Improving access to, and the use of, sustainable water, sanitation and hygiene (WASH) services in communities and healthcare facilities in marginalised districts of Ethiopia, Malawi and Rwanda.

Where did we work?

Deliver Life focused on addressing a lack of clean water, decent toilets and good hygiene at community level in the rural Burie Zuria woreda (district) and Burie Town in Ethiopia; Kasungu, Machinga and Nkhotakota districts in Malawi; and Rweru and Gashora sectors in Bugesera District, Rwanda. Ethiopia, Malawi and Rwanda have made progress overall towards improving access to water and sanitation services, but inequity has been increasing in rural areas and groups that face marginalisation and exclusion have the least access to these services at home and in schools and healthcare facilities.  

Before we began the Deliver Life project, the lack of access to water, sanitation and hygiene (WASH) in rural poor communities in these three countries – underpinned by political neglect – was contributing to a vicious cycle of poverty. Inadequate WASH in healthcare facilities was undermining efforts to improve maternal and newborn health by contributing to healthcare-acquired infections and reducing the overall quality of care. The local and national governments' management of the WASH sector needed to be strengthened – across communities, schools and healthcare facilities, alongside the role of civil society.  

What did we do?

We designed Deliver Life using our programmatic approach, which enables us to bring about transformational change through service delivery and advocacy initiatives, delivered in partnership at community, national and international levels. Each country team addressed WASH-related barriers facing communities and affecting maternal and newborn health, including the availability and awareness of suitable facilities, the confidence of staff at maternity units and sustainable hygiene behaviour. 

Enabling education

Adisae washes her hands at the new tapstand at her school in Burie district, West Gojjam, Amhara, Ethiopia.

Image: WaterAid/ Genaye Eshetu

What did we achieve?


  • We reached 128,259 people across 177 communities with sustainable and inclusive WASH services.  
  • In Ethiopia, we provided ten schools with access to WASH facilities: water supply systems, water points, gender-segregated latrines and hygiene training including menstrual hygiene.
  • In Ethiopia, we trained eight small enterprises on solid and liquid waste management and business planning, providing vehicles to transport waste. This sub-project was designed to provide economic opportunities and work will continue beyond the Deliver Life project.  
  • In Ethiopia and Malawi, 45 communities have been declared free of open defecation. 
  • Where possible, we used solar technology to power water supply systems, reducing dependence on unreliable hydropower and high-emitting diesel-powered generators.  


  • We built latrine blocks for patients and staff in 22 health centres, reducing open defecation.  
  • We built facilities for the safe disposal of medical waste, including incinerators and placenta pits, in 22 health centres. 
  • Across Ethiopia, Malawi and Rwanda, we trained 1,187 health staff and community facilitators in hygiene and in maternal and neonatal health – more than the target of 810. 
  • We brought a complete package of WASH facilities and behaviours – water supply systems and water points, sanitation and medical waste disposal facilities, hygiene training for staff and hygiene messaging for patients – to 21 healthcare facilities, and latrine blocks and safe waste disposal to one further healthcare facility. 
  • Demand for services in health centres has increased.  
  • Our new partnership with Malawi’s Ministry of Health demonstrated the strides taken to encourage greater integration between the WASH and health sectors. 

Policy change

  • In Rwanda, we supported Bugesera District to develop an action plan, which it is now implementing, to improve the coordination and monitoring of WASH stakeholders. 
  • In Ethiopia, we supported Burie local government to develop and implement the One WASH strategic plan, in-line with the national development strategy for Ethiopia known as Growth and Transformation Plan II.
  • In Malawi, we supported the development of District Investment Plans in all three districts, one of which was approved by the end of the project. 
  • Also in Malawi, we advocated for more attention to and investment in WASH in health at local and national level. This included sharing project learnings during our Global Hygiene Conference, recording a podcast for the WHO Quality of Care Network, presenting on WASH in healthcare facilities at the Pan African WASH in Healthcare Facilities Conference, participating in the Infection Control African Network and facilitating a WASH in healthcare facilities learning workshop in Tanzania.   
  • In Rwanda, the Government committed to trialling Deliver Life's approach in delivering sustainable WASH in four other districts, and, pending the outcome of the trial, potentially across all districts nationwide. 

This project was part-funded by the UK Government.

Top image (desktop): Veronica Makiyi, 30, with her newborn child in Katimbila Health Centre, Nkhotakota district, Malawi.

Top image (mobile): Baby Evelless sleeps in the arms of her grandmother while her mother sits beside them at Simulemba health centre, Malawi.

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