National Sanitation and Hygiene Strategy 2018 - 2024

1.1. BACKGROUND..............................................................................................................1

1.2 RATIONALE OF THE STRATEGIC PLAN ....................................................................2 CHAPTER 2: CONSULTATION PROCESS AND FINDINGS........................................3

2.1 PROCESS OF DEVELOPING THE STRATEGIC PLAN...............................................3

2.2 KEY FINDINGS ...............................................................................................................3 2.2.1 EFFECTIVENESS OF THE SCOPE, MECHANISMS AND ACTIONS APPLIED IN THE IMPLEMENTATION OF THE ODF/HWWS STRATEGIES.....................................3

2.2.2 SCOPE, MECHANISM AND ACTION IN CURRENT STRATEGIES......................5 2.2.3 REVIEW OF ODF AND HWWS STRATEGIES WITH EMPHASIS ON ORIGINAL ASSUMPTIONS ........................................................................................................................6

2.2.4 THE EXTENT TO WHICH DIFFERENT PROGRAMS, APPROACHES AND OTHER CROSS CUTTING ISSUES HAVE CONTRIBUTED TO THE IMPLEMENTATION OF THE ODF AND HWWS STRATEGIES ............................................................................................6 2.2.5 ISSUES SUGGESTED BEING INCLUDED IN THE NEW ODF AND HWWS STRATEGIES ............................................................................................................................6

2.3 POLICY ENVIRONMENT ..............................................................................................8 CHAPTER 3: NATIONAL SANITATION AND HYGIENE...............................................9

3.1 VISION AND MISSION...................................................................................................9

3.2 GUIDING PRINCIPLES ................................................................................................10

3.3 STRATEGIC GOALS .....................................................................................................11

3.4 THEMATIC AREA 1: RURAL SANITATION AND HYGIENE ..................................12

3.5 THEMATIC AREA 2: URBAN SANITATION AND HYGIENE..................................13

3.6 THEMATIC AREA 3: INSTITUTIONAL SANITATION AND HYGIENE ................14

3.7 THEMATIC AREA 4: BEHAVIOUR CHANGE AND COMMUNICATION..............16

3.8 THEMATIC AREA 5: WASTE MANAGEMENT .........................................................16

3.9 THEMATIC AREA 6: MENSTRUAL HYGIENE MANAGEMENT ...........................18

3.10 THEMATIC AREA 7: CROSS CUTTING ISSUES.....................................................18 CHAPTER 4: IMPLEMENTATION ARRANGEMENTS ..............................................23

4.1 IMPLEMENTATION MODALITIES.............................................................................23 CHAPTER 5: IMPLEMETATION PLAN .........................................................................25

5.1 FIVE YEAR IMPLEMENTATION PLAN .....................................................................25

5.2 RESOURCE PLANNING...............................................................................................25 i National Sanitation and Hygiene Strategy 2018 – 2024

5.3 FINANCING ...................................................................................................................26 CHAPTER 6: MONITORING AND EVALUATION FRAMEWORK...........................28

6.1 OVERVIEW ....................................................................................................................28

6.2 STRATEGIC DIRECTION.............................................................................................28

6.3 STRATEGIC PERFORMANCE.....................................................................................28 ANNEXES...............................................................................................................................29 ANNEX A: DETAILED COSTED IMPLEMENTATION PLAN ...........................................30 TABLE OF CONTENTS ANNEX B: IMPLEMENTATION MATRIX ..........................................................................42 ANNEX C: POLICY LINKAGES ...........................................................................................69 DECLARATION/POLICY WHAT IT STIPULATES........................................................71 Annex D: Information on Behaviour Change Models for WASH Sector...................................72 ii National Sanitation and Hygiene Strategy 2018 – 2024 LIST OF ACRONYMS ADC Area Development Committee AEC Area Executive committee AMREF African Medical and Research Foundation ASHPP Accelerated Sanitation and Hygiene Practices Programme CHAG Community Health Action Group CLTS Community Led Total Sanitation CSOs Civil Society Organisation LIST OF ACRONYMS DCT District Coordinating Team DEM District Education Manager DSHC District Sanitation and Hygiene Committee DCTs District Coordinating Teams DEHOs District Environmental Health Officers EH Environmental Health GoM Government of Malawi GSF Global Sanitation Fund HESP Hygiene Education and Sanitation Promotion HSAs Health Surveillance Assistants HWWS Hand Washing With Soap JMP Joint Monitoring Programme MBS Malawi Bureau of Standards M&E Monitoring and Evaluation MEHA Malawi Environmental Health Association MDGs Millennium Development Goals MHM Menstrual Hygiene Management MoAIWD Ministry of Agriculture, Irrigation and Water Development MoEST Ministry of Education, Science and Technology MoGCDSW Ministry of Gender, Community Development and Social Welfare MoHP Ministry of Health and Population MoLG&RD Ministry of Local Government and Rural Development MOU Memorandum of Understanding NCST National Commission of Science and Technology NSA Non-State Actors NGO Non-Governmental Organization NOTF National Open Defeacation Task Force NSHCU National Sanitation and Hygiene Coordinating Unit NSHTC National Sanitation and Hygiene Technical Committee NSHS National Sanitation and Hygiene Strategy NSP National Sanitation Policy OD Open Defeacation ODF Open Defeacation Free PEA Primary Education Advisor PHAST Participatory Hygiene and Sanitation Transformation PHHE Participatory Health and Hygiene Education PTAs Parents Teachers Associatio ns SGDs Sustainable Development Goals SLTS School Led Total Sanitation iii National Sanitation and Hygiene Strategy 2018 – 2024 SWAps Sector Wide Approaches TAs Traditional Authorities TOR Terms of Reference UNICEF United Nations Children’s Fund USAID United States Agency for International Development VHC Village Health Committee WASH Water, Sanitation and Hygiene WASHTED Centre for Water, Sanitation, Health and Appropriate Technology Development LIST OF ACRONYMS WESNET Water and Environmental Sanitation Network WHO World Health Organisation WPCs Water Points Committees WSSCC Water Supply and Sanitation Collaborative Council WUA Water Users Association iv National Sanitation and Hygiene Strategy 2018 – 2024 GLOSSARY Sanitation: Is the hygienic means of preventing human contact from the hazards of waste to promote health and environmental integrity. It is generally used to refer the provision of facilities and services for safe management and disposal of human urine and faeces. Safely managed sanitation: An improved sanitation facility which is not shared with other households, and where excreta (including infant and child faeces) are safely disposed in situ, or transported and treated off-site, and where a hand washing facility with soap and water is present. Improved sanitation facilities: Those designed to hygienically separate excreta from human contact. These include wet sanitation technologies (flush and pour flush toilets connecting to sewers, septic tanks or pit latrines) and dry sanitation technologies (ventilated improved pit latrines; pit latrines; or composting toilets). Pit Latrine: A latrine with a pit for collection and decomposition of excreta from which liquid GLOSSARY infiltrates into the surrounding soil. Hygiene: Encompasses the set of conditions and practices associated with the preservation of good health and healthy living. It consists of behaviours related to the safe management of human excreta such as hand washing with soap, or the safe disposal of children's feaces, menstrual hygiene management, and food hygiene. Hand Washing Hygiene: The washing of hands with soap at critical times including: · After defecation · After cleaning child's bottom or changing diapers · Before feeding a child · Before and after eating, · Before preparing food and during cooking Open defecation: The practice of defecating outside and not into a designated toilet, leaving feces exposed. Open defecation free (ODF): When no faeces are openly exposed to the air, that is ODF. A central term for community-led total sanitation (CLTS) programs and primarily means the eradication of open defecation in the entire community. It also includes the following additional criteria: Household latrines are hygienic, provide the safe containment of faeces, offer privacy, have a lid on the defecation hole or a water seal and a roof to protect the user All household members and all members of the community use these toilets A hand washing facility is nearby with water, soap and is used regularly ODF Declaration Status level 1: 95% of the households must have latrines All available latrines must offer privacy, good state of repair, with good roof All latrines must show evidence of being used All households must properly dispose baby's faecal matter No sign of open defecation in the area v National Sanitation and Hygiene Strategy 2018 – 2024 5% sharing of latrines is allowed ODF Declaration Status level 2: 100% of the households must have latrines All latrines must offer privacy, good state of repair, with good roof All latrines must show evidence of being used All households must properly dispose baby's feacal matter No sign of open defeacation in the area No sharing of latrines is allowed All latrines must have hand washing facilities Community-led total sanitation (CLTS): An integrated approach to achieving and sustaining open defecation free (ODF) status. It entails the facilitation of the community's analysis of their sanitation profile, their practices of defecation and the consequences, leading to collective action to become ODF. GLOSSARY Triggering: Refers to ways of initiating community interest in ending open defecation. The term “triggering” is central to the CLTS process. The aim is to have community-centred change that is spontaneous and long term. CLTS Plus: Focuses on improving access to and adoption of improved sanitation with the aim to move households up the sanitation ladder sustainably. The “plus” (+) represents a focus that goes beyond the original CLTS interpretation that exclusively focuses on ending open defecation. The “+” always explicitly emphasizes hand washing with soap after defecation and installing a fixed-point. The “+” also often combines demand creation for sanitation with efforts to strengthen local availability of sanitation products and services, encouraging innovation with locally appropriate latrine designs using local materials to meet geophysical challenges and often involving small-scale materials suppliers and service providers. Behaviour Change Communication: a multilevel, interactive processes with communities/segment of populations aimed at developing tailored messages and approaches using variety of communication channels (interpersonal, group and community dialogue and mass media) to adopt and engage in specific behaviors/set of behaviors to achieve specific outcomes that promotes their well-being or foster positive behavior, promote and sustain individual, community and societal behavioral changes and maintain appropriate behaviors. vi National Sanitation and Hygiene Strategy 2018 – 2024 FOREWORD T he Government of Malawi is committed to improving the health and livelihoods of all Malawians through effective sanitation and hygiene. Despite progress in these areas, there is still a long way to go to achieve access to adequate and equitable sanitation and hygiene for all and end open defaecation as defined by Sustainable Development Goal 6.2. This Goal also requires us to pay special attention to the needs of women and girls and those in vulnerable situations. The Ministries of Health and Agriculture, Irrigation and Water Development have, and will continue to lead in all efforts to ensure sustainable provision of safe sanitation and hygiene for all Malawians. This is best achieved through participatory efforts, involving community groups as key beneficiaries and owners of interventions and developing a demand driven sanitation and hygiene sector. The National Sanitation and Hygiene Strategy builds on the lessons learnt from previous sanitation and hygiene related strategies and sets out the Government of Malawi approach to addressing the challenges of sanitation and hygiene. It aims to consolidate the gains of the previous Open Defaecation FOREWORD Free (ODF) and Hand Washing With Soap (HWWS) Strategies, and re-organises and repositions the country programme to ensure it is anchored on modeling and rights based approaches. Specifically, it will extend the national programme to include: sanitation and hygiene, waste management and menstrual hygiene management underpinned by effective financial, leadership, coordination and knowledge exchange systems. The Strategy builds on progress made to-date and lessons learnt from the 2011-2015 Malawi ODF and 2011-2012 HWWS Campaign strategies. Critically, it adjusts the previous strategic approaches in light of their implementation experiences. The strategy strengthens a shift from a supply-driven approach, with a strong emphasis on technologies; to a demand-management, sustainability approach, with emphasis on behaviour change and services responding to community and consumer demand. The Government of Malawi assures the sector it will support and ensure effective coordination through the National Sanitation and Hygiene Coordination Unit and the associated Sanitation and Hygiene Technical Committee (formally National ODF Task Force). These bodies will ensure inter-sectoral and multidisciplinary membership to strengthen integration and implementation. I commend this NSHS Strategy to all WASH Sector Policy makers, managers, practitioners and financiers as a guide to achieving the shared vision of sustainable access to sanitation and hygiene nationally, and eliminating open defaecation in Malawi. The Government of Malawi seriously and continuously commits to monitor and provide guidance to the implementation of this strategy. Hon. Atupele Muluzi, MP Minister of Health and Population vii National Sanitation and Hygiene Strategy 2018 – 2024 ACKNOWLEDGEMENTS T his National Sanitation and Hygiene Strategy (NSHS) 2018 – 2024 builds on the rejuvenation and refocusing of the sanitation and hygiene sector. The objective of the Strategy is to provide a framework for improving and sustaining sanitation and hygiene service delivery for all Malawians, (including HWWS), eliminating of open defecation (reducing open defecation from 11% to under 0% by 2024), and making significant progress towards the attainment of the Sustainable Development Goals (SDG6). Such a strategy has therefore, included the input, collaboration, and support of an array of stakeholders. ACKNOWLEDGMENT The development process was led by Malawi Government through the Ministry of Health and Population who would like to extend their sincere gratitude to all individuals, groups and organizations who contributed to the development of this NSHS strategy; specifically World Vision International Malawi, ONSE (USAID) and WaterAid for sponsoring delegates from some districts to the national consultative meeting held at the Cross Roads Hotels in Lilongwe. So grateful that WaterAid had to finance the rigorous task of editing the first draft strategy A special vote of thanks should go to UNICEF for largely financing the processes to this strategy review and development. Many thanks also go to stakeholders that were involved in the consultation stages of the development of this strategy. These included local leaders, men, women, youths, sanitation entrepreneurs, hygiene promoters and the marginalized (elderly and physically challenged) who participated in focus group discussions. Lastly I request all stakeholders to utilize this strategic document in implementing their activities. Dr. Dan Namarika Secretary for Health and Population viii National Sanitation and Hygiene Strategy 2018 – 2024 EXECUTIVE SUMMARY T he Government of Malawi is committed to end open defecation in the country by 2025 which is in line with the revised global target set by the United Nations. Presently around 11% of the Malawian population practice open defecation. Percentage of households with improved sanitation access is estimated at 13.8 while ODF coverage is at 41.7%. Evidence of actual hand washing practice is scanty but studies in rural areas suggest that the actual practice of HWWS at key times is EXECUTIVE SUMMARY between 6 – 18% but more likely on the lower end of this scale, as responses tend to exaggerate actual and regular practice. Besides, sanitation facilities need to be provided to numerous institutions such as schools, health centres, market centres and there is need for promotion of open defecation free in urban areas. In line with the current sustainable development goals, government places its priority on the following areas: Increase percentage of households with improved sanitation access (climbing sanitation ladder) from current 13.8% to 75% by 2030 Increase ODF coverage from 41.7% to 90% by 2030 Increase number of people accessing safe water supply from 83% to 90% by 2030 Increase percentage of households using hand washing facilities with soap from 10.5% to 75% by 2030 In view of the above, the National Open Defaecation Free Task Force (NOTF) identified the need for a national review of the previous ODF (2011 – 2015) and HWWS (2010 – 2011) strategies to ensure they are aligned with the Malawi Growth and Development Plan and the Sustainable Development Goals and therefore, undertook the development of a road map for making Malawi an open-defecation free country by 2030. The vision of the National Sanitation and Hygiene strategy (NSHS) is the realization of a healthy environment, for human dignity, privacy, rights, and improved quality of life for all always and everywhere in Malawi by 2030. The mission is to facilitate, with minimal negative impact on the environment, provision of acceptable, affordable, accessible and sustainable sanitation and hygiene services for both rural and urban households, institutions and public places .The NSHS aims to support Malawi to attain the SDGs and specifically contribute to national overarching policies and strategies. The road map proposed in this report examines the justification for an open-defecation- free Malawi, assess the adequacy of the steps taken in the past and the strategies needed to achieve the goal. This has been done through a set of strategies and action points. These strategies, action points and targets are in seven key areas as follows: 1. Rural Sanitation and Hygiene: To increase sustained access and use of improved and appropriate sanitation and hygiene facilities for all in domestic rural settings through an integrated approach. Target: 29 districts, 263 traditional authorities and all 38,682 villages 2. Urban Sanitation and Hygiene: To increase sustained access and use of improved and appropriate sanitation and hygiene facilities for all in domestic urban settings through an integrated approach. Target: All cities (Mzuzu, Lilongwe, Zomba and Blantyre) , municipalities (Kasungu, Mangochi and Lunchenza), and 145 trading centres by 2024 3. Institutional Sanitation and Hygiene: To increase access and use of improved and appropriate sanitation and hygiene facilities for all in institutional settings through an integrated approach. Target: 30 institutions per district use improved sanitation (870) by 2024 ix National Sanitation and Hygiene Strategy 2018 – 2024 4. Behaviour Change and Communication: To ensure that programmes incorporate promotive approaches that are cognizant of context, technology, behavioural science and economics for improved sanitation and hygiene. Target: All 29 district councils incorporate BCC approaches in WASH promotion by 2024. 5. Waste Management: To promote sustainable waste management practices and ensure a clean and healthy environment. Target: All health care facilities, markets, schools, institutions, EXECUTIVE SUMMARY commercial and communities have desired waste management facilities by 2024. 6. Menstrual Hygiene Management: To increase sustained access to quality and appropriate menstrual hygiene services. Target: All WASH programmes include Menstrual Hygiene Management activities in all the 29 district councils by 2024. 7. Cross cutting issues: To ensure effective financing, leadership, coordination and knowledge exchange to achieve targets in sanitation and hygiene for all. Target: Establish a sanitation and hygiene department by 2024. The process of developing the 2018-2024 NSHS was highly participatory and drew lessons from previous strategy reviews. A technical team (NOTF) led by the Ministry of Health and Population, was constituted through which consultations were conducted with: Central Government Departments and Agencies; local councils; Civil Society Organizations (CSOs); development partners; Non- Governmental Organizations (NGOs); private sector; academic members of the public universities and other prominent stakeholders. The NSHS has been developed to allow all stakeholders to participate in the development of the country. Its implementation will, therefore, involve all stakeholders. Issues of hygiene and sanitation practices will attract attention of a range of key stakeholders that include Ministry of Health and Population (MoHP), Ministry of Agriculture, Irrigation and Water Development (MoAIWD), Ministry of Education, Science and Technology (MoEST), Ministry of Gender, Children, Disability and Social Welfare Community (MoGCDSW), Ministry of Local government (MoLG&RD), Non State Actors (NSA), communities and households. The MoHP will lead the implementation process through technical coordination and a consolidated national budget. It is expected that all stakeholder institutions including donors, development and co-operating partners and the academia will align their activities and support to NSHS. The road map has also worked out the indicative investment for making the country open-defecation free by 2024. The total investment estimated works out to US$79, 903, 000 for the period of 6 years (2018 to 2024) and this translates to less than US$1 per person per year and approx. US$4 per person for the period of the strategy. The Government of Malawi will have to increase funding and lobby local and international institutions that support the ODF campaign to continue offering the support. The NSHS document is structured as follows: Chapter 1 gives a background and strategy rationale and Chapter 2 summarises the consultative process and its key findings. Chapter 3 gives a brief description of the strategy vision and mission, the guiding principles, the strategic themes and their objectives while Chapter 4 outlines the implementation modalities. The five year implementation plan as well as the resource planning and financing are presented in chapter 5. Chapter 6 provides the monitoring and evaluation frameworks. The annexes provide additional details on costed implementation, policy links and information on behavior change models for WASH sectors x ONE National Sanitation and Hygiene Strategy 2018 – 2024 CHAPTER 1 INTRODUCTION

1.1. Background CHAPTER ONE Malawi is a landlocked country with a population of nearly 17 million people – which is expected 1 to surpass 20 million in the next ve years . Malawi has 28 administrative districts, which are further divided into traditional authorities (TA) and villages, the smallest administrative unit. Malawi's economy has expanded over the last 30 years, with the real GDP growth estimated to be 2.9% in 2016. It remains predominantly an agricultural country, with agriculture, forestry and fishing contributing 28% of GDP. Currently GDP per capita is approximately $380, and given that inflation and population growth currently outstrip economic growth, average living standards are falling. In 2010-11, 29% of households lived under the international poverty line of $2 per day. Poverty remains particularly prevalent in rural areas, where over 14 million people live – more than 80% of the population. Morbidity and mortality from diarrhoeal disease continues to be a signicant burden to the Malawian population. With the main burden falling on children under the age of 5, it has been estimated that 360, 000 deaths from diarrhoea per year can be attributed to environmental contamination and exposure. Infection could be caused through numerous environmental routes; however it is clear that following enteric pathogen excretion, effective sanitation and hygiene practices, including hand washing with soap, are integral to the reduction of disease transmission. The control of open defaecation is a primary public health concern in the reduction of diarrhoeal disease morbidity and mortality, and the spread of diseases such as cholera across vulnerable populations. In 2012, it was estimated that globally 280,000 people, mostly children under five years old, died from diarrhoea caused by lack of basic sanitation 2. These deaths could be prevented in part, by improving access to safely managed sanitation and improved hygiene practices 3. Hand washing with soap at critical moments, such as before eating and after defaecation, can also prevent infectious diseases by interrupting the transmission of infectious agents. Evidence 45 suggests that handwashing with soap reduces the risk of diarrhea by 47% , acute lower respiratory infections by up to 34% 7, and soil-transmitted helminths 8, and it has been recognized as one of the most cost-effective health interventions to reduce the burden of disease. Yet, only 19% of the global population is estimated to wash their hands with soap after using sanitation facility or handling children's excreta 9. Good hygiene is of vital importance in Malawi due to the lack of basic sanitation in the country. Evidence of actual hand washing practice is scanty but studies in rural areas suggest that the actual practice of HWWS at key times is between 3 – 18% but more likely on the low end of this scale, as responses tend to exaggerate actual and regular practice. Observations in Malawi show that HWWS promotion is undertaken as an ad hoc activity both at national and local level. Current efforts to promote good hygiene and HWWS in particular, have not been sufficient to bring about mass behaviour change 1 All information in this section comes from the HSSP II, the ODF and HWWS Situation Analysis and Malawi Demographic Health Survey. 2 6 Prüss-Ustün et al. 2014 Luby et al., 2005 3 7 Brown et al. 2014 Strunz et al, 2014 4 8 Curtis and Cairncross, 2003 Bartram and Cairncross, 2010 5 9 Cairncross, 2010 Freman et al, 2014 1 National Sanitation and Hygiene Strategy 2018 – 2024 on the scale that is needed. Efforts producing piecemeal village-by-village and pilot approaches have had some impact in Malawi but nothing on a large or national scale has been attempted (MoHP, 2015)

1.2 Rationale of the Strategic Plan The 2018-2024 National Sanitation and Hygiene Strategy (NSHS) aims to re-align Malawi's efforts in attaining universal, sustainable, and equitable access to sanitation and hygiene, and the elimination of open defecation as reflected in the Sustainable Development Goals (SDG 6: Ensuring availability and sustainable management of Water, Sanitation for all). However these issues are also cross cutting and impact on several other SDGs including: sanitation and hygiene in education (SDG 4) and health care facilities (SDG 3); Menstrual Hygiene Management (MHM) and other interventions focusing on women and girls (SDGs 5 and 16); targeted sanitation and hygiene interventions in support of programmes to reduce malnutrition (SDG 2); and to end poverty (SDG 1). Improved sanitation and CHAPTER ONE hygiene practices will also contribute to the achievement of other SDG goals and targets including: sustainable cities (SDG 11); reduced inequalities between and within countries (SDG 10); environmental protection and climate change (SDG 13); and decent working conditions (SDG 8). The strategy consolidates achievements and learning of the earlier Malawi sanitation and hygiene related strategies (ODF 2011-2015 strategy and HWWS 2011-2012 campaign strategy) and moves the agenda forward. As such, this new Strategy outlines how sanitation sector players and development partners will work in support of government to meet the challenges of the ambitious sustainable development agenda in a rapidly changing world. In order to facilitate attainment of the set goals and objectives the strategy has laid out key actions necessary to create a more scientifically and culturally acceptable, sustainable, integrated and efficient sanitation and hygiene system. Specifically, the NSHS seeks to: Build consensus on integrated sanitation and hygiene to unite stakeholders from multiple sectors around a unified plan. This consensus includes the vision and mission of sanitation and hygiene, the priority issues, solutions and activities and its role in achieving sector plans. Identify gaps in support for sanitation and hygiene so that Government of Malawi (GoM) and partners can target where further resources and support are needed. This includes examining existing guidelines and policies, knowledge and skills in the sanitation and hygiene sector, and other resources (e.g. human, infrastructure, etc.). Establish standards to ensure consistency and quality of all aspects of sanitation and hygiene – including processes and coordination, communication and implementation. Develop an integrated implementation plan in order to translate consensus, resources, and ideas into action that will lead to improved sanitation and hygiene. The integrated implementation plan aligns with national plans and the sustainable development goals. It maps key activities by responsible stakeholders and timelines to ensure ease of use for stakeholders at all levels. Build partnerships for effective implementation in order to foster high quality integrated services and performance improvements, continuous leverage of resources and minimal duplication. As a key player in the Malawi WASH sector, in this strategy, the GoM will continue to play the role of catalysing transformative changes and championing solutions required to accelerate progress and achieve access to safe water, sanitation and hygiene for all by 2030. 2 National Sanitation and Hygiene Strategy 2018 – 2024 TWO Chapter 2 CONSULTATION PROCESS AND FINDINGS

2.1 Process of Developing the Strategic Plan CHAPTER TWO The National Open Defaecation Free Task Force (NOTF) identified the need for a national review of the previous ODF (2011 – 2015) and HWWS (2010 – 2011) strategies to ensure aligned with the Malawi Growth and Development Plan and the Sustainable Development Goals. It was important that the review took into consideration both the effectiveness and gaps of the previous strategies during the years of implementation. This consultative process took into consideration original assumptions, links to SDGs, integration with other sectors and policies, and cross cutting issues. The process of developing the 2018-2024 NSHS was highly participatory and drew lessons from previous strategy reviews. A technical team (NOTF) led by the Ministries of Health and Agriculture, Irrigation and Water Development was constituted through which consultations were conducted with: Central Government Departments and Agencies; local councils; Civil Society Organizations (CSOs); development partners; Non-Governmental Organizations (NGOs); private sector; academia members 10 of the public and other prominent stakeholders . These consultations throughout the process supported the: Initial assessment of the Malawi sanitation and hygiene situation by identifying strengths and challenges (Situation Assessment). Identification and prioritization of key issues related to sanitation and hygiene Identification and prioritization of activities to address key issues. Recommendations related to key issues emerging from workshops Decisions about core components of the NSHS. Development of a five-year implementation plan

2.2 Key Findings

2.2.1 Effectiveness of the scope, mechanisms and actions applied in the implementation of the ODF/HWWS Strategies The effectiveness of the scope of the strategies was based on the impact they have achieved since their implementation in 2011. The prevalence of OD in 2011, (National ODF Malawi 2011-2015 Strategy) was estimated at 11%; and in 2017 (JMP, 2017), was estimated at 6%, demonstrating significant reduction. By 2017, 43.18% of villages were both triggered and achieved ODF, 24.68% were triggered and 32.14% were not triggered. These national figures, however, mask significant disparities between: Urban and rural areas, as urban areas have not been the focus of the previous ODF strategy implementation. The level of ODF coverage between districts varies from 0% to 100% coverage at Level 1. 10 The eminent stakeholders are individuals that are considered to be experts in their areas of focus. This team included selected members of academia, Economics Association of Malawi, private sector and NGOs. 3 National Sanitation and Hygiene Strategy 2018 – 2024 The achievement of Level 1 ODF status in preference to Level 2 ODF, which requires the presence of improved sanitation and effective hand washing with soap facilities and practices. The ODF status as of June 2018 in all the districts is shown in Table 1. Table 1: Number of TAs declared ODF as of 29th June, 2018 District TAs ODF District TAs ODF District TAs ODF Chitipa 3 Karonga 0 Rumphi 10 Mzimba North 1 Mzimba 0 Nkhata 1 South Bay Likoma 0 Nkhotakota 6 Ntchisi 7 CHAPTER TWO Dowa 7 Salima 1 Kasungu 18 Mchinji 2 Lilongwe 2 Dedza 0 Ntcheu 0 Balaka 10 Mangochi 6 Machinga 2 Zomba 1 Phalombe 3 Mulanje 3 Thyolo 0 Chiradzulu 0 Blantyre 2 Mwanza 0 Neno 2 Chikwawa 5 Nsanje 2 Total TAs ODF 94 th From Table 1 above, four districts were declared ODF as of 29 June, 2018 and these were Balaka, Nkhotakota, Ntchisi and Dowa. About 94 of the total 263 TAs were declared ODF representing 35%. Specifically, for the TAs declared ODF, there were no visible signs of human excreta signaling that community members disposed of their faecal matter in a pit-latrine. However, the available pit-latrines (i.e. traditional pit-latrines) were of poor quality, weak and could not withstand extreme weathers (e.g. heavy rains and winds), therefore often end up collapsing. All areas of the country are yet to attain Level 2 of ODF where more durable latrines (i.e. improved pit-latrines) should be constructed so as to sustain the ODF status. Apart from the poor quality of latrines in the TAs that were declared ODF, institutions (e.g. schools, hospitals, prisons, market places and trading centers) within the TAs had inadequate pit latrine coverage. In terms of hand washing with soap, an increase of 10% from 24 – 34% coverage of hand washing was reported between 2011 and 2016 (Figure 1). However, this does not necessarily reflect the presence or use of soap. A key challenge to HWWS was the absence of durable hand washing facilities (HWF), which could withstand extreme weathers and cannot be vandalized. Our review revealed that the practice of hand washing is a challenge even to households that have HWF. Soap was considered as a scarce and/or expensive and valued commodity that was usually prioritized for other important uses e.g. for washing clothes and not for hand washing. 4 National Sanitation and Hygiene Strategy 2018 – 2024 CHAPTER TWO Figure 1: Percentage of latrines with a hand washing facility compared to those with soap Approaches that facilitated the attainment of the above achievements over the last 10 years have included Hygiene Education and Sanitation Promotion (HESP); Participatory Hygiene and Sanitation Transformation (PHAST); Community Led Total Sanitation (CLTS); School Led Total Sanitation (SLTS) and Sanitation Marketing.

2.2.2 Scope, mechanism and action in current strategies It was found that both the ODF and HWWS strategies did not provide specific definitions of latrines, hand washing facilities, etc. which led to variation in implementation. The ODF strategy focused only on the rural population, implementation focused on households with limited improvements in schools, and no action taken in other institutional settings. There was no reference or integration of ODF strategy with menstrual hygiene management and solid waste management. The strategy did not include support for vulnerable and marginalized groups and it did not consider the sanitation chain especially for those in urban and peri-urban areas. ODF strategy implementation was to be overseen by the National Open Defaecation Task Force (NOTF), which represented the Ministry of Health and the Ministry of Agriculture, Irrigation and Water Development with key development partners and civil society. However this excluded other ministries with a direct interest in sanitation and hygiene such as Education and Local Government. Although there was the inclusion of 2 levels of ODF status, there was little reference to the effective use of the sanitation ladder to achieve continued improvement and sustainability. The HWWS strategy was limited in terms of integration with other key strategies (e.g. Nutrition, mother and child health, immunizations, school health and nutrition, etc.) and relied largely on mass media rather than focused behavior change communication.

2.2.3 Review of ODF and HWWS strategies with emphasis on original assumptions CLTS was deemed to be the most effective tool for achieving ODF over the 5-year strategy and was outlined as the only method to be adopted for scaling up. It was assumed that achievement of ODF Level 1 would automatically lead to a community striving to maintain the status and/or continue development to achieve Level 2. In order to accelerate implementation, the Strategy required the development of TA level teams who would identify and incorporate Natural Leaders to work with District extension staff. However, in the majority of cases the responsibility for CLTS has landed 5 National Sanitation and Hygiene Strategy 2018 – 2024 specifically with the HSA in the area, with limited input from other extension workers. In terms of implementation by HSAs, CLTS was viewed as a 'project', with activities stopping when the funding from partners came to an end. There was also the intention to use schools as a platform to promote SLTS and subsequently CLTS, through teachers and youth. However neither schools nor youth were effectively involved to support uptake and sustainability. The HWWS Campaign 2011 – 2012 made a number of key assumptions including: households wash hands with water only and do not see the value of using soap to improve this; participatory approaches such as PHAST can effectively promote HWWS behaviours; school children (including CBCCs) would provide an eager and willing resource that can be instrumental in bringing messages home, to friends/peers, family and relatives. In addition it was assumed that teachers would combine campaign activities with school lessons (e.g. poster competitions in art classes), and both schools and health facilities would promote good practice at home. An effective mix of communication channels would be CHAPTER TWO used from mass media, to direct contact, and institutional settings such as churches, health facilities and schools would facilitate behaviour change communication. The public and private sector would work together using their skills to improve access to HWWS opportunities. The private sector would help with the development of low cost and effective HWF. The survey found that there was little involvement of the private sector. Small business people operating as mansions were present in some villages and their role was to construct low cost latrines at a fee for those who can afford in the communities.

2.2.4 The extent to which different programs, approaches and other cross cutting issues have contributed to the implementation of the ODF and HWWS strategies Since the launch of the ODF Strategy and HWWS Campaign in 2011 and 2012, respectively, a number of sanitation and hygiene programmes have been implemented to support the Government of Malawi's efforts to meet its sanitation and hygiene goals both under the MDG and SDG frameworks. These include: Malawi National Health Policy (2012), Health Sector Strategic Plan I and II (2011-2016), National Water Policy, 2007, The National Sanitation Policy (2008), City Councils, Municipalities and district councils by-laws, National Household Water Treatment and Safe Storage Action (2016- 2021) Plan, Malawi National Health Promotion Policy, (2013), Infection Control and Waste Management Plan for Malawi, 2016 and Guidelines for Infection Prevention and Control for TB including MDR-TB and XDRTB. The supporting programmes included the Global Sanitation Fund, UNICEF, World Vision, African Development Bank and Australian Aid projects.

2.2.5 Issues suggested being included in the new ODF and HWWS strategies Table 2: Summary of issues suggested being included in the new ODF and HWWS strategies Focus Action ODF Proper and strong criteria for declaring ODF. The following to be considered: certication · Update ODF criteria to reect SDGs and other country developments · TAs that have a school, market or health facility without ODF should not be declared, · Households to have all requirements (latrine, drop hole cover, hand washing facility, water and soap for washing hands etc.), · Pay sudden visits in the communities to appreciate what is really happening. · Proper guidelines for sampling and certication; · Who to preside over if T/ A attains ODF, the Minister need to come once to a district, that is if the whole district is ODF, otherwise for the T/As, NOTF can declare and the District Commissioner can preside over the celebrations 6 National Sanitation and Hygiene Strategy 2018 – 2024 Integration · ODF strategy should have clarity on how it will further integrate with other relevant policies i.e. health, education and nutrition. Funding · Need to increase the percentage of funds in the national budget that goes towards WASH related activities. · Revisit the no subsidy notion on building of toilets in communities in relation to sustainability. Sustainability · Develop structured post ODF activities · Specically recognize natural leaders, supervise and support them · Clearly dene toilet standards to be used in CLTS – encourage the construction of durable facilities. · Engage more extension workers (other than HSAs) in ODF strategies. Schools and · SLTS guidelines to be developed and disseminated effectively. institutions CHAPTER TWO · School toilet standards to be nalized and disseminated effectively. · Ensure adequate toilets in schools. Furthermore, cleanliness of toilets in schools needs to be emphasized in order to encourage usage. Some students resort to using the bush due to inadequate toilets. However, some pupils don’t use the few available toilets for lack of cleanliness. · Minimum criteria for health facilities and public places to be developed and met. Innovation · Show a visible link between non-washing of hands and diseases · Develop more Behaviour Change techniques in the new strategies. · Develop better sanitation technologies that can withstand bad weather · Develop latrines suitable for the marginalized. · Improve privacy in the toilets especially for women. · Include the whole shit ow diagram in the new ODF strategies, what happens when the toilets are full, especially in schools? We may need to develop emptying strategies among others. Advocacy · Wide dissemination of the new strategies at all levels (national to local). Although effective in the achievement of ODF status for many communities. The review of implementation has highlighted a number of concerns which must be considered in strategic planning as we go forward: Lack of planning and support for specific latrine construction to ensure sustainability in terms of infrastructure and use. It was reported that available pit-latrines (i.e. traditional pit-latrines) were of poor quality, weak and could not withstand extreme weathers (e.g. heavy rains and winds) and often end up collapsing Perception of CLTS at District level as a donor project with external funding and support. Once ODF status has been achieved the supervision and monitoring stops and slippage to open defaecation occurs. Lack of long term planning for monitoring and support to communities to maintain ODF status. Emphasis on hand washing facilities at the latrine only, with no drive to ensure hand washing with soap is also convenient at other critical times. These challenges were compounded by the limited scope in the ODF and HWWS strategies for the inclusion of other participatory approaches or a strong integration of context specific behavior change methods. The review also determined a number of cross cutting issues which affected the implementation of the previous ODF and HWWS strategies: 7 National Sanitation and Hygiene Strategy 2018 – 2024 · Some areas of the strategies were fully implemented due to poor institutional arrangements, · The ODF and HWWS strategies lacked synergy and leverage; · The scope of the ODF strategy lacked flexibility within strategic themes to engage new thinking on current and emerging issues. · The strategies did not address the impact of climate change and issues of the environment

2.3 Policy Environment To achieve the SDG target to achieve access to adequate and equitable sanitation and hygiene for all and end open defecation, paying special attention to the needs of women and girls and those in vulnerable situations by 2030, Malawi will need to ensure a multidisciplinary and multi-sectoral approach, including effective integration of sanitation and hygiene issues in other relevant strategies CHAPTER TWO and programmes. As such, this strategy aligns with globally-validated international frameworks and national-level policies. Being a member of international and regional development frameworks, Malawi has aligned NSHS to these development frameworks. As such, by implementing strategic themes, the international development objectives shall be adhered to. While the implementation of all international development frameworks shall use the national plan, reporting shall be based on the requirements for specific commitments and protocols. The international development frameworks that Malawi has committed to and are reflected in this strategy include the Alma Atta Declaration (1978) and Ottawa charter (WHO, 1986). The Alma Atta Declaration promoted a more realistic commitment to Public Health which underlines the importance of primary health care as the key to the attainment of 'Health for All'. The declaration committed countries to provide an adequate supply of safe water and basic sanitation among others. Since then, the Alma Atta Declaration has been the most useful resource for health promotion to WHO member countries (which Malawi subscribes to). Overtime the importance of health promotion has received global attention and the Ottawa Charter that was developed in 1986 provides five main priority areas (Annex 3). Subsequent international declarations which are directly related to sanitation and hygiene (Annex 3) have expanded on the themes of Alma Atta Declaration and Ottawa Charter. More recently, the Sustainable Development Goals (SDGs) 2030 Agenda provides for progressive and universal access to sanitation and hygiene. SDG 6 strives to ensure availability and sustainable management of Water and Sanitation for all. Sustainable development cannot be achieved in Malawi without the attainment of rights to water, sanitation and hygiene for all. These basic rights are at the core of inclusive human development. Through these, WHO member states have reafrmed their commitment to implement all conventions and declarations that have a bearing on health and the environment. National level policies such as the National Sanitation Policy, 2008 which helps to coordinate stakeholders in implementation of sanitation and hygiene in Malawi; the National Health Policy, 2018 which provides a comprehensive framework for achieving national health system that is well- functioning, improves health, prioritizes satisfaction and financial protection of patients, and contributes to Universal Health Care and; the National Health Promotion Policy, 2016 which harmonizes the dissemination of messages for health including sanitation and hygiene and many others (Annex C) have also been considered. The international frameworks and national-level policies, taken together, provide an excellent platform for the implementation of quality interventions which are specifically tailored to the needs of the country but also focusing on meeting global standards. The implementation of this strategy should ultimately direct its attention to fulfilling these declarations and policies which have influence in shaping the broader sanitation and hygiene vision and values stipulated in Chapter 3. 8 National Sanitation and Hygiene Strategy 2018 – 2024 THREE CHAPTER 3 NATIONAL SANITATION AND HYGIENE CHAPTER THREE

3.1 Vision and Mission The vision of the National Sanitation and Hygiene strategy (NSHS) is the realization of a healthy environment, for human dignity, privacy, rights, and improved quality of life for all always and everywhere in Malawi by 2030. The mission is to facilitate, with minimal negative impact on the environment, provision of acceptable, affordable, accessible and sustainable sanitation and hygiene services for both rural and urban households, institutions and public places. The NSHS aims to support Malawi to attain the SDGs and specifically contribute to national overarching policies and strategies: Malawi Growth and Development Strategy III (2017 – 2022) Objective 6 to improve health and quality of the population for sustainable socio-economic development and specifically improved hygienic and sanitation practices through: Providing and promoting use of improved and accessible sanitation facilities in all public places Promote adoption of safe water and sanitation practices at individual and household levels Improving management and disposal of both liquid and solid waste. National Health Sector Strategic Plan (2017 – 2022) Objective 2, to reduce environmental and social risk factors that have an impact on health with particular reference to safe water and environmental health and sanitation. National Sanitation Policy (2008) vision where all people have access to improved sanitation, where safe hygienic behavior is the norm, and where recycling of solid and liquid waste is widely practiced, leading to a better life of all the people in Malawi. National Health Policy (2018) to improve the health status of all people of Malawi by reducing the risk of ill health and the occurrence of premature deaths. National Health Promotion Policy (2013) to reduce preventable deaths and disability through effective health promotion interventions. 9 National Sanitation and Hygiene Strategy 2018 – 2024 The NSHS will be achieved through six guiding principles which are embedded within seven strategic areas (Figure 2). Figure 2: Overview of strategic themes (green) and guiding principles of the NSHS. CHAPTER THREE

3.2 Guiding Principles To achieve the vision and mission, the NCHS has outlined 6 cross-cutting guiding principles that lay the foundation for a strong, well-functioning sanitation and hygiene sector in Malawi. Participation and Engagement Involvement of all stakeholders from the initial stages of implementation to enable full participation of partners and communities in the management of sanitation and hygiene activities. Ensure that programs address the needs and priorities of the Malawian people and those community members have ownership and remain accountable for the sanitation and hygiene of their communities. Equity and Inclusion All the people in Malawi including women, the vulnerable population, and residents of hard to reach areas receive high quality sanitation and hygiene services at the community level. The strategy shall also ensure that the sanitation and hygiene sector achieves gender equality at all levels. 10 National Sanitation and Hygiene Strategy 2018 – 2024 Integration Ensure that programs and initiatives related to sanitation and hygiene integrate seamlessly at national, district and community level through coordination of service delivery, supervision, training, and M&E. This integrated approach requires close partnership across communities, programs, partners and sectors as well as efforts to fully leverage existing resources. Innovation and Excellence The culture of excellence is based on the philosophy of continuous improvement, always stretching the performance boundaries to higher levels. Innovation is not just technology but also includes new CHAPTER THREE programming models and management practice focusing on the imperative of scaling up and continued improvement of products and services at all levels. Transparency and Accountability Stakeholders shall discharge their respective mandates in a manner that is transparent and takes full responsibility for the decision they make Learning and Sustainability Promote continuous learning and correction based on strengthened monitoring and evaluation of the sanitation and hygiene activities

3.3 Strategic Goals 1. Rural Sanitation and Hygiene: To increase sustained access and use of improved and appropriate sanitation and hygiene facilities for all in domestic rural settings through an integrated approach. Target: 29 districts, 263 traditional authorities and all 38,682 villages by 2024 2. Urban Sanitation and Hygiene: To increase sustained access and use of improved and appropriate sanitation and hygiene facilities for all in domestic urban settings through an integrated approach and hygiene promotion models. Target: All cities (Mzuzu, Lilongwe, Zomba and Blantyre), municipalities (Kasungu, Mangochi and Lunchenza), and 145 trading centres by 2024 3. Institutional Sanitation and Hygiene: To increase access and use of improved and appropriate sanitation and hygiene facilities for all in institutional settings through and integrated approach. Target: 30 institutions per district use improved sanitation (870) by 2024 4. Behaviour Change and Communication: To ensure that programmes incorporate promotive approaches that are cognizant of context, technology, behavioural science and economics for improved sanitation and hygiene. Target: All 29 district councils incorporate BCC approaches in WASH promotion by 2024 11 National Sanitation and Hygiene Strategy 2018 – 2024 5. Waste Management: To promote sustainable waste management practices and ensure a clean and healthy environment. Target: All health care facilities, markets, schools, institutions, commercial and communities have desired waste management facilities by 2024 6. Menstrual Hygiene Management: To increase sustained access to quality and appropriate menstrual hygiene services. Target: All WASH programmes include Menstrual Hygiene Management activities in all the 29 district councils by 2024 CHAPTER THREE 7. Cross cutting issues: To ensure effective financing, leadership, coordination and knowledge exchange to achieve targets in sanitation and hygiene for all. Target: Establish a sanitation and hygiene department for coordination of stakeholders and government agencies by 2024 The NSHS strategic objectives form the framework for recommendations, interventions, and activities that are the roadmap to achieving the vision, mission, and objectives of the NSHS (Figure 3). These strategic objectives and their targets stem from extensive consultations, and guide the recommendations in Sections 3.4 to 3.9 below. The detailed implementation plan in Annex A contains additional information on each NSHS activity. Figure 3 – Relationships between NSHS strategic objectives, recommendations, interventions and activities.

3.4 Thematic Area 1: Rural Sanitation and Hygiene Strategic Objective: To increase sustained access and use of improved and appropriate sanitation and hygiene facilities for all in domestic rural settings through an integrated approach. Strategies: Continued promotion of standardised and context appropriate CLTS and associated innovative methods to achieve ODF status at scale. To build on the current successes in 12 National Sanitation and Hygiene Strategy 2018 – 2024 achieving ODF status, we ensure the use of multidisciplinary approaches to promote effective sanitation and hygiene solutions for rural populations including the continued use of CLTS. Support maintenance of ODF status through district mechanisms. The achievement of sustained ODF needs buy in from the District health staff through effective management, supervision, monitoring and evaluation and embedding sanitation activities in routine work. Promote household progression up the sanitation and hygiene ladder through effective, context appropriate and innovative sanitation marketing. Integrated with behavior change and communication, all programmes to support rural sanitation and hygiene must ensure they encourage households to climb the sanitation ladder and improve upon basic and traditional latrine construction. Development and use of supporting tools to provide consistency in promoting and supporting CHAPTER THREE sanitation and hygiene coverage and use in rural areas. Malawi currently uses a range of implementation tools for sanitation and hygiene programmes including CLTS. In order to achieve consistency in approach and sustainability these tools must be consolidated to form national guidance and toolkits. Interventions and activities: To strengthen rural sanitation and hygiene, the NSHS recommends the following strategic interventions. The activities for each intervention are outlined in Annex A. Continue promotion of ODF status. Key activities will include: Triggering of non-triggered communities at cluster level; Follow up; Coordinated supporting campaigns in OD areas to achieve ODF status, (e.g. exchange visits, open days, ODF champions); Support maintenance of ODF status. Key activities include: Disseminate role clarity and job descriptions to relevant extension workers and development partners; Training of district and extension workers on the maintenance of ODF status; Training and mentoring of natural leaders and village health committees to support maintenance of ODF status; Continued follow-ups as part of routine work for verification after declared ODF; Promotion of concomitant incentives to encourage maintenance of ODF status; Mentoring and supervision programmes to promote maintenance of ODF status. Promote progression up the sanitation and hygiene ladder. Key activities include: Develop effective communications campaign to increase desire to move up the sanitation and hygiene ladders; Develop and roll out of compendium of technological solutions (including climate resilient) supported by sanitation and hygiene marketing and entrepreneurs; Train and promote entrepreneurs for promoting sanitation marketing and enterprises; Establish demonstration sites within public institutions (e.g. schools, health facilities, churches, etc.) to promote technologies; Promote community finance systems to support construction and improvement of sanitation and hygiene facilities. Development and use of supporting tools: Key activities include: Review and develop clear guidance and tools for the ODF verification process; Review, develop and disseminate training manual and tools for CLTS; Develop and disseminate guidance manuals for sanitation marketing.

3.5 Thematic Area 2: Urban Sanitation and Hygiene Strategic Objective: To increase sustained access and use of improved and appropriate sanitation and hygiene facilities for all in domestic urban settings through an integrated approach and hygiene promotion models. 13 National Sanitation and Hygiene Strategy 2018 – 2024 Strategies: Evaluate current legal requirements and standards for sanitation and hygiene across all city councils and develop consistency across all by-laws. Currently city councils are developing and implementing city specific by-laws and standards which need to be evaluated and aligned to ensure consistency of approach across the country. Increase awareness and understanding of the legal requirements and standards for sanitation and hygiene. Once by-laws and standards have been ratified then local councils and other stakeholders must ensure there is wide dissemination of the legal requirements to support compliance. Promote household progression up the sanitation and hygiene ladder through effective, context appropriate and innovative sanitation marketing. Integrated with behavior change CHAPTER THREE and communication, all programmes to support rural sanitation and hygiene must ensure they encourage households to climb the sanitation ladder and improve upon basic and traditional latrine construction. Development and use of supporting tools to provide consistency in promoting and supporting sanitation and hygiene coverage and use in urban areas. Malawi has previously focused on rural ODF status and as such there is little consistent guidance for improving sanitation and hygiene practice in urban settings. In order to achieve consistency in approach and sustainability these tools must be developed and consolidated to form national guidance and toolkits. Interventions and activities: To strengthen urban sanitation and hygiene sector, the NSHS recommends the following strategic interventions. The activities for each intervention are outlined in Annex A Review and development of legal requirements and standards. Key activities: Work with city councils to review current legal requirements and standards for sanitation and hygiene; Standardise by-laws for sanitation and hygiene for all cities to be effective and realistic. Awareness of legal requirements and standards. Key activities: Develop and implement awareness campaign to highlight requirements of standardised by-laws. Promote progression up the sanitation and hygiene ladder. Key activities include: Develop effective communications campaign to increase desire to move up the sanitation and hygiene ladders; Develop and roll out of compendium of technological solutions (including climate resilient) supported by sanitation and hygiene marketing and entrepreneurs; Train and promote entrepreneurs for promoting sanitation marketing and enterprises; Establish demonstration sites within public institutions (e.g. schools, health facilities, churches, etc.) to promote technologies; Promote finance systems to support construction and improvement of sanitation and hygiene facilities; Develop and disseminate guidance manuals for sanitation marketing.

3.6 Thematic Area 3: Institutional Sanitation and Hygiene Strategic Objective: To increase sustained access and use of improved and appropriate sanitation and hygiene facilities for all in institutional settings through an integrated approach. Strategies: Scale up access to improved sanitation and hygiene in schools (including early childhood development centres). Despite receiving priority in the previous ODF and HWWS strategies progress to achieve sanitation and hygiene targets in schools has been limited. Priority needs to 14 National Sanitation and Hygiene Strategy 2018 – 2024 be given to improving sanitation facilities in schools in terms of quality and quantity to impact attendance and health indicators. This includes facilities that allow the marginalized and vulnerable to attend school. Scale up adequate, safe and clean sanitation and hygiene facilities in health facilities. Health facilities should be educational centres of good practice for visiting clients. However facility sanitation and hygiene coverage is poor in many areas in terms of toilet and water access. Health facilities must comply with the Ministry of Health standards for these areas taking into consideration the needs of marginalized and vulnerable groups. Scale up adequate, safe and clean sanitation and hygiene facilities in markets. As sources of food, and venues for high volumes of customers, markets must maintain a high standard of CHAPTER THREE sanitation and hygiene to reduce disease transmission and the health of the population. Facilities must also be accessible to the marginalized and vulnerable members of the community. Scale up adequate, safe and clean sanitation and hygiene facilities in other public institutions. Other public institutions such as prisons, offices, etc. also require meeting minimum standards of sanitation and hygiene to ensure inclusion and the health of their occupants and users. Interventions and activities: To strengthen sanitation and hygiene in institutional settings, the NSHS recommends the following strategic interventions. The activities for each intervention are outlined in Annex A. Improved sanitation and hygiene in schools (including early childhood development centres). Key activities include: Support review and revision of school standards (ensuring child friendly, and inclusive designs) with Ministry of Education, Science and Technology; Sensitisation and enforcement of school standards through PEA, DEM, SMC, PTA and other stakeholders using SLTS and other mechanisms; Support provision of appropriate sanitation and hygiene facilities within all schools; Management and maintenance of school sanitation and hygiene facilities by SMC; Establishment and sustained support of sanitation clubs; HSAs and PEA to provide hygiene promotion and education; Use of schools as a central hub for sanitation and hygiene education in the community; Develop mechanism for safe pit emptying Improved sanitation and hygiene in health facilities. Key activities include: Sensitisation and enforcement of health facilities standards through Director of Health and Social Services; Provide adequate sanitary facilities (with appropriate security) and resources to enhance and maintain hygiene practices; Manage and maintain sanitation and hygiene facilities through health facility management; Provide adequate resource allocation for the development, maintenance and cleaning of sanitary facilities; Use of health facilities as a central hub for sanitation and hygiene education in the community Improved sanitation and hygiene in markets. Key activities include: Support review and revision of market standards to standardise across the country in partnership with Ministry of Local Government; Sensitisation and enforcement of market standards through District and City Councils; Provide adequate sanitary facilities (with appropriate security) and resources to enhance and maintain hygiene practices; Manage and maintain sanitation and hygiene facilities through District and City Council; Provide adequate resource allocation for the development, maintenance and cleaning of sanitary facilities; Regular inspections by District and City Councils to ensure compliance with standards. Improved sanitation and hygiene in public institutions. Key activities include: Support review and revision of standards to standardise across the country in partnership with Ministry of Local Government; Sensitisation and enforcement of standards through appropriate 15 National Sanitation and Hygiene Strategy 2018 – 2024 authorities; Provide adequate sanitary facilities (with appropriate security) and resources to enhance and maintain hygiene practices; Manage and maintain sanitation and hygiene facilities through appropriate authorities; Provide adequate resource allocation for the development, maintenance and cleaning of sanitary facilities; Regular inspections by appropriate authorities to ensure compliance with standards.

3.7 Thematic Area 4: Behaviour Change and Communication Strategic Objective: To ensure that programs incorporate promotive approaches that is cognisant of context, technology, behavioural science and economics for improved sanitation and hygiene. CHAPTER THREE Strategies: Consolidate hygiene behaviours to be prioritised for behaviour change. There is a need to prioritise the areas to be targeted for behaviour change, and to ensure that this is achieved using a multidisciplinary approach. Develop communication messages and methods for prioritised hygiene behaviours using appropriate models of behaviour change communication based on behaviour centred design (Annex D). Behaviour change messages must be cognizant of the context in which they are being delivered and the effective triggers which may achieve sustained change in a population. With this in mind, behavioural science experts should be enlisted to support the development of messages to ensure they are both appropriate and effective. To implement a comprehensive behaviour change communication programme. Once the programme has been developed a clear map on how it will be implemented in partnership with other stakeholders must be developed and implemented. Interventions and activities: To ensure effective integration of behavior change and communication in the sanitation and hygiene sector, the NSHS recommends the following strategic interventions. The activities for each intervention are outlined in Annex A . Assessment of priority areas: Key activities include: Review of current programmes and research; Consultation with stakeholders. Development of communication programmes: Key activities include: Co-design of communication programmes with beneficiaries; Consultation with stakeholders Implementation of communication programmes: Key activities include: Dissemination of developed programmes with stakeholders; Launch of communication programme through appropriate channels.

3.8 Thematic area 5: Waste Management Strategic Objective: To promote sustainable waste management practices and ensure clean and healthy environment. Strategic Recommendations: Promote and ensure sustainable solid waste management practices. Ensure an effective, timely and sustainable waste management chain - collection, storage, transportation and 16 National Sanitation and Hygiene Strategy 2018 – 2024 disposal/recycling - for all types of waste at all levels Promote and ensure sustainable industrial and other hazardous waste management practices. Currently there is limited guidance on the management and disposal of industrial and hazardous waste. This will be undertaken in collaboration with Environmental Affairs to ensure consistency of approach and integration of regulation. Promote and ensure sustainable medical waste management. Currently there are no finalized guidelines for the management and disposal of medical waste. Current standards will be consolidated to provide national guidance for regulation and management. Promote and ensure sustainable urban wastewater management. Currently wastewater management in urban settings is erratic and lacks maintenance and sustainability. As such this strategy will seek to increase the capacity of major urban authorities and utilities to effectively CHAPTER THREE and efficiently manage wastewater and increase urban sewerage coverage. Interventions and activities: To ensure effective management of waste, the NSHS recommends the following strategic interventions. The activities for each intervention are outlined in Annex A. Sustainable solid waste management. Key activities include: Develop district based investment plan for refuse collection and disposal; Develop guidelines and standards ideal for managing solid waste; Promote private public partnership for solid waste management; Enforcement and inspection for solid waste management; Promote recycling of solid waste by the public and private sector; Public awareness of solid waste management techniques; Rehabilitate existing solid waste facilities. Sustainable industrial and other hazardous waste management. Key activities include: Develop guidelines and standards ideal for industrial and hazardous waste; promote industrial waste monitoring and surveillance systems; Enforcement and inspection for industrial and hazardous waste; Promote construction of incinerators for industrial waste handling; Public awareness of industrial and hazardous waste management. Sustainable medical waste management practices. Key activities include: Develop guidelines and standards ideal for medical waste; Promote medical waste monitoring and surveillance systems; Enforcement and inspection for medical waste; Promote construction of incinerators for medical waste handling; Public awareness of medical waste management; Develop colour coding system for medical waste at the point of generation. Sustainable wastewater management practices. Key activities include: Develop district and city based investment plan for waste water management; guidelines and standards ideal for waste water management; Promote waste water monitoring and surveillance systems; Enforcement and inspection for waste water; Promote an effective infrastructure for waste water handling; Public awareness of waste water management; Monitoring of waste water effluent; Rehabilitate existing waste water facilities; Promote reuse of waste water; Regulate pit emptying mechanisms. Increase district and city authorities' capacity to management solid waste. Key activities include: Training of appropriate personnel on guidelines; Provide support to maintain effective waste collection services where appropriate; Support and promote recycling industry; Increase access to recycling opportunities for households. 17 National Sanitation and Hygiene Strategy 2018 – 2024

3.9 Thematic area 6: Menstrual Hygiene Management Strategic Objective: To increase sustained access to quality and appropriate menstrual hygiene services Strategies Improve menstrual health and hygiene practices. There are currently no national guidelines on the manufacture and sale/provision of absorbent materials or facilities. Coordination is needed across stakeholders to provide necessary standards and consistency of approach to ensure women and girls are provided with effective and appropriate support. CHAPTER THREE Improve menstrual hygiene facilities. There are no national guidelines or requirements for the provision of MHM facilities in institutional settings. There need to be set standards to be met to support both women and girls to function normally during menses irrespective of their location or circumstances. Promote MHM awareness. National programmes for mass media and integration of MHM issues into national curricula can assist in reducing the stigma associated with menstruation. Interventions and activities: To ensure improved menstrual hygiene management, the NSHS recommends the following strategic interventions. The activities for each intervention are outlined in Annex A. Promotion of the integration of MHM beyond sanitation and hygiene promotion. Key activities include: Development of guidelines for the construction and provision of MHM facilities; Development of guidelines and standards for absorbent materials; Support the provision of MHM facilities and absorbent materials to girls and women; Coordinated campaigns to raise awareness and reduce stigma around menstrual hygiene issues; Inclusion of MHM in the new sanitation policy and other related policies; Development of checklist that is inclusive of all the sanitation standards including MHM; Fully functional commodity supply chain system; Advocacy for MHM; Awareness of MHM among both men and women in order to break the silence. Update and integrate improved sanitation and hygiene curricula content at all levels. Key activities include: Evaluation and update of school, higher education and training curricula.

3.10 Thematic area 7: Cross-cutting Issues Strategic objective: To ensure effective financing, leadership, coordination and knowledge exchange to achieve targets in sanitation and hygiene for all. Strategies: Finance Increase budgetary allocations for sanitation and hygiene sector at the national and district level. Neither national nor local authorities have a budget line for sanitation and as such they have not been appropriately prioritised in local government budgets. Retaining and developing sanitation and hygiene services is critical issue, which requires effective financial planning. Traditional and innovative opportunities for funding both internally and externally must be constantly reviewed and consolidated. 18 National Sanitation and Hygiene Strategy 2018 – 2024 Increase nancial support from development and research partners to achieve the NSHS objectives. Effective sanitation and hygiene programmes are dependent on support from development partners for targeted and national programmes to achieve the ambitious targets set by the SDGs and the NSHS. Increase public and private sector investment in sanitation and hygiene services. A major bottleneck to making improved sanitation and hygiene accessible to the majority of Malawians is low levels of public investment in the sanitation and hygiene sector. The prioritization of water supplies rather than sanitation and hygiene services has inculcated a strong dependency amongst consumers, especially rural households and created a focus on construction of new facilities, rather than on service sustainability. Increased nancial support for the vulnerable and marginalised populations. It must be CHAPTER THREE recognized that there are specific groups, including vulnerable, marginalized, disabled and hard to reach populations who need to be supported through alternative financing mechanisms to provide appropriate access to sanitation and hygiene. Leadership and coordination Establish an enabling national institutional framework. This would ensure effective execution of the sanitation and hygiene functions and regulation throughout the districts, as there is currently an absence of a formally established institutional mechanism to promote vertical and horizontal collaboration at District level. A clear and agreed national institutional framework for sector coordination and regulation, would reduce the current challenges of disjointed, uncoordinated, duplicative and even contradictory interventions. Promote and entrench good governance practices and strengthen accountability at all levels. The National Sanitation Policy, 2008 and the Malawi Growth and Development Strategy 2018 envision a more ethical, fair and inclusive society guided by the values of good governance, integrity, fairness, social justice, equity and professional public service which is accountable for its administrative actions and demonstrates high professional and ethical standards. To this regard, good governance practices and accountable and ethical leadership are therefore critical ingredients for effective and efficient sanitation and hygiene service delivery. Research and Knowledge Exchange Develop a clear research agenda for sanitation and hygiene sector. Research is currently poorly coordinated in the sector often leading to duplication of effort with little uptake of evidence to policy and programme development. This agenda will direct and ensure effective collaboration and progress. Increase the use of evidence based decision making in programme and policy development. This will require coordinated efforts and training of government, academic, and non- governmental staff to provide the capacity needed. Increase funding for research. This area requires sustained and appropriate support to ensure that operational research remains a core component of tacking the challenges faced by the sanitation and hygiene sector in Malawi. Forge effective relationships with academic and research institutions. A more formalized arrangement should be developed to ensure regular engagement and support between the government and research institutions to support sanitation and hygiene progress. Promote dissemination of research and knowledge exchange across all sectors. A consistent approach to dissemination and coordination of dissemination events is needed to maximize the 19 National Sanitation and Hygiene Strategy 2018 – 2024 impact of research and knowledge exchange in the sector. Interventions and activities: To ensure an effective and engaged sanitation and hygiene sector, the NSHS recommends the following strategic interventions. The activities for each intervention are outlined in Annex A. Financing Development of a sector nancing scheme. Key activities include: Financing of sector wide approach (SWAp) for sanitation and hygiene, with ring fenced funding secured to meet the CHAPTER THREE objectives of the NSHS including support for NSHCU coordination at national and district level; Promote the use of innovative financing systems for sanitation and hygiene at community level; Promote the availability of funds for research to fulfil the sanitation and hygiene research agenda. Advocacy within government, donors and development partners to support the sector nancing scheme. Key activities include: Development of an advocacy framework for increased financing with support from non-state actors; Delivery of advocacy framework in partnership with non-state actors. Leadership and coordination Development of a Sector Wide Approach (SWAp) for sanitation and hygiene. Scale up and enhance coordination mechanisms at the national level. Key activities include: Disseminate of NSHS at all levels; Brief stakeholders on sanitation and hygiene roles and responsibilities and governance structures; Sign Memorandums of Understanding with partners working in sanitation and hygiene; Lead regular coordination and sector strengthening meetings; Review the National Sanitation Policy to provide clear principles, norms and guidelines; Coordinate dissemination of findings of programs and research to national, district and development partners; Participation from high level national figures to raise the profile of sanitation and hygiene and lead advocacy of the NSHS objectives. Scale up and enhance coordination mechanisms at district level. Key activities include: Undertake sector strengthening assessments; Develop and implement sanitation and hygiene plans for each district that feed into the DIP; Lead regular coordination and sector strengthening meetings through DCT; Partner mapping and registers. Strengthen coordination linkages across national, district and community levels. Key activities include: Establish strong communication and reporting lines between the national EH section, District Coordination Team, health surveillance assistants, water monitoring officers and partners; Establish cross sector linkages and communication across national, district and community levels. Research and Knowledge Exchange Develop sanitation and hygiene agenda. Key activities include: development of a research agenda with full stakeholder input in Year 1 and aligned with the key thematic areas of the NSHS. Build capacity in stakeholders to develop, undertake, interpret and use evidence from research. Key activities include: Training at national and district level in applied research and 20 National Sanitation and Hygiene Strategy 2018 – 2024 evidence based decision-making, • Integrate operational research in current and future programmes. Key activities include: All programmes to be submitted and approved by the NSHTC at National level; all programmes to be approved by the DCT at District level and ensure the inclusion of operational research to provide evidence of outcomes and impact. • Advocacy programme for sanitation and hygiene research funding. Key activities include: Align advocacy programme with the research agenda to support and promote funding • Dissemination. Key activities include: Support, develop and sustain programmes for regular academic and operational research dissemination through symposia, reports, technical working groups, joint sector reviews, etc. CHAPTER THREE

3.11 Key Assumptions Table 3 below shows key assumption proposed for the strategy Table 3: key assumptions ASPECT ASSUMPTIONS Toilet construction · Households, schools, institutional settings and private institutions will construct appropriate and adequate sanitation facilities. Latrine usage · Latrines will be properly and consistently used by all Latrine maintenance · Latrines will be kept properly clean; · Facilities for pit emptying or relocation exist · Cost of emptying and relocation will be the responsibility by the owner Hygiene facilities · Households, schools, institutional settings and private institutions will provide appropriate and adequate facilities for hand washing with soap at critical times. Hygiene behaviour · Extension and education programmes will lead to sustained positive changes in behaviour Availability of water · Households, schools, institutional settings and private institutions will have sufcient water in terms of quality and quantity to undertake hygiene practices at critical times. Health improvements · Combination of increased and consistent usage of safe water for hygiene, other changes in hygiene behaviour, universal of latrine usage, will result in fewer faecal -oral infections. Technology · Technology will be affordable, maintainable, culturally acceptable and of resilient to adverse climatic conditions Leadership · Active leadership will be provided from all levels (community to national) to support achievement of sanitation and hygiene targets 21 National Sanitation and Hygiene Strategy 2018 – 2024 Stakeholders and · Program should involve all stakeholders from the community development stage, to enable communities to fully participate and take ownership. Inclusiveness · All gender, marginalized and vulnerable groups are actively involved in sanitation and hygiene programmes Ownership · A high degree of motivation will be achieved in target populations through education and capacity building Stable funding · There will be funding from collaborating partners and government CHAPTER THREE Advocacy and Support · Government and stakeholders will continue to advocate for nancing and support to meet sanitation and hygiene targets. ASPECT ASSUMPTIONS for nancing and support to meet sanitation and hygiene targets. Institutional framework · Roles and responsibilities clear at national and district level · Adequate personnel in place at national and district level to implement programmes Enabling environment · Presence of necessary legal instruments and political will · Capacity in personnel to implement legal instruments Proper monitoring and · There will be an effective monitoring and evaluation at a evaluations specied period during the implementation Effective sectoral and · Designed to mitigate root causes of challenges of social protection growth and development, including social and gender programmes inequalities Good governance is · Transparency, accountability and zero tolerance for entrenched and corruption at all levels and in all activities. institutionalized 22 National Sanitation and Hygiene Strategy 2018 – 2024 FOUR CHAPTER 4 IMPLEMENTATION ARRANGEMENTS CHAPTER FOUR

4.1 Implementation Modalities The NSHS has been developed to allow all stakeholders to participate in the development of the country. Its implementation will, therefore, involve all stakeholders. Issues of hygiene and sanitation practices will attract attention of a range of key stakeholders that include Ministry of Health and Population (MoHP), Ministry of Agriculture, Irrigation and Water Development (MoAIWD), Ministry of Education, Science and Technology (MoEST), Ministry of Gender, Children, Disability and Social Welfare Community (MoGCDSW), Ministry of Local government (MoLG&RD), Non State Actors (NSA), communities and households. The MoHP will lead the implementation process through technical coordination and a consolidated national budget. It is expected that all stakeholder institutions including donors, development and co- operating partners and the academia will align their activities and support to NSHS. At national level, the MoHP is responsible for enforcement of sanitation and hygiene laws in Malawi (CAP34:01 sections 16, 17, 59-95, 106-112) and will lead and coordinate the implementation of NSHS at all levels. The MoAIWD is responsible for the implementation of sustainable management and utilization of water resources in order to ensure sustainable access of water. The NSHCU with co-opted members from other government ministries and non-state actors (NSA) forms the National Sanitation and HygieneTechnical Committee (NSHTC). The NSHTC is responsible for coordination of sanitation and hygiene interventions at national level, oversight and advisory role at district level. At district level the MoEST is responsible for ensuring that water and sanitation facilities are available in all schools including CBCCs. The MoGCDSW is responsible for coordinating with government and district Councils to ensure participation of men and women in promotion of sanitation and hygiene practices. The MoLG&RD is responsible for coordinating the sanitation and hygiene through the district coordinating committee (DCT) chaired by the District Environmental Health Officer (DEHO). NSA includes the Civil Society Organisations (CSO), Non-Governmental Organisations (NGO), Development Partners (DP), donors and the academia. These are responsible for proving financial and 23 National Sanitation and Hygiene Strategy 2018 – 2024 technical support to the implementation of sanitation and hygiene strategy and are part of the NSHTC and DCT committees. At Community level, sanitation and hygiene activities are done collectively through established community structures. Community Health Action Group (CHAG) is CHAPTER FOUR responsible for coordinating sanitation and hygiene activities at group village headman level. The CHAG is part of the Area Development Committee (ADC) and Area Executive Committee (AEC) responsible for identifying sanitation and hygiene issues and takes them to the council. The CHAG supported by extension workers also works with Water Point Committees (WPC) and Village Health Committees (VHC) in planning, implementation, monitoring and evaluation of sanitation and hygiene activities in Figure 4: Stakeholders for NSHS Implementation the community. 24 National Sanitation and Hygiene Strategy 2018 – 2024 FIVE CHAPTER 5 IMPLEMETATION PLAN

5.1 Five Year Implementation Plan CHAPTER FIVE In order to achieve this ambitious National Sanitation and Hygiene Strategy (2018 – 2023) Malawi will need buy in from all stakeholders in the sector. This will include central and local government, partners, and community members. Activities will take place at national, district and community level and will require designated stakeholders to work diligently to ensure effective implementation, integration and participation. Only then will Malawi succeed in achieving its targets for sanitation and hygiene by 2024. The implementation plan aligns with current guidelines to decentralize services and promote ownership of planning and implementation at district and community level. This approach will build upon the previous success of the Open Defaecation Free and Hand Washing With Soap strategies. Planned activities also seek to build upon the successes achieved in those previous strategies while specifically addressing the gaps identified through consultations. The NSHS will be continually assessed throughout the implementation plan to ensure efficacy of the programme is tracked. This will be achieved in line with the monitoring and evaluation framework (Chapter 6). Implementation is summarized in Annex A and B.

5.2 Resource Planning Malawi loses 8.8 Billion Malawi Kwacha per year (1.1% of Gross Domestic Product) due to poor sanitation which translates to 3.3 USD per person per year11. In 2012, Malawi was estimated to spend 12 0.1 to 0.5% of its GDP on sanitation . The total cost of implementing the NSHS is estimated at US$79, 903, 000 for the period of 6 years (2018 to 2024) and this translates to less than US$1 per person per year and approx. US$4 per person for the period of the strategy. The Government of Malawi will have to increase funding and lobby local and international institutions that support the ODF campaign to continue offering the support. An estimated total of US$79, 903, 000 is needed for the full implementation of the NSHS over the six year period. Year by year costs are: · Year 1: US$10, 471, 000 · Year 2: US$12. 290, 000 · Year 3: US$14, 399, 000 · Year 4: US$13, 488, 000 · Year 5: US$13, 559, 000 · Year 6: US$15, 697, 000 11 Water and Sanitation Program. Water and Sanitation Programs Economic impacts of poor sanitation in Africa: Malawi [Internet]. WSP. 2012 [cited 2018 Jun 9]. Available from: http://www.wsp.org/sites/wsp.org/files/publications/WSP-ESI-Malawi.pdf Water and Sanitation Program. 12 Water and Sanitation Programs Economic impacts of poor sanitation in Africa: Malawi [Internet]. WSP. 2012 [cited 2018 Jun 9]. Available from: http://www.wsp.org/sites/wsp.org/files/publications/WSP-ESI-Malawi.pdf 25 National Sanitation and Hygiene Strategy 2018 – 2024 Overall the NSHS will also be supported from costs incurred within the National Community Health Strategy (NCHS) due to the funding of community health cadres being assigned to their programme. The aligned NCHS acknowledges that sanitation and hygiene are roles undertaken by the Ministry of Health's community health cadres, and also includes financing of infrastructure (HSA housing), supervision, transport (bicycles and motorbikes) and training, which will be of direct benefit to the success of the NSHS. Integration of services at community health as outlined in both the NCHS and NSHS will be essential to the achievement of sanitation and hygiene targets. Estimated costs per population are in line with other African country strategies including, National 13 ODF Kenya 2020 campaign framework (2016) estimated the cost of the campaign for four years at

41.6 Kenyan Shillings (412, 256,000 USD) which translates to USD8 per person for the four years taking into account the total population of Kenya estimated at 51million. Nigeria's ODF 2016 to 2025 strategy is estimated to cost 159, 895 million Nigerian Naira (444,052,813 USD) for 10 years which is CHAPTER FIVE 14 estimated at 2.3 USD per capita (Making Nigeria ODF by 2025) . The Mozambique WASH programme is estimated to cost 44,000,000 USD with ODF campaign alone costing 18, 640, 000 USD. With a total population of 30,528,673, the attainment of ODF from 2017 to 2020 was estimated at 0.6 15 USD per capita (Mozambique WASH programme 2017-2020) . Table 4: Ination rates for Malawi Year Ination (%) 1. April, 2018 9.7 2. April, 2017 14.6 3. April, 2016 20.9 4. April, 2015 18.8 5. April, 2014 23.9 6. April, 2013 35.8 7. April, 2012 12.4

5.3 Financing Implementation of the NSHS will require financing from national and district government, donors, and the private sector. Only with the support of all stakeholders will the country be able to achieve its vision to improve the livelihoods of all people in Malawi. Central and district governments will be the first source for NSHS financing. The central government will continue to contribute resources towards sanitation and hygiene. Central government will lead programme management costs such as the NSHTC operational costs and policy and guideline development which will support broader mobilization of resources both domestically and internationally. The district governments will play a critical role especially with the continued transition to a decentralized system. District governments will be the primary source for district salaries and supervision while it is also expected that districts will provide significant support towards transport. Communities will be expected to participate and contribute through work as volunteers, community groups such as VHCs, WPCs and WUAs and support in infrastructure especially with supplying materials and labour for the construction and maintenance of domestic, school and health facility sanitation and hygiene. Stakeholders including donors, implementing partners and the private sector will be looked upon to fill critical gaps in NSHS financing requirements. Development partners, including multilateral donors, bilateral donors, foundations, development finance institutions, and NGOs are crucial for financing the 13 https://www.washwatch.org/uploads/filer_public/2c/8f/2c8f15cb-70f7-4387-a648- 0cb440a8df95/odf_open_defecation_free_2020_campaign_framework_kenya_2016.pdf 14 https://www.unicef.org/nigeria/NATIONAL_ROAD_MAP_FOR_ELIMINATING_OPEN_DEFECATION_IN_NIGERIA.pdf 15 http://files.unicef.org/transparency/documents/Mozambique%20CPD%20-%20%20WASH%20Strategy%20Note%20-%2028%20March%202016.pdf 26 National Sanitation and Hygiene Strategy 2018 – 2024 successful implementation of the NSHS. The NSHTC will track financing commitments and progress toward established targets throughout the implementation of the strategy. To do so, the NSHTC will develop a funding database with the Aid Coordination Unit of the MoHP to allow active management of funding for community health. To promote transparency and accountability, NHSTC will share updates with all stakeholders through quarterly and annual meetings at the national and district levels. The NSHTC will also be responsible for adjusting targets, supporting resource mobilisation, and prioritising resources – as necessary – based on year-to-year progress. CHAPTER FIVE 27 National Sanitation and Hygiene Strategy 2018 – 2024 SIX CHAPTER 6 MONITORING AND EVALUATION FRAMEWORK

6.1 Overview CHAPTER SIX The monitoring and evaluation (M&E) plan will provide a national framework to measure and track progress of the implementation of the strategy at all levels. The strategy provides an overview of the M&E framework and a detailed M&E plan will be developed in the first phase of the NSHS implementation. M&E will take place at every stage of implementation and will allow the environmental health section to continuously improve current and future programme planning, implementation, and decision-making. The NSHS M&E framework is based on Results-Based Management (RBM) principles and a theory of change, with a clear results chain, indicators, targets, milestones, means of verification, frequency and responsible institution. A summary of monitoring and

6.2 Strategic Direction Under the assessment of the strategic direction of the MoHP and MoAIWD, the check list would include such issues like: 1) Are we moving in the right direction? 2) Are key things or activities falling into place? 3) Are our assumptions or premises about major trends and changes still correct? 4) Are we doing the critical things that need to be done? 5) Should we adjust or abort the strategy or strategies that were formulated?

6.3 Strategic Performance Under the assessment of the strategic performance of the MoHP and MoAIWD, the check list would include such issues as: 1) How well are we performing in our plans? 2) Are objectives being met? 3) Are responsible personnel doing their respective assignments? While strategic control will attempt to steer the responsible ministries over an extended period, operational controls will provide post-action evaluation and control over short periods falling within one year. To be effective, operational control systems shall be based on the following four steps: 1) Set standards of performance 2) Measure actual performance quantitatively or qualitatively. 3) Identify deviations from targets 4) Initiate corrective action 28 National Sanitation and Hygiene Strategy 2018 – 2024 ANNEXES 29 30 Annex A: Detailed costed Implementation Plan Level Responsible Interventions Activities stakeholder Cost 2018 – 19 2019 – 20 2020 – 21 2021 – 22 2022 – 23 2022 - 24 Cost US$ MWK (Million) (Thous) Year 1 Year 2 Year 3 Year 4 Year 5 Year 6 Thematic area 1: Rural Sanitation and Hygiene National MoHP, Continue Triggering of non-triggered communities at 50 100 100 50 50 50 400 544 and MoAIWD, promotion of cluster level. District NSHTC and ODF status Follow ups 5 10 10 10 10 10 55 75 DCT Coordinated supporting campaigns in OD 0 30 0 0 30 0 60 82 areas to achieve ODF status, (e.g. exchange visits, open days, ODF champions); National MoHP, Support Disseminate role clarity and job 100 100 50 40 30 20 340 463 and MoAIWD, maintenance of descriptions to relevant extension workers District NSHTC and ODF status and development partners DCT Training of district and extension workers 100 50 50 30 30 20 280 381 on the maintenance of ODF status; Training and mentoring of natural leaders 10 5 5 5 5 5 35 48 and village health committees to support maintenance of ODF status. Continued follow-ups as part of routine 2 1 1 1 1 1 7 10 work for verication after declared ODF Promotion of concomitant incentives to 2 2 2 2 2 2 12 16 encourage maintenance of ODF status Mentoring and supervision programmes to 4 4 4 4 4 4 24 33 promote maintenance of ODF status. National DCT, NSHTC Promote Develop effective communications 4 3 0 0 0 0 7 10 and progression up campaign to increase desire to move up District the sanitation the sanitation and hygiene ladders; and hygiene Develop and roll out of compendium of 5 4 0 0 0 0 9 12 ladder technological solutions (including climate resilient) supported by sanitation and hygiene marketing and entrepreneurs Train and promote entrepreneurs for 3 3 3 3 2 2 16 22 promoting sanitation marketing and National Sanitation and Hygiene Strategy 2018 – 2024 Level Responsible Interventions Activities stakeholder Cost 2018 – 19 2019 – 20 2020 – 21 2021 – 22 2022 – 23 2022 - 24 Cost US$ MWK (Million) (Thous) Year 1 Year 2 Year 3 Year 4 Year 5 Year 6 enterprises. National DCT, NSHTC Establish demonstration sites within public 5 4 1 1 0 0 11 15 and institutions (e.g. schools, health facilities, District churches, etc.) to promote technologies Promote community nance systems to 2 1 0 0 0 1 4 5 support construction and improvement of sanitation and hygiene facilities. National NSHTC and Development Review and develop clear guidance and 20 0 0 0 0 0 20 27 partners and use of tools for the ODF verication process supporting Review, develop and disseminate training 10 0 0 9 0 0 19 26 tools manual and tools for CLTS Develop and disseminate guidance 10 0 0 0 0 0 10 14 manuals for sanitation marketing Thematic area 2: Urban Sanitation and Hygiene National Sanitation and Hygiene Strategy 2018 – 2024 National, NSHTC, Review and Work with city councils to review current 100 150 0 0 0 0 250 340 District MoHP, development of legal requirements and standards for and MoAIWD and legal sanitation and hygiene. Council partners requirements Standardise by-laws for sanitation and 200 100 0 0 0 0 300 408 and standards hygiene for all cities to be effective and realistic. Awareness of Develop and implement awareness 0 299 100 50 50 30 529 720 legal campaign to highlight requirements of requirements standardised by-laws and standards Promote Develop and implement effective 20 15 10 5 5 5 60 82 progression up communications campaign to increase the sanitation desire to move up the sanitation and and hygiene hygiene ladders; ladder Develop and roll out of compendium of 10 10 10 5 5 5 45 61 technological solutions (including climate resilient) supported by sanitation and hygiene marketing and entrepreneurs. 31 Level Responsible Interventions Activities 32 stakeholder Cost 2018 – 19 2019 – 20 2020 – 21 2021 – 22 2022 – 23 2022 - 24 Cost US$ MWK (Million) (Thous) Year 1 Year 2 Year 3 Year 4 Year 5 Year 6 National, NSHTC, Train and promote entrepreneurs for 150 50 60 0 0 10 270 367 District MoHP, promoting sanitation marketing and and MoAIWD and enterprises. Council partners Establish demonstration sites within public 5 5 5 5 5 5 30 41 institutions (e.g. schools, health facilities, churches, etc.) to promote technologies. Promote nance systems to support 4 4 4 4 4 4 24 33 construction and improvement of sanitation and hygiene facilities. Develop and disseminate guidance 60 30 0 0 0 0 90 122 manuals for sanitation marketing Thematic area 3: Institutional Sanitation and Hygiene National MoEST, Improved Support review and revision of school 25 20 0 0 0 0 45 61 and MoHP, sanitation and standards (ensuring child friendly and District MoLG&RD hygiene in inclusive designs) with Ministry of schools Education, Science and Technology. (including early Sensitisation and enforcement of school 80 70 60 0 0 0 210 286 childhood standards through PEA, DEM, SMC, PTA development and other stakeholders using SLTS and centres) other mechanisms. Management and maintenance of school 100 100 100 100 100 100 600 816 sanitation and hygiene facilities by SMC. Establishment and sustained support of 60 40 30 0 0 0 130 177 sanitation clubs. HSAs and PEA to provide hygiene 40 40 40 40 40 40 240 327 promotion and education Use of schools as a central hub for 20 20 20 20 20 20 120 163 sanitation and hygiene education in the community Develop safe systems for pit emptying 60 0 0 0 0 0 60 82 National MoHP, Improved Sensitisation and enforcement of health 100 100 100 100 50 50 500 680 and NSHTC and sanitation and facilities standards through Director of District hygiene in Health and Social Services. National Sanitation and Hygiene Strategy 2018 – 2024 Level Responsible Interventions Activities stakeholder Cost 2018 – 19 2019 – 20 2020 – 21 2021 – 22 2022 – 23 2022 - 24 Cost US$ MWK (Million) (Thous) Year 1 Year 2 Year 3 Year 4 Year 5 Year 6 DCT health facilities Provide adequate sanitary facilities (with 100 100 100 100 100 100 600 816 appropriate security) and resources to enhance and maintain hygiene practices. Manage and maintain sanitation and 10 15 20 10 5 5 65 88 hygiene facilities through health facility management. Provide adequate resource allocation for 200 200 200 200 300 350 1450 1973 the development, maintenance and cleaning of sanitary facilities. Use of health facilities as a central hub for 50 50 50 50 50 50 300 408 sanitation and hygiene education in the community National MoHP, Improved Support review and revision of market 180 0 100 0 0 0 280 381 and MoLG&RD, sanitation and standards to standardise across the District hygiene in country in partnership with Ministry of National Sanitation and Hygiene Strategy 2018 – 2024 NSHTC, DCTs markets Local Government. Sensitisation and enforcement of market 80 80 80 80 80 80 480 653 standards through District and City Councils Provide adequate sanitary facilities (with 100 200 300 300 400 500 1800 2449 appropriate security) and resources to enhance and maintain hygiene practices. Manage and maintain sanitation and 100 100 100 200 300 400 1200 1633 hygiene facilities through District and City Council. Provide adequate resource allocation for 80 90 90 100 120 150 630 857 the development, maintenance and cleaning of sanitary facilities. Regular inspections by District and City 100 100 80 70 60 50 460 626 Councils to ensure compliance with standards National MoHP Improved Support review and revision of standards 60 60 0 0 60 0 180 245 and sanitation and to standardise across the country in 33 Level Responsible Interventions Activities 34 stakeholder Cost 2018 – 19 2019 – 20 2020 – 21 2021 – 22 2022 – 23 2022 - 24 Cost US$ MWK (Million) (Thous) Year 1 Year 2 Year 3 Year 4 Year 5 Year 6 District (Directorate of hygiene in partnership with Ministry of Local Preventive public Government. Health, institutions Sensitisation and enforcement of 8 8 8 0 0 0 24 33 NSHTC standards through appropriate authorities Provide adequate sanitary facilities (with 200 200 200 200 200 300 1300 1769 appropriate security) and resources to enhance and maintain hygiene practices. Manage and maintain sanitation and 200 200 200 200 200 300 1300 1769 hygiene facilities through appropriate authorities. Provide adequate resource allocation for 200 200 200 200 200 300 1300 1769 the development, maintenance and cleaning of sanitary facilities. Regular inspections by appropriate 100 100 200 200 300 350 1250 1701 authorities to ensure compliance with standards Thematic area 4: Behaviour Change and Communication National MoHP, Assessment of Review of current programmes and 50 70 0 0 0 0 120 163 MoAIWD, priority areas research NSHTC, DCT, Consultation with stakeholders 0 30 20 0 0 0 50 68 Development Development Co-design of communication programmes 0 40 20 0 0 0 60 82 partners communication with beneciaries programmes Consultation with stakeholders 0 0 60 0 0 0 60 82 Implementation Dissemination with stakeholders 0 0 100 100 0 0 200 272 of communication programmes Launch of communication programme 0 0 0 50 0 0 50 68 through appropriate channels Thematic area 5: Waste management National Sanitation and Hygiene Strategy 2018 – 2024 Level Responsible Interventions Activities stakeholder Cost 2018 – 19 2019 – 20 2020 – 21 2021 – 22 2022 – 23 2022 - 24 Cost US$ MWK (Million) (Thous) Year 1 Year 2 Year 3 Year 4 Year 5 Year 6 National MoLG&RD, Sustainable Develop district-based investment plan for 0 0 0 60 0 0 60 82 and MoHP, solid waste refuse collection and disposal Council Department of management Develop guidelines and standards ideal 0 0 0 70 40 0 110 150 Environmental for managing solid waste Affairs (EAD) Promote private public partnership for 50 50 50 50 50 50 300 408 solid waste management NSHTC Enforcement and inspection for solid 80 80 80 80 80 80 480 653 waste management Promote recycling of solid waste by the 100 150 150 200 100 100 800 1088 public and private sector Public awareness of solid waste 150 150 90 100 110 100 700 952 management techniques Rehabilitate existing solid waste facilities 200 200 200 200 300 300 1400 1905 National MoLG&RD, Sustainable Develop guidelines and standards ideal 0 0 150 0 0 0 150 204 and industrial and for industrial and hazardous waste National Sanitation and Hygiene Strategy 2018 – 2024 MoHP, Council MoAIWD, other Promote industrial waste monitoring and 0 0 100 100 150 200 550 748 NSHTC, hazardous surveillance systems waste Enforcement and inspection for industrial 0 0 100 100 150 200 550 748 MBS, EAD management and hazardous waste Promote construction of incinerators for 0 0 0 200 200 100 500 680 industrial waste handling Public awareness of industrial and 0 0 200 250 300 300 1050 1429 hazardous waste management MoHP, Sustainable Develop guidelines and standards ideal 0 0 100 0 0 0 100 136 MoLG&RD, medical waste for medical waste MBS, management MoAIWD, practices National Promote medical waste monitoring and 0 0 50 50 50 50 200 272 NSHTC, EAD and surveillance systems District Enforcement and inspection for medical 0 0 60 60 60 70 250 340 waste Promote construction of incinerators for 0 0 500 600 700 700 2500 3401 medical waste handling 35 Level Responsible Interventions Activities 36 stakeholder Cost 2018 – 19 2019 – 20 2020 – 21 2021 – 22 2022 – 23 2022 - 24 Cost US$ MWK (Million) (Thous) Year 1 Year 2 Year 3 Year 4 Year 5 Year 6 Public awareness of medical waste 0 0 30 50 50 48 178 242 management Develop colour coding system for medical 0 0 40 0 0 0 40 54 waste at the point of generation National MoLG&RD, Sustainable Develop district and city based investment 0 200 0 200 0 0 400 544 and MoHP , waste water plan for waste water management District NSHTC management Develop guidelines and standards ideal 0 60 0 0 0 0 60 82 practices for waste water management Promote waste water monitoring and 0 48 48 48 48 60 252 343 surveillance systems Enforcement and inspection for waste 0 100 100 100 100 100 500 680 water Promote an effective infrastructure for 0 300 300 300 300 400 1600 2177 waste water handling Public awareness of waste water 0 0 100 100 100 150 450 612 management Monitoring of waste water efuent 0 0 60 60 70 70 260 354 Rehabilitate existing waste water facilities 0 0 400 500 600 700 2200 2993 Promote reuse of waste water 0 0 500 350 400 700 1950 2653 Regulate pit emptying mechanisms 100 100 100 100 150 150 700 952 National MoLG&RD, Increase Training of appropriate personnel on 300 300 400 400 500 600 2500 3401 and MoHP, EAD, district and city guidelines District Development, authorities Provide support to maintain effective 100 100 150 150 200 300 1000 1361 Training capacity to waste collection services where management appropriate Institutions solid waste Support and promote recycling industry 100 100 100 80 90 70 540 735 Increase access to recycling opportunities 50 50 50 50 60 60 320 435 for households National MoLG&RD, Increase city Reduce discharge of untreated 60 60 60 60 90 100 430 585 and MoHP, EAD, authority wastewater into water courses District Development, capacity to Training manage urban wastewater National Sanitation and Hygiene Strategy 2018 – 2024 Level Responsible Interventions Activities stakeholder Cost 2018 – 19 2019 – 20 2020 – 21 2021 – 22 2022 – 23 2022 - 24 Cost US$ MWK (Million) (Thous) Year 1 Year 2 Year 3 Year 4 Year 5 Year 6 Institutions Repair and effectively manage wastewater 300 500 400 100 200 100 1600 2177 treatment systems Expand and extend sewerage systems 400 500 700 900 0 800 3300 4490 and wastewater treatment in urban areas National MoLG&RD, Increase public Develop and launch campaign to improve 70 0 0 90 0 0 160 218 and MoHP, EAD, awareness of living and public environments District Development, rights to clean Increase civic responsibility and raise 140 140 140 140 140 140 840 1143 Training and healthy awareness on legal rights regarding waste environment management Institutions Thematic area 6: Menstrual Hygiene Management National MoEST, Promotion of Development of guidelines for the 0 100 100 0 0 0 200 272 and MoHP, the integration construction and provision of MHM District MoGCSW of MHM beyond facilities sanitation and Development of guidelines and standards 0 50 60 0 0 0 110 150 National Sanitation and Hygiene Strategy 2018 – 2024 hygiene for absorbent materials; promotion Support the provision of MHM facilities 100 100 100 100 100 100 600 816 and absorbent materials to girls and women; Coordinated campaigns to raise 150 150 150 150 150 150 900 1224 awareness and reduce stigma around menstrual hygiene issues. Inclusion of MHM in the new sanitation 200 0 0 0 0 0 200 272 policy and other related policies Development of checklist that is inclusive 0 0 50 0 0 0 50 68 of all sanitation standards including MHM Promote fully functional commodity supply 30 30 30 30 40 40 200 272 chain system for MHM Advocate for MHM in institutions and 50 50 50 50 50 50 300 408 households Awareness of MHM among both men and 50 50 50 50 50 50 300 408 women in order to break the silence 37 Level Responsible Interventions Activities 38 stakeholder Cost 2018 – 19 2019 – 20 2020 – 21 2021 – 22 2022 – 23 2022 - 24 Cost US$ MWK (Million) (Thous) Year 1 Year 2 Year 3 Year 4 Year 5 Year 6 National MoHP, Update and Evaluation and update of school, higher 0 0 100 0 60 0 160 218 and MoEST, integrate education and training curricula District MoGCSW improved PTAs sanitation and hygiene curricula content at all levels Thematic area 7: Cross Cutting Issues Sub-Theme (a): Financing National MoHP Development of Financing of sector wide approach 500 500 600 100 200 300 2200 2993 a sector (SWAp) for sanitation and hygiene, with nancing ring fenced funding secured to meet the scheme objectives of the NSHS including support for NSHCU coordination at national and district level. National MoHP, Promote the use of innovative nancing 200 200 300 300 400 100 1500 2041 and MoAIWD, systems for sanitation and hygiene at District NSHCU, community level. NSHTC Promote the availability of funds for 100 100 100 100 100 100 600 816 research to full the sanitation and hygiene research agenda National MoHP, Advocacy Development of an advocacy framework 0 60 0 0 0 0 60 82 and MoAIWD, within for increased nancing with support from District NSHCU, government, non-state actors NSHTC donors and Delivery of advocacy framework in 0 70 50 20 10 5 155 211 development partnership with non-state actors partners to support the sector nancing scheme Sub-Theme (b): Leadership and coordination National Sanitation and Hygiene Strategy 2018 – 2024 Level Responsible Interventions Activities stakeholder Cost 2018 – 19 2019 – 20 2020 – 21 2021 – 22 2022 – 23 2022 - 24 Cost US$ MWK (Million) (Thous) Year 1 Year 2 Year 3 Year 4 Year 5 Year 6 National MoHP, Development of Develop a Sector Wide Approach (SWAp) 100 100 0 0 0 0 200 272 and MoAIWD, a Sector Wide for sanitation and hygiene District NSHTC, Approach NSHCU, DCT (SWAp) for sanitation and hygiene Scale up and Disseminate of NSHS at all levels 25 25 0 0 0 0 50 68 enhance Brief stakeholders on sanitation and 20 20 0 0 0 40 54 coordination hygiene roles and responsibilities and mechanisms at governance structures; the national Sign Memorandums of Understanding 2 2 2 2 2 2 12 16 level with partners working in sanitation and hygiene; Lead regular coordination and sector 12 12 12 12 12 12 72 98 strengthening meetings; National Sanitation and Hygiene Strategy 2018 – 2024 Advocate for revision of the National 70 60 0 0 0 0 130 177 Sanitation Policy to provide clear principles, norms and guidelines. Coordinate dissemination of ndings of 100 150 100 200 300 200 1050 1429 programs and research to national, district and development partners. Participation from high level national 15 20 10 10 10 15 80 109 gures to raise the prole of sanitation and hygiene and lead advocacy of the NSHS objectives. National MoHP, Scale up and Undertake sector strengthening 10 10 0 0 0 0 20 27 and MoAIWD, enhance assessments; District NSHTC, coordination Develop and implement sanitation and 0 100 100 100 18 18 336 457 NSHCU, DCT mechanisms at hygiene plans for each district that feed district level into the DIP; Lead regular coordination and sector 112 112 112 112 112 112 672 914 strengthening meetings through DCT Partner mapping and registers 6 6 6 6 6 6 36 49 39 Level Responsible Interventions Activities 40 stakeholder Cost 2018 – 19 2019 – 20 2020 – 21 2021 – 22 2022 – 23 2022 - 24 Cost US$ MWK (Million) (Thous) Year 1 Year 2 Year 3 Year 4 Year 5 Year 6 National MoHP, Strengthen Establish strong communication and 300 400 0 0 0 0 700 952 and MoAIWD, coordination reporting lines between the national EH District DCTs, section, District Coordination Team, health linkages across NSHCU national, surveillance assistants, water monitoring district and ofcers and partners. community Establish cross sector linkages and 60 60 0 0 0 0 120 163 levels communication across national, district and community levels Sub-Theme 3: Research and Knowledge Exchange National Research Develop Form a sanitation and hygiene agenda 40 0 0 0 0 0 40 54 and institutions, sanitation and with full stakeholder input in Year 1 and District development hygiene agenda aligned with the key thematic areas of the partners, NSHS Build capacity Train personnel at national and district 40 40 40 50 50 60 280 381 MoHP, in stakeholders level in applied research and evidence- MoAIWD, to develop, based decision-making development undertake, partners interpret and use evidence from research Integrate Integrate operational research in current 10 10 10 15 15 15 75 102 operational and future programmes research in DCT to ensure inclusion of operational 10 10 10 15 15 15 75 102 current and research in all programmes at District future level to provide evidence of outcomes and programmes impact Advocacy Align advocacy programme with the 0 10 10 10 10 10 50 68 programme for research agenda to support and promote sanitation and funding hygiene research funding National Research Dissemination Support, develop and sustain programmes 0 25 30 40 50 60 205 279 National Sanitation and Hygiene Strategy 2018 – 2024 Level Responsible Interventions Activities stakeholder Cost 2018 – 19 2019 – 20 2020 – 21 2021 – 22 2022 – 23 2022 - 24 Cost US$ MWK (Million) (Thous) Year 1 Year 2 Year 3 Year 4 Year 5 Year 6 and institutions, for regular academic and operational District development research dissemination through symposia, partners, reports, technical working groups, joint MoHP, sector reviews MoAIWD, development partners Total Cost 7696 9033 10583 9914 9966 11537 58729 79903 National Sanitation and Hygiene Strategy 2018 – 2024 41 Annex B: Implementation Matrix 42 STRATEGIC THEME AREA 1: RURAL SANITATION AND HYGIENE Outcome: Increased sustained access and use of improved and appropriate sanitation and hygiene facilities for all in domestic rural settings by 2024 Objective(s) Output(s) Performance Indicator(s) Baseline Target Source(s) of Responsible Verication Ofce To increase Continued promotion of % of triggered communities at 43 Annual reports MoHP, MoAIWD, sustained access ODF status. cluster level NSHTC and use of Number of exchange Visit reports MoHP, MoAIWD, improved and visits,(Coordinated supporting NSHTC appropriate campaigns in OD areas) sanitation and hygiene facilities Number of open days Reports, minutes MoHP, MoAIWD, for all in domestic Coordinated supporting NSHTC rural settings campaigns in OD areas through an Sustained ODF status % of communities maintaining 75% NSHTC and MoHP, MoAIWD, integrated in communities ODF status months after DCT reports NSHTC approach. certication Number of DCTs trained and 0 28 Training reports MoHP, MoAIWD, mentored to support the NSHTC maintenance of ODF Number of extension workers 75% Training reports NSHCU, trained and mentored to NSHTC, DCTs support the maintenance of ODF National Sanitation and Hygiene Strategy 2018 – 2024 STRATEGIC THEME AREA 1: RURAL SANITATION AND HYGIENE Outcome: Increased sustained access and use of improved and appropriate sanitation and hygiene facilities for all in domestic rural settings by 2024 Objective(s) Output(s) Performance Indicator(s) Baseline Target Source(s) of Responsible Verication Ofce Number of natural leaders All Training reports MoHP, MoAIWD, village health committees involved in NSHTC trained and mentored to ODF support maintenance of ODF declared T/As Number of village health 75% of Training reports MoHP, MoAIWD, committees trained and VHYC in NSHTC mentored to support ODF maintenance of ODF declared National Sanitation and Hygiene Strategy 2018 – 2024 areas Number of continued follow- 80% of the Reports from NSHTC ups as part of routine work for declared HSAs verication after declared areas ODF; Promoted progression Increased number of 50% District reports DCT, NSHTC up the sanitation and Households adopting new and meeting hygiene ladder sanitation technologies minutes Reviewed and used Number of reviewed and 1 1 Review meeting NSHTC supporting tools developed clear guidance and minutes and tools for the ODF verication attendance list process 43 STRATEGIC THEME AREA 1: RURAL SANITATION AND HYGIENE 44 Outcome: Increased sustained access and use of improved and appropriate sanitation and hygiene facilities for all in domestic rural settings by 2024 Objective(s) Output(s) Performance Indicator(s) Baseline Target Source(s) of Responsible Verication Ofce Number of reviewed, 1 Review meeting NSHTC developed and disseminated minutes and training manuals and tools attendance list Number of disseminated 1 Review meeting NSHTC guidance manuals for minutes and sanitation marketing attendance list National Sanitation and Hygiene Strategy 2018 – 2024 STRATEGIC THEME AREA 2: URBAN SANITATION AND HYGIENE Outcome: Increased sustained access and use of improved and appropriate sanitation and hygiene facilities for all in domestic urban settings in areas declared ODF Objective(s) Output(s) Performance Indicator(s) Baseline Target Source(s) of Responsible Verication ofce To increase Reviewed and Number of 1 Review reports NSHTC and sustained access developed legal developed/reviewed legal partners and use of requirements and requirements and standards improved and standards for sanitation and hygiene; appropriate sanitation and Increased awareness Number of developed and 10 Awareness MoHP, MoAIWD, hygiene facilities and understanding of implemented awareness campaign partners for all in domestic the legal requirements campaigns reports urban settings and standards for through an sanitation and hygiene National Sanitation and Hygiene Strategy 2018 – 2024 integrated Promoted household Number of developed 10 campaign MoHP, MoAIWD, approach progression up the effective communications reports sanitation and hygiene campaigns ladder through effective, context appropriate and Number of developed and 1 Reports from MoHP, innovative sanitation rolled out compendium of NSHTC MoAIWD,, marketing. technological solutions Research (including climate resilient) institutions, masons Percentage of trained and 75% of Memorandum of MoHP,NSHTC promotes sanitation masons/e understanding, MoAIWD, marketing and entrepreneurs ntreprene Reports from Masons urs NSHTC 45 STRATEGIC THEME AREA 2: URBAN SANITATION AND HYGIENE 46 Outcome: Increased sustained access and use of improved and appropriate sanitation and hygiene facilities for all in domestic urban settings in areas declared ODF Objective(s) Output(s) Performance Indicator(s) Baseline Target Source(s) of Responsible Verication ofce Number of established 28 (at Annual reports, MoLG&RD, demonstration sites within least one minutes of MoHP public institutions to promote for each meetings technologies district) Number of developed and 0 1 Existence of NSHTC disseminated guidance manuals manuals for sanitation marketing. Developed and used Number of developed and 1 Existence of NSHTC, NSHCU supporting tools to used supporting tools to tools provide consistency in promote and support promoting and sanitation and hygiene supporting sanitation coverage and hygiene coverage in urban areas National Sanitation and Hygiene Strategy 2018 – 2024 STRATEGIC THEME AREA 3: INSTITUTIONAL SANITATION AND HYGIENE Outcome: Increased access and use of improved and appropriate sanitation and hygiene facilities for all in institutional settings IN ODF declared areas Objective(s) Output(s) Performance Indicator(s) Baseline Target Source(s) of Responsible Verication ofce To increase Improved sanitation Number of reviewed and revised 0 1 Available MoEST, MoHP, sustained access and hygiene in school standards (ensuring child standards MoLG&RD and use of schools (including friendly, and inclusive designs) improved and early childhood appropriate development % of institutions provided with 45% 80% Reports and MoEST, MoHP, sanitation and centres) appropriate sanitation and minutes MoLG&RD hygiene facilities hygiene facilities for all in institutional % of schools with proper 15% 75% Reports and PTAs settings through management and maintenance minutes an integrated of school sanitation and hygiene National Sanitation and Hygiene Strategy 2018 – 2024 approach facilities Proportion of schools with 65% 100% Reports and PTAs, School, established school sanitation and minutes clubs hygiene clubs Proportion of schools with 40% 80% Reports and MoEST, MoHP, developed mechanism for safe minutes MoLG&RD pit emptying % of sensitized and enforced 65% 100% Reports and MoEST, PTA and school sanitation standards minute other Existence and stakeholders use of standards 47 48 STRATEGIC THEME AREA 3: INSTITUTIONAL SANITATION AND HYGIENE Outcome: Increased access and use of improved and appropriate sanitation and hygiene facilities for all in institutional settings IN ODF declared areas Objective(s) Output(s) Performance Indicator(s) Baseline Target Source(s) of Responsible Verication ofce Improved sanitation % of health facilities sensitised 55% 95% Health facility MoHP, NSHTC and hygiene in and enforced with health facilities reports and health facilities standards minutes of meetings % of Health facilities provided 75% 90% Health facility MoHP, NSHTC with adequate sanitary facilities reports and (with appropriate security) and minutes of resources meetings % of health facilities with 75% 90% Health facility MoHP, NSHTC managed and maintained reports and sanitation and hygiene facilities minutes of meetings % of Health facilities allocated 75% 90% Health facility MoHP, NSHTC with adequate resource for the reports and development, maintenance and minutes of cleaning of sanitary facilities meetings % of Health facilities used as a 75% 90% Health facility MoHP, NSHTC central hub for sanitation and reports and hygiene education in the minutes of community meetings National Sanitation and Hygiene Strategy 2018 – 2024 STRATEGIC THEME AREA 3: INSTITUTIONAL SANITATION AND HYGIENE Outcome: Increased access and use of improved and appropriate sanitation and hygiene facilities for all in institutional settings IN ODF declared areas Objective(s) Output(s) Performance Indicator(s) Baseline Target Source(s) of Responsible Verication ofce Improved sanitation % of markets with reviewed and 35% 75% Reports and MoHP, and hygiene in revised market standards across minutes of MoLG&RD, markets the country meetings NSHTC, DCTs % of markets with sensitized staff 35% 75% Reports and MoHP, and enforced market standards minutes of MoLG&RD, meetings NSHTC, DCTs Number of markets allocated with 35% 75% Reports and MoHP, adequate sanitary facilities (with minutes of MoLG&RD, appropriate security) and meetings NSHTC, DCTs National Sanitation and Hygiene Strategy 2018 – 2024 resources Proportion of markets with well 35% 75% Reports and MoHP, managed and maintained minutes of MoLG&RD, sanitation and hygiene facilities meetings NSHTC, DCTs Number of inspections conducted 35% 75% Reports and MoHP, markets to ensure compliance minutes of MoLG&RD, with standards meetings NSHTC, DCTs Improved sanitation % of public institutions with 25% 70% Existence and MoHP and hygiene in reviewed and revised standards use of (Directorate of public institutions across the country standards, Preventive reports Health, NSHTC 49 50 STRATEGIC THEME AREA 3: INSTITUTIONAL SANITATION AND HYGIENE Outcome: Increased access and use of improved and appropriate sanitation and hygiene facilities for all in institutional settings IN ODF declared areas Objective(s) Output(s) Performance Indicator(s) Baseline Target Source(s) of Responsible Verication ofce % of markets with sensitized staff 35% 75% Existence and MoHP and enforced market standards use of (Directorate of standards, Preventive reports Health, NSHTC Number of public institutions 20% 70% Survey and MoHP allocated with adequate sanitary inspection (Directorate of facilities (with appropriate reports Preventive security) and resources Health, NSHTC Proportion of public institutions 20% 70% Survey MoHP with well managed and maintain inspection and (Directorate of end sanitation and hygiene reports Preventive facilities Health, NSHTC) Number of inspections conducted 20% 70% Inspection MoHP public institutions to ensure Reports (Directorate of compliance with standards Preventive Health, NSHTC) National Sanitation and Hygiene Strategy 2018 – 2024 STRATEGIC THEME AREA 4: BEHAVIOUR CHANGE AND COMMUNICATION Outcome: Sensitised and raised public awareness on the benets of improved environmental sanitation and hygiene practices sanitation and hygiene. Objective(s) Output(s) Performance Indicator(s) Baseline Target Source(s) of Responsible Verication ofce To ensure that Consolidated Frequency of reviewed current N/A 5 Review MoHP, NSHTC programs hygiene behaviours sanitation and hygiene meetings incorporate to be prioritised for programmes and research reports promotive behaviour change. implemented by various approaches that is stakeholders cognisant of context, Number of Consultation with NA 10 Minutes of MoHP, NSHTC, technology, stakeholders held. consultative Development behavioural meetings partners science and economics for Developed Number of co-designed Documented MoHP, NSHTC, National Sanitation and Hygiene Strategy 2018 – 2024 NA 8 improved communication communication programmes with communication Development sanitation and messages and beneciaries programmes partners hygiene. methods for prioritised hygiene behaviours using appropriate models of behaviour change communication based on behaviour centred design (Annex X). 51 52 STRATEGIC THEME AREA 4: BEHAVIOUR CHANGE AND COMMUNICATION Outcome: Sensitised and raised public awareness on the benets of improved environmental sanitation and hygiene practices sanitation and hygiene. Objective(s) Output(s) Performance Indicator(s) Baseline Target Source(s) of Responsible Verication ofce Implemented Number of dissemination NA 29 Documented MoHP, NSHTC, comprehensive programmes developed dissemination Development behaviour change programmes with stakeholders programmes partners communication programme Number of launched 0 1 Documented MoHP, NSHTC, communication programmes launched Development through appropriate channels communication partners programmes Improved household % of households using 36.7% 85% Reports from MoHP, NSHTC, and personal appropriate HWFWS extension Development hygiene practices workers partners National Sanitation and Hygiene Strategy 2018 – 2024 STRATEGIC THEME AREA 5: WASTE MANAGEMENT Outcome: Enhanced sustainable waste management practices and ensured and maintained clean and healthy environment. Objective(s) Output(s) Performance Indicator(s) Baseline Target Source(s) of Responsible Verication ofce To promote Promoted and Number of developed town, Total of Reports and MoLG&RD, sustainable waste ensured municipality, town councils district districts, minutes of MoHP, NSHTC management sustainable solid based investment plan for refuse town meetings practices and waste collection and disposal assemblies, ensure clean and management municipaliti healthy practices es In environment. Malawi Number of developed guidelines 1 1 Existence of the MoLG&RD, and standards ideal for managing standards MoHP, solid waste Department of Environmental National Sanitation and Hygiene Strategy 2018 – 2024 Affairs NSHTC Number of private /public 0 2 MOUs MoLG&RD, partnership involved in waste MoHP, NSHTC management; Number of inspection and cases 0 5 Prosecuted MoHP, brought for prosecution cases or court Department of les Environmental Affairs, Judiciary Number of solid waste recycling 2 29 MOUs, reports MoHP, centres owned by the public and MoLG&RD private sector; 53 STRATEGIC THEME AREA 5: WASTE MANAGEMENT 54 Outcome: Enhanced sustainable waste management practices and ensured and maintained clean and healthy environment. Objective(s) Output(s) Performance Indicator(s) Baseline Target Source(s) of Responsible Verication ofce Number of public awareness 0 29 Reports MoHP (Health campaigns on solid waste education management techniques; section, Advocacy group Number or percentage of 0 17 Rehabilitation MoLG&RD, rehabilitated existing solid waste reports MoHP, MoAIWD facilities Promoted and Number of developed guidelines 0 2 Existence of MoLG&RD, ensured and standards ideal for industrial guidelines MoHP, MoAIWD, sustainable and hazardous waste NSHTC, industrial and other Department of hazardous waste Environmental management Affairs practices Number of industrial waste 0 1 Existing MBS, monitoring and surveillance monitoring and Department of systems surveillance Environmental systems Affairs, MoHP Number of inspection and NA 5 Inspection MoHP, MBS. prosecuted cases for industrial reports and Department of and hazardous waste documented Environmental mismanagement court cases Affairs National Sanitation and Hygiene Strategy 2018 – 2024 STRATEGIC THEME AREA 5: WASTE MANAGEMENT Outcome: Enhanced sustainable waste management practices and ensured and maintained clean and healthy environment. Objective(s) Output(s) Performance Indicator(s) Baseline Target Source(s) of Responsible Verication ofce Number of incinerators 9 58 Existence of MoHP, constructed and put into use for working MoLG&RD incinerators of industrial waste incinerators handling Number of Public awareness NA 29 Awareness MoHP (Health campaigns conducted for campaign education unit), industrial and hazardous waste reports development management partners, advocacy groups Promoted and Number of developed guidelines 0 1 Existence of MoLG&RD, National Sanitation and Hygiene Strategy 2018 – 2024 ensured and standards ideal for medical guidelines MoHP, MoAIWD, sustainable waste; NSHTC, medical waste Department of management Environmental Affairs Number of medical waste 0 1 Existing MBS, monitoring and surveillance monitoring and Department of systems; surveillance Environmental systems Affairs, MoHP Number of inspection and NA 5 Inspection MoHP, MBS. prosecuted court cases for reports and Department of medical waste documented Environmental court cases Affairs 55 56 STRATEGIC THEME AREA 5: WASTE MANAGEMENT Outcome: Enhanced sustainable waste management practices and ensured and maintained clean and healthy environment. Objective(s) Output(s) Performance Indicator(s) Baseline Target Source(s) of Responsible Verication ofce Number of constructed 9 58 Existence of MoHP, incinerators for medical waste working MoLG&RD handling incinerators %r of waste handlers using colour 5% 80% Medical waste MoHP, NSHTC coding for medical waste at the handling reports point of generation. Existence of infection prevention committee at the health facility Promoted and Number of developed district and 0 One for Existence of MoLG&RD ensured city based investment plan for district and investment sustainable urban waste water management; city councils plans wastewater guidelines and standards ideal for management. waste water management Percentage of inspections carried 50% of the Inspection MoLG&RD, out and number of cases cases reports MoHP , NSHTC prosecuted for waste water reported and recorded National Sanitation and Hygiene Strategy 2018 – 2024 STRATEGIC THEME AREA 5: WASTE MANAGEMENT Outcome: Enhanced sustainable waste management practices and ensured and maintained clean and healthy environment. Objective(s) Output(s) Performance Indicator(s) Baseline Target Source(s) of Responsible Verication ofce Number of infrastructure for waste 9 58 Available MoG&RD, MoHP water handling infrastructures, survey reports Number of public awareness NA 29 Awareness MoHP (Health campaigns conducted for waste campaigns Education water management reports survey section) reports Number of rehabilitated existing NA 17 Reports from MoLG&RD, waste water facilities DCTs and MoHP councils, survey National Sanitation and Hygiene Strategy 2018 – 2024 reports Number of waste water recyclers NA 84 MOUs MoLG&RD, MoHP Number of regulated pit emptying 5 29 Existence of MoHP, mechanisms. adopted newly adopted Department of pit emptying Environmental facilities Affairs, MBS Increase district Number of trainings of NA 200 Training reports, MoLG&RD, and city authorities’ appropriate personnel on Certicates of MoHP, Training capacity guidelines attendance institutions management solid waste. % increase in nancial support 3% 50% MOUs, Financial MoLG&RD, provided to maintain effective reports, grants MoHP, waste collection services where proposal funded Department of 57 STRATEGIC THEME AREA 5: WASTE MANAGEMENT 58 Outcome: Enhanced sustainable waste management practices and ensured and maintained clean and healthy environment. Objective(s) Output(s) Performance Indicator(s) Baseline Target Source(s) of Responsible Verication ofce appropriate Environmental Affairs, Development partners Number of training private 3 29 Training reports, MoHP, industries on waste recycling Certicates of Department of attendance Environmental Affairs, Training institutions % Increase of access to recycling 10% 60% Waste recycling MoHP, opportunities for households. reports MoLG&RD, Department of Environmental Affairs National Sanitation and Hygiene Strategy 2018 – 2024 STRATEGIC THEME AREA 6: MENSTRUAL HYGIENE MANAGEMENT Outcome: Improved sustained access to quality and appropriate menstrual hygiene services Objective(s) Output(s) Performance Indicator(s) Baseline Target Source(s) of Responsible Verication ofce To increase Improved Number of developed guidelines 0 1 Existing and MoEST, sustained access menstrual health and standards for absorbent used guidelines MoGCSW, to quality and and hygiene materials MoHP appropriate practices menstrual hygiene services Number of developed checklist 0 1 Existing and MoEST, that is inclusive of all the used, checklist MoGCSW, sanitation standards including MoHP MHM % of Primary & Higher education 58 80% Availability of MoEST, institutions with MHM included in curriculum MoGCSW MoHP National Sanitation and Hygiene Strategy 2018 – 2024 the curriculum incorporating MHM Improved Number of existence of Fully 0 1 Availability of MoEST menstrual hygiene functional commodity supply distribution MoGCSW MoHP facilities chain system centres in rural and urban centres for sanitary pads and towels supply (buying) Number of centres established to 58 300 Availability of MoEST, support the provision of MHM distribution MoGCSW MoHP facilities and absorbent materials centres in rural and urban 59 STRATEGIC THEME AREA 6: MENSTRUAL HYGIENE MANAGEMENT 60 Outcome: Improved sustained access to quality and appropriate menstrual hygiene services Objective(s) Output(s) Performance Indicator(s) Baseline Target Source(s) of Responsible Verication ofce to girls and women centres for sanitary pads and towels supply (buying) % of public schools with regularly 58 80% Availability of MoEST, MoHP, supplied with sanitary towels/pads distribution MoGCSW centers around schools and in schools themselves Promoted MHM Number of coordinate campaigns 0 300 Campaigns MoHP, MoEST, awareness conducted to raise awareness report, survey MoGCSW PTAs and reduce stigma around reports menstrual hygiene issues Number of advocacy meetings 0 58 Advocacy MoHP, MoEST, held for MHM meeting reports, MoGCSW survey reports Advocacy groups National Sanitation and Hygiene Strategy 2018 – 2024 STRATEGIC THEME AREA 7: CROSS CUTTING ISSUES (Financing. Leadership, Coordination and Research and knowledge exchange Outcome 1.1ncreased mobilization of nancial resources and enhanced efcient management of nancial resources by 2024 for sanitation and hygiene Objective(s) Output(s) Performance Indicator(s) Baseline Target Source(s) of Responsible Verication ofce To ensure Increased domestic % of government expenditure on 0.03% from 5% NHA Report MoHP effective tax-based nancing sanitation and hygiene as ORT nancing, for the health percentage of total Government sector expenditure leadership, coordination and knowledge Project grant Number of project grant proposal NA 29 Grant proposals MoHP, MoAIWD, exchange to proposals funded written NSHCU, NSHTC achieve targets in development sanitation and enhanced hygiene for all. National Sanitation and Hygiene Strategy 2018 – 2024 Public private Percentage of private expenditure 11% 46% NHA Report MoHP partnerships as a percentage of total established Sanitation and hygiene expenditure Donor and partner Proportion of donors and partners NA 75% Aid Coordination MoHP (Aid coordination with approved MOUs unit database s Coordinating enhanced to unit), Donor ensure alignment partners to national, and local authority priorities 61 62 STRATEGIC THEME AREA 7: CROSS CUTTING ISSUES (Financing. Leadership, Coordination and Research and knowledge exchange Outcome 1.1ncreased mobilization of nancial resources and enhanced efcient management of nancial resources by 2024 for sanitation and hygiene Objective(s) Output(s) Performance Indicator(s) Baseline Target Source(s) of Responsible Verication ofce Pooling and Percentage reduction of 11% 46% NHA Report MoHP (Aid management of fragmented pools of health Coordinating local and external resources unit), MoAIWD, sector resources Donor partners strengthened Pro-active Percentage increase in number of 0% 100% Department of MoHP mechanisms for Sanitation and hygiene grants Health (Department of mobilizing external mobilized from external resources Research Health Research resources annual reports promoted Prudence, Percentage reduction in sanitation 0% 100% Financial and MoHP., MoAIWD efciency, and hygiene nancial and Procurement transparency and procurement audit queries Audit Reports accountability in the use of sanitation and hygiene nancial resources promoted Mechanisms for Percentage of revised allocation NA 80% Department of Department of equitable and formula in place Planning and Planning and efcient allocation Policy Policy of sanitation and Development Development hygiene related reports National Sanitation and Hygiene Strategy 2018 – 2024 STRATEGIC THEME AREA 7: CROSS CUTTING ISSUES (Financing. Leadership, Coordination and Research and knowledge exchange Outcome 1.1ncreased mobilization of nancial resources and enhanced efcient management of nancial resources by 2024 for sanitation and hygiene Objective(s) Output(s) Performance Indicator(s) Baseline Target Source(s) of Responsible Verication ofce resources strengthened Investment plan Number of investment plans 23 35 Development Ministry of developed developed by the cities, plans put in Economic municipalities, towns and districts place planning Increased nancial % of vulnerable and marginilised NA 30% Availability of MoHP, support for the accessing funding or given funding for the MoGCSW, National Sanitation and Hygiene Strategy 2018 – 2024 vulnerable and subsidy vulnerable and Development marginalised marginilised partners populations 63 STRATEGIC THEME AREA 7: CROSS CUTTING ISSUES (Financing. Leadership, Coordination and Research and knowledge exchange 64 Outcome 2: Improved leadership and coordination to support strategy activities implementation at all levels by 2024 Objective Output(s) Performance Indicator(s) Baseline Target Source(s) of Responsible Verication ofce To improve Established strong Number of communication reports 29 29 Communication MoHP (NSHCU) leadership and communication and written reports and coordination to reporting lines memos and support strategy between the reports activities national EH section implementation at all levels Established Number of established enabling 0 1 NSHTC reports MoHP, MoAIWD, enabling national institutional framework and minutes NSHCU institutional framework Strengthened DCT % of DCT strengthened in all 0 29 DCT reports and MoHP, DCTs in all districts districts minutes Established Number of established enabling 0 1 Existence MoHP, MoAIWD, enabling national national institutional framework /availability of NSHCU, institutional frameworks Judiciary framework Scaled up and Number of NSHS dissemination 1 2 l or monthly MoHP, MoAIWD, enhanced meetings conducted at all levels; reports NSHTC, NSHCU coordination Dissemination mechanisms at the forums national and district levels National Sanitation and Hygiene Strategy 2018 – 2024 STRATEGIC THEME AREA 7: CROSS CUTTING ISSUES (Financing. Leadership, Coordination and Research and knowledge exchange Outcome 2: Improved leadership and coordination to support strategy activities implementation at all levels by 2024 Objective Output(s) Performance Indicator(s) Baseline Target Source(s) of Responsible Verication ofce Number of signed Memorandums NA 3 MOUs MoHP, MoAIWD , of Understanding with partners NSHTC, NSHCU working in sanitation and hygiene Number of lead regular 4 12 Coordination MoHP coordination and sector meeting minutes (Directorate of strengthening meetings; and reports Preventive Health) Strengthened Number of established strong All districts All Communication MoHP, DCTs, coordination communication and reporting districts reports NSHCU linkages across lines between the national EH Established National Sanitation and Hygiene Strategy 2018 – 2024 national, district section, District Coordination reporting lines and community Team, health surveillance levels assistants, water monitoring ofcers and partners; Number of established strong All districts All Communication MoHP, MoAIWD, communication and reporting districts reports NSHCU lines between the national EH Established section, District Coordination reporting lines Team, health surveillance assistants, water monitoring ofcers and partners; 65 66 STRATEGIC THEME AREA 7: CROSS CUTTING ISSUES (Financing. Leadership, Coordination and Research and knowledge exchange Outcome 3: Enhanced research capacity and knowledge exchange, and Improved collaborative links by 2024 Objective(s) Output(s) Performance Indicator(s) Baseline Target Source(s) of Responsible Verication ofce To enhance Increased use of Number of guidelines for Health N/A 4 Policy Policy research capacity, evidence based Policy Development revised and in Development Development knowledge decision making in place Unit reports Unit exchange and programme and improve policy development collaborative links Research data- Number of data base or repositories 0 1 National Health MoHP base established created Accounts Report (Department of Research) Local capacity to Percentage of sanitation and 2% 15% National Health MoHP carry out policy hygiene expenditure allocated to Accounts Report (Department of relevant health research activities Research) research strengthened A developed clear Percentage of research 2% 15% Health MoHP research agenda conducted in line with national Research (Department of for sanitation and sanitation and hygiene research Department Research) hygiene sector. agenda reports Mechanisms for Number of tools for monitoring 0 1 Research MoHP monitoring implementation of policies, reports and (Department of implementation of strategies, plans put in place minutes of Research) sanitation and research hygiene research meetings generated policies, strategies and National Sanitation and Hygiene Strategy 2018 – 2024 STRATEGIC THEME AREA 7: CROSS CUTTING ISSUES (Financing. Leadership, Coordination and Research and knowledge exchange Outcome 3: Enhanced research capacity and knowledge exchange, and Improved collaborative links by 2024 Objective(s) Output(s) Performance Indicator(s) Baseline Target Source(s) of Responsible Verication ofce plans institutionalized Mechanisms for Number of knowledge translation 0 1 Health MoHP Knowledge platform put in place Research (Department of translation Department Research) strengthened reports Increased access Number of developed sanitation 2 4 existing and Research National Sanitation and Hygiene Strategy 2018 – 2024 to appropriate technology options adopted new Institutions, Sanitation and technologies Masons, MoHP, Hygiene Development technology options partners especially for the vulnerable and the % increase in access to products 20% 45% Existence of MoGCSW, poor and services for the vulnerable subsidies to the MoHP and marginalized vulnerable and marginalised % of marginilised benetting from NA 90% existing and MoGCSW, user friendly technologies adopted new MoHP technologies 67 68 STRATEGIC THEME AREA 7: CROSS CUTTING ISSUES (Financing. Leadership, Coordination and Research and knowledge exchange Outcome 3: Enhanced research capacity and knowledge exchange, and Improved collaborative links by 2024 Objective(s) Output(s) Performance Indicator(s) Baseline Target Source(s) of Responsible Verication ofce Improved Number of collaborative research 2 15 Collaborative Research collaborative links agreements made research institutions, meetings, development MOUs partners, MoHP, MoAIWD Number of collaborative projects 2 15 MOUs Research institutions, partners, MoHP, MoAIWD Number of contract research 2 15 Existence of Research enhanced contracts, institutions, MOUs development partners, MoHP, MoAIWD, development partners NB: Key assumptions made to this implementation and implementation matrix are presented in Table 3 above National Sanitation and Hygiene Strategy 2018 – 2024 National Sanitation and Hygiene Strategy 2018 – 2024 Annex C: Policy Linkages Declara on/Policy What it s pulates Alma Atta Declaration An International Conference of Primary Health Care which was held on 12th September, 1978, expressed the need for urgent action by all governments, all health and development workers and the world community to protect and promote health for all people of the world. Primary health care is essential health care based on practical, scientifically sound and socially acceptable methods and technology made universally accessible to individuals and families in the community through their full participation and at a cost that the community and county can afford to maintain at every stage of their development in the spirit of self-reliance and self- determination Social determinant of health were also recognized including adequate supply of safe water and basic sanitation as important for Primary Health Care Ottawa Charter An international conference of health promotion was held in Ottawa-Canada in 1986. The outcome of this conference was a creation of the Ottawa Charter which has five main priority areas as follows: • Building Public Policy: enables a healthy choice to be an easy choice • Strengthening Community Action: to empower communities • Developing Personal Skills: to make healthy decisions people need information and education • Reorienting Health services: the health system must go beyond clinical and curative services and needs to also focus on promoting health and preventing disease • Creating Supportive Environments: Living and working conditions should promote health EThekwini Declaration Declaration on Sanitation and Hygiene, 2008, Made at the AfricaSan conference on Sanitation and Hygiene, 2008 during the international Year of Sanitation by the Ministers and Heads of Delegation responsible for sanitation and hygiene from 32 African countries, together with senior civil servants, local government officials, professionals from sector institutions, academia, civil society, development partners, and the private sector under the auspices of the African Ministers’ Council on Water and Sanitation (AMCOW), and the other co-hosts of AfricanSan at the second African Conference on Hygiene and Sanitation in Durban, South Africa , 2008. 69 National Sanitation and Hygiene Strategy 2018 – 2024 Declaration/Policy What it stipulates Libreville Declaration, 2008 & NGOR Declaration, 2014 Declarations on Health and Environment which commit countries to provide resources for sanitation and hygiene. African ministers responsible for health and the environment, meeting from 28 to 29 August 2008 in Libreville, Gabon; Reafrmed their commitment to implement all conventions and Declarations that bear on health and environment linkages. The Constitution of Malawi The strategy is aligned with the Constitution under CAP. 34:01. The section provides for the enforcement of sanitation and hygiene in Malawi. Malawi Vision 2020 Vision 2020 is an overarching Policy document for the Government of Malawi. It outlines key strategic options for improving the health status of Malawians. Malawi Growth and Development An overarching strategic document identifies Health as one Strategy III of the national priorities. The MGDS recognizes that a healthy and educated population is essential if Malawi is to achieve sustainable socio-economic growth National Sanitation Policy, 2008 Helps to coordinate stakeholders in implementation of sanitation and hygiene in Malawi National Health Policy, 2018 Provides a comprehensive framework for achieving national health system that is well-functioning, improves health, prioritizes satisfaction and financial protection of patients, and contributes to UHC National Health Promotion Policy, Harmonizes the dissemination of messages for health 2016 including sanitation and hygiene National Environmental Health Promotes the protection of environmental pollution Policy, 1997 National Community Health Defines a new community health system for Malawi, Strategy, 2017-2022, including the package of essential health services to be delivered at the community-level by community health workers 70 National Sanitation and Hygiene Strategy 2018 – 2024 Declaration/Policy What it stipulates Decentralization Policy, 1997 Spells out the responsibilities of government departments and agents at district and local levels National Water Policy, 2005 Regulates the provision of safe water supply Policy on Equalization of Opportunities on People with Strives to make water and sanitation services and facilities Disability, 2006 more inclusive and accessible for Persons with Disability. 71 ASH Sector