WASHplus Benin Carries Out Experimental Urban CLTS

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WASHplus with local implementing partner ABMS/PSI improves hygiene conditions through behavior change and community mobilization in two peri-urban neighborhoods of Cotonou, the largest city of Benin. Wedged between the Atlantic Ocean and lagoons, Cotonou is floodprone and its slum neighborhoods experience cholera outbreaks during the rainy season. After promoting handwashing with soap and chlorination of household drinking water in 1,700 households, the pressing issue of open defecation came up time and again. The few public latrines are rickety structures built over the lagoons, but most residents prefer open defecation to these unsafe facilities. WASHplus connected with the provincial office of the Ministry of Health (MOH) responsible for sanitation in these zones to join in a first-ever (for Benin) experiment in community-led total sanitation (CLTS) adapted for peri-urban settings.

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After adapting and testing CLTS tools for this new setting, all decision making and influential (social, religious, and governmental) persons from the two target neighborhoods were invited for an institutional “pre-triggering” prior to involving the entire community. They saw results of a simple survey situating the open defecation spots and public and household toilets. Community triggering was carried out on May 13. About 75 residents assembled in an open space, and two trained MOH facilitators led the group through the mapping exercise and a calculation of health-related household expenses. The Walk of Shame was not carried out as the event was far from the open defecation place. The result in urban areas is not necessarily a decision to construct latrines, and in this case, the group decided to create a special task force to follow up the decisions to destroy the open defecation places and work with the rest of the community to come up with solutions, especially concerning work with managers for the improvement of public latrines. The residents expressed a desire for modern toilets and said they were prepared to pay for them.

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CLTS in this setting is different from rural settings, where the local chief has the power to convene and order people to implement decisions. These neighborhoods are extremely heterogeneous. Also, open defecation is forbidden by law, and the residents were reluctant to admit to the practice or to identify the open defecation places, thus the pre-survey came in handy. The participation of the “chef quartier,” the highest ranking local official, provided assurances that the decisions will receive strict follow-up. Plans are underway to replicate the triggering in the other zones of this very extensive neighborhood.

WASHplus Year Five Annual Report, October 2015

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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.

The Science of Habit: Creating Disruptive and Sticky Behavior Change in Handwashing Behavior

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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.

WASHplus Presents Poster at ASTMH 2015

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@wasplusinfo’s Renu Bery presents a poster on integrating into at 2015 ASTMH Meeting!

In October 2015, WASHplus presented a poster at the American Society of Tropical Medicine and Hygiene Annual Meeting on the current situation, intervention design, behavior change plan, and expected results of its Burkina Faso WASH and neglected tropical disease (NTD) pilot activity, called “How Can Integrating Sanitation and Hygiene into an NTD Control Program Accelerate Reduction in NTDs?” View the poster here.

Benin: Model Moms

Benin Model MomsA mother is interviewed as part of the model moms contest.WASHplus implementing partner in Benin ABMS/PSI conducted an informal assessment via simple questionnaire and observations of any hygiene behavior changes in the two peri-urban pilot neighborhoods of Cotonou. This allowed outreach workers to observe improvements in hygiene practices the project is advocating, such as handwashing and point-of-use water treatment, and to select candidates for “Model Mother.” Of the 300 mothers assessed, 123 had perfect scores on a scale of one to 10, with 72 others close behind. Winners will be announced soon with much fanfare to continue to motivate others.

Bangladesh: Safe Infant Feces Disposal and Job Aids 

 

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In August 2015, months of collaborative planning bore fruit as WASHplus carried out a training of master trainers with WASH and nutrition partner SHIKHA. The training for project managers responsible for community and household level outreach focused on Why WASH Matters for Child Growth, and provided new information and skills for safe feces management in USAID Feed the Future areas. Workshop sessions focused on breaking the fecal-oral cycle through latrine improvements and introduced WASHplus’s small doable action (SDA) approach to safe disposal of infant feces. Through this training and subsequent field visits, WASHplus was able to finalize a menu of SDAs for various infant and young child age cohorts. Workshop participants also provided input into job aids to help implement the SDA approach in the field. A second training was held in October. A poster on the subject of infant feces disposal was presented at the Integrated Nutrition Conference, Nairobi, Kenya, in September. In addition, WASHplus has published flipcharts, flashcards, and other materials in Bangladeshi on topics ranging from latrine improvement to tube well construction to menstrual hygiene management. Access the tools here.

SPLASH Project Wraps Up Four Years

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A SPLASH staffer displays MHM materials at the end of project event. Hygiene Behavior Change Technician Mayombo Mandevu displays SPLASH menstrual hygiene management products, accomplishments, and stories at the end-of-project event.

WASHplus’s Schools Promoting Learning Achievement through Sanitation and Hygiene (SPLASH) project ended its four-year program with an event held on August 20 in Lusaka. The half-day event was designed to showcase the different activities that SPLASH carried out to deliver a truly comprehensive school WASH program, what was learned in the process, and most importantly, to advocate for WASH (water, sanitation, and hygiene) to be adopted nationally by the Ministry of Education (MOE) as a key element of quality education. To this end, SPLASH invited every provincial chief of the MOE to attend, along with a range of stakeholders from the WASH and education sectors. The 80 attendees were divided into groups and made the rounds to eight themed stations designed and manned by SPLASH and Government of Zambia partner staff. Each booth showcased a SPLASH intervention with its key activities, achievements, and lessons learned displayed on a poster. A flurry of publications were finalized for the event, including A Teacher’s Guide to Integrating WASH in Schools, School WASH Facilities Operations and Maintenance Guidelines, and two new stories from the field on integrating WASH into existing government programs and infrastructure and school enrollment.

To respond to the project objective of improving learning outcomes, SPLASH undertook a longitudinal study for three terms in 124 intervention and control schools. Results of this analysis by school term indicate a statistically significant effect of the intervention for all indicators tracked: student absenteeism (roll call and two-week recall), teacher absenteeism, and student-teacher contact time. It shows that WASH improvements in schools can reduce student absenteeism by up to 50 percent.

What the H is the big deal with hygiene?

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.

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Handwashing Resources from WASHplus

Make it a habitOn Global Handwashing Day and every day we dedicate ourselves to increasing awareness and understanding about the importance of handwashing with soap to prevent diseases and save lives. Please see below handwashing resources developed by WASHplus on: the small doable approach to handwashing; how to make tippy taps for handwashing; making a habit of handwashing; and integrating WASH  into nutrition and HIV programs.

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sda thumbnailSmall Doable Actions: A Feasible Approach to Behavior Change, Learning Brief, 2015. This brief takes a look at how WASHplus has applied the Small Doable Action approach to handwashing, water treatment, improved sanitation, menstrual hygiene management, and food hygiene.

habitHandwashing and the Science of Habit, Webinar, 2014.  This webinar emphasizes 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.

WASH HIVIntegrating Safe Water, Sanitation, and Hygiene into HIV Programmes: A Training and Resource Pack for Uganda, 2014. This training manual teaches the four key WASH practices: safely transporting, treating, storing, and serving drinking water; safe handling and disposal of feces; safe handling and disposal of menstrual blood; and handwashing with soap (or ash) and water.

WASH nutritionIntegrating Safe Water, Sanitation, and Hygiene into Infant and Child Nutrition Programmes: A Training and Resource Pack for Uganda, 2014. This resource pack can  aid health workers in helping household and community members to overcome, or change, the many daily obstacles to improved water, sanitation, and hygiene (WASH) practices in the home.

tippy tap makingHow to Make Other Types of Tippy Taps, 2014. This pamphlet shows how to make Tippy Taps for handwashing from mineral water bottles, tin cans, and hollow tubes. The tippy tap is a hands free way to wash your hands and is especially appropriate for areas where there is no running water.

Global Handwashing Day is for all of us!

Oct 15 is Global Handwashing Day

By Ron Clemmer, Strategy and Business Development Manager, WASH, FHI 360.

photoAbout the author: Ron Clemmer joined FHI360 in May after working with World Vision as Senior Technical Advisor for WASH for six years. Ron is passionate about building sustainable water and sanitation services through the public and private sectors, hygiene behavior change that becomes habit, and integrated programming of WASH with nutrition, HIV, neglected tropical diseases, education, and women’s empowerment.

Last month at a PTA meeting at our local elementary school the teacher who leads the PTA Health & Wellness Committee announced the upcoming date for Global Handwashing Day.  Several of the parents scrunched up their noses and looked at each other with befuddlement, as if to say “What?! Is there such a thing.  Why is she talking about it?”  So the teacher explained this day focuses on handwashing around the world and how it is important for everyone’s wellness, even in our school.  But for my neighbors, handwashing was either taken for granted or its importance was a mystery or it was just silly.  For my neighbors, handwashing was not valued.

This got me thinking about handwashing.  I already think about handwashing a lot! I think about how to best facilitate the motivation of behavior change so people wash their hands properly even though they live in poor conditions.  I also think about handwashing a lot in my own personal life.  I think about handwashing when my daughter appears at the kitchen table ready to eat much too quickly after she went to wash her hands, and then my wife tells her to try it again using soap and some scrubbing this time.  I think about handwashing when I am eating at a restaurant and I am trying to figure out how to navigate through multiple doors that stand as barriers between me and my hands which I just washed and the target of getting back to the table with my hands still being clean.  And sometimes I think about how I wish I had never gotten into a public health profession because all of this concern about handwashing is just a huge bother!  It is so inconvenient to make sure that our hands are clean!  Much less thinking about everyone else’s hands around us!  Did that waiter just touch the top of my glass with his hands; I’d better ask for a straw!  Or better yet, I had better never eat out again!  Can’t I just forget about hand sanitation for a while!  Handwashing is an endless bother!

Last year, I was at a food security meeting in a session that was talking about the importance of handwashing as part of water, sanitation, and hygiene (WASH) interventions to prevent malnutrition increase from disease burden.  One of the international development professionals said she found it too difficult to wash her hands at every one of the critical times now that she had a baby, as it just took too much time.  But she said people in a village really have to do it because the risk is so much greater.

So handwashing take too much time.  It is such a bother.  And my neighbors do not really value it.  But surely when I am with my WASH colleagues, I find the encouragement and reinforcement to stick with handwashing.  Well…  Actually…  Maybe not always.  One of my WASH colleagues has told me for years of how he has repeatedly sat through a morning of discussion of the critical nature of handwashing with WASH professionals, and then when it is time for lunch, he watches closely and sees hardly anyone going to wash their hands before eating.  Do we think that if we live in the city or that if we are a professional working at a table then we do not need to wash our hands?  Will anyone listen to us talking about the importance of handwashing if we do not practice the behavior we are promoting?  Handwashing must be for someone else besides WASH professionals.

Here are the lessons that I take away from these personal experiences that helps me to think about my professional task of helping people to adopt better handwashing.  For everyone, handwashing is a bother.  For everyone, handwashing is inconvenient.  For everyone, handwashing takes too much time.  For everyone, some people in our communities will really think that handwashing is just plain silly.  And for everyone, hardly anything we can do will protect our health and our children’s health as much as handwashing.

The inconvenience of handwashing is one of the issues which makes the small doable actions approaches of behavior change programming so compelling.   The inconvenience of handwashing an issue which makes handwashing as being a core of being polite in your neighborhood to be such an important motivating factor.  The inconvenience of handwashing is an issue which makes the need for marketing of the aspirational appeal of handwashing to be so important.

So it is a good lesson for me to remember how difficult handwashing and the social norm of handwashing is in the communities where we work, by looking at handwashing in the communities where I live.  So Global Handwashing Day is for everyone!  And since I don’t want my daughter to be sick too much this winter, I hope that my neighbors learn that the value of handwashing for their kids!