... 49useandtesting,andthesurveillanceforhealthoutcomes–havebeendiscussedinsomedetailwithstaff.IssuesthoughttobeofparticularrelevancearereportedinSections3.5and3.7.3.4Education(health),productpromotionandfinance(loans)Educationandproductpromotioniscentraltothisproject.Thekeypeopleintermsofdeliveringthisarethevendors,whohavebeentrainedbySWAPprojectstaff.ThevendorsareindividualsidentifiedfromHIVsupportandcommunitygroups(typicallytwoindividualspervillagecommunity)mostofwhomarewomen,andwhoarealreadyinvolvedinsomeformofbusinessactivity,forexamplesellingagriculturalproduce(Figure3.5).Figure3.5Oneoftheprojectvendors(atrear,right)withtheprojectandevaluationstaff.Thisvendorhadoneofthefewkiosksforadvertisingandsellingproducts‐mostwoulddosodirectlyfromtheirhomes,whentheyvisit,atmeetings,etc.ThekioskcontainedasmallstockofHWTproductsandstoves.(PhotoCredit:BruceN,2009)Initially,visitsaremadetothegroupswhereSWAPisintroducedandallitsproductsarepromoted,emphasizingthehealthandeconomicimpacts.Thegroupsareencouragedtousethisasanincomegeneratingactivityandatthesametimeimprovetheirownhealth.The'EducationThroughListening'(ETL)methodisusedforallteaching.ETLisamethodthathasbeendevelopedbyCDC/DrBobbiePerson(SeniorBehaviouralScientist,CDC,Atlanta),whichplacesemphasisonencouragingthehouseholder/potentialcustomertothinkabouttheirsituationandneedsandhowtheymightbeabletomeetthesewiththeproductsavailable.Onceagroupbecomesavendortheyqualifyfortraining.Trainingcoverssafewater(onedaytrainingfortheentiregroup),andanintroductiontomicrofinanceservices,sincesomegroupsreportedthattheydonothaveenoughcapitaltopurchasetheproducts.OncetheyregisterwithKRep(theorganisationofferingMicrofinanceservices)andqualifyforaloanafteratleasteightweeksofsavings,theyundergotraininginbusinessskills.Thisprovidesbasicskillsonhowtomanageasmallscalebusiness,generationofbusinessideas,marketing,recordkeeping,andsoon.Duringthebusinesstraining,theywillbetakenthroughalloftheproductsagain,theirusedemonstrated,andhealthbenefitsexplained,togetherwithhowtheycanturnvendingtheseproductsintoanincomegeneratingactivity.Aclearmessagefromtheprojectisthattheproductswillnotbefreegive‐aways,andanimportantissuehasbeenhowhand‐outsfromanumberofotherNGOsandaidorganizations(especiallyduringfloods,anddrought)haveinterferedwiththemarketsustainabilityofSWAP'sactivities. ... Linkagestowidereconomicdevelopmentprograms,asmentionedinSection2.8.2couldalsobemade.Thesuccessofsuchinterventionsrestsonpeople’swillingnessandabilitytopaythem,andthusasustainablemarket(withorwithoutsupportivefinancialinstruments),isessential.HealthimpactThedataonhealthbenefitsareinconclusive,mainlyduetolackofinformationonvalidatedcompliancewithwatertreatmentandIAPexposurechanges.Furthermore,bothwatertreatmentandhouseholdenergyinterventionshavehadmixedsuccess,anddebatecontinuesabouttheextentandnatureoftheirhealtheffectsinpractice.Someoftherecommendationsin2.7includesuggestionsforimproveddatacollection.Asfaraswecouldnote,thebeneficiariesappearedtobeinterestedandactivelyparticipating,andalsoseemedmoreawareofconsequencesfortheirhealthasaresultoftheGTZeffortssince2006.ThiswasalsoseenintheGTZfinalreportasreportedinSection2.4.Wenotedacleardemandforcleandrinking‐waterintheinterventionblocksvisited,andneighbouringresidentswerealsovocalaboutwantingtheirblockstobeincludedinthestudy.Itmustalsobenotedthatthebenefitsfromwater‐treatmentprojectsinlow‐incomesettingsalsorestonotherbarriersoftransmissionofwater‐relateddisease(Cairncross,etal.,2010).Assuch,hygieneandsanitationareessentialcomponentsofanyapproachaimingatthesediseases.Similarly,safewaterstoragecouldhavebeenamoreimportantcomponentinmonitoringthisproject.SafestorageisanessentialpartofHWTS,asanyrecontaminationfrompoorhouseholdwatermanagementpracticescouldnullifytheeffectsoftreatment.MambandaMultiStoveTheproductdemonstratedpotentialforscalingup.Thoughhealthwasincludedinitspromotion,itssuccessseemstohavestemmedfromthetechnologicalandaestheticimprovements,comparedtotraditionalcookingmethods,thatitprovided.Itspopularityasafuel‐savingstovethatwasalsoabletouseagreaterrangeoffuelextendeditspopularitybeyondMambanda,andinsomecasesevenDouala.Todate,therehasbeennoresearchonreductionsinemissions,exposureorhealtheffects.However,adegreeofreducedvisiblesmokewasnoted(asinKenya,section3),andtheMMSwasbuiltonseveraldesignsofimprovedstove,whichhavebeenshowntoreduceemissions.Thoughinterestwashigh,costwasamajorbarriertouptake.Microfinancecouldbeapossiblewayofaddressingthisissue,butwasnotpursued.Whatwaspursuedwastheformationofafinancingcommittee,usingthelocalprojectteam,whichcouldbeself‐sustainingafteraninitialstart‐upfund.Asdiscussedabove,fundingsolutionsarevital.HWTSTheevaluationnotedacleardemandforsafe,cleanwater.Beneficiariesnotedhowtheircommunity’sattitudestowater,healthandhygienehadpositivelychangedsincetheGTZ’sprojectsinMambanda.Earlierwementionedhowthedemandforcleanwaterseemedto ... Figure2.2“MamiPegna”poster(ExtractedfromGTZ,2009)Promotionaleventswereheldregularlyatfocalpointssuchaschurches,schoolsandcommunitycentres(particularlywithwomen'scommittees).ThesewereheldbyboththeACMSandlocalprojectimplementers.Meetingswereheldineachoftheinterventionblocks,withjointdemonstrationsshowcasingWG,MMS,andthefirelesscooker(brieflymentionedinSection2.4.2).Thesewereaccompaniedbyexplanationsofgoodpractices,groupactivitiesledbyACMS,cookingdemonstrationsandpublichealtheducation.Thecommunityworkersplayedacriticalroleincommunitymobilizationandproductuptake.Overthecourseofthefirstproject,atrademarkhadbeencreated,knownas“MamiPegna".Thecommunityworkersworebrightt‐shirtsshowingacartoonrepresentationof"“MamiPegna”asillustratedinFigure2.2above."MamaPegna"isawomansymbolisinggoodmorals 37# AreaofpotentialsynergyorantagonismSynergy(Benefit) Antagonism(Shortcoming)information.Easierfortrustandacceptanceofprojectimplementers&communityworkers.ACMScouldpromoteotherpublichealthsuppliesviathelocalimplementers,includingITNnets,condomsandsoap.Overall,thisassessmentfoundthattheintegrateddeliveryofproductsforimprovingthehouseholdenvironmentwaspositive....