As the world wraps up with the pursuit of the Millennium Development Goals (MDGs), it is now time for stakeholders to pause, reflect, and take stock of the strengths, weaknesses, and gaps that characterized the 15-year period of hardwork toward the creation of a better world. Remarkably, some developing countries have made great strides, namely, in improving maternal health, reducing child mortality, and ensuring universal basic education. However, there are still other countries that for various reasons, have made little progress on some of the United Nations' MDGs. Globally-speaking, one may agree that all countries need to continue to strive to attain environmental sustainability. We still have a long way to go in working to create a world where more than half of the population have reliable and continuous access to safe drinking water, and where all countries - both rich and poor - "integrate the principles of sustainable development into policies and programs and reverse loss of environmental resources."
As scientists, epidemiologists, economists, and other professionals within the public health sphere, how do we measure how far we have come, and how far we still need to go in improving lives? With this question in mind, the Johns Hopkins Water Institute and World Bank Water and Sanitation Program (WSP) convened a half-day long workshop under the heading "Monitoring Sanitation Program Progress Post-2015" at the World Bank Headquarters in Washington, D.C. The meeting brought together experts in the water, sanitation and hygiene (WASH) field who shared ideas and compared notes to identify the monitoring gaps in WASH programs carried out in developing countries. This Workshop was held on October 27, 2014 with the objective to discuss ways to collect, analyze, and display sanitation monitoring data to show how programs are contributing progress towards the post-2015 "Sustainable Development Goals." As Hopkins is one of several research entities that undertake WASH program monitoring and evaluation, the workshop served as a platform for the different entities to engage with each other for possible future collaborations. A few students - mostly from the Johns Hopkins School of Public Health- were given the opportunity to join the Water Institute and the World Bank WSP at the workshop. Our backgrounds ranged from one Master of Public Health (MPH) student who had previously served in Liberia with Doctors Without Borders and had decided to attend out of a curiousity to learn how WASH interventions could be leveraged to solve the Ebola crisis, a Master of Health Science (MHS) student at the department of Biochemistry and Molecular Biology of the JHSPH with an interest in water and health, a fresh graduate of the Master of Science in Public Health (MSPH) program concentration in Global Disease Epidemiology Control (GDEC) with a focus on the intersections of behaviour change strategies and WASH sustained adoption of WASH practices, among several others.
The speaker presentations ranged from a survey of the new sustainable development goal indicators, to specifications on novel measurement tools and metrics for evaluating these new definitions of sanitation coverage, to practical notes from World Bank field programs around the globe. The workshop included a break-out session into small groups, where attendees had the opportunity to engage in discourses with the speakers and other WASH sector experts. Luke MacDonald, who is the deputy director of the Johns Hopkins Water Institute, presented findings from an open defecation assessment in Ghana, as part of the ongoing Performance Monitoring and Accountability 2020 (PMA2020) project. PMA2020 is a five-year project that "contributes to a global monitoring and evaluation (M&E) system for family planning and provides rich information useful for reporting, planning, operational decisions and advocacy at the community, country and global levels."
Eddy Perez, a Lead Sanitation Specialist for the World Bank WSP discussed specific measurements that surveys so often lacked. He linked WASH to child growth by mentioning that countries with more access to improved sanitation are more likely to have fewer incidences of under 5 stunting. Furthermore, Mr. Perez gave a stark reminder that the current rate of global development implies that 216 million individuals around the world must have access to sanitation in order to meet the 2030 WASH sector development goals. We welcomed his emphasis on targeting programs to truly impact the poorest 40 percent and, thereby, reducing inequalities in service provision. The discussed monitoring indicators that now focus on sustainability and behavior change will, ideally, influence the agenda of implementing partners, evaluators, and policy makers to choose programs that would expand coverage and provide quality evidence to support implementation and evaluation.
The World Bank’s Sustainable Development Goals monitoring workshop was successful in providing a forum for participants to share and benefit from ideas. The next step is to translate these ideas into practical, working applications in the research and policy sectors. We need to establish usable metrics, and utilize these findings to improve implementation in a way that supports equal access and sustained behaviour change. As young and eager public health researchers, we were quite disappointed to learn during the conference that very few of these metrics exist in practice, and that virtually no indicators exist to assess sustained behaviour change. While this gap must be addressed as the field evolves, we gained a sense of the skillset and knowledge base that would be necessary to help overcome these monitoring gaps.
While the term ‘public health’ is so vast, it is exciting to discover the depths of the areas within the broad area of public health. Little did we know about the existence of the many opportunites to impact lives with the WASH field. Moreover, through our participation in the workshop, we came to understand how crucial this particular sector is - afterall, water is essential to life. But, above all, we appreciated the extent of the crisis of the unavailablity of sustainable safe drinking water and good sanitation to millions of people around the world. It is truly an exciting time for water, public health, and sanitation and hygiene. The beauty of a Hopkins education is that as it stirs up a passion from deep within you, it also equips students with the most relevant skillset and knowledge to emerge as leaders who will give their very best to "save lives, millions at a time."
About the authors: Nina Martin, MSPH is a 2014 graduate of the Global Disease Epidemiology and Control program at the Johns Hopkins Bloomberg School of Public Health. Anne-Marie Giangiulio is an MPH candidate and Afreen Khan is an MHS candidate at the Department of Biochemistry and Molecular Biology at the Bloomberg School.