Water to improve face washing and environmental improvement to reduce trachoma.

Until 2016, these projects were HH’s and all projects will be continued by HH O/S.

The Fred Hollows Foundation (FHF) has commenced work in Ethiopia to reduce the high levels of trachoma. The methodology used is following the World Health Organisation (WHO) trachoma reduction strategy of SAFE (Surgery, Antibiotics, Face washing and Environment). FHF have had great success delivering the first two components of the program, Surgery and Antibiotics, in the Oromia region to over 5 million people so far.

The Face washing and Environment improvement stages of the program, without which the long-term eye health gains are difficult to sustain, have proved more difficult. Lack of water infrastructure at a local level means there is no regularly available water for face washing.  There is also an urgent need to reduce the other important contributors to trachoma - dust and flies.

HH was invited by the FHF to visit Ethiopia and develop a trial program to propose ways to remediate these environmental problems and complement their existing program.

In 2014, HH completed an initial visit and determined:

  • a suitable location for the trial program,
  • the key infrastructure components currently available and possible improvements to water supply and toilet facilities,
  • local partners, skills and future project workers,
  • potential roles for WS trades, WPC and IAPMO to assist in the works. 

The FHF decided that a small scale trial project would not register on the radar of the ‘big contributors’ to world trachoma elimination unless they were involved in all stages of the project and committed funds to the trial.

At the request of HH, IAPMO and the WPC met with the FHF in Sydney to discuss lobbying the ‘big contributors’ to play a role in any trial program by having a WPC representative join the International Coalition for Trachoma Control.

In the interim, HH proposed and conducted 2x2x2 design challenges, for design and medical students, to find ways of using limited amounts of water to achieve efficient face and hand washing. These events have been held in Sydney, Brisbane and Newcastle. The ideas noted in the challenges will provide valuable detail for the final design.


2x2x2 Design Challenge

HH partnered with Universities in Sydney, Brisbane and Newcastle to ask students from design, engineering and health faculties to develop ideas to contribute to the HH designed toilet for Ethiopia. 

The challenge was to develop, design and construct a prototype solution to successfully use less than 2L of water per person, per day (the estimated maximum water available in an Ethiopian village devoted to these specific activities) to achieve the following in order of priority:

  • washing faces (eyes), 
  • washing hands,
  • water stored for other uses (such as extra water for drinking and cooking),
  • washing a concrete toilet floor with wastewater from uses 1 and 2 above.

Trial project plan

A trial project with the support and involvement of the FHF and the International Coalition for Trachoma Control and with on the ground support from IAPMO and WorldSkills trade contribution.

Trial works would include:

  • increasing the existing water supply,
  • increasing family access to the available water,
  • toilet construction, using local construction skills, to remove human waste safely and consequently reduce the volume of trachoma carrying flies,
  • the detailed design and trial of face and hand washing systems linked to each toilet facility,
  • the ongoing survey measurement  of trachoma levels, water use and the fly population to assess the success of the trial.