J.15 - Mozambique WASH Project Appraisal Document.pdf

MOZAMBIQUE WATER, SANITATION AND HYGIENE (M-WASH)

PROJECT APPRAISAL DOCUMENT (PAD)

(2019-2024)

Women and children pose for photographs while walking down a road in Nampula, Mozambique.

Photo Credit: Kate Holt/MCSP and Jhpiego

~T~~t~ MOZAMBIQUE

TABLE OF CONTENTS

I. INTRODUCTION

II. CONTEXT OF THE DEVELOPMENT CHALLENGE

A. Stakeholder Analysis

III. RELATIONSHIP WITH THE MISSION STRATEGY

IV. PROJECT DESCRIPTION

A. Project Purpose and Theory of Change Intermediate Result (IR) 1: WASH sector governance strengthened

IR 2: Expanded availability of water and sanitation services

IR 3: Adoption of key WASH behaviors accelerated

B. Critical Assumptions and Risks C. Guiding Principles D. Geographic Focus

V. OTHER LEVERAGED RESOURCES

VI. SUMMARY FROM CONCLUSIONS OF ANALYSES

A. Environmental B. Gender C. Climate Risk D. Water and Sanitation Market Systems

VII. PROJECT MANAGEMENT AND IMPLEMENTATION PLAN

A. Activity Plan B. Project Management

VIII. MONITORING, EVALUATION AND LEARNING

IX. FINANCIAL PLAN

X. ANNEXES

Annex 1: Project Logic Model & Results Framework Annex 2: Project Logical and Indicator Framework Annex 3: Gender Analysis Annex 4: Climate Risk Management Screening Matrix Annex 5: Water and Sanitation Market System Maps Annex 6: Findings of World Bank WASH Poverty Diagnostic (2017) Annex 7: UN Sustainable Development Goal #6: Water and Sanitation for All

ACRONYMS AND ABBREVIATIONS

ADS USAID’s Operational Policy AFORAMO Association of Water Providers of Mozambique AIAS Administration for Water and Sanitation Infrastructure ARA Regional Water Administration CFPAS Training Center for Water and Sanitation CIL USAID’s Climate Integration Lead CLTS Community Led Total Sanitation CRA Water Regulatory Council DA Development Assistance DCAR Delegated Cooperation Agreement DAS Water and Sanitation Department (in municipal and provincial government) DfID UK Department for International Development (UKAID) DHS Demographic and Health Survey DNAAS National Directorate for Water Supply and Sanitation of MOPHRH DNGRH National Directorate of Water and Resources Management FIPAG Water Supply Investment and Asset Fund FSM Fecal Sludge Management GDA Global Development Alliance (a USAID public-private-partnership agreement) GDP Gross Domestic Product GRM Government of the Republic of Mozambique IEE Initial Environmental Examination IR Intermediate Result JMP Joint Management Plan (of WHO and UNICEF) M&E Monitoring & Evaluation MCC Millennium Challenge Corporation MCSP USAID’s Maternal and Child Survival Program MEL Monitoring, Evaluation & Learning MISAU Ministry of Health MOPHRH Ministry of Public Works, Housing and Water Resources MZN Mozambique Metical (currency) NGO Non-Government Organization ODF Open Defecation Free O&M Operations and Maintenance PAD Project Appraisal Document PRONASAR National Rural Water Supply and Sanitation Program PWP Private Water Providers (FPA in Portuguese) SDG Sustainable Development Goal SINAS National Information System for Water and Sanitation SNV Netherlands Development Organization SPEED+ USAID’s Supporting the Policy Environment for Economic Development Program SUWASA USAID’s Sustainable Water and Sanitation in Africa Program UNICEF United Nations International Children’s Relief Fund USAID United States Agency for International Development WASH Water, Sanitation and Hygiene

I. INTRODUCTION

With a population of 28 million people, Mozambique ranks 180th out of 188 countries on the United Nations Development Program 2017 Human Development Index (HDI). It has one of the highest under-five mortality rates in the world (71 per 1,000 live births), 16 percent of which can be attributed to inadequate water and sanitation and poor hygiene practices.1 According to UNICEF2 and USAID3, 43 percent of children under 5 years of age are stunted, but regional variations persist, with the highest rates of stunting in Nampula (55 percent) and Cabo Delgado (52 percent) provinces, and the lowest rates in Maputo Province and Maputo City (23 percent each). Sixty percent of the country’s population lives in low-lying coastal areas, vulnerable to floods and associated water borne diseases. Due to critically low rates of access to basic water, sanitation and hygiene (WASH) needs, Mozambique ranks 12th out of 193 countries (with 1 indicating highest need) on the USAID WASH Needs Index4. Within Southern Africa, only Madagascar ranks higher (11th).

Historically, USAID investments in the WASH sector in Mozambique have been relatively small in scale, dispersed across various integrated-health mechanisms, and primarily focused on community-based and health facility outcomes. These programs included:

● USAID’s Strengthening Communities through Integrated Programming (2009-2014), which focused on integrated health and livelihoods of women, children and families in 32 districts of Nampula and Zambezia provinces, with WASH in some of these districts;

● USAID/Mozambique’s Maternal and Child Survival Program (MCSP) (2015-2019), which includes nutrition, malaria, family planning, reproductive health, and WASH focused on increasing demand for community and household products and promoting key hygiene practices; and,

● USAID’s Sustainable Water and Sanitation in Africa (SUWASA) technical support program (2011- 2015) and Supporting the Policy Environment For Economic Development (SPEED+) activity (2016-2020), which have supported water sector policy implementation to strengthen the role of private water providers (PWPs) in peri-urban areas.

Since 2009, Congressional appropriations have included a global directive for WASH activities and a sub-directive for Sub-Saharan Africa. Water Directive funds provided to USAID/Mozambique have been steadily increasing from $4 million in FY2016, to $9 million in FY2017 and $7.5 million in FY2018. In light of the country’s needs and increasing levels of WASH funding for Mozambique, this Project Appraisal Document (PAD) was created to develop a more strategic approach for USAID investments in the WASH sector. This Mozambique Water, Sanitation and Hygiene (M-WASH) Project (2019-2024) represents the Mission-level approving document for approximately $55 million of Water Directive funds. The estimated value of other leveraged resources from other development partners is $70 million over the life of the project.

1 UNICEF, WHO, World Bank, UN-DESA Population, 2015. Levels and Trends in Child Mortality 2015 Report.

2 UNICEF 2017. Reducing Stunting in Children Under Five Years of Age: A comprehensive evaluation of UNICEF’s Strategies and Program Performance, Republic of Mozambique country Case Study.

3 USAID 2018. Mozambique Nutrition Profile. March 2018. https://www.usaid.gov/sites/default/files/documents/1864/Mozambique-Nutrition- Profile-Mar2018-508.pdf.

4 WASH Needs Index. Need is defined by a drinking water, sanitation, and hygiene needs index. The index is calculated using publicly available, country-level statistics on drinking water and sanitation access rates and the causes of childhood mortality. Basic and safely managed drinking water access, basic sanitation access, and open defecation rates are drawn from the World Health Organization and the United Nations International Children’s Emergency Fund’s Joint Monitoring Program database (http://washdata.org). Estimates of the number and proportion of under-five mortality due to diarrheal disease are drawn from the WHO database on the causes of childhood mortality http://www.who.int/healthinfo/global_burden_disease/estimates/en/index3.html.

https://www.usaid.gov/sites/default/files/documents/1864/Mozambique-Nutrition-Profile-Mar2018-508.pdf https://www.usaid.gov/sites/default/files/documents/1864/Mozambique-Nutrition-Profile-Mar2018-508.pdf http://www.who.int/healthinfo/global_burden_disease/estimates/en/index3.html

II. CONTEXT OF THE DEVELOPMENT CHALLENGE

Over the past decade, Mozambique’s economy has expanded at a rapid rate, as evidenced by its gross domestic product (GDP) growing between 5 and 7 percent per year. However, economic growth has not been distributed evenly; almost half of the country’s population still lives in poverty. While poverty exists throughout the country, it is most concentrated in two provinces, Nampula and Zambezia, where 48 percent of the 11.2 million poor Mozambicans live.5

In 2015, 47 percent of the Mozambican population had access to basic water services, 24 percent had access to basic sanitation facilities, and only 12 percent had soap and water available on their residences. In rural areas, these rates drop to 32 percent for access to basic water services, 10 percent for improved sanitation facilities, and 8 percent of households had soap and water on their premises.6,7

The gap in access to basic WASH infrastructure is most acute in the north and center of Mozambique, where poverty and population density is higher than in the south. The national rate (2015) of open defecation in rural areas is 47 percent; however in Zambezia, it is 72 percent8.

Mozambique’s steady economic growth has also been coupled with population growth and rapid urbanization. From 1990 to 2015, the population more than doubled, from 13.6 million to 27.1 million, while the number of people living in urban areas tripled. Urban development has not been able to keep up with the growing population, putting pressure on cities and small towns to provide water and sanitation services. For example, the capital of Cabo Delgado Province, Pemba, is capable of providing water for only six hours per day; and the capital of Niassa Province, Lichinga, is capable of providing water for eight hours per day. In Maputo, the capital city, water provision in some areas has been cut to less than 5 hours per day.

With support from development partners and non-governmental organizations (NGOs), the Government of the Republic of Mozambique (GRM) has been making substantial investments, particularly in expanding both production and distribution of water supply in both rural and urban areas. In the late 1990s, the GRM embarked on a sector reform process in urban areas, with the implementation of the Delegated Management Framework, which enabled the transfer of operational responsibilities for water supply to professional service providers, and created new sector institutions, including the National Directorate of Water Supply and Sanitation/Direcção Nacional do Abastecimento de Água e Saneamento (DNAAS). In 2010, the National Rural Water Supply and Sanitation Program (PRONASAR) was developed as the main implementation modality for the GRM and has since been jointly implemented by various partners (government, NGOs, international agencies, etc.).

Mozambique ’s newly revised Constitution provides opportunities for advancing decentralization of planning, investment and management of government services, including water and sanitation services, to provinces and districts. The GRM and development partners have committed to support the decentralization process, which in the water and sanitation sector is led by DNAAS.

5 World Bank. 2018. Findings of the Mozambique Water Supply, Sanitation, and Hygiene Poverty Diagnostic. WASH Poverty Diagnostic. World Bank, Washington, DC.

6 WHO/UNICEF JMP 2015. https://washdata.org/data.

7 Basic water service is defined as drinking water from an improved source provided that the collection time is not more than 30 minutes for a roundtrip, including queuing. A basic sanitation service is defined as the use of improved facilities that are not shared with other households.

8 WHO/UNICEF JMP 2015. https://washdata.org/data.

https://washdata.org/data https://washdata.org/data

The GRM Five-Year Plan (2015-2019), which lacks a detailed investment plan, includes the following WASH and water resources management goals:

● Increase access to basic water services to 75 percent coverage in rural areas and 90 percent in urban areas;

● Increase access to basic sanitation services to 50 percent coverage in rural areas and 80 percent in urban areas;

● Build and expand the capacity of irrigation and water storage infrastructure; and

● Ensure the integrated management of water resources and international river basins.

Beyond increasing access to WASH, the GRM faces significant challenges in meeting its sustainable development goals (SDGs). These challenges include:

● Weak governance and institutional capacities. The Ministry of Public Works, Housing and Water Resources (MOPHRH), through DNAAS, has overall responsibility for water management.

Policies and institutional arrangements exist for the water sector, but implementation remains weak. The evolving and still uncertain legal and regulatory framework weakens transparency and predictability of market signals from government to private investors—individuals and companies—in the water sector, which increases investment and business risks.9 In the sanitation sector, there is a lack of clear policies and strategies and insufficient political will to strengthen weak service delivery institutions.

● Sector financing gaps, particularly for rural sanitation. The GRM estimates that approximately $4.16 billion in WASH sector financing (75 percent water and 25 percent sanitation is needed to achieve universal access by 203010. The GRM plans to invest $80 million in water and water resource management in 2019 to meet the targets set in the GRM Five-Year Plan 2015-2019. At these rates, the annual investment needs for the sector will reach less than a quarter of the goal. About 75 percent of these funds are allocated to urban areas while 25 percent to rural areas. In the last seven years, on average about 80 percent of the funding for the WASH sector came from external resources.

● Low sustainability of WASH service delivery. Approximately 30 percent of water points are non-functional at any time. Communities are left to maintain water points after they are constructed because District Water Offices do not conduct routine monitoring and maintenance. The challenge to maintain water points increases in remote areas with low population density.

● Poor nutritional status compounded by weak health infrastructure. Currently, there are only 1,300 health facilities in the country, many of which are in a poor state of repair and lack essential services such as water, functioning sanitation and waste disposal systems, and electricity. Malnutrition and stunting rates are increased due to deficiencies in basic water and sanitation services. Chronic malnutrition (stunting or low height-for-age) affects more than two million children under the age of five (43 percent)11.

A. Stakeholder Analysis

9 USAID. 2018. Rapid Water and Sanitation Market Assessment. USAID/Mozambique SPEED+ Activity.

https://pdf.usaid.gov/pdf_docs/PA00TMHV.pdf.

10 Club of Mozambique. “Four billion dollars needed for water and sanitation – Government.” 10 Feb 2017.

https://clubofmozambique.com/news/four-billion-dollars-needed-water-sanitation-government/ 11 USAID 2018. Mozambique Nutrition Profile. March 2018. https://www.usaid.gov/sites/default/files/documents/1864/Mozambique-Nutrition- Profile-Mar2018-508.pdf.

https://pdf.usaid.gov/pdf_docs/PA00TMHV.pdf https://clubofmozambique.com/news/four-billion-dollars-needed-water-sanitation-government/

The PAD’s stakeholder analysis included consultations with over 100 WASH stakeholders in 2018 and USAID’s Rapid Water and Sanitation Market Assessment. The stakeholder analysis details the key actors within the government, development partners, and service providers, and the relationships between these parties. The dynamics of the relationships among these stakeholders will be further explored during Activity Design in order to better understand, influence and monitor systems-level changes in the WASH sector.

The ecosystem of water and sanitation services in Mozambique is diverse, fragmented and comprises:

• Government;

• Other Donors;

• Civil Society (international and local organizations); and

• Private Sector.

Government - Policy and Regulatory Bodies The GRM has various government institutions responsible for the policy, regulation, and provision of water and sanitation services in rural, urban, small-town, and peri-urban areas. See USAID Rapid Market Assessment12 for further details.

• DNAAS, within MOPHRH, is responsible for policy development, management, strategies and investment mobilization for water supply and sanitation in rural and urban areas. DNAAS leads the implementation the National Program for Water and Sanitation in Rural Areas (PRONASAR).

With USAID support, DNAAS led the development of Decree 51/2015 that legitimized the role of PWPs under five-year licenses.

• Water Regulatory Council/Conselho de Regulação do Abastecimento de Água (CRA): CRA was created as an autonomous entity to reconcile the interests of users and their public and private water supply providers. CRA also works to ensure a balance between the quality of service, the interests of users, and economic sustainability (including adjustment of tariffs). CRA sets the tariffs for both public and privately operating water systems and regulates sanitation treatment and disposal. All water tariffs must be approved by the relevant municipal council. The involvement of municipal councils in tariff approvals potentially introduces political influence onto CRA’s ability to function as an independent regulator and set tariffs that enable water system operators to recoup operating costs and depreciation while protecting customers from exorbitant charges. CRA also has a regulatory enforcement mandate, but lacks the resources to conduct and process water testing kits.

• Regional Waters Administration (ARA) is tasked with regulating the use of surface and ground water resources by authorizing and registering well development and collecting fees for water abstracted by both public and private water service providers. ARA has five regional offices (South, Central, Center-North, Zambezi, and North).

• Municipal/District Governments play an increasingly more important role in rural water and sanitation sector as PRONASAR incorporates more decentralized planning and investment systems and international partners strengthen the capacity of local institutions to implement and monitor these investments. Within the context of privatized water provision as promulgated in Decree 51/2015, a Water and Sanitation Representative under local authorities, municipal councils and district governments are charged with the provision of licenses to all

12 USAID. 2018. Rapid Water and Sanitation Market Assessment. USAID/Mozambique SPEED+ Activity.

PWPs—although many municipalities collect an annual business fee from PWPs in lieu of managing a formal licensing system.

• Ministry of Health/Ministério da Saúde (MISAU): Hygiene and sanitation activities are included in MISAU’s responsibilities. The ministry also responds to the health effects of emergencies such as floods. At the sub-national level, a Provincial Health Directorate organizes and coordinates health and WASH activities for each province, and leads the various District Services for Health, Women and Social Action.

Government - Water Service Providers

• National Directorate of Water and Resources Management/Direcção Nacional de Gestão Recursos Hídricos (DNGRH), within MOPHRH, is responsible for developing policies and strategies related to the conservation, use, and exploitation of water resources and river basins, including state management for drought and flood planning and mitigation.

• Water Supply Investment Assets Fund/Fundo de Investimento e Património do Abastecimento de Água (FIPAG) manages public investment and maintenance of the urban water supply networks in 21 cities across Mozambique through 15 regional offices13. FIPAG directly manages 15 city water systems and has delegated the management of another six urban water systems to a private operator. FIPAG also manages one small town system in Ilha de Moçambique.

• Water and Sanitation Infrastructure Administration/Administração de Infra-Estruturas de Água e Saneamento (AIAS): AIAS was established as an autonomous public entity to manage water supply and sanitation systems in 130 small cities and towns outside of FIPAG’s scope. AIAS has constructed water systems in five secondary cities and 126 towns14.

Development Partners

• The World Bank is the largest development partner in the WASH sector, with approximately $300 million in water sector investments focused on urban water in three projects: Greater Maputo Water Supply Project (2013-2019); Water Services and Institutional Support II Project (2016-2022); and Integrated Growth Poles (2013-2019), the latter of which only a portion is water-related. The World Bank is presently preparing a large project to focus on urban sanitation in select large cities. One of the newer financing modalities that the World Bank has been using is results-based financing known as Program-for-Results, which the health and nutrition sector is adopting.

• The United Kingdom Department for International Development (DfID) has made significant investments in WASH in Mozambique. DfID’s direct financial support to PRONASAR includes £30 million for infrastructure and £8 million for capacity building. While DfID prioritizes support to Nampula and Zambezia provinces, it also plans to work in other provinces given the absorption capacity challenges in Nampula and Zambezia. Similar to the World Bank, DfID has adopted a results-based financing approach; lessons from this effort will be used to inform future investments in the sector and will be incorporated into the design of the PRONASAR Joint Fund.

Under this Project, USAID will support the PRONASAR Joint Fund via DfID (see Section VI). DfID provides technical support in select districts/provinces (Nampula and Zambézia) to build local and decentralized capacity and address institutional barriers related to results-based performance indicators.

13 USAID. 2018. Rapid Water and Sanitation Market Assessment. USAID/Mozambique SPEED+ Activity.

14 USAID. 2018. Rapid Water and Sanitation Market Assessment. USAID/Mozambique SPEED+ Activity.

https://pdf.usaid.gov/pdf_docs/PA00TMHV.pdf.

http://projects.worldbank.org/P125120/greater-maputo-water-supply-expansion-project?lang=en http://projects.worldbank.org/P125120/greater-maputo-water-supply-expansion-project?lang=en http://projects.worldbank.org/P149377?lang=en http://projects.worldbank.org/P149377?lang=en http://projects.worldbank.org/P127303/mozambique-integrated-growth-poles-project?lang=en

• The United Nations International Children’s Emergency Fund (UNICEF) invests approximately $23 million annually in WASH programs in rural areas, small towns and institutions (schools and health care facilities), and emergency/disaster response contexts. UNICEF Mozambique has an integrated WASH and nutrition program in Nampula and Zambezia. UNICEF is also developing a concept to establish a financing facility to expand water supply services into 20-30 towns. To improve this concept and attract private and public international investment into the sector, USAID’s WASH Finance activity will offer technical assistance to UNICEF. UNICEF also supports sanitation in targeted towns.

• The Royal Government of the Netherlands primarily supports the urban water sector in large and secondary cities, with a focus on utility strengthening and reform. Dutch-funded programs provide technical support to 16 small or secondary cities across the country. Layering with Dutch-funded technical assistance, USAID’s WASH Finance activity will test and scale innovative models for financing for AIAS public-private partnership service delivery models.

• The Government of Austria and Government of Switzerland, both members of the PRONASAR Common Fund, have actively supported the development of the PRONASAR Joint Fund.

Switzerland funds WaterAid activities in Niassa Province and has committed an additional $2.48 million per year to PRONASAR; Austria has committed $0.56 million per year to PRONASAR.

Civil Society

• Non-governmental organizations (CARE, Helvetas, SNV, WaterAID, World Vision, etc.)

implement rural WASH programs. SNV, in particular, has been playing a capacity building role under the DFID-funded PRONASAR program, both at the central (Maputo) and decentralized levels in Zambezia and Nampula. Helvetas has also been working on governance at the provincial and district levels as well as promoting mini-and small piped systems in rural growth centers using innovative technologies and management models.

• The National Stakeholder Group for Water Supply, Hygiene and Sanitation is a coordination and knowledge sharing platform that meets monthly. Co-chaired by DNAAS and UNICEF, it includes government institutions, donors, NGOs, and other relevant stakeholders.

• The WASH Donor Coordination Group, chaired by DNAAS, DFID, and UNICEF, is a group of development partners that meets quarterly. Another donor group, chaired by the Dutch, focuses on water resource management and convenes at the same time.

Private Sector Both FIPAG and AIAS have struggled to meet demand growth, maintain the delivery of existing services, and recover operating costs. As a result, there is a growing gap between demand and public water service provision that is being filled by local governments NGOs and by PWPs, particularly in the Greater Maputo Area. Where piped-water solutions and rent-seeking consumers are present, PWPs provide a viable option for scaling water and sanitation services to underserved communities in urban, peri-urban and small-town areas.

• Private Water Providers (PWPs)/Fornecedores Privados de Agua (FPAs), which in 2018 numbered 1,800, supply an estimated 1.8 million people. With $40 million of investments, PWPs own assets and infrastructure that effectively deliver piped water to an estimated 23 percent of peri-urban populations in Mozambique, with most coverage concentrated in the Greater Maputo Area. Despite their success and rapid expansion of coverage, PWPs are largely unlicensed, pay no abstraction fees, and their reliance on groundwater resources poses risks for resource sustainability.

• Private Water Operators (AIAS secondary systems and small/mini rural piped systems):

Fourteen private companies and individuals manage 26 rehabilitated water supply systems in secondary cities/small towns. The number of small and mini rural piped system operators is currently unknown how many exist.

• Fecal Sludge Managers: Less than 12 micro/small enterprises provide fecal sludge removal services in the Maputo area.

III. RELATIONSHIP WITH THE MISSION STRATEGY

M-WASH represents the first USAID/Mozambique project to focus solely on the WASH sector, which is important to other development sectors such as economic growth, health, education, energy, and natural resources management. The M-WASH project results framework is illustrated in Figure 1.

Figure 1: M-WASH Project Purpose and Intermediate Results

The goal of the M-WASH project—“Improved well-being of communities, especially women and girls”— is most closely linked to Development Objective (DO) 4 —health status of target populations improved—within USAID Mozambique’s Country Development Cooperation Strategy (CDCS). In addition to DO4, the M-WASH Project IRs will support other DOs within the CDCS as illustrated in Figure 2 below:

● IR-1 focuses on strengthening WASH sector governance and is linked to DO1, DO2, and DO4;

● IR-2 targets the expansion of water and sanitation services and is linked to DO2 and DO4;

● IR-3 focuses on increasing the adoption of key WASH behaviors and is linked to DO3 and DO4.

Figure 2: Linkages of M-WASH Intermediate Results to CDCS Intermediate Results

USAID/Mozambique plans to develop a new CDCS in 2019-2020 into which WASH programs will be fully integrated and explicitly described.

IV. PROJECT DESCRIPTION

A. Project Purpose and Theory of Change

Despite high rates of economic growth, Mozambique continues to lag behind in access to water and sanitation services due to weak governance and institutional capacity, insufficient public sector investments, inadequate operations and maintenance of water schemes, and poor hygiene practices.

The purpose of the M-WASH project is “Increased use and sustainable management of water and sanitation services.” Achievement of this purpose will contribute to the overall goal of improving the well-being of target communities, especially women and girls. “Well-being” is a broad concept, but for the purposes of the M-WASH project will be measured through the reduction of daily time spent on water collection and the reduction of the incidence of diarrhea in children under five. Although M-WASH activities are not expected to achieve these high-level results on their own, the project activities, in concert with other USAID programs, GRM-led initiatives, and other donors’ programs, will contribute to results in these areas.

To achieve this purpose, the Project will focus on three components (also referred to as Intermediate Results or IRs). The first component will strengthen WASH sector governance through participatory dialogue with GRM counterparts coupled with a focus on capacity building to strengthen local systems.

The second component will expand availability of water and sanitation services by catalyzing domestic private sector resources to complement public sector investments. The final component will accelerate adoption of key WASH behaviors that not only lead to improved health outcomes, but also address sustainability by ensuring that investments in physical infrastructure are used and maintained.

Underlying all three project components is an intentional focus on increasing women’s empowerment, defined as women’s leadership, decision-making, and active participation in all aspects of the WASH sector. All activity designs under the M-WASH PAD will include a Gender Action Plan to increase gender equality and women’s empowerment outcomes in the WASH sector.

Figure 3: M-WASH Project Results Framework

Goal-level indicators include:

• Percentage of children who had diarrhea in the preceding 24 hours, disaggregated by age and gender (DHS Indicator)

• Estimated number of hours spent per week on water collection, disaggregated by age and gender

Purpose-level indicators include:

• Child Health Indicator: Average of the three proximity-to-target scores for access to adequate sanitation, access to improved water, and child mortality (USAID Self Reliance Indicator)

• Percent of households in target areas with access to safely managed drinking water

• Percent of households in target areas with access to basic sanitation

Intermediate Result (IR) 1: WASH sector governance strengthened

Water and sanitation policies and strategies exist in Mozambique, however the legal framework can be strengthened by addressing the needs of various government and non-governmental stakeholders (e.g., addressing barriers that restrict the private sector from providing water and sanitation in underserved areas). Moreover, weak institutions at both the central and decentralized levels continue to be a formidable barrier to achieving the SDGs15 (see Annex 6: SDG #6 Water for All). Strong institutions are important to aligning incentives and promoting a favorable environment for both public and private organizations to help deliver, directly or indirectly, better WASH services.

WASH sector governance refers to the institutional capacities and capabilities to develop and implement sector policies, regulations, investment planning, management and monitoring of WASH sector actions.

Strengthening WASH sector governance will increase equity and inclusion—address rural versus urban disparities as well as wealth and gender inequalities—and ensure sustainability of WASH investments by attracting additional public funds and private finance to close the significant financing gaps.

To strengthen WASH governance, USAID will support government and non-governmental water and sanitation providers to improve the policy and regulatory frameworks, strengthen institutional capacity at national and sub-national levels, and improve the investment and business climate to attract private sector investment towards achieving universal access and sustainable service delivery.

IR 1 expected results:

● Improved capacity of national, provincial, and district-level government staff to plan, budget, and monitor progress in WASH service provision

● Improved monitoring of water and sanitation infrastructure in all provinces and particularly rural districts

● Increased budget allocations for operations and maintenance of water infrastructure at district levels in select provinces (i.e., fewer out-of-service water points)

IR 1 outcome-level indicators:

● HL.8.4-1: Value of new funding mobilized to the water and sanitation sectors as a result of USG assistance

● Government of Mozambique financial resources allocated to WASH on an annual basis

● HL.8.3-3: Number of water and sanitation sector institutions strengthened to manage water resources or improve water supply and sanitation services as a result of USG assistance

Sub-IR 1.1: Policies and regulations improved Within the water supply sector, the evolving and still uncertain legal and regulatory framework weakens transparency and reduces the predictability of market signals from government to private investors, individuals and companies, thereby increasing investment and business risks.16 USAID will work on improving transparency and reducing these market barriers in order to expand private sector participation in the water and sanitation value chain for expanded and equitable service delivery. In the sanitation sector, there is a lack of clear policies and strategies to strengthen weak service delivery.

USAID will work closely with other development partners (e.g. DfID, SNV, UNICEF) to support the GRM to improve policies and strategies as well as advocate for and provide technical assistance to promote increased public investment, planning, and management in the water supply and sanitation sector, 15 A recent World Bank report (Mumssen, Yogita, Gustavo Saltiel, and Bill Kingdom. 2018. “Aligning Institutions and Incentives for Sustainable Water Supply and Sanitation Services: Report of the Water Supply and Sanitation Global Solutions Group, Water Global Practice, World Bank.”

World Bank, Washington, DC.) cites weak institutions as responsible for project shortcomings in the water supply and sanitation (WSS) sector, based on the Independent Evaluation Group’s evaluation of WSS projects in a 10-year period.

16 USAID. 2018. Rapid Water and Sanitation Market Assessment. USAID/Mozambique SPEED+ Activity.

particularly for underserved areas. Aligning objectives and incentives among different actors is necessary to improve community well-being.

Sub-IR 1.1 output-level indicators:

● Number of policies or regulations drafted, amended, proposed or approved (disaggregated)

● Monetary benefits accrued through policy reform efforts

Sub-IR 1.2: Institutional capacity to plan, budget, implement, and monitor improved The current robust policies are poorly implemented due to low levels of funding and government capacity. In addition, low levels of transparency and accountability make the situation worse. The government is currently ineffective at planning, budgeting, implementation, and monitoring. For instance, the government does not have accurate data on water-point locations and functionality.

USAID will build on the experiences of PRONASAR and other programs in strengthening the capacity of the institutions tasked with planning, budgeting, implementation, and monitoring. USAID is currently providing technical support to improve DNAAS’ ability to monitor the operational status of water systems, which is critical for informing decisions on where to invest in operations and maintenance. The National Water and Sanitation Information System of Mozambique (SINAS) is a web-based decision support system that collects, analyzes, and disseminates information on public expenditures in the water and sanitation sectors. SINAS is being piloted in select districts of four provinces (Cabo Delgado, Nampula, Manica, Sofala and Maputo). DNAAS envisions that information collected by other donor-funded (e.g., Belgium) monitoring platforms covering other provinces/districts will migrate into SINAS.

However, there is not currently enough funding for districts to collect and maintain quality data.

Sub-IR 1.2 output-level indicators:

● Budget execution of PRONASAR

● Percent of districts with full mapping of water points in target provinces

● Number of provincial and district-level engagements with Water Management Committees related to WASH planning and management

● Increased budget allocations for operations and maintenance of WASH infrastructure at district levels in select provinces

Sub-IR 1.3: Business climate to attract private sector participation strengthened There is already a lot of private sector participation in the water sector, especially in the southern part of the country. The private sector for sanitation services is much less developed. There are several constraints that reduce private investment in water and sanitation services. For example, interest rates for loans are extremely high, the current regulations for public-private partnerships heavily favor the government’s interests over the private sector, and there is poor coordination between several government entities involved in the provision of water (i.e. FIPAG, AIAS, CRA). Similarly, in secondary cities and towns, the predominant model is a five-year lease agreement between AIAS and a private operator; if provided with a 10-year (or longer) lease agreement that provides for greater return on investment, some PWPs have expressed a greater willingness to invest in infrastructure upgrades.

USAID will build on lessons from SUWASA, SPEED+ and WASH-FIN to strengthen private-sector participation in water service delivery. USAID will work to strengthen the business environment to further attract PWPs to expand water services in underserved areas and provide incentives for small-town private operators to invest in infrastructure development through longer-term contracts and innovative financing mechanisms.

Sub-IR 1.3 output-level indicators:

● Number of PWPs that established or scaled up businesses with USG support

● Total estimated revenue of private sector water and sanitation entities

IR 2: Availability of water and sanitation services expanded

The M-WASH project embraces the WHO-UNICEF Joint Management Plan (JMP) definitions for drinking water and sanitation, which is consistent with USAID’s Water Supply and Sanitation Standard Indicators (HL.8). Drinking water services refers to the accessibility, availability and quality of the main source used by households for drinking, cooking, personal hygiene and other domestic uses17. Sanitation services refer to the management of excreta from the facilities used by individuals, through emptying and transport of excreta for treatment and eventual discharge or reuse18. The JMP definitions for “basic” and “safely managed” water and sanitation, and the so-called ladder of lesser preferred (i.e., “limited, unimproved, surface water, and open defecation”) are provided below in Figure 4.

Figure 4. JMP World Baseline Estimates for Drinking Water and Sanitation

The JMP interactive website19 includes 2015 data for Mozambique. In urban areas, basic and safely managed drinking water has reached 79 percent20. In rural areas, access to basic waters drops to an average of 32 percent, coverage rates low as 3.5 percent in remote rural areas.21 A Demographic and Health Survey (DHS) analysis reveals that only 8 percent of rural households have access to improved water within the 30-minute international standard22. While M-WASH Project aims to increase the use and sustainable management of “safely managed” water, activities have adaptive-management discretion to focus on increasing the use and sustainable management of “basic” water supply as well as specific barriers that support the transition from toward “safely managed” in target communities.

IR 2 expected results:

● Increased percentage of population with access to basic and safely managed drinking water

17 WHO-UNICEF Joint Monitoring Plan (JMP). Mozambique data (2015). https://washdata.org/data/household#!/.

18 Ibid.

19 Due to the interactive nature of the JMP website, figures of Mozambique rates are not illustrated.

20 WHO-UNICEF Joint Monitoring Plan (JMP). Mozambique data (2015). https://washdata.org/data/household#!/.

21 National Institute of Statistics, Household Expenditure and Budget Survey 2014/15.

22 Borja-Vega, Christian; Murrell, Kim E.; Kullmann, Craig Phillip; Raha, Shomikho; Srivastava, Vivek; Andres, Luis Alberto; Skilling, Heather; Luengas Sierra, Pavel. 2018. Findings of the Mozambique water supply, sanitation, and hygiene poverty diagnostic (English). WASH Poverty Diagnostic.

World Bank Group. http://documents.worldbank.org/curated/en/533401520611543407/Findings-of-the-Mozambique-water-supply-sanitation-and-hygiene-poverty-diagnostic.

https://washdata.org/data/household#!/ https://washdata.org/data/household#!/

● Increased percentage of population with access to basic sanitation services

● Increased capacity of public and private sector water and sanitation providers

IR 2 outcome indicators:

● HL.8.1-1: Number of people gaining access to basic drinking water services as a result of USG assistance

● HL.8.2-2: Number of people gaining access to a basic sanitation service as a result of USG assistance

● HL.8.1-3: Number of people receiving improved service quality from an existing basic drinking or safely managed water service as a result of USG assistance

Sub-IR 2.1: Consumer-responsive, affordable, women-friendly WASH infrastructure developed or rehabilitated

Public demand has shifted from hand pumps23 to piped water systems with access near homes. Piped systems are more expensive and more complicated to establish. Innovative financing mechanisms and service delivery models need to be tested and scaled up to meet the public demand. USAID will work with the government and private sector to test new service delivery models and financing mechanisms and share the experiences of developing piped water systems from other countries (see Sub IR2.3).

Community Led Total Sanitation (CLTS) has resulted in increasing building and use of latrines, but households across all wealth quintiles are still unwilling to invest beyond basic, self-built models24. This indicates that desirable sanitation products may not be available in the market. The private sector for sanitation in rural areas primarily includes artisans that manufacture concrete slabs in small geographic areas. USAID will invest in expanding the private sector in sanitation services to identify new products that meet the demands of men and women.

Sub-IR 2.1 output-level indicators:

● HL.8.1-4: Number of institutional settings gaining access to a basic drinking water services as a result of USG assistance

● HL.8.2-4: Number of basic sanitation facilities provided in institutional settings as a result of USG assistance

Sub-IR 2.2: Capacity of providers and communities to manage water services improved The low financial, technical, and management capacity of water service providers is a key challenge to sustaining service delivery. Dispersed rural water points are a challenge and community management is not working. Roles in the provision of water are changing. The private sector is more engaged in the operation of mini and small piped systems. The skills of the private sector, government, and community leaders does not match the new system. The private sector needs support to improve the quality of services and expand services, community leaders need to monitor service delivery, and the government needs to enforce environmental and water quality standards.

23 The cost of a water point is approximately $5,000 with prices dependent on remoteness, geology, and depth of water table at the site. For more information on the cost of hand pumps: https://www.ircwash.org/sites/default/files/washcost_c-03a_costs_of_point_sources_jan-jun_2011_mozambique_english.pdf.

24 Borja-Vega, Christian; Murrell, Kim E.; Kullmann, Craig Phillip; Raha, Shomikho; Srivastava, Vivek; Andres, Luis Alberto; Skilling, Heather;

Luengas Sierra, Pavel. 2018. Findings of the Mozambique water supply, sanitation, and hygiene poverty diagnostic (English). WASH Poverty Diagnostic. World Bank Group. http://documents.worldbank.org/curated/en/533401520611543407/Findings-of-the-Mozambique-water-supply-sanitation-and-hygiene-poverty-diagnostic.

https://www.ircwash.org/sites/default/files/washcost_c-03a_costs_of_point_sources_jan-jun_2011_mozambique_english.pdf https://www.ircwash.org/sites/default/files/washcost_c-03a_costs_of_point_sources_jan-jun_2011_mozambique_english.pdf

Sub-IR 2.2 output-level indicators:

● Annual funds spent on operations and maintenance by water providers

● Percentage of recurrent costs for water supply services covered by communities served

● Number of providers and communities using monitoring and customer feedback mechanisms to improve service quality

Sub-IR 2.3: Innovative models for financing and service delivery tested and scaled up The GRM has begun testing the involvement of the private sector in water service delivery through delegated management under a public-private-partnership contract in small towns and rural growth centers or by establishing a licensing process for private water providers in peri-urban areas. However, challenges remain in terms of selecting the proper business and financial model that can be adopted in order to expand or scale up services, particularly to the unserved and underserved. Innovative models for service delivery in sanitation also need to be tested. In Maputo City, only 9 percent of households have sewerage connections, while the rest depend on septic tanks and latrines.25 In other cities these percentages are even lower, with negative implications for the environment and public health. In low-income peri-urban areas, rural areas, and small towns, targeted subsidies will be required to help the poorer people move up the sanitation ladder.

Sub-IR 2.3 output-level indicators:

● Number of private sector firms benefiting from new financing models

● Number of service delivery models tested

● Number of service delivery models scaled up

IR 3: Adoption of key WASH behaviors accelerated

Human behavior is a critical factor in WASH program success. For example, an evaluation an MCC rural water project in Mozambique found that nearly 50 percent of household samples of stored drinking water (collected from hand pumps) had unsafe levels of fecal contamination, likely from poor water storage and handling practices. In order for households to reap the full health benefits of infrastructure investments, individual behaviors must also be addressed.26

In relation to water and sanitation in Mozambique, “human behavior” usually means “women’s behavior.” In the 84 percent of Mozambique homes without water on their premises, the main persons responsible for carrying water are women (80 percent) and girls (4 percent). Women are responsible for child care duties, for household water collection and storage, and for disposing of child and animal waste. The decision-making of women related to sanitation is less clear, particularly in relation to women’s ability to influence the use of household financial resources for sanitation improvements.

Achieving a better understanding of household decision making behaviors as they relate to WASH will be a key component of this IR. As the primary gatherers of water, women also have a key role in ensuring that water management and water point committees are able to influence the design, placement, and cost recovery of water systems to meet the needs of all community members.

25 Hawkins, P. and Odete Muximpua, 2015. Developing business models for fecal sludge management in Maputo.

https://www.wsp.org/sites/wsp/files/publications/WSP-Developing-Business-Models-for-Fecal-Sludge-Management-Maputo.pdf 26 Hall, Ralph & Davis, Jennifer & Houweling, Emily & Vance, Eric & Carzolio, Marcos & Seiss, Mark & Russel, Kory. 2014. Impact Evaluation of the Mozambique Rural Water Supply Activity. 10.13140/RG.2.1.1498.9844.

https://vtechworks.lib.vt.edu/bitstream/handle/10919/71300/2014828_MCC_ImpactRepNampula.pdf;sequence=1 https://www.wsp.org/sites/wsp/files/publications/WSP-Developing-Business-Models-for-Fecal-Sludge-Management-Maputo.pdf https://vtechworks.lib.vt.edu/bitstream/handle/10919/71300/2014828_MCC_ImpactRepNampula.pdf;sequence=1

The M-WASH project includes a significant focus on social and behavior change (SBC). The key WASH behaviors targeted under this IR include, but are not limited to: ceasing open defecation, latrine adoption, hygienic latrine use, safe disposal of child and animal feces, safe household water storage and handling practices. Other behaviors include increases in community participation, with a focus on women’s participation, to ensure active functioning of community-level water and management structures and community-level fundraising for operations and maintenance of WASH infrastructure.

While SBC programming is critical to stimulate improved hygiene and promote gender equity within IR 3, it is also an important approach to achieve IR 1 and IR 2. Within IR 1, SBC activities can help to increase households’ awareness of their rights as consumers to fair and reliable services, as well as encourage civic participation from women and disadvantaged groups to demand better public services (sub-IR 1.1 and 1.2). SBC activities to promote increased demand for improved sanitation, particularly improved models, will complement market-based sanitation activities (sub-IR 2.1) aimed at increasing the supply of affordable, women-friendly sanitation products.