly from
one country to another, the present findings suggest there are certain requirements that have to be met if
industrialization is not to exact the same toll of accidents and diseases on the 21st century as it did on the
20th . For that reason workers who may be exposed to hazards should be monitored in a systematic program
of medical surveillance that is intended to prevent occupational injury and disease.
6.4. Cross cutting issues

6.4.1. Equity
In order to achieve universal coverage, the HEH takes into consideration the situation and needs of un
served members of the society who often live in congested inner city slum areas and outskirts of towns. In
the Ethiopian context, this includes women, children, differently-able people, elderly people, people with
chronic illness, including HIV/AIDS and people living in remote and/or peripheral areas, and people living
on the street. People living in low quality rented houses, shelters provided by towns and religious orders,
even prisons, may also be inaccessible to quality HEH services. The HEH strategy will adopt the following
strategies to address the issue of equity:
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 The HEH program shall address exclusion from urban, rural and pastoral HEH and promote
universal access to services based on the principle of nobody will be left behind.
 HEH related studies, communications and development programs shall give due attention in
addressing the problem related with equity. Standards have to be developed for different types of
facilities at different functions to give access to everyone including those identified as differently-
abled, women/girls, elders and so forth.
 All public facilities including public toilets, showers, and access that are either under operation or
under construction should be checked for safety for differently-able users. Country-wide standards
for facilities in the public domain and services to institutions such as hotels, bars, schools and health
facilities should be applied and enforced by municipalities. The standards should take note of safety
for everyone but with special emphasis for differently-able..
 The Strategy shall address women’s needs as well as access to HEH facilities for people living with
HIV-AIDS. In addition the HEH strategic action plan shall consider:
o Ways to increase the continuity of the supply of water (quantity or facilities or both) in all
public, community, health, school and institutional facilities
o Avoidance of physical infrastructure such as steps, narrow entrances, slippery floors for HEH
services
o Setting up of responsible institutions which could handle policy/strategy provisions for the
differently-able, knowledge, skills, information, appropriate designs and consultation
mechanisms and
o Preparation of legal provisions and social environment that protect prejudice, pity, isolation,
overprotection, stigma, misinformation and shame.
 Public recreations sites, schools, religious establishments, open areas where elders gather and
children play should be maintained clean and accessible.
 Towns, rural and pastoral areas need to special basket fund that is dedicated to creating access to
improved HEH facilities that may include proper excreta disposal, liquid and solid waste
containment facilities for residents living in extreme poverty. Such municipal funding can be
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directed to the mandated service providers to extend services to the poor through clear contractual
arrangements and through onward delegation of services to locally-based SMEs.
 HEH management systems should be used as a source of income to the able poor and those who can
participate in one way or another through job creation.
6.4.2. Gender
The HEH strategy recognizes the important value that is linked with gender HEH in general. With active
and enhanced involvement of the UHEP and the WDA, the HEH aims to:
 Increase the involvement of women in designing rural, urban and pastoral HEH programs;
which, in turn, helps empowerment and local ownership and capacity
 Increase the focus on the needs of women and girls by integrating HEH programs such as
separate sanitation facilities and menstrual hygiene management
 Empower and capacitate women in economically viable management of HEH facilities
 Increase opportunities for women and girls in developmental activities related to prevention of
HEH related diseases
 Use model women as change agents in addressing HEH related issues
 Increase engagement of women associations, forums and stakeholders working on gender
 Encourage creation of job opportunities for unemployed women, female school-leavers and
youth through construction work, through business management roles, through engagement
within SMEs in primary solid waste collection, waste reuse and recycling, public toilet service
provision and fecal sludge management.
6.4.3. Environment
Effective urban, rural and pastoral HEH is important not only for human health and for economic and social
benefit, but is also essential for preservation of sensitive ecosystems. It is necessary to reverse the damage
that has been caused through water, soil and air pollution.
The serious deficiencies in HEH services, the inadequacy of sewerage infrastructure, random defecation in
urban areas and poor control of industrial and commercial wastes have created dangerous EH problems.
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Rivers and streams in the vicinity of both big cities and small towns have become open sewers and is one of
the main sources of infections resulting in diarrhea and other related diseases. They also damage aquatic
ecosystems thereby compromising their ability to filter, cleanse, aerate and mitigate polluted water.
In this Strategy, the following interventions are given due attention in order to reduce the impact of poor
urban, rural and pastoral HEH and industrial and commercial activities on the environment:
 Ensure that Environmental Impact Assessments are carried out strictly and implemented accordingly
for all new urban, rural and pastoral domestic, institutional, commercial and industrial activities as
per existing proclamations.
 Ensure that adequate resources are included for Environmental Impact Assessments and mitigation
measures in all development programs.
 Conduct continuous environmental monitoring of effluent treatment, drainage systems, water bodies,
ecosystems and open areas, and identify sources of possible pollution sources.
 Ensure that environmental protection requirements are fully enforced for all new and existing
domestic, institutional, commercial and industrial premises.
 Encourage residents to reduce waste at sources, and to sort out the waste into classifications aimed at
possible reuse and recycling.
 Follow optimum standards in disposing of effluents and other wastes.
Particular attention should be given to climate change. Erratic and extreme meteorological events are likely
to undermine the development of urban, rural and pastoral areas, the state of the environment and will have
health impacts. It is of upmost importance that the systems and the facilities that will be developed through
the HEH are conceived in order to i) limit the impact in the terms of greenhouses emissions and therefore
limit the impact on the environment and the climate and ii) ensure an increased resilience to the
communities/towns served against the effect of climate change.
6.4.4. Health and Safety
The strategy will make the maximum effort possible to reduce and eventually eliminate all accidents,
injuries and occupational illnesses of those involved in urban, rural and pastoral HEH service provision.
Continuous efforts to identify and eliminate or manage safety risks associated with the activities will be
given due attention by implementing the following interventions:
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 Those engaged in urban, rural and pastoral HEH service provision will get training on health
and safety as well as risks associated with service delivery
 Provision of PPE and enforcement of use
 Establish systems to respond quickly, effectively and with care to emergencies or accidents that
result from operational activities
 All operators are required to establish and monitor low accident tolerance zones with full
investigation and reporting procedures. The expense related to risk mitigation will be covered
partly by operators through inclusion in tariffs and partly it will be covered through a subsidy
from the government administration
6.4.5. Private sector engagement

There is some scope for private sector participation in HEH services installation and management. The
engagement of the private sector is mainly limited to consultancy, construction and supervision of facilities,
solid and liquid waste collection, manufacturing and supply of sanitation facilities. These are expected to
continue while efforts are also made to create financially viable business environment to attract further
involvement of the private sector in HEH service delivery. The lead Federal institutions will play a critical
role in creating the enabling environment for increased engagement of the private sector.
The strategy will address e stepping stones for including private sector provision within a contracting,
supply chain and delegated management framework. It will be necessary to ensure that health and safety
measures are put into place to protect workers and that both the public and the environment are protected.
At the same time it will be necessary to ensure that private operators are able to run viable businesses within
an enabling regulatory framework. This can be achieved through clear contractual arrangements it is
envisaged that the private sector could be viably and advantageously engaged in most parts of the HEH
supply chains, including:
 Formative research and IEC interventions, including creative concepts for behavior change at both
consumer and institutional levels
 Research and development
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 Provide consultancy services in a wide area including institutional reform, financial analysis and
business planning, master planning, feasibility studies, design and contract supervision
 Capacity building in terms of system development and implementation, organizing tailor-made
short-term training
 Primary solid waste collection
 Secondary solid waste storage, sorting and transport
 Solid waste disposal site operation
 Recycling industries
 Pit latrine, cesspit and septic tank manual and mechanized emptying services
 FSM treatment and product marketing stages
 Production of sanitation marketing products such as pre-fabricated latrine and toilet units
Overall feasibility of business models will be conducted for each intervention to see how the private sector
or SMEs can be engaged to deliver services of quality and in an efficient manner.
In order for the private sector to engage and contribute in the chain of HEH are expected:
 To review all possible bottlenecks that hinder the engagement of the private sector in the
sanitation chain.
 Revise or develop operational guidelines that create a suitable enabling environment for the
private sector. Special arrangement will be made in the areas that have not yet been traditional
areas of engagement for the private sector
 To ensure business opportunities through clustering or packaging different HEH service
components
 To support the private sector in accessing finance (special loan arrangement to be used for
investment), tax relief period, and capacity building of staff
6.4.6. Community engagement and ownership
The success of urban, rural and pastoral HEH management is highly dependent on the level of community
engagement. The GoE has developed and introduced different arrangements to increase engagement of the
community. The current widely adopted arrangements whereby political leaders and local communities are
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brought together on one platform could be used to discuss the type of services to be provided, set standards,
reflect on tariff setting, trigger community mobilization, and monitor performance.
The HDA and HEWs shall continue to serve community members to work hand in hand in promoting urban
health extension programs. The main activity supports are a) leading communities to climb up the sanitation
ladder, b) construct and arrange their own sanitation facilities, c) agents for integration, coordination and
partnership and d) continue to bear the responsibility of clean green sustainable village and city/towns. The
main contribution expected from households within each community for achieving total HEH will be in
terms of on-site HEH facilities and will involve contributions in labour, cash and materials. The following
include strategies for community engagement;
 Community representation in HEH committees should be made from different segments of the
society. Mainly representation is expected from women associations, youth associations, elders,
private operators, private businesses, public institutions, CBO's, NGO's, and representatives of
people with disabilities.
 Communities can play a very important role as “watchdog” consumer groups in monitoring how
public and private service providers (water, liquid and solid wastes) and delegated operators perform
in relation to their small and micro cooperation. Consumer complaints and willingness to pay can be
monitored by such groups and play a vital role in efficient service delivery. Generally, such groups
of responsible citizens may have either monetary incentives, from the money being generated from
tariffs and collection fees, or non-monetary incentives.
 The federal and regional governments are responsible for developing guidelines and checklists on
how the community engagement and representation should look and for establishing possible
platforms of engagement. They should also monitor and ensure functionality of the platforms.
 All towns and rural dwellers should then create community engagement platforms that are
compatible with the expectations set out. Towns are fully mandated to decide and create the enabling
ground on how to manage and use community engagement platforms to achieve minimum standards
of HEH services. Urban, rural and pastoral communities should note that the success of HEH
management is highly dependent on the level of transparent community engagement.
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6.4.7. Sustainability
The need for sustainable service delivery is the key challenge facing HEH services development in all
Ethiopian towns, rural and pastoral communities. Addressing sustainability requires a comprehensive
institutional, technological, financial and environmental approach and places users and communities at the
center of service development.
Institutional sustainability involves choosing sound service delivery and regulatory mechanisms with full
consumer participation while technological sustainability needs full involvement of SMEs to establish
appropriate tools and equipment. Financial analysis to determine business viability related to levels of
service and affordable tariffs and charges is at the heart of public service sustainability, while environmental
sustainability means compliance with environmental management plans (EMPs) based on environmental
protection laws and guidelines.
Sustainability has a direct link with the amount of resources allocated for the operation, maintenance and
rehabilitation and the financing systems put in place. Though government requires cost recovery on public
service delivery, it is clear that, in reality, tariffs and charges for solid waste, sludge and liquid waste
collection, treatment and disposal only cover a fraction of the operating costs. Most water utilities struggle
to cover their operational costs for water supply. However, demand and willingness to pay for reliable and
safe water is higher than paying for sanitation services. Improvements in water service delivery therefore
offer the potential for cross subsidy to the sanitation services. Many Ethiopian utilities are responsible for
both water and sanitation so there is the possibility of subsidizing sanitation costs from water revenues at
local level (within clusters of municipalities for instance)..
Key sustainability strategies include:
 Both financial and environmental sustainability gains will be made by application of the 3Rs (Reduce,
Reuse, Recycle). However, sustainable service delivery will mostly depend on highly efficient but labour
intensive methods, short hauls to local treatment and transfer stations located within the communities, low
energy treatment, local reuse, clear sub-contract conditions and strict regulation.
 It is expected that sustainable HEH service delivery will require grants, loans and subsidies in the short
to medium term. This means that sustainability will rely on long-term agreement on funding and subsidies
from non-sanitation revenue streams to some degree.
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 The HEH strategy encourages all actors to prioritize sustainability in all studies and implementation of
programs.
 Different responsible federal and regional institutions together with the private sector will build the
technical and managerial capacity of local government to ensure that sustainability is factored properly with
all interventions.
 Adequate budget provision will need to be allocated and all necessary technical measures considered
improving services to a level where they exceed minimum agreed standards in all towns. Federal and
regional governments can advise towns on how to carry out socio-economic studies and financial analyses
so as to set levels of service compatible with consumer ability to pay. At a minimum, operation and
maintenance of HEH facilities should be covered by a combination of revenue and agreed subsidy
mechanisms.
 Urban, rural and pastoral communities will assign HEH standards that are aligned with national
standards and options. The federal and regional responsible institutions will promote the use of sustainable,
affordable and acceptable facilities to urban, rural and pastoral communities.
 Subsidies targeted to the destitute and extremely vulnerable groups to sustain proper functioning of
facilities can be arranged at local service delivery level. Involvement of local management staff in delegated
operations helps to identify individuals and families in the greatest need.
 Creating community ownership by engaging the community members through the whole processes of
planning, implementation, monitoring and evaluation of urban, rural and pastoral HEH issues.
6.5. Partnership, coordination integration and networking

Strengthen coordinated activities at all levels, initiate aligned and integrated planning with stakeholders,
create partnership and networking with governmental, and non- government actors, such as faith based and
private sectors, NGOs to enhance and scale up desired HEH changes. And, it is also very crucial
strengthening the integration of HEH with other programs and initatives, such as nutrition, maternal and
child health, CASH, NTD control, public health emergency management and climate change related
programs.
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6.6. Finance
The strategy is expected to be funded by regular government budget allocation, multilateral and bilateral
sources, one WASH national program, fund raising mechanisms using a structured system, and by engaging
the community.
6.7. Monitoring, Evaluation, Learning and research

Monitoring and evaluation will be done at various levels to review progress and take prompt actions. Data
exchange, documentation and regular reporting with different stakeholders implementing the domains of the
strategy. In addition research in each of the domains will be encouraged through identifying priority
research topics. Program evaluation will be applied through establishing baseline and mid and terminal data
collection and analysis. Quarterly and annual data generation, analysis and reporting at different level for
selected indicators will be done. Annual multi stakeholder’s program review and learning will be conducted
at different level.
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PART III
STRATEGIC ACTION PLAN
1. Program Management Arrangements

In order to ensure high level coordination, create harmonious relationship, support, simplifying monitoring
and feedback mechanism are necessary to strengthen the existing resources and organizations at all level.
Community development draws on existing human and material resources from the community to enhance
self-help and social support, and to develop flexible systems for strengthening public participation in all
health matters. The HEWs and WDA give avenue to accelerate the community engagement in HEH
programs
1.1. HEH INITIATIVES

1.1.1.Basic hygiene and sanitation
 Hand, oral, face and body hygiene
 Menstrual Hygiene Management
 Neglected tropical diseases prevention and control
 Proper Excreta Disposal
 Slum and informal settlement WASH
 Domestic and commercial Solid and liquid waste management
 Sanitation marketing promotion
 E-waste management
 Emergency WASH response / Strengthen Emergency WASH for epidemic control
1.1.2.Food hygiene and water safety

 Food hygiene and safety promotion/ Promotion of Food Hygiene and Safety at household level
 Water quality monitoring and surveillance
 Water Safety Plan (Introduce and implement water safety plan)
 Household water treatment and safe storage
 Promotion of Hazard Analysis Critical control Point ( HACCP)
1.1.3. Institutional health and environmental management
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 Climate change adaptation on health
 Indoor and ambient air pollution prevention
 Hazardous and toxic chemical waste management
 Institutional (School, Health Facilities, Prison and Public gathering) WASH promotion
 Healthful housing promotion/ Promote & regulate construction materials safety (glass shield
buildings etc..)
 Health care waste management
 Work place health and safety promotion
 Promote safe use of chemicals for control of vector and rodent control
 Pollution control and climate change mitigation measure
2. Strategic Solutions for Successful outcome

2.1. Create or strengthen the enabling/ supportive environments
The focus of this HEH strategic action plan is to deal with the problem of HEH domains. In the rural or
urban communities.
Existing enabling environments that needs to be strengthen includes:
a. The trained human resources in the system at all levels to be more involved and motivated (right person
at right place)
b. Enhancing the use of policies, strategies, standards, guidelines, protocols and directives that related
with HEH
c. The organization structure at woreda (WWT) to support all WaSH activities and at kebele (KWT) level
to be more focused and supportive of the community level activities
d. Strengthening the community outreach initiative conducted by HEW to be even more robust and
supportive of community based initiatives and the WDA.
e. Enhancement of coordination and collaboration activities with stakeholders
2.2. ENGAGE STAKEHOLDERS AT ALL LEVEL

HEH is a cross cutting discipline that all have to function as one in order to rip the benefits of living in a
clean and healthy environment. For this reason federal, regional, zone, woreda and kebele level government
organizations; international, bilateral and local partners; community based organizations (CBOs) should be
involved to support the implementation of HEH activities at all levels. Organizations at all levels will have
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to coordinate intervention programs in their settings and attract support from outside their circles. Learning
from practice and sharing and scale up of best experience and knowledge to others will have to be the norm
at all levels
2.3. CAPACITY BUILDING

Environmental health professionals, HEWs and other sector staffs working on HEH programs need practical
training on the following thematic areas:
 Community dialogue which is needed to communicate do-able-actions at community, household and
institutional level using job aids. It also helps to have persistent contacts and dialogue for more simple
intervention methods.
 CLTSH and SLTSH facilitation skills: CLTSH training for HEWs in the integrated Refreshment
training was not adequate for facilitation of CLTSH since it has its own steps and each step must be
addressed efficiently CLTSH as a tool needs to be refreshed to those HEWs, environmental health
professionals and other sector staffs for effective facilitation.
 The Planning process should be a continuous exercise by all sectors especially to start behavior change
activities
 Conducting surveys, analyzing data and presentation: It is known that timely, reliable and up to date
report with quality data is useful for planning program management such as, planning and evaluation.
One of the main gaps in the health sectors is the lack of correct, reliable and up-to-date data. Sector staff
should be able to collect relevant and make analysis and use information for making evidence based
decision..
2.4. SBCC and MEDIA SUPPORT

Starting with positive aspect of hygiene is much preferable than using of the germ theory and disease.
Basing our behavior change approach on the existing behavior and qualifying it further according to
appropriate communication models/theories
Successful behavior change program will focus on the following principles:
 Behavior change and practice for sanitation and hygiene become more productive if it is based on
knowledge on key aspects of what people KNOW, DO AND WANT
 New knowledge does not equal new practice but existing knowledge can be developed further.
 Build capacities of those common WaSH actors and the uncommon community groups on simple and
focused behavior change methods and principles of approximate behaviors
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 Relate behavior change programs to social issues such as dignity, pride, comfort than to germs and
diseases
 Start from behavior that is truly a stumbling block but which does not incur any unnecessary material
and financial burden beyond the means of the households in a community.
 Keep the technology options introduced to be appropriate, replicable, sustainable and yet functional
 Total engagement communities using different media, such as radio, wriitten materials, community
conversation, local dram a and in churches and , mosques etc using approximate practices may
enhance behavior change .
Media is a very important mechanism to transmit information to the general public. Nowadays, FM,
national and regional radios, TVs, cell phones/mobiles, other social media and newspapers are resources
that we have to capitalize. HEH is very important social issue that need to be addressed and get the requires
attention of the media. .
2.5. DEVELOP PERSONAL SKILLS

Enabling people to learn, throughout life will help to prepare them cope with environmental problems in the
change processes. This has to be facilitated in school, home, work and community settings. Health
promotion supports personal and social development through providing information, education for health,
and enhancing life skills.
2.6. STRENGTHEN COMMUNITY ACTIONS

Health promotion works through concrete and effective community action in setting priorities, making
decisions, planning strategies and implementing them to achieve better health. Community development
draws on existing human and material resources in the community to enhance self-help and social support,
and to develop flexible systems for strengthening public participation in and direction of health matters.
This requires full and continuous access to information, learning opportunities for health, as well as funding
support
2.7. STRIVE TO ENSURE SUSTAINABILITY AND REPLICABILITY

Sustainability is ensured only when a program is owned by individuals, groups or community. Since this
HEH strategy is designed to promote health, wealth, dignity and development to communities. Hence, it
will be owned, promoted, monitored and evaluated by community resource people who are residents,
trusted and influential individuals, and hence ensuring sustainability.
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Community based and owned program which uses indigenous knowledge and skill processed by
communities will be replicated by other similar communities. The learning and community mobilization is
embedded on what people know, practice and believe.
In the community based approach the religious leaders will be leading the HEH programs in their
communities and is believed to be replicated easily in other communities.
The fact that the skill, technology, tools and materials used in all intervention programs are natural resources available
in the community ensure replicability and sustainability.
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3. Strategic Action Steps and Milestones
Developing the National HEH Strategy Program requires an integrated strategic plan and the collaboration of partners. The program has
created a timeline to plan for the annual milestones, FY 2016 to 2020. These milestones are guided by the goals and objectives stated within
this strategic plan and will support the vision and mission of the Program.
Table 1: Five Years Strategic Plan (2016-2020)

Implementation
Objectiv
Period
es
Targets Strategic Initiatives Major Activities Indicators

% %
% % %
Construction of new improved % of households with 28 42 55 68 82
latrines access to improved latrine
SO1: By 2020 achieve access to adequate and equitable
Target 1: Increase  CLTSH/SLTSH Upgrading basic latrines to

proportion of households
improved latrine Number of sanitation
with access to improved  Sanitation marketing
Initiate communal and public marketing centers
latrines and hand
washing facilities from  liquid waste management latrine facilities for slum and established / Proportion of 0 10 15 25 20
informal settlements Woredas with at least 1
28% to 82%. service
Create and strengthen sanitation sanitation market centers
sanitation for all.
 solid waste management marketing centers

Target 2: Increase service Create awareness at community
proportion of latrine % of households properly
 capacity building level on proper utilization of 71 78 86 92 100
utilization from 71% to utilizing latrine facilities
larine facilities
100%  advocacy and social
Target 3: Increase
mobilization Supporting kebeles to become
proportion of Open open defecation free % of open defecation free
Defecation Free (ODF)  IUSH implementation kebeles
18 34 50 66 82
and verified Kebeles Scale-up and sustain ODF
from 18% to 82% kebeles
Target 4: Proportion of Raising public awareness on % of households
households with integrated solid waste practicing proper handling 22 37 52 67 82
integrated solid waste management and storage of solid waste
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management service Strengthen private sector and
from 22% to 82% Medium and small scale
enterprises participation
Improve institutional capacity
in collecting, practicing 3Rs
(reduce, recycle and re-use) and
disposing solid waste
management
Target 5: Proportion of
% of households
households with
Construction of sewer line and practicing proper handling 50 58 65 73 80
integrated liquid waste
treatment plant in urban areas and disposing of liquid
management service
waste
from 50% to 80%
Target 6: Proportion of Create public awareness on
household latrines empting and managing latrines % of household latrines
emptied and properly emptied and properly 100
disposed from baseline to Empting latrines and proper disposed
100% disposing of sludge
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Objectiv
Implementation
Targets Strategic Initiatives Major Activities Indicators Period
% % % % %
es
Target 1: Increase the  CLTSH/SLTSH Awareness creation on benefits

SO2: By 2020 promote basic hygiene behavior in order to control
number of households and utilization of hand washing

practicing hand washing  Hygiene education and facilities
% of population
practicing hand washing 1 21 42 61 82
with soap/substitute at promotion Facilitate Installation of hand with soap/substitute at
all critical moments
from the present 1% to  MHM implementation washing facilities with soap critical moments
around latrines
82%  capacity building
related communicable diseases.
% of population
 Advocacy, awareness and Creating awareness on face and practicing face washing
Target 2: Increase the
social mobilization body hygiene with soap at least once a
number of people
day.
practicing face, oral and  Implement HEH 58 69 79 89 100
% of population
body hygiene from Create water supply and soap
communication guideline practicing oral hygiene
58.3% to 100%. for face and body washing at
during morning and
 Capacity building house hold level
evening time.
 School health promotion Create awareness on menstrual
hygiene
Target 3: Increase the Develop /Improve menstrual
number of women hygiene facilities at house hold % of women practicing 46 60 73 87 100
practicing menstrual level menstrual hygiene
hygiene from 46% to Facilitate market availability of
100%. menstrual hygiene products
supply
Deliver training on BCC/SBCC
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Implementation
Objecti
Targets Strategic Initiatives Major Activities Indicators Period

ves
% % % % %
 Household water % of households with access
Target 1: Increase to safe water supply.
number of households treatment and safe Expansion of municipal water
using drinking water supply systems % of households using safe
storage
SO3: By 2020 ensure safe water from the point of source to consumption
narrow necked water storage 57 67 78 89 100

from protected source
from the baseline 57%  water quality container
to 100% monitoring and Strengthening community based
WASHCOs
surveillance Provision of effective capacity
 introduce HWTS building on water quality testing
and sanitary risk assessment.
Target 2: Increase technology options
Engage private sectors on
effective correct and  water safety plan provision and marketing of
consistence use of % of households use water 10 16 23 28 35
household water promotion effective water treatment options treatment options
treatment options from  Capacity building Facilitating different pathways for
baseline 10% to 35% HWTS options
 Advocacy awareness Awareness creation on household
and social mobilization water treatment, proper handling
and storage
designate & strengthen the
Target 3: Increase
capacity of national laboratory in
regulation of water regulating water treatment Number of water treatment
treatment products product granted market 100
products
from the baseline to authorization
Properly implement the regulation
100%
guideline
Target 4: Increase training for local actors on water
proportion of safety plan
% of water improved schemes
improved water 100
implementing water safety
scheme implementing Improve the capacity of water
plan
water safety plan from utilities
the baseline to 100%.
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Train professionals on water
quality testing
Target 5: Increase Equip rural woreda’s with portable
water supply system water quality test kits % of water supply facilities
quality surveillance 100
Sensitize and enforce water safety regulated
and regulation from
the baseline to 100% proclamation and laws
Establish water quality
surveillance system.
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Implementation
Objecti
Targets Period
Strategic Initiatives Major Activities Indicators
ves
% % % % %
 CASH Construction and maintenance
Target 1: Increase of gender and disable friendly
proportion of  Institutional WASH complete WASH facilities
institutions with gender % of schools with adequate
surveillance and (water, VIPL, handwashing
and disable sensitive gender and differently abled 20 30 40 50 60
and waste disposal pit)
complete improved regulation friendly latrines
Promote proper hygiene and
WASH package from
20% to 60%.  Capacity building latrine utilization practice in
institutions
 Advocacy awareness % schools with access to
and social improved water supply
system
mobilization
Proportion of other
SO4: By 2020 ensure basic WASH in all institutions
Target 2: Increase  School wash institutions with solid and

Establish and strengthen liquid waste management
institutional WASH  SLTSH regular WASH institutional 100
surveillance and Proportion of other
 Institutional WASH surveillance and regulation
regulation from the institutions with access to safe
system
baseline to 100% facilities design water supply facilities
standardization Proportion of other
institutions with adequate
 hazardous waste gender and differently abled
friendly latrines
management
Target 3: Increase % of health facilities with
proportion of health  promote adequate and gender friendly
facilities implementing latrine facilities
institutionalization
CASH (risk based Implement CASH and national
100
WASH) and national WASH in all health facility standards
health facility standards % of health facilities with
institutions adequate water supply system
from the baseline to
100%.
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Implementation Period
Object
Targets
ives
% % % % %
Target 1: Increase number  good hygienic Implement safe storage and handling of food at
of households implementing household level
% of
good hygienic practice from practice Implement hygienic utensil handling and
households
the baseline to 100% implementation preparation area.
implementing 100
Conduct different trainings on food hygiene and
 institutional food safety at community level.
Good Hygienic
Practice
safety surveillance Introduce innovative technologies for proper food
hygiene and safety
and regulation
SO5: By 2020 ensure food safety from farm to fork
Target 2: Increase Conducting Comprehensive baseline survey and

institutional food safety  promote and follow periodic researches on food service providers and
% of
surveillance and street venders
good manufacturing institutions
regulation from the Capacitate regional regulatory bodies and
baseline to 100% regulated to 100
practice strengthen coordination
implement food
Establish and Capacitate federal and regional
implementation and hygiene and
food laboratory facility
safety
food safety Certifying and register all food establishments
measures and food service providers in all value chains.
Target 3: Increase number Develop national food hygiene and safety policy % of
of institutions  monitoring, Endorse regulation tools (Food GMP GHP, institutions
implementing Good surveillance and HACCP guidelines and other ISO standards) implementing
Manufacturing Practice Provide training for health inspectors on hygiene GMP and other 100
and other food safety regulation of food & safety of food. food safety
management systems and products management
Support and enforce institutions to establish
Good Hygienic Practice system and
internal quality assurance system
from the baseline to 100%  Capacity building GHP
Sensitize and enforcing food hygiene and safety
 Advocacy
proclamation and laws
Target 4: Increase
awareness and Implement continual inspection and auditing of Number of food
surveillance and
food products products 100
regulation of food social mobilization
Create early response and recall system from granted market
products from the baseline
federal to kebele level. authorization
to 100%.
Confirm quality and safety standard of food
through laboratory analysis.
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Objec
Targets Implementation Period
tives
% % % % %
Target 1: Increase  Environmental Create awareness on vector % of communities
environmental management control and the need for mobilized for 100
management
SO6: By 2020 reduce vector borne diseases.
for vector control by environmental management. environmental

mobilizing communities from  Housing Mobilize communities to management
the baseline to 100% manage vector breading sites
Target 2: Increase household  Vector and rodent control % of households
hygiene by creating  Personal hygiene Create awareness at implementing basic
awareness at household level household level basic hygiene 100
from the current baseline to  Capacity building household hygiene
100%  Advocacy awareness and
Target 3: Increase biological Strengthen and establish Number of institutions
vector control from the social mobilization biological vector control developing biological
baseline to 43%. developing institutions vector controls
Create awareness on Number of regions
necessity and use of implementing 43
biological vector control at biological vector
community level control
Implement biological vector
control on selected regions
Object
Targets Implementation Period

ives
% %% % %
 Promote OHS good % of institutions
Create occupational health
practice Implementing
working environment in all institutions.
and safety awareness in all

SO7: By 2020 ensure safe and conducive
 Monitoring and regulation occupational health

institutions
Target 1: Increase number of and safety standards.
of OHS standards
institutions implementing Implement occupational % of institutions
 Promote and advocate OHS health and safety standards. regulated on
occupational health and safety 100
standards from the baseline technology options occupational health
to100%.  Capacity building Conduct occupational health
and safety
 Advocacy awareness and and safety surveillance and
social mobilization regulation.
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Objec
tives Targets Implementation Period
% % % % %
 Waste management Support and enforce institutions
Target 1: to implement environmental
 Enforce and support Environment
SO8: By 2020 enable abatement of generation and exposure to sources of
management plan. % of institutions

Increase the
management plan implementation implementing
number of Sensitize and enforce environmental
institutions that  Enforce and support institutions to institutions to comply with management plan.
are emitting pollutants regulation
environmental mitigate and control of environmental proclamation, laws and
pollutants (air, standards 100
pollution
water, land and Promote Environmental Proportion of
noises) below  Implement and support health friendly production and industries/factories
the limiting environmental management applying
adaptation plan to climate change
standard from plan Environment friendly
the baseline to  Monitor and regulate emission of Capacitate institutions on production
pollution.
100%. Management of toxic and

pollutants
infectious wastes
 Enforce and support national and Monitor institutions hazardous
% of institutions
international environmental pollution waste generation and chemicals
regulated
management
Target 2: standards % of institutions
Increase  Promote and advocate environmental Develop Institutional early regulated and
institutional warning system for release of monitored for
surveillance and friendly technology options hazardous and toxic substances hazardous waste 100
regulation from  Capacity building management
the baseline to Developed early
100%  Advocacy awareness and social Create awareness on early warning system in
mobilization warning system for hazardous place for release of
and toxic substances hazardous and toxic
substances
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Objecti
Implementation
Targets
Strategic Initiatives Major Activities Indicators Period
ves
% % % % %
 Strengthen community Awareness creation, attitudinal and behavior change on
targeted hygiene and environmental health indicators
community through organized and
SO9: By 2020 ensure empowered
platforms Organize community members and provide capacity

promotional interventions.
Target 1: Increase  HEP building interventions

Strengthen women development groups to improve
awareness, attitude  Capacity building implementation of hygiene and environmental health
Number of
and behavior of community
the people towards  Advocacy awareness activities developmen
Conducting advocacy and social mobilization for 90
targeted behavioral and social t groups
indicators of HEH influential leaders and decision makers on community strengthene
from the baseline mobilization empowerment d
to 90%.  Strengthen partnership
Enhancing the capacity of religious leaders, clan leaders
and collaboration and other social networks.
Implementation
Objecti
Targets Period
ves
% % % % %
Target 1: Develop  Capacity building
enabling environment for hygiene and
SO10: By 2020 create reliable and
and implement
 Strengthen Establishing appropriate structure at all level and sectors
environmental health activities
HEH viable
structure coordination,
Target 2: Strength Establishing and/or strengthening the hygiene and Number of
sector wide integration and environmental health task force at federal and regional sectoral
coordination, collaboration with in level and technical working groups for each of the working
integration, domains group
networking and and /or among sectors Design sector wide coordination and implementation organized
partnership.  Enhance networking framework on hygiene and environmental health issues and
Strengthen WASH integration in related health and other functional
and partnership relevant programs
 Develop and advocate Facilitate networking with Universities and research
institutions.
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HEH structure at all Development of hygiene and sanitation implementation
Target 3: Develop levels guidelines
Number of
and put in action Development of HWTS and water quality surveillance
implementation  Ensure and mobilize implementation guideline
implementat
ion guide
guidelines for each adequate resources Development of HWT products regulation guideline lines
domains of the Development of food safety implementation guideline
strategy  Develop and put in developed
Development of pollution control and regulation
action policy brief, guideline
guidelines, directives Fulfilling structure with skilled human resource at all
level and sectors
Target 4: Human and manuals Education and training of environmental health workers
Number of
resource  Strengthen Monitoring Developing and/ or revising and using standardized
professional
development and guidelines and manuals
evaluation and s trained
capacity building TOT training cascading in all strategic objectives
research. Continuous professional development through
certification and accreditation
Target 5: Ensure Government commitment and allocation of funds.
adequate Finance Advocate donors and partners for funding
Target 6: Create Establishing environmental lab at national and regional Number of
adequate and level
strengthen public researches
and
and environmental Provision of field testing kit at all levels
Laboratories. evidence
generated
Target 7: Ensure Create platform for continues learning and reporting
on hygiene
ongoing and Organize annual multi stakeholder learning events
and
continuous Facilitate and support research and survey environment
learning and Continuously innovate, adopt, and implement new al health
research. technologies.
Target 8: Conduct supportive supervision
Strengthen Establish baseline and conduct mid and end term
Monitoring and performance evaluation
evaluation. Conduct sector wide HEH activities inventory
N.B. The strategic targets that leave as empty are those targets doesn`t have baseline data
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1. RESEARCH, LEARNING AND SHARING
The natural resources such as water, land and air are continuously threatened by industrialization,
population growth and urbanization. Pollution of these resources expose to adverse and chronic health
problems, climate change, land degradation and water resources pollution. Therefore it’s important that the
ministry of health have to make special organizational, financial and human resource arrangement to
enhance research, learning and sharing through collaboration with higher teaching institutes, and research
centers, for new findings, innovative ideas and solutions for the adverse environmental outcomes.
2. Program coordination and planning

Hygiene and environmental health is a cross cutting program with public health disciplines such as
nutrition, maternal and child health, HIV/AIDES etc.; education, water, agriculture, industry, tourism, and
other development issues are somehow interrelated with environment and health. Coordination, aligned
planning and information exchange, is essential to avoid duplication of work, enhancement of learning and
for efficient fund management for a successful and sustained result.
The Hygiene and Environmental Health Strategy (HEHS) advocates strengthening the hygiene and
environmental health program coordination in the federal, regions, zones and woredas through capacity
building, use of CLTSH, and development of WaSH plans identify priority problems, providing strategic
solutions and monitoring implementation of the solutions.
3. Resources
3.1. FUNDING REQUIREMENT
The Government of Ethiopia expends immense budget for salary and operational costs. However, funding is
needed for capacity building of sectors from federal to grass root levels.
The total budget that requires for the implementation of hygiene and environmental health activities at all
levels of the health system and sectors that have input for the achievement of these strategy is estimated to
be 12,533,000,000.00 ( Twelve billion five hundred thirty three million ETB).
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3.2. Budget by each Strategic Initiatives
Strategic
Targets Strategic Initiatives Estimated Budget
Objectives
Target 1: Increase proportion of
Increase access to
households with access to improved
improved latrines and 1,517,000,000.00
latrines and hand washing facilities from
hand washing facilities
28% to 82%.
Target 2: Increase proportion of latrine
Increase latrine utilization 20,000,000.00
utilization from 71% to 100%
SO1: By 2020 Target 3: Increase proportion of Open Increase Open Defecation

achieve access to Defecation Free (ODF) and verified Free (ODF) verified 350,000,000.00
adequate and Kebeles from 18% to 82% Kebeles
equitable Target 4: Proportion of households with Increase integrated solid
sanitation for all. integrated solid waste management waste management 70,000,000.00
service from 22% to 82% service
Target 5: Proportion of households with Increase integrated liquid
integrated liquid waste management waste management 1,000,000.00
service from 50% to 80% service
Target 6: Proportion of household latrines Increase latrines emptied
emptied and properly disposed from and properly disposal 20,000,000.00
baseline to 100% services
Target 1: Increase the number of Increase hand washing
households practicing hand washing with practice with
SO2: By 2020 10,000,000.00
soap/substitute at all critical moments soap/substitute at all
promote basic
from the present 1% to 82% critical moments
hygiene behavior
Target 2: Increase the number of people
in order to control Increase face, oral and
practicing face, oral and body hygiene 10,000,000.00
related body hygiene practice
from 58.3% to 100%.
communicable
Target 3: Increase the number of women Increase menstrual
diseases.
practicing menstrual hygiene from 46% hygiene management 26,000,000.00
to 100%. practices
Target 1: Increase number of households Increase using drinking
using drinking water from protected water from protected 11,000,000.00
source from the baseline 57% to 100% source
Target 2: Increase effective correct and Increase effective correct
SO3: By 2020 consistence use of household water and consistence use of
ensure safe water 17,000,000.00
treatment options from baseline 10% to household water
from the point of 35% treatment
source to Target 3: Increase regulation of Increase household water
consumption household water treatment products from treatment products 51,000,000.00
the baseline to 100% regulation
Target 4: Increase proportion of improved
Increase implementation
water scheme implementing water safety 15,000,000.00
in improved water scheme
plan from the baseline to 100%.
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Increase water supply
Target 5: Increase water supply system
system quality
quality surveillance and regulation from 2,565,000,000.00
surveillance and
the baseline to 100%
regulation
Target 1: Increase proportion of Increase institutions with
institutions with gender and disable gender and disable
2,505,000,000.00
sensitive complete improved WASH sensitive complete
package from 20% to 60%. improved WASH package
SO4: By 2020 Target 2: Increase institutional WASH Increase institutional
ensure basic surveillance and regulation from the WASH surveillance and 10,000,000.00
WASH in all baseline to 100% regulation
institutions Increase health facilities
Target 3: Increase proportion of health
implementing CASH (risk
facilities implementing CASH (risk based
based WASH) and 50,000,000.00
WASH) and national health facility
national health facility
standards from the baseline to 100%.
standards
Target 1: Increase number of households Increase Good Hygienic
implementing GHP from the baseline to Practice implementation 21,000,000.00
100% at household level
Target 2: Increase institutional food Increase institutional food
safety surveillance and regulation from safety surveillance and 71,000,000.00
the baseline to 100% regulation
SO5: By 2020
Target 3: Increase number of institutions Increase institutions
ensure food safety
implementing Good Manufacturing implementing Good
from farm to fork
Practice and other food safety Manufacturing Practice 10,000,000.00
management systems and Good Hygienic and other food safety
Practice from the baseline to 100% management systems
Target 4: Increase surveillance and Increase surveillance and
regulation of food products from the regulation of food 12,000,000.00
baseline to 100%. products
Target 1: Increase environmental
Increase environmental
management for vector control by
management for vector 8000000
mobilizing communities from the
control
SO6: By 2020 baseline to 100%
reduce vector Target 2: Increase household hygiene by
Increase household
borne diseases. creating awareness at household level 5,000,000.00
hygiene
from the current baseline to 100%
Target 3: Increase biological vector Increase biological vector
30,000,000.00
control from the baseline to 43%. control
SO7: By 2020
Target 1: Increase number of institutions Increase institutions
ensure safe and
implementing occupational health and implementing
conducive working 17,000,000.00
safety standards from the baseline occupational health and
environment in all
to100%. safety standards
institutions.
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Increase the number of
Target 1: Increase the number of
institutions emitting
institutions that are emitting
SO8: By 2020 environmental pollutants
environmental pollutants (air, water, land 19,000,000.00
enable abatement (air, water, land and
and noises) below the limiting standard
of generation and noises) below the limiting
from the baseline to 100%.
exposure to sources standard
of pollution. Target 2: Increase institutional Increase institutional
surveillance and regulation from the surveillance and 4,000,000.00
baseline to 100% regulation
SO9: By 2020
Target 1: Increase awareness, attitude and
ensure empowered Increase awareness,
behavior of the people towards targeted
community attitude and behavior on
behavioral indicators of hygiene and 21,000,000.00
through organized hygiene and
environmental health from the baseline to
and promotional environmental health
90%.
interventions.
Develop and implement
Target 1: Develop and implement
hygiene and
hygiene and environmental health viable 1,000,000.00
environmental health
structure from federal to kebele level.
viable structure
Strength sector wide
Target 2: Strength sector wide
coordination, integration,
coordination, integration, networking and 4,000,000.00
networking and
partnership.
partnership.
Develop and put in action
Target 3: Develop and put in action
implementation
implementation guidelines for each 13,000,000.00
SO10: By 2020 guidelines for each
domains of the strategy
create reliable and domains of the strategy
enabling Human resource
Target 4: Human resource development
environment for development and capacity 1,023,000,000.00
and capacity building
hygiene and building
environmental Target 5: Ensure adequate Finance for the
health activities implementation of the strategic Ensure adequate Finance 2,000,000.00
objectives.
Create adequate and
Target 6: Create adequate and strengthen strengthen public and
4,000,000,000.00
public and environmental Laboratories. environmental
Laboratories.
Ensure ongoing and
Target 7: Ensure ongoing and continuous
continuous learning and 13,000,000.00
learning and research.
research.
Target 8: Strengthen Monitoring and Strengthen Monitoring
11,000,000.00
evaluation. and evaluation.
Total Budget 12,533,000,000.00
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3.3. SOURCE OF FUND
The principal funding sources are:
 Government allocation: Salary of staff, production of communication materials, capacity building
support
 NGOs, CWA, Partner working on HEH: Water Supply, Study and design, capacity building and
management support, Sanitation and urban environmental improvements will include dislodging
equipment and facilities, latrine sludge/septage treatment plant and public toilets construction, and
development of wastewater management systems in selected locations, Institutional WaSH support to
improving water supply and sanitation facilities and hygiene practices at health institutions as well as
Water Quality Monitoring
4. ROLES and Responsibilities of Government and Partner Organizations

Each health sector division will play a leadership role in coordinating partners to strengthen capacity
and drive for coordinated hygiene and environmental health responses.
4.1. Role and Responsibilities of Federal Ministry of Health (FMOH)
Ministry of Health with leadership and coordination role of Hygiene and Environmental Health
program would have the following roles and responsibilities:
 Create awareness, enhance knowledge and create the enabling environment for the
advancement of Environmental health
 develops strategies, guidelines, protocols, manuals, print/electronic, tools, strategies, IEC,
job aids
 Ensure the proper utilization of the strategy by all stakeholders who are engaged on
hygiene and environmental health interventions
 Support Regional Health Bureaus and other Sector Offices to establish a viable H&EH
program , adopt the strategy and avail the necessary resources (hum an, material, financial).
 Establish and follow a robust H&EH monitoring and evaluation system in
collaboration with key stakeholders.
 Provide special support for emerging regions to implement the strategy in the context of
pastoralist and agro-pastoralist context
4.2. Role and Responsibilities of Regional Health Bureaus
Regional Health Bureaus with leadership and coordination of respective Hygiene and Environmental
Health section will have the following roles and responsibilities:
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 Create awareness on how to utilize the strategy in collaboration with regional partners using
available communication strategies
 Employ the strategy to develop any materials such as print/electronic, tools, strategies, IEC,
job aids, etc. Ensure proper utilization of the strategies by all stakeholders who have engaged
on hygiene and environmental health intervention in their respective regions and
 Support zonal/Woreda Health Department/ Offices and other sector offices who work hygiene
and environmental health to adopt/adapt the strategy in availing resources including
manpower and financial support
4.3. Role and Responsibilities of Zonal/ Woreda Health Department/ Offices
 Familiarize the strategy with health programmers and health communicators
 Collaborate with local partners to develop culturally-relevant hygiene and environmental
health
 Make use of the strategy to develop promotional materials such as print/ electronic,
tools, strategies, IEC, job aids, etc.
 Provide support to guide utilization of the strategy for those involved in hygiene and
environmental Health
 Provide support to Woreda Health Offices, PHCU and other sector offices to adopt and
adapt the strategy and in availing resources – human resource and financial
4.4. Role and Responsibilities of Primary Health Care Units
All actors in primary health care units, such as health centers, Health Extension Posts (with HEWs) and
Health Development Army (HDA) and kebele health committees would use this strategy to conduct
hygiene and environmental health at community and household level, along with the following roles and
responsibilities:
 Make use of the strategy to follow and develop culturally-relevant promotional materials
 Provide support in understanding and implementing the strategy
 Ensure that the strategy links and guides HEWs in their day to day hygiene and
environmental health efforts
As shown in the following table the roles and responsibilities of each agency in each category are
indicated. The local actors however, have to also be supported from sectors at federal, regional and
woreda level stakeholders. Thus the roles and responsibilities of the key actors in Water, Hygiene and
Environmental health programs are shown in the following table.
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Table 2: Stakeholders Analysis for hygiene and environmental health strategy
Sectors Roles and Responsibly Coordinating mechanism
Agencies By involving in H& EH Task force Member
accountable to By being membership of emergency task force
FMOH To incorporate WaSH activities
 Prepare and endorse national food safety policy, proclamation, By joint planning, implementation
regulation, guidelines, standards in collaboration with other and monitoring of Wash activities
sectors By involving in review of WaSH Programme
 Identify and register all food producers and food service By encouraging to participate and lead WaSH
FMHACA providers including street vendors related researches
 Audit food and drinking producers, vendors and food service By supporting the dissemination and
providers documentation of research findings
 Ensure the safety of food and water products by using continual By sponsoring WaSH related researches
testing and conformation throughout the value chain
 Purchase materials for the proper implementation of WaSH
PFSA
activity
Conduct study and research in the area of hygiene and
environmental health
EPHI
Conduct pre emergency WaSH infrastructures assessment
Provide support on emergency situation
MOWIE Provide adequate and potable drinking water supply By involving in H& EH Task force
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Conducting water quality monitoring on regular basis By joint planning, implementation and
Plan and Strengthen implementation of integrated liquid waste monitoring of WaSH activities
management system By involving in review meeting of hygiene and
prepare policy, strategy guidelines and regulations as well as environment health
initiate the implementation of waste water management By conducting joint supervision
promote appropriate waste water management systems and By Sharing sanitary assessment and water
technologies quality test results
monitor and evaluate implementation of waste water WQMS
management In the construction of water supply systems in
capacity building on waste water management the health facilities
Working in coordination for WaSH facilities
access, utilization and sustainability issues
fulfill WaSH facility demand for schools By involving in H& EH Task force Member
establish and strengthen WaSH club at schools By being membership of task force that involve
Provide hygiene education to school community WaSH activities
establish WaSH demonstration site in primary amd secondary By joint planning, implementation and
MOE schools monitoring of Wash activities
conducting Joint supervision with MOH In review of Wash activities
Conducting operational research and assessment in relation Encourage Universities to involve in conducting
WaSH Programme researches regarding to WaSH
Providing capacity building on new sanitation technologies and Financing the documentation and dissemination
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new approaches of WaSH promotion of WaSH related researches
Producing skilled and competent environmental health
professionals
Sensitizing workers and employers about occupational safety By involving in H& EH Task force Member
establish safety standards for manufacturing enterprises and By being membership of task force that involve
institutions Environmental health activities
Inspecting working environment in institutions and enterprises By joint planning, implementation and
for complying with safety standards monitoring of WaSH facilities in institutions
MOLSA
promoting hygiene and sanitation for homeless citizens and and enterprises
orphanage By involving In review of Wash activities
By cooperating in data collection
,documentation and dissemination about safety
of workers
controlling and monitoring the application of pesticides and By joint planning, implementation and
herbicides in to farms to protect environmental pollution (water, monitoring of Environmental health activities
food and soil ) with toxic chemicals By involving in review of hygine and
MOANR
promoting biogas and composting to reduce indoor air pollution environmental health activities
and solid wastes respectively By conducting joint supervision in emergency
preparedness and mitigation activities
Coordinate measures to ensure that the environmental objectives By involving in H& EH Task force Member
MEFCC
provided under the Constitution are realized. By being membership of task force Related to
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Establish a system for environmental impact assessment of environment
public and private projects, as well as social and economic By joint planning, implementation and
development policies, strategies, laws, and programmers monitoring of Wash activities
In cooperation with competent agencies, carry out studies to By involving in review of hygiene and
combat desertification and /or mitigate the , effects of drought environmental health Programme
and prepare corrective measures and create favorable conditions By conducting joint operational research and
for their implementation assessment on environmental health and
 Set environmental standards and ensure compliance with those environmental pollutions
standards In data collection ,documentation and
Formulate environmental safety policies and laws on the dissemination
production, importation, management and utilization of
hazardous substances or wastes as well as on the development of
genetically modified organisms and the importation, handling
and utilization of genetically modified and alien species, and
upon approval, ensure their implementation
Establish an environmental information system that promotes
efficiency in environmental data collection, management and use
Promote and provide non-formal environmental education
programs, and cooperate with the competent agencies with a
view to integrating environmental concerns in the regular
educational curricula
Promote best available and environmental friendly technologies
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to protect the environmental pollution.
Collaborate sectors to control environmental pollution
establishing and revising health related standards together with By involving in H& EH Task force Member
health sector (Water, food and air) By being membership of task force of WaSH
Ethiopian
related standard setting
Standardizatio
By involving in review of Wash activities
n Agency
by sharing WaSH related operational research
findings
complying with environmental health standards while By involving in H& EH Task force Member
establishing manufacturing enterprises By being membership of task force involving
monitoring manufacturing enterprises to comply with sanitation, WaSH activities
hygiene and safety standards By joint planning, implementation and
monitoring of WaSH activities
MOI
In the area of study, research undertaking and
dissimilation of new research findings
by sharing WaSH related operational research
findings
ensuring compliance of heath standards before issuing license of By involving in H& EH Task force Member
MOT trading By being membership of task force that set
monitoring trade enterprises in collaboration with relevant standards of food and drinking establishments
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stakeholders including health sector  involving WaSH activities
By joint planning, implementation
and monitoring of Wash activities
By involving operational researches rated to
premises.
By sharing WaSH related operational research
findings
Promoting ODF by sensitizing and controlling transporters not to By involving in review of Wash activities
MO transport let clients for open defecation By sharing WaSH related operational research
Fulfilling WaSH facilities to Bus stations findings
Collaborate to monitor and control environmental pollutions By joint planning, implementation and
related with industrial waste monitoring of Wash activities
Strengthening environmental, social impact assessment and By involving in review of Wash activities
environmental management plan By involving in WaSH related case studies
monitoring and evaluation of the implementation of By sharing WaSH related operational research
MO Industry
environmental, social impact assessment and environmental findings
management plan
mainstreaming environmental team/representative expert at all
industries
enforce laws regarding industrial related environmental and
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social issues
creating awareness on WaSH to women By joint planning, implementation and
organizing women into WDA (Women Development Army) to monitoring of Wash activities
promote and utilize WaSH services By involving in review of Wash activities
By involving in WaSH related operational
MOWCA
researches and assessments
By involving in supervision of In emergency
preparedness and that require WaSH
intervention
Developing master plans of towns and cities that take into By involving in H& EH Task force Member
consideration solid waste management By being membership of task force that
encourage private sectors engagement in integrated solid waste incorporate WaSH activities
management By joint planning, implementation and
provide capacity building related with integrated solid waste monitoring of Wash activities
management By involving in review of Wash activities
MoUDH prepare laws and regulation, strategies, standards, and By involving in operational researches related to
implementation manuals on integrated solid waste management urban setting
monitoring and strengthen the implementation of legal By sharing WaSH related operational research
frameworks related with integrated solid waste management findings by involving in operational researches
promote appropriate integrated solid waste management systems related to urban setting
and technologies Cooperating In data collection ,documentation
and dissemination
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Conducting inspection and supervision at service providing By involving in H& EH Task force Member
facilities (hotels, motels, loges, cultural halls, restaurants ) By joint planning, implementation
Awareness creation on hygiene and environmental health and monitoring of Wash activities
associated with communicable diseases By involving in review of Wash activities
Conduct research and interventions on harmful waste By involving in WaSH related operational
MOCT management researches, assessments and survey
Promoting hygiene and sanitation activities of tourism sites By sharing WaSH related operational research
Provide sustainable and adequate water, sanitation and hygiene findings
for tourist sites, heritages and conservation sites Cooperating in data collection ,documentation
Building effective waste management systems for tourist sites, and dissemination
heritages and conservation sites
Providing technical and financial support to WaSH programme By involving in H& EH Task force Member
Introducing new sanitation technologies and approaches of By joint planning, implementation
WaSH promotion and monitoring of Wash activities
Sharing best experiences of WaSH of other countries success By involving in review of Wash activities
Development Providing capacity building on WaSH to professionals at all By involving in WaSH related operational
partner levels researches, assessments and survey
By sharing WaSH related operational research
findings
Cooperating in data collection ,documentation
and dissemination
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Providing technical and financial support to WaSH programme By involving in H& EH Task force Member
Introducing new sanitation technologies and approaches of By joint planning, implementation and
WaSH promotion monitoring of Wash activities
NGOs Implementing WaSH strategy in project areas By involving in review of Wash activities
working in Sharing best experiences of other countries WaSH success By involving in WaSH related operational
WaSH Providing capacity building on WaSH to professionals at all researches, assessments and survey by sharing
levels WaSH related operational research finding
By cooperating in data collection
,documentation and dissemination
mobilizing communities to keep personal and environmental By joint planning, implementation and
hygiene monitoring of Wash activities
Faith based supporting health extension workers in educating households to By involving in review of Wash activities
organization fulfill health extension packages By sharing WaSH related operational research
arranging meetings to mobilize communities at religious findings
institutions
Administratio Mobilizing executives to meet SDG including WaSH related By involving in review of Wash activities
n (Region, targets By sharing WaSH related operational research
zone, woreda support and involve in implementation of Health Extension findings joint supervision in emergencies that
and kebele) Programme require WaSH interventions
Support health sector to implement Woreda transformation plan
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5. MONITORING AND EVALUATION
All organizations who have a designed goal and a set program process will want to know if
they are on the right track in achieving their goals within the set time period. The target set
for Hygiene and environmental Health program is to achieve 100 % improvement on HEH
domains in the strategy.
Table 3: Monitoring and Evaluation Indicators
Parameters Indicators Source
Access to adequate % of households with access to improved latrine HMIS
and equitable Number of sanitation marketing centers established Survey
sanitation for all % of open defecation free kebeles HMIS
% of households properly utilizing latrine facilities HMIS
% of households practicing proper handling and storage of solid waste HMIS
% of households practicing proper handling and disposing of liquid waste Report
% of household latrines emptied and properly disposed Report
Promote basic % of population practicing hand washing with soap/substitute at critical Survey
hygiene behavior moments
% of population practicing face washing with soap at least once a day Survey
% of population practicing oral hygiene during morning and evening time Survey
% of women practicing menstrual hygiene Survey
% population with basic knowledge personal hygiene Survey
Ensure safe water % of households with access to safe water supply. HMIS
from point of % of households using safe narrow necked water storage container Survey
source to % of households use water treatment options HMIS
consumption Number of household water treatment product granted market authorization Report
% of water improved schemes implementing water safety plan Survey
% of water supply facilities regulated report
Ensure basic % of schools with adequate gender and differently abled friendly latrines Survey
WASH in all % schools with access to improved water supply system HMIS
institutions % of health facilities with adequate and gender friendly latrine facilities Survey
% of health facilities with adequate water supply system HMIS
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Proportion of other institutions with adequate gender and differently abled HMIS
friendly latrines
Proportion of other institutions with access to safe water supply facilities Report
Proportion of other institutions with solid and liquid waste management Report
Ensure food safety % of households implementing GHP Survey
from farm to fork % of institutions regulated to implement food hygiene and safety Survey
% of institutions implementing good manufacturing practice and other food Survey
safety management system and GHP
Number of food products granted market authorization Report
Reduce vector born % of communities mobilized for environmental management of vector Report
disease breeding sites
% of households implementing basic hygiene Survey
Number of institutions developing biological vector controls report
Number of regions implementing biological vector control Survey
Ensure safe and % of institutions Implementing occupational health and safety standards. Survey
conducive working % of institutions regulated on occupational health and safety. Report
environment
Enable abatement % of institutions implementing environmental manageme nt plan. Report
generation and % of institutions regulated Report
exposure to Proportion of industries/factories applying Environment friendly production Survey
pollution % of institutions regulated and monitored for hazardous waste management Report
Developed early warning system in place for release of hazardous and toxic Document
substances
Empowering Number of community development groups strengthened Report
community
Create reliable and Created hygiene and environmental health directorate Document
enabling Number of sectoral working group organized and functional Report
environment for Number of implementation guide lines developed Document
hygiene and Number of professionals trained Report
environmental Number of researches and evidence generated on hygiene and environmental Document
health program health
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6. ANNEX
6.1. Annex 1: Strategic Result framework
A result is a describable or measurable developmental change. The logical framework below indicates the process, outcome and impact of
community centered HYGIENE AND ENVIRONMENTAL HEALTH program in Ethiopia.
Program Process Program results
Output Activity indicators Outcome Impacts
Households practice Households will be advised on the merits of making water safe for drinking and All household will use Disease related to
safe water transport, food preparation through: clean water transport and contaminated water such
storage, handling  Transporting water in a closed container. water storage with a screw as diarrhea, giardiasis ,
and safe use is  Store water in a narrow necked, screw cupped container cup and use chlorine amoeba etc are
practiced  Wash water transport and storage container thoroughly at least once in every 3rd . bleach for maximum controlled
day safety.
 Use chlorine product to disinfect water in storage

 Water drinking utensils such as cups are kept off the ground surface, washed and
stored on shelves rim down wards.
Household Household will be made aware on the relationship of human feces to disease All households in a Fecal oral disease such
construct an transmission not only to the household but to the whole community. Household community have clean, as helminthes, giardiasis,
improved latrine, will also be advised on: safe and dignified typhoid etc and soil
with cleanable floor,  Sitting and construction of a functional latrine which would resist collapse during improved sanitation based parasitic infection
well plastered rainy season and termites facility utilized by such as hook worm
superstructure and  Households will also be explained the importance of each part of a latrine such everyone in the family and transmission is
tight squat hole cover as the latrine (cleanable or washable), squat hole cover, walls, roofs and doors open defection is made eliminated
history.
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which are necessary for disease prevention, comfort, dignity etc.,
When the source of water is protected and available at homestead level or at short
distance from the house water consumption is increased, hygiene enhanced and
water contamination is also reduced. Therefore:
 Communities will be mobilized to plan in participating the development for a
safe water supply
 Conduct periodic water quality monitoring program to safe guard communities
from using contaminated water and to maintain safety standards.
 Disinfect water sources with chlorine solution whenever necessary or advised by
water quality test result.
Households practice  To place a hand washing device near latrines or kitchens to remind them the
hand washing with practice
soap or a substitute  Use soap or ash or sand to rub the hands to remove dirt
at all critical  Filling the hand washing device with water
moments
Solid and Liquid Households are advised on the benefits and harm of solid and liquid waste All households in a Diseases transmitted
waste properly products generated at household level. The proper management will be on: community practice safe through wasted and
managed and waste  The benefits of solid and liquid waste if used as natural product for soil solid and liquid waste environmental pollution
recycling and reuse conditioning, energy (fire) use, biogas generation and watering plants. handling, process for use problem is eliminated
practiced  The importance of managing solid and liquid waste at point of generation in and dispose properly.
order to avoid community environmental pollution
 Demonstrate how waste is segregated into compostable and non-compostable
items and how composting processed
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 Advise households on how to manage liquid waste in a simple seepage pit with
local grass grease filters.
 Encourage households to clean the compound from any debris and use the waste
as compost mix or spread in the backyard farm.
Households practice Households should be able to understand that food contamination is eminent with All households in the The household members
proper food poor handling and storage. community practice proper and the community at
protection  People should know where the food is coming from. If the source is food protection and large are protected from
contaminated then it will also contaminate surfaces other than being a health storage to Food borne diseases and
hazard. Safeguard household outbreaks.
 Cooks in the household should keep all food contact surfaces such as cutting members especially
board, moseb, or food eating utensils such as plates, spoons and forks; water children from having
drinking utensils such as glasses, tin can etc. health problem and
 Household members should also know on how to store and heat leftover food. prevent food wastage
 Household have to be encouraged the cultural food preservation methods of

drying meat, washing and smoking milk storage, adding ash in to grain storage
to control grain bugs, raising grain storage from the ground to control rats etc.
 Household should be advised again and again to wash their hands with soap or
ash before touching any food for preparation, eating or feeding.
 Household should be encouraged to have a storage shelf made from wood and
plastered with mud as introduced by HEWs in Kebeles for food, food utensils
storage.
Domestic Hygiene The housing condition in Ethiopia especially in the rural and poor neighborhoods All community members Communicable disease
including ventilation in urban areas is poor. Overcrowding due to space problem; luck of separate live in a comfortable and transmission as a result
69 | P a g e
and lighting kitchen, food storage and in some rural communities co habiting with animals, lack sanitary house. of overcrowded
improved of ventilation and lighting, exasperate the situations. Therefore household should condition such as
be encouraged and mobilized: respiratory disease,
 To add more rooms when constructing a new house or modify existing house scabies and other
so that overcrowding is minimized. zoonotic diseases are
 Households will also be motivated to have a separate barn for their animals and eliminated.
break the cultural belief that animals need human warmth and vice versa.
 Household will be encouraged to open windows of appropriate size or open
several holes at the eve of the house to let fresh air in the house and also
provide more natural light.
 Households will also be advised to smoothly plaster and paint their house with
available resources such as mud or dung and painted with wood ash paste,
calcium carbonate (nora) to discourage breeding and hiding of bedbugs and
other insects.
Rats, insects and Traditional housing have no windows for ventilation, hence, the houses are dark, All households discourage No disease transmission
other vermin of smell bad, and encourage rats and other vermin to breed and hide. Overcrowded rat and insect breeding and such as trachoma,
public health condition increase heat and humidity conducive for insects such as body louse, bed live in a sanitary house. malaria, etc and people
importance are bugs, and rats. Evidences from local survey indicate that rats are heartfelt problems living in dignity is
controlled to the extent that community members thought that they are unavoidable. “Rats enhanced
and death are unavoidable phenomena” Rats are abundant so is infestation with
fleas. Since beliefs such as this are exposing the general public a sanitary measure
will be needed to:
 All food storage especially grains must be kept at least 20 cm off the floor.
 Mobilize communities improve the housing conditions especially unorganized
70 | P a g e
storage.
 Rats should be denied food and watery product and a shelter to nest.
 Lighting the house through windows and providing sky light using transparent
sheet will be encouraged
 Unnecessary growth of bushes, water ponds near houses should be cleared or
filled with earth to avoid the breeding of insects and mosquitoes.
 Households are mobilized to control flies through eliminating breeding areas
such as removing compostable waste product, cow dung and covering pit latrines
Indoor air pollution The cause of ARI in children, eye sight problem of mothers is suspected to be a All households in the ARI problem and eye
is controlled result of indoor air pollution and heat exposure. The pollution problem resulted community use smokeless inflammation as a result
from using unprocessed biomass fuel such as wood and dung in the households. energy saving stove in a of indoor air pollution
This problem will be tackled through well ventilated kitchen and heat is eliminated.
 Mobilization of households to build a local energy saving/smokeless stove with
chimney or those who can afford to buy cement stove.
 Households cook in separate kitchens to minimize exposure to other members of
the households.
 Raise the smokeless/energy saving stove above ground to prevent burn of toddlers
 Kitchen or any cooking area to be well ventilated through windows or opening at
the eve.
71 | P a g e
Health, education Schools, health facilities and prisons are organizations are part of communities. All WaSHproportion of Safe behavior and
and detention represent large population segment and deserve optimum Water, sanitation and Schools with functional practice result in
institutions hygiene services will have to be enhanced Therefore: WaSH services improved health and
HYGIENE AND  Communities will form a parent and teacher student committee to change things proportion of Health wellbeing.
ENVIRONMENTAL which are within their abilities and capacities. Services with functional
HEALTH conditions  The student and prison population will also be mobilized using CLTSH triggering WaSH services
improved with basic tool to improve the sanitation and hygiene conditions proportion of detention
services  Advocacy with Government will be enhanced to provide adequate water and centers with functional
sanitation services in the institutions. WaSH services
Emergency Community may be exposed to emergencies such as disease epidemics, earth proportion of well Disease outbreaks,
preparedness at quake, fire etc where in this case communities and government entities have some managed disaster injuries and death
community level preparedness. Community resource People, students, HEWs, WaSHCOs, PHCU incidences incidence of eliminated.
enhanced staff etc will be trained on: injury in a given
 Site selection for emergency camps community due to disaster
 Preparations of solid waste pit, trench latrines and hand washing stations
 Arrangement of water supply complete with disinfection facility
 Preparation and arrangement of cloth lines to expose bedding materials and
clothes to the sun
 Establishment of first aid station, ambulatory service
72 | P a g e
6.2. ANNEX 2: Key Critical Barrier Analysis
Existing/Current H and EH Feasible or do-able-behavior Ideal behavior
Behavior
1. Sanitation
1.1. Excreta Disposal
1.1.1. Many people still defecate in  People can use simple methods (cat method) and cover their feces to prevent any Everyone in a community use an
the open access by flies and animals improved latrine which is cleanable
1.1.2. Most of the existing Latrines  Even if people can’t construct improved latrine with slabs of concrete available and that which lasts longer, protect
are unimproved, not providing latrines can be transformed to have the features of an improved type with local the users from disease and that
adequate privacy materials which all household family are
1.1.3. People in urban and rural  People can help child defecate on leaves, paper, and broken clay and dispose it comfortable and proud to have and
communities don’t dispose child in latrine or cover it with soil to deny fly access. use This ultimately lead us to have
feces properly open defecation free (ODF)
1.1.4. Those who own and use latrine  communities.

Latrine floors can be made with dung or mud to make it smooth and cleanable
don’t keep their latrine clean,  latrine squat holes can be covered with any available discarded household
cover squat holes and maintain materials
it regularly  Pot makers in the community can easily shape clay cover for squat holes
1.1.5. Significant households  Converting the existing latrines to improved latrines Everyone own water courage latrine
constructed their own latrine but  Make more accessible by locating the latrine within a yard inside of a house
not use it consistently.  Upgrade the superstructure of latrine to enable privacy
1.1.6. Latrine is not considered part  Households can use their house building skill to also construct proper latrine Latrine floor and walls can be
of the living house  Households can make the latrine floor, walls etc cleanable and comfortable constructed from durable materials
73 | P a g e
using local materials that will not cost them money but only their time. such as cement, brick or blocks and
covered with tin sheet
1.2. Solid and Liquid Waste Management
1.2.1. The immediate housing  People has to be encouraged to do daily cleaning, Use cow dung together with human
environment in communities are  Practice proper storage that discourage fly breeding or other animals harborage feces for biogas production
littered with animal waste (dung Use the organic wastes such as house sweepings and dung waste for Compost all organic waste and use it
and urine), farm (crop chaffs) composting, land reclamation, soil conditioning or plastering of walls and for soil conditioning.
and other solid waste floors.
1.2.2. Liquid waste from cloth  People should be made aware of the health effects of such wastes and
washing, food utensil washing, encouraged to dispose in a seepage pit or use the waste water to water plants
bathing, animal urine are
indiscriminately thrown outside
the house
2. Personal hygiene
2.1. Hand washing practice
2.1.1. People who own latrines have  Building latrine is a huge task for people who are starting to use latrines but Hand washing facility with running
no hand washing facility hand washing arrangement is so simple to be motivated and once the water and soap or soap substitute or
arrangement by the latrine and if arrangement is made adding water and soap or substitute such as ash for hand soap dispenser available ideally by
they have it has no water and if cleansing is simple. the toilet and kitchen
there is water there is no soap or
substitute.
2.1.2. People don’t practice proper  People can be made aware about the critical moments and encouraged to wash
hand washing even if they have their hand with soap or substitute such as ash
74 | P a g e
the facility and water
2.2. face and personal hygiene
2.2.1. People don’t take bath  Regular bathing with soap in the rivers or at homes is affordable. Behavior People wear clean and suitable cloth,
regularly and whenever they do change is the key in adopting such practice regularly. take bath every day with soap.
they don’t use soap as a
cleansing agent
2.2.2. Parents don’t wash their child  Regularly washing child face with soap
eyes and faces regularly
2.2.3. People’s working cloth is old  Awareness creation for people to wear clean working cloth
and dirty
3. Water quality
3.1. HWTS
3.1.1. People are still using an  Water boiling is a simple and cheap method of making water safe for drinking All people rural/urban use improved
unprotected water source Use water guard which is simple to use, accessible and affordable water source in at least at
3.1.2. Water transport, storage Water container should be cleaned every time when water is fetched or intermediate access level
containers and water drawing whenever water is finished from storage
utensils are largely unclean
3.1.3. People don’t practice Point of  Use locally available water treatment and filtering materials
Use treatment for water Chlorine solutions such as wuha agar which is available in local pharmacies and
affordable can be used for disinfection
4. Food Hygiene
4.1. People don’t properly and  Food can be stored above ground in covered utensils. Storing food according to
hygienically store cooked and  Use local preservatives methods such as drying, salting meat. temperature requirement (cold or
75 | P a g e
uncooked food; store food hot) and stored in covered
efficiently covered containers.
4.2. People use food items  Encourage farmers to use natural fertilizers Producing organic food items
intoxicated by chemicals such as Maximizing labor intensive agriculture practice
fertilizers, pesticides and
insecticides
4.3. Food producers and venders  Strengthen food inspection and community whispering system Delivering genuine food products
adulterate food products Creating awareness on food adulteration and its effect
5. Housing and Institutional health
5.1. House environment in urban  Storage of goods in the house, cleanliness of compound, arranging compost hip People in urban or rural communities
and rural areas are poorly managed in the compound, should live in:
5.2. Housing in rural and urban  Having windows for cross or through ventilation should be encouraged to  a comfortable and well ventilated
slum areas are largely poorly improve air circulation and add light into the house rooms
ventilated and small to  Have separate bedrooms,
accommodate the family members  Use separate kitchen
5.3. People in the rural  People should be encouraged to construct separate animal pens and chicken  clean compound
communities largely cohabit with coops with local materials
farm, chicken and pack animals
6. Vector control
6.1. Vectors of Public Health Importance manageme nt
6.1.1. The fact that malaria relapsing fever, typhus is  Households and the community could be mobilized to drain A well-drained community with no
still reporting indicate that communities are not mosquito breeding sites using hand tools. ponds, open drainage; floors made
motivated to be part of the solution  People must be mobilized to wash clothes with soap or local from easily washable cement or
76 | P a g e
indod and practice personal hygiene ceramic floors; Walls with no cracks
6.1.2. Using chemicals such as DDT, malathion and  People should be aware on how to safely and properly use and painted, lighted and well ventilated
other chemicals is contaminating the environment store chemicals and poisons such as malathion and different houses will keep away rats, bugs,
and is accident hazards types of rat poisons, fleas and malaria mosquitoes.
6.1.3. The present housing conditions in rural and urban  Denying foods for rats, shelter and keeping the house well
areas is not discouraging from having shelter, ventilated and illuminated with natural light will keep rats
food etc. which are very important for their away. Storing food above floor surface also helps to avoid
propagation rats.
6.1.4. Bed bugs and fleas were problems making all  Plastering walls and floors, ventilation and lighting will also
family members irritated and losing sleep control bedbugs and fleas.
7. Pollution
7.1. Indoor Air Pollution
7.1.1. Over 90% of Households in Ethiopia use  Indoor air pollutant especially from biomass smoke can be Using electricity or using dung and
biomass fuel. expelled through windows. Opening air inlet and outlet in the other organic waste for biogas
7.1.2. ARI and eye diseases are rampant especially in house is an easy task for the households. production can be an ideal
the rural areas.  Constructing smokeless and energy saving stoves using local arrangement
materials such as stone and mud can be made by housewives.
7.2. Water Pollution
7.2.1. Defecation in the open is polluting surface  Avoid open defecation, rather use private, communal or Train communities on aspects of
water source public laterine waste management, source
7.2.2. People washing inside, animals drinking and  Surface water sources can be protected either by a zoning the protection and maintenance to
wading through contaminate the water source. water course-the upper end being for drinking, the middle for sustain the services.
7.2.3. People don’t take care of the protected water bathing and washing and the lower end for animals.
77 | P a g e
sources such as springs and well water. No  Communities could easily fence water service centers, dig
fencing, no diversion ditches, poor maintenance diversion ditch very easily and even learn to maintain pumps
and management and cement walls.
7.3. Land Pollution
7.3.1. Plastic bags are observed in all towns and even  Enforcing law on the proper use of plastics for any purposes Applying stringent rules for citizens
rural communities  Municipalities and or kebele administrations should be able to abide by in disposing wastes
7.3.2. Dead animals, offal’s from slaughtering of to arrange for dead animal pick up. generated at home.
animals are also polluting the environment  Individuals should contain any waste products from animal
7.3.3. Open defecation is very visible especially in slaughtering and take to the nearest dumpster. Municipalities having an efficient
cities and towns  People should have latrines and if they have no space to build waste collection, recycling and
latrines, they have to be able to use public toilets. disposal methods.
8. Occupational Health and Safety
78 | P a g e
7. BIBLIOGRAPHY
1. CSA 2015
2. Health Sector Transformation Plan (HSTP) (august 2015),2015/16-2019/20
3. Henrietta M (2011) Enabling Assessment Report, Ethiopia. Unpublished
4. MoH (2012) Health Development Program IV. Unpublished
5. Boydell, F., (1987) a sanitation sector strategy paper. Water supply and sewerage
authority (WSSA)Addis Ababa
6. WHO/UNICEF (2001) Joint monitoring program for water supply and sanitation
coverage in Ethiopia estimate 1980-2000
7. WHO (1997), Health and Environment for sustainable development
8. World Bank, (2012)Preliminary studies on child feces disposal in Ethiopia, unpublished
9. MoH (2003) Health and Health Related Indicators, annual report
10. WHO/UNICEF(2014) water and sanitation update
11. Global SURS (2013), study result for each SURS countries, circular. Unpublished
12. Feachem, R., D Bradley, H Garelick, et al. Sanitation and Disease: Health Aspects of
Excreta and Wastewater Management. World Bank Studies in Water Supply and
Sanitation 3. Chichester, UK: John Wiley & Sons, 1983.
13. Godana, W. and B. Mengistie “Determinants of Acute Diarrhoea Among Children Under
Five Years of Age in Derashe District, Southern Ethiopia”. Rural and Remote Health13:
2329. (Online Version: http://www.rrh.org.au, 2013)
14. Abebe B. tafere A et al (2014) Situational analysis of access to improved sanitation in
the capital of Ethiopia and the urgency of adopting an Integrated Fecal Sludge
management System
15. WSP (2015) Desk review on Economics of Sanitation (ESI) for Ethiopia, unpublished
16. Ibid
17. EDHS (2011) Ethiopia demographic and Health Survey.
18. EDHS (2016) Ethiopia demographic and Health Survey.
19. Ethiopian Central Statistical Agency, EDHS,2012.
20. World Bank. 2005. Ethiopia: A Country Status Report on Health and Poverty, Volume 1,
Executive Summary. Washington, DC: The World Bank
.https://openknowledge.worldbank.org/handle/10986/8685.
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21. Central Statistical Agency and ICF International. EDHS. 2012. Ethiopia Demographic
and Health Survey 2011. Addis Ababa, Ethiopia, and Calverton, Maryland: Central
Statistical Agency and ICF International.
22. DHS (2011) Ethiopia Demographic and Health Survey report.
23. MDG report (2010), MOH
24. Health Sector Transformation Plan (HSTP) 2015, MoH publication.
25. Faris K. and Fekadu Ayele (2000), hygiene and sanitation risk factors based on 5
Environmental Health domains, a report submitted to UNICEF and MOH. Unpublished.
26. Christine van Wija and Tineke Murre Motivating better hygiene behaviour IRC
international, Water and Sanitation Center, the Hague, Netherlands
27. Esrey SA, Feachem RG, and Hughes JM (1991) intervention of the control of diarrhea
diseases among young children : Improving water and Excreta disposal facilities ,
Bulletin of the WHO, 63 (4) 757-772)
28. Esrey SA (1991) Intervention for the control of diarrheal diseases among young children
: fly control, Geneva: WHO , WHO/CDD/91.37
29. VanDerlice and Briscoe (1990) Human excreta disposal and diarrhea.
30. Esrey SA, Feachem RG, and Hughes JM (1985) intervention of the control of diarrhea
diseases among youn children : Improving water and
31. Esrey SA (1991) Intervention for the control of diarrheal diseases among young children
: fly control, Geneva: WHO , WHO/CDD/91.37
32. Curtis V (2002), talking dirty, how to save a million lives without mentioning health : in
Larson D. Nanan et al (2003) Evaluation of water,
33. Sanitation and hygiene education intervention in North Pakistan. WHO Bulletin 81: 160-
165.
34. Asefa M., Robert D. and Fasil T (2000) A birth cohort study in Southwest Ethiopia to
identify factors associated with infant mortality that are amenable for intervention, Eth.
Journal of Health Development; 14 (2): 161-168
35. Intervention for the control of diarrheal disease among young children: fly control,
Geneva: WHO, WHO/CDD/91.37
36. Health effects of outdoor air pollution in developing countries of Asia; a literature
review. Boston, Health Effects Institute, 2004.
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37. Collings D.A., Martin,K.S and Sithole,S.D Indoor wood Smoke pollution
38. Ministry of Health, Health Services Directory. 1994
39. Kloos, H., and Zein Ahmed Zein, The ecology of health and disease in Ethiopia. West
view press, San Fransisco. 1993
40. Muhe, L, ARI in rural Ethiopia children, description of the study setting and review of
literature. The Ethiopian Journal of Health development. 1997 Vol. II, special Issue.
41. Kosove, D. Smoke filled rooms and respiratory infections. in: World Health statistics
quarterly, 1993 Vol. 43, No.3.
42. Aberra K., [Ethiop. J. Health Dev.2010;24(3):156-166]
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human health and chemical mixtures: problems facing developing countries.
Environmental Health Perspectives 2002; 110 (6): 901-909.
44. EPHI: Water Quality assessment in SNNPR
45. JSI (2016), DRAFT survey report, unpublished and uncirculated
46. WaterAid Ethiopia, Analysis of Policy and Practice Bottlenecks and Opportunities for
Integrating WaSH in MNCH, November 2015
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April 2015
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Hygiene and EH Strategy

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Hygiene and EH Strategy

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The Federal Democratic Republic of Ethiopia

National Hygiene and Environmental Health

H.E Ato Admassu Nebebe

H.E. Mr. Kare Chewicha

H.E. Mr. Demese Shito

H.E. Dr. Samuel Kifle

H.E. W/ro Meaza G/Medhin

Table of Contents ................................................................................................................................ iv

List of Tables ...................................................................................................................................... vii

List of Figures.................................................................................................................................... viii

Definition of terms/ Operational Definition .........................................................................................x

Acronyms .......................................................................................................................................... xiii

Executive summery ........................................................................................................................... xvi

4. Situational Analysis ........................................................................................................................ 5

4.1. Status of HEH in Ethiopia ................................................................................................ 5

Hygiene and Environmental Health Program Strategy ..................................................................... 13

Strategic Action Plan ......................................................................................................................... 34

1. Program Management Arrangements ....................................................................................... 34

6.1. Annex 1: Strategic Result framework ............................................................................ 67

prevent disease through community participation and empowerment.

AEA Agriculture Extension Agents

4.1. Status of HEH in Ethiopia

4.2. Health and economic effect of poor HEH Conditions

1 World bank 2013

4.3. Emerging Hygiene and Environmental Health challenges

4.4. SWOT Analysis

Fig. 1: Strategy development process for HEH strategy

Fig. 3: Sstrategic framework for HEH Strategy

5.3. Strategic Objectives

Objective 4: By 2020 ensure WASH in all institutions.

Objective 5: By 2020 ensure food safety from farm to fork

Objective 6: By 2020 reduce vector borne diseases.

Objective 8: By 2020 enable abatement of generation and exposure to sources of pollution

Objective 9: By 2020 ensure community empowerment through organized and promotional

Fig 4: Program management components

6.1. Institutional Development

6.3. Access to Basic HEH Facilities

6.4. Cross cutting issues

6.4.5. Private sector engagement

6.5. Partnership, coordination integration and networking

6.7. Monitoring, Evaluation, Learning and research

1. Program Management Arrangements

1.1. HEH INITIATIVES

1.1.2.Food hygiene and water safety

1.1.3. Institutional health and environmental management

2. Strategic Solutions for Successful outcome

2.2. ENGAGE STAKEHOLDERS AT ALL LEVEL

2.3. CAPACITY BUILDING

2.4. SBCC and MEDIA SUPPORT

2.5. DEVELOP PERSONAL SKILLS

2.6. STRENGTHEN COMMUNITY ACTIONS

2.7. STRIVE TO ENSURE SUSTAINABILITY AND REPLICABILITY

Table 1: Five Years Strategic Plan (2016-2020)

Targets Strategic Initiatives Major Activities Indicators

Target 1: Increase  CLTSH/SLTSH Upgrading basic latrines to

 solid waste management marketing centers

Target 1: Increase the  CLTSH/SLTSH Awareness creation on benefits

number of households and utilization of hand washing

Targets Strategic Initiatives Major Activities Indicators Period