Evaluating water and sanitation projects: lessons from I mo State, Nigeria

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Abstract
The Imo State Drinking Water Supply and Sanitation Project was a pilot intervention launched in late 1982. In the three intervention villages, the project installed boreholes with handpumps, promoted ventilated improved pit latrines, provided health and hygiene education through village-based workers and encouraged a high level of community involvement. An evaluation of the health impact was an integral part of the project's implementation and was based on a quasi-experimental design with two control villages. The evaluation used both longitudinal and cross-sectional surveys to collect information over the 3V4 year period covering the pro-, peri-, and post-intervention periods. Diarrhoea and dracunculiasis (guinea worm disease) were the main health indicators studied. In addition a wide range of intervening variables was also examined. The project experienced a number of difficulties with implementation, particularly with regard to the sanitation and educational components, because of the experimental approach and emphasis on community involvement. Due to the widespread use of water from boreholes, the project showed an impact on dracunculiasis. The impact on diarrhoea was not clearly shown although some water-associated behaviour was associated with a lower risk of diarrhoea in the intervention villages. The prevalence of wasting (under 80% weight-for-height) among children under three years of age decreased significantly over time in the intervention but not in the control villages. The lessons learned from the health impact evaluation have important implications for future studies. A number of recommendations are made which relate to the planning and implementation of water and sanitation projects and to their monitoring and evaluation.

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