EVALUATION OF THE HEALTH IMPACT OF AMERICAN RED CROSS POSTHURRICANE MITCH WATER AND SANITATION RECONSTRUCTION EFFORTS IN CENTRAL AMERICA

From October 26 to November 1, 1998, Hurricane Mitch struck Central America, killing an estimated 10,000 people, leaving approximately 500,000 people homeless, and causing regional damage to infrastructure. The American Red Cross (ARC) provided relief and reconstruction assistance to Honduras, Nicaragua, El Salvador, and Guatemala, including water and sanitation improvements in many communities. ARC and the Centers for Disease Control and Prevention (CDC) are collaborating on an evaluation of the public health impact and sustainability of ARC's post-hurricane water, sanitation and hygiene education activities in seven study areas from the four countries where ARC implemented water and sanitation interventions. CDC and ARC planned three evaluations: 1) a survey of baseline water and sanitation resources and health indicators, conducted in February 2000, before the water and sanitation interventions were in place; 2) a 1-year follow-up survey, performed in February 2001, to evaluate the initial effectiveness of the interventions; and 3) a 2-year follow-up survey to be conducted in February 2002, to evaluate the sustainability of the interventions and their effect on the communities. This paper describes the ARC Hurricane Mitch water and sanitation reconstruction program for Central America, the techniques used to evaluate the program, and a comparison of the baseline and mid-term surveys for two of the communities evaluated. The two case studies presented demonstrate the importance of tailoring the technologies and training used to meet community needs and resources and fine-tuning the evaluation for the unique conditions in each community. Even at an intermediate stage, the ARC interventions have contributed to improving community health and access to water and sanitation and have positively affected hygiene behaviors. Access to water and sanitation facilities improved in the study communities, as did knowledge and practice of appropriate hygiene behaviors. Beneficiaries who reported having received hygiene, water, and sanitation training generally demonstrated better routine hygiene practices and performed more actions that tend to decrease the risk of diarrheal disease. The evaluation revealed areas where ARC should focus during the completion of the interventions in these communities and lessons learned for improving the evaluation process during future water and sanitation projects.