In its Year Five Annual Report, WASHplus has stories to tell, results to share, events to celebrate, and studies that add to the evidence base. WASHplus activities serve as the backdrop for many stories: the Zambian school girl who has access to privacy and menstrual supplies when she needs them, the Malian household that can now build an improved latrine on their rocky soil, the mother in Bangladesh who understands the importance of a feces-free environment, the Nepali home breathing cleaner air as it trials an improved cookstove. And perhaps more compelling than the individual stories are the results the project is beginning to record through endline data collection in Kenya and formative research on school enrollment and in Zambia. Providing water, sanitation, and hygiene (WASH) infrastructure to schools is having a notable impact on enrollment. Community-led total sanitation (CLTS) may be inoculating communities exposed to cholera. Numbers also tell the story of the project’s impact. Look for a snapshot of those figures throughout the report.
The conclusion of field activities in Uganda and Zambia this year provided opportunities to reflect, celebrate accomplishments through end-of-project (EOP) events, and share lessons learned. Several articles were published this year in peer-reviewed journals and others submitted on topics ranging from consumer preferences and willingness to pay for improved cookstoves to habit formation and costing of handwashing. WASHplus also played a key role in preparing the joint document on WASH and nutrition for publication and distribution.
WASHplus’s focus on integrating WASH into other development initiatives enabled the project to get in on the ground floor on subjects that are gaining traction at USAID and globally, such as WASH and nutrition, neglected tropical diseases, and MHM. This integration focus dovetailed nicely with the project’s mandate to serve a technical leadership role, and project staff had many opportunities this year to share its work and lessons from the field on a global stage, strategize with partners on important advocacy issues, inform policy, and develop guidance in multiple countries. Also toward that end, WASHplus launched its first two learning briefs on small doable actions and WASH and nutrition. This series details the variety of approaches WASHplus uses to improve WASH and household air pollution (HAP) across its portfolio of countries.
And finally, it’s been an exciting year for innovation with pilot projects underway in Ethiopia and Bangladesh focusing on sanitation marketing and sand envelopment. These two efforts will add to WASHplus’s body of knowledge on sanitation innovation and aligns closely with USAID’s global interest on the topic. WASHplus is also documenting its fecal sludge management work in Madagascar to tell the next chapter in that story.
Integrating basic science insights from psychology, cognitive science, and behavior change research, “The Science of Habit: Creating Disruptive and Sticky Behavior Change in Handwashing Behavior” presents six principles for creating greater initiation and maintenance of handwashing change. Read the new WASHplus report here.
On October 21, 2015, the Global Public-Private Partnership for Handwashing (PPPHW) and FHI 360 co-hosted a hygiene advocacy event, “What the “H” is the big deal with hygiene?” The event focused on why the “H” in WASH should be silent no longer and how we can help build and maintain the momentum around this crucial component of health and development both in the Sustainable Development Goals (SDGs) and beyond. The event was live streamed and a recording will be made available on the PPPHW website. You can follow the live twitter feed from the learning event here.
Forty attendees from NGOs, universities, and multilateral institutions learned about how Global Handwashing Day was marked around the world, why a hygiene indicator should be included in the Global Goals, and how habits can be leveraged for behavior change. Attendees learned from experts why handwashing matters as we begin to work on the Global Goals, what is new in this old behavior, and how the latest in hygiene behavior change can be applied more widely. To kick off the event, Hanna Washburn, Director of the PPPHW Secretariat spoke on the status of hygiene and why handwashing matters,in the upcoming Global Goals.
WASHplus’s Deputy Director and Behavior Change Specialist Julia Rosenbaum spoke on the latest in hygiene behavior change. Julia’s talk focused on the science of habit as a crucial tool for making hygiene the norm. She spoke about habit formation and how we can make handwashing reflexive (a habit), not reflective. During her presentation Julia also discussed the six underlying principles of a strategy for creating handwashing habits to trigger cues & practice.
Hand Washing and the Science of Habit: A Webinar
On December 4, WASHplus and the global Public Private Partnership for Handwashing (PPPHW) co-hosted a webinar with David Neal, Ph.D., from Catalyst Behavior Sciences and the University of Miami. Dr. Neal is a social psychologist specializing in behavior change and the advanced measurement of human decision making. He discussed the usefulness of habit theory for health programming targeting households. Although he emphasized ways to apply the basic science of habit and behavior change to real world health interventions and program delivery, with a focus on behavior change for handwashing with soap, his ideas are relevant to anyone working on behavior change activities. The webinar was well attended by nearly 200 participants from 15 countries with more than 1,000 subsequent views. The countries included: Bhutan, Cambodia, Canada, India, Nepal, Pakistan, the Philippines, Uzbekistan, and Zambia. A recording of the webinar and slides are available here.
At the 2014 UNC Water and Health Conference, the USAID funded WASHplus Project’s Monitoring and Evaluation Advisor, Orlando Hernandez, coordinated a panel session entitled “The Theory and Practice of Handwashing Habits.” Organized by WASHplus and institutional partners WSP, LSHTM and PPPHW, the panel 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. A summary of the panel session is provided below:
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.