From Fragmentation to Synergy: Evaluating Water, Sanitation and Hygiene (Wash) Sector Coordination in Ethiopia

From Fragmentation to Synergy: Evaluating Water, Sanitation and Hygiene (Wash) Sector Coordination in Ethiopia | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article From Fragmentation to Synergy: Evaluating Water, Sanitation and Hygiene (Wash) Sector Coordination in Ethiopia Abireham Misganaw Ayalew This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-7310562/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract Background: In Ethiopia, WASH services have a documented history spanning more than six decades, dating back to the establishment of Gondar Public Health College in 1954, which served as the springboard for the commencement of training and the activation of sanitation services. The regulatory function in sanitation was developed in the 1950s, with subsequent rearrangements in the 1970s. WASH concerns have been categorically outlined in the country’s constitution - Article 44: all Persons have the right to have a clean and healthy environment; Article 90: the right to access to Public Health. Following the constitution, Policies, Strategies, frameworks, proclamations, and guidelines associated with EH have been launched and implemented in the last decades. Despite successful implementations, WASH indicators still have the lowest so far compared to required service standards due to various socio-economic factors and weak implementation practices and processes that are detached from policies 1 . Currently, the WASH program is implemented and coordinated by the MOH, from which the WASH directorate originates and is mandated Diseases Prevention and Control Program wing among four additional directorates (MCH, DPC, Health Extension and Health Education, and Health System Special Support directorates). Despite progress, existing coordination structures continue to face challenges in implementing WASH programs. Identifying the most relevant platforms, diagnosing blockages, and ensuring alignment with coordination structures. Objective: The primary objective of this analysis was to assess existing platforms relevant to WASH coordination, identify blockages within the current sector coordination platforms, examine major interventions, analyze the persistent challenges affecting coordination task forces and platforms, and provide actionable recommendations. Methods: The study employed a qualitative cross-sectional design, utilizing both primary and secondary data sources with a focus on qualitative data collection methods. The primary target groups for the assessment were key stakeholders in the Water, Sanitation, and Hygiene (WASH) sector. The study used purposive sampling based on their level of engagement and roles within WASH platforms. Data collection was conducted using qualitative methods. Results: To implement national GTPs and MDGs/SDGs in alignment with the country’s policies and strategies, various coordination mechanisms exist in the WASH Sectors, including the Water Sector Working Group (WSWG) structure, and the Hygiene and Environmental Health Steering/Technical Committee (SC/TC 2 ). Another key mechanism is the National WASH Steering and Technical Committees, previously known as the WASH Taskforce, established in April 2016 under the leadership of the MoH with a signed Memorandum of Understanding (MoU) and Terms of Reference (ToR). The Water and Sanitation Forum (WSF) was established and organized by the Consortium of Christian Relief and Development Associations (CCRDA) to coordinate efforts, address common challenges in the WASH enabling environment, exchange innovative sector ideas, and periodically organize learning events to assess the contributions of civil society organizations (CSOs) to the WASH sector. Figures Figure 1 Figure 2 Figure 3 INTRODUCTION In Ethiopia, WASH services have a documented history spanning more than six decades, dating back to the establishment of Gondar Public Health College in 1954, which served as the springboard for the commencement of training and the activation of sanitation services. The regulatory function in sanitation was developed in the 1950s, with further reorganization in the 1970s. WASH concerns have been categorically outlined in the country’s constitution - Article 44: all Persons have the right to have a clean and healthy environment; Article 90: the right to access to Public Health. Following the constitution, Policies, Strategies, frameworks, proclamations, and guidelines associated with EH have been launched and implemented in the last decades. Despite successful implementations, WASH indicators still have the lowest so far compared to required service standards due to various socio-economic factors and weak implementation practices and processes that are detached from policies 3 . Currently, the WASH program is implemented and coordinated by the MOH, from which the WASH directorate originates and is mandated Diseases Prevention and Control Program wing among four additional directorates (MCH, DPC, Health Extension and Health Education, and Health System Special Support directorates). Despite progress, existing coordination structures continue to face challenges in implementing WASH programs. Identifying the most relevant platforms, diagnosing blockages, and ensuring alignment with coordination structures. For the achievements of the WASH program, alignment and harmonization among sectors working in WASH are crucial. The FMOH has established various sector coordination mechanisms to bring all actors on board. The achievements of GTPs and SDGs will not be realized without proper institutional arrangements and coordination mechanisms to mobilize resources, strengthen efforts, improve functionality, and promote horizontal and vertical coherence while avoiding duplication of limited resources. For instance, nearly two-thirds (65%) of the 169 SDG targets will not be met without the engagement and coordination of local, provincial, and regional governments 4 . This underscores the need to strengthen implementation and revitalize partnerships for sustainable development. Although some WASH coordination platforms established under the OWNP structure have been successful, many remain weak. Most have struggled to fulfill their intended purposes, while others, meant to support hygiene and sanitation coordination, have failed to serve as strategic platforms for meaningful engagement between civil society and government actors or as mechanisms for mutual accountability. Government-led coordination structures and joint health financing arrangements have improved donor coordination and aid effectiveness in the WASH sector. However, challenges persist, including sectoral autonomy limiting decision-making, difficulties in reaching multi-sectoral agreements, poor sectoral commitment to meetings and decisions, unilateral actions bypassing coordination systems, and weak leadership marked by a lack of transparency and dominance. Additional issues include unclear objectives, sectoral protectionism, varying capacity levels affecting decision-making, a lack of authority to address poor performance, reluctance to share information publicly, and constraints in information management 5 . Furthermore, the sector relies heavily on external financing, suffers from aid fragmentation, lacks private sector and civil society engagement, and sees declining coordination capacity at the regional and local levels. Effective coordination requires clear structures, governance mechanisms, and tools to foster confidence among WASH stakeholders. This ensures accountability and predictability in implementing WASH interventions nationwide. Coordination functions must be well-designed, structured, and applied across all government levels, from national to community levels. A WASH coordination platform analysis can provide recommendations for improving coordination through structured frameworks, joint work plans, strategic planning, resource mobilization, and performance monitoring. Despite progress, existing coordination structures still face challenges in WASH program implementation. Identifying the most relevant platforms, diagnosing blockages, and ensuring alignment with coordination structures will help the FMOH WASH directorate—encompassing Basic Sanitation Services, Food and Water Safety, Institutional WASH, and Climate Change teams—reform coordination mechanisms. This will enhance mutual accountability among government sectors, development partners, CSOs, and private sector alliances, while improving aid effectiveness, leadership, and primary healthcare capacity building. This sector coordination gap analysis identifies the most relevant WASH platforms, examines coordination barriers, highlights best practices, and proposes mechanisms to strengthen accountability among stakeholders (government, development partners, CSOs, and the private sector) in hygiene and environmental sector planning, implementation, and monitoring. Despite policy and strategy developments, weak institutional leadership has hindered sanitation service delivery, a key unmet MDG target. The National WASH Strategy (NWASHS) and Integrated Urban Sanitation and Hygiene Strategy were developed with stakeholder input, yet challenges such as implementation complexity and fragmentation persist. The signing of the MOU aims to enhance ownership and accountability among the signatory sectors for the implementation of joint commitments 6 . OBJECTIVE: The primary objective of this analysis was to assess existing platforms relevant to Hygiene and Environmental Health coordination, identify blockages within the current WASH sector coordination platforms, examine major interventions, analyze the persistent challenges affecting coordination task forces and platforms, and provide actionable recommendations. METHOD AND MATERIALS Study Design: The study employed a qualitative design, utilizing both primary and secondary data sources with a focus on qualitative data collection methods. Study Units: The primary target groups for the assessment were key stakeholders in the Water, Sanitation, and Hygiene (WASH) sector, including NGOs actively engaged in WASH initiatives, government ministries signatory to the National WASH (NWASH) program, WASH-related coordination platforms, and representatives from nine regional state health bureaus and two city administration health bureaus (environmental health departments). Additionally, consultations were held with sector management in Addis Ababa, as well as with professional associations, consultants, and other relevant stakeholders. Sampling method: The study used purposive sampling, with participants selected based on their level of engagement and roles within WASH platforms. Data Collection Methods : Data collection was conducted using qualitative methods, including key informant interviews, small group discussions with stakeholders (government agencies, NGOs, and bilateral partners), and desk reviews of literature, policy documents, Terms of Reference (TORs), and task force meeting minutes. The following data collection tools were utilized: Interviews and Consultative Meetings with Key Stakeholders: Consultative meetings with WASH sector leaders (MoH) were held from the inception phase through data collection and analysis. These meetings helped clarify expectations, gather input, and address challenges encountered by the consultant team. In-Depth Interviews: A total of 33 development partners working in WASH, government WASH signatory ministries, 10 WASH coordination platforms, and representatives from nine regional health bureaus and two city administration health bureaus (environmental health departments) were interviewed. Structured and semi-structured open-ended questionnaires were used for these interviews. Benchmarking of Other Countries’ Experiences: A web-based review of other countries’ WASH practices was conducted as a benchmarking study and synthesized in this report. Desk Review: The assessment began with a preliminary review of existing information on WASH partners and task force practices from trusted sources. This included sector-specific reports, annual partner plans, strategic documents, policy guidelines, national and regional statistical reports, and research publications. Key documents reviewed for tool development and literature synthesis included: Government performance reports and partner project documents, proposals, and reports Policy documents, strategies, protocols, strategic plans, checklists, and guidelines TORs of coordination platforms, memoranda of understanding (MOUs) among signatory ministries, and meeting minutes from the Hygiene and Environmental Sub-Committee/Technical Committee (SC/TC) and later the NWASH TC/SC Published Demographic and Health Survey reports Research outputs and occasional papers from various sources Questionnaire: Both Open and closed-ended questions related to the research questions were prepared and utilized Data quality control measures : To prevent interviewer bias during data collection, respondents were coded, all field workers were trained before data collection, and regular supervision was done during the data collection. Each data collector was checking the questionnaires for completeness before leaving each study participant. All filled questionnaires were reviewed at the end of the day by the supervisor. The original questionnaire was prepared in English and then translated into Amharic. This helps easily manage the survey and better understand for responses. Data analysis and management: Based on the responses obtained from the questionnaire, the data that were obtained from the respondents in interviews and desk reviews were interpreted in a meaningful manner by using qualitative tools of data analysis through description. Operational Definition Task Force (TF): A Task Force is a temporary grouping under one leader established to accomplish a specific objective (Merriam-Webster Dictionary). It is a formal, temporary organization created to address a particular problem by formulating multiple solutions and selecting the best option based on predefined standards. The Task Force presents its findings and recommendations to the institution that commissioned it, but the institution retains responsibility for implementing those recommendations. Technical Working Group (TWG): A Technical Working Group is formed for a fixed, short-term period to address specific tasks. Members are expected to actively participate in meetings, collaborate, and contribute expertise to achieve the group’s goals. Coordination: Coordination is a process that harmonizes different elements into an efficient relationship (Oxford English Dictionary). It involves integrating, unifying, and synchronizing the efforts of various organizations to achieve common goals. Coordination Framework/Platform: A tool designed to bring different stakeholders into a structured and harmonious working relationship. WASH Coordination Mechanism: A mechanism led by a core coordination team and involving all relevant stakeholders. It oversees functions such as health needs assessment, strategic planning, action planning, monitoring and evaluation, advocacy, and resource mobilization for the WASH sector. Sub-National Level: Administrative levels below the national tier, including regional, zonal, Woreda, Kebele, or city administration levels. Stakeholder: Any agency, organization (governmental, non-governmental, private, or other), group, or individual with a direct or indirect interest in WASH activities, services, or their impacts. Strategic Operational Framework: A framework that includes the elements of a strategic plan, along with guiding principles and standards to inform response planning and actions. Partners: Individuals or organizations collaborating to achieve mutually agreed-upon objectives. Partnership: A relationship based on shared goals, joint responsibility for outcomes, distinct accountabilities, and reciprocal obligations. Hygiene: Practices associated with preserving health and promoting healthy living. Sanitation: The principles and practices related to the proper collection, removal, and disposal of human excreta, household wastewater, and refuse to prevent adverse effects on people and the environment. Components of Environmental Health: All physical, chemical, and biological factors external to a person, along with related behavioral influences. This includes the assessment and control of environmental factors affecting health, such as personal hygiene, safe water supply, human waste disposal, solid waste management, vector control, food hygiene, housing and institutional health, water pollution, and occupational health (WHO, 2016). Steering Committee: A committee established to provide advice, support, and guidance, representing whole-of-government perspectives. It oversees progress to ensure the delivery of outputs and achievement of outcomes, focusing on rapid decision-making rather than passive reporting. Technical Team: A group of professionals selected from different organizations to contribute their expertise in addressing sector-specific challenges. Environmental Health Basic Disciplines: Five core disciplines contribute to environmental health: environmental epidemiology, toxicology, exposure science, environmental engineering, and environmental law. While each discipline provides unique insights, there is some overlap in addressing environmental health problems and solutions. Ethical Approval: The study was ethically cleared by the Ministry of Health WASH department and the ethical committee established by the department Limitations of the study: Challenges encountered during this research were: most of the respondents were busy, and frequent restructuring within the sectors. Some respondents may not give the right responses or basic information on sensitive data. Some respondents did not easily understand what they were asked to answer. However, efforts were made to get the required information by cross-checking responses using different data collection methods. RESULTS EXISTING WASH COORDINATION PLATFORM AT THE FEDERAL LEVEL To implement national and global commitments, various coordination mechanisms exist in the Health and Water Sectors. For instance, the Water Sector Working Group (WSWG) structure consists of four platforms: the Emergency WASH Cluster Coordination, the Urban WASH Technical Working Group, the Rural WASH Technical Group, and the Hygiene and Environmental Health Steering/Technical Committee (SC/TC 7 ). The most common existing coordination mechanisms are summarized below. The Water Sector Working Group (WSWG) was established in July 2015 to serve as a forum for the Government and donors to jointly promote, support, and coordinate sustainable and integrated water resource development and management for Ethiopia’s socio-economic development, in line with the GTP and subsequent development plans. Under this institutional structure, the WSWG comprises two subgroups: (1) Water, Sanitation, and Hygiene (WASH) and (2) Water Resource Management (WRM) 8 . The WSWG Secretariat is hosted by the Ministry of Water and Energy (MoWE), and meetings are conducted regularly as scheduled. Within the WASH sub-group, desk reviews indicate that the Hygiene and Environmental Health SC/TC is one of the four WASH sub-group coordination platforms, alongside the WASH Cluster Coordination, the Urban WASH Technical Working Group, and the Rural WASH Technical Group. However, key informants from the Ministry of Health (MoH) strongly oppose this classification, arguing that the WASH Taskforce is not part of this subgroup and was incorporated without MoH’s consensus (see Figure 1). Another key mechanism is the National WASH Steering and Technical Committees, previously known as the WASH Taskforce, established in April 2016 under the leadership of the MoH with a signed Memorandum of Understanding (MoU) and Terms of Reference (ToR). The MoU was signed between the MoH and several other ministries, including the Ministry of Education (MoE), the Ministry of Water, Irrigation, and Energy (MoWE), the Ministry of Finance and Economic Cooperation (MoFEC), the Ministry of Environment, Forest, and Climate Change (MoEFCC), the Ministry of Transport and Communications (MoTC), and the Ministry of Urban Development and Housing (MoHUD), with the Ministry of Agriculture (MoA) joining later. The Technical Committee, chaired by the MoH, includes partners, donor agencies, multilateral and bilateral organizations, and international NGOs, while the Steering Committee is chaired by the MoH State Minister. However, these are not the only national-level coordination platforms. Other sub-groups under the WASH Technical Committee include the National Global Handwashing Technical Working Group, the National Menstrual Hygiene Management (MHM) Technical Working Group, the Self-Supply Technical Working Group, and the Sanitation Marketing Multi-Stakeholder Platform (MSP). The National Integrated Urban Sanitation and Hygiene Steering Committee (NIUSH SC) incorporates steering committee activities into the official planned strategic activities of the respective sectors from the outset, so that the activities are prioritized. The committee will review and endorse the consolidated annual IUSH program plan and budget proposed by the USH Technical Team. It will also approve funds from partners for sector ministries and regional states/municipalities while ensuring that fund allocation to sectors for IUSH implementation follows agreed modalities and arrangements with partners. Additionally, the committee will oversee the proper functioning of the IUSH program monitoring and evaluation (M&E), provide overall guidance and direction for program implementation, and ensure the establishment and proper functioning of IUSH coordination mechanisms at all levels. The NIUSH SC will advocate the Memorandum of Understanding (MoU) to partners, regional state sector bureaus, and municipalities to secure support and encourage regions to adapt the program to their context and plans. The committee will conduct quarterly meetings, with the option for any ministry to propose an urgent extraordinary meeting when necessary. Decisions will be based on evidence and consensus. Furthermore, the committee will ensure that the annual IUSH Multi-Stakeholder Forum (MSF) is conducted and will follow up on the implementation of its undertakings. Any additional duties and responsibilities identified over time by the IUSH SC will also be addressed. The National IUSH Technical Team (NIUSH TT) comprises appropriate directors assigned by their respective ministries. The Federal Ministry of Health’s Hygiene and Environmental Health Directorate director serves as the chairperson and coordinator of the technical team, while the Ministry of Urban Development and Housing (MoUDH) representative acts as the committee secretary. The technical team is directly accountable to the National WASH Steering Committee and has the following roles and responsibilities: facilitating inter-ministerial communication and cooperation; preparing and submitting strategic and annual plans for WASH SC approval; implementing strategic decisions and directions made by the WASH SC; liaising with donors to seek program support; ensuring financial disbursement aligns with WASH SC decisions; and maintaining WASH SC and TT structures at all levels. The technical team will regularly monitor program implementation, provide guidance, and report to the WASH SC. It will design programs for experience sharing both within and outside the country, establish and assign responsibilities to task groups as needed, and manage the WASH MSF and other review meetings while following up on the implementation of their outcomes. The team will also ensure that Plans of Action (PoA) for funded programs of respective ministries and regional states/municipalities are submitted on time. Beyond traditional funding partners, it will seek and engage new funding organizations. Additionally, the team will review consolidated national WASH semi-annual and annual reports before submission to the SC and, in collaboration with development partners (DPs), organize WASH Joint Technical Reviews (JTR) and MSF while securing approval for the required budget. The Water and Sanitation Forum (WSF) was established and organized by the Consortium of Christian Relief and Development Associations (CCRDA) to coordinate efforts, address common challenges in the WASH enabling environment, exchange innovative sector ideas, and periodically organize learning events to assess the contributions of civil society organizations (CSOs) to the WASH sector. The forum has supported the Ethiopian government in implementing WASH programs that improve the lives of people in rural and urban areas. It consists of approximately 61 member organizations. However, there is no direct linkage with the WASH coordination office. The Ethiopia Water, Sanitation, and Hygiene (WASH) Movement was launched in 2004 as part of a global WASH campaign to promote behavioral and social change on WASH-related issues and to secure political and social commitment through mobilization and promotional activities. By 2013, the movement had over 90 members, including international NGOs, UN agencies, faith-based organizations, the private sector, and media representatives. Lessons learned from the movement highlight the importance of clearly defining member responsibilities, appointing local staff to facilitate communication, and ensuring regular funding. However, the WASH Media Forum eventually diminished due to various challenges. The WASH Media Forum, initially established in 2008 by WaterAid, RiPPLE, and a few media professionals, serves as a platform for media professionals and WASH sector actors to discuss and engage in policy dialogue on WASH issues. Previously managed by WaterAid/WASH Ethiopia Movement, the forum is now chaired by the Ministry of Health (MoH) with financial support from WSSCC/SNV as part of the WASH Technical Committee and Health Media Forum. Its activities include training media professionals, organizing field visits, producing media packs, IEC materials, WASH-specific publications, and awarding WASH media achievements. To ensure sustainability, the forum should establish stronger linkages with journalist associations rather than engaging individuals separately. Coordination of emergency WASH responses in Ethiopia is led by the Ministry of Water and Energy (MoWE) with support from UNICEF under the Water Sector Working Group. The Emergency Task Force (WASH Cluster) was established in 2006 to provide a platform for stakeholders to share information and coordinate emergency WASH interventions. This structure is also maintained in six drought- and flood-prone regions: Afar, Amhara, Oromia, SNNP, Somali, and Tigray. The WASH Task Force (TF) ensures leadership, accountability, and partnership in emergency WASH services, including preparedness, response, and rehabilitation. However, sector coordination remains challenging due to the involvement of multiple ministries (MoWE and MoH) and numerous agencies and CSOs. Notably, the MoH WASH Directorate is not actively engaged in cluster coordination, and there is no linkage with WASH cluster profiles. The Sanitation Marketing Multi-Stakeholder Platform (MSP) was established in February 2014 following the 2013 National Sanitation Marketing Guideline, developed under the Health Sector Development Program (HSDP-IV, 2011–2015). The MSP aims to create an enabling environment for sanitation marketing, improve access to affordable sanitation and hygiene technologies through private sector engagement, and stimulate demand for improved sanitation solutions. Chaired by MoH with Transform WASH as the secretariat, the MSP facilitates quarterly discussion platforms where sector bureaus and development partners report progress, review challenges, exchange information, and make joint decisions. As shown in Fig. 2, the MSP has four Technical Working Groups (TWGs), each with specific objectives and deliverables: The Technology Options TWG, chaired by MoH/FMHACA and co-chaired by TVET. The Business Development TWG is chaired by the Job Creation and Safety Net Agency and co-chaired by the World Bank. The Demand Creation and Promotion TWG, chaired by MoH and co-chaired by Transform WASH. The Private Sector TWG, with a chair and co-chair selected by private sector representatives. These TWGs report to the Steering Committee, which decides their continuation or deactivation based on relevance and achievement of objectives. WASH-NTD Technical Working Group: The WASH-NTD Technical Working Group (TWG) was recently established at the Ministry of Health (MoH) level and is co-chaired by the National NTD Programme Manager and the WASH Directorate. Its primary tasks include identifying synergies across NTDs and between NTDs and WASH, strengthening platforms for knowledge sharing and collaboration, and improving awareness about NTDs and the opportunities provided by joint interventions among professional communities within and beyond the WASH and NTDs national framework. Additionally, the TWG formulates cross-cutting program monitoring and evaluation (M&E) systems, including standardized success indicators, and collects disaggregated data. It defines an agenda for applied operational research on effective implementation, provides guidance on joint WASH-NTD coordination, and disseminates standards and guidelines into policy and practice. The group also supports the development and strengthening of governance and institutional arrangements that enable collaboration. Furthermore, the TWG facilitates the joint use of existing datasets and reports among stakeholders and across sectors to track progress and inform decision-making at national and sub-national levels. It tests integration toolkits, monitors their implementation, and enhances coordination between regional, zonal, and woreda-level partners working on WASH and behavioral change for NTDs. This involves collaboration across various departments and sectors, including the Health Extension Program, the WASH sector, the Education sector, and WASH partners. According to the analysis of Task Force (TF) minutes—sometimes referred to as WASH Steering and Technical Committee meetings—the National Hygiene and Environmental Health Steering Committee/Technical Committee (SC/TC) members conducted meetings with a total of 14 minutes documented. The meetings were generally well-organized, as the minutes included agendas, attendee lists, action points, invitations, official letters for meeting calls, established contact addresses, and continuity in discussing related issues. A critical review of these 14 meeting minutes revealed that attendance ranged from a minimum of 6 to a maximum of 22 participants, representing approximately 12 government sectors, 15 non-governmental organizations (NGOs), and 3 United Nations (UN) agencies. Key agenda items discussed and proposed for further action included: The preparation, endorsement, and launching of various strategies (such as the Hygiene & Environmental Health Strategy, Integrated Urban Sanitation and Hygiene Strategy, and School WASH Strategy), guidelines (including post-ODFE triggering, Hygiene and Sanitation Communication, CLTSH certification and verification, and School WASH guidelines), manuals for rural and urban settings, and a Memorandum of Understanding (MoU) on integrated strategy implementation. These documents were produced in both English and Amharic. The WASH Task Force (WASHTF) also provided progress updates and plans to cascade these efforts to regions and city administrations through regional familiarization workshops, document distribution, and online publication on ministry websites for easy access. Other major agenda items included the celebration of international and national events (such as Menstrual Hygiene Management Day and Global Handwashing Day), annual work plans and performance reports, implementation and budget utilization of the One WASH National Program/CWA, and associated challenges. Additionally, initiatives and projects like sanitation marketing, water quality improvement, sanitation technology, and urban WASH projects in 23 towns were discussed. Operational definitions of terms such as "improved latrine" were clarified, and various documents—including baseline surveys (e.g., KAP on MHM), concept notes (e.g., learning towns), accountability frameworks for WASH committees, and WASH technical committee plans—were reviewed. Joint discussions between the Technical Committee (TC) and the Joint Steering Committee (JSC) were held, along with coordination efforts with management and urban WASH projects in 20 towns (WAE). WASH COORDINATION STRUCTURES AT THE SUB-NATIONAL LEVEL The Ministry of Health, along with regional steering and technical committees, established a coordination structure that was cascaded to nearly all regions. Regions and city administrations reported the formation of these committees, though their functionality has not been officially confirmed. To create an enabling environment for the sustainability of these task forces at the regional level, WASH directorates were established in most regional health bureaus, except in the Amhara, Tigray, and SNNP regions due to a lack of approval from regional Civil Service Bureaus (see Table 1). In the Addis Ababa city administration, task force coordination follows MoH guidelines. The Health Bureau collaborates with relevant sectors through a signed Memorandum of Understanding (MOU) and jointly reviews WASH activities. Under the task force, various Technical Working Groups (TWGs) were formed, composed of experts from different sectors. Each sector has focal persons, and the TWGs ensure alignment in annual sectoral plans. The steering committee, chaired by the Health Bureau’s deputy head, consists of bureau heads and meets biannually. TWGs report to the steering committee for review. In the SNNP region, the WASH structure remains at the case team level under the Disease Prevention and Health Promotion Directorate. Five case teams exist: Health Extension, Malaria, TB, NTDs, NCDs, and WASH. Although plans were made two years ago to elevate the WASH case team to a directorate, the regional Civil Service Bureau has not yet approved this. A task force was established, but it has not been updated, and the drafted MOU remains unsigned by the relevant bureaus. Currently, members do not meet to discuss WASH issues, and task force activities have shifted to other TWGs, such as Sanitation Marketing, due to an ongoing project in the region. Table 1: Regional WASH-related Coordination Forum Name WASH structure Name of the platform Functionality Availability of Clear TOR/MoU Members actively participating Oromia WASH and NTDs Directorate OWNP technical and steering committees Yes No Gov (Hygiene, water quality, HE focal), One WASH, and partners Multi-Sectoral platform (MSP forum)- Sanitation Marketing Yes Yes WSSCC-SNV, PSI, Plan International, UNICFE, Health office, Water and energy office, TVET, MFI WASH and NTDs Directorate WASH steering and technical committee Yes Yes Health, Water, Education, Finance, urban dev’t, culture and tourism, agriculture, Amhara Case team OWNP technical and steering committees and technical committees Yes No Gov (Hygiene, water quality, HE focal), One WASH, Carter, JSS, WASH emergency, UNCIF) Multi-Sectoral platform (MSP forum)- Sanitation Marketing Yes Yes Government : TVET, Health, Water and Energy, MFI, Job creation, Women and Child, Education, BOFED Partners: IRC, WSSCC-SNV, Invited participants: Carter Center, Care Case team WASH steering and technical committee Yes Yes Health, Water, Education, Finance, urban dev’t Dire Dawa Directorate One WASH technical team Yes Education, health, Water, and mineral energy, BOFED Multi-Sectoral sanitary platform Yes Yes TVET, MFI, Job creation, Women and Child, Education, NGO-CRS, SNV Directorate WASH steering and technical committee Yes Yes Health, Water, Education, Finance, urban dev’t Somali Case team Multi-Sectoral platform (MSP forum)- Sanitation Marketing Yes Yes WSSCC-SNV, PSI, Plan International, UNICFE, Health office, Water and energy office, TVET, MFI WASH Cluster Yes Yes Government : Health(co-chair), water and Energy- Chair, Education and disaster, and risk Partners: All WASH partners such as UNCIF, Save the Children, WHO, Islamic Relief, Transform WASH, etc. Sanitation and hygiene TWG Yes Yes Government : Health, water, Energy, and Education Partners: All WASH partners such as UNCIF, Save the Children, WHO, Islamic Relief, Transform WASH, etc. Case team WASH steering and technical committee Yes Yes Health, Water, Education, Finance, urban dev’t Gambella Directorate Sanitation marketing Yes Yes Partner : AMRIF, Plan, PSI, SNV, Samaritan Purse, UNCIFE Gov’t : (Health office, Water and Energy, Food security, MFI, TVET, office OWNP technical and steering committees Yes Yes Education, health, Water, and mineral energy, BOFED Directorate WASH steering and technical committee Yes Yes Health, Water, Education, Finance, urban dev’t Afar Directorate Emergency WASH Task Force (Regional WASH cluster) Yes Yes Education, health, Water, and mineral energy-Chair, BOFED, Metrology, UNCIF, CARE, AMRIF, Save the Children, AFDA, RDRM OWNP technical and steering committees Yes Yes Education, health, Water, and mineral energy, BOFED Multi-Sectoral platform/Sanitary marketing Yes Yes TVET, MFI, Job creation, Women and Child, BoFED, Health, Education, NGO- IRC, WSSCC-SNV, PSI Urban Sanitation Forum No No Health, urban and house construction and planning, Agriculture, Water, Women and Children, Environmental protection, trade and industry, Tourism Directorate WASH steering and technical committee Yes Yes Health, Water, Education, Finance, urban dev’t Tigray Case team OWNP technical and steering committees Yes Yes Gov’t : Education, health, Water, and mineral energy, BOFED Partner : REST, Plan, IRC, PSI, World Vision, UNCIF Multi-Sectoral platform (MSP forum)- Sanitary Marketing Yes Yes Gov’t : Health office, Science and technology, Women, Child and Youth, Water and Energy, SME MFI, TVET, BoFED Partner : REST, Plan, IRC, PSI, World Vision, UNCIF Directorate WASH steering and technical committee Yes Yes Health, Water, Education, Finance, urban dev’t SNNPR Pinpoint OWNP technical and steering committees Yes No Gov (Hygiene, water quality, HE focal), One WASH, and partners Multi-Sectoral platform (MSP forum)-Sanitation Marketing Yes Yes WSSCC-SNV, PSI, Plan International, UNICFE, Health office, Water and energy office, TVET, MFI Directorate WASH steering and technical committee Yes Yes Health, Water, Education, Finance, urban dev’t NB: Functionality: at least one meeting per quarter EFFECTIVENESS OF EXISTING COORDINATION ARRANGEMENTS IN ETHIOPIA Sector coordination is critical for unified WASH service delivery, ensuring harmonized strategies, resource mobilization, and performance monitoring. Five guiding principles assess coordination effectiveness: MoH Leadership: The ministry should lead resource coordination. Partner Technical Support: Partners should assist the ministry. National Plan Alignment: Resources should align with the national health sector plan. Inclusive Planning: The Government should engage multilateral/bilateral agencies in national planning. Partner Commitment: Partners should prioritize national objectives over administrative or commercial interests. These principles inform evaluation criteria, including: Leadership and Ownership: MoH’s WASH Directorate leads, with multi-sector involvement. Participation Scope: While signatory sectors and some NGOs engage, the private sector and academic institutions lack full participation (except Bahir Dar University in Amhara). Periodicity: National-level meetings are regular, but regional/local coordination is inconsistent. Integration: Alignment with health policies exists, but links to other sectors’ strategies are unclear. High turnover of focal persons and weak accountability hinder MoU adherence. Coordination Breadth: The multisectoral mechanism spans 9 regions and 2 city administrations but remains weak below the national level. Decision Adherence: Members generally fulfill assigned roles, but attendance and accountability gaps persist. Sector Efficiency: Coordination reduces duplication (e.g., shared strategy development). Sector Effectiveness: Impact assessment requires further research and documentation. Equity Effects: Insufficient data exist to evaluate geographical or target group equity. Sustainability: The mechanism is sustainable unless government policies shift. Costs: Cost-benefit analysis is pending due to data gaps. COORDINATION PLATFORMS LIMITATIONS NATIONAL LEVEL Several challenges were identified, including frequent turnover of committee members without proper knowledge transfer to replacements, the lack of a legal framework supporting the MoU (leading to accountability gaps), and inconsistent attendance by WASHTF members. Meetings often proceeded with low attendance due to reliance on individual commitment rather than structured participation. Ensuring full attendance required timely invitations, facilitation, and negotiations, which proved difficult. Additional challenges included the absence of a responsible body to follow up on action points, inconsistent naming conventions (e.g., WASH Task Force, Technical Committee, Steering Committee, Technical Working Group), and the lack of a common budget or inclusive actions among signatory ministries. Many ministries did not incorporate the program (e.g., IUSHS) into their Annual Work Plans (AWPs). There was also no officially designated chairperson, co-chair, or secretary for the Task Force, though in some instances, the WASH director acted as chair and a technical assistant as secretary. Other issues included last-minute agenda setting, incomplete coverage of hygiene and environmental health topics, and participants’ busy schedules delaying agreed-upon assignments due to weak accountability mechanisms. Regional WASH platforms lacked Terms of Reference (TOR), dedicated staff, and trained personnel for coordination. Agenda selection often prioritizes current issues (e.g., One WASH National Program) or NGO-driven initiatives rather than comprehensive sectoral needs. Furthermore, there was insufficient evidence of strategy implementation (e.g., Integrated Urban Sanitation and Hygiene Strategy and Hygiene & Environmental Health Strategy) at all levels by WASH and Urban Sanitation and Hygiene (USH) steering committees and technical teams. Limited efforts were made in evidence generation, research, documentation of lessons learned, and best practices. Finally, there was no clear system for resource allocation, mobilization, or utilization, including funding, supplies, and dedicated staff for WASH coordination. REGIONAL LEVELS Several challenges hinder effective coordination at the regional level. First, there is a shortage of skilled WASH professionals, even in the job market, affecting regions, zones, and woredas. Universities have also discontinued WASH departments, exacerbating the skills gap. Second, budget constraints limit task force activities, as there is no dedicated funding line—operations rely on partner support or internal bureau budgets. Additionally, no budget is allocated to extend task forces to sub-city and woreda levels. Third, regional leaders often prioritize urgent issues like security over WASH coordination, leading to low commitment. Fourth, no accountability mechanism for sector bureaus that fail to meet MOU obligations, making it difficult to enforce compliance. Fifth, inadequate follow-up and supportive supervision hinder the implementation and functionality of task forces. Sixth, the absence of a structured learning, monitoring, and evaluation system weakens performance tracking. Seventh, poor integration and cooperation among TWG members reduce effectiveness. Eighth, partner participation in regional meetings is limited, as many NGOs lack permanent regional offices, and government offices fail to facilitate coordination meetings effectively. Ninth, weak facilitation and follow-up prevent full stakeholder engagement. Tenth, the lack of a full-time, dedicated coordination lead at the regional level disrupts the cascading of task forces to zones and woredas. Finally, overlapping mandates—such as urban WASH construction falling under the Construction and Urban Development Bureau—create confusion and hinder TWG performance. COORDINATION PLATFORMS BEST PRACTICES The One WASH National Program (OWNP) is a government-driven, sector-wide approach (SWAp) designed to address the needs of rural, urban, and pastoralist communities, as well as schools and health posts, in an integrated manner while reducing administrative fragmentation in WASH service delivery. The program was launched in September 2013 following the signing of a Memorandum of Understanding (MoU) in November 2012 between the Ministry of Water and Energy (MoWE), the Ministry of Health (MoH), the Ministry of Education (MoE), and the Ministry of Finance and Economic Development (MoFED). The WASH Implementation Framework (WIF) was approved in March 2013 to guide the program. OWNP operates on principles of harmonization, integration, alignment, and partnership between development partners and the Government of Ethiopia. Its objectives include addressing disparities in WASH coverage across regions and urban areas, improving aid effectiveness, and promoting institutional reforms, particularly in capacity development at all levels. For coordination, the National WASH Coordination Office (NWCO) was established to oversee planning and implementation. Program Management Units within the four WASH ministries (MoWE, MoH, MoE, and MoFED) drive implementation, with the National WASH Steering Committee (NWSC)—comprising ministers from these ministries, chaired by MoWE—providing strategic oversight. Since its inception, OWNP has recorded several best practices and lessons, including: Supportive Policy and Regulatory Frameworks: The WASH sector is guided by policies, strategies, proclamations, and guidelines that enhance coordination, transparency, and accountability. Key documents include the OWNP itself, the WASH Implementation Framework (WIF), the Universal Access Plan (UAP) 2005, the Plan for Accelerated and Sustained Development to End Poverty (PASDEP) 2005, and the Growth and Transformation Plan (GTP II). Additionally, the Ministry of Health has developed supplementary programs such as the Health Sector Development Program (HSDP) and the Health Extension Program (HEP), which aim to achieve universal primary health care coverage. Alignment of Development Partners: Development partners align their targets, plans, and activities with OWNP principles. New WASH projects are designed per the program’s strategies, ensuring harmonized and integrated approaches. Civil society organizations (CSOs) and NGOs participate in sector reviews, evaluations, and implementation, with their activities incorporated under the OWNP umbrella. Partners receive quarterly progress reports, financial updates, and audit findings through the NWCO. Structured Coordination Mechanisms: The NWCO coordinates planning and oversight, while Program Management Units operate within each WASH ministry. The NWSC and National WASH Technical Team consist of ministers and directors from these ministries, respectively. Similar structures exist at regional levels, where Regional WASH Steering Committees (RWSC) oversee implementation. At the woreda (district) level, Woreda WASH Teams—comprising representatives from water, health, education, and finance offices—implement activities under the guidance of a Woreda WASH Steering Committee (WWSC). Kebele (village)-level plans are approved by local councils, supported by Health Extension Workers (HEWs). Financial Support Mechanisms: The government and development partners contribute to a Consolidated WASH Account (CWA) at the federal level. Other partners, including bilateral organizations and CSOs, provide technical assistance, supplies, and alternative funding. The Development Assistance Group (DAG) facilitates donor coordination. Focus Areas and Implementation Modalities: OWNP prioritizes rural/pastoral WASH, urban WASH, institutional WASH, and program management/capacity building. Strategic interventions include self-supply scaling, WASH technician training, supply chain strengthening, urban water system construction, data management, social inclusion, climate resilience, and communication strategies. Implementation follows four modalities: Woreda-Managed Modality (funds administered by woreda-level teams) Community-Managed Project Modality (communities plan and manage projects) NGO Modality (varied funding/management arrangements) Self-Supply (household investments in water infrastructure) Phase III Continuity: Following an evaluation of OWNP Phase I (2015), Phase II (2015–2020) maintains institutional arrangements and modalities from Phase I, supplemented by semi-annual Joint Technical Reviews (JTR), annual Multi-Stakeholder Forums (MSF), and regular Forum for Learning on Water and Sanitation (FLOWS) meetings. PROPOSED WASH COORDINATION STRUCTURE OPTIONS As shown in Fig. 3, three options are proposed to enhance coordination: Option 1: A fully dedicated WASH Coordination Office with functions including: Service delivery oversight Needs assessment and gap analysis Strategic planning and budgeting Monitoring and evaluation Capacity building Advocacy and cross-cutting issue integration Option 2: A modified WASH Steering Committee/Technical Committee (SC/TC) with enhanced components. Option 3: Strengthening the existing platform by scaling up best practices and addressing gaps. Option 1’s proposed structure begins with a National Health Security Council (chaired by the Deputy Prime Minister), followed by a Strategic Advisory Committee (signatory ministries) and a WASH Coordination Office with dedicated resources and authority. A. Using a Modified Form of the Existing WASH SC/TC by Adding Components The first approach involves modifying the existing WASH SC/TC by incorporating additional components while maintaining its core coordination functions, except for establishing a fully operational coordination mechanism. This includes revising the Terms of Reference (TOR) of the coordination platform with more appropriate terminology, such as replacing "Task Force (TF)"—which implies a temporary group led by a single individual to achieve a specific objective—with alternatives like "WASH Support Group," "Council of H&EH," "Advisory Board," or "Strategic Advisory Group." Additionally, specific working groups should be established at the case team level, ensuring that members possess the necessary interest, time, qualifications, and commitment beyond their general membership in the overall coordination mechanism. It is important to address existing gaps and encountered problems in each proposed structure. The sub-working groups mentioned earlier can be formed under the main coordination body. B. Using the Existing Platform by Scaling Up Good Practices and Addressing Identified Gaps The second approach involves utilizing the existing coordination platform while scaling up successful practices and implementing corrective measures for identified gaps. This structure can be refined by addressing the constraints and challenges highlighted in previous sections. Table 2 highlights the summary of proposed structures, pros, and cons. Table 2: Summary of proposed WASH coordination structure No Proposed Coordination Mechanisms Advantages Disadvantages 1 Establishing a fully dedicated and standalone WASH coordination office Suitable for inclusive stakeholder participation; capable of implementing action plans; allows for monitoring and evaluation; ensures accountability; operates autonomously with a clear mandate; facilitates coordination activities; manages WASH TWGs under the platform; functions as an independent office guided by defined job descriptions; enables easy design and implementation of accountability and monitoring systems; aids in resource mobilization; prevents duplication of efforts; ensures proper resource allocation; holds stakeholders accountable; supports a unified national plan, budget, and reporting system for H&EH interventions. Requires budget and human resources at national, regional, zonal, and woreda levels; needs legal approval for establishment; necessitates drafting new TORs, MOUs, and additional efforts for setup. 2 Modifying the existing WASH SC/TC by adding components and revising the platform No need for new MOUs; facilitates easier design and implementation of action plans; allows the formation of temporary TWGs for specific tasks; requires fewer resources compared to Option 1. Requires TOR revisions; lacks dedicated time for coordination due to officers' other responsibilities; potential role conflicts between MoH and MOWE persist; challenges in securing resources and dedicated staff remain. 3 Using the existing platform with improvements Strengthens existing mechanisms; identifies gaps for scaling up and corrective actions. Role conflicts between MoH and MOWE may persist; securing resources and dedicated staff remains a challenge. CONCLUSION AND RECOMMENDATIONS CONCLUSION The WASH Coordination Mechanism is a structured approach for aligning the efforts of all relevant stakeholders, led by the Ministry of Health's WASH Directorate. This mechanism is responsible for various coordination functions, including health needs assessments, strategic and action planning, implementation, monitoring and evaluation, advocacy, resource mobilization, knowledge sharing, policy dialogue, and information exchange. To ensure effective coordination, immediate corrective measures must address key challenges such as the multi-disciplinary and multi-sectoral nature of Health and Environmental Health (H&EH), existing coordination gaps, insufficient follow-up, and limited engagement from senior officials. Strengthening or establishing a new coordination office is essential to address sector-wide gaps, including weak WASH coordination, limited access to basic WASH facilities, and lagging progress toward WASH-related Sustainable Development Goals (SDGs). This assessment aimed to identify relevant coordination platforms, major interventions, and observed bottlenecks using pre-defined methodologies. The findings indicate that existing structures are performing relatively well, with coordination meeting minutes well-documented and action points consistently reviewed. However, challenges such as resource constraints, structural weaknesses, and accountability mechanisms persist. Additional challenges include the lack of a functional WASH Task Force (TF) structure with a dedicated focal person for coordination and resource mobilization, inconsistent member attendance, low engagement from signatory ministries, role conflicts with the Ministry of Water, Irrigation, and Energy (MoWE), and weak TF structures at regional and zonal levels. Despite these challenges, opportunities exist, such as strong government commitment to the sector, supportive policies and strategies, green legacy initiatives, the presence of multiple sector stakeholders, and established coordination mechanisms at the Prime Minister’s Office for cross-sector interventions. Successful models like the One WASH National Program (OWNP) demonstrate effective coordination. In conclusion, leveraging the findings of this gap analysis, including observed strengths, sector opportunities, best practices, and corrective actions, should be a priority for the health sector, partners, and donors. Aligning with the proposed structure under the health sector’s mandate will enhance WASH implementation sustainability. The recommendations below outline short-, medium-, and long-term actions. RECOMMENDATIONS The following recommendations are categorized into short, medium, and long-term actions to facilitate implementation: Short-Term Recommendations Develop a comprehensive Terms of Reference (TOR) for the WASH coordination platform to clarify terminology, accountability mechanisms, TF structures, and membership criteria. The TOR should be consistent, easily understandable, and incorporate key components (e.g., TF, Technical Working Groups, Steering Committees). Cascade, facilitate, and support the establishment of WASH Directorates with functional case teams in regional and city administration health bureaus. Currently, few regions have established WASH Directorates, while most operate with understaffed case teams and limited budgets. Regional Health Bureaus should adopt Memoranda of Understanding (MoUs) based on the national model. Conduct regular TF meetings at all levels, aligned with an annual action plan. Effective meeting facilitation, including timely invitations, agenda sharing, feedback collection, minute-taking, and action point follow-up, is critical. Assigning a dedicated focal person for WASH TF coordination, funded either by the Ministry of Health or partners, is essential. Strengthen joint planning, monitoring, and implementation among WASH TF members. Sectoral plans should align, and a common Annual Work Plan should be endorsed at all levels. The WASH Directorate should advocate for the inclusion of WASH/health indicators in the Health Management Information System (HMIS) and link them to the National WASH MIS to track progress toward national targets accurately. Conduct regular stakeholder mapping to identify WASH-focused Civil Society Organizations (CSOs). Over 100 CSOs operate in the sector, making systematic engagement vital. Medium-Term Recommendations Establish and strengthen WASH coordination systems at regional, zonal, and woreda levels, mirroring the national structure. Regular follow-up and supportive supervision are necessary, along with standardized guidelines (e.g., Standard Operating Procedures, MoUs, TORs). Create a dedicated WASH coordination office separate from the One WASH or Water Sector Working Group, with a full-time coordinator, budget, legal recognition, and specialized Technical Working Groups (TWGs). Define roles and linkages with other WASH forums (e.g., WASH Ethiopia Movement, academic institutions, professional associations). Enhance high-level engagement beyond MoU signings. Advocate for stronger federal, regional, and zonal leadership through consultative meetings, evidence-based policy dialogues, and cross-country learning. Ensure broad participation from partners, donors, the private sector, and civic associations. Conduct stakeholder mapping and communicate TF membership criteria to potential participants. Integrate WASH coordination plans into the Annual Work Plans of all MoU signatory ministries, supported by legal accountability frameworks. Collaborate with the Ministries of Finance, Water, Irrigation & Energy, and Education to secure adequate resources, professionals, and clear targets for sanitation and hygiene within government plans. Strengthen knowledge management through learning events, workshops, and multi-stakeholder forums to capture and disseminate best practices, research, and innovations. Long-Term Recommendations Establish legal enforcement for WASH coordination to ensure accountability and prevent overlapping mandates. High-level discussions (e.g., at the Prime Minister’s Office) should resolve role conflicts, particularly between the Ministry of Health and MoWE. Conduct regular studies, document best practices, and strengthen monitoring, evaluation, and learning at national and regional levels. Allocate dedicated budgets for TF activities, resource mobilization, and pooled funding for joint initiatives like capacity building and monitoring. Build stakeholder capacity to reduce turnover. Ministries and partners should assign permanent focal persons and institutionalize knowledge retention through systematic documentation. LIST OF ABBREVIATIONS CCRDA Consortium of Christian Relief and Development Associations CLTS Community-led Total Sanitation CSO Civil society organization CWA GTP Growth and Transformation Plan H&EH Hygiene and Environmental Health HEP Health Extension program HEW Health Extension Worker HSDP Health Sector Development Plan M&E Monitoring and Evaluation MOA Ministry of Agriculture MoE Ministry of Education MoEFCC Ministry of Environment, Forest and Climate Change Mound Ministry of Housing & Urban Development MoH Ministry of Health MOU Memorandum of Understanding MoWIE Ministry of Water, Irrigation, and Energy MSP Marketing Multi-Stakeholder Platform NGO Non-governmental organization NWCO National WASH Coordinating Office NWSC National WASH Steering Committee ODF Open Defecation Free OWNP One WASH National Program PH Primary Health SM Sanitation Marketing SNNPR Southern Nations and Nationalities SWAP Sector-wide approach WASH Water, sanitation, and hygiene WRM Water Resource Management WSF Water and Sanitation Forum WSWG Water Sector Working Group Declarations COMPETING INTERESTS: The authors declare no competing interests. AUTHOR’S CONTRIBUTIONS: AM: developed the research proposal, collected data, coordinated the research field work, conducted the data analysis, developed the results and reports, and developed the manuscript and reports. ACKNOWLEDGMENTS: First and foremost, I would like to express my sincere gratitude to the Ministry of Health for their unwavering support and commitment throughout the assessment process. I also extend our appreciation to key WASH and health development partners, including the federal and regional ministries of Health and Water, Irrigation, and Energy. Additionally, we thank professional associations, task force focal persons, and all individuals who contributed directly or indirectly to this study. Their willingness to participate and provide honest responses was invaluable to the success of this assessment. I am profoundly thankful to my beloved family, whose unwavering support, encouragement, and prayers have been my greatest source of strength. Your love and patience have sustained me through the challenges and long hours of this research. FUNDING: The principal investigator funded the study CONSENT FOR PUBLICATION: Not Applicable AVAILABILITY OF DATA AND MATERIALS: The datasets used and/or analyzed during the current study are available from the corresponding author upon reasonable request. ETHICS APPROVAL AND CONSENT TO PARTICIPATE: The study was approved by the ethics committee of the Ministry of Health WASH department. In compliance with the Helsinki Declaration, this study does not contain any person’s data in any form (including individual details, images, or videos. Informed oral consent of participants was requested before starting interviews and discussions by explaining the objective and how the results would be used. All interviews that were conducted with vulnerable populations were conducted with, and privacy, confidentiality, and anonymity will be maintained. References Kumie A, Ali A. An overview of environmental health status in Ethiopia with particular emphasis on its organization, drinking water, and sanitation : A literature survey. Ministry of Water, Irrigation and Energy Terms of Reference for the Establishment of The Water Sector Working Group ( WSWG ) And its Secretariat Kumie A, Ali A. An overview of environmental health status in Ethiopia with particular emphasis on its organization, drinking water, and sanitation : A literature survey. United Nations. (2015). Transforming Our World: The 2030 Agenda for Sustainable Development. World Health Organization (WHO) & UNICEF. (2020). Joint Monitoring Programme for Water Supply, Sanitation, and Hygiene (JMP). FMoH (2021). National WASH Strategy and Integrated Urban Sanitation and Hygiene Strategy. Ethiopia. Ministry of Water, Irrigation and Energy Terms of Reference for the Establishment of The Water Sector Working Group ( WSWG ) And its Secretariat WASH sector report on CSOs’ contributions in. 2018 As the health system is decentralized, regional, zonal, or Woreda WASH coordination office, and the Coordination structure is similar to the national structure, only the scope and contents may differ. Additional Declarations No competing interests reported. Cite Share Download PDF Status: Posted Version 1 posted You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-7310562","acceptedTermsAndConditions":true,"allowDirectSubmit":true,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":506195445,"identity":"e9c31130-9894-4c1b-af4b-95fb582690ca","order_by":0,"name":"Abireham Misganaw Ayalew","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAA5klEQVRIiWNgGAWjYDACCQaGA4wNEnL87M0HQFwZYrVYGEv2HEsAcXmI0sLA2FCRuOFGjgGIT1gL/+zehwd/7pAwNriR8/nVjRoLHgb2w0c34LXkznGDw7xnJOQkz7zdZp1zDOgwnrS0G3ituZHGcJixTcKY73juNuMcNqAWCR4zvFrkgVoO/myTSGw4kPPMOOcfEVoMgFoO8AK1TDiRw/w4t40ILYZ3jjEcBmoBBbIZc26fBA8bIb/I3W5j/vizrQ4UlY8/53wDMQ4fw+99JMAmASaJVQ4CzB9IUT0KRsEoGAUjBwAAvPtM+Z+7cmYAAAAASUVORK5CYII=","orcid":"","institution":"Pathfinder International","correspondingAuthor":true,"prefix":"","firstName":"Abireham","middleName":"Misganaw","lastName":"Ayalew","suffix":""}],"badges":[],"createdAt":"2025-08-06 14:08:22","currentVersionCode":1,"declarations":{"humanSubjects":false,"vertebrateSubjects":false,"conflictsOfInterestStatement":false,"humanSubjectEthicalGuidelines":false,"humanSubjectConsent":false,"humanSubjectClinicalTrial":false,"humanSubjectCaseReport":false,"vertebrateSubjectEthicalGuidelines":false},"doi":"10.21203/rs.3.rs-7310562/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-7310562/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":90541976,"identity":"168ae2a9-db15-4256-bd13-90466f1a3534","added_by":"auto","created_at":"2025-09-03 23:58:40","extension":"png","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":29194,"visible":true,"origin":"","legend":"\u003cp\u003eWSWG Structure\u003c/p\u003e","description":"","filename":"floatimage1.png","url":"https://assets-eu.researchsquare.com/files/rs-7310562/v1/8070dbc1d49623880362c2bf.png"},{"id":90543828,"identity":"ea9be601-7225-4721-9618-55f35181d0d2","added_by":"auto","created_at":"2025-09-04 00:14:40","extension":"png","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":36045,"visible":true,"origin":"","legend":"\u003cp\u003eCoordination structure of MSP\u003c/p\u003e","description":"","filename":"floatimage2.png","url":"https://assets-eu.researchsquare.com/files/rs-7310562/v1/649f33306c61cf6753592afe.png"},{"id":90541982,"identity":"e8fcb692-1774-4e68-83c3-0b29d7034a2d","added_by":"auto","created_at":"2025-09-03 23:58:41","extension":"png","order_by":3,"title":"Figure 3","display":"","copyAsset":false,"role":"figure","size":93388,"visible":true,"origin":"","legend":"\u003cp\u003eProposed WASH Coordination Office\u003csup\u003e9\u003c/sup\u003e\u003c/p\u003e","description":"","filename":"floatimage3.png","url":"https://assets-eu.researchsquare.com/files/rs-7310562/v1/06ef59a688a48e4cf0802b52.png"},{"id":106403293,"identity":"7307af9e-d37f-4fa9-a46f-599c0af06bd3","added_by":"auto","created_at":"2026-04-08 09:14:00","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":953263,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-7310562/v1/c67393f6-5234-464d-876d-d1bd56b152d2.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"\u003cp\u003eFrom Fragmentation to Synergy: Evaluating Water, Sanitation and Hygiene (Wash) Sector Coordination in Ethiopia\u003c/p\u003e","fulltext":[{"header":"INTRODUCTION","content":"\u003cp\u003eIn Ethiopia, WASH services have a documented history spanning more than six decades, dating back to the establishment of Gondar Public Health College in 1954, which served as the springboard for the commencement of training and the activation of sanitation services. The regulatory function in sanitation was developed in the 1950s, with further reorganization in the 1970s. WASH concerns have been categorically outlined in the country\u0026rsquo;s constitution - Article 44: all Persons have the right to have a clean and healthy environment; Article 90: the right to access to Public Health.\u0026nbsp;Following the constitution, Policies, Strategies, frameworks, proclamations, and guidelines associated with EH have been launched and implemented in the last decades.\u0026nbsp;Despite successful implementations, WASH indicators still have the lowest so far compared to required service standards due to various socio-economic factors and weak implementation practices and processes that are detached from policies\u003csup\u003e3\u003c/sup\u003e. Currently, the WASH program is implemented and coordinated by the MOH, from which the WASH directorate originates and is mandated Diseases Prevention and Control Program wing among four additional directorates (MCH, DPC, Health Extension and Health Education, and Health System Special Support directorates). Despite progress, existing coordination structures continue to face challenges in implementing WASH programs. Identifying the most relevant platforms, diagnosing blockages, and ensuring alignment with coordination structures.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eFor the achievements of the WASH program, alignment and harmonization among sectors working in WASH are crucial. The FMOH has established various sector coordination mechanisms to bring all actors on board. The achievements of GTPs and SDGs will not be realized without proper institutional arrangements and coordination mechanisms to mobilize resources, strengthen efforts, improve functionality, and promote horizontal and vertical coherence while avoiding duplication of limited resources. For instance, nearly two-thirds (65%) of the 169 SDG targets will not be met without the engagement and coordination of local, provincial, and regional governments\u003csup\u003e4\u003c/sup\u003e. This underscores the need to strengthen implementation and revitalize partnerships for sustainable development.\u003c/p\u003e\n\u003cp\u003eAlthough some WASH coordination platforms established under the OWNP structure have been successful, many remain weak. Most have struggled to fulfill their intended purposes, while others, meant to support hygiene and sanitation coordination, have failed to serve as strategic platforms for meaningful engagement between civil society and government actors or as mechanisms for mutual accountability.\u003c/p\u003e\n\u003cp\u003eGovernment-led coordination structures and joint health financing arrangements have improved donor coordination and aid effectiveness in the WASH sector. However, challenges persist, including sectoral autonomy limiting decision-making, difficulties in reaching multi-sectoral agreements, poor sectoral commitment to meetings and decisions, unilateral actions bypassing coordination systems, and weak leadership marked by a lack of transparency and dominance. Additional issues include unclear objectives, sectoral protectionism, varying capacity levels affecting decision-making, a lack of authority to address poor performance, reluctance to share information publicly, and constraints in information management\u003csup\u003e5\u003c/sup\u003e. Furthermore, the sector relies heavily on external financing, suffers from aid fragmentation, lacks private sector and civil society engagement, and sees declining coordination capacity at the regional and local levels.\u003c/p\u003e\n\u003cp\u003eEffective coordination requires clear structures, governance mechanisms, and tools to foster confidence among WASH stakeholders. This ensures accountability and predictability in implementing WASH interventions nationwide. Coordination functions must be well-designed, structured, and applied across all government levels, from national to community levels. A WASH coordination platform analysis can provide recommendations for improving coordination through structured frameworks, joint work plans, strategic planning, resource mobilization, and performance monitoring.\u003c/p\u003e\n\u003cp\u003eDespite progress, existing coordination structures still face challenges in WASH program implementation. Identifying the most relevant platforms, diagnosing blockages, and ensuring alignment with coordination structures will help the FMOH WASH directorate\u0026mdash;encompassing Basic Sanitation Services, Food and Water Safety, Institutional WASH, and Climate Change teams\u0026mdash;reform coordination mechanisms. This will enhance mutual accountability among government sectors, development partners, CSOs, and private sector alliances, while improving aid effectiveness, leadership, and primary healthcare capacity building.\u003c/p\u003e\n\u003cp\u003eThis sector coordination gap analysis identifies the most relevant WASH platforms, examines coordination barriers, highlights best practices, and proposes mechanisms to strengthen accountability among stakeholders (government, development partners, CSOs, and the private sector) in hygiene and environmental sector planning, implementation, and monitoring.\u003c/p\u003e\n\u003cp\u003eDespite policy and strategy developments, weak institutional leadership has hindered sanitation service delivery, a key unmet MDG target. The National WASH Strategy (NWASHS) and Integrated Urban Sanitation and Hygiene Strategy were developed with stakeholder input, yet challenges such as implementation complexity and fragmentation persist. The signing of the MOU aims to enhance ownership and accountability among the signatory sectors for the implementation of joint commitments\u003csup\u003e6\u003c/sup\u003e.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eOBJECTIVE:\u003c/strong\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003eThe primary objective of this analysis was to assess existing platforms relevant to Hygiene and Environmental Health coordination, identify blockages within the current WASH sector coordination platforms, examine major interventions, analyze the persistent challenges affecting coordination task forces and platforms, and provide actionable recommendations.\u003c/p\u003e"},{"header":"METHOD AND MATERIALS","content":"\u003cp\u003e\u003cstrong\u003eStudy Design:\u003c/strong\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003eThe study employed a qualitative design, utilizing both primary and secondary data sources with a focus on qualitative data collection methods.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eStudy Units:\u003c/strong\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003eThe primary target groups for the assessment were key stakeholders in the Water, Sanitation, and Hygiene (WASH) sector, including NGOs actively engaged in WASH initiatives, government ministries signatory to the National WASH (NWASH) program, WASH-related coordination platforms, and representatives from nine regional state health bureaus and two city administration health bureaus (environmental health departments). Additionally, consultations were held with sector management in Addis Ababa, as well as with professional associations, consultants, and other relevant stakeholders.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eSampling method:\u003c/strong\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003eThe study used purposive sampling, with participants selected based on their level of engagement and roles within WASH platforms.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eData Collection Methods\u003c/strong\u003e\u003cstrong\u003e:\u0026nbsp;\u003c/strong\u003eData collection was conducted using qualitative methods, including key informant interviews, small group discussions with stakeholders (government agencies, NGOs, and bilateral partners), and desk reviews of literature, policy documents, Terms of Reference (TORs), and task force meeting minutes. The following data collection tools were utilized:\u003c/p\u003e\n\u003cul\u003e\n \u003cli\u003e\u003cstrong\u003eInterviews and Consultative Meetings with Key Stakeholders:\u003c/strong\u003e Consultative meetings with WASH sector leaders (MoH) were held from the inception phase through data collection and analysis. These meetings helped clarify expectations, gather input, and address challenges encountered by the consultant team.\u003c/li\u003e\n \u003cli\u003e\u003cstrong\u003eIn-Depth Interviews:\u003c/strong\u003e A total of 33 development partners working in WASH, government WASH signatory ministries, 10 WASH coordination platforms, and representatives from nine regional health bureaus and two city administration health bureaus (environmental health departments) were interviewed. Structured and semi-structured open-ended questionnaires were used for these interviews.\u003c/li\u003e\n \u003cli\u003e\u003cstrong\u003eBenchmarking of Other Countries\u0026rsquo; Experiences:\u003c/strong\u003e A web-based review of other countries\u0026rsquo; WASH practices was conducted as a benchmarking study and synthesized in this report.\u003c/li\u003e\n \u003cli\u003e\u003cstrong\u003eDesk Review:\u003c/strong\u003eThe assessment began with a preliminary review of existing information on WASH partners and task force practices from trusted sources. This included sector-specific reports, annual partner plans, strategic documents, policy guidelines, national and regional statistical reports, and research publications. Key documents reviewed for tool development and literature synthesis included:\u003col\u003e\n \u003cli\u003eGovernment performance reports and partner project documents, proposals, and reports\u003c/li\u003e\n \u003cli\u003ePolicy documents, strategies, protocols, strategic plans, checklists, and guidelines\u003c/li\u003e\n \u003cli\u003eTORs of coordination platforms, memoranda of understanding (MOUs) among signatory ministries, and meeting minutes from the Hygiene and Environmental Sub-Committee/Technical Committee (SC/TC) and later the NWASH TC/SC\u003c/li\u003e\n \u003cli\u003ePublished Demographic and Health Survey reports\u003c/li\u003e\n \u003cli\u003eResearch outputs and occasional papers from various sources\u003c/li\u003e\n \u003c/ol\u003e\n \u003c/li\u003e\n\u003c/ul\u003e\n\u003cp\u003e\u003cstrong\u003eQuestionnaire:\u003c/strong\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003eBoth Open and closed-ended questions related to the research questions were prepared and utilized\u003c/p\u003e\n\u003cp id=\"_Toc453881924\"\u003e\u003cstrong\u003eData quality control measures\u003c/strong\u003e\u003cstrong\u003e:\u003c/strong\u003e To prevent interviewer bias during data collection, respondents were coded, all field workers were trained before data collection, and regular supervision was done during the data collection. Each data collector was checking the questionnaires for completeness before leaving each study participant. All filled questionnaires were reviewed at the end of the day by the supervisor. The original questionnaire was prepared in English and then translated into Amharic. This helps easily manage the survey and better understand for responses.\u003c/p\u003e\n\u003cp id=\"_Toc453881925\"\u003e\u003cstrong\u003eData analysis\u0026nbsp;\u003c/strong\u003e\u003cstrong\u003eand management:\u003c/strong\u003e Based on the responses obtained from the questionnaire, the data that were obtained from the respondents in interviews and desk reviews were interpreted in a meaningful manner by using qualitative tools of data analysis through description.\u003c/p\u003e\n\u003cp id=\"_Toc453881926\"\u003e\u003cstrong\u003eOperational Definition\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cul\u003e\n \u003cli\u003eTask Force (TF): A Task Force is a temporary grouping under one leader established to accomplish a specific objective (Merriam-Webster Dictionary). It is a formal, temporary organization created to address a particular problem by formulating multiple solutions and selecting the best option based on predefined standards. The Task Force presents its findings and recommendations to the institution that commissioned it, but the institution retains responsibility for implementing those recommendations.\u003c/li\u003e\n \u003cli\u003eTechnical Working Group (TWG):\u0026nbsp;A Technical Working Group is formed for a fixed, short-term period to address specific tasks. Members are expected to actively participate in meetings, collaborate, and contribute expertise to achieve the group\u0026rsquo;s goals.\u0026nbsp;\u003c/li\u003e\n \u003cli\u003eCoordination:\u0026nbsp;Coordination\u0026nbsp;is a process that harmonizes different elements into an efficient relationship (Oxford English Dictionary). It involves integrating, unifying, and synchronizing the efforts of various organizations to achieve common goals.\u003c/li\u003e\n \u003cli\u003eCoordination Framework/Platform:\u0026nbsp;A tool designed to bring different stakeholders into a structured and harmonious working relationship.\u003c/li\u003e\n \u003cli\u003eWASH Coordination Mechanism:\u0026nbsp;A mechanism led by a core coordination team and involving all relevant stakeholders. It oversees functions such as health needs assessment, strategic planning, action planning, monitoring and evaluation, advocacy, and resource mobilization for the WASH sector.\u003c/li\u003e\n \u003cli\u003eSub-National Level:\u0026nbsp;Administrative levels below the national tier, including regional, zonal, Woreda, Kebele, or city administration levels.\u003c/li\u003e\n \u003cli\u003eStakeholder:\u0026nbsp;Any agency, organization (governmental, non-governmental, private, or other), group, or individual with a direct or indirect interest in WASH activities, services, or their impacts.\u003c/li\u003e\n \u003cli\u003eStrategic Operational Framework:\u0026nbsp;A framework that includes the elements of a strategic plan, along with guiding principles and standards to inform response planning and actions.\u003c/li\u003e\n \u003cli\u003ePartners:\u0026nbsp;Individuals or organizations collaborating to achieve mutually agreed-upon objectives.\u003c/li\u003e\n \u003cli\u003ePartnership:\u0026nbsp;A relationship based on shared goals, joint responsibility for outcomes, distinct accountabilities, and reciprocal obligations.\u003c/li\u003e\n \u003cli\u003eHygiene:\u0026nbsp;Practices associated with preserving health and promoting healthy living.\u003c/li\u003e\n \u003cli\u003eSanitation:\u0026nbsp;The principles and practices related to the proper collection, removal, and disposal of human excreta, household wastewater, and refuse to prevent adverse effects on people and the environment.\u003c/li\u003e\n \u003cli\u003eComponents of Environmental Health:\u0026nbsp;All physical, chemical, and biological factors external to a person, along with related behavioral influences. This includes the assessment and control of environmental factors affecting health, such as personal hygiene, safe water supply, human waste disposal, solid waste management, vector control, food hygiene, housing and institutional health, water pollution, and occupational health (WHO, 2016).\u003c/li\u003e\n \u003cli\u003eSteering Committee:\u0026nbsp;A committee established to provide advice, support, and guidance, representing whole-of-government perspectives. It oversees progress to ensure the delivery of outputs and achievement of outcomes, focusing on rapid decision-making rather than passive reporting.\u003c/li\u003e\n \u003cli\u003eTechnical Team:\u0026nbsp;A group of professionals selected from different organizations to contribute their expertise in addressing sector-specific challenges.\u003c/li\u003e\n \u003cli\u003eEnvironmental Health Basic Disciplines: Five core disciplines contribute to environmental health: environmental epidemiology, toxicology, exposure science, environmental engineering, and environmental law. While each discipline provides unique insights, there is some overlap in addressing environmental health problems and solutions.\u003c/li\u003e\n\u003c/ul\u003e\n\u003cp\u003e\u003cstrong\u003eEthical Approval:\u003c/strong\u003e The study was ethically cleared by the Ministry of Health WASH department and the ethical committee established by the department\u003c/p\u003e\n\u003cp\u003eLimitations of the study: Challenges encountered during this research were: most of the respondents were busy, and frequent restructuring within the sectors. Some respondents may not give the right responses or basic information on sensitive data. Some respondents did not easily understand what they were asked to answer. However, efforts were made to get the required information by cross-checking responses using different data collection methods.\u003c/p\u003e"},{"header":"RESULTS","content":"\u003cp\u003e\u003cstrong\u003eEXISTING WASH COORDINATION PLATFORM AT THE FEDERAL LEVEL\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eTo implement national and global commitments, various coordination mechanisms exist in the Health and Water Sectors. For instance, the Water Sector Working Group (WSWG) structure consists of four platforms: the Emergency WASH Cluster Coordination, the Urban WASH Technical Working Group, the Rural WASH Technical Group, and the Hygiene and Environmental Health Steering/Technical Committee (SC/TC\u003csup\u003e7\u003c/sup\u003e). The most common existing coordination mechanisms are summarized below.\u003c/p\u003e\n\u003cul\u003e\n \u003cli\u003eThe Water Sector Working Group (WSWG) was established in July 2015 to serve as a forum for the Government and donors to jointly promote, support, and coordinate sustainable and integrated water resource development and management for Ethiopia\u0026rsquo;s socio-economic development, in line with the GTP and subsequent development plans. Under this institutional structure, the WSWG comprises two subgroups: (1) Water, Sanitation, and Hygiene (WASH) and (2) Water Resource Management (WRM)\u003csup\u003e8\u003c/sup\u003e. The WSWG Secretariat is hosted by the Ministry of Water and Energy (MoWE), and meetings are conducted regularly as scheduled. Within the WASH sub-group, desk reviews indicate that the Hygiene and Environmental Health SC/TC is one of the four WASH sub-group coordination platforms, alongside the WASH Cluster Coordination, the Urban WASH Technical Working Group, and the Rural WASH Technical Group. However, key informants from the Ministry of Health (MoH) strongly oppose this classification, arguing that the WASH Taskforce is not part of this subgroup and was incorporated without MoH\u0026rsquo;s consensus (see Figure 1).\u003c/li\u003e\n \u003cli\u003eAnother key mechanism is the National WASH Steering and Technical Committees, previously known as the WASH Taskforce, established in April 2016 under the leadership of the MoH with a signed Memorandum of Understanding (MoU) and Terms of Reference (ToR). The MoU was signed between the MoH and several other ministries, including the Ministry of Education (MoE), the Ministry of Water, Irrigation, and Energy (MoWE), the Ministry of Finance and Economic Cooperation (MoFEC), the Ministry of Environment, Forest, and Climate Change (MoEFCC), the Ministry of Transport and Communications (MoTC), and the Ministry of Urban Development and Housing (MoHUD), with the Ministry of Agriculture (MoA) joining later. The Technical Committee, chaired by the MoH, includes partners, donor agencies, multilateral and bilateral organizations, and international NGOs, while the Steering Committee is chaired by the MoH State Minister. However, these are not the only national-level coordination platforms. Other sub-groups under the WASH Technical Committee include the National Global Handwashing Technical Working Group, the National Menstrual Hygiene Management (MHM) Technical Working Group, the Self-Supply Technical Working Group, and the Sanitation Marketing Multi-Stakeholder Platform (MSP).\u003c/li\u003e\n \u003cli\u003eThe National Integrated Urban Sanitation and Hygiene Steering Committee (NIUSH SC) incorporates steering committee activities into the official planned strategic activities of the respective sectors from the outset, so that the activities are prioritized. The committee will review and endorse the consolidated annual IUSH program plan and budget proposed by the USH Technical Team. It will also approve funds from partners for sector ministries and regional states/municipalities while ensuring that fund allocation to sectors for IUSH implementation follows agreed modalities and arrangements with partners. Additionally, the committee will oversee the proper functioning of the IUSH program monitoring and evaluation (M\u0026amp;E), provide overall guidance and direction for program implementation, and ensure the establishment and proper functioning of IUSH coordination mechanisms at all levels.\u003c/li\u003e\n\u003c/ul\u003e\n\u003cp\u003eThe NIUSH SC will advocate the Memorandum of Understanding (MoU) to partners, regional state sector bureaus, and municipalities to secure support and encourage regions to adapt the program to their context and plans. The committee will conduct quarterly meetings, with the option for any ministry to propose an urgent extraordinary meeting when necessary. Decisions will be based on evidence and consensus. Furthermore, the committee will ensure that the annual IUSH Multi-Stakeholder Forum (MSF) is conducted and will follow up on the implementation of its undertakings. Any additional duties and responsibilities identified over time by the IUSH SC will also be addressed.\u003c/p\u003e\n\u003cp\u003eThe National IUSH Technical Team (NIUSH TT) comprises appropriate directors assigned by their respective ministries. The Federal Ministry of Health\u0026rsquo;s Hygiene and Environmental Health Directorate director serves as the chairperson and coordinator of the technical team, while the Ministry of Urban Development and Housing (MoUDH) representative acts as the committee secretary. The technical team is directly accountable to the National WASH Steering Committee and has the following roles and responsibilities: facilitating inter-ministerial communication and cooperation; preparing and submitting strategic and annual plans for WASH SC approval; implementing strategic decisions and directions made by the WASH SC; liaising with donors to seek program support; ensuring financial disbursement aligns with WASH SC decisions; and maintaining WASH SC and TT structures at all levels.\u003c/p\u003e\n\u003cp\u003eThe technical team will regularly monitor program implementation, provide guidance, and report to the WASH SC. It will design programs for experience sharing both within and outside the country, establish and assign responsibilities to task groups as needed, and manage the WASH MSF and other review meetings while following up on the implementation of their outcomes. The team will also ensure that Plans of Action (PoA) for funded programs of respective ministries and regional states/municipalities are submitted on time. Beyond traditional funding partners, it will seek and engage new funding organizations. Additionally, the team will review consolidated national WASH semi-annual and annual reports before submission to the SC and, in collaboration with development partners (DPs), organize WASH Joint Technical Reviews (JTR) and MSF while securing approval for the required budget.\u003c/p\u003e\n\u003cul\u003e\n \u003cli\u003eThe Water and Sanitation Forum (WSF) was established and organized by the Consortium of Christian Relief and Development Associations (CCRDA) to coordinate efforts, address common challenges in the WASH enabling environment, exchange innovative sector ideas, and periodically organize learning events to assess the contributions of civil society organizations (CSOs) to the WASH sector. The forum has supported the Ethiopian government in implementing WASH programs that improve the lives of people in rural and urban areas. It consists of approximately 61 member organizations. However, there is no direct linkage with the WASH coordination office.\u003c/li\u003e\n \u003cli\u003eThe Ethiopia Water, Sanitation, and Hygiene (WASH) Movement was launched in 2004 as part of a global WASH campaign to promote behavioral and social change on WASH-related issues and to secure political and social commitment through mobilization and promotional activities. By 2013, the movement had over 90 members, including international NGOs, UN agencies, faith-based organizations, the private sector, and media representatives. Lessons learned from the movement highlight the importance of clearly defining member responsibilities, appointing local staff to facilitate communication, and ensuring regular funding. However, the WASH Media Forum eventually diminished due to various challenges.\u003c/li\u003e\n \u003cli\u003eThe WASH Media Forum, initially established in 2008 by WaterAid, RiPPLE, and a few media professionals, serves as a platform for media professionals and WASH sector actors to discuss and engage in policy dialogue on WASH issues. Previously managed by WaterAid/WASH Ethiopia Movement, the forum is now chaired by the Ministry of Health (MoH) with financial support from WSSCC/SNV as part of the WASH Technical Committee and Health Media Forum. Its activities include training media professionals, organizing field visits, producing media packs, IEC materials, WASH-specific publications, and awarding WASH media achievements. To ensure sustainability, the forum should establish stronger linkages with journalist associations rather than engaging individuals separately.\u003c/li\u003e\n \u003cli\u003eCoordination of emergency WASH responses in Ethiopia is led by the Ministry of Water and Energy (MoWE) with support from UNICEF under the Water Sector Working Group. The Emergency Task Force (WASH Cluster) was established in 2006 to provide a platform for stakeholders to share information and coordinate emergency WASH interventions. This structure is also maintained in six drought- and flood-prone regions: Afar, Amhara, Oromia, SNNP, Somali, and Tigray. The WASH Task Force (TF) ensures leadership, accountability, and partnership in emergency WASH services, including preparedness, response, and rehabilitation. However, sector coordination remains challenging due to the involvement of multiple ministries (MoWE and MoH) and numerous agencies and CSOs. Notably, the MoH WASH Directorate is not actively engaged in cluster coordination, and there is no linkage with WASH cluster profiles.\u003c/li\u003e\n \u003cli\u003eThe Sanitation Marketing Multi-Stakeholder Platform (MSP) was established in February 2014 following the 2013 National Sanitation Marketing Guideline, developed under the Health Sector Development Program (HSDP-IV, 2011\u0026ndash;2015). The MSP aims to create an enabling environment for sanitation marketing, improve access to affordable sanitation and hygiene technologies through private sector engagement, and stimulate demand for improved sanitation solutions. Chaired by MoH with Transform WASH as the secretariat, the MSP facilitates quarterly discussion platforms where sector bureaus and development partners report progress, review challenges, exchange information, and make joint decisions. As shown in Fig. 2, the MSP has four Technical Working Groups (TWGs), each with specific objectives and deliverables:\u003cul\u003e\n \u003cli\u003eThe Technology Options TWG, chaired by MoH/FMHACA and co-chaired by TVET.\u003c/li\u003e\n \u003cli\u003eThe Business Development TWG is chaired by the Job Creation and Safety Net Agency and co-chaired by the World Bank.\u003c/li\u003e\n \u003cli\u003eThe Demand Creation and Promotion TWG, chaired by MoH and co-chaired by Transform WASH.\u003c/li\u003e\n \u003cli\u003eThe Private Sector TWG, with a chair and co-chair selected by private sector representatives.\u003c/li\u003e\n \u003cli\u003eThese TWGs report to the Steering Committee, which decides their continuation or deactivation based on relevance and achievement of objectives.\u003c/li\u003e\n \u003c/ul\u003e\n \u003c/li\u003e\n \u003cli\u003eWASH-NTD Technical Working Group: The WASH-NTD Technical Working Group (TWG) was recently established at the Ministry of Health (MoH) level and is co-chaired by the National NTD Programme Manager and the WASH Directorate. Its primary tasks include identifying synergies across NTDs and between NTDs and WASH, strengthening platforms for knowledge sharing and collaboration, and improving awareness about NTDs and the opportunities provided by joint interventions among professional communities within and beyond the WASH and NTDs national framework. Additionally, the TWG formulates cross-cutting program monitoring and evaluation (M\u0026amp;E) systems, including standardized success indicators, and collects disaggregated data. It defines an agenda for applied operational research on effective implementation, provides guidance on joint WASH-NTD coordination, and disseminates standards and guidelines into policy and practice. The group also supports the development and strengthening of governance and institutional arrangements that enable collaboration.\u003c/li\u003e\n\u003c/ul\u003e\n\u003cp\u003eFurthermore, the TWG facilitates the joint use of existing datasets and reports among stakeholders and across sectors to track progress and inform decision-making at national and sub-national levels. It tests integration toolkits, monitors their implementation, and enhances coordination between regional, zonal, and woreda-level partners working on WASH and behavioral change for NTDs. This involves collaboration across various departments and sectors, including the Health Extension Program, the WASH sector, the Education sector, and WASH partners.\u003c/p\u003e\n\u003cp\u003eAccording to the analysis of Task Force (TF) minutes\u0026mdash;sometimes referred to as WASH Steering and Technical Committee meetings\u0026mdash;the National Hygiene and Environmental Health Steering Committee/Technical Committee (SC/TC) members conducted meetings with a total of 14 minutes documented. The meetings were generally well-organized, as the minutes included agendas, attendee lists, action points, invitations, official letters for meeting calls, established contact addresses, and continuity in discussing related issues. A critical review of these 14 meeting minutes revealed that attendance ranged from a minimum of 6 to a maximum of 22 participants, representing approximately 12 government sectors, 15 non-governmental organizations (NGOs), and 3 United Nations (UN) agencies. Key agenda items discussed and proposed for further action included:\u003c/p\u003e\n\u003cul\u003e\n \u003cli\u003eThe preparation, endorsement, and launching of various strategies (such as the Hygiene \u0026amp; Environmental Health Strategy, Integrated Urban Sanitation and Hygiene Strategy, and School WASH Strategy), guidelines (including post-ODFE triggering, Hygiene and Sanitation Communication, CLTSH certification and verification, and School WASH guidelines), manuals for rural and urban settings, and a Memorandum of Understanding (MoU) on integrated strategy implementation. These documents were produced in both English and Amharic. The WASH Task Force (WASHTF) also provided progress updates and plans to cascade these efforts to regions and city administrations through regional familiarization workshops, document distribution, and online publication on ministry websites for easy access.\u003c/li\u003e\n \u003cli\u003eOther major agenda items included the celebration of international and national events (such as Menstrual Hygiene Management Day and Global Handwashing Day), annual work plans and performance reports, implementation and budget utilization of the One WASH National Program/CWA, and associated challenges. Additionally, initiatives and projects like sanitation marketing, water quality improvement, sanitation technology, and urban WASH projects in 23 towns were discussed. Operational definitions of terms such as \u0026quot;improved latrine\u0026quot; were clarified, and various documents\u0026mdash;including baseline surveys (e.g., KAP on MHM), concept notes (e.g., learning towns), accountability frameworks for WASH committees, and WASH technical committee plans\u0026mdash;were reviewed. Joint discussions between the Technical Committee (TC) and the Joint Steering Committee (JSC) were held, along with coordination efforts with management and urban WASH projects in 20 towns (WAE).\u003c/li\u003e\n\u003c/ul\u003e\n\u003cp\u003eWASH COORDINATION STRUCTURES AT THE SUB-NATIONAL LEVEL\u003c/p\u003e\n\u003cp\u003eThe Ministry of Health, along with regional steering and technical committees, established a coordination structure that was cascaded to nearly all regions. Regions and city administrations reported the formation of these committees, though their functionality has not been officially confirmed. To create an enabling environment for the sustainability of these task forces at the regional level, WASH directorates were established in most regional health bureaus, except in the Amhara, Tigray, and SNNP regions due to a lack of approval from regional Civil Service Bureaus (see Table 1).\u003c/p\u003e\n\u003cp\u003eIn the Addis Ababa city administration, task force coordination follows MoH guidelines. The Health Bureau collaborates with relevant sectors through a signed Memorandum of Understanding (MOU) and jointly reviews WASH activities. Under the task force, various Technical Working Groups (TWGs) were formed, composed of experts from different sectors. Each sector has focal persons, and the TWGs ensure alignment in annual sectoral plans. The steering committee, chaired by the Health Bureau\u0026rsquo;s deputy head, consists of bureau heads and meets biannually. TWGs report to the steering committee for review.\u003c/p\u003e\n\u003cp\u003eIn the SNNP region, the WASH structure remains at the case team level under the Disease Prevention and Health Promotion Directorate. Five case teams exist: Health Extension, Malaria, TB, NTDs, NCDs, and WASH. Although plans were made two years ago to elevate the WASH case team to a directorate, the regional Civil Service Bureau has not yet approved this. A task force was established, but it has not been updated, and the drafted MOU remains unsigned by the relevant bureaus. Currently, members do not meet to discuss WASH issues, and task force activities have shifted to other TWGs, such as Sanitation Marketing, due to an ongoing project in the region.\u003c/p\u003e\n\u003cp\u003eTable\u0026nbsp;1: Regional WASH-related Coordination Forum\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" width=\"980\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 56px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eName\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 120px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eWASH structure\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 228px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eName of the platform\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 78px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eFunctionality\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 102px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eAvailability of Clear TOR/MoU\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 396px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eMembers actively participating\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"3\" valign=\"top\" style=\"width: 56px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eOromia\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" valign=\"top\" style=\"width: 120px;\"\u003e\n \u003cp\u003eWASH and NTDs Directorate\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 228px;\"\u003e\n \u003cp\u003eOWNP technical and steering committees\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 78px;\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 102px;\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 396px;\"\u003e\n \u003cp\u003eGov (Hygiene, water quality, HE focal), One WASH, and partners\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 228px;\"\u003e\n \u003cp\u003eMulti-Sectoral platform (MSP forum)- Sanitation Marketing\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 78px;\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 102px;\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 396px;\"\u003e\n \u003cp\u003eWSSCC-SNV, PSI, Plan International, UNICFE, Health office, Water and energy office, TVET, MFI\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 120px;\"\u003e\n \u003cp\u003eWASH and NTDs Directorate\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 228px;\"\u003e\n \u003cp\u003eWASH steering and technical committee\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 78px;\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 102px;\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 396px;\"\u003e\n \u003cp\u003eHealth, Water, Education, Finance, urban dev\u0026rsquo;t, culture and tourism, agriculture,\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"3\" valign=\"top\" style=\"width: 56px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eAmhara\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" valign=\"top\" style=\"width: 120px;\"\u003e\n \u003cp\u003eCase team\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 228px;\"\u003e\n \u003cp\u003eOWNP technical and steering committees and technical committees\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 78px;\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 102px;\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 396px;\"\u003e\n \u003cp\u003eGov (Hygiene, water quality, HE focal), One WASH, Carter, JSS, WASH emergency, UNCIF)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 228px;\"\u003e\n \u003cp\u003eMulti-Sectoral platform (MSP forum)- Sanitation Marketing\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 78px;\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 102px;\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 396px;\"\u003e\n \u003cul\u003e\n \u003cli\u003e\u003cstrong\u003e\u003cu\u003eGovernment\u003c/u\u003e\u003c/strong\u003e\u003cu\u003e:\u003c/u\u003e TVET, Health, Water and Energy, MFI, Job creation, Women and Child, Education, BOFED\u003c/li\u003e\n \u003cli\u003e\u003cstrong\u003e\u003cu\u003ePartners:\u003c/u\u003e\u003c/strong\u003e IRC, WSSCC-SNV,\u003c/li\u003e\n \u003cli\u003eInvited participants: Carter Center, Care\u003c/li\u003e\n \u003c/ul\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 120px;\"\u003e\n \u003cp\u003eCase team\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 228px;\"\u003e\n \u003cp\u003eWASH steering and technical committee\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 78px;\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 102px;\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 396px;\"\u003e\n \u003cp\u003eHealth, Water, Education, Finance, urban dev\u0026rsquo;t\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"3\" valign=\"top\" style=\"width: 56px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eDire Dawa\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" valign=\"top\" style=\"width: 120px;\"\u003e\n \u003cp\u003eDirectorate\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 228px;\"\u003e\n \u003cp\u003eOne WASH technical team\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 102px;\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 396px;\"\u003e\n \u003cp\u003eEducation, health, Water, and mineral energy, BOFED\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 228px;\"\u003e\n \u003cp\u003eMulti-Sectoral sanitary platform\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 78px;\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 102px;\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 396px;\"\u003e\n \u003cp\u003eTVET, MFI, Job creation, Women and Child, Education, NGO-CRS, SNV\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 120px;\"\u003e\n \u003cp\u003eDirectorate\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 228px;\"\u003e\n \u003cp\u003eWASH steering and technical committee\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 78px;\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 102px;\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 396px;\"\u003e\n \u003cp\u003eHealth, Water, Education, Finance, urban dev\u0026rsquo;t\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"4\" valign=\"top\" style=\"width: 56px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eSomali\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"3\" valign=\"top\" style=\"width: 120px;\"\u003e\n \u003cp\u003eCase team\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 228px;\"\u003e\n \u003cp\u003eMulti-Sectoral platform (MSP forum)- Sanitation Marketing\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 78px;\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 102px;\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 396px;\"\u003e\n \u003cp\u003eWSSCC-SNV, PSI, Plan International, UNICFE, Health office, Water and energy office, TVET, MFI\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 228px;\"\u003e\n \u003cp\u003eWASH Cluster\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 78px;\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 102px;\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 396px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u003cu\u003eGovernment\u003c/u\u003e\u003c/strong\u003e\u003cu\u003e:\u003c/u\u003e Health(co-chair), water and Energy- Chair, Education and disaster, and risk\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e\u003cu\u003ePartners:\u003c/u\u003e\u003c/strong\u003e All WASH partners such as UNCIF, Save the Children, WHO, Islamic Relief, Transform WASH, etc.\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 228px;\"\u003e\n \u003cp\u003eSanitation and hygiene TWG\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 78px;\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 102px;\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 396px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u003cu\u003eGovernment\u003c/u\u003e\u003c/strong\u003e\u003cu\u003e:\u003c/u\u003e Health, water, Energy, and Education\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e\u003cu\u003ePartners:\u0026nbsp;\u003c/u\u003e\u003c/strong\u003eAll WASH partners such as UNCIF, Save the Children, WHO, Islamic Relief, Transform WASH, etc.\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 120px;\"\u003e\n \u003cp\u003eCase team\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 228px;\"\u003e\n \u003cp\u003eWASH steering and technical committee\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 78px;\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 102px;\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 396px;\"\u003e\n \u003cp\u003eHealth, Water, Education, Finance, urban dev\u0026rsquo;t\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"3\" valign=\"top\" style=\"width: 56px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eGambella\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" valign=\"top\" style=\"width: 120px;\"\u003e\n \u003cp\u003eDirectorate\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 228px;\"\u003e\n \u003cp\u003eSanitation marketing\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 78px;\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 102px;\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 396px;\"\u003e\n \u003cp\u003e\u003cstrong\u003ePartner\u003c/strong\u003e: AMRIF, Plan, PSI, SNV, Samaritan Purse, UNCIFE\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003eGov\u0026rsquo;t\u003c/strong\u003e: (Health office, Water and Energy, Food security, MFI, TVET, office\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 228px;\"\u003e\n \u003cp\u003eOWNP technical and steering committees\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 78px;\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 102px;\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 396px;\"\u003e\n \u003cp\u003eEducation, health, Water, and mineral energy, BOFED\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 120px;\"\u003e\n \u003cp\u003eDirectorate\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 228px;\"\u003e\n \u003cp\u003eWASH steering and technical committee\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 78px;\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 102px;\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 396px;\"\u003e\n \u003cp\u003eHealth, Water, Education, Finance, urban dev\u0026rsquo;t\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"5\" valign=\"top\" style=\"width: 56px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eAfar\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"4\" valign=\"top\" style=\"width: 120px;\"\u003e\n \u003cp\u003eDirectorate\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 228px;\"\u003e\n \u003cp\u003eEmergency WASH Task Force (Regional WASH cluster)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 78px;\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 102px;\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 396px;\"\u003e\n \u003cp\u003eEducation, health, Water, and mineral energy-Chair, BOFED, Metrology, UNCIF, CARE, AMRIF, Save the Children, AFDA, RDRM\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 228px;\"\u003e\n \u003cp\u003eOWNP technical and steering committees\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 78px;\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 102px;\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 396px;\"\u003e\n \u003cp\u003eEducation, health, Water, and mineral energy, BOFED\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 228px;\"\u003e\n \u003cp\u003eMulti-Sectoral platform/Sanitary marketing\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 78px;\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 102px;\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 396px;\"\u003e\n \u003cp\u003eTVET, MFI, Job creation, Women and Child, BoFED, Health, Education, NGO- IRC, WSSCC-SNV, PSI\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 228px;\"\u003e\n \u003cp\u003eUrban Sanitation Forum\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 78px;\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 102px;\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 396px;\"\u003e\n \u003cp\u003eHealth, urban and house construction and planning, Agriculture, Water, Women and Children, Environmental protection, trade and industry, Tourism\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 120px;\"\u003e\n \u003cp\u003eDirectorate\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 228px;\"\u003e\n \u003cp\u003eWASH steering and technical committee\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 78px;\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 102px;\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 396px;\"\u003e\n \u003cp\u003eHealth, Water, Education, Finance, urban dev\u0026rsquo;t\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"3\" valign=\"top\" style=\"width: 56px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003eTigray\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" valign=\"top\" style=\"width: 120px;\"\u003e\n \u003cp\u003eCase team\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 228px;\"\u003e\n \u003cp\u003eOWNP technical and steering committees\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 78px;\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 102px;\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 396px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eGov\u0026rsquo;t\u003c/strong\u003e: Education, health, Water, and mineral energy, BOFED\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003ePartner\u003c/strong\u003e: REST, Plan, IRC, PSI, World Vision, UNCIF\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 228px;\"\u003e\n \u003cp\u003eMulti-Sectoral platform (MSP forum)- Sanitary Marketing\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 78px;\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 102px;\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 396px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eGov\u0026rsquo;t\u003c/strong\u003e: Health office, Science and technology, Women, Child and Youth, Water and Energy, SME MFI, TVET, BoFED\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003ePartner\u003c/strong\u003e: REST, Plan, IRC, PSI, World Vision, UNCIF\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 120px;\"\u003e\n \u003cp\u003eDirectorate\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 228px;\"\u003e\n \u003cp\u003eWASH steering and technical committee\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 78px;\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 102px;\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 396px;\"\u003e\n \u003cp\u003eHealth, Water, Education, Finance, urban dev\u0026rsquo;t\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"3\" valign=\"top\" style=\"width: 56px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eSNNPR\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" valign=\"top\" style=\"width: 120px;\"\u003e\n \u003cp\u003ePinpoint\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 228px;\"\u003e\n \u003cp\u003eOWNP technical and steering committees\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 78px;\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 102px;\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 396px;\"\u003e\n \u003cp\u003eGov (Hygiene, water quality, HE focal), One WASH, and partners\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 228px;\"\u003e\n \u003cp\u003eMulti-Sectoral platform (MSP forum)-Sanitation Marketing\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 78px;\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 102px;\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 396px;\"\u003e\n \u003cp\u003eWSSCC-SNV, PSI, Plan International, UNICFE, Health office, Water and energy office, TVET, MFI\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 120px;\"\u003e\n \u003cp\u003eDirectorate\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 228px;\"\u003e\n \u003cp\u003eWASH steering and technical committee\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 78px;\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 102px;\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 396px;\"\u003e\n \u003cp\u003eHealth, Water, Education, Finance, urban dev\u0026rsquo;t\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003eNB:\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003eFunctionality: at least one meeting per quarter\u003c/p\u003e\n\u003cp\u003e\u003cbr\u003e\u003c/p\u003e\n\u003cp\u003eEFFECTIVENESS OF EXISTING COORDINATION ARRANGEMENTS IN ETHIOPIA\u003c/p\u003e\n\u003cp\u003eSector coordination is critical for unified WASH service delivery, ensuring harmonized strategies, resource mobilization, and performance monitoring. Five guiding principles assess coordination effectiveness:\u003c/p\u003e\n\u003col start=\"1\" type=\"1\"\u003e\n \u003cli\u003eMoH Leadership: The ministry should lead resource coordination.\u003c/li\u003e\n \u003cli\u003ePartner Technical Support: Partners should assist the ministry.\u003c/li\u003e\n \u003cli\u003eNational Plan Alignment: Resources should align with the national health sector plan.\u003c/li\u003e\n \u003cli\u003eInclusive Planning: The Government should engage multilateral/bilateral agencies in national planning.\u003c/li\u003e\n \u003cli\u003ePartner Commitment: Partners should prioritize national objectives over administrative or commercial interests.\u003c/li\u003e\n\u003c/ol\u003e\n\u003cp\u003eThese principles inform evaluation criteria, including:\u003c/p\u003e\n\u003cul\u003e\n \u003cli\u003eLeadership and Ownership: MoH\u0026rsquo;s WASH Directorate leads, with multi-sector involvement.\u003c/li\u003e\n \u003cli\u003eParticipation Scope: While signatory sectors and some NGOs engage, the private sector and academic institutions lack full participation (except Bahir Dar University in Amhara).\u003c/li\u003e\n \u003cli\u003ePeriodicity: National-level meetings are regular, but regional/local coordination is inconsistent.\u003c/li\u003e\n \u003cli\u003eIntegration: Alignment with health policies exists, but links to other sectors\u0026rsquo; strategies are unclear. High turnover of focal persons and weak accountability hinder MoU adherence.\u003c/li\u003e\n \u003cli\u003eCoordination Breadth: The multisectoral mechanism spans 9 regions and 2 city administrations but remains weak below the national level.\u003c/li\u003e\n \u003cli\u003eDecision Adherence: Members generally fulfill assigned roles, but attendance and accountability gaps persist.\u003c/li\u003e\n \u003cli\u003eSector Efficiency: Coordination reduces duplication (e.g., shared strategy development).\u003c/li\u003e\n \u003cli\u003eSector Effectiveness: Impact assessment requires further research and documentation.\u003c/li\u003e\n \u003cli\u003eEquity Effects: Insufficient data exist to evaluate geographical or target group equity.\u003c/li\u003e\n \u003cli\u003eSustainability: The mechanism is sustainable unless government policies shift.\u003c/li\u003e\n \u003cli\u003eCosts: Cost-benefit analysis is pending due to data gaps.\u003c/li\u003e\n\u003c/ul\u003e\n\u003cp\u003eCOORDINATION PLATFORMS LIMITATIONS\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eNATIONAL LEVEL\u003c/p\u003e\n\u003cp\u003eSeveral challenges were identified, including frequent turnover of committee members without proper knowledge transfer to replacements, the lack of a legal framework supporting the MoU (leading to accountability gaps), and inconsistent attendance by WASHTF members. Meetings often proceeded with low attendance due to reliance on individual commitment rather than structured participation. Ensuring full attendance required timely invitations, facilitation, and negotiations, which proved difficult.\u003c/p\u003e\n\u003cp\u003eAdditional challenges included the absence of a responsible body to follow up on action points, inconsistent naming conventions (e.g., WASH Task Force, Technical Committee, Steering Committee, Technical Working Group), and the lack of a common budget or inclusive actions among signatory ministries. Many ministries did not incorporate the program (e.g., IUSHS) into their Annual Work Plans (AWPs). There was also no officially designated chairperson, co-chair, or secretary for the Task Force, though in some instances, the WASH director acted as chair and a technical assistant as secretary.\u003c/p\u003e\n\u003cp\u003eOther issues included last-minute agenda setting, incomplete coverage of hygiene and environmental health topics, and participants\u0026rsquo; busy schedules delaying agreed-upon assignments due to weak accountability mechanisms. Regional WASH platforms lacked Terms of Reference (TOR), dedicated staff, and trained personnel for coordination. Agenda selection often prioritizes current issues (e.g., One WASH National Program) or NGO-driven initiatives rather than comprehensive sectoral needs.\u003c/p\u003e\n\u003cp\u003eFurthermore, there was insufficient evidence of strategy implementation (e.g., Integrated Urban Sanitation and Hygiene Strategy and Hygiene \u0026amp; Environmental Health Strategy) at all levels by WASH and Urban Sanitation and Hygiene (USH) steering committees and technical teams. Limited efforts were made in evidence generation, research, documentation of lessons learned, and best practices. Finally, there was no clear system for resource allocation, mobilization, or utilization, including funding, supplies, and dedicated staff for WASH coordination.\u003c/p\u003e\n\u003cp\u003eREGIONAL LEVELS\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eSeveral challenges hinder effective coordination at the regional level. First, there is a shortage of skilled WASH professionals, even in the job market, affecting regions, zones, and woredas. Universities have also discontinued WASH departments, exacerbating the skills gap. Second, budget constraints limit task force activities, as there is no dedicated funding line\u0026mdash;operations rely on partner support or internal bureau budgets. Additionally, no budget is allocated to extend task forces to sub-city and woreda levels.\u003c/p\u003e\n\u003cp\u003eThird, regional leaders often prioritize urgent issues like security over WASH coordination, leading to low commitment. Fourth, no accountability mechanism for sector bureaus that fail to meet MOU obligations, making it difficult to enforce compliance. Fifth, inadequate follow-up and supportive supervision hinder the implementation and functionality of task forces.\u003c/p\u003e\n\u003cp\u003eSixth, the absence of a structured learning, monitoring, and evaluation system weakens performance tracking. Seventh, poor integration and cooperation among TWG members reduce effectiveness. Eighth, partner participation in regional meetings is limited, as many NGOs lack permanent regional offices, and government offices fail to facilitate coordination meetings effectively.\u003c/p\u003e\n\u003cp\u003eNinth, weak facilitation and follow-up prevent full stakeholder engagement. Tenth, the lack of a full-time, dedicated coordination lead at the regional level disrupts the cascading of task forces to zones and woredas. Finally, overlapping mandates\u0026mdash;such as urban WASH construction falling under the Construction and Urban Development Bureau\u0026mdash;create confusion and hinder TWG performance.\u003c/p\u003e\n\u003cp\u003eCOORDINATION PLATFORMS BEST PRACTICES\u003c/p\u003e\n\u003cp\u003eThe One WASH National Program (OWNP)\u0026nbsp;is a government-driven, sector-wide approach (SWAp) designed to address the needs of rural, urban, and pastoralist communities, as well as schools and health posts, in an integrated manner while reducing administrative fragmentation in WASH service delivery. The program was launched in September 2013 following the signing of a Memorandum of Understanding (MoU) in November 2012 between the Ministry of Water and Energy (MoWE), the Ministry of Health (MoH), the Ministry of Education (MoE), and the Ministry of Finance and Economic Development (MoFED). The WASH Implementation Framework (WIF) was approved in March 2013 to guide the program.\u003c/p\u003e\n\u003cp\u003eOWNP operates on principles of harmonization, integration, alignment, and partnership between development partners and the Government of Ethiopia. Its objectives include addressing disparities in WASH coverage across regions and urban areas, improving aid effectiveness, and promoting institutional reforms, particularly in capacity development at all levels.\u003c/p\u003e\n\u003cp\u003eFor coordination, the\u0026nbsp;National WASH Coordination Office (NWCO)\u0026nbsp;was established to oversee planning and implementation. Program Management Units within the four WASH ministries (MoWE, MoH, MoE, and MoFED) drive implementation, with the\u0026nbsp;National WASH Steering Committee (NWSC)\u0026mdash;comprising ministers from these ministries, chaired by MoWE\u0026mdash;providing strategic oversight.\u003c/p\u003e\n\u003cp\u003eSince its inception, OWNP has recorded several best practices and lessons, including:\u003c/p\u003e\n\u003cul\u003e\n \u003cli\u003eSupportive Policy and Regulatory Frameworks: The WASH sector is guided by policies, strategies, proclamations, and guidelines that enhance coordination, transparency, and accountability. Key documents include the OWNP itself, the WASH Implementation Framework (WIF), the Universal Access Plan (UAP) 2005, the Plan for Accelerated and Sustained Development to End Poverty (PASDEP) 2005, and the Growth and Transformation Plan (GTP II). Additionally, the Ministry of Health has developed supplementary programs such as the Health Sector Development Program (HSDP) and the Health Extension Program (HEP), which aim to achieve universal primary health care coverage.\u003c/li\u003e\n \u003cli\u003eAlignment of Development Partners: Development partners align their targets, plans, and activities with OWNP principles. New WASH projects are designed per the program\u0026rsquo;s strategies, ensuring harmonized and integrated approaches. Civil society organizations (CSOs) and NGOs participate in sector reviews, evaluations, and implementation, with their activities incorporated under the OWNP umbrella. Partners receive quarterly progress reports, financial updates, and audit findings through the NWCO.\u003c/li\u003e\n \u003cli\u003eStructured Coordination Mechanisms: The NWCO coordinates planning and oversight, while Program Management Units operate within each WASH ministry. The NWSC and National WASH Technical Team consist of ministers and directors from these ministries, respectively. Similar structures exist at regional levels, where Regional WASH Steering Committees (RWSC) oversee implementation. At the woreda (district) level, Woreda WASH Teams\u0026mdash;comprising representatives from water, health, education, and finance offices\u0026mdash;implement activities under the guidance of a Woreda WASH Steering Committee (WWSC). Kebele (village)-level plans are approved by local councils, supported by Health Extension Workers (HEWs).\u003c/li\u003e\n \u003cli\u003eFinancial Support Mechanisms: The government and development partners contribute to a Consolidated WASH Account (CWA) at the federal level. Other partners, including bilateral organizations and CSOs, provide technical assistance, supplies, and alternative funding. The Development Assistance Group (DAG) facilitates donor coordination.\u003c/li\u003e\n \u003cli\u003eFocus Areas and Implementation Modalities: OWNP prioritizes rural/pastoral WASH, urban WASH, institutional WASH, and program management/capacity building. Strategic interventions include self-supply scaling, WASH technician training, supply chain strengthening, urban water system construction, data management, social inclusion, climate resilience, and communication strategies. Implementation follows four modalities:\u003c/li\u003e\n\u003c/ul\u003e\n\u003col start=\"1\" type=\"1\"\u003e\n \u003cli\u003eWoreda-Managed Modality (funds administered by woreda-level teams)\u003c/li\u003e\n \u003cli\u003eCommunity-Managed Project Modality (communities plan and manage projects)\u003c/li\u003e\n \u003cli\u003eNGO Modality (varied funding/management arrangements)\u003c/li\u003e\n \u003cli\u003eSelf-Supply (household investments in water infrastructure)\u003c/li\u003e\n\u003c/ol\u003e\n\u003cul\u003e\n \u003cli\u003ePhase III Continuity: Following an evaluation of OWNP Phase I (2015), Phase II (2015\u0026ndash;2020) maintains institutional arrangements and modalities from Phase I, supplemented by semi-annual Joint Technical Reviews (JTR), annual Multi-Stakeholder Forums (MSF), and regular Forum for Learning on Water and Sanitation (FLOWS) meetings.\u003c/li\u003e\n\u003c/ul\u003e\n\u003cp\u003ePROPOSED WASH COORDINATION STRUCTURE OPTIONS\u003c/p\u003e\n\u003cp\u003eAs shown in Fig. 3, three options are proposed to enhance coordination:\u003c/p\u003e\n\u003col\u003e\n \u003cli\u003eOption 1:\u0026nbsp;A fully dedicated WASH Coordination Office with functions including:\u003cul\u003e\n \u003cli\u003eService delivery oversight\u003c/li\u003e\n \u003cli\u003eNeeds assessment and gap analysis\u003c/li\u003e\n \u003cli\u003eStrategic planning and budgeting\u003c/li\u003e\n \u003cli\u003eMonitoring and evaluation\u003c/li\u003e\n \u003cli\u003eCapacity building\u003c/li\u003e\n \u003cli\u003eAdvocacy and cross-cutting issue integration\u003c/li\u003e\n \u003c/ul\u003e\n \u003c/li\u003e\n \u003cli\u003eOption 2:\u0026nbsp;A modified WASH Steering Committee/Technical Committee (SC/TC) with enhanced components.\u003c/li\u003e\n \u003cli\u003eOption 3:\u0026nbsp;Strengthening the existing platform by scaling up best practices and addressing gaps.\u003c/li\u003e\n\u003c/ol\u003e\n\u003cp\u003eOption 1\u0026rsquo;s\u0026nbsp;proposed structure begins with a National Health Security Council (chaired by the Deputy Prime Minister), followed by a Strategic Advisory Committee (signatory ministries) and a WASH Coordination Office with dedicated resources and authority.\u003c/p\u003e\n\u003cp\u003eA. Using a Modified Form of the Existing WASH SC/TC by Adding Components\u003c/p\u003e\n\u003cp\u003eThe first approach involves modifying the existing WASH SC/TC by incorporating additional components while maintaining its core coordination functions, except for establishing a fully operational coordination mechanism. This includes revising the Terms of Reference (TOR) of the coordination platform with more appropriate terminology, such as replacing \u0026quot;Task Force (TF)\u0026quot;\u0026mdash;which implies a temporary group led by a single individual to achieve a specific objective\u0026mdash;with alternatives like \u0026quot;WASH Support Group,\u0026quot; \u0026quot;Council of H\u0026amp;EH,\u0026quot; \u0026quot;Advisory Board,\u0026quot; or \u0026quot;Strategic Advisory Group.\u0026quot;\u003c/p\u003e\n\u003cp\u003eAdditionally, specific working groups should be established at the case team level, ensuring that members possess the necessary interest, time, qualifications, and commitment beyond their general membership in the overall coordination mechanism. It is important to address existing gaps and encountered problems in each proposed structure. The sub-working groups mentioned earlier can be formed under the main coordination body.\u003c/p\u003e\n\u003cp\u003eB. Using the Existing Platform by Scaling Up Good Practices and Addressing Identified Gaps\u003c/p\u003e\n\u003cp\u003eThe second approach involves utilizing the existing coordination platform while scaling up successful practices and implementing corrective measures for identified gaps. This structure can be refined by addressing the constraints and challenges highlighted in previous sections. Table 2 highlights the summary of proposed structures, pros, and cons.\u003c/p\u003e\n\u003cp\u003eTable 2: Summary of proposed WASH coordination structure\u003c/p\u003e\n\u003ctable border=\"0\" cellspacing=\"0\" cellpadding=\"0\" width=\"792\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 32px;\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 112px;\"\u003e\n \u003cp\u003eProposed Coordination Mechanisms\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 414px;\"\u003e\n \u003cp\u003eAdvantages\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 234px;\"\u003e\n \u003cp\u003eDisadvantages\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 32px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 112px;\"\u003e\n \u003cp\u003eEstablishing a fully dedicated and standalone WASH coordination office\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 414px;\"\u003e\n \u003cp\u003eSuitable for inclusive stakeholder participation; capable of implementing action plans; allows for monitoring and evaluation; ensures accountability; operates autonomously with a clear mandate; facilitates coordination activities; manages WASH TWGs under the platform; functions as an independent office guided by defined job descriptions; enables easy design and implementation of accountability and monitoring systems; aids in resource mobilization; prevents duplication of efforts; ensures proper resource allocation; holds stakeholders accountable; supports a unified national plan, budget, and reporting system for H\u0026amp;EH interventions.\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 234px;\"\u003e\n \u003cp\u003eRequires budget and human resources at national, regional, zonal, and woreda levels; needs legal approval for establishment; necessitates drafting new TORs, MOUs, and additional efforts for setup.\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 32px;\"\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 112px;\"\u003e\n \u003cp\u003eModifying the existing WASH SC/TC by adding components and revising the platform\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 414px;\"\u003e\n \u003cp\u003eNo need for new MOUs; facilitates easier design and implementation of action plans; allows the formation of temporary TWGs for specific tasks; requires fewer resources compared to Option 1.\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 234px;\"\u003e\n \u003cp\u003eRequires TOR revisions; lacks dedicated time for coordination due to officers\u0026apos; other responsibilities; potential role conflicts between MoH and MOWE persist; challenges in securing resources and dedicated staff remain.\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 32px;\"\u003e\n \u003cp\u003e3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 112px;\"\u003e\n \u003cp\u003eUsing the existing platform with improvements\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 414px;\"\u003e\n \u003cp\u003eStrengthens existing mechanisms; identifies gaps for scaling up and corrective actions.\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 234px;\"\u003e\n \u003cp\u003eRole conflicts between MoH and MOWE may persist; securing resources and dedicated staff remains a challenge.\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp id=\"_Toc204593312\"\u003e\u003cbr\u003e\u003c/p\u003e"},{"header":"CONCLUSION AND RECOMMENDATIONS","content":"\u003cp\u003eCONCLUSION\u003c/p\u003e\n\u003cp\u003eThe WASH Coordination Mechanism is a structured approach for aligning the efforts of all relevant stakeholders, led by the Ministry of Health\u0026apos;s WASH Directorate. This mechanism is responsible for various coordination functions, including health needs assessments, strategic and action planning, implementation, monitoring and evaluation, advocacy, resource mobilization, knowledge sharing, policy dialogue, and information exchange.\u003c/p\u003e\n\u003cp\u003eTo ensure effective coordination, immediate corrective measures must address key challenges such as the multi-disciplinary and multi-sectoral nature of Health and Environmental Health (H\u0026amp;EH), existing coordination gaps, insufficient follow-up, and limited engagement from senior officials. Strengthening or establishing a new coordination office is essential to address sector-wide gaps, including weak WASH coordination, limited access to basic WASH facilities, and lagging progress toward WASH-related Sustainable Development Goals (SDGs).\u003c/p\u003e\n\u003cp\u003eThis assessment aimed to identify relevant coordination platforms, major interventions, and observed bottlenecks using pre-defined methodologies. The findings indicate that existing structures are performing relatively well, with coordination meeting minutes well-documented and action points consistently reviewed. However, challenges such as resource constraints, structural weaknesses, and accountability mechanisms persist.\u003c/p\u003e\n\u003cp\u003eAdditional challenges include the lack of a functional WASH Task Force (TF) structure with a dedicated focal person for coordination and resource mobilization, inconsistent member attendance, low engagement from signatory ministries, role conflicts with the Ministry of Water, Irrigation, and Energy (MoWE), and weak TF structures at regional and zonal levels.\u003c/p\u003e\n\u003cp\u003eDespite these challenges, opportunities exist, such as strong government commitment to the sector, supportive policies and strategies, green legacy initiatives, the presence of multiple sector stakeholders, and established coordination mechanisms at the Prime Minister\u0026rsquo;s Office for cross-sector interventions. Successful models like the One WASH National Program (OWNP) demonstrate effective coordination.\u003c/p\u003e\n\u003cp\u003eIn conclusion, leveraging the findings of this gap analysis, including observed strengths, sector opportunities, best practices, and corrective actions, should be a priority for the health sector, partners, and donors. Aligning with the proposed structure under the health sector\u0026rsquo;s mandate will enhance WASH implementation sustainability. The recommendations below outline short-, medium-, and long-term actions.\u003c/p\u003e\n\u003cp\u003eRECOMMENDATIONS\u003c/p\u003e\n\u003cp\u003eThe following recommendations are categorized into short, medium, and long-term actions to facilitate implementation:\u003c/p\u003e\n\u003cp\u003eShort-Term Recommendations\u003c/p\u003e\n\u003cul\u003e\n \u003cli\u003eDevelop a comprehensive Terms of Reference (TOR) for the WASH coordination platform to clarify terminology, accountability mechanisms, TF structures, and membership criteria. The TOR should be consistent, easily understandable, and incorporate key components (e.g., TF, Technical Working Groups, Steering Committees).\u003c/li\u003e\n \u003cli\u003eCascade, facilitate, and support the establishment of WASH Directorates with functional case teams in regional and city administration health bureaus. Currently, few regions have established WASH Directorates, while most operate with understaffed case teams and limited budgets. Regional Health Bureaus should adopt Memoranda of Understanding (MoUs) based on the national model.\u003c/li\u003e\n \u003cli\u003eConduct regular TF meetings at all levels, aligned with an annual action plan. Effective meeting facilitation, including timely invitations, agenda sharing, feedback collection, minute-taking, and action point follow-up, is critical. Assigning a dedicated focal person for WASH TF coordination, funded either by the Ministry of Health or partners, is essential.\u003c/li\u003e\n \u003cli\u003eStrengthen joint planning, monitoring, and implementation among WASH TF members. Sectoral plans should align, and a common Annual Work Plan should be endorsed at all levels.\u003c/li\u003e\n \u003cli\u003eThe WASH Directorate should advocate for the inclusion of WASH/health indicators in the Health Management Information System (HMIS) and link them to the National WASH MIS to track progress toward national targets accurately.\u003c/li\u003e\n \u003cli\u003eConduct regular stakeholder mapping to identify WASH-focused Civil Society Organizations (CSOs). Over 100 CSOs operate in the sector, making systematic engagement vital.\u003c/li\u003e\n\u003c/ul\u003e\n\u003cp\u003eMedium-Term Recommendations\u003c/p\u003e\n\u003cul\u003e\n \u003cli\u003eEstablish and strengthen WASH coordination systems at regional, zonal, and woreda levels, mirroring the national structure. Regular follow-up and supportive supervision are necessary, along with standardized guidelines (e.g., Standard Operating Procedures, MoUs, TORs).\u003c/li\u003e\n \u003cli\u003eCreate a dedicated WASH coordination office separate from the One WASH or Water Sector Working Group, with a full-time coordinator, budget, legal recognition, and specialized Technical Working Groups (TWGs). Define roles and linkages with other WASH forums (e.g., WASH Ethiopia Movement, academic institutions, professional associations).\u003c/li\u003e\n \u003cli\u003eEnhance high-level engagement beyond MoU signings. Advocate for stronger federal, regional, and zonal leadership through consultative meetings, evidence-based policy dialogues, and cross-country learning.\u003c/li\u003e\n \u003cli\u003eEnsure broad participation from partners, donors, the private sector, and civic associations. Conduct stakeholder mapping and communicate TF membership criteria to potential participants.\u003c/li\u003e\n \u003cli\u003eIntegrate WASH coordination plans into the Annual Work Plans of all MoU signatory ministries, supported by legal accountability frameworks.\u003c/li\u003e\n \u003cli\u003eCollaborate with the Ministries of Finance, Water, Irrigation \u0026amp; Energy, and Education to secure adequate resources, professionals, and clear targets for sanitation and hygiene within government plans.\u003c/li\u003e\n \u003cli\u003eStrengthen knowledge management through learning events, workshops, and multi-stakeholder forums to capture and disseminate best practices, research, and innovations.\u003c/li\u003e\n\u003c/ul\u003e\n\u003cp\u003eLong-Term Recommendations\u003c/p\u003e\n\u003cul\u003e\n \u003cli\u003eEstablish legal enforcement for WASH coordination to ensure accountability and prevent overlapping mandates. High-level discussions (e.g., at the Prime Minister\u0026rsquo;s Office) should resolve role conflicts, particularly between the Ministry of Health and MoWE.\u003c/li\u003e\n \u003cli\u003eConduct regular studies, document best practices, and strengthen monitoring, evaluation, and learning at national and regional levels.\u003c/li\u003e\n \u003cli\u003eAllocate dedicated budgets for TF activities, resource mobilization, and pooled funding for joint initiatives like capacity building and monitoring.\u003c/li\u003e\n \u003cli\u003eBuild stakeholder capacity to reduce turnover. Ministries and partners should assign permanent focal persons and institutionalize knowledge retention through systematic documentation.\u003c/li\u003e\n\u003c/ul\u003e"},{"header":"LIST OF ABBREVIATIONS","content":"\u003ctable border=\"0\" cellspacing=\"0\" cellpadding=\"0\" width=\"457\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 115px;\"\u003e\n \u003cp\u003eCCRDA\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 342px;\"\u003e\n \u003cp\u003eConsortium of Christian Relief and Development Associations\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 115px;\"\u003e\n \u003cp\u003eCLTS\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 342px;\"\u003e\n \u003cp\u003eCommunity-led Total Sanitation\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 115px;\"\u003e\n \u003cp\u003eCSO\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 342px;\"\u003e\n \u003cp\u003eCivil society organization CWA\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 115px;\"\u003e\n \u003cp\u003eGTP\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 342px;\"\u003e\n \u003cp\u003eGrowth and Transformation Plan\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 115px;\"\u003e\n \u003cp\u003eH\u0026amp;EH\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 342px;\"\u003e\n \u003cp\u003eHygiene and Environmental Health\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 115px;\"\u003e\n \u003cp\u003eHEP\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 342px;\"\u003e\n \u003cp\u003eHealth Extension program\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 115px;\"\u003e\n \u003cp\u003eHEW\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 342px;\"\u003e\n \u003cp\u003eHealth Extension Worker\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 115px;\"\u003e\n \u003cp\u003eHSDP\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 342px;\"\u003e\n \u003cp\u003eHealth Sector Development Plan\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 115px;\"\u003e\n \u003cp\u003eM\u0026amp;E\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 342px;\"\u003e\n \u003cp\u003eMonitoring and Evaluation\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 115px;\"\u003e\n \u003cp\u003eMOA\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 342px;\"\u003e\n \u003cp\u003eMinistry of Agriculture\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 115px;\"\u003e\n \u003cp\u003eMoE\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 342px;\"\u003e\n \u003cp\u003eMinistry of Education\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 457px;\"\u003e\n \u003cp\u003eMoEFCC \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; Ministry of Environment, Forest and Climate Change\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 115px;\"\u003e\n \u003cp\u003eMound\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 342px;\"\u003e\n \u003cp\u003eMinistry of Housing \u0026amp; Urban Development\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 115px;\"\u003e\n \u003cp\u003eMoH\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 342px;\"\u003e\n \u003cp\u003eMinistry of Health\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 115px;\"\u003e\n \u003cp\u003eMOU\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 342px;\"\u003e\n \u003cp\u003eMemorandum of Understanding\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 115px;\"\u003e\n \u003cp\u003eMoWIE\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 342px;\"\u003e\n \u003cp\u003eMinistry of Water, Irrigation, and Energy\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 115px;\"\u003e\n \u003cp\u003eMSP \u0026nbsp;\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 342px;\"\u003e\n \u003cp\u003eMarketing Multi-Stakeholder Platform\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 115px;\"\u003e\n \u003cp\u003eNGO\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 342px;\"\u003e\n \u003cp\u003eNon-governmental organization\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 115px;\"\u003e\n \u003cp\u003eNWCO\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 342px;\"\u003e\n \u003cp\u003eNational WASH Coordinating Office\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 115px;\"\u003e\n \u003cp\u003eNWSC\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 342px;\"\u003e\n \u003cp\u003eNational WASH Steering Committee\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 115px;\"\u003e\n \u003cp\u003eODF\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 342px;\"\u003e\n \u003cp\u003eOpen Defecation Free\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 115px;\"\u003e\n \u003cp\u003eOWNP\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 342px;\"\u003e\n \u003cp\u003eOne WASH National Program\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 115px;\"\u003e\n \u003cp\u003ePH\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 342px;\"\u003e\n \u003cp\u003ePrimary Health\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 115px;\"\u003e\n \u003cp\u003eSM\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 342px;\"\u003e\n \u003cp\u003eSanitation Marketing\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 115px;\"\u003e\n \u003cp\u003eSNNPR\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 342px;\"\u003e\n \u003cp\u003eSouthern Nations and Nationalities\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 115px;\"\u003e\n \u003cp\u003eSWAP\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 342px;\"\u003e\n \u003cp\u003eSector-wide approach \u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 115px;\"\u003e\n \u003cp\u003eWASH\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 342px;\"\u003e\n \u003cp\u003eWater, sanitation, and hygiene\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 115px;\"\u003e\n \u003cp\u003eWRM\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 342px;\"\u003e\n \u003cp\u003eWater Resource Management\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 115px;\"\u003e\n \u003cp\u003eWSF\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 342px;\"\u003e\n \u003cp\u003eWater and Sanitation Forum\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 115px;\"\u003e\n \u003cp\u003eWSWG\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 342px;\"\u003e\n \u003cp\u003eWater Sector Working Group\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e"},{"header":"Declarations","content":"\u003cp\u003eCOMPETING INTERESTS: The authors declare no competing interests.\u003c/p\u003e\n\u003cp\u003eAUTHOR\u0026rsquo;S CONTRIBUTIONS:\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eAM:\u0026nbsp;developed the research proposal, collected data, coordinated the research field work, conducted the data analysis, developed the results and reports, and developed the manuscript and reports.\u003c/p\u003e\n\u003cp\u003eACKNOWLEDGMENTS:\u0026nbsp;First and foremost, I would like to express my sincere gratitude to the Ministry of Health for their unwavering support and commitment throughout the assessment process. I also extend our appreciation to key WASH and health development partners, including the federal and regional ministries of Health and Water, Irrigation, and Energy. Additionally, we thank professional associations, task force focal persons, and all individuals who contributed directly or indirectly to this study. Their willingness to participate and provide honest responses was invaluable to the success of this assessment. I am profoundly thankful to my beloved family, whose unwavering support, encouragement, and prayers have been my greatest source of strength. Your love and patience have sustained me through the challenges and long hours of this research.\u003c/p\u003e\n\u003cp\u003eFUNDING:\u0026nbsp;The principal investigator funded the study\u003c/p\u003e\n\u003cp\u003eCONSENT FOR PUBLICATION:\u0026nbsp;Not Applicable\u003c/p\u003e\n\u003cp\u003eAVAILABILITY OF DATA AND MATERIALS:\u0026nbsp;The datasets used and/or analyzed during the current study are available from the corresponding author upon reasonable request.\u003c/p\u003e\n\u003cp\u003eETHICS APPROVAL AND CONSENT TO PARTICIPATE: The study was approved by the ethics committee of the Ministry of Health WASH department. In compliance with the Helsinki Declaration, this study does not contain any person\u0026rsquo;s data in any form (including individual details, images, or videos. Informed oral consent of participants was requested before starting interviews and discussions by explaining the objective and how the results would be used. All interviews that were conducted with vulnerable populations were conducted with, and privacy, confidentiality, and anonymity will be maintained.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n\u003cli\u003eKumie A, Ali A. An overview of environmental health status in Ethiopia with particular emphasis on its organization, drinking water, and sanitation : A literature survey. \u003c/li\u003e\n\u003cli\u003eMinistry of Water, Irrigation and Energy Terms of Reference for the Establishment of The Water Sector Working Group ( WSWG ) And its Secretariat\u003c/li\u003e\n\u003cli\u003eKumie A, Ali A. An overview of environmental health status in Ethiopia with particular emphasis on its organization, drinking water, and sanitation : A literature survey. \u003c/li\u003e\n\u003cli\u003eUnited Nations. (2015). Transforming Our World: The 2030 Agenda for Sustainable Development.\u003c/li\u003e\n\u003cli\u003eWorld Health Organization (WHO) \u0026amp; UNICEF. (2020). Joint Monitoring Programme for Water Supply, Sanitation, and Hygiene (JMP).\u003c/li\u003e\n\u003cli\u003eFMoH (2021). National WASH Strategy and Integrated Urban Sanitation and Hygiene Strategy. Ethiopia.\u003c/li\u003e\n\u003cli\u003eMinistry of Water, Irrigation and Energy Terms of Reference for the Establishment of The Water Sector Working Group ( WSWG ) And its Secretariat\u003c/li\u003e\n\u003cli\u003eWASH sector report on CSOs\u0026rsquo; contributions in. 2018\u003c/li\u003e\n\u003cli\u003eAs the health system is decentralized, regional, zonal, or Woreda WASH coordination office, and the Coordination structure is similar to the national structure, only the scope and contents may differ. \u003c/li\u003e\n\u003c/ol\u003e\n"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":true,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":true,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"","lastPublishedDoi":"10.21203/rs.3.rs-7310562/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-7310562/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cstrong\u003eBackground: \u003c/strong\u003eIn Ethiopia, WASH services have a documented history spanning more than six decades, dating back to the establishment of Gondar Public Health College in 1954, which served as the springboard for the commencement of training and the activation of sanitation services. The regulatory function in sanitation was developed in the 1950s, with subsequent rearrangements in the 1970s. WASH concerns have been categorically outlined in the country’s constitution - Article 44: all Persons have the right to have a clean and healthy environment; Article 90: the right to access to Public Health. Following the constitution, Policies, Strategies, frameworks, proclamations, and guidelines associated with EH have been launched and implemented in the last decades. Despite successful implementations, WASH indicators still have the lowest so far compared to required service standards due to various socio-economic factors and weak implementation practices and processes that are detached from policies\u003csup\u003e1\u003c/sup\u003e. Currently, the WASH program is implemented and coordinated by the MOH, from which the WASH directorate originates and is mandated Diseases Prevention and Control Program wing among four additional directorates (MCH, DPC, Health Extension and Health Education, and Health System Special Support directorates). Despite progress, existing coordination structures continue to face challenges in implementing WASH programs. Identifying the most relevant platforms, diagnosing blockages, and ensuring alignment with coordination structures.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eObjective: \u003c/strong\u003eThe primary objective of this analysis was to assess existing platforms relevant to WASH coordination, identify blockages within the current sector coordination platforms, examine major interventions, analyze the persistent challenges affecting coordination task forces and platforms, and provide actionable recommendations.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eMethods: \u003c/strong\u003eThe study employed a qualitative cross-sectional design, utilizing both primary and secondary data sources with a focus on qualitative data collection methods. The primary target groups for the assessment were key stakeholders in the Water, Sanitation, and Hygiene (WASH) sector. The study used purposive sampling based on their level of engagement and roles within WASH platforms. Data collection was conducted using qualitative methods.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eResults: \u003c/strong\u003eTo implement national GTPs and MDGs/SDGs in alignment with the country’s policies and strategies, various coordination mechanisms exist in the WASH Sectors, including the Water Sector Working Group (WSWG) structure, and the Hygiene and Environmental Health Steering/Technical Committee (SC/TC\u003csup\u003e2\u003c/sup\u003e). Another key mechanism is the National WASH Steering and Technical Committees, previously known as the WASH Taskforce, established in April 2016 under the leadership of the MoH with a signed Memorandum of Understanding (MoU) and Terms of Reference (ToR). The Water and Sanitation Forum (WSF) was established and organized by the Consortium of Christian Relief and Development Associations (CCRDA) to coordinate efforts, address common challenges in the WASH enabling environment, exchange innovative sector ideas, and periodically organize learning events to assess the contributions of civil society organizations (CSOs) to the WASH sector.\u003c/p\u003e","manuscriptTitle":"From Fragmentation to Synergy: Evaluating Water, Sanitation and Hygiene (Wash) Sector Coordination in Ethiopia","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-09-03 23:58:36","doi":"10.21203/rs.3.rs-7310562/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"a8069c09-a16c-4e31-9bea-69c13ba25c85","owner":[],"postedDate":"September 3rd, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[],"tags":[],"updatedAt":"2026-04-06T21:54:05+00:00","versionOfRecord":[],"versionCreatedAt":"2025-09-03 23:58:36","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-7310562","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-7310562","identity":"rs-7310562","version":["v1"]},"buildId":"XKTyCvWXoU3ODBz1xrDgd","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}