Evaluation of DG ECHO’s Action in the Water and Sanitation...

Evaluation of DG ECHO’s Action in the Water and Sanitation/Public Health Sector in Zimbabwe

March 2011-May 2011

Main Report

Submitted by

Peter DeVillez (Team Leader) Christine Bousquet

Nyasha Lawrence Nyagwambo

On behalf of AGEG Consultants eG

Cost of the report in €: 87.698 Evaluation costs as percentage of budget evaluated: 0,92 %

Contract Number: ECHO/ADM/BUD/2011/01201

The report has been financed by and produced at the request of the European Commission. The comments contained herein reflect the opinions of the consultants only.

Evaluation of DG ECHO’s Action in the Water and Sanitation/Public Health Sector in Zimbabwe Main Report

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Table of Contents

LIST OF ACRONYMS ....................................................................................................................................... II

EXECUTIVE SUMMARY....................................................................................................................................1

QUESTION ............................................................................................................................................................2

CONCLUSIONS ....................................................................................................................................................2

RECOMMENDATIONS.......................................................................................................................................2

1. BACKGROUND AND INTRODUCTION ................................................................................................5

2. METHODOLOGY.......................................................................................................................................5

3. DG-ECHO IN ZIMBABWE........................................................................................................................6

4. THE WERU APPROACH...........................................................................................................................7

5. EVALUATION QUESTIONS...................................................................................................................11 5.1 RELEVANCE.........................................................................................................................................11 5.2 EFFECTIVENESS ...................................................................................................................................15 5.3 EFFICIENCY .........................................................................................................................................17 5.4 COHERENCE, COMPLEMENTARITY (LRRD).........................................................................................21 5.5 CROSS-CUTTING ISSUES.......................................................................................................................24

6. CONCLUSION AND RECOMMENDATIONS......................................................................................26


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List of Acronyms

ACF Action Contre la Faim ACP African Caribbean and Pacific ARI Acute Respiratory Infections CAP Consolidated Action Plan CFR Case Fatality Rate CPU Civil Protection Unit CTC Cholera Treatment Centre CTU Cholera Treatment Unit C4 Cholera Command and Control Centre DDF District Development Fund DEHT District Environmental Health Technician DfID Department for International Development (UK) DHO District Health Office DMO District Medical Officer DWSSC District Water Supply and Sanitation Committee EDC Department of Epidemiology and Disease Control EDF European Development Fund EHT Environment Health Technician FPA Framework Partnership Agreement FRC French Red Cross GAA German Agro Action GIZ German Technical Cooperation Agency GoZ Government of Zimbabwe HDPCG Health Development Partners Coordination Group HERU Health Emergency Response Unit HIP Humanitarian Implementation Plan HTF Health Transition Fund IDSR Integrated Disease Surveillance Response IEC Information Education and Communication IMC International Medical Corps INGO International Non-Governmental Organisation IRC International Rescue Committee IWRM Integrated Water Resources Management IWSD Institute of Water and Sanitation Development LRRD Linking Relief to Rehabilitation and Development


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MDM Médecins du Monde MDTF Multi-Donor Trust Fund M&E Monitoring and Evaluation MoHCW Ministry of Health and Child Welfare MoU Memorandum of Understanding MWRDM Ministry of Water Resources Development and Management NAC National Action Committee NCU National Coordination Unit NFI Non Food Item OCHA Office for the Coordination of Humanitarian Affairs OFDA Office of U.S. Foreign Disaster Assistance (USAID) ORP Oral Rehydration Point ORS Oral Rehydration Salts PHHE Public Health and Hygiene Education PLWWH/A People Living with HIV/AIDS PMD Provincial Medical Directorate RDT Rapid Diagnostic Test RRT Rapid Response Team SAG Strategic Advisory Group ToR Terms of Reference UNICEF United Nations International Children Fund USAID U.S Agency for International Development VHW Village Health Worker VLOM Village Level Operation and Maintenance VMAHS Vital Medicines Availability and Health Services WASH Water Sanitation and Hygiene Cluster WERU WASH Emergency Response Unit WES Water Environmental Sanitation WHO World Health Organization WVI World Vision International ZimAHEAD Zimbabwe Applied Health Education and Development (NGO) ZINWA Zimbabwe National Water Authority


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Executive Summary

1. At independence in 1980 Zimbabwe had a well developed and professionally managed municipal water and sanitation infrastructure in all major towns and cities. Between 1980 and 2000 the rural water and sanitation sector benefited from a comprehensive programme of development resulting in the overall WatSan sector being the envy of other developing countries at the end of the century. From 2000 onwards Zimbabwe suffered a dramatic decline in governance standards resulting in a catastrophic collapse in the social, economic and health sectors culminating in hyper-inflation, wide unemployment and political instability. During the same period the water and sanitation sector suffered from under investment and the abandonment of repair and maintenance programmes across the country resulting in the physical collapse of the water supply systems and sewage treatment facilities. In the rural areas the majority of water points fell into disrepair and the primary health care system all but ceased to function.

2. In 2008 cholera outbreaks occurred in some high density urban areas and infected the communities and the water and sanitation networks. Cholera rapidly spread to become an epidemic affecting nearly every region of the country; nearly 100,000 people were infected and 4,288 deaths from the disease were recorded. The epidemic peaked in January 2009 and had subsided to a minimal level by the middle of 2009. During the cholera peak, 55 out of the country’s 62 districts were affected, including major urban populations such as Harare, Kadoma and Chegutu. In 2010, twenty districts were affected and the Case Fatality Rate was still at 2.1% but the number of cholera cases was reduced to 1,022 with 22 deaths. In 2011 ten districts remain the focus of cholera alerts, mostly in Masvingo, Manicaland, and Mashonaland West provinces.

3. At the time of the cholera outbreak the Government of Zimbabwe was unable to respond to the epidemic in any meaningful way and it fell to the NGO community to fill the gap as best it could. Initially two, then later four and eventually six, international NGOs who were already working in the WatSan sector came together in 2008 to form what eventually became known as WERU (WASH Emergency Response Unit) in an attempt to deal with the rapidly spreading emergency. With grant funding from ECHO these WERU partners shared responsibility for the emergency response on a geographic basis and set up response teams to assess the water supply needs of the clinics who were reporting suspected cholera cases. The WERU partners developed a collective response strategy over the next two years which included time based targets for responding to cholera alerts, establishing potable water supplies and distributing non-food water treatment items to affected communities. By pre-positioning WASH supplies in regional stores the response teams were able to reduce the response times to a minimum given the huge areas being covered by the teams. While this strategy was not well documented at the time the WERU partners achieved a high degree of commonality in their individual implementation strategies and co-operated with other local and international NGOS throughout the 2008 to 2010 period under review. UNICEF appointed a WASH cluster co-ordinator based in Harare and the WASH cluster met every month to report on and to review progress across the country. UN-OCHA was funded by ECHO to assist with co-ordination and management of data and information.

4. This evaluation was conducted between April and May 2011 and has attempted to document the chronology of the evolution of the WERU approach in Zimbabwe and then to evaluate the WERU covering the period 2008 to 2010. As this was not a pre-planned


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intervention programme with data collection or monitoring components built in it has been difficult to assemble verifiable indicators of past performance for comparison against preset targets. Consequently much of the evaluation has been subjective rather than objective and based on anecdotal evidence and direct observations by the evaluation team. Although this is not an ideal modality it has been possible to develop an understanding of the nature of the WERU and achieve an assessment of its performance against the prescribed DAC criteria. The Terms of Reference for this evaluation appear in Annex to this report.

5. From discussions at all levels in the water and sanitation sector in Zimbabwe the overall impression is that the work done by WERU partners during and shortly after the peak of the cholera crisis in 2008 and 2009 was a major contributing factor to the control of the disease and was greatly appreciated by the Government of Zimbabwe. Their post-emergency activities continued to address the chronic short-comings in the water and sanitation infrastructure and contributed to the eventual suppression of the disease. Nevertheless, the poor quality of technical workmanship seen during the evaluation field trips does not generate confidence in the longevity of the rehabilitated water systems and this factor should be addressed during the next phase of the evolution of WERU or its successor. Similarly the co-ordination mechanisms operated during the latter stages of WERU activity are not considered to be ideal in that they are entirely voluntary and do not have any executive powers to enforce technical or health sector standards. This should also be addressed during the next phase of WERU.

6. The following matrix shows the major finding and recommendations of the evaluation. The questions are taken directly from the Terms of Reference for this assignment.

Question Conclusions Recommendations

Q1: Relevance.

To what extent have the considerations taken into account when establishing the WERU contributed to the achievement of its objectives and the positive impacts on the ground?

In the WatSan sector in Zimbabwe at the time there was no active GoZ leadership in place.

The WERU response was not anticipated nor pre-planned.

The formulation of the WERU response was voluntary, iterative and appropriate.

WERU followed a continuously evolving development pattern in response to changing conditions.

Emergency preparedness should be planned in advance: support should be given to the re-emerging GoZ sector co-ordination structures.

Capacity should be built into the emerging GoZ WatSan structures to achieve an appropriate response to any new emergency.

Q2: Effectiveness.

To what extent has the WERU concept and its individual projects achieved the stated objectives?

The WERU response was co-ordinated centrally by a UNICEF appointed co-ordinator but the voluntary nature of the appointment restricted effectiveness.

The adoption of time based targets made a positive contribution to the effectiveness of the

Co-ordination should be vested in a properly empowered body with executive powers.

Support should be given to rebuilding the GoZ WatSan institutional structure.

The planning of future technical response


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implementation.

The flexibility of the WERU partners allowed for effective responses to emerging problems.

The use of ad hoc procedures for the assessment of technical issues led to inconsistent and poorly planned rehabilitations.

Standardised technical selection and installation procedures were not followed.

strategies should include the preparation of standardized assessment tools and response procedures.

All future installations and rehabilitation standards should comply with prescribed technical standards.

Q3: Efficiency.

To what extent have the existing implementation and coordination processes, as well as the resources available, contributed to a positive impact?

The WERU intervention was instrumental in saving lives and empowering the degraded rural health clinics.

Despite the urgency of the situation at the time of the outbreak of cholera it should have been possible to record the de facto situation parameters at an early stage.

The large geographical areas covered by each of the WERU actors stretched their human and material resources to the limit.

Field staff were not closely supervised and would have benefited from more technical and managerial support from their internal structures.

Further efforts should be made during the transition process to consolidate the Health institutions progress achieved during the cholera crisis.

The data collection and analysis functions of the State WatSan and Health sector agencies should be reinforced to re-establish their import roles in managing information for planning purposes.

In future crises of this nature more attention should be paid to recruiting adequate numbers of appropriately qualified and experienced staff.

Q4: Coherence and complementarity.

How does the WERU approach fit into the LRRD context and facilitates transition to longer term development strategies?

The WERU approach is an emergency response developed in unique Zimbabwean circumstances and therefore does not easily lend itself to replication or transition.

During emergency response activities it is still necessary to consider long term effects as well as short term gains.

The externalizing of transition and delegation of the LRRD process from WatSan actors to sector wide bodies does not contribute to convergence of LRRD strategies

The LRRD question should be addressed at all levels in the WatSan sector: partner level, WatSan NGO sector and within GoZ institutions. Convergence of these individual processes can be achieved by creating links to the parallel structures at all levels.

The LRRD process being initiated at all levels within the WatSan sector should


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and implementation. embed sustainability into the next phase of sector progress.

Q5. Cross-cutting issues:

To what extent have DG-ECHO and its partner organizations taken into account cross-cutting issues such as gender, children, environmental protection and HIV/AIDS, in the planning and implementation of the action?

The suddenness and unique nature of the cholera emergency in Zimbabwe did not readily lend itself to developing special considerations for specific sub-sectors of the affected population.

Despite being established WatSan actors the WERU partners did not appear to pay adequate attention to some sector-wide cross-cutting issues such as IWRM and environmental protection.

In the next phase of development of the re-emerging WatSan sector more consideration should be given to the over-arching considerations in the WatSan sector such as IWRM and environmental issues.

7. While the emergency phase of WERU was considered to be successful the next phase must pay more attention to the transition process from relief towards recovery. This will continue to be challenging while the GoZ structures that are ultimately responsible for development and management of the national water resources remain weak and ineffective. However, the newly resurgent Ministry of Water Resources Development and Management and its National Action Committee are positive signs of a new attitude within Government towards the WatSan Sector.

8. The MoWRDM has recently received an improved budget from Treasury and has convened a WASH sector task force with invitations to all the current NGOs in the sector to contribute to its work. While recognising their still weakened and under-budgeted status the Ministry is actively courting the involvement and support of the parallel structure put in place during the cholera crisis (including the WERU partners) and is adopting an inclusive and pro-active stance in the sector. This presents the WASH cluster members and the WERU partners with an opportunity to contribute positively to the development of the WatSan sector over the next year and more. This opportunity should be seized and every effort should be made to integrate the current water and sanitation sector actors and activities into a viable and sustainable strategy for the future.


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1. Background and Introduction

9. The Directorate General for Humanitarian Aid and Civil Protection of the European Commission (DG-ECHO) is responsible for formulating EU humanitarian aid policy and for funding humanitarian aid to victims of conflicts and disasters in non-EU countries. Its mandate is to save and preserve life, to reduce or prevent human suffering and to safeguard the integrity and dignity of those affected by humanitarian crises. EC regulations concerning humanitarian aid lay down rules for the establishment and implementation of regular evaluations of which this report is one output.

10. Between 2008 and 2010 DG-ECHO was instrumental in the development and funding of a response to the cholera epidemic which broke out during that period in Zimbabwe; this response came to be known by the acronym WERU standing for Water, sanitation and health Emergency Response Unit. As the cholera emergency response in Zimbabwe eventually moved from relief into recovery it became important to consolidate the WERU approach in order to optimize the impact and build on the gains made. Since 2010 the Zimbabwe situation has required more developmental, structural actions to ensure sustainability of the water supply and sanitation infrastructure in the country, activities which are outside the scope and mandate of DG-ECHO and constitute integral components of linking relief, recovery and development otherwise known as the LRRD process.

11. As public health interventions have been the focus of DG-ECHO’s strategy and funding in Zimbabwe since 2008 and will continue to be the sole focus during 2011 an evaluation of these actions became fully justified and particularly useful in light of the current preparations being made for new grant and contribution agreements scheduled for the end of July 2011. In December 2010 Terms of Reference were drawn up for an evaluation of DG-ECHO’s involvement in WERU and a selection of consulting consortia was invited to bid on the contract. The evaluation contract was awarded to AGEG of Germany in February 2011 and the proposed consulting team comprised a senior water and sanitation specialist (team leader), a senior public health specialist and a Zimbabwean water and sanitation sector consultant. The team had been carefully selected to fulfil the specific requirements of the assignment in Zimbabwe as well as to provide a wide range of related experience in the evaluation process and in the sector internationally.

2. Methodology

12. The team commenced work on the assignment with a briefing session in Brussels at the DG-ECHO offices where staff involved in the WERU programme were interviewed and some documentation was provided for subsequent review and assessment. It became apparent at that briefing session that there was insufficient documentation available specifically explaining the formulation of the WERU approach and detailing its main features and implementation modality. Inputs and intended outputs had been identified in the fichops1 but the important features of the methodology and logistics were not well documented. It was resolved at that stage that documenting the WERU approach should be included in the list of tasks to be performed during the evaluation assignment.

1 Fichops: Project documentation maintained by ECHO for each funding application.


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13. After all available documents were reviewed an inception report was prepared and presented to DG-ECHO at the beginning of April; a final version of this report was agreed and the team assembled in Harare on the 11th of April. The first week was spent meeting the ECHO team and the WERU partners in Harare. Contacts were established with other members of the WASH Cluster and the Cluster co-ordinator in UNICEF (See Annex for the List of Persons Met).

14. A programme of field visits was drawn up for the second week and new documents were assembled for review at the weekend. The selection of sites to be visited took into account a range of representative projects in rural and urban areas, including those that were implemented in provinces reporting cholera outbreaks and provinces free of cholera. The itinerary therefore aimed for a balance of geographical locations, taking into account the constraints of travel to remote areas and the time available. (See Annex for the programme of activities). During the 2nd and 3rd weeks field trips to the four partner areas were organized and undertaken as well as extra meetings with various members and stakeholders both in the field and in the capital, Harare. The last week of the in-country part of the assignment was spent attending follow-up meetings, compiling notes and an aide mémoire, conducting a de-briefing workshop for all partners and attending a meeting with the Minister of Water Resources Development and Management (MWRDM). The list of documents reviewed and minutes of key informant interview, group discussions and direct observations conducted while in Zimbabwe appears in Annex to this report. The consulting team’s international members left Harare on the 7th of May.

15. During the field visit to Zimbabwe efforts were made to gather any and all documentation that would assist in drawing a clearer picture of what WERU was, how it was planned and implemented and what are the critical features of the WERU approach which would be pertinent to the development of an LRRD strategy. This effort was only partially successful as the WERU approach itself and the application of it to the cholera crisis in Zimbabwe is sparsely documented. The picture that was eventually developed was largely based on anecdotal evidence from those parties who had been instrumental in both the development of the approach and its implementation in the field. In some instances the anecdotal evidence was consistent across the range of actors in the field but in several cases there were inconsistencies and even some lack of agreement on core principles. These agreements and disparities have been recorded and discussed in the main text of this report.

3. DG-ECHO in Zimbabwe

16. DG-ECHO has been present in Zimbabwe since 2002, mainly focusing on food security. Other sectors were also covered, including Home Based Care – HIV/AIDS; water and sanitation; nutrition; UN Co-ordination; Orphans and other Vulnerable Children; and Internally Displaced Populations. In September 2006, priorities were redefined and DG- ECHO supported social services and actions in health, epidemics, and Water and Sanitation. For the period 2002-2007, DG ECHO has made available €110,654,1193 and responded to the needs of approximately 22,151,799 beneficiaries.

17. In the period of 2008 to the present DG-ECHO has mainly provided support in the areas of Water and Sanitation, health and food security. During this period, DG ECHO has been instrumental in the support and development of the WASH cluster. In mid-2009, in response to the magnitude and the spread of cholera, DG-ECHO employed the WERU approach. Through this approach, DG-ECHO has targeted cholera outbreaks in every province of the


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country. Six and, and later in 2010, four key international Non Governmental Organisations (INGOs) and two UN agencies have been the main implementers of the approach (see Annex for the list of projects funded under WERU). For the period 2008 – 2010, the total amount allocated to WERU implementation has been estimated at € 9,528,0102.

18. In February this year DG-ECHO Zimbabwe updated its Humanitarian Implementation Plan (HIP) reducing their contribution from €15M in 2010 to €10M in 2011 as food assistance is phased out completely following a successful exit strategy from the sector. The new budget will be largely channelled into actions to support the delivery of integrated public health services and making progress towards more sustainability in the transition phase.

4. The WERU approach

19. During the preparatory phase of this evaluation it became clear that the activities funded by DG-ECHO under the acronym WERU had not been planned and executed in the project mode as would have taken place if WERU were funded as a development intervention under the European Development Fund (EDF) system. There were no identification or formulation documents available and no project document to which specific reference could be made. Consequently there were no independent mid-term or final evaluations performed on any of the individual programmes funded by ECHO although there were internal project reports contained within the fichops. There were separate fichops on each annual phase of individual intervention programmes implemented by the various WERU partners some of which referred directly to WERU by name while others alluded to WERU without mentioning the acronym specifically. During the course of the evaluation two documents came to light which directly addressed the WERU concept; one an e-mail dated November 2009 from the WASH co-ordinator discussing the creation of a WERU and the other being an attachment to an e-mail prepared by OXFAM in June 2010 which mentions the proposed composition of the WERU partners. Both documents outline the general principles of WERU but neither one specifies the WERU mandate within the national context nor any hierarchy of responsibilities or chain of command and neither document mentions any external reporting, monitoring or evaluations requirements.

20. Despite the lack of formalized documentation it is clear that the collective understanding of the WERU approach was a voluntary agreement by the four organizations who had signed partnership agreements with UNICEF (Framework Partnership Agreements or FPAs) were signed with German Agro Action (GAA), OXFAM, Action Contre la Faim (ACF) and Mercy Corps) and the numerous members of the WASH Cluster who participated in the programme of activities to work in a collaborative and structured manner in tackling the WASH aspects of the cholera crisis.

21. The main features of the approach that came to be referred to as WERU developed over time and are now known to include the following:

1. At the time of the cholera peak, health partners did not have full capacity to respond to the outbreak and four WASH partners and two other organizations (World Vision International-WVI and CARE) assumed leadership roles in six clearly defined geographical areas of Zimbabwe and all members of the WASH cluster working in

2 Note that there has not been an official list of specific WERU projects. Rather, the list has been compiled by the evaluation team in Harare following discussions with DG ECHO’s Head of Office.


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those areas agreed to co-operate with the lead organizations in delivering the WatSan services at health institutions.3. (See the WERU map on next page and in Annex.)

2. The response to a cholera alert should commence within 24 hours of receiving the alert. This response should start with an assessment of the water supply needs of the rural health clinic reporting the alert (For the administrative and logistical organisation of the health system in Zimbabwe, see Annex.)

3. Within 72 hours of receiving an alert the partner should have established an emergency water supply of potable water, sufficient in both quality and quantity to sustain the staff and caseload being managed by the clinic.

4. Within 14 days of receiving the alert the partner should have established a sustainable supply of potable water which does not require the further intervention of the WERU team.

5. Sphere standards should be used in determining the quantity and quality of water supply delivered to the clinic.

6. A WERU tracking system is used to monitor the performance of the partners against the agreed target times.

7. Common assessment tools are used for initial rapid assessment of clinic WASH requirements.

8. A standard District Emergency Response Kit (hardware) should be used by partners during their initial response to a reported alert.

9. Post-response assessment should be done by partners twice a week after completion of the initial WERU response.

10. WASH emergencies are not confined to cholera only.

22. Although all ten items listed above appear in the proposal for a WERU not all ten have been adopted universally by all partners. This is not to say that the ten principles have not been accepted but as the association of voluntary organizations is not a contractual agreement it only requires a member of the WASH cluster to voluntarily agree to the overall principles of the WERU approach for them to be considered to be WERU members. As mentioned earlier there is no hierarchy of responsibility within the WASH cluster and all partners and members have an equal status within the grouping.

23. During the course of the evaluation and its many meetings WERU was referred to variously as a response unit, a response system, a programme, an approach, a concept, a methodology and also as an EU Programme. It is clear from this wide range of understandings that WERU evolved to mean different things to different people and not a fixed programme or philosophy which can be defined, refined and replicated outside the context within which it developed. In order to understand how this came about it is necessary to understand the background of the sector which gave rise to the WERU response.

3 WVI and Care subscribed to the approach but were not fully implementing it all throughout the 2008 – 2010 period. WVI received one funding tranche during the cholera outbreak (January – August 2009). CARE received one funding tranche too (July 2009 – March 2010).


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Map showing geographical areas of responsibility for WERU actors

24. A detailed chronology of the evolution of the WERU idea, as well the background to cholera response in Zimbabwe (2008-2011) are contained in Annex to this report but it is important to note some significant factors which define and ultimately limit its application and replicability. Between 1980 (independence for Zimbabwe) and 2000 great efforts were made and impressive progress was achieved across the country in the water and sanitation sector culminating in Zimbabwe having extensive coverage of community operated and maintained water supply points in all rural areas of the country. Hygiene promotion had been spearheaded by the Ministry of Health and Child Welfare (MoHCW) and rural water supply and sanitation technology successfully developed by the Blair Research arm of the MoHCW. The rural water sector itself was ably overseen by the National Action Committee (NAC) whose secretariat (the National Co-ordinating Unit or NCU) was pro-active in its management and co-ordination along Integrated Water Resources Management (IWRM) principles4. In the urban areas water reticulation and sewerage systems were also highly developed and well maintained by the responsible local governments in the larger cities and towns and by the national government in the smaller towns and Growth Points. As a result of the dramatic decline in Government of Zimbabwe (GoZ) funding and under investment in the sector, due in part to the hyperinflationary macroeconomic environment during that period, the entire water and sanitation sector fell into almost total disrepair and dysfunction within six years whereby urban water utilities become moribund and rural water supplies had ceased to 4 Integrated Water Resources Management is a systematic process for the sustainable development, allocation and monitoring of water resource use in the context of social, economic and environmental objectives. Its basis is that the many different uses of finite water resources are interdependent.


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function or receive any supervisory attention. There was no rural extension services actively promoting or maintaining the national water sector interests and hygiene promotion in rural areas had stopped entirely.

25. The huge gap in water sector support services after 2000 was only partly being filled by NGOs, both national and international, which were active in the rural areas. When the cholera arrived in the country (possibly brought in by migrant workers from neighbouring countries) the breakdown in the water and sanitation sector had created ideal conditions for the rapid spread of the disease across the country, initially form urban to rural areas. As the reports of cholera started to come in ever increasing numbers the Government was powerless to respond and the leading INGOs diverted their already thinly spread resources from development oriented WatSan work to relief oriented activities in an attempt to stem the tide of the disease. While working in isolation the NGOs had only limited effect and so the idea of a combined and co-ordinated response was borne out of necessity and in the absence of any GoZ guidance or assistance.

26. Due to the application of restrictions on donor funding to the Zimbabwe Government (implemented under Article 96 of the Cotonou Agreement) the EC was not inclined to fund Government activities directly through the EDF and so the ECHO funding route became the most suitable for addressing the humanitarian crisis. DG-ECHO was able to consider direct grants to suitably qualified and organized INGOs on a one year basis and their flexibility in processing funding applications made it possible for DG-ECHO to effect prompt and suitable funding. This situation was further complicated by the prevailing economic crisis in Zimbabwe at the time with hyper-inflation having rendered the local currency (the former Zimbabwe Dollar) virtually worthless and of no use as a financial instrument in funding the humanitarian response to the cholera outbreak.

27. This fragmented and dysfunctional background to the evolution of the WERU approach explains why the focus of this evaluation (the WERU approach itself) is not recorded in a definitive project document or legally enforceable contract. It must also be noted that the scope of this evaluation covers the period 2008 to 2010 only and does not include the current activities variously funded under the WERU label and still ongoing to this day. Since the end of the cholera epidemic the WERU partners have further refined their strategic approach to their response to the possibility of further cholera outbreaks and this has resulted in further changes to the WERU philosophy. These later changes to the WERU approach are now addressing the issue of transition and sustainability of gains made earlier in the WERU life cycle.

28. Since the middle of 2010 the cholera epidemic has been completely downgraded to a post-crisis operation with two main focuses referred by DG ECHO as to the “connected vessels”. On the one hand the WERU partners are expected to maintain their cholera response preparedness by keeping their response teams available for any new alerts that may be raised anywhere within their geographical areas of responsibility. This response preparedness now includes the ability to respond to any other water borne disease which would benefit from the provision of a sustainable potable water supply at any clinic in the country. This widening of the focus from one specific disease to include other diarrhoeal diseases is a welcome outcome of the original intervention philosophy even if in practice there has been an almost exclusive focus on cholera.

29. At the same time as maintaining their response capacity the WERU partners are also using their logistical capacity (staff, transport and supply chains) to effect repairs and


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rehabilitations at other rural clinics which have not so far been affected by the cholera epidemic but are considered to be at risk. The response teams have liaised with the GoZ water and sanitation structures to identify specific clinics which can benefit from the use of the partners’ abilities while they are not fully occupied on emergency response. This strategy has resulted in rural health clinics across the country having had their water supply upgraded as an important input into cholera prevention without waiting for the next epidemic to arrive. While working at the unaffected clinics the response teams are simultaneously available for redeployment at short notice to deal with any new outbreak that may be suspected in their geographical area.

30. This aspect of WERU’s current work represents a positive step in the direction of LRRD as it uses resources and facilities put in place during the earlier humanitarian crisis to promote a recovery and development strategy with a view to sustainable evolution of the water and sanitation sector. As with the earlier WERU evolution this new shift in strategy is taking place outside of an overall sector strategy addressing the whole LRRD question and without close consideration of and co-operation with the recovering Government structures that are eventually to assume overall responsibility for the long term development of the sector (See Overview of Water and Sanitation Sector in Annex.) It is also noted that this latest stage of WERU evolution is not yet documented and is being co-ordinated unofficially by the DG-ECHO and UN-OCHA offices in Harare. The development of this LRRD strategy is an unofficial recognition of the need for both an exit strategy for the various INGOs that have been hitherto involved in the emergency response to the cholera epidemic as well as the need for a coherent sector strategy for addressing the LRRD issues that are becoming ever more urgent.

5. Evaluation Questions

31. This evaluation is based on a set of key questions which are intended to give a more precise and accessible form to the evaluation criteria and to articulate the key issues. These questions have been developed and refined throughout the evaluation and the final evaluation framework matrix and data collection tools appear in Annex to this report. The evaluation questions address the key OECD/DAC criteria wherever relevant to the specific humanitarian situation and include reference to the cross-cutting issues and the objective of LRRD.

32. While a structured approach has been adopted by the evaluation team it is important to note that the DAC criteria are only guidelines and do not constitute rules that limit the scope and depth of the evaluation. Accordingly other relevant issues are addressed throughout the report and incorporated into the text wherever appropriate. In this way a comprehensive understanding of the reality of the situation existing at the time and in the location of the intervention is achieved rather than a strictly clinical appreciation of specific aspects of the situation.

5.1 Relevance

33. Q1: Relevance. To what extent have the considerations taken into account when establishing the WERU contributed to the achievement of its objectives and the positive impacts on the ground?

34. As explained elsewhere in this report it is now known that the response to the cholera emergency in Zimbabwe was not a carefully planned programme which was established in


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advance to cater for all the eventualities that could have arisen during a fixed period of implementation. The WERU approach that slowly emerged from the emergency response of several separate agencies and actors in the sector was iterative in nature and organic in its growth and development. Between 2008 and 2010 the WERU programme developed core features which were only properly understood by the members of the WASH cluster and even to this time have not been formulated on paper as a definitive explanation of the essence of WERU. The WASH cluster that was convened under the co-ordinating overview of UNICEF had at its core the four partners who signed FPAs with UNICEF. These four partners assumed the lead roles in the geographic sectors they voluntarily assigned to themselves and they collectively agreed to time-based targets for response to cholera outbreaks and to logistical arrangements such as pre-positioning of relief supplies. At all times it was believed by the partners and the ECHO office in Harare that their response programme was specifically and entirely relevant to the situation that existed at the time and to the progressively developing situation that evolved nationally. This arrangement was referred to by the WASH Cluster co-ordinator as a “coalition of the willing” and is based more on personalities within organizations than on formal agreements entered into by the institutions themselves. The drawback with this sort of ad hoc personality based approach to co-ordination is that without the presence of the personalities involved there is little institutional momentum created and the long term sustainability of the arrangement is questionable.

35. The main aspects of the cholera response that contributed to the establishment of the WERU were:

• The existence of specific funding restrictions occasioned by the application of Article 96 of the Cotonou Agreement.

• The existence of several INGOs working in the water and sanitation sector in the country prior to the outbreak of cholera.

• The diverse and adaptable human and logistical resources available within the pre-existing WatSan community.

• The presence of strong and decisive management personnel within the INGOs and donor community who were willing to take important and often difficult decisions.

• The ability and willingness of the WatSan community to realign their priorities away from their predefined development programmes towards the cholera relief operation.

• The existence of an operational UNICEF office which was willing to assume the co-ordinating role for the relief programme.

• The almost complete absence of a functioning Government structure for delivering water and sanitation services within Zimbabwe.

• The initial reluctance on the part of the GoZ to admit to the scale and seriousness of the cholera epidemic and the subsequent acceptance by the same GoZ of the need for external assistance without the prerequisite of planning permission and project approval.

36. With this background of urgent need and the absence of external guidance and control the partners in the WERU devised a response strategy that was entirely relevant, realistic and pragmatic at the time. In part it was based on experiences gained in other countries and with other organizations and partly a local initiative to address the specifics of the Zimbabwe situation. This strategy recognised the differences between the various agencies while


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maximising the strengths of their common features. In this way the six WERU partners were able to apply their individual skills and experiences in the most appropriate way possible depending on the local conditions in their own separate geographical areas of influence.

37. The overwhelming need in 2008 and early 2009 was for emergency relief from the shortage of potable water available at clinics affected by the cholera outbreak. To address this need the WERU partners developed plans to respond to the announcement of new outbreaks within a very short time period (24 hours) so that the specific needs of each clinic could be assessed and subsequently addressed urgently. As the various teams were deployed they became experienced in assessing and predicting the needs and subsequently targeted the establishment of a potable water supply within 48 hours of receiving the alert and often combined the assessment and the response visit into a single activity, enabling the clinic in question to have a clean water supply well within the target time of 48 hours. As all partners gained more experience in the relief operation and got to know their own geographical areas better they became ever more adept at providing water supplies promptly and effectively and almost always were able to complete the entire assessment, response and completion exercise within a 72 hour period. During the course of the evolution of the relief operation the 24 hour, 48 hour and 72 hour target times became the backbone of the WERU approach and were specifically relevant to the reality of the situation pertaining at the time in the cholera affected areas.

38. During the evolution of the response mechanism the pre-positioning of relief supplies in strategically located store centres was adopted as a significant factor in getting to the affected clinics in time to save lives and this development became an additional factor in the strategy of the WERU. It was well known also that the provision of clean water alone would not prevent further cholera outbreaks and the provision of non-food items (NFIs) to the affected communities was added to the range of measures undertaken by the partners. These water related components (water containers, water sterilization chemicals and soap) were distributed free of charge to affected communities along with the health promotion training necessary for their effective use. This secondary response activity was integrated into the establishment of water supplies at the affected clinics with a view to containing the outbreak and adding value to the medical relief provided by the clinic staff. In this way it was intended to propagate the “clean water” psychology beyond the boundaries of the clinic itself to prevent further outbreaks of the disease and to contain the local outbreak to those inpatients admitted to the clinics and Cholera Treatment Centres (CTCs).

39. While the field work of the relief programme was evolving on the ground the administrative provisions at the co-ordination level were also being fine tuned to adapt to the developing situation. With the active co-operation of the ECHO office a common LogFrame was developed for all the WERU partners in order to promote further convergence of implementation strategies and enhance the adoption of common goals and standards. In this way the evolution of the cholera response mechanism attempted to keep pace with the evolution of the cholera epidemic itself as it progressively migrated from densely populated urban areas to more sparsely populated rural locations. At all times the WERU partners strived to produce the most relevant response mechanism possible in order to enhance and improve their performance throughout the relief programme.

40. Between 2008 and 2009 the WERU approach was always attempting to keep up with the dramatic spread of cholera throughout the country which ultimately affected 55 out of 62 districts in the country. WERU also filled the capacity gap left by health partners who later


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organized themselves into the Health Emergency Response Unit (HERU) under the leadership of WHO. As the epidemic started to wane in the middle of 2009 and the WERU approach reached its maturity the impact of WERU became less visible as new outbreak reports became less frequent. By the time the cholera was under control and unofficially no longer an epidemic the WERU approach had been fine tuned and finalized to a point where it was clearly understood and well implemented operational modality accepted by all partners and WASH cluster members across the country.

41. The context within which the cholera epidemic developed in Zimbabwe was itself characterised by a rapidly changing (and mostly deteriorating) social, political and economic environment. The catastrophic hyper-inflation and consequential economic melt-down in the country was a serious impediment to any successful financial planning and the inability of the Government to co-ordinate any effective response to the health crisis only compounded the difficulties faced by the affected population. It is therefore considered that the response to the cholera that became known as WERU was well developed and entirely relevant to the dramatic evolution of the cholera epidemic in the country.

42. As the cholera case load dwindled to a trickle during 2010 the cholera public health needs of the general population changed from emergency response to emergency preparedness. At the same time the focus of public health concerns expanded from exclusively cholera oriented to a wider concern about water borne diseases country-wide. The chronic state of the nation’s entire water and sanitation infrastructure, including all major cities and rural areas, had not significantly improved despite the numerous clinics which had benefited from the restoration of potable water supplies. The threat of a sudden and rapidly spreading water borne disease outbreak remained a significant factor in the minds of public health practitioners and WatSan service providers alike.

43. During the latter stages of the 2008-2010 period in WERU’s evolution the emphasis of activity shifted from rapid response to new alerts towards emergency preparedness through the pre-emptive upgrading of rural health clinic water facilities in areas that did not have a known record of cholera outbreaks. The selection of which clinics to upgrade in advance of any cholera outbreak was done in collaboration with the local Government structures including the various Water and Sanitation sub-Committees, the Ministry of Local Government and the MoHCW. It is this pre-selection of clinics for upgrading which remains a difficult task when the implementation resources are finite and all clinics cannot be accessed across the entire country, while the threat of cholera and other water borne diseases is not confined to known areas.

44. The new outbreaks of cholera which have been reported towards the end of 2010 and now into 2011 are not statistically disaggregated in a way that would enable their analysis to identify if the new outbreaks are occurring in clinic catchment areas that have previously benefited from upgrading under the WERU programme or not. This important statistical analysis is missing from the data that is being presented to the WASH cluster and yet it could prove critical in assessing the relevance of continuing with the WERU approach in its current pre-emptive phase.

45. In summation it can be said that the core principles of the WERU approach (timely response and flexibility) were entirely relevant to the conditions that pertained during the 2008-2009 crisis period when the need for potable water supplies at rural clinics was dire. However the WERU approach was not as obviously relevant to the task of post emergency


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that followed after the crisis. This is not to say that the WERU approach is inappropriate; however the evidence to prove its appropriateness is not readily available.

5.2 Effectiveness

46. Q2: Effectiveness. To what extent has the WERU concept and its individual projects achieved the stated objectives?

47. The principal objective of the WERU approach as stated in the Logical Framework is to contribute to the reduction of morbidity/mortality rates in urban, peri-urban and rural areas, caused by WASH emergencies. Specifically the WERU programme sought to reduce and eliminate the threat of the spread of water borne disease outbreaks. These are obviously very high targets to set in the context of a cholera epidemic and especially the elimination of the threat of the spread of all water borne diseases. It is entirely reasonable therefore to expect a less than 100% success rate on such ambitious targets. However, as the health statistics illustrate in Annex, the reduction of cholera cases and deaths over time suggests that the coordinated coverage and response as initiated under WERU have largely contributed, together with other national and international efforts, to the prevention and control of cholera in Zimbabwe.

48. At the level of individual projects, the progress made is difficult to document despite partner efforts to develop a common monitoring tool. The WERU tracker is being used to monitor whether the alert and response are carried in a timely manner (24 and 48 hour). However, in its current form, the tool does not provide a comprehensive picture of progress over time. Anecdotal evidence from the current cholera outbreaks in Manicaland province suggests that a timely response is highly dependent on the ability of the health staff to conduct a preliminary epidemiological investigation and to identify the cause and origin/source. As of 2010, the implementation of Rapid Response Teams (RRTs) through the Integrated Surveillance and Response (IDSR) system is intended to improve the timeliness of the outbreak response at district level. It is hoped by partners that this initiative will gradually improve the notification delays. The establishment of RRTs, under the MoHCW leadership, has for the first time provided a common structure for outbreak investigation and response, where information to be collected and reported can also be harmonized.

49. The WERU approach was an evolutionary approach which sought to utilize pre-existing WatSan development expertise in a rapidly evolving situation by being both flexible and prompt in its performance.

50. The innate flexibility of the WERU approach enabled several aspects of the work to be effectively implemented. Firstly the ability to respond immediately in any part of the country through the organization of geographical territories for each partner and their various co-operating organisations (local and INGOs) enabled a structured and organized response system to develop which contributed to the high success rate in terms of assessment and response time limits. Whilst it cannot be statistically or clinically proved that the provision of potable water at any clinic saved lives it is safe to say that the basic requirement of every rural health clinic to have access to clean water was effectively fulfilled in those rural health clinics that reported suspected cholera cases. As the 2010 Vital Medicines Availability and Health Services (VMHAS) survey results demonstrate, 77.3% of rural health clinics (n=1,123) had a source of drinking water available on their premises. Out of the 900 rehabilitated rural health


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clinics, 38.8% (n=350) have been rehabilitated by WERU partners5. Therefore the WERU approach is assessed as having contributed successfully to the increase in the number of facilities with a source of drinking water and possibly in the reduction in morbidity and mortality rates in those clinics that benefited from WERU attention. However, the evaluation found that WERU partners would benefit from a better understanding of diarrhoeal disease patterns at rural health clinic level. Even though the common LogFrame adopted by WERU partners in 2010 has broadened the focus from cholera to diarrhoeal diseases, in practice partners have mainly implemented rapid and short term interventions. This seems to have created a situation where endemic diarrhoeal disease is not fully considered despite the fact that it accounts on annual basis for a higher mortality and morbidity burden than epidemic cholera.

51. In order to control cholera, the WERU partners focused also on the promotion and training for safe WASH practices during distribution of NFIs and through house to house campaigns, meetings with community leaders, training of Village Health Workers (VHWs) and distribution of posters. The risk practices of the community were well identified and interventions appropriately addressed the risk practices. In particular, community gatherings were a suitable mode of communication because of local rituals performed during epidemics.

52. The absence of baseline data regarding practices before the WERU-funded interventions makes it impossible to evaluate whether the projects have resulted in an improved understanding of cholera risk factors, or improved WASH practices. Discussions with various stakeholders and field visits, however, indicate that hygiene promotion was successful in conveying messages that translated in an increased understanding of multiple cholera transmission routes and potential health benefits.

53. Over time, as cholera epidemic curve declined, Public Health and Hygiene Education (PHHE) became less of a priority, especially in free-cholera areas where the focus shifted to hardware. In affected districts, water supply is still accompanied by health education and hygiene promotion. These activities are often carried out in conjunction with Environmental Health Technicians (EHTs). The evaluation team found that EHTs played a crucial role during outbreak investigation by targeting contacts of index cases and providing them with information on the risks of person-to-person transmission in the family.

54. The added value of the WERU approach was that where clinics did have their water supply restored under WERU the health staff were empowered to fulfil their normal public health roles much more effectively than they would otherwise have been able to do. In the same vein the provision of financial incentives to clinic staff (which in some cases accompanied the WatSan activities) provided a significant impetus to the cholera relief response by actually enabling staff to go to work when they were not well disposed to doing so due to lack of payment of their normal GoZ salaries. This flexible approach to the chronic problem of clinic staffing was very effective at the time.

55. The intervention of the WERU partners at the rural clinic level also provided a valuable bridge between the remote rural health facility and the higher administrative levels in the MoHCW. This was particularly marked where EHTs accompanied the WERU partner vehicles to make their initial assessments and subsequently facilitated the clinical diagnosis of

5 Personal communication, UNICEF. This number may be higher as other rural health clinics covered by HERU partners have also benefited from water and sanitation work under DG ECHO funding.


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suspect cases at District and Provincial level. The internal communication systems within the MoHCW, including the epidemiological data collection and disease surveillance systems were largely dysfunctional during the cholera epidemic and the parallel reporting and response systems facilitated by the WERU partners were invaluable in monitoring and evaluating the progress of the disease. This aspect of WERU intervention was very effective and much appreciated by the MoHCW.

56. From anecdotal and on-site evidence accumulated during the evaluation the provision of potable water supplies to the rural health clinics in Zimbabwe is clearly considered to have contributed effectively to the reduction of new and uncontrolled outbreaks of water borne diseases in those clinic catchments that were previously without potable water supplies. All health and ancillary staff, including beneficiary community committees, at the clinics that were visited unanimously agreed that the case load would have been much higher had the clinic not benefited from access to potable water. This applied not just to cholera cases but to all water borne diseases, maternal health as well as accident and emergency cases. Furthermore, anecdotal evidence suggested that communities within the vicinity of clinics provided with potable water had access to the improved supply such that benefits of the WERU reached beyond the intended target.

57. Whilst the case for effectiveness in the emergency phase of the WERU programme between 2008 and 2009 is well made it is not so clear in the latter and current stages of the cholera outbreaks (2010-2011) when the WERU partners were pre-selecting clinics for WatSan rehabilitation in anticipation of and in preparedness for any new public health emergency. It is not currently possible to correlate the pattern of new cholera outbreaks to the coverage of pre-emptive rehabilitations of rural clinic water supplies and so it is not possible to relate the two in a cause-effect relationship. If new outbreak alerts identified the location as either having benefited from pre-emptive WatSan activity or not having benefited it would have been possible to deduce whether the pre-emptive programme is having any preventative effect on the spread of cholera. This short-coming in the current epidemiological data collection and reporting system under utilizes the potential of the data collection system.

5.3 Efficiency

58. Q3: Efficiency. To what extent have the existing implementation and coordination processes, as well as the resources available, contributed to a positive impact?

59. Recognising the evolutionary nature of the response to the cholera outbreak in 2008 and 2009 it is prudent to consider efficiency of implementation and co-ordination as being assessed relative to the alternatives available at the time and in the context of the socio-political environment pertaining both nationally and internationally. At the time of the epidemic the official GoZ social and utility services were almost entirely dysfunctional after nearly eight years of neglect and degradation. The entire GoZ network of WatSan and health care delivery and services had deteriorated beyond recognition and the ability of the national administration to respond to the rapid spread of cholera throughout the country negligible. During the period 2000 to 2008 several INGOs and many national NGOs were working at grass roots level to address the community health and water and sanitation needs of the population in an effort to substitute for the diminishing Government services. This community of actors and agents in the informal WatSan sector were not able to substitute entirely for the missing GoZ services but were only attempting to provide a minimum basic service to the rural population during their very difficult times.


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60. At the time of the cholera outbreak this informal and rather fragmented network of NGOs agreed to address the rapidly emerging and initially overwhelming problem of a massive cholera epidemic with only limited material resources and a human resource base that had little or no experience of cholera to draw on. The collective response was however impressive. With the co-ordinating of UNICEF and with a spirit of collective responsibility and good will all the organizations that became part of the WASH cluster (more than 100) organized themselves as best they could to deal with the nationwide emergency. The “coalition of the willing” as it became known transformed themselves from planned local development implementers into an emergency response unit covering the entire country while at the same time attempting to reorganize their own supply lines for funding and relief materials. ECHO’s role in this rapidly developing situation was pivotal as the Harare ECHO office was able to respond to funding requests and dispense those funds with alacrity and flexibility. ECHO also assumed a large role in the planning and coordination efforts of the WASH cluster and was considered by the development community to have been responsible in a large part for the success of much of the relief work that was planned, funded and completed during the crisis.

61. Efforts were also made to work with HERU partners. WERU promoted and increased collaboration through joint- assessments; joint-meetings and divisions of responsibilities. As a result, partners reported an improved quality of partnerships for humanitarian action. In some occasions, however, duplication between WERU and HERU activities were noted, especially those related to the initial assessment and response. For instance, at rural health clinic level, health staff did not always understand who was doing what and had difficulties to differentiate between the respective roles of WERU and HERU partners. This situation seems common in areas where the District Medical Offices (DMOs) played a reactive rather than a proactive coordination role.

62. In general coordination with the district authorities, water and sanitation local institutions and MoHCW has improved over time. During the cholera peak, leadership at district level was not always clear. As of 2009/10, district authorities have engaged efforts in coordination and a series of forums and platforms exist whereby WERU partners report and coordinate activities. For instance, in provinces with extensive rehabilitation work, partners carry out initial assessment in conjunction with local government structures and, to some extent, involve them in the rehabilitation work.

63. However, during the three years of implementation of the WERU phases there does not appear to have been much convergence achieved on the co-ordination efforts made by the WERU partners to implement the use of common assessment and response tools. It was observed that partners were not using a common form and some were not using any forms at all, preferring to allow their field crews to make their own personal assessments on the spot. This lack of common implementation modalities allowed discrepancies to develop between the various implementers which are not only likely to jeopardize the longevity of some of the installations but may lead to a multiplicity in approaches all purporting to be WERU.

64. Assessment of the efficiency of the WERU approach during the early part of the period under scrutiny is necessarily rather subjective for a number of reasons. Firstly it must be understood that the initial response mechanism did not have a strong element of monitoring and evaluation (M&E) built into it so there are no reports or evaluations available for consultation and no independently verifiable data to analyse. One source of information which would normally be available is the MoHCW disease surveillance system but this system had


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also been weakened by the time the epidemic took hold so official records are only available as of 2009 when the Cholera Command and Control Centre (C4) became operational and played an important information management role.

65. A monitoring tool was being developed called the WERU tracker and yet it was not developed to a stage when it could be used to identify trends and patterns that would be useful in modifying the response mechanism constructively. The WERU tracker produces a map of Zimbabwe showing recent historical data on the performance of the response teams under the WERU programme. This data is useful for assessing the degree of success achieved by the response teams working in the field but there are no data verification tools available to validate the information being submitted and the tracker itself is not managed on a strictly regular basis.

66. It is also clear that the partner organizations do not have a coherent M&E strategy in place yet and understanding of the relevance of the LogFrame at field level is still rather low. This has resulted in gaps in the information gathering system which cannot be easily filled retrospectively. Without a structured information gathering system it is difficult to assess past field work efficiency other than by direct observation of current activities. With current activities being rather different to the original WERU activities during the emergency phase the assessment will necessarily be subjective rather than based on objectively verifiable indicators.

67. It is also recognised by the WASH cluster community that the response to the crisis organised by the WERU partners was not pre-planned and the partners were only chasing after the various outbreaks and were always trying to keep up with the rapid spread of the disease rather than trying to catch up with and control its spread.

68. Those aspects of implementation efficiency which would normally be considered include staffing levels and suitability, logistical aspects such as supply lines, transport, communications, technical expertise and experience, financial resources and management as well as overall managerial ability and capacity. None of these factors were recorded or assessed at the time of the crisis and therefore the overall efficiency can only be assessed by field observations and output evidence. It was observed during the evaluation team’s field visits that many field staff were quite junior in the INGO hierarchy and did not have much in-house expertise. This necessarily inhibited their effectiveness in performing their duties as they were receiving on the job training in a learning-by-doing mode. While this is entirely appropriate in a developmental environment it is not the most efficient implementation modality in a time crucial situation demanding prompt and efficient action.

69. It was also observed that the WERU partners were working with limited resources whereas a needs-based analysis would have demanded a much larger resource of both human and logistical inputs in view of the large geographical areas to be covered and the unpredictability of where the next outbreak could occur. There was a noticeable lack of supervisory capability in the partner organizations and this allowed inefficient procedures to become entrenched. An example of such inefficiency was the absence of any structured planning for field trips resulting in unnecessary distances being covered by field crews. The use of maps in determining optimal routes rather than instinct could have saved some time and expense.

70. There are no audited financial reports available for scrutiny; there are no independently verifiable reports available which detail the performance of individual organizations relative


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to others in the WASH cluster and there was no system in place for external evaluations to be undertaken during the course of the crisis. This is considered to be a short-coming of the emergency response system that was operating in Zimbabwe between 2008 and 2010; very little written evidence was made available to the evaluation team during the field work in Zimbabwe and much of the assessment is based on anecdotal evidence and face to face interviews with people who, in a majority of the cases, were not on the ground at time of the crisis. Even the reporting system used by ECHO relies heavily on the self assessment of the recipients of ECHO funding as contained in the fichops reports. There is very little external evidence on which to base a structured assessment of the efficiency levels achieved during the crucial period of WERU activity.

71. Despite limited documentary evidence it is understood by the assessment team that the consensus of the development and donor community at the time in Zimbabwe was that the effect of the response was mostly positive and was managed and performed as well as could have been hoped for under the very difficult circumstances pertaining in the country at the time. In an interview with the Honourable Minister of WRDM, Mr S. S. Nkomo, it was stated that without the WERU approach and the financial support from ECHO the Government of Zimbabwe believed they could have lost 75,000 lives instead of the 4,288 officially recorded cholera deaths. This is considered to be to the credit of the ECHO Harare staff and the partner organizations equally.

72. At the end of 2009 and into 2010 when the response was less urgent and there was more time for planning and consideration of alternatives (especially technical alternatives and their relative financial merits) there is little evidence of any reflection and review of implementation modalities that resulted in technical or economic improvements to the performance of the partner teams. The third round of funding (sometimes referred to as WERU III) during 2010 was based on a refinement of the earlier programme rationale but in effect was a duplication of the implementation modalities that had been used under the crisis conditions that existed during WERU I and II. The result of this lack of review was a continuation of some of the practices which had worked well before but were not so readily applicable towards the end of the programme.

73. The most obvious short-coming in the later stages of the intervention was the continuation of a technical work ethic based on a “quick and dirty” strategy which resulted in poor quality work being done when there were in fact both time and resources available to complete technical work to a higher standard. This resulted in inefficiencies which are likely to have a detrimental effect on the sustainability of the installed water facilities in the near future. Several water point installations which were visited were recently completed to a disappointingly low standard of work which might result in the source becoming unreliable, or even pose a health risk in some cases, within a short period of time. In the same vein it was observed during field visits to both recently completed as well as ongoing rehabilitation works that technical work was being done by unqualified or inexperienced staff to an unapproved design and layout resulting in sub-standard work being offered to a usually very grateful beneficiary community (see Annex on Technical assessment).

74. As highlighted in the above Annex, it also became clear that little or no economic analysis of the various technical options was being undertaken resulting in some installations appearing to be rather more expensive than appeared to be justified by the needs of the beneficiaries. It must be emphasised here that without access to any financial data or audit reports it is not possible to specify the exact costs or benefits that would have been derived


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from selection of alternative implementation options but personal experience suggests that the normal best practice and cost benefit analyses would not have indicated the same selection of technologies or suppliers as were used towards the end of the current implementation phase. This is acknowledged to be a subjective assessment of the limited number of installations that were visited during the evaluation but objective data was not available to the evaluation team at the time of the field visits.

75. There does not appear to be a common agreement amongst the WERU partners, members and co-ordinators on the precise definition of the water supply targets either in quantity of water or in the special scope of the target areas. Even though Sphere standards are being applied, it was not possible to get a clear and unified answer to the question of the target quantity of water supplied per person at a clinic or the geographical scope of the target area (just the clinic’s own water supply point or all water supply points within the clinic’s catchment area?). This lack of clarity has resulted in different organizations working towards different targets although it is recognised that all respondents have claimed to have achieved their own targets of both water supply quantity and location. It is therefore not possible to give an objective assessment of how efficiently the targets were met across the spectrum of WERU partners and members. Overall however it is recognised that efficiency was better achieved during the emergency phase of the WERU programme between 2008 and 2010 than during the less stressed post-emergency phase during and after 2010.

5.4 Coherence, Complementarity (LRRD)

76. Q4: Coherence/complementarity. How does the WERU approach fit into the LRRD context and facilitates transition to longer term development strategies?

77. Addressing the LRRD question from the WERU approach raises a number of issues which need clarification before the question can be answered. Firstly it must be recognised that WERU is by definition an emergency response which was never planned as anything other than an adaptation technique for long term development actors to use their skills and facilities in an unforeseen emergency situation. From this background it must be understood that WERU was not designed with any exit strategy in mind nor did it evolve into a sustainable development strategy. It was an emergency response with only limited concern for long term planning, sustainability and ownership issues. It was specifically developed to substitute for the absence of any GoZ capacity or capability in dealing with water and sanitation issues in a public health crisis such as the cholera epidemic. Only in the latter part of the WERU programme of activities did the questions of transition, ownership and sustainability start to be considered. While WERU is not a DG-ECHO programme it is noted that the current DG-ECHO Zimbabwe HIP (dated 25.02.2011 and included in Annex as part of the EU Transitional Framework for Zimbabwe) incorporates a strong element of LRRD for the WatSan and food security sectors while incorporating a nominal allocation of €10M to the post-WERU phase of the cholera response.

78. Despite not having been planned as long term programme WERU did promote several beneficial effects for the water and sanitation infrastructure in rural health clinics and the linkages to public health. In coordination with HERU partners, WERU did facilitate the survival of the rural health clinic as a functioning entity along with its staff of EHTs and health staff and did re-establish the links between the rural health services and the District level administration of the MoHCW. Ownership of and responsibility for the water supply system at rural clinic level was greatly enhanced and will continue to be of value to the health


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system for some time to come. Those rural health clinics which benefited from upgrading of their water supply system in the latter part of the three year programme despite not having suffered from cholera during the epidemic have also achieved significant progress in their emergency preparedness and response capabilities in the event of any future outbreak of water borne diseases.

79. In addition to the hardware components of the WERU there have been substantial gains made at all levels in the WatSan community by way of linkages established with the GoZ institutional hierarchy which is now trying to re-establish its rightful place as the custodian of the nation’s water resources. Links have been forged between the WASH cluster (of which the WERU partners are an important part) and the newly rehabilitated NAC and its secretariat the NCU under the MWRDM. Whilst both these bodies are only shadows of their former selves having suffered chronic deterioration since their zenith in 2000 they have recently been re-staffed and re-financed with a view to them eventually taking over their former duties from the WASH cluster once the political and logistical climate is conducive. Although this may take some time (probably between 1 to 5 years) the opportunity this development presents for developing a transition strategy should not be overlooked. Connections with the MoHCW have been established and maintained in an effort to support their efforts at rebuilding their capacity at all levels in the health service delivery and this co-operation has been well received by the incumbent staff at both national and provincial level.

80. In recent months the development section within the European Commission’s Delegation in Harare has become involved with the water and sanitation sector through the award of four grants to INGOs under the EU’s Water Facility6. All these grants are likely to contribute positively to the sustainable development of the WatSan sector in Zimbabwe and will be managed by DG-Development in Harare. While this is considered to be a positive development for the WatSan sector in Zimbabwe it is regrettable that there does not appear to be a co-ordinated transition strategy within the EU Delegation in Harare to link its activities in DG-ECHO with those taking place within DG-Development. This is considered to be a weak link in the development of a successful transition from relief through rehabilitation to development, especially within such a small institutional framework as the Harare Delegation. It is also known that the WatSan sector is no longer a focal area either in the EU’s Short Term Framework for Zimbabwe in 2011 nor in the overall funding programme of the 10th EDF. With the spotlight moving away from water in the near future it behoves all parties involved to get the maximum value from the current funding programme before those funds expire and a coherent transition strategy within the EC Delegation itself would go a long way to achieving that goal.

81. In the current political, institutional and economic climate in Zimbabwe there appear to be three levels at which transition can take place and these should be well co-ordinated so as to facilitate convergence in the future without unnecessary conflict. At INGO level the various organizations themselves do not appear to be developing their own transition strategy based on their own philosophy and purpose. While all the larger INGOs were able to adapt their previously development oriented programmes to the needs of an emergency such as the cholera epidemic there appears to be some reluctance on their part to address the question of returning to the pre-cholera position and addressing longer term development issues. This may be in part explained by the need of the INGOs to secure external funding and that has been most easily forthcoming from ECHO during the emergency. Equally the uncertainty in 6 ACF, Oxfam Novib, International Federation of Red Cross and Red Crescent Societies and Practical Action.


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the political climate of the country makes it difficult for such NGOs to lay out concrete plans for the future. It may therefore be a tactic of the INGOs to wait until the funding streams have announced their future intervention strategies before they declare their own interests; in this way the INGOs may well be in the best position to avail themselves of continuum funding for their Zimbabwe operations.

82. The WASH cluster itself with a very wide and representative membership has not yet developed its leadership role in the transition phase although the question has been raised on occasions in their regular meetings. While the WASH cluster remains “a coalition of the willing” it will not have the managerial or institutional capacity to force consideration of transition on its members and it seems likely that the question will be left with individual members to debate and for the politicians to consider in their own time. Consideration of LRRD issues within the WASH cluster is further complicated by the lack of a common understanding of what LRRD involves and how a strategy can be developed. The problem appears to hinge on the cluster system being an emergency response strategy and the cluster members not having any experience of developing a transition strategy but now having to do so in the absence of GoZ leadership on the issue.

83. At a national level it is known that the GoZ has charged the NAC with the responsibility of developing an official national transition strategy to ensure its newly energised organs of state are developed along lines which converge, as far as possible, with the INGO sector which is currently managing the water sector. However with the INGO sector waiting to see where the funding is going to be focused the Government institutions do not have a clear target to focus on.

84. While the WERU was originally an emergency response unit it has shifted its focus slightly towards developing new capacity in emergency preparedness through its programme of pre-emptive rehabilitations of rural health clinics not currently suffering from the cholera epidemic. This is itself a quasi-transition activity and a good starting point for developing a more coherent transition strategy. While the current programme of ECHO funding is due to be complete in July this year the need to develop a transition strategy is becoming ever more pressing. While it is accepted that the ECHO mandate is limited to humanitarian assistance it is recognised that the current ECHO funding programme has been successfully applied in starting the debate on transition at the same time as taking the first few tentative steps in what is likely to become the initial direction for transition to longer term sustainable development of the WatSan sector.

85. A key component of any process which attempts to link relief to rehabilitation and development is the sustainability of the technology which was installed during the emergency response phase of the relief exercise. In this aspect of LRRD the WERU did not perform as well as could have been expected. Technical standards and quality of workmanship achieved at the water points which were visited were assessed as being less than optimal and in most cases do not auger well for long term sustainability. The “quick and dirty” approach which was adopted by partners during the emergency phase of the intervention was sustained well into the later rehabilitation phase of WERU and appears to be continuing to the present. This lack of attention to detail will necessarily represent an inhibiting factor in developing a longer term strategy for operation and maintenance of the water infrastructure in the future. This is considered to be a serious deficiency in the current implementation strategy which will have an impact on the transition strategy to be adopted in the future.


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86. In October 2010, the African Development Bank proposed a project for further restoration and stabilization of water and sanitation services in six urban areas7. This initiative is to be financed by the Multi Donor Trust Fund (MDTF). Other donors active in the water sector (GIZ and AusAid) are focusing their activities on addressing the water supply and sewerage problems in major towns in the country. Their work is predominantly funding of the supply of water treatment chemicals and supervising the rehabilitation of some water treatment plants and sewage works. Once the physical engineering work is complete the long term question of sustainability of the infrastructure and service delivery system will become more pressing. Without the financial resources to maintain the equipment and with chronically depleted income generation and collection facilities the Municipalities that have benefited from the rehabilitation process will struggle to keep the systems going without further external financial assistance. This is recognised by the donors and is currently the subject of ongoing discussions with the Municipalities concerned.

87. To address this issue on a long term basis the GoZ is in the process of convening a WASH Sector Working Group and has invited all interested parties to join this forum. The intention is for the Government to take the lead in developing a comprehensive transition strategy for the sector and at the same time to incorporate all the knowledge and experience of the NGO community (both international and national) in that process. It is therefore considered that this new forum presents itself as a suitable entry point for both the partners and DG-ECHO to contribute towards the development of a national transition strategy for the WatSan sector.

5.5 Cross-cutting Issues

88. Q5. Cross-cutting issues: To what extent have DG-ECHO and its partner organizations taken into account cross-cutting issues such as gender, children, environmental protection and HIV/AIDS, in the planning and implementation of the action?

89. As mentioned elsewhere in this evaluation the WERU programme was not implemented in accordance with a well prepared plan which was devised in isolation from the context of the WatSan sector in Zimbabwe. The main partners of WERU and the co-ordinating office of UNICEF were already in place and working in the sector for many years prior to the outbreak of cholera in the country. As such all parties to the WERU process (official partners and WASH cluster members) were already using their own implementation strategies and modalities based on their previous experience and policies devised elsewhere. As all the major players in the emergency response were well known and long established organizations it was assumed that their various core activities were already complying with the internationally agreed standards that were acknowledged as a prerequisite for sustainable long term development within the sector.

90. Those organizations which were involved in water point technology were already working to the established guidelines for environmental protection, gender and HIV/AIDS considerations as well as following child sensitive guidelines (especially girl-child) and the sector standards for ownership and participation considerations. The hand pumps which were used as standard by WERU partners were already approved by GoZ as being locally 7 Twenty eight million ($US) are to be allocated to WASH, including Municipality support in Harare, Kwe Kwe, Masvingo, Chegutu and Mutare. Source: Minutes of the Donor Coordination Meeting on the water and sanitation sector (December 2010).


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produced, VLOM suitable, mother and child friendly as well as economically sustainable8. The design and layout of the headworks used as a standard in Zimbabwe was developed specifically to incorporate environmental protection issues (no splash, no spillage, no standing water, local materials and fenced) and communities had been sensitized over many years to accepting ownership and maintenance responsibilities.

91. Despite the favourable pre-existing conditions in the water sector in Zimbabwe it was recognised throughout the cholera response that the social and economic environment was radically different to the situation that pertained prior to 2000 when the infrastructure decline started. In order to save lives at short notice it was necessary to temporarily suspend some of the normal considerations and this led to the relaxing of the normal requirements to use a participatory approach to water supply rehabilitation. It was imperative that the water supplies to rural health clinics should be restored as quickly as possible and in most cases this restoration had to be achieved using technologies which did not necessitate the involvement of the community themselves. In some cases bladder tanks were brought in by vehicle and filled using water delivered by bowser from the nearest available source of potable water. In other cases plastic water tanks were installed on plinths and filled from municipal or alternative sources without the involvement of the local communities or their consultation. This is entirely appropriate given the urgent need for relief supplies and cannot be considered as having ignored the normal cross-cutting issues.

92. Zimbabwe is one of the countries most affected by HIV/AIDS, with an adult sero-prevalence estimated at 14.3%. An estimated 1.2 million people live with HIV/AID (UNAIDS, 2009). In this setting where HIV is a significant problem, DG-ECHO has incorporated a strong focus on this cross-cutting issue and has ensured that HIV/AIDS is mainstreamed in every funded project.

93. The circumstances at rural health clinics made HIV/AIDS a relevant issue. On the one hand, People Living with HIV/AIDS (PLWH/As) have reduced immunity to all infectious diseases, including cholera and might be affected more severely. On the other hand, the deteriorating conditions of water supply and sanitation, including medical waste management, have a direct impact on the health system for water-borne related diseases, HIV/AIDS and maternal health. Therefore improved access to clean and safe reliable water may have reduced the potential for contracting infectious diseases which would have devastating impact on the well-being of vulnerable groups.

94. During the peak of cholera, a lack of knowledge about cholera specific symptoms was reported. In a number of occasions, PLWH/A came to CTCs mistaking diarrhoea for cholera symptoms, thus resulting in increased exposure to cholera. WERU partners addressed this issue through awareness raising activities during community gatherings and prior to NFIs distribution. They also ensured that chronically ill households were given priorities during targeted NFI distribution and provided training to their staff as part of internal mainstreaming.

95. The spread of diseases such as cholera and the introduction of the HIV virus have re-emphasized the need to minimize the risk of exposure by both patients and health staff. In Zimbabwe, rural health clinics are generally the most critical health service delivery points. Unless proper precautions are taken, they may become a source of infection. Hand washing to avoid cross infection and maintain sanitary premises and dispose of waste safely are amongst

8 A VLOM pump is one which can be operated using Village Level Operation and Maintenance.


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the essential elements of universal precautions. DG ECHO has encouraged WERU partners to adhere to the respect of, and monitoring of the universal precautions. The evaluation found that universal precautions were put in place, although the effectiveness varies from site to site. In particular, much more could be done in order to facilitate access to medical waste disposal if a systematic consideration of this issue was taken during the assessment and planning stages of rehabilitation work at rural health clinic.

6. Conclusion and Recommendations

96. The situation in Zimbabwe which gave rise to the evolution of the WERU approach was unusual and is unlikely to reappear anywhere in the foreseeable future. The combination of a national economic collapse characterised by unprecedented hyper-inflation, a totally decrepit and dysfunctional water and sanitation infrastructure, the deteriorated health system, the complete absence of central Government management of the crisis and the prior existence of INGOs already in place and operating in the sector contrived to produce a desperate scenario that almost defied resolution. Despite being based on a concept which had been piloted in previous crises the WERU that evolved in Zimbabwe was unique and in the time of dire need was also very effective.

97. The recommendations that have been derived from the evaluation team’s field visit to Zimbabwe and perusal of the sparse documentation which accompanied the action are divided into two sections. Firstly recommendations are given for improving the effectiveness of any future WERU programme which might arise in closely similar conditions to Zimbabwe in 2008-2010. This set of recommendations are only likely to recur in Zimbabwe itself in the near future while the underlying problems in the sector remain unsolved and new strategies are not yet developed to prevent a recurrence. A second set of recommendations are presented for consideration in the future where some proper planning and forethought can be applied to a new crisis. These recommendations are necessarily generic in nature and include considerations of LRRD which cannot be retrospectively applied to the situation in Zimbabwe.

98. Short term recommendations:

1. The procedures followed by all WERU partners when collecting and analysing field data for the assessment of water point needs (at a clinic or other site) should be standardised, adopted and implemented uniformly. The agreed procedure should be drawn up by the WASH co-ordinator in agreement with the partners and in co-ordination with OCHA and relevant Ministries to ensure consistency and smooth integration with the WERU tracker database.

2. All parties actively engaged in repair or rehabilitation of water supply systems (WERU partners or WASH cluster members) should adopt approved WatSan sector technical standards in all their WatSan installation and supervision activities. These technical standards should include hand pump selection and installation, headworks design, layout and construction as well as industry standards for the selection, construction and installation of all hardware components of motorized pumping systems, water storage and reticulation systems as well as electro-mechanical monitoring and control systems. The WASH cluster co-ordinating partner should collect, collate and disseminate the standards to be followed by all partners and members.


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3. The future operation and maintenance strategy for water supply systems installed or rehabilitated under the WERU programme should be clarified with the relevant GoZ authorities with a view to improving their longevity and enhancing their sustainability. This will best be undertaken by active engagement with the NCU and their recently convened WASH sector working group.

4. Future ECHO funding of all INGOs for WERU implemented activities should be dependent upon the selection and recruitment of appropriately qualified personnel to ensure that all activities funded from EC Member States resources are implemented to the quality standards commensurate with the best practice procedures of the EU. DG-ECHO should also establish quality assurance procedures for project M&E throughout the tenure of the grant contract rather than only at the time of completion of the contract.

5. The focus of attention for water point rehabilitation in future WERU co-ordinated interventions should be widened from the clinic’s own borehole to the clinic catchment area which might include several water sources. Where appropriate according to the logistics of the local water supply environment all water points located within an area affected by a cholera outbreak alert should be considered for rehabilitation even if a nearby borehole is under the supervision of another clinic catchment. In this way the water supply needs of the community affected by cholera should dictate the type of WatSan activity that is undertaken rather than the existing administrative arrangements for the existing water supply systems.

6. The current WASH situation in Zimbabwe facilitates the easy transmission of diarrhoeal disease (including cholera). After the emergency phase, rather than limiting consideration to cholera alone, the links to public health should be strengthened by adopting a diarrhoeal disease approach and incorporating it into the implementation of WERU-funded projects. By taking into account the health data available at DMO level, the list of water-borne priority diseases in Zimbabwe and the on-going IDSR initiative, such an approach would improve the identification of rehabilitation work and facilitate the move towards recovery.

7. The WASH cluster should be encouraged to harmonize data collection in such a way that all the databases maintained across the sector can provide a dynamic view of the sector rather than simply recording static data. The databases should be continuously queried for trends and patterns so that the live sector picture can feed back to the partners without requiring a special effort by one or other database managers. This database harmonization should be supervised and co-ordinated by the WASH cluster co-ordinating partner.

8. All ECHO funded partners in the WASH cluster should be included in and be part of the M&E activities undertaken by the cluster co-ordination mechanism in order to ensure parity of performance across the sector. In this regard UN-OCHA have an important role to play in supporting the Cluster co-ordinator as they are specifically funded by DG-ECHO for co-ordination activities and M&E. Greater effort should be made to integrate their activities into the partners’ own M&E strategies.

9. In the current transition phase of WASH cluster selection of focal areas for emergency preparedness should be discussed with the MoHCW and based on epidemiological data from the MoHCW database rather than strictly according to geographic or provincial boundaries. The use of risk analysis from MoHCW sources at both national and district level and in close consultation with HERU partners should be encouraged.


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10. The WASH cluster meetings should include follow-up on previously reported challenges to add value to the current information exchange actions. This should specifically include the use of reported information (analysis of trends, identification of weaknesses and opportunities for improvement etc.) which can be used in fine tuning the field response mechanism. Specifically this should include analysis of epidemiological reports for risk analysis and follow-up information on the efficacy of distribution of NFIs.

11. The WASH cluster should engage more actively with the GoZ for the purpose of developing an effective and sustainable transition strategy. Use of the NCU for access to GoZ policy and strategy updates should be increased. Links with the emerging GoZ WatSan structures at all levels should be actively encouraged rather than passively accepted. DG-ECHO and the partners should engage fully with the newly convened WASH Sector Working Group under the supervision of the MWRDM.

12. All ECHO funded partners should develop their own transition strategies internally as part of their own individual organizational strategy. These individual strategies should then be incorporated into a WatSan sector transition strategy to be developed collectively under the stewardship of the co-ordinating partner. This sector transition strategy must be developed in parallel with the current developments within the GoZ institutional structures which are already charged with the responsibility for developing a national transition strategy. Transition always takes place at several levels; the challenge is to harmonize those processes to arrive at the same point in the future.

99. The foregoing recommendations are all considered to be realistic and pragmatic and can be implemented promptly within the timeframe of the current funding cycle. It is known that several of the proposals are already being considered within the WASH cluster and some members and partners have already taken the initiative on some issues.

100. As the current WERU programme of activities draws to a close with the waning of the emergency response and the focus of activities moves towards transition and longer term plans it is necessary to draw lessons from the wealth of experience gained by all partners, members and donors involved in the relief operation. All individual entities which have been involved since 2008 will have assimilated their own experiences and will be developing their own institutional strategies for their own short and long term future in the WatSan sector in Zimbabwe.

101. Consideration must also be given for longer term policy development and especially for DG-ECHO to refine its own operational strategies and policy review processes. From the experience of previous evaluations and the specific information drawn from the current Zimbabwe situation some generalised but nevertheless practical recommendations are presented here for consideration in the future.

102. Long term recommendations:

1. The difficulties experienced during this evaluation in identifying the precise nature of the WERU approach can be avoided in the future by ensuring that future programmes are more methodically planned and systematically implemented. This will require a greater degree of structured planning and co-ordinated implementation than was achieved under the WERU process. It will be important at the outset of any new emergency intervention to consult with suitably qualified and experienced senior staff both within and outside of the ECHO management structure to ensure that a more robust co-ordination,


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management and monitoring system for the funding programme is established as early as possible.

2. Exit strategies for the funded partners should be considered at the outset of any future intervention and not left until the closing stages of the emergency response. If exit strategies cannot be developed in advance of the intervention then funded partners should be required to develop them as early as possible during the course of the implementation phase of the emergency response.

3. In the case of future emergencies involving an element of water and sanitation all interventions should be developed with an active component of integrated water resource management. IWRM is not an add-on consideration but should be an integral part of any relief operation so as to maximize the beneficial effects of the intervention and to avoid introducing new and possibly detrimental factors into the long term resolution of the emergency.

4. Wherever possible and practical DG-ECHO should insist on close adherence to EU technical standards throughout EC funded activities implemented by recipients of grant funding. It is seldom cost effective to do “quick and dirty” work when the opportunity exists to do the job properly the first time. The achievement of acceptable technical standards of implementation has a positive beneficial effect on the longer term sustainability of relief work and facilitates a much less costly LRRD process. Wherever necessary and technically prudent local standards may be adopted where these are deemed to be specifically relevant to the local technical environment.

5. In the case of any technical relief operation which is occasioned by a medical emergency it should always be the public health factors which dictate the relief and rehabilitation strategy and not the technology itself. For example focusing on the public health aspects of the cholera outbreak would have redirected more effort to the clinic catchment areas and thereby concentrated water supply rehabilitation activities in a smaller geographical area; this in turn would have reduced the logistical problems associated with targeting widely dispersed clinics only.

6. While it is recognised that in emergency situations it is often necessary to make quick decisions which might exclude unknown entities such as local indigenous NGOs it is always possible to update and augment the knowledge and skills base available during protracted relief operations by engaging with and involving local organizations where appropriate. Greater effort in this regard should be made during the LRRD process.

7. As WatSan is not a focal sector under the 10th EDF DG-ECHO should ensure that where extensive relief operations involving the water and sanitation sector are funded the recipients of those grant funds are made aware of the short term nature of the funding to avoid developing any kind of donor dependency based on the assumption that WatSan will continue to attract development funding after the emergency is over. This recommendation should be followed in parallel with encouraging the implementing agency (INGO or other) to develop its own exit and transition strategies where applicable.

103. These longer term recommendations are more applicable to the longer term policy framework for DG-ECHO than to the current activities in Zimbabwe and should be read in the context of an imminent conclusion of the cholera relief response in Zimbabwe.

Evaluation of DG ECHO’s Action in the Water and Sanitation...

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