Bangladesh—Sending Poo to its Final Address

Bangladesh_Poster_What to do with Infant Poo_WASHplus

WASHplus continued pioneering work developing a menu of small doable actions for the safe disposal of infant feces. Working with program partners, the project team further refined doable behaviors for four cohorts of infant and young children, and worked with designers to develop a set of job aids to integrate Essential WASH Actions into Feed the Future nutrition implementing partner work. The materials all work around the theme “Poo’s Final Address,” highlighting that whether the child defecates in the courtyard, potty, or infant wrapper cloth, the poo needs to end up in the family latrine. This poster provides an overview of the WASHplus approach to infant feces disposal along with examples of small doable actions for several age groups.

Download the poster here.

 

Celebrate Global Handwashing Day: Raise a Hand for Hygiene!

Blue-Raise-a-Hand-250x250-v2

October 15 marks the annual celebration of Global Handwashing Day. Over 200 million people will be promoting one simple behavior that can save lives all over the world—handwashing with soap. Every year, 1.7 million children are killed by diarrhea and pneumonia—two diseases that can be significantly prevented through good hygiene practices. Even with the knowledge that handwashing with soap can improve health and save lives, it isn’t practiced nearly enough, and resources geared toward its promotion, necessary supplies, or facilities are inadequate.

The WASHplus project, funded by USAID, is working diligently to address the lack of infrastructure that prevents access to handwashing with soap, and promoting simple messaging around washing hands with soap at critical times. This can reduce the incidence of diarrhea among children under 5 by 47 percent and respiratory infections by approximately 25 percent.

Hygiene is also critical to educational achievement, ensuring that students don’t miss school due to illness; economics, through increased worker attendance and productivity; and equity, which girls gain when they are able to safely manage menstruation at school. Given the broad impact of hygiene, it is essential that handwashing facilities and behavior change programs be prioritized.

Join us in raising a hand for hygiene on Global Handwashing Day and every day! Enjoy the joyful images of handwashing activities from our project activities, where we work to increase awareness and understanding about the importance of handwashing with soap as an effective and affordable way to prevent diseases and save lives.

Add caption
These school children in Zambia’s Eastern Province know the importance of having clean hands and can now practice good hygiene behavior thanks to the SPLASH (Schools Promoting Learning Achievement through Sanitation and Hygiene) project’s installation of handwashing stations at their school.
Add caption
Plastic water bottles are easy to find and turn into simple tippy taps for handwashing. Strung together on a pole, they make a group handwashing station at a school in Madagascar.
Through SPLASH, WASH-Friendly Schools in Zambia teach students about the importance of hand washing and provide hand washing stations nearby latrines.
Thanks to WASHplus’s SPLASH project in Zambia, students at Kakumbi Primary take their lessons on handwashing seriously and pass these improved behaviors along to their households and communities.
Mother and child in Bangladesh wash hands before mealtime
In Bangladesh, WASHplus works to integrate important WASH (water, sanitation, and hygiene) behaviors into nutrition activities. Washing hands before cooking, eating, or feeding a baby is emphasized to mother’s groups.
Schoolboy washing his hands
This school boy is lucky to attend a WASH-Friendly school that ensures its students have enough latrines for boys and girls with available handwashing stations, a clean schoolyard, and lessons that incorporate important sanitation and hygiene messages.
Children at EPP Ambanitsena washing their hands with soap and water before going home for lunch.
Children in Madagascar wash their hands with soap and water before going home for lunch.
Woman washing hands at a tippy tap in Benin
WASHplus trains community health workers in Benin to make household tippy taps for handwashing using readily available materials. These workers pass on the knowledge through household visits and community events.
A little girl learns to wash her hands before eating
As part of its nutrition screening and referral activity in Mali, WASHplus shows how to wash hands properly with soap before children eat at nutrition centers and before meals are prepared during community cooking demonstrations.
DSC_2120
New water points and soap encourage handwashing at schools in Zambia and also have a profound impact on surrounding communities that are encouraged to use them after attending sensitization training on how to protect the infrastructure and contribute to its maintenance.

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!

WASHplus Participates in Panel on Behavior Change to Facilitate Clean Cooking

On Tuesday April 21, the USAID Translating Research into Action Project (TRAction) held a panel discussion at the National Press Club in Washington, DC to discuss behavior change strategies for clean cooking. The event highlighted lessons from a recently published special issue of the Journal of Health Communication, Advancing Communication and Behavior Change Strategies for Cleaner Cooking.

Household air pollution (HAP), caused by the indoor burning of wood, crop residue, and other solid fuels, causes millions of premature deaths every year. Correct and consistent use of clean cooking technologies and fuels can reduce household air pollution, but adoption requires significant changes to existing cooking behaviors. The special issue of the Journal of Health Communication presents findings on methods to promote the adoption of clean cooking technologies and fuels, and aims to advance our understanding of behavior change related to technology, the enabling environment, and demand creation.

Julia Rosenbaum, USAID/WASHplus Project Deputy Director, and Elisa Derby, the WASHplus Indoor Air Pollution Specialist, co-authored an article in the Journal of Health Communication titled “Behavior Change Communication: A Key Ingredient for Advancing Clean Cooking.” On April 21, Julia joined several guess editors and authors of the special issue to discuss lessons learned and next steps for behavior change in the clean cooking sector. This panel discussion on “Behavior Change for Clean Cooking: Current Knowledge and Next Steps” featured Jay Graham from George Washington University, Sumi Mehta from the Global Alliance for Clean Cookstoves, Nigel Bruce from the University of Liverpool, Anita Shankar from Johns Hopkins University, and Jessica Lewis from Duke University.

During her presentation, Julia emphasized that behavior change is possible by showing examples from the water and sanitation, HIV, and nutrition sectors. She highlighted the need for comprehensive strategies including but not limited to, communication tactics, researching a range of actors on the values chain, and systematically understanding what motivates a particular target group to perform a behavior. One cross cutting approach to changing clean cooking behaviors is to identify small doable actions that are feasible and can have a significant health impact.

View a recording of an interview with Julia below. See her presentation: “Behavior Change Approaches to Facilitate Clean Cooking and Reduced Household Air Pollution” (download presentation slides).

Posters illustrate latrine construction in Mali

The WASHplus Project in Mali developed four posters to illustrate the construction process for latrines it designed for difficult-to-build geographies, such as rocky, sandy, and flood-prone areas.

Mali latrine construction poster

WASHplus will continue its market-based sanitation activities in Mopti. Local builders are currently prototyping latrine models with characteristics identified as preferable during a marketing assessment. A communications firm is implementing a media campaign and marketing strategy for the improved latrine models.

In addition, WASHplus is also working with local implementing partners YAG-TU and Sahel Eco, on Open Defecation Free (ODF) certification of additional villages and implementation of post-certification activities aimed at improving sustainability and minimizing “slippage” after the intervention. WASHplus is also applying the Small Doable Action (SDA) approach to behavior change to improve the adoption of healthy nutrition and hygiene practices among mothers with children under two. The NGO facilitation teams and relais (community health workers) at community level will fine tune the use of WASH-nutrition job aids to negotiate SDA at the household level, the project’s primary mechanism to influence the adoption of healthy practices.

WASHplus Presents at USAID Mini-University 2015

miniu-logo-nodate-sm

WASHplus collaborated with USAID counterparts on three presentations at the Global Health Mini-University in March, with topics that included: 1) Gauging Consumer Preferences on Improved Cookstoves in Bangladesh, 2) Food Hygiene and Child Growth, and 3) Infant Feces Disposal.

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.  

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.

cotonou1

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. 

cotonou2

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.

cotonou3

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.

cotonou4

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.