Strengthening Evidence for Sustainable WASH Through the STREAMS Programme

In healthcare facilities, access to safe water, sanitation and hygiene is fundamental to quality care, infection prevention and the safety of patients, healthcare workers and families. Recognising the importance of sustainable WASH systems, Transform International, in partnership with the Desert Research Institute (DRI) and local partners, developed the STREAMS programme to improve the sustainability of WASH services in healthcare facilities.

STREAMS has been implemented in Rumphi District, Malawi, using an innovative circuit rider approach that combines technical support for WASH infrastructure with quality-of-care support focused on hygiene, cleaning, waste management and related practices. The programme has been working across healthcare facilities to strengthen both the physical systems and the practices needed to sustain WASH improvements.

As the programme continues to evolve, the need for a strong monitoring, evaluation and learning system has become increasingly important. This is where Beyond Borders D-E Consulting Group is making a contribution.

Building a Stronger Evidence System

Beyond Borders is currently supporting Transform International and DRI in the development of a comprehensive Monitoring and Evaluation System and Framework for the STREAMS programme. The assignment is being led by Erasmo Mbemba, Lead Consultant at Beyond Borders D-E Consulting Group.

The work is designed to strengthen how STREAMS captures, manages, analyses and uses information to understand programme performance and demonstrate results. Rather than focusing only on reporting, the M&E system is being developed as a practical mechanism for promoting accountability, learning and evidence-based decision-making.

The development process has included the establishment of a logical framework, indicators, M&E plan, data flow processes and quarterly reporting mechanisms, together with the broader framework required to bring these components into one coherent system.

Connecting Data, Learning and Action

A central focus of the work has been to ensure that information generated through STREAMS can move beyond data collection and reporting to support meaningful programme learning.

This is particularly important for STREAMS because the programme seeks to address both infrastructure and behaviour. The technical circuit rider component supports WASH infrastructure, maintenance and problem solving, while the quality-of-care component supports practices such as hand hygiene, cleaning and waste management. A strong M&E system therefore provides an important mechanism for bringing these different dimensions together.

Reaching the Final Phase

The development of the STREAMS M&E system is now at its final phase. The final phase is focused on consolidating the different components of the system, incorporating feedback and ensuring that the framework and tools are practical, coherent and aligned with the needs of the STREAMS programme.

Once finalised, the system will provide a structured approach for tracking implementation, measuring results, documenting lessons and strengthening accountability across the programme.

A Contribution to Sustainable WASH

The M&E system being developed by Beyond Borders adds another important layer to the STREAMS approach: the ability to systematically demonstrate what works, what needs improvement and what can be learned for future expansion.

For Transform International and DRI, this creates an opportunity to strengthen the evidence base around the STREAMS model and support future programme decisions. For Beyond Borders, the assignment demonstrates the organisation's growing capacity to provide professional M&E, WASH, public health and health systems strengthening services within complex development programmes.