WASHplus Year Five Annual Report, October 2015

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.

9 AM EST, Feb 16 Webinar: WASHing Away Diseases, Two Hands at a Time

On February 18 at 9:00 AM EST, please join the Global Public-Private Partnership for Handwashing and the USAID/WASHplus project for a webinar discussing why water, sanitation, and hygiene (WASH) matter to neglected tropical diseases (NTDs), and addressing the need for new approaches for multi-sector initiatives to promote equity, poverty alleviation, health, and well-being.

Register here today!

Featuring experts from WaterAid, Sightsavers, the FHI 360-led USAID/WASHplus project, and USAID, this webinar is an excellent opportunity for those working in both WASH and NTDs to learn about the global landscape of WASH/NTD strategy and glean practical insights from projects that are operating in this context.

This webinar will include brief presentations on:

• The link between WASH and NTDs
• How we can work together to achieve common goals through the World Health Organization’s Joint WASH-NTD strategy; and
• Integration in practice.

About the panelists:

• Renuka Bery, MPH, Senior Program Manager for the USAID/WASHplus project, has an extensive background in WASH integration.
• Sophie Boisson, PhD, Technical Officer for Water, Sanitation, Hygiene and Health at the World Health Organization (invited).
• Edouard Tianhoun, RN, MSc, WASH-NTD Coordinator for the USAID/WASHplus Burkina Faso pilot project, has been in involved in WASH programs in his native Burkina Faso since 2011.
• Yael Velleman, MSc, Senior Policy Analyst on Health and Sanitation, leads WaterAid’s strategy, advocacy, and research agenda on health.
• Merri Weinger, MPH, Senior Environmental Health Advisor at USAID’s Bureau for Global Health, has over 30 years of experience in health programs at USAID, WHO, and PAHO.
• Geordie Woods, MPH, Technical Adviser-NTDs at Sightsavers, specializes in health behavior and strategic communication with a technical focus that includes NTDs and WASH.

Following the presentations there will be a Question & Answer session.

Register now!

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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This post is a re-blog and first appeared on the Global Public Private Partnership for Handwashing (PPPHW) website here.

March 22, 2015

By Layla McCay, Secretariat Director, the Global Public-Private Partnership for Handwashing (PPPHW)

Love is in the air – or rather, in the water. This World Water Day, nutrition and handwashing with soap may be the hottest ‘celebrity couple’. The two have been enjoying a close relationship for years, so what has propelled them into the public eye, as seen in recent developments such as the new policy in India mandating handwashing before the midday meal in schools? The answer is integration.

Integration means linking different sectors together to leverage synergies and achieve greater impact than could be achieved working alone. It is also the latest buzzword in international development. At first glance, nutrition and handwashing may not seem like obvious bedfellows. One is about ensuring affordable access to adequately nutritious food; the other is about soap, water and turning a behavior into a habit to prevent infections. But in fact, nutrition and handwashing are closely linked.

The World Health Organization (WHO) tells us that 50 percent of child undernutrition cases are due to repeated diarrhea and intestinal infections caused by poor sanitation and hygiene conditions or by a lack of safe water. This means that handwashing with soap is a critical determinant for achieving and maintaining good nutrition. It plays an important part in preventing micronutrient deficiencies, stunting, wasting and nutrition-related deaths. To properly address child undernutrition, we need to address hygiene.

We know that good nutrition is about more than consuming nutritious foods; it’s about the body’s ability to absorb nutrients. If people don’t wash their hands before handling food, disease-carrying germs have a direct route into their mouth and down into their gut where they can inhibit the body’s ability to use the food’s nutrients. In fact, germs can directly consume nutrients before they even get into the body.^[i] They can also directly damage the intestinal lining (a condition called environmental enteropathy), which contributes to nutrients being lost in feces instead of being absorbed.^[ii] Germs can furthermore irritate the gut lining so that toxins can get inside and cause inflammation – using up nutrients in the process.^[iii] Since children who are undernourished are more susceptible to developing diarrhea when they come into contact with disease-causing germs, lack of handwashing and undernutrition can become a vicious cycle.

Good handwashing with soap can prevent nearly half of all cases of childhood diarrhea. It is also estimated that drinking clean water and handwashing with soap can reduce the loss of nutrients through diarrhea, and reduce stunting in children under the age of five by up to 15 percent.^[iv],[v] Handwashing with soap should be an integral part of nutrition programs, and this World Water Day, let’s think seriously about their integration. #Wateris fundamental to good nutrition through handwashing. It’s time for handwashing and nutrition to take their relationship to the next level.

This World Water Day share what water means to you by using #WaterIs on social media. 

^[i] Solomons NW. Pathways to the impairment of human nutritional status by gastrointestinal pathogens. Parasitology 1993; 107:S19–35.

^[ii] Solomons NW. Pathways to the impairment of human nutritional status by gastrointestinal pathogens. Parasitology 1993; 107:S19–35.

^[iii] Sharp TM, Estes MK. An inside job: subversion of the host secretory pathway by intestinal pathogens. Curr Opin Infect Dis 2010; 23:464–9.

^[iv] Fenn, B. et al. (2012). An evaluation of an operations research project to reduce childhood stunting in a food-insecure area in Ethiopia. Public Health Nutrition, 15(9), 1746-1754.

^[v]  Dangour, A. D. et al. (2013). Interventions to improve water quality and supply, sanitation and hygiene practices, and their effects on the nutritional status of children. The Cochrane Library.

Everybody is Doing It: How Social Networks Can Increase Handwashing

This blog post first appeared on Medium here. This post is authored by Hanna Washburn (@WASH_Hanna), Deputy Secretariat Director for the Global Public Private Partnership for Handwashing (PPPHW). The PPPHW is a coalition of international stakeholders that aims to give families, schools, and communities in developing countries the power to prevent diarrhea and respiratory infections by supporting the universal promotion and practice of proper handwashing with soap at critical times. For more information, contact the Global Public-Private Partnership at +1 202-884-8398 or contact@globalhandwashing.org

If you were asked to describe a social network how would you respond? Would you reference Facebook, Twitter, or other social media sites? Perhaps you’d list an organization you are a part of, such as a professional association. Or, you might have no idea how to describe a social network, but a vague idea that it has to do with relationships.

Which would be true.

At the most basic level, a social network is a group of actors (this could be corporations, groups, individuals, or so on) that are connected to one another in some way. We are all embedded in social networks. We are born into some, such as our families or countries. Others we choose, such as social groups. And still other social networks are dictated to us, such as social standing.

Social networks can be local or global; they can be physical and include those with whom we regularly have contact, but this might not necessarily always be the case. With disease outbreaks, these physical networks are particularly salient, as they can illuminate how illness spreads from one individual to another. Handwashing is a critical public health behavior because when people practice poor hygiene it doesn’t only impact themselves.

Rather, poor hygiene can put whole schools, communities, and regions at risk. The illnesses and diseases that can spread when people don’t wash their hands can quickly move through a whole social network or community.

As such, it takes everyone washing their hands at critical times to promote good public health.

Social networks can also be leveraged to help the vision of universal handwashing to become a reality. One way in which this occurs is through the development of social norms surrounding good hygiene. Social norms are rules that apply to certain situations. For example, a culture might have a social norm that you take your shoes off when you visit someone’s home. People abide by the rule if others do so and if the same is expected of them. These norms are created and governed by the social network. As such, instituting a norm of handwashing can be a powerful way to help make handwashing a habit.

In social networks there are some actors which are more highly regarded than others or better connected. These individuals and organizations can also play an important role in hygiene promotion as they can help to shape norms and create expectations of those in their wide social networks to adopt certain behaviors as social norms. In the fight against Ebola, for example, the Grand Imam of Guinea used his influence to promote behaviors, such as safe burial practices, that are necessary to prevent the spread of the virus.

We all exist within social networks. They can influence us, but we can also use them to influence others in a positive manner.

No matter what your role is, you can be an agent of change for better health by promoting good hygiene in your social networks, and reaching out to motivate those in other social networks to turn handwashing with soap into their network’s social norm too.

Read more about social norms and handwashing here. This post was inspired by a presentation given by Erin Gamble (ACDI/VOCA) and Nicole Fernandez (Georgetown University) discussing social network analysis at a meeting of the D.C.-based Comm4Dev Community of Practice. 

Design, Delivery, and Monitoring & Evaluation for Handwashing With Soap Programs

This course is designed by the Center for Global Safe Water at Emory University and the Global Public-Private Partnership for Handwashing (PPPHW) for program implementers, policy makers, teachers, and M&E specialists on the design, delivery and monitoring and evaluation of hand washing with soap (HWWS) programs. The course is geared towards those interested in promoting handwashing with soap among populations in the Global South.

This course will cover concepts including:

• Community- and school-based HW promotion
• Marketing and social marketing
• Private sector approaches
• Government, NGO and community led-approaches
• Approaches for low- and middle-income settings

At the end of this course, participants will:

1. Understand the current state of knowledge for HWWS
2. Identify current approaches to hygiene and HWWS promotion
3. Utilize a specific behavioral framework to design a program for HWWS
4. Develop a HWWS behavior change strategy
5. Know the steps of developing a HWWS program
6. Become familiar with the basic tools to monitor and evaluate HWWWS program

The course includes two modules that will help participants learn practical guidance on how to design and implement HWWS behavior change programs that target marginalized groups in communities, schools, health centers and other institutions.

Module 1 covers:

• The state of knowledge and evidence base for HWWS
• The key times for to promote HWWS
• The technologies used for HWWS
• How HWWS is promoted by different stakeholders
• Examples of HWWS programs, including current approaches and behavioral frameworks

Module 2 covers:

• Developing a HWWS behavior change strategy
• Planning a HWWS program from buy-in to concept and execution
• Monitoring and evaluating a HWWS program to ensure program sustainability and learning

Click here to download the course curriculum, module 1, module 2, and supplemental readings.

Hand Washing and the Science of Habit: A Webinar

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.  

“Are you still pouring your WASH investments down the drain?”

At Stockholm World Water Week 2014, the USAID funded WASHplus Project in partnership with PPPHW, Wateraid and Plan International organized a side event entitled ‘Are you still pouring your WASH investments down the drain?” The meeting promoted the importance of hygiene in the post-2015 agenda including both handwashing with soap. The purpose  was to alert practitioners and donors that investments in infrastructure will not be able to reap desired benefits if done alone without including hygiene, both handwashing with soap and menstrual hygiene management. It was argued that in addition to health and nutrition benefits associated with the hygiene practices advocated, there are other issues to be considered: economic, educational and equity.

On behalf of WASHplus, Dr. Orlando Hernandez, Monitoring and Evaluation Advisor, presented the findings of a recent analysis on the economic cost implications when handwashing is not addressed. Data for Kenya were presented showing that the Kenyan economy could save $153 million/per year given the disease aversion effects of handwashing. This amount is equivalent just over 50% of the Fiscal Year 2013 USAID investment in Kenya and about one third of the central Kenya government health budget in 2012. The analysis was performed by FHI 360 health economists using a methodology developed by Guy Hutton under the Economics of Sanitation Initiative under WSP sponsorship.

view the full presentation here.

An interconnected approach to improving handwashing behaviors

By Hanna Woodburn, Deputy Secretariat Director, Global Public–Private Partnership for Handwashing (PPPHW)

Each year on Global Handwashing Day, hundreds of millions of people around the world gather to celebrate the power of handwashing with soap to save lives. This day also provides an opportunity to consider the current status of the hygiene sector and catalyze further action. As we look toward the future of hygiene behavior change, we need to ensure that we are maximizing the broader topic of integrated development and fully considering its relationship to hygiene.

Integrated development, which can be defined in many different ways, is increasingly being discussed within the international development community, and FHI 360 plays an active role in convening this conversation. I recently had the opportunity, on behalf of the Global Public–Private Partnership for Handwashing (PPPHW), to attend an event hosted by FHI 360 titled Does 1+1=3? Proving the Integration Hypothesis, which brought together expert panelists from academia, government, donors and nongovernmental organizations.

I took away many key learnings from this event, but the one that stuck with me most is this: If we hope to move the needle on the most entrenched development challenges, we need to consider the benefits that could be offered by combining services or sectors.

Systemic, intentional and strategic integration has the potential to greatly improve handwashing behaviors and boost progress in many other areas of development. For example, handwashing can significantly reduce the risk of diarrhea and other infections, so why not integrate it into education programs, to help reduce absenteeism; into breastfeeding programs, to keep babies healthy during their most vulnerable months; into nutrition programs, to tackle environmental causes of intestinal disorders; and so on?

The PPPHW has taken a leading role in exploring the evidence and practice of integrating hygiene into other program areas, such as nutrition and early childhood development, through our involvement in the Clean, Fed & Nurtured Community of Practice. To truly tackle the world’s development challenges, we must all look toward innovative ways to increase synergy, reduce redundancies and work in collaboration.

In the spirit of integration, on Global Handwashing Day, we call upon our colleagues in all sectors of development to consider how hygiene could be incorporated into current or new programming. Only by working together in smarter ways will we be able to achieve our common goal of ending extreme poverty.

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

by Layla McCay

About 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.