BACKGROUND: According to the World Health Organization, diarrheal disease is the second top killer of

children under five years of age (U5), claiming around 760,000 young children’s lives every year, and 88% of diarrheal disease is attributed to unsafe water supply, inadequate sanitation and hygiene. The humanitarian aid organization, World Vision, launched community-based water, sanitation and hygiene (WASH) project in 76 Area Development Programs (ADPs) for 506,019 target U5 population across Southern Africa Region (SAR): Malawi, Mozambique and Zambia in 2010.

OBJECTIVE: This study estimated the retrospective health impact of the project between 2010 and 2014 to

measure how effectively WASH interventions were implemented.

METHODS: Computer-based modeling software, Lives Saved Tool (LiST) was utilized for quantitative

analysis. The effectiveness and scaled up coverage of five WASH interventions—improved water source, home water connection, improved sanitation, hand washing with soap, and hygienic disposal of children’s stools—were calculated by conducting ADP field visits and analyzing SAR’s quantitative data.

RESULTS: The significant impact demonstrated that the combined effect of interventions have prevented 989,745 diarrheal cases; this translated to the prevention of 1.96 cases of diarrhea for every U5 and 13% prevention rate for diarrhea. It contributed a 209% mean increase in percentage of U5 lives saved and 15.5% mean decrease in U5 mortality rates. The total number of U5 lives saved from diarrhea was 550.

CONCLUSIONS: These results suggest that the project is achieving the organization’s ultimate goal, “Every child deserves clean water,” and LiST acted as an effective tool for conducting the quantitative impact assessment of the project at subnational level. To reach the universal coverage by 2020 to prevent all 3 cases of diarrhea per child each year, programming activities must include promotion and facilitation of household-level water connection and regular availability of soap or equivalent, WASH-related health interventions must be fully incorporated into programming, and the existing community-level water treatment sensitization meetings should be leveraged as a forum to bring together additional sector representatives for raising awareness about integrated WASH programming.