Improve the access to integrated health and WASH interventions to water borne disease in  White Nile State _ SHF 1st SA_ Envelope 2 According to the report issued in May, 2017 by the SMOH and Epidemiological Department, White Nile has a history of acute watery diarrhea (AWD) where the state witnessed outbreak of AWD in 2005, 2006, 2010 2012 and 2014. There is concrete evident between the AWD and the drinking water and sanitation due to contamination of water sources with human excreta as a direct result of open defecation., 23% of population has access to improved water facilities and the rest 77% are using unimproved water facilities which include shallow wells, canals and river which is difficult to be controlled. The spread of AWD in all localities is a very strong evidence that all localities have very fragile WASH situation. According to State Ministry of Health (SMOH), there is correlation between AWD and unsafe drinking water and poor sanitation due to contamination of water sources with human excreta as a direct result of open defecation. According to SMOH, 43% of people in WNS practice open defecation Also, the results of survey conducted by Plan International Sudan and FMOH in August 2017 revealed that 77.8% (1272) of the communities in White Nile State have open defecation.

This project will focus on the integrated Health and WASH activities in the targeted locations of the project which has been identified in consultation with the SMoH and WES in White Nile State in close collaboration with SMoH / WES , INGOs, communities and UN agencies to increase the Health and WASH prevention measurers coverage at health facilities with consideration for people with disability and communities  . 

The project is supporting the AWD preparedness and the project intervention focused basically on the preparedness, in addition the project will  consider the response intervention in case of any occurrence that might take place during the project lifespan.  Therefore the project focus will be on strengthening the existing system of service provision for water borne diseases control with focus on AWD outbreaks in order to prevent and control the outbreaks. these interventions will concentrate in its details on coordination at different level, the  surveillance, early warning system and reporting, interventions for improving access to adequate quality of safe water supply, Improving access to and use of safe excreta disposal, improving hand-washing and other hygiene practices, communication, improve health education towards behavior change and social mobilization, as well as provide the adequate support for SMoH and build the capacities of the health personnel and equip them to perform the case management and infection control at health facilities and treatment centers  . These interventions has been has been agreed up on based on the discussion  with the SMoH,WHO,UNICEF and WES at state level and will be implemented according to the FMoH and WHO guidelines, considering the importance of firm coordination with the project  stakeholders.

The philosophy of Community Led Total Sanitation (CLTS), is to help the communities change its sanitation habits and requirement through it is own efforts and desire, since this leads to long lasting and consistent change in behavior, therefore the project will focus on 90 communities in the two localities to apply CLTS approach. these communities were identified in collaboration with MOH based on the sanitation level and the magnitude of the AWD cases in the last outbreak. The further expectation that such behavior changes do care and lead overtime the individual house hold will upgrade the initial simple low cost toilet hardware to higher standards following sanitation ladder. Also the CLTS approach relies on energizing local community on the issue of open defecation by including a sense of shame, and then helping the community to tackle the sanitation issue without government or NGO funding or support (zero subsidy), which will strengthening the community based long lasting solution of the sanitation issue.