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Health Through Sanitation and Water (HESAWA)

Keywords: Poverty Eradication
Women & Gender equality


The HESAWA programme began in 1985 on the basis of a Specific Agreement between Tanzania and Sweden on cooperation concerning rural water supply, environmental sanitation and health education. The programme area covers the Lake Zone, made up of Kagera, Mara and Mwanza regions, which border Lake Victoria.

The overall aim of the programme is to improve the welfare of the rural population through improved health education, environmental sanitation, drinking water supply, community participation, and capability and capacity building at village and district levels. The pillars or Principles on which HESAWA activities are funded include: Affordabillity, Sustainability, Replicability, Credibility, Cost-efficiency.


The overall aim of the programme is to improve the welfare of both rural and urban populations of the regions that border Lake Victoria, through improved health education, environmental sanitation and drinking water supply. Over the years these were seen to deteriorate as shown by a survey of school children's health situation. The studies indicated that most of the pupils suffered from lack of clean water and basic sanitation due to waterborn diseases.

The government discovered that the high occurrence of water borne diseases among children was a community problem which could only be tackled through high community awareness and participation through capability and capacity building at village and district levels ensuring long-term sustainability. The programme, developed in July 1995 by the Governments of Tanzania and Sweden, covers the Kagera, Mwanza and Mara Regions in the lake zone involving a total of 730 villages in all the 15 districts in 1993. There were some 32 villages in the pilot project in 1985. Coverage has increased more than 26 times since 1985.

The HESAWA programme has grown large and complex over time and covers a wide geographic area of the lake zone whose total population exceeds 4 million people.

According to the 1990-93 Plan of Action (POA) the operative goals of the programme are:

Improved Water Supply
Make water supply reliable and continuous, of improved quality of greater quantity, more accessible and valuable for various household purposes (also financially self-sustained:1994-95 POA).

Improved Health and Environmental Sanitation
This was to be achieved by:
i) increasing people's awareness as to how to maintain the quality of water from source to consumption,

ii) increasing popular participation, especially the participation of women,

iii) health and environmental sanitation education directed towards water and hygiene - related diseases,
iv) Construction of sanitary latrines which are socially and culturally acceptable,

v) Improving vector control through improved drainage and waste disposal (also promoting full village coverage of household latrines - 1994/98 Plan of Action)

Capacity and Capacity Building and Strengthening at All Levels
This was to be done by:
i) Overall human resources development (especially with emphasis on women - 1994/98 Plan of Action)

ii) legislative backing for management at village level

iii) improving managerial capacities at village and other levels

iv) Imparting technical skills to the grassroots level (Also increasing gender awareness at all levels - 1994/98 Plan of Action)

Since 1995 when the project was started, HESAWA has produced a marked impact in meeting its objectives, most of which is qualitative, given the nature of the programme aimed at creating a qualitative change of attitudes regarding Health through Sanitation and Water (HESAWA) using local resources.

To date, HESAWA has undertaken activities in more than 600 villages, spread over more than 180 wards. All 15 districts in the Lake Zone are undertaking HESAWA activities to some degree or other. The programme has expanded significantly during the past year or so. On the basis of village and other studies carried out the major achievements of the HESAWA Programme can be summarized as follows:

- The creation of an improved potential for the reduction of diseases and the achievement of general health and hygiene improvement, recognized and acknowledged by the villages themselves;

- Increase coverage of improved water supply in the Lake Zone;

- Acceptance by both government workers and villagers of more appropriate, affordable, and sustainable water supply technologies, including rainwater harvesting systems and improved traditional water sources;

- Positive steps forward in promoting and operationalizing community-based approach;

- Impacts at village level in terms of greater convenience and quantity of water supply, cleaner and safer water, time, gains, reductions in the burdens of women, and opportunities to improve nutrition through garden watering;

- Increases in knowledge, skills and capacities at regional, district and village level for planning implementing and operating and maintaining water supply improvements and, to a lesser extent, hygiene and health activities; and,

- Progress in transferring implementation responsibility from regions to districts, through the use of inter-departmental promotion teams working at village level.


Alleviation of Povery and Job Creation
HESAWA provides health education to improve the environment. Improved health indirectly enables people to actively participate in economic activity leading to improved incomes and reduction of poverty. About 1289 new jobs have been created, most private local consultants. With the recent shift in government policy towards higher private sector involvement more jobs are foreseen in the supply of spares and carrying out of drilling operations of boreholes. No study has been undertaken to measure change since 1985.

Reduction of Pollution and Improving Environmental Health
The programme has provided its services to urban dwellers in Mwanza Municipality as well as other regional centres. It is soon launching special programmes for the small towns of Mugumu, Ngudu and Bihalamulo. The increased use of pit latrines and protected water sources in the rural areas has greatly reduced the dangers of faecal pollution. The reduction in water borne and pollution related diseases has not been quantified so far for lack of baseline data.

Extension of Safe Water Supply and Sanitation
This is the major preoccupation of HESAWA in about 730 villages by 1993, through health education and water supply. As a result 1797 wells have been constructed, 289 wells rehabilitated, 65 piped water schemes constructed or rehabilitated, 850 traditional water sources improved and 1798 village health workers, both men and women (50%), trained. Through the programme, thousands other participants have been trained in various human resource development activities. Based on this success, the government has decided to introduce the HESAWA approach in other regions. With the support of UNDP, a strategic workshop was undertaken in Arusha in 1992 for this purpose.

Local Government
HESAWA is implemented through the local government system who provide both, money and personnel also some materials. The contribution of funds from the local government varies with status at 5% or 3% of total budget. Provide office space and workers housing.

Central Government
They are the HESAWA managers (coordinators)

Non-Governmental Organisations (NGOs)
HESAWA works with Religions organisations, hospitals, relief organisations such as CARITAS and local environmental NGOs e.g. TAHARE. These are useful for local mobilization and provide experts for training programmes at all levels.

Private Sector
The programme utilises the services of the private sector right from provision of consultancy services by Business Care Services to supply of materials by other outlets. More future role of the private sector is planned.

International Agencies
The programme utilizes the services of Hifab, SIDA, AMREF for various specialised services while training is done at ESAMI and other universities abroad.

HESAWA produces its own newsletter and plans a radio programme with a newly established Radio Free Africa of Mwanza.

Women are involved at all levels of the programme development. Gender awareness raising is part and parcel of the programme. Noticable changes are showing up whereby men are taking up roles traditionally in the women's domain. Free gender discussions are carried out. The water projects are reducing women's workloads, distance travelled and liberate time for women who now can participate in other activities. Women have made a sustainable contribution to the programme, mainly taking up roles based on the social division of labour. However, this is changing as both men and women have equal access to training to become village health workers and water pump care-takers on a basis of equal participation.

HESAWA provides for water source protection to protect its water schemes. However, it works closely with environmental NGOs in afforestation. Also the programme promotes fuelwood efficient technologies. The now-popular mud-stoves help reduce fuel wood consumption leading to long-term conservation effects.

HESAWA works on the principle of involving the people in planning and decision making processes.

It is a result oriented programme whose outcomes are helping to solve health problems facing the people;

People in the target areas are finally responsible for maintaining facilities to ensure their sustainability.

HESAWA promotes local independence in decision making on the use of funds.

It also promotes increased cooperation among actors to speed up success.

As a response to the SIDA Evaluation Report of 1993, HESAWA is now working on data banking to develop its monitoring capacity and the necessary indicators for planning and development.


2150 wells have been constructed.
336 wells have been rehabilitated.
1077 piped water scheme domestic points have been constructed or rehabilitated.
921 traditional water sources have been improved.
447 institutional latrines have been constructed.
5401 household latrines have been constructed.
1128 village health workers have been trained.
Thousands of participants have been trained in other HRD activities.

Besides these measurable achievements, other notable accomplishments are for exampled: community participation at village level in planning, financial management by opening HESAWA accounts and more women participation in HESAWA committee.

As a result of these achievements the Tanzanian Government has decided to introduce HESAWA also in other regions. In 1991/92, with the support of UNDP. HESAWA started in Arusha region. A strategic workshop in Arusha marked that take-off.


HESAWA prints the by-laws and distribute to the people to make their rights known. Most of HESAWA activities are covered in the by-laws hence it only plays the role of dissemination.

The programme strategy is to achieve change of attitudes towards project ownership at local level. As a result village accounts have been opened as a step towards project maintenance and purchase of spares.
The educational approach towards sanitation, participatory evolvement of projects and the establishment of schools water clubs aims at sustainable results of the programme involving both men and women.

The water committee at village level is comprised of 3 men and 3 women. These make decisions of the day to day activities and some are signatories to the village water account. Expenditures are approved by the village water committee. One signatory to the account is drawn from district level. The HESAWA office in Mwanza is the overall coordinator of the programme.

The programme is jointly financed by the governments of Tanzania and Sweden. Whereas Tanzania provides local funds, personnel, offices, housing, access to institutions and equipment, Sweden throug SIDA, supplies the foreign funds needed. The Swedish support contribution has been around 37 million Swedish Kronor per year since 1985. In 1994 this amount stood at 41 million Swedish Kronor or approximately 6 million US Dollars. Budgets are prepared at all levels based on needs from below:

In ensuring sustainability, HESAWA puts more emphasis on the following:
(i) Integrating HESAWA activities into existing government structures;
(ii) Human resource development at the village, ward and district levels;
(iii) Instituting community-based operation and maintenance by ensuring that each HESAWA village has:
- Bank A/C to cater for future operation and maintenance of HESAWA interventions;
- Functional HESAWA committee to ensure management of the installed facilities;
- two trained well-caretakeres (at least one woman) to undertake service and repair of installations; and,
- the use of appropriate technology.


    Mr. Makerere, HESAWA
    P.O. Box 604
    (255 68) 50718/42184; Fax: 50248/50564


    Ministry of Community Development, Women Affairs & Children (MCDWC), Tanzan
    Ministry of Community Development, Women
    Dar es Salaam
    255 51 31301-5


    Embassy of Sweden/Sida, Dar es Salaam
    Lars Norvik, Embassy of Sweden/Sida
    P.O. Box 9274
    Dar es Salaam
    255 51 33581; Fax: 255 51 46928

    Mr. Mtui, HESAWA Director
    P.O. Box 604
    (255 68) 50718/42184; Fax: 50248/50564

    Margaretha Sundgren, Sida Sweden

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