Learning by Observation: Children and Hand Washing in Periurban Cotonou

armand picby Armand A. AGUIDI, WASHplus Coordinator in Benin

Although they are important beneficiaries of hand washing awareness raising campaigns, children are not directly targeted by community mobilizers unless the activities take place at schools. Household-based activities target primarily, and sometimes exclusively, mothers or children’s  caretakers. In fact when children attend these awareness-raising activities geared toward their parents, they are not always welcome. The organizers, and also the parents, don’t hesitate to chase away these “troublemakers” so attention can be focused on the adults.

However, my observation of community mobilization activities in periurban districts of Cotonou calls attention to the missed opportunities of this adult-centered approach.

Setting up a Hand Washing Device in Enagnon

During a tippy tap training organized at a youth center in Enagnon, one of the WASHplus intervention neighborhoods of Cotonou, two things captured the participant’s attention: demonstration of the various hand washing devices and the group of children gathered together to follow the activities. The gathering was particularly large during the fixed hand washing device testing, and these children attentively followed the way in which the trainees washed their hands. They were very disappointed when, at the end of the exercise, the device was moved from the doorway to the interior of the training center, preventing any access to it. The situation changed when one of the participants asked that the hand washing device be displayed again by the doorway and left within the children’s reach. We then observed the children moving automatically as a group toward the hand washing device.

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We may be tempted to attribute part of the children’s interest to curiosity, but we must nevertheless also recognize that this attitude demonstrates the potential for flexibility, maneuverability, and willingness of children, all important elements in behavior change activities.

Later in the day the same afflux of children was observed watching a hand washing with soap demonstration for mothers. Although they lacked permission from the hygiene promoters to participate in the demonstration, these children attentively followed the actions and gestures of the adults from start to finish. Imagine our surprise when we passed by the same house a few minutes later and saw the children gathered around the water giving each other a lesson in washing their hands with water and soap. They were inspired by the advice given to their parents a few minutes earlier. 

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Children Imitate and Learn

We observed that children gather around each time hygiene promoters visit households to present information. Often the adults chase them away or prevent them from having access to the tools utilized. But driven by curiosity, they resist in many cases and find ways to overcome their exclusion. They attentively observe the adults’ actions, they memorize and imitate them, and instruct themselves at the same time as the adults. Therefore, without knowing it, and also without meaning to, the hygiene promoters train both parents and children, killing two birds with one stone. The impact is thus amplified and increases in value.

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These comments on the hygiene promoters relate primarily to the fact that no room is made for children within household behavior change activities. School seems to be the only environment for children to learn about these activities. In reality, children are also available when they are at home and must be included in, or at a minimum tolerated during, sessions held with their parents. Children should, from now, be considered as direct beneficiaries of household awareness-raising activities, and be invited to the household hand washing sessions in the same way as their parents. For this learning by observation, no particular effort is needed except to hold the sessions in places that facilitate children’s access.

In educational psychology, we say that learning by observation and imitation necessitate the presence of a model (in this case, the hygiene promoter) who demonstrates a behavior, and a trainee (in this case, the child) who observes. The model doesn’t necessarily have the intention of teaching; it is the trainee who decides to learn from the model.

Children Look for Models

In every society, human beings need a course of action, a model to follow, people to refer to. This need for a model is even more pronounced in children.

Where hand washing ins concerned, children also look to their parents as models. Parents must tell themselves that children want to see their parents adopt the promoted behaviors not just hear about them. When hand washing becomes a regular habit of the parents, the behavior will be reproduced by the children with significant benefits to everyone’s well-being.

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Children are Information Carriers and Awareness Raisers

Beyond the fact that children reproduce their parents’ gestures and in this way ensure the adoption of desired behaviors, children can also serve as information carriers to their families and with their friends. It is not rare to see children correcting their parents. In objecting, “Oh mom, you told us that we must always wash our hands before eating, but you didn’t do it,” the child points out the parent’s responsibility to model correct behavior and reminds her that her lesson was well absorbed by her child. Didn’t the poet say, “Each child that we teach is a person we win?”

It follows that children must not be expelled or excluded from household awareness-raising sessions. They must not be barred because in raising awareness with their mothers, we target them indirectly. Hygiene promoters will benefit from accepting them and letting them express themselves.

L’apprentissage par l’observation: les enfants et le lavage des mains en milieu périurbain de Cotonou

armand picArmand A. AGUIDI, Coordonnateur de WASHplus au Benin

Quoique faisant pleinement partie des bénéficiaires finaux des programmes de sensibilisation pour le lavage des mains les enfants ne sont directement visés par les animateurs que lorsque leurs activités sont orientées vers les écoles. Dans les maisons par contre, ils ciblent prioritairement et parfois exclusivement les mères ou les gardiennes d’enfants. Dans certains cas, lorsque les enfants viennent assister à ces actions de sensibilisation qui visent leurs parents, ils ne sont pas toujours les bienvenus. Les animateurs et même les parents n’hésitent pas à chasser ces « perturbateurs » qui s’attroupent autour d’eux avec incongruité afin d’accorder toute leur attention aux adultes.

Cependant, des expériences vécues ces derniers temps au cours de certaines actions de mobilisation  communautaire dans les quartiers périurbains de Cotonou, interpellent sur l’attitude  à adopter face aux enfants dans les actions de communication interpersonnelle à domicile.

La mise en place du dispositif de lave-mains à Enagnon

Lors de la formation des relais sur le tipi-tap organisée à la maison des jeunes de Enagnon l’un des quartiers d’intervention du projet USAID/WASHplus (Programme Péri-urbain d’Amélioration de l’Hygiène) au Benin, outre l’intérêt des participants pour les outils variés de lavage des mains qui leur sont proposés, le comportement d’un autre groupe a attiré l’attention des participants. Il s’agit des enfants massivement mobilisés pour suivre les activités et surtout les outils de lavage des mains montés sur place. La mobilisation de ce groupe a été  particulièrement plus grande lors de la phase d’expérimentation du dispositif et ces enfants suivaient avec beaucoup d’attention la façon dont les relais procédaient pour se laver les mains. Aussi, grande a été leur déception lorsqu’ à la fin de l’exercice le dispositif a été déplacé du portail du centre de formation vers l’intérieur leur empêchant tout accès. Mais la situation a changé lorsque l’un des participants a demandé que le dispositif de lave-mains soit exposé à nouveau au portail et laissé à la portée des enfants. En effet, nous avons observé un mouvement automatique et général des enfants vers le dispositif de lave-mains.

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Même si   on peut être tenté d’attribuer en partie cet intérêt des enfants à la curiosité, il faut cependant reconnaitre aussi  que cette attitude montre d’une certaine façon le potentiel de flexibilité, de maniabilité et de volonté chez l’enfant autant d’éléments qui comptent dans une activité de communication pour un changement de comportement.

La démonstration du lavage des mains avec les femmes mères d’enfants dans le quartier Enagnon

Au cours d’une séance de démonstration du lavage des mains à l’eau et au savon dans le quartier Enagnon dans la même journée, le même attroupement d’enfants autour des adultes s’est observé. Suivant attentivement, à défaut d’avoir été autorisé par les relais communautaires à participer aux côtés de leurs parents à la démonstration, ces enfants ont usé de patience pour suivre les faits et gestes des adultes jusqu’à la fin.  Quelle n’a pas été notre surprise de repasser une dizaine de minutes plus tard devant la même maison et de voir les enfants qui autrefois n’avait pas eu la possibilité de participer à la démonstration de lavage de mains rassemblés autour de l’eau pour s’offrir à leur tour leur séance de lavage des mains à l’eau et au savon. Ils se sont inspirés des conseils donnés à leurs parents quelques minutes plus tôt par les relais communautaires pour faire un lavage des mains dans les règles de l’art.

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Les enfants apprennent en imitant

L’une des remarques faites lors des différentes séances est que les enfants  se mobilisent massivement chaque fois que des informations doivent être transmises aux ménages par des  agents communautaires. Bien souvent aussi les adultes les chassent des lieux ou les empêchent d’y avoir accès ou encore d’avoir accès aux outils utilisés.  Mais poussés par la curiosité, ils résistent dans bien des cas et finissent par se trouver une place et à vaincre ainsi l’exclusion. Ils observent avec attentions les actions des adultes, les mémorisent et les reprennent, s’instruisant ainsi en même temps que ces derniers. Sans le savoir donc et même sans le vouloir, les relais communautaires forment parents et enfants faisant d’une pierre deux coups. Le travail s’en trouve amplifié et mieux valorisé.

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Les remarques faites plus haut sur l’attitude des relais communautaires est principalement due au fait qu’aucune place n’est faite aux  enfants dans les activités de communication pour un changement de comportement  à domicile. On s’imagine que l’école est le seul endroit où les enfants peuvent être touchés par ces activités. Mais en réalité, les enfants sont aussi disponibles quand ils sont à la maison et doivent être associés ou simplement tolérés lors des séances tenues avec leurs parents. Il est donc important désormais que les enfants soient considérés comme des bénéficiaires directs des actions de sensibilisation à domicile et qu’ils soient invités au même titre que les parents aux séances de sensibilisation pour le lavage des mains dans les maisons. Pour cet apprentissage par observation, aucun effort particulier n’est demandé sinon de tenir les séances dans des endroits qui leur facilitent l’accès.

En psychologie de l’éducation, on dit que l’apprentissage par observation et imitation nécessite la présence d’un modèle (en l’espèce le relais communautaire), qui produit un comportement, et d’un apprenti (en l’espèce l’enfant) qui observe. Le modèle n’a pas forcément l’intention de lui apprendre, c’est l’apprenti qui décide d’apprendre via le modèle.

Les enfants recherchent des modèles

Dans toute société, les êtres humains ont besoin d’une ligne de conduite, d’un modèle à suivre, de personnes de référence. Ce besoin de modèle est encore plus prononcé chez l’enfant.

C’est ainsi que démarre chez l’enfant le processus d’imitation. Dès son plus jeune âge, l’enfant cherche un modèle à imiter. C’est pour cela qu’on voit souvent les enfants qui   imitent leurs parents, leurs frères et sœurs ainés. Par ce fait, ils reproduisent leurs gestes et se les approprient.

Dans le domaine du lavage des mains aussi les enfants recherchent, en leurs parents, des modèles à imiter. Un grand défi se pose donc à ces derniers qui, pour assurer l’enseignement par l’exemple, ont l’obligation d’adopter les bons gestes et les bons comportements.  Chaque parent doit donc se dire qu’au-delà des  mots son enfant veut le voir adopter les comportements qu’il veut que son enfant adopte. C’est pour cela que le lavage des mains doit entrer dans les habitudes des parents afin d’être reproduit par les enfants pour leur bien-être physique.

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Les enfants sont des  vecteurs d’informations et des éveilleurs de conscience

Au-delà du fait qu’ils reproduisent les gestes de leurs parents et s’assurent par cette voie l’adoption des comportements souhaités, les enfants peuvent aussi être des vecteurs d’information dans leur famille et auprès de leurs amis. Il n’est pas rare de voir les enfants rappeler aux parents « déviants » les bons gestes que ces derniers leur ont appris eux-mêmes. En objectant « Ah maman, tu nous avais dit qu’on doit toujours se laver les mains avant de manger, mais tu ne l’as pas fait », l’enfant accroit la responsabilité du parent et lui rappelle que sa leçon a été bien assimilée par son enfant. Le poète n’a-t-il pas dit que « chaque enfant qu’on enseigne est un homme qu’on gagne »?

Il résulte de ce qui précède que les enfants ne doivent pas être renvoyés ni exclus des séances de sensibilisation à domicile. Ils ne doivent pas être empêchés de paroles alors même qu’en sensibilisant leurs mères, on les vise indirectement. Les animateurs gagneront à les accepter et les laisser s’exprimer.

Q&A: What have we learned about consumer preferences of cookstoves in Bangladesh?

CROPPED-DerbyElisabethWASHplus Project’s Household Air Pollution Specialist Elisa Derby recently participated in an online Q&A session hosted and facilitated by The World Bank’s Clean Stove Initiative. The Q&A session focused on lessons learned about consumer preferences for improved cookstoves in Bangladesh, through the WASHplus project, and in Indonesia through the World Bank’s Indonesia Clean Stove Initiative. Key findings from the WASHplus consumer preferences study and related excerpts from the Q&A are provided below.

Key Findings: Understanding Consumer Preference and Willingness to Pay for Improved Cookstoves in Bangladesh

Methodology

  • “Trials of Improved Practices” testing user reactions to one of five different improved cookstoves (ICS) in 120 households.
  • Three-day kitchen performance tests (KPT) in 116 study households and 24 control households.

Cooking Practices

  • A major obstacle was that the cooking time was slower using the ICS.
  • Households prefer to cook rice for the whole day all at once in the morning during the three-month winter, rather than throughout the day, as is customary during the rest of the year.

Cookstove Preferences

  • At least two stoves were perceived as preferable to traditional stoves during the trials.
  • None as then produced met all consumer needs, and none met sufficient consumer needs to completely replace traditional stoves.
  • A vast majority believed ICS produced less smoke than their traditional stoves.
  • Participants widely complained of the inability to cook large volumes of food in large pots.
  • The horizontal fuel entry of ICS was not desirable. 

Fuel Saving

  • Homes using four out of the five improved stoves were found to use at least 16 percent to 30 percent less fuel than the control homes over the course of the KPT. 

Willingness to Pay and Decision Making

  • Certain stove features were valued, but the monetary worth of the stove was dramatically undervalued (most estimated them to be 1/2 to 1/4 of their actual calculated value).
  • Householders realized that metal stoves are expensive, but they were not ready to buy them at market price.
  • When given the stove as a gift in one village, almost all participants chose to keep the stove over a market value cash buy-back.

To learn more about WASHplus’ consumer preference study, download the brief “What Do Cooks Want? What Will They Pay? A Study of Improved Cookstoves in Bangladesh” and the full report “Understanding Consumer Preference and Willingness to Pay for Improved Cookstoves in Bangladesh.”

Q&A with Elisa Derby: What have we learned about consumer preferences of cookstoves in Bangladesh?

Elisa Derby has worked in the cookstoves sector for over a decade and manages Winrock International’s household energy and health program, with projects and partnerships that reduce fuel use and exposure to cooking-related household air pollution. This work incorporates field-based capacity building, formative research, network building, knowledge dissemination, grants management, and direct implementation activities. She is the household energy and household air pollution specialist for the WASHplus project, and supports WASHplus consumer preferences, needs and willingness to pay research, and other activities designed to support the Global Alliance for Clean Cookstoves mission and goals.

Q: What do you think was the most unexpected result stemming from your study? And how do you think this finding will likely impact the market (stove manufacturers) and future development initiatives?

A: Our willingness to pay results were the most surprising result from the WASHplus study in Bangladesh. Only one out of 105 study participants given the option to purchase the stoves at market value did so, although of the remaining 15 households given the stoves as gifts and then offered the option of a cash buyout at that same market value, only three chose cash; the other 12 preferred to keep their stove. People valued the stoves when acquisition barriers were removed, indicating a need for better financing options.

Q: The WASHplus study adopted the Trials of Improved Practices (TIPs) methodology. What makes this innovative and could you please explain how this methodology works?

A: The USAID Mission in Bangladesh enlisted WASHplus to help it assess consumer preferences and identify types of stoves that would be a good fit for its cookstove promotion program, as a follow-on activity to a cookstove market assessment already undertaken. Because cooking is such a personal experience and so integral to daily life, there’s no better way to get feedback on a particular stove type than to ask potential consumers to bring the stove into their homes and assess it as they go about their daily routine over a period of weeks. TIPs is an established qualitative methodology in the WASH sector and invites participants to interact with researchers and identify, discuss, and resolve barriers to using the new technologies through semi-structured “elicitation” questions. We gave each household one of five imported ICS models to evaluate, and used both qualitative and quantitative methods to gather data. The latter included monitoring wood and stove usage via KPT and stove use monitoring sensors for both traditional and improved stoves, as well as household air pollution in a subset of homes. We ended the trials with two different perceived value and willingness to pay approaches.

Q: How do you select five imported ICS models?

A: We chose the stove models based on regional availability, performance, and characteristics. All models were produced in China or India; only the Grameen Greenway stove was currently available for purchase in Bangladesh at the time of the study, albeit in small quantities, but others had potential to be manufactured and/or assembled in Bangladesh. They all met a minimum of Tier 2 fuel efficiency according to ISO IWA 11:2012 guidelines (the Tier 0 traditional baseline in Bangladesh is a hand-built, sunken-hole mud stove). Stoves were selected by characteristics (chimney/not, fan/not, portable/not), not by brand, to represent a range of stove types. An added benefit of using imported stoves with which consumers were not familiar was the avoidance of any influence of brand loyalty. Several of the manufacturers have made modifications to their stoves in response to consumer feedback from our study, and are exploring or already pursuing expanding their markets into Bangladesh. 

Q: Is there room for adoption of dedicated devices that would be efficient for specific tasks such as  water boiling or rice cooking? In other words, could the future be towards several types of efficient task-focused devices rather than trying to go for the “mythical” do-it-all-cleanly-and-efficiently-while-customer-friendly stove?

A: As a follow-up activity to the consumer research, we’re now doing customer segmentation and market strategy work in Bangladesh and one recommendation from that research is bundling the improved cookstoves with products like electric rice cookers, as the combination would then be expensive enough to trigger microfinance options, and the products would complement each other nicely, as the rice cooking is the weak point of many of the improved stoves. This is of course only possible for homes that are electrified, one of several customer segments. In my own kitchen I have an oven, stovetop, microwave, toaster, and coffee maker, and have been thinking of investing in a slow-cooker; I’m clearly no believer in a mythical do-it-all technology! 

Q: Is water boiling a main task in Bangladesh? It is an interesting finding in Indonesia. Almost all households only drink boiled water (this a common practice in China, too).

A: Unfortunately (for other health considerations!) boiling water for drinking or bathing is not common practice in Bangladesh.

Q: Bundling products with complementary functions sounds good. But I wonder how many households will invest in such bundle. If bundling products is not targeting poor households, then the households who choose the bundle probably don’t need microfinancing either.

A: For better or worse, there are many segments of “poor” in Bangladesh, and the poorest of the poor don’t usually have electricity, so the rice cooker bundling is a moot point for them anyway. Fortunately, we won’t have to just speculate how/whether this will work, as the WASHplus research findings and market strategies are directly feeding into the USAID’s Catalyzing Clean Energy in Bangladesh program, so they’ll be able to report back to us how/whether this has worked in the next couple years.

Q: Was the finding regarding “unwillingness of customers to chop wood” reported to stove manufacturers/designers (e.g., the tech. people)? What is their reaction to this issue? This is major in my mind, as it goes directly towards adoption and actual use … because the trend in adoption overall is towards devices that make life easier and (possibly more pleasurable), not that do good only if you follow a certain set of rules. And there may be some unintended consequences on the social side of this increase need for chopped wood.

A: Yes, all of our findings were shared with manufacturers. Fuel processing is always an especially challenging factor. We know that we get the most complete combustion and therefore cleanest burn from fuel with high surface/mass ratios, but of course any user would rather just throw a big log in the fire, not have to chop up the fuel or continuously feed it. I know many in our sector have high hopes for a fuel processing service solution—wherein entrepreneurs can make a living processing wood, or selling processed wood to users who then get a cleaner burn. I wish I had the answer!

Q: Based on the study, what do you think is the biggest challenge/barrier in promoting ICS in countries like Bangladesh and Indonesia? Was the lesson learnt from your study applicable for other developing nations as well?

A: I think the biggest challenge in our sector, regardless of where cookstoves are promoted, is that we don’t have biomass solutions that both burn cleanly (read: meets WHO air quality guidelines) and that users like to use and prefer over their traditional stove 100% of the time. So we see a LOT of stove stacking, and the benefits of ICS are watered down at best and completely negated at worst. But it’s entirely rational—if you spend 5-7 hours/day cooking, of course you’d rather do it on the easy-to-use stove than the “allegedly better but annoying to actually use” option, even though the latter may provide health benefits down the road. Everyone loves cooking on LPG (and I posit in most cases would do so almost exclusively were it not for cost), and I firmly believe that universal clean fuel access should be our end goal, but we need many really good biomass solutions in the meantime that cooks will use consistently, correctly, and exclusively, and we’re just not there yet. I’m grateful for the R&D funding that’s been brought to the table in recent years to support that work.

Q: I would be interested in hearing from the Bangladesh experience about distribution channels that were used to reach users in remote areas, in particular women. For example, there is an organization called Solar Sisters that is operating in several African countries, which trains and hires women entrepreneurs from the community to market and sell stoves. It seems like an interesting approach. What good steps and strategies were used to reach the end user beyond broad marketing?

A: As the WASHplus Bangladesh activity was a research study involving imported ICS not currently available in Bangladesh, we did not rely on any distribution channels, rather we selected the 120 participant households and brought them the stoves ourselves. Previous ICS promotion supported by the Government of Bangladesh has relied primarily on sanitation shops and NGOs for distribution. I expect that the USAID Catalyzing Clean Energy in Bangladesh project (which will be the implementation follow-on to the WASHplus research) will expand their distribution networks, and the Solar Sisters model may be a good fit—I’ll pass on the suggestion!

Q: Could you please share some key lessons learnt from your project, or essential take-aways, especially on those topics that have not yet been discussed in the above thread? Anything that might be helpful for future project development and design, social marketing, awareness campaign is warmly welcomed.

A: Some important take-aways from our research in Bangladesh is the need for larger and higher fire-power stoves for Bangladesh, and given the prevalence of mixed fuel use we also recommended the development of a mixed-fuel stove. Happily, several of the manufacturers we worked with have come out with larger/higher fire-power versions of their stoves to better meet Bangladeshi needs. Prakti has received Global Alliance for Clean Cookstoves funding specifically to develop a mixed-fuel stove for Bangladesh, which is already in prototype stage. Finally, I would say our findings underscore the need I think we all recognize for consumer-centered design, to really meet consumer needs while still achieving emissions reductions and efficiency goals.

The other take-away from our work in Bangladesh that we haven’t gotten into on this thread is the issue of quality control and durability. By way of background, Bangladesh has a long history of improved stove promotion over the decades, primarily focusing on variations of one type of artisanal clay (and more recently cement) chimney stove, generally called the Bondhu Chula, of which there are an estimated 500,000 still in use. We performed controlled cooking tests on both the imported and (expertly constructed) Bondhu Chula stoves, and they all demonstrated significant efficiency gains over the traditional stove. All of the chimney stoves were very successful in venting the smoke out of the kitchen. But in the field we saw a LOT of very smoky Bondhu Chulas. This is likely in part due to varying quality control prevalent with artisanal production. That said, even expertly constructed Bondhu Chulas depend on the user to keep the stove well-maintained.

The challenge with any chimney stove is that when not cleaned regularly, they can redirect all the smoke (maybe just as much as the traditional stove generates) back into the cooking area. In Bangladesh there isn’t a culture of chimney cleaning, and given that the Bondhu Chula has a cement chimney that must be cleaned from the top (unlike metal chimneys that you can clean just by banging on the side), and many homes have thatched roofs, this kind of cleaning can be next to impossible. So field testing for chimney stoves over time is really critical, especially in Bangladesh.

Report from Dan Sweeney on the ISO Clean Cooking Solutions Meeting in Guatemala

About the Author: Dan Sweeney is a D-Lab Biomass Fuel Research Scientist at the Massachusetts Institute of Technology.  His blog post below was originally published on October 30, 2014 on the MIT D-Lab blog. Read about other events on D-Lab News.

D-Lab’s Dan Sweeney attends ISO Clean Cooking Solutions Meeting in Guatemala

Last week, I returned from a nine-day visit to Antigua, Guatemala. Working with D-Lab partner organization Soluciones Comunitarias (SolCom), I performed field tests on a couple of their improved, wood-fired cookstoves. And, I participated in a meeting of the working and task groups for the International Standards Organization (ISO) Technical Committee on Clean Cooking Solutions. For my blog about cookstove testing on this trip read here.

Dan Sweeney & Marta Rivera (Fundacion Solar) during an ISO Fuels task group meeting.

Global Alliance for Clean Cookstoves connection

So you may be asking “how the heck did Dan get wrapped up in all of this?” Many of you may be familiar with the Global Alliance for Clean Cookstoves (aka The Alliance, cleancookstoves.org), a public-private partnership at the UN Foundation, initiated by Hillary Clinton to bring awareness to the three billion people worldwide who use biomass to meet their household energy needs through advocacy, funding opportunities and other efforts to scale improved cooking technologies. The Harvest Fuel Initiative (HFI), which I focus most of my efforts on at D-Lab, is a member of the Alliance and over the past couple of months we have become a greater voice in Alliance conversations about cooking fuels which recognize improved fuels as a needed innovation in improved cooking (the Alliance recently hired a fuels technical expert, Seema Patel, who is one of my new best friends).

International Standards OrganizationTechnical Committee on Clean Cooking Solutions

The Alliance has also convened experts from various backgrounds and locations, ISO Technical Committee 285 (TC285), tasked with producing a globally recognized ISO standard for “Improved Cooking Solutions” – in short, a comprehensive, globally adopted guide for evaluating, rating, certifying and measuring impacts from cooking technology. The challenge is that cooking practices and technology are different everywhere and stakeholders have a wide variety of opinions about what is important when evaluating a cookstove- should tests be performed in a controlled-laboratory environment (like D-Lab’s stove lab), or should tests be performed in the field during actual use conditions? And what tests should be required by the standard so as to sufficiently measure important aspects of the technology (e.g. fuel efficiency, emissions, pollutant exposure, durability, safety) but not be prohibitively expensive for stove manufacturers who may not be able to afford an expensive lab or field test campaign.

These are a few of the issues, among many more that TC285 is trying to tackle through a consensus based process over the next couple of years. Last week’s meeting in Antigua marked the start of the nitty-gritty work. The four TC285 working groups (Conceptual Framework, Harmonized Laboratory Protocols, Field Testing, Social Impacts) and two task groups (Communications, Fuels) met during several sessions to hash out scopes, work plans, write tables of contents and delegate responsibilities.

Creating international standards

For me, it was a crash course in international standards, an opportunity to represent D-Lab’s fuels research and the partners that we work with in the field, and a chance to meet a lot of folks who have paved the way in improved cooking tech.

Creating standards is a lot of work, especially for a product that is so varied in type and use, in many locations, potentially by large numbers of people. Navigating to a consensus decision seems impossible, but attending this meeting gave me some hope for the process. Drafting sections, editing and revising will be a long, ongoing process for the next couple of years, but the people involved are very passionate about seeing it get done.

I was encouraged to be involved in the Fuels Task Group, assisting group convener Marcelo Gorritty (UMSA, Bolivia). The Fuels Task group will provide guidance to other working group’s on fuels related issues, and perform a review and gap analysis of existing relevant fuels standards. I am also a member of the Lab and Field Testing Working Groups.

Introducing the Harvest Fuel Initiative to the Group

Attendees were particularly interested in the unique approach that HFI is taking in engaging directly with producers to scale alternative fuels, and also with our capacity building and design summit work. For example, there was interest in applying some of D-Lab and HFI’s design methodologies to cooking technology, such as a design summit focused on improved cooking tech and working with refugee communities to produce clean fuels.

Tour: San Antonio Aguas Calientes, cookstove factory

During our last day, some of us spent a few hours visiting San Antonio Aguas Calientes where social entrepreneur Marco Tulio runs Eco Comal, an impressive factory operation where he builds a several models of improved wood-fired cookstoves including steel-top planchas, and rocket stoves. I was particularly impressed with Marco’s intricately designed cast masonry stove internals produced from local materials, on-site, and to relatively tight tolerances.

And a . . . talent show

It was great to meet and work with some notable “stovers” like Dean Still (Aprovecho) and Tami Bond (Universithy of Illinois). In the evening following our last round of working group meetings, we kept with tradition by having a talent show where attendees performed, among others, solo flamenco guitar, traditional Rwandan dance and song, and a Nepali trekking song.

Read Dan’s Blog on Cookstove Field Tests in Guatemala.

For more information, contact Dan Sweeney.

What to do with infant poo? The blind spot of the blind spot

Reblogged from http://www.communityledtotalsanitation.org/blog/what-do-infant-poo-blind-spot-blind-spot

infant poo

After a few years researching and working on sanitation, I feel (felt) that I have a good knowledge about the topic, or at least good knowledge of most of it and a clear picture of the areas I should learn more about. Moreover as a shit-worker I –and probably most of us in the sector– have developed a sort of pride or even vanity about being a herald of a neglected cause…

Last week at the UNC Water and Health Conference I was humbled and even slightly embarrassed when I ‘discovered’ the world of children’s faeces in an exciting side session: “What to Do with Infant Poo? Evidence-based Programming to support safe disposal of young children’s faeces”. Convened by WSP, UNICEF and USAID / WASHPlus Project, the session included presentations of experiences from Kenya, Bangladesh and Cambodia, followed by group work on ways forward.

It is not that I ignored everything about child faeces; I had read something, had had some coincidental observations while staying in Indian villages, where I also included the issue partially in household surveys by gathering information of individuals’ defecation practices. But overall my knowledge was limited to the fact that child faeces have more pathogens than adult shit, and therefore should be disposed of safely; I had not fully acknowledged the complexities of the issue and kind of took for granted that improvements in adult sanitation would automatically lead to better management of child faeces. I was thus struck by a study in Bangladesh (by ICDDR,B), a country where adult open defecation is minimal, that showed that only 11-14% of children’s faeces are disposed of in latrines.

I had also not reflected about of the different defecation practices by age groups (my nephew is still in the nappy-phase) which vary country to country and require specific approaches. In Cambodia, for instance, Watershed’s research has shown that children up to six months, not having control over their bowels, rely on nappies (either disposable or reusable –more or less rudimentary). From seven months to two years they generally defecate openly, mostly in the courtyard. From two to five years they start using the potty or the latrine if available.

Finally, I had not given much thought either to how the different choices impact the environment and the implications in terms of solid and liquid waste management. In Cambodia again, in villages with high latrine coverage, when potties are used, in 92% of the cases these are emptied in latrines. Faeces in the courtyard are removed with a scoop or an improvised tool, just to be thrown farther away or in the trash. Baby’s disposable nappies always end up in the trash, which is mostly burnt or buried. Cloth diapers –used by 30%– are emptied in the latrines and then cleaned, but the resulting wastewater is again disposed of in or near the courtyard.

So what to do about children faeces?

The Bangladesh experience was based in supporting caregivers in potty training and promoting the best potty after a test of different models available in the local markets. In Cambodia, efforts have been made to develop potty designs that are more stable than those traditionally used, which small children cannot use on their own. In parallel, WSP and UNICEF are developing 25 country profiles summarising available data on child faeces disposal and providing ideas to strengthen safe practices.

These emergent efforts are very interesting… but very scarce. We need more people and more organisations that engage in this topic and contribute take children faeces out of the blind spot. Please share your thoughts and any related experience you know about!

Celebration Marks End of Open Defecation in Three Villages in Mopti Region, Mali

The WASHplus Project, funded by the United States Government via USAID, triggers change in sanitation practices through the community-led total sanitation (CLTS) approach with a “plus” component that includes an emphasis on hand washing with soap after using the toilet. In Mali the plus component also signifies supply-side interventions to develop and promote low-cost latrine models appropriate to the unique environmental conditions in each district coupled with training community-based masons to build robust latrines using local materials. To complement the CLTS-driven approach in rural areas, WASHplus is beginning a sanitation marketing activity to engage materials suppliers and local entrepreneurs to market a line of aspirational sanitation products in Mopti’s urban areas. The WASHplus project is led by FHI 360 globally. In Mali, WASHplus activities are implemented through CARE International and two Malian NGOs, YAG-TU and Sahel Eco.

Recently the WASHplus Project in Mali organized public ceremonies to certify Open Defecation Free (ODF) status of three villages in the Mopti Region. These villages, each of which are located in priority areas for USAID’s Feed the Future and Global Health initiatives, were recognized as being the first in their municipality to reach ODF status.

From September 25th to 27th 2014, the USAID/Mali Director Gary Juste, accompanied by the Governor of Mopti Region, and the National Director of Sanitation led certification ceremonies in three villages in the presence of national and regional authorities, the CARE Mali Country Director, as well as local officials and residents from the villages. All three villages reached or exceeded the targeted criteria for certifications. The village of Allaye-Daga built 31 latrines against a target of 28. Wendeguele achieved 150% of their latrine target, and Kanikombole built 28 latrines against a target of 10. Local community leaders, women and youth all recognized the importance of the project and the impact safe disposal of human feces with have on the health and nutritional status of the populations, especially children under five. In the village of Allaye Daga, there was not a single latrine before the project, but now everybody uses latrines and the community has adopted social conventions to deal with noncompliance with ODF standards.

Photos from the certification ceremonies are posted below. These photos and description of the certification ceremonies were originally published on the USAID website here: http://www.usaid.gov/news-information/photo-gallery/certification-end-open-air-defecation-ceremony and here: http://www.usaid.gov/mali/news/usaid-promotes-hygiene-and-sanitation-through-innovative-approach

The Mayor of Sio hands out certificate to the village chief

The Mayor of Sio handing certificate over to the chief of the village of Wendeguele. Photo credit: USAID Mali.

Youth in Kanikombole vow to abide by hygiene and sanitation standards

Youth in Kanikombole vow to abide by hygiene and sanitation standards. Photo credit: USAID Mali.

USAID WASH Adviser engages communities on WASH

USAID WASH Adviser engages communities on WASH. Photo credit: USAID Mali.

Girls stood up against open-air defecation

Community-Led Total Sanitation benefits girls in Kanikombole. Photo credit: USAID Mali.

Communities in KaniKombole recognize USAID through a special award handed out to USAID WASH Advisor (Right)

Communities in KaniKombole recognize USAID through a special award handed out to USAID/Mali WASH Advisor (Right). Photo credit: USAID Mali.

USAID/Mali Director and Mopti Governor pose after unveiling the certification plaque. Photo credit: USAID Mali.

USAID Director (right), WASH Adviser (midlle), and Health Office Director

USAID/Mali Director (right), WASH Adviser (middle), and Health Office Director. Photo credit: USAID Mali.

There is the toilet!! Mopti Governor and USAID Director pointing to it

There is the toilet!! Mopti Governor and USAID/Mali Director pointing to it. Photo credit: USAID Mali.

USAID Director and Mopti Governor unveil certification sign board in Wendeguele

USAID/Mali Director and the Governor of Mopti unveil the certification sign board in Wendeguele. Photo credit: USAID Mali.

Mopti Governor and USAID Director visit a latrin under construction

Certification of End-of-open air defecation ceremony: Mopti Governor and USAID/Mali Director visit a latrine under construction. Photo Cresit: USAID Mali

USAID Director hand out certification for Allaye-Daga to Mopti Governor

USAID/Mali Director hand out certification for Allaye-Daga to Mopti Governor. Photo credit: USAID Mali.

USAID Director admires certification plaque for Allaye-Daga

USAID/Mali Director admires certification plaque for Allaye-Daga. Photo credit: USAID Mali.

Highlights from the University of North Carolina Water and Health Conference

Highlights from the University of North Carolina Water and Health Conference Oct. 13-17, 2014, complied by the USAID WASHplus Project. For more information about the conference, schedule and available presentations, visit: http://whconference.unc.edu/

WATER

Water Systems and Household Water Treatment and Storage 

  • Vestergaard has developed a water filter that may be used by vendors in developing countries to sell treated water to consumers. This unit has a cost of US$310, but they are attempting to have vendors recover the cost by selling water through jerrycan users as well as consumers that may be interested in buying cups of safe water. The jerrycan sales include a jerrycan swap program component which allows water sellers to exchange a consumer-owned jerrycan with one clean one offered by the vendor through this program.
  • Edema Ajomo from the Water Institute at UNC suggested that the following factors influencing the sustainability and scale-up of HWTS programs:
    • User preferences: culture and norms may determine people’s choices (“Black-colored filters are evil because everything that is that color is evil’; “I just cannot stand the smell of chlorinated water”.
    • Integration and collaboration: piggy-back HWTS interventions with other interventions already with known track in the field (‘Add HWTS lecture to a sanitation lecture or promotion activity”) and seek inter-ministerial collaboration
    • Have clear standards, certification and regulation procedures for HWTS
    • Availability of resources: address financial resources needed for consumers to buy promoted HWTS products, but also ensure that there are trained human resources and the necessary supply chain to repair/replace technologies purchased by consumers
  • A study from Bangladesh on POU suggested that direct observation of water treatment in homes may provide a more accurate picture of practices as opposed to chlorine residuals which is considered a more objective measure than self-reports.

Public Financing for Water System Services

IRC, WSUP, and Tremolet Consulting have formed a working group exploring avenues for public financing for WASH services at the local government level. Their work suggests that both taxes and tariffs will need to grow at local governance levels in order to support water services in the long term. The focus of the working group is exploring methods of growing those, or other, revenue streams to finance the life cycle costs of water and sanitation delivery systems.

WSUP is currently conducting research on the role of advocacy at the local level, as well as some experimentation with “sanitation surcharges” attached to municipal water fees in order to cover district government costs of monitoring, enforcing, and supporting sanitation (i.e., a tax that supports the Environment Health Department to conduct its duties).

Water Point Mapping

This was an interesting presentation from the MWA based on their Lazos de Agua work in Central America. They used AKVO-FLOW for a baseline on 1009 households which categorized results into four areas based on the water service level ladder defined by IRC – quantity, quality, accessibility, reliability. The visuals on results were very arresting – for example, you could see what locations scored high on certain dimensions of service but when all four dimensions were considered, few were receiving high levels of water service.

The Global Water Challenge is attempting to compile a global database of all water points (whether collected by govt. NGO, researcher, etc.). They are currently working on a core data set based on what they found to be common denominators.

SANITATION

What To Do with Infant Poo!

Session jointly sponsored by UNICEF, the Water & Sanitation Program of the World Bank, and the USAID/WASHplus Project.

Although the impact of poor sanitation is often measured on children under five, little is known about what happens to the feces OF children under 5. Most sanitation interventions target adults and school aged children.

A reanalysis of DHS/MICS data by UNICEF and the Water & Sanitation Program of the World Bank shows that only 39%-47% of caregivers in 78 low and middle income countries reported using an improved type of feces disposal for their children under five (Null & Reese, 2012 and 2013). Poor, rural and younger children are most at risk for unsafe disposal and its associated impacts.

There are only a few programs focusing on young children’s sanitation, and we have little evidence base for effective strategies for safe disposal of child feces. Significant knowledge gaps must be filled before comprehensive practical evidence-based policy and program guidance will be available. Some organizations and experts are working to fill that gap and have published a number of recommendations and possible methods for incorporating child feces management into existing programs.

The standing room only session at UNC began with a brief overview of the findings from the DHS analysis, and focused on giving an overview of programs and policies by governments and organizations throughout the world which have been implemented to increase the safe management of child feces. Leaders of these programs presented their work in small participatory group discussions. Two sub-sessions focused on the WASH Benefits studies in Kenya and Bangladesh, large RCTs that among other variables are looking at the uptake and impact of several ‘enabling’ technologies for improved infant feces management, technologies like child potties and pooper scoopers to dump open air child feces into the latrine. A third session by the USAID WASHplus project shared the WASHplus experience in Bangladesh, where they are beginning to identify a series of ‘small doable actions’ by age cohort (infant, toddler, young child) to facilitate safe disposal of feces. The last of four sessions focused on the work of WaterShed in Cambodia, also highlighting a range of ‘enabling technologies’ including potties and child-friendly squat mats, to encourage improved infant feces management and document the outcome of these improved practices. WaterShed was successful in improving practices through the use of promotion and enabling technologies.

The final part of the session invited participants to critique a series of recommended actions, organized by categories of increasing demand, improving supply and strengthening the enabling environment. These actions are based on the available evidence base, which though still not comprehensive, allow for pioneering programming to move forward the best practice in this emerging area. Based on participant input, they will be revised and disseminated to guide programming globally.

Confronting the Challenge: Sanitation Behavior Change in Rural North India

Convened by Bill and Melinda Gates Foundation plus the RICE Institute from Emory

Despite large government and NGO programs, despite substantially increased public spending on sanitation, and despite sustained economic growth, open defecation is declining slowly in rural “Hindi heartland” north India. If the international community is going to stop open defecation by 2030 as advocated by the SDGs under discussion, the preference for open defecation that exists in India will have to be addressed. Widespread resistance to using simple latrines in the rural north Indian plains states is a human development challenge, which others refer to as a crisis, and a serious puzzle: this is an area of the world where open defecation is most common and where high population density most raises the human and economic costs of open defecation. And 80% of rural households in India are believed to practice open defecation.

Evidence is now accumulating from many sources that north Indian states present a unique challenge: what worked in Bangladesh, Southeast Asia, or sub-Saharan Africa is unlikely to work here. Below are some of the possible explanations why:

Many people prefer defecating in the open, and believe it is healthier and nicer.

  • Many people may be willing to accept a latrine that they can repurpose, but they have little desire to use one.
  • Millions of households have working latrines that some household members use, but others do not. This is not captured in household-level survey data.
  • Rural north Indian villages are deeply socially fragmented. Any approach that depends on villagers coming together as a “community” will likely fail. In Indian English, the word “community” means common caste or religious group, not geographic neighbors.
  • Many people believe that the proper, religiously pure, and socially acceptable place to put feces is far from one’s own house.
  • Open defecation is an accepted part of life. Indeed, for some people, pit latrines are a disgusting notion!

Rural north India is not “just one place” or “merely one part of a big country,” and concern ourselves with other pockets where open defecation remains but is in the process of going away. How can we learn, tinker, and experiment in Northern India? How can we adjust what worked elsewhere to the different context of rural north India? How can we prevent millions of child deaths and stunted bodies and lives?​ The answer may partially lie in being consumer oriented and in getting the consumers’ voice be heard instead of implementing vertical sanitation programs which may fail.

Evidence of the Efficacy, or Lack Thereof, of CLTS

A number of evaluations examining the health impact of CLTS implementation were conducted, all of which suggest limited ability to trace CLTS back to concrete health metrics. Tom Clausen of Emory/LSHTM did a large randomized control trial on WaterAid’s heavily subsidized sanitation work in India as promoted by the Indian government’s Total Sanitation Campaign, and found no significant health impact: no change in diarrhea, anthropometric measurements such as stunting, or intestinal worm infection. The study found that latrines were being used by less than 70% of the community members (perhaps due to the nature of the approach). It was therefore not surprising that the RCT, despite costing 4.2M dollars to complete, did not detect any change in health outcomes. The findings support the notion that sanitation coverage must reach close to 100% in order to reduce pathogen transmission from the environment to the level which results in health impacts.

Amy Pickering of Stanford did a large 2-year trial of UNICEF’s CLTS work in Mali. She found no effect on diarrhea in ODF certified communities, but did find a significant effect on stunting. The difference in their findings may be due to population density, and baseline sanitation status in Mali vs. India. In essence, CLTS impact goes a longer way in Mali, where population density and baseline sanitation is lower.

Why is CLTS Successful?

The UNC Water Institute has conducted a series of studies with PLAN, looking at the enabling factors for successful CLTS, as well as modalities of CLTS that result in greater and sustained ODF certification among communities. Overall, research suggests that CLTS (even combined with sanitation marketing and other approaches) is not an intervention that works everywhere.

CLTS appears most effective in areas where baseline sanitation coverage is low, but has diminishing returns as sanitation coverage is higher/increased. Similarly, while it does create demand for unimproved toilets, it only minimally impacts uptake of improved toilets and returns are diminishing as coverage increases. As such, it may not be the most appropriate intervention in communities that have even 50% latrine coverage. It is increasingly clear that CLTS needs to be considered more dynamic – what are the various modalities of CLTS that we can implement based on the community and environmental factors.

HYGIENE

The Theory and Practice of Handwashing Habits, organized by USAID/WASHplus and partners including the Water and Sanitation Program, London School of Hygiene & Tropical Medicine, and the Global Public Private Partnership for Handwashing with Soap.

This session focused on the seven principles of habit formation, explored how they could be applied to the handwashing arena, and discussed applications where enabling products have been developed and tried as cues to guide practices and habit formation. Potential implications for future handwashing programs were discussed, beyond the mere creation of cues.

Diarrheal disease accounts for 11% of child mortality worldwide. Yet, there is a cost-effective way of reducing diarrheal disease in children under five and in turn reduce child mortality: handwashing with soap at critical junctures, especially among caretakers, grouped into two large categories, before food handling and after contact with fecal matter. Handwashing with soap at such junctures can reduce diarrheal incidence by up to 43%.

Handwashing promotion has been an important part of many WASH interventions and such programs have been able to increase handwashing practices among target populations using a variety of approaches. More recently, these approaches rely on conceptual framework that argue in favor of using psychosocial determinants and emotional appeals. Such frameworks have their origin in reflective psychology which suggests that behavior is volitional and guided by factors internal to the individual.

Handwashing programs constructed on reflective psychology theories and models have proven effective to generate behavior change. However, is there any evidence that they have been useful in helping to maintain the practice overtime? Research on the sustainability of handwashing practices overtime is inconclusive. Yet, interpretations of findings overtime suggests that factors in the context in which individuals behave may be partially responsible for their perdurance.

A couple of studies argue in favor of the presence of water and soap as contributing factors to handwashing sustainability. Such suggestions point in the direction of the science of habits which proposes that factors initiating practices are not the same as those that maintain them. Whereas reflective psychological models may explain the practice of new behaviors, reflexive models offer an explanation for keeping them alive.

An interconnected approach to improving handwashing behaviors

WASHplus Project in Kenya Shares Experiences in Transitioning Workshop

By George Nyairo Obanyi, FHI 360

george_obanyi1About the Author: George Nyairo Obanyi is the Information Officer for FHI 360/Kenya based in Nairobi. George provides communications support to the country office and field programs.

The USAID-funded WASHplus project ended its four years in Kenya with an experience-sharing workshop for key stakeholders held in Nairobi on September 25th 2014.

Representatives from USAID, government, other partners and community members converged for the one-day event during which the project showcased its achievements through plenary presentations, video shows and a photo gallery.

Kenya is one of seven countries where the WASHplus project works with partners to create supportive environments for healthy households and communities by creating and delivering interventions that lead to improvements in water supply, sanitation, and hygiene (WASH) and household air pollution.

In Kenya, the project partnered with the Ministry of Health to strengthen the capacity in public and private sectors as well as communities to implement sustainable WASH interventions.

WASHplus introduced and successfully promoted the small doable action (SDAs) concept, which has been accepted by government and other WASH actors to encourage hand washing, use of latrines, menstrual hygiene management and water treatment and safe storage.

Another key WASHplus achievement was its pioneering role in promoting inclusive sanitation approaches under an innovative, value-added community-led total sanitation (CLTSplus) approach to promote open defecation free (ODF) communties, which was successfully piloted in two rural counties and one urban site.

In its role as a national mechanism, the project helped to develop policies and training guides including a training curriculum for WASH-HIV integration and a module for training community volunteers.

Other notable achievements include:

  • Over 650 trainers from government and 8,000 CHWs trained on WASH-HIV integration and inclusive sanitation through Community Strategy
  • Improving access to sanitary pads for girls and women in communities
  • Community volunteers and leaders trained to help make supportive devices for individuals with disabilities

Interventions initiated and supported by WASHplus have now been transitioned to the government and other USAID-supported health projects.

Kenya’s deputy Chief Public Health Officer Dr John Kimani addresses the WASHplus Kenya end-of-project experience-sharing workshop held in Nairobi on September 25th 2014. Photo: Elisha Ratem

Kenya’s deputy Chief Public Health Officer Dr John Kimani addresses the WASHplus Kenya end-of-project experience-sharing workshop held in Nairobi on September 25th 2014. Photo: Elisha Ratem

Speaking at the experience-sharing workshop, the Deputy Director for Public Health at Kenya’s Ministry of Health, Dr. John Kariuki, said the WASHplus program had made strategic contributions to improving WASH interventions in the country.

“County legislators should now invest money to continue the process,” he said. “As we have worked with WASHplus, we will as a Ministry continue to give policy direction and guidelines to the counties.”

Said Dr. Kariuki: “The biggest lesson is about equity and sanitation. We cannot talk about a county being ODF if the people who are disabled or the old people are not using latrines. They are Kenyans and have a right to sanitation.”

The official urged stakeholders to lobby county governments to allocate funds for WASH activities:  “It does not happen automatically. You must be proactive, not wait for thing to happen.”

Representatives of organizations that partnered with WASHplus also praised the project for helping to shape the WASH interventions. Charles Ngira of the NGO Plan International said: “We should be talking of inclusive CLTS, not just CLTS. This model will totally solve our sanitation problem.”

Dr. Kariuki called for integrated CLTS programs that promote practices such as hand washing, menstrual hygiene management, the work of traditional birth attendants and air pollution, among other aspects.

“Let’s use CLTS as a vehicle to ensure we improve the health of our people,” he said.

“Sanitation has improved but we need to address equity and inclusion,” said Dr. Mores Loopapit, deputy project director of the USAID-funded APHIAplus Imarisha. “There is need to consider health outcomes in studies on access to hygiene and sanitation.”

Simon Makori, associate director of APHIAplus Nuru ya Bonde, urged stakeholders to support community health volunteers because they play a critical role on promoting WASH practices.

“Community health workers should be engaged in income-generating activities for sustainability,” he said.

For more information about the project, visit the WASHplus Kenya page: http://www.washplus.org/countries/kenya

Pic6_Charles Odira

Pic-4_Makena presents

Pic6_Charles Odira

Update from UNGA and TEDMED: Handwashing, Partnerships, Integration and Innovation

by Layla McCay

Cropped_headshot_reasonably_smallAbout the author: Dr. Layla McCay is the Director of the Public Private Partnership for Handwashing (PPPHW) Secretariat, housed at FHI 360. The USAID-funded WASHPlus Project supports the PPPHW in its efforts to promote handwashing and hygiene improvement. Follow Layla on Twitter: @LaylaMcCay

Partnerships and integration were the buzz words surrounding the UN General Assembly in New York in September. The Public Private Partnership for Handwashing secretariat delved into the deluge of international development players, with the purpose of seeking opportunities for handwashing, and learning about current issues in partnerships for international development.

A key message being reiterated in the development community over the course of UN General Assembly week is that as a community, we are becoming ‘post-public-private-divide’. There is increasing appreciation of the synergies and complementary roles of the different sectors, and an appetite to bring all players together to maximize impact. While that can be easier said than done, tendencies to either sanctify or vilify different sectors or particular players were deemed outdated; instead, the focus this September was on the benefits of working together to inspire and drive better practices all around. In terms of business, there was recognition that social good is starting to move out of the CSR/philanthropy departments to become business as usual, a business investment in efficiency and sustainability – which means we should expect more public-private partnering. Indeed, looking towards the successors to the Millennium Development Goals (MDGs), the Sustainable Development Goals (SDGs) are expected to be key drivers of the multi-sector partnerships that will be needed to deliver them.

Another persistent message during ‘UNGA’ was the importance of integration, as opposed to programming in silos. In the context of handwashing, this means exploring opportunities to integrate handwashing programs ‘horizontally’ into a range of sectors, such as sanitation, nutrition, maternal and child health, healthcare, HIV/AIDS, education, gender empowerment, economic development… but also considering how to integrate ‘vertically’, across the enabling environment, including investment in infrastructure and the social determinants of health. This approach is about harnessing the power of cross-sectoral partnerships to address a range of development challenges being experienced by a population, rather than focusing on single issues. It was striking how many of our development colleagues believed the barrier to meaningful, strategic integration was not just the practicalities of integrating on the ground, but the ‘single issue’ nature of funding for international development. For example, investing in school uniforms may help girls attend school – but to keep them in school, investing in menstrual hygiene materials and facilities may be needed too, but these two interventions may have entirely different funders and programs. The “celebrity couple” of nutrition and hygiene came up repeatedly, with the implication that this “couple” should think about taking their relationship to the next level, with greater integration of nutrition and hygiene work.

Integration across sectors for health promotion was also a theme at the TEDMED conference, which I got the opportunity to attend in September. You can read my general write-up of the whole event here. In terms of food for thought regarding handwashing, there was a compelling discussion about refreshing and diversifying messaging for health promotion. Using the example of breastfeeding promotion, one speaker noted that messages about breastfeeding for babies’ health are important but as these messages become increasingly familiar to people, they (a) risk losing their impact, and (b) only engage a subset of people. However by diversifying the messages to also make breastfeeding a women’s health issue, and a heart health issue (focusing on how breastfeeding reduces the mother’s risk of obesity and heart disease), new lines of engagement are opened, with the opportunity for new champions, new messages, new incentives, greater reach, more targeted appeal, and hopefully more uptake of the behavior. There may be useful lessons for diversifying hygiene messages to expand impact.

My first experience of seeing a ‘celebrity handwashing champion’ in action came in the form of Kajol, at Unilever’s Help a Child Reach 5 hygiene event with USAID. Her messages were simple, but her presence created a clear buzz. In addition to the keen interest of press in the room, some of whom told me they were there specifically to see her, it was interesting to see Kajol’s legions of fan clubs and fans around the world picking up and retweeting her handwashing messages (a tweet I sent about her reached over 100,000 people). This was an interesting insight into the potential reach of handwashing promotion messages from strategically selected and deployed celebrity champions.

Finally, the use of technology to improve hygiene is always an interesting question, and it tends to come up on these forward-looking platforms. It was inspiring, for example, to see examples from Unilever and MAMA of how mobile phones can be used to deliver hygiene education directly to pregnant women. At TEDMED, there was also some interesting discussion about crowdfunding health – using the web to set up facilities like Kickstarter to enable the public to directly fund specific health interventions in specific places. With the Millennials embracing this sort of targeted giving, there could be some interesting opportunities for crowdfunding hygiene in future. Throughout the events, there was significant talk about harnessing the voice, experiences, ideas, and energy of youth to drive progress.

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