As part of the Water, Sanitation, and Hygiene for Trachoma Elimination (WASH Tra) project, SNV in Ethiopia and partners concluded the development of a Trachoma Programming Strategy document. The document provides implementation guidance for WASH intervention-related trachoma prevention in Oromia; the most trachoma-endemic region in Ethiopia.
Since 2013, the Fred Hollows Foundation (FHF), in collaboration with the Oromia Regional Health Bureau (ORHM), has been implementing a large-scale trachoma elimination programme to address surgery backlog and treat eye infections through mass drug administration (MDA) in the region.
Though progress was being made, results showed that the region’s trachoma elimination programme would be more effective if complemented by WASH sector interventions.
In 2018, SNV and the FHF partnered to scale up facial cleanliness and environmental improvements (F & E) as a strategy for trachoma elimination. Specifically, the partnership is committed to increase access to clean water, construct/rehabilitate sanitation facilities improvements and motivate hygiene behavioural change.
About the strategy document
The Trachoma Programming Strategy document is a first attempt to standardise Ethiopia’s F & E programming approach within trachoma prevention efforts. It applies the F & E component of the World Health Organization’s SAFE  approach and integrates recommendations from various national/international policy and guiding documents.
To ensure the effectiveness of F & E strategy and programming tools, results of an SNV formative research in five implementation woredas informed the design of social behaviour change communication (SBCC) strategies and tools. Effective messaging includes the production and distribution of gender-sensitive/inclusive SBCC messages and engaging mass media to disseminate messages. The research also validated the importance of trainings to build capacity of WASH stakeholders and actors.
The strategy document contains a set of principles and how-to strategies for the design and implementation of locally relevant/context-specific solutions. The document includes sections in guiding principles, target behaviours, audiences and programme settings, and F & E programme objectives, indicators and approaches.
The strategy document is envisaged to be instrumental in alleviating the burden of trachoma which stands at 29.8% (on average) in Oromia, and ranges between 39% and 48.8% in WASH Tra project intervention woredas. Said Tokuma Bekele, Jimma Geneti woreda Health Office Head,
Though the woreda has been exerting a lot of efforts for many years before the WASH Tra project, it has been a challenge to realise ODF. Since early 2019, the WASH Tra project has been strengthening the capacity of woreda health and education experts. These efforts have helped realise primary ODF certification of four out of seven project kebeles within eight months.
About WASH Tra
The WASH Tra project is currently in its first phase (2018-2021). In less than one year, parts of the region have started to show signs of progress.
- 18% of target kebeles have become ODF;
- 27.14% more households have built their own latrine;
- at the Degem woreda, for example, water coverage has increased by 16.5% and non-functionality rates of water points dropped by 10%; and
- in two schools surveyed, the presence of flies has dropped and nasal and ocular discharges are showing a downward trend.
Through these improvements, we are starting to see heightened water supply access, increased latrine construction and strengthened sanitation ownership by WASH clubs in schools.
 Between 2012 and 2014 the Global Trachoma Mapping Project (GTMP) found that approximately 41% (109/265) of districts were hyper-endemic (TF prevalence greater than 30%), and 56% (149/265) were meso-endemic (TF prevalence between 10% and 30%).
 The WHO-endorsed SAFE strategy (Surgery, Antibiotics, Facial Cleanliness, and Environmental Improvement) provides a guiding framework for trachoma elimination efforts and effective disease control.
 The guiding principles include adequate resourcing, evidence-based approaches, audience centred, context specific, integration and linkage, gender and social inclusion, use of multimedia channels, diverse messaging and capacity building.