The TSEDU-Ethiopia Campaign Launched by the Prime Minister

The TSEDU-Ethiopia Campaign Launched by the Prime Minister 

By Abireham Misganaw, Policy and Advocacy Head, WaterAid Ethiopia

Recognizing the need for comprehensive action to accelerate sanitation, on April 26, 2024, Dr Abiy Ahmed, the Prime Minister of Ethiopia, launched the "TSEDU-Ethiopia" Campaign, which aims to create a "Clean Ethiopia" that aspires citizens to live a dignified life through improved Sanitation. 

The Campaign’s primary goal is to eradicate open defecation and urination by ensuring widespread access to basic sanitation and hygiene facilities while fostering sustainable changes in public behaviour. Importantly, the campaign has started in Addis Ababa, the national capital and will be replicated across the country. To ensure its success and effectiveness, a rigorous monitoring mechanism was put in place. The Prime Minister's Office has established a Project Management Unit to oversee the campaign's progress and strict supervision. 

WaterAid Ethiopia has been partnering with the Ministries of Health and Water & Energy for the last 2 years to make the top leadership's campaign agenda a political priority. In his national address, the PM called for all parties to join hands to transform the campaign and urged for financial support to fund the campaign. Following the call, citizens across the country including politicians, public figures, and religious institutions started pledging contributions including immediate fund transfers through banks. The campaign adopts a multifaceted strategy that encompasses the construction of sanitation facilities, advocacy, and social and behavioural change promotions. By integrating various approaches, the campaign aims to create sustainable improvements in sanitation practices across Ethiopia, ultimately enhancing the well-being and dignity of its citizens.

Ethiopia has seen a notable 57% reduction in open defecation since 2000, resulting in a substantial decrease in under-five mortality rates from 166 to 67 per 1,000 live births. However, less than 10% of constructed latrines meet basic sanitation standards, and only a quarter of targeted areas have achieved Open Defecation Free [1]. Although Ethiopia has made progress in recent years, it still struggles to provide adequate sanitation services, posing significant challenges. This issue has extensive impacts, affecting the health, welfare, and overall progress of both individuals and communities. Open defecation remains prevalent in Ethiopia, with an estimated 17% of the population still practicing it, despite considerable advancements over the past two decades, according to the WHO/UNICEF Joint Monitoring Programme[2].

The Government aims to achieve 100% sanitation coverage by 2030, aligning with the UN Resolution 64/292 from 2010, which recognizes safe and clean drinking water and sanitation as fundamental human rights essential for a fulfilling life. Although the right to safe sanitation hasn't been fully integrated into national policy, Ethiopia has embraced the Sustainable Development Goals (SDGs), striving to ensure access to adequate sanitation and hygiene for all and eliminate open defecation by 2030. As an interim target, Ethiopia aims to provide at least basic sanitation services to 60% of households by 2025.[3],[4]

Poor sanitation remains a significant contributor to disease burden, responsible for 30% of health issues, with diarrhoea being the second leading cause of death among under-fives. The poor coverage of adequate sanitation services has a major impact on health. In Ethiopia, under-five mortality per 1,000 live births decreased from 200 in 1990 to 51 in 2019. Despite this improvement, Ethiopia still experiences over 175,000 under-five deaths annually. This figure is ten times higher than under-five mortality in Europe and Northern America (5.3 in 2019), and four times higher than in upper-middle-income countries (13.4 in 2019)[5].  Unsafe water, insufficient sanitation and inadequate hygiene practices heighten the likelihood of diarrhea and other illnesses, which can deplete children with essential nutrients, contribute to chronic undernutrition, and elevate the risk of mortality.  [6]

 Diarrhea is one of the primary causes of death among children under the age of five in Ethiopia, accounting for an estimated 19-23%[7]. Therefore, improving the quality of sanitation services will contribute to saving the lives of 30,000 to 40,000 small children every year.

The estimated cumulative deaths in Ethiopia from diseases linked to water, sanitation, and hygiene (WASH) reached 60,000, with more than 3.7 million disability-adjusted life years (DALYs) reported[8][9]. On average, each person in Ethiopia loses more than 11 productive days per year due to diseases associated with WASH. Enhancements in sanitation coverage and quality are vital steps in combating various neglected tropical diseases, including Trachoma, Soil-Transmitted Helminthiasis, Schistosomiasis, Podoconiosis, and Guinea Worm Disease[10]. For example, Ethiopia carries the greatest burden of active trachoma worldwide, with an estimated 30% of sub-Saharan cases occurring there. This disease persists as a significant health issue, being a primary cause of infectious blindness in the country.[11]

Inadequate sanitation services incur significant costs. According to a recent desk review using the World Bank's Economics of Sanitation Initiative (ESI) from the Water and Sanitation Program (WSP), the average annual health benefit of enhanced sanitation per household is estimated at ETB 760, totalling ETB 15 billion annually equivalent to 2.1% of GDP.[12] This ETB 760 quantifies the economic value resulting from a decrease in premature mortality, healthcare expenses and lost productivity (due to absenteeism) solely attributable to diarrhea. The WASH sector stands at the forefront of this initiative, with WaterAid assuming a central role in leading the campaign's design process since June 2019. A pivotal occasion in this campaign happened during a crucial meeting held in June 2019 where the representatives from the WASH sector, along with WaterAid and other stakeholders, convened to envision a strategy where TSEDU Ethiopia could come to the forefront. It was during this meeting that the name "TSEDU," which stands for "Total Sanitation to End Open Defecation and Urination" in Ethiopia, emerged as a theme. 

TSEDU Ethiopia strategy development workshop June 2019, Addis Ababa

So far, WaterAid played a pivotal technical lead role in spearheading the design and development of the campaign strategy,  creation of a program implementation manual, development of model household and public latrines for learning and replication, conducted assessments of national sanitation capacity, and produced latrine designs catalogues. In collaboration with UNICEF, WaterAid also formulated strategies for social and behavioural change.  Moreover, WaterAid facilitated knowledge-sharing opportunities by organizing learning exchanges for government officials to India's Swachh Bharat Mission, offering valuable insights to support the development of the campaign. 

The Prime Minister’s announcement of the National TSEDU Ethiopia Campaign is an opportunity for WaterAid to advance its vision of the new Country Strategy to end the WASH crisis nationwide. We will grab this opportunity and collaborate with the government and other actors to ensure the campaign is a success.