The WASH specialist from Sihay: coronavirus insights from an ex-Oxfamer’s 15 years’ experience

Margaret (R) during a visit to Mahama Burundi refugee camp in Rwanda when a water storage tank was under construction by Oxfam in November 2015. Photo by Mark Chitelesi/Oxfam.

My fear is that COVID-19 cases are increasing in the region when most countries are not very well prepared. Some countries are already weakened by multiple crises such as droughts, floods and locusts.

Margaret Apiyo Asewe grew up in a tiny village in Kenya called Sihay in Siaya County, Ugenya Sub-County. She grew up seeing children and adults suffer due to limited water access. She herself walked 2 kilometers every morning and evening to fetch water from river ‘Nyachim’. She saw how diarrhoea related diseases impacted her community. This inspired her to work as a public health nurse. Now, she has just retired after working with Oxfam for 15yrs leading improvements in water access, sanitation and hygiene for people across the world who Oxfam supports.

Her successes? Strengthening dialogue between communities and Oxfam. Championing a dynamic rethink of the humanitarian-development nexus. Supporting over 16 countries (including Afghanistan, Chad, DRC, Ethiopia, Haiti, Indonesia, Kenya, Pakistan, Philippines, Rwanda, Sierra Leone, Somali, South Sudan, Tanzania and Uganda) in emergency WASH programmes during droughts, Tsunami, earthquake, typhoon, floods, conflict and disease outbreaks such as Ebola, and recently, COVID-19. She lays all her achievements at the feet of the belief that everyone has a role to play in fighting inequality and in ending poverty and injustice. And she continues to rise, championing the need to utilize local systems during humanitarian responses.

Martin Namasaka, our Regional Media and Communications Advisor had a good natured and honest skype-call interview with Margaret. Her sitting in flood-hit Kisumu, in western Kenya, him working from home in drizzly Dar es Salaam, Tanzania.

Martin: Apiyo? Not a name I would say I heard before. What does it mean?

Margaret: Apiyo means the first twin. I have a twin sister, who works in the health sector too.

Martin: What have you been engaged in while working at Oxfam?

Margaret: First, I had the chance to work in different capacities during my time at Oxfam. These include the Public Health Promotion Team (PHP) Team Leader, PHP capacity builder, PHP coordinator and most recently as the Horn East and Central Africa (HECA) Regional WASH Advisor. In my capacity as the HECA Regional WASH Advisor, I was at the forefront of advocating for the community engagement approach in our programming in the region. I represented Oxfam in various high-level platforms such as the WASH cluster working group, cholera platforms, the WHO and health partners meetings and many more. I was there during the 2014 – 2016 Ebola outbreak in West Africa and I have been here during the COVID-19 pandemic, supporting country offices within HECA (Burundi, DRC, Ethiopia, Kenya, Uganda, Rwanda, Sudan, Somalia, South Sudan and Tanzania) in prevention and preparedness.

Second, besides supporting recruitement of WASH teams in the region including those in the Global Humanitarian Team (GHT) I also provided technical support, guidance and capacity building to staff and partners. This strengthened programme quality and regional staff skills in humanitarian programming, disaster risk reduction programming and building links between long-term livelihood interventions and public health priorities.

Third, Oxfam has a long history of developing new innovations and technologies, and since 2004 I have supported field testing and feedback of these innovations for emergency responses. It is important to listen to communities and when changing our programming we should always consider feedback from affected communities.

Some of the climate resilient WASH interventions that Margaret has supported in HECA.

Some of the innovations and technologies that I have supported include handwashing practices especially for children, e.g. 'Mums’ Magic Hands' which encourages handwashing practices at critical times. Others include testing of sustainable sanitation – urine diversion toilets, tiger worm toilet (TWT) and community engagement in WASH.

Handwashing nudges research in 2017-2018 to motivate handwashing outside latrines in Nduta camp in Tanzania. Photo by Margaret Asewe/Oxfam.

Martin: What challenges do you see in the WASH Sector and what does it mean for the COVID-19 response?

Margaret: Often, WASH works separately from the health sector, there is now a need for these activities to be considered an essential public health intervention.

The COVID-19 pandemic presents a challenge for those working in the water, sanitation, and hygiene sector. The time is now for WASH professionals to re-envision their strategies — and to do it quickly.

People living in densely populated settings — including urban areas, refugee and internally displaced people camps, and prisons — are especially vulnerable.

Left: Margaret conversing with partners during a visit to IDP camps in Wau, South Sudan, to support the Ebola preparedness work.

There are also questions and concerns around the technical capacity of WASH workers. Travel restrictions limit the ability of organizations to send experts to countries struggling to control the virus. Because of this, we need to use the expertise that is already on the ground as much as possible. The scale of COVID-19 emphasizes the need for localization of humanitarian responses. We are now seeing how important it is to strengthen and utilize local systems, particularly given the operational constraints on aid agencies and the scale of this crisis.

In terms of the health of WASH workers, some of the most vulnerable will include workers in health care facilities, especially those removing bodies after COVID-19 related deaths. We can't afford to have WASH professionals sick in large numbers — that would really have a direct impact on access to WASH services.

Existing ways of accessing communities may not be feasible during the COVID-19 pandemic because of the emphasis on social distancing to prevent the spread of the virus. We need to emphasize the importance of not conducting any community events to promote hygiene so that we are not increasing the likelihood of exposure. Reaching more communities through digital and other social media platforms is now necessary.

Martin: What’s the future of the WASH sector?

Margaret: The WASH sector will remain relevant in humanitarian responses especially in the HECA region. The humanitarian context of the region is dominated by double crises, conflict, climate-induced drought and flooding, locust infestation and food insecurity. However, traditional approaches to humanitarian assistance are constantly challenged by both protracted emergencies with populations remaining displaced and dependent on humanitarian aid for many years. There is need to move beyond handouts and leverage on local systems especially during the COVID-19 response.

Access to safe water and sanitation is a major priority in these crises; a human right and component of ensuring living in dignity especially for people afflicted by and made more vulnerable by the emergencies. Without access to safe water and sanitation services, displaced people are at a high risk of disease outbreaks when forced to live in conditions where they are overcrowding and with poor hygiene practice.

Beyond COVID-19, there will always be the need for WASH in most humanitarian programmes. However, we may need to do it differently. The future of Oxfam’s relevance in the WASH sector depends on its ability to continue looking at technologies that offer better returns; both in terms of quality and quantity for water and sanitation; systems that facilitate sustained access to safe water and sanitation. But, most importantly adoption of approaches that encourage continued engagement with communities, listening to the voices of those we work with so that they can be part of generating solutions to their challenges and implementing them.