Institutionalizing improved management practice and reporting to sustain sanitation service delivery

Low open defecation free (ODF) achievement in Malawi can be partially attributed to the poor management of Health Surveillance Assistants (HSAs). Engineers Without Borders Canada (EWB) partnered with Salima District’s Environmental Health Department to co-develop and deploy a reporting process to improve the incorporation of sanitation activities into the routine work of HSAs. The process was deployed using an “arm’s length approach” that strengthened the local management structures in the district. This brought clarity on the scope of HSA responsibilities to both HSAs and their managers. The resulting report represented the first comprehensive report to capture the activity performance of 187 HSAs in the department. Further, monthly reports revealed that each HSA, on average, performed only 1.5 of 4 required sanitation activities. This equipped managers with new data that could enable them to improve activity prioritizations and address root causes to underperformance.