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.

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

WASH NTDs webinar

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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Nutrition and Handwashing

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 2and 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.