On December 3, 2024, the Hands4Health consortium gathered online for its final general meeting. Held via Zoom from 9:00 AM to 1:00 PM CET, the meeting provided an essential moment for reflection and forward planning. Representatives from all partner organizations attended, with discussions focused on achievements, challenges, and the future of the consortium.
The meeting opened with the importance of reflecting on the milestones and lessons of 2024, discussing achievements, addressing obstacles, and sharing diverse insights from partners across countries while looking at what stays beyond the project. The meeting also served as a celebration of the dedication and collaboration that fueled the year’s success.
Reflections on 2024
The year was marked by significant progress, including the completion of endline data collection across the four project countries: Mali, Burkina Faso, Nigeria, and Palestine. Continuing work on innovations in topics such as drinking water chlorination, infrastructure rehabilitation, and efforts to scale behavior change initiatives were key highlights. Strengthening engagement with national authorities yielded significant positive results, for example, improving national guidelines for water chlorination in Mali or establishing a nationwide platform for monitoring chlorine levels in drinking water in schools in Palestine. Additionally, there was significant progress in the development of resources like fact sheets, technical guidelines, and a smartphone-based app for water chlorination. Activities conducted with control groups in the project areas provided deeper insights into the local contexts and factors influencing the health outcomes measured by the project.
Despite these accomplishments, several challenges underscored the year. Ongoing complex crises in Palestine, Mali, and Burkina Faso, severe flooding in Maiduguri, Nigeria, and funding shortfalls hindered some activities. The complexity of coordinating many and diverse consortium members (and their local sub-contractors) added to these hurdles, highlighting areas for improvement.
Country Highlights
In Mali, the production and installation of 24 Gravit’eau stations were accompanied by training on maintenance. Baseline, midline, and endline data collection were successfully conducted in 24 health care facilities. Further achievements included the successful implementation of RANAS campaigns, chlorination training, and support for the Ministry of Health in creating a national water chlorination protocol. Looking ahead, data analysis and result communication are planned for early 2025, with further opportunities to explore evidence-building on hand hygiene and showcasing success stories.
Burkina Faso saw the drafting and monitoring of 24 Gravit’eau units and follow-ups on water quality. RANAS campaigns in 12 health centers and chlorination training for 20 health workers marked progress. However, challenges in result interpretation highlighted areas for technical improvement. Promoting Gravit’eau to other NGOs and projects remains a key goal.
In Nigeria, the rehabilitation of water sources and the upgrade of 33 Gravit’eau stations were complemented by the distribution of latrine cleaning kits and extensive training for teachers on WASH maintenance and chlorination. Focus group discussions, stakeholder interviews, and post-flood WASH assessments demonstrated comprehensive engagement. In particular, relations to the Ministry of Health, the Ministry of Education and the Rural Water Supply and Sanitation Agency were intensified, with trainings on chlorination, FRC measurements and on handwashing implemented. Revitalized hygiene clubs and training for 450 members underscored the commitment to community-driven solutions. However, the devastating floods added to the existing challenges like infrastructure maintenance, and they reduced sample sizes due to student transfers, which impacts the statistical analysis of data. Research data showed that the intervention led to strong increases in handwashing behavior among students (particularly before eating), both in self-reported and in observed data. Data analysis is on-going, as well as rehabilitation of WASH infrastructure in schools.
The efforts in Palestine included the rehabilitation of 10 schools in the control group and RANAS implementation in 8 schools. In the face of the difficulties encountered in implementing infrastructure-based interventions, complementary activities such as trainings in MHPS were implemented. Qualitative data collection efforts, such as key informant interviews, provided valuable insights, though the ongoing crisis led to the cancellation of enplane activities. Monitoring data from the field highlighted significant deficiencies related to the levels of FRC (Free Residual Chlorine) in water and underscored the need for booster chlorination and improved mixing in water storage tanks.
Endline Findings in Mali and Burkina Faso
The study in Mali and Burkina Faso, conducted across 48 healthcare centers and involving 309 health workers, revealed minimal differences between control and intervention groups (preliminary results subject to review and change) . Potential explanations for these findings included staff turnover, inconsistent soap use, and infrastructure disparities. Despite these challenges, the interventions’ strengths lie in their capacity-building initiatives, collaborative efforts, and the support of ministries of health.
Updates and Innovations
Key updates from 2024 included the ongoing development of a searchable database integrated into the project website and enhancement to Gravit’eau designs, such as improved soap dispensers and filtration systems. The chlorination app, a multilingual, open-source tool, promises to support accurate chlorine dosing and user feedback. Representation at international conferences, including events in Switzerland, the USA, China, and Taiwan, showcased the consortium’s active global engagement.
Looking Ahead
As 2024 draws to a close, Hands4Health reflects on a year of resilience, innovation, and impactful collaboration. While challenges remain, the consortium is committed to building on its successes, fostering stronger partnerships, and advancing its mission into 2025 and beyond. Together, the team remains dedicated to improving health and hygiene outcomes across its project regions. One highlight to look forward is the planned Symposium, to be jointly organized by members of the h4h consortium and the Swiss Water and Sanitation Consortium in June 2025.