Approche systémique pour la promotion de l’hygiène en milieu périurbain au Benin

Depuis octobre 2012, le projet WASHplus est mis en œuvre dans deux quartiers périurbains de Cotonou, la principale ville du Bénin. Après une étude de base quantitative et une analyse situationnelle qui ont permis de comprendre la problématique de l’hygiène dans ces quartiers, un programme pilote a été conçu en partenariat avec l’ONG ABMS/PSI. Ce programme pilote comprend un volet communication pour le changement de comportements et un volet de marketing social, et comporte trois axes à savoir le lavage des mains à l’eau et au savon, le traitement et la conservation de l’eau de boisson et enfin l’utilisation et l’entretien des latrines. Les mères et gardiennes d’enfants de 0 à 5 ans constituent la cible principale de ces actions de communication qui envisage de réduire les maladies diarrhéiques et le choléra.

L’analyse situationnelle réalisée au seuil du programme pilote a révélé que les connaissances des habitants des deux quartiers sur les mesures d’hygiène et d’assainissement sont en général faibles. Parmi ceux qui possèdent de bonnes connaissances, beaucoup n’en font pas toujours bon usage. Au manque d’information, s’ajoute l’ancrage des mauvaises habitudes en matière d’hygiène et d’assainissement dans le quotidien des populations, et le manque de disponibilité de produits WASH. Les populations gèrent leurs problèmes au quotidien et personne ne semble se préoccuper des répercussions négatives des actes actuels sur les populations elles-mêmes, les populations environnantes et les générations futures.

On peut donc dire que le défi auquel faisait face les acteurs du projet était très grand. Pour venir à bout de cette situation, des actions croisées de communication pour un changement de comportement étaient nécessaires, actions qui devaient tenir compte de la grande mobilité des populations de ces quartiers, de leurs activités, de leurs différentes occupations au cours d’une journée, bref des espaces qui occupent leurs vies au cours d’une journée.

Les principales caractéristiques des quartiers périurbains de Cotonou sont notamment la forte densité de la population, le dynamisme de la population, l’insertion de cette dernière dans des réseaux associatifs ou religieux qui se caractérise par la présence de nombreuses églises et groupements de femmes, la présence dans ces quartiers d’un nombre important d’écoles, la présence de radios locales très populaires auprès des populations. Ces éléments sont les constituants d’un système qui gouverne la vie dans les quartiers de Enagnon et Agbato.

Par définition, un système est un ensemble d’éléments interdépendants constituant une entité, une unité globale avec une limite. C’est un ensemble d’unités en interrelations mutuelles. Dans le cas d’espèce, le système est composé des ménages, des centres de santé, des écoles, des structures gouvernementales locales ou municipales, des structures religieuses comme églises, des groupements de femmes ou de représentants des quartiers.

Les ménages sont au centre de ce système car les cibles du programme passent une bonne partie de leur temps dans leurs maisons qui constituent donc de véritables espaces de communication et de démonstration des comportements promus par le programme WASHplus. Il n’est donc pas surprenant que les visites domiciliaires soient le principal mode d’action des relais communautaires dans ces deux quartiers. Chaque ménage reçoit deux visites hebdomadaires des relais qui touchent du doigt les dispositifs des lave-mains installés par les ménages ainsi que ceux de conservation de l’eau de boisson et la bonne pratique du lavage des mains et de l’utilisation des latrines.

Les formations sanitaires sont aussi un élément du système. En effet, le programme WASHplus vise les mères et gardiennes d’enfants de 0 à 5 ans et une bonne partie de ces dernières fréquentent ces centres pour les visites postnatales et pour les séances de vaccinations des bébés.

Les groupements sont aussi un élément du système car ils constituent des espaces de solidarité et partage d’expérience entre les membres. Ces groupements sont des associations non formelles qui réunissent essentiellement des femmes. Il s’agit donc de rassemblements de personnes pour un but donné, soit pour mener une activité commune, soit pour l’épargne et le crédit, soit des actions de solidarité. Ils sont le plus souvent constitués de femmes même si certains sont mixtes. Chaque groupement se réunit selon une périodicité donnée pour des activités données. C’est donc au cours de leur réunion que les relais passent les messages du projet WASHplus et échangent à bâton rompu avec les membres. L’intérêt ici est de communiquer avec plusieurs mères et gardiennes d’enfants à la fois.

Les structures religieuses sont un autre élément du système car elles constituent des espaces d’enseignement dont WASHplus s’est approprié pour faire passer le message sur l’hygiène et l’assainissement dans ces communautés. Nous sommes, en effet, en présence de populations très attachées à la pratique de la religion ce qui se remarque par la présence de nombreuses dénominations aussi bien catholiques, protestantes qu’évangéliques ainsi que musulmanes. Les responsables de certaines de ces structures ont donc accepté ouvrir leurs lieux de cultes à l’équipe de WASHplus afin de faciliter la communication avec les fidèles.

Les radios locales font aussi partie du système car elles sont très écoutées par les populations de Enagnon et Agbato. Elles sont donc de puissants outils de communication des messages sur le WASH. L’équipe du projet WASHplus a donc intégré CAPP FM et radio Tokpa, deux radios locales les plus suivies dans sa stratégie de communication avec la population. De nombreuses personnes ont témoigné avoir été touchées grâce aux spots et aux émissions interactives diffusés sur les ondes de ces radios.

Les écoles constituent un maillon important du système en place à Agbato et Enagnon. En effet, il est aujourd’hui démontré que travailler avec les écoles sur les questions WASH conduit non seulement au changement des comportements des élèves, mais exerce aussi une influence indirecte sur ceux de la communauté. Les enfants deviennent auprès de leurs parents des « relais » efficaces pour la duplication et la pérennisation dans la communauté des comportements souhaités ce qui confirme la pensée du poète Victor Hugo qui disait que « chaque enfant qu’on enseigne est un homme qu’on gagne ».

Comme on peut le voir, les différents éléments du système sont en interaction permanente. Les personnes visées par l’intervention à savoir les mères et gardiennes d’enfants se retrouvent en relation avec les différents éléments du système communautaire à des moments donnés de la journée. Ainsi, il n’y a pas de solution unique, exclusive. Les éléments du système fonctionnent de façon à réaliser ses objectifs à partir de différents points de départ et par différents moyens.

L’approche systémique donc est une façon innovante d’appréhender un système humain et de trouver la stratégie optimale pour l’aider à intégrer des changements. Il s’agit de répondre à un besoin de changement en s’appuyant sur les composants fondamentaux de la communauté afin de mobiliser les acteurs concernés dans une direction donnée de sorte à produire un résultat utile pour ces acteurs.

Grâce à cette approche le message du projet WASHplus passe par différents faisceaux pour atteindre les mères et gardiennes d’enfants parce qu’elles se trouvent à un moment donné de la journée ou de la semaine en contact ou impliquées dans l’un des éléments de ce système.

Armand A. AGUIDI
Coordonnateur WASHplus au Bénin

WASHplus Weeklies

WASHplus Weekly: The WASHplus Weekly highlights latest research and resources on topics such as Water, Sanitation, Hygiene, Household Air Pollution, Clean Cooking, Innovation, Nutrition, Food Safety, WASH in Schools, WASH Integration, and more.

2016

Issue 224 July 8, 2016 Focus on WASHplus Project Publications
Issue 223 May 25, 2016 Focus on Menstrual Hygiene

Issue 222 April 5 2016 Focus on the State of Handwashing
Issue 221 March 21 2016 Focus on Water Quality, Supply, and Livelihoods

Issue 220 March 4 2016 Focus on WASH and Nutrition
Issue 219 Feb. 19 2016 Focus on Sustainability, Accountability, and Governance
Issue 218 Feb. 5 2016 Focus on Behavior Change and WASH
Issue 217 Jan. 22 2016 Q&A on Investments in Cookstoves with Jörg Peters, RWI
Issue 216 Jan. 8 2016 Q&A with Adam Creighton

2015

Issue 215 Dec. 18 2015 Focus on Water Quality
Issue 215 Dec. 7 2015 Focus on WASH in Schools
Issue 213 Nov. 6 2015 World Pneumonia Day 2015
Issue 212 Oct. 30 2015 Focus on Enabling Environments
Issue 211 Oct. 23 2015 Lessons Learned in Sanitation
Issue 209 Oct. 9 2015 Focus on Global Handwashing Day 2015
Issue 208 Sept. 25 2015 Focus on Water & Agriculture
Issue 207 Sept. 18 2015 Focus on Handwashing Research
Issue 206 Sept. 11 2015 Focus on Cookstoves for Displaced Populations
Issue 205 Sept. 4 2015 Focus on Neglected Tropical Diseases
Issue 204 August 28 2015 Focus on WASH & Innovation
Issue 203 August 21 2015 Focus on World Water Week 2015
Issue 202 August 14 2015 Focus on Community-Led Total Sanitation (CLTS)
Issue 201 August 7 2015 Focus on Animal Waste Management
Issue 200 July 31 2015 Focus on Wearables for WASH & Health
Issue 199 July 17 2015 Focus on WASH & Financing
Issue 198 July 10 2015 Focus on Waste Pickers
Issue 197 July 2 2015 Focus on WASH & Nutrition
Issue 196 June 26 2015 Management of Infant and Child Feces
Issue 195 June 19 2015 Role of Women in Clean Cooking
Issue 194 June 5 2015 WASH & HAP & Child Health
Issue 193 May 28 2015 Menstrual Hygiene Management
Issue 191 May 15 2015 Focus on WASH & Pastoralism
Issue 190 May 8 2015 Focus on Hygiene
Issue 189 May 1 2015 Focus on Desalination
Issue 188 April 24 2015 Behavior Change in the Clean Cooking Sector
Issue 187 April 17 2015 WASH and Enabling Environments
Issue 186 April 10 2015 WASH in Non-Household Settings, including Schools
Issue 185 April 3 2015 Focus on World Health Day 2015 – Food Safety
Issue 184 March 27 2015 Focus on Water Safety Plans (WSP)
Issue 183 March 20 2015 Focus on Microfinance
Issue 182 March 13 2015 Focus on Urban Wastewater
Issue 181 March 6 2015 Community-Led Total Sanitation
Issue 180 Feb 27 2015 Water Quality
Issue 179 Feb 20 2015 Focus on WASH & Nutrition
Issue 178 Feb 13 2015 Focus on Barriers to Improved Cookstove Adoption
Issue 177 Feb 6 2015 Focus on Rainwater Harvesting (RWH)
Issue 176 Jan 30 2015 Focus on Fecal Sludge Management (FSM)
Issue 175 Jan 23 2015 Focus on WASH & Zoonotic Diseases
Issue 174 Jan 16 2015 Focus on Handwashing Research
Issue 173 Jan 9 2015 Focus on Multiple-Use Water Services

2014

Issue 172 Dec 19 2014 Focus on Clean Cookstoves
Issue 171 Dec 12 2014 Focus on WASH & Nutrition
Issue 170 Dec 5 2014 Focus on WASH & Climate Change
Issue 169 Nov 26 2014 Focus on Monitoring, Evaluation, Resolution, and Learning (MERL)
Issue 169 Nov 14 2014 Focus on World Toilet Day 2014
Issue 168 Nov 7 2014 Focus on WASH in Public Facilities
Issue 167 Oct 31 2014 Focus on WASH and Ebola
Issue 166 Oct 24 2014 Focus on Clean Cookstoves
Issue 165 Oct 10 2014 Focus on Community-Led Total Sanitation (CLTS)
Issue 164 Oct 3 2014 World Habitat Day – Focus on Slums
Issue 163 Sept 26 2014 Focus on Sanitation as a Business
Issue 162 Sept 19 2014 Focus on WASH & Human Rights
Issue 161 Sept 12 2014 Focus on Rural Water Supply
Issue 160 Sept 5 2014 Focus on WASH & Nutrition
Issue 159 August 29 2014 Focus on Cookstoves Monitoring & Testing
Issue 158 August 22 2014 Focus on WASH and Monitoring
Issue 157 August 8 2014 Focus on Disease Outbreaks
Issue 156 August 1 2014 Focus on Hand Washing
Issue 155 July 25 2014 Focus on Clean Cooking in Nepal
Issue 154 July 18 2014 Focus on Gaming Applications for WASH
Issue 153 July 11 2014 Focus on Fecal Sludge Management
Issue 152 July 3 2014 Focus on WASH and Nutrition
Issue 151 June 27 2014 Focus on Violence and Gender in the WASH and
Issue 150 June 20 2014 Focus on Gender Mainstreaming and Clean Cookstoves
Issue 149 June 6 2014 Focus on Community-Led Total Sanitation (CLTS)
Issue 148 May 30 2014 Focus on the Future of Water
Issue 147 May 23 2014 Focus on Menstrual Hygiene Day
Issue 146 May 16 2014 Focus on Clean Cookstoves and Behavior Change
Issue 145 May 9 2014 Focus on Information and Communications Technology (ICT)
Issue 144 May 2 2014 Focus on Sanitation
Issue 143 April 25 2014 Focus on WASH and Nutrition=
Issue 142 April 18 2014 Focus on Sanitation and Water for All
Issue 141 April 11 2014 Focus on WASH and Maternal Health
Issue 140 April 4 2014 Focus on Child Feces Disposal
Issue 139 March 28 2014 Global Burden of Disease from Household Air Pollution
Issue 138 March 21 2014 Focus on World Water Day 2014
Issue 137 March 7 2014 Focus on Multiple-Use Water Services
Issue 136 February 28 2014 Focus on Learning from Failure
Issue 135 February 21 2014 Focus on WASH-Related Diseases
Issue 134 February 14 2014 Focus on WASH and Small Towns
Issue 133 February 7 2014 Focus on WASH and Design Thinking
Issue 132 January 31 2014 Focus on Handwashing
Issue 131 January 24 2014 Focus on WASH and Nutrition
Issue 130 January 17 2014 Focus on Sanitation Marketing
Issue 129 January 10 2014 Focus on Carbon Finance for Cookstoves
Issue 128 January 3 2014 Focus on Microfinance

2013

Issue 127 December 20 2013 Focus on Inclusive WASH
Issue 126 December 13 2013 Focus on Community-Led Total Sanitation
Issue 125 December 6 2013 Focus on ICS Adoption in Bangladesh
Issue 124 November 22 2013 Household Water Treatment & Safe Storage
Issue 123 November 15 2013 Focus on World Toilet Day 2013
Issue 122 November 8 2013 Focus on Self Supply
Issue 121 November 1 2013 Focus on the Health Impacts of WASH Interventions
Issue 120 October 11 2013 Focus on Hand Washing
Issue 119 October 4 2013 Focus on Cookstoves and Consumers
Issue 118 September 27 2013 Focus on Management of Health Care Waste
Issue 117 September 20 2013 Focus on WASH and Nutrition
Issue 116 September 13 2013 Focus on Rural Water Supply
Issue 115 September 6 2013 Focus on Monitoring & Evaluation of Cookstoves
Issue 114 August 30 2013 Focus on Water Cooperation
Issue 113 August 23 2013 Focus on WASH and Emergencies
Issue 112 August 16 2013 Focus on Sanitation Marketing
Issue 111 August 9 2013 Cholera Prevention and Control
Issue 110 August 2 2013 Household Energy and Climate Change
Issue 109 July 26 2013 Focus on Rural Water Supply and Sanitation
Issue 108 July 19 2013 Focus on Food Hygiene

Issue 107 July 12 2013 Focus on Menstrual Hygiene Management, 2nd Edition
Issue 106 July 3 2013 Focus on Behavior Change

Issue 105 June 28 2013 Focus on Sanitation for Preschool-Age Children
Issue 104 June 7 2013 Focus on Microfinance for Sanitation
Issue 103 May 31 2013 Focus on Cookstove Fuels
Issue 102 May 24 2013 Focus on WASH-Related Diseases
Issue 101 May 17 2013 Focus on Rainwater Harvesting
Issue 100 May 10 2013 Focus on Community-Led Total Sanitation
Issue 99 May 3 2013 Focus on Water and Food Security
Issue 98 April 26 2013 Cookstoves and the Environment
Issue 97 April 19 2013 A Hand Washing Update
Issue 96 April 12 2013 Focus on Financing WASH Services
Issue 95 April 5 2013 Focus on Urban Sanitation
Issue 94 March 29 2013 Focus on Health Impacts of Household Air Pollution
Issue 93 March 21 2013 Focus on World Water Day 2013
Issue 92 March 15 2013 Focus on WASH Sustainability
Issue 91 March 8 2013 Focus on Gender Issues
Issue 90 February 22 2013 Focus on Sanitation Marketing
Issue 89 February 15 2013 Focus on Household Water Treatment & Safe Storage (HWTS)

Issue 88 February 8 2013 Focus on Neglected Tropical Diseases
Issue 87 February 1 2013 Focus on Cookstove Stacking
Issue 86 January 25 2013 Focus on WASH and Maternal Health
Issue 85 January 18 2013 Focus on Post-2015 MDG Goals, Targets and Indicators
Issue 84 January 11 2013 Focus on WASH and Environmental Conservation

2012

Issue 83 December 21 2012 Focus on HAP and the Global Burden of Disease
Issue 82 December 14 2012 Focus on Community-Led Total Sanitation
Issue 81 December 7 2012 Focus on Water Kiosks
Issue 80 November 30 2012 Focus on Fecal Sludge Management
Issue 79 November 16 2012 Focus on World Toilet Day 2012
Issue 78 November 9 2012 Focus on World Pneumonia Day 2012
Issue 77 November 2 2012 Focus on Water Conflicts
Issue 76 October 26 2012 Focus on Climate Change
Issue 75 October 19 2012 Focus on Waste Pickers
Issue 74 October 12 2012 Global Handwashing Day
Issue 73 October 5 2012 Focus on Water Technologies
Issue 72 September 28 2012 Focus on Entrepreneurship in WASH and Household Energy
Issue 71 September 14 2012 Focus on Household Water Treatment & Safe Storage
Issue 70 September 7 2012 Focus on WASH and Child Survival
Issue 69 August 31 2012 Focus on Biogas for Cookstoves
Issue 68 August 24 2012 Focus on Multiple-Use Water Services
Issue 67 August 17 2012 Focus on Water and Food Security
Issue 66 August 10 2012 Focus on Cholera Prevention and Control
Issue 65 August 3 2012 Focus on Menstrual Hygiene Management
Issue 64 July 27 2012 Focus on Marketing Cookstoves
Issue 63 July 20 2012 Focus on HIV AIDS and WASH
Issue 62 July 13 2012 Focus on Soil-Transmitted Helminth Infections
Issue 61 July 6 2012 Focus on Community-Led Total Sanitation
Issue 60 June 29 2012 Focus on WASH in Emergencies
Issue 59 June 8 2012 Focus on Public-Private Partnerships
Issue 58 June 1 2012 Focus on WASH-Related Diseases
Issue 57 May 25 2012 Focus on the Integration of WASH and the Prevention of IAP
Issue 56 May 18 2012 Focus on Water Security

Issue 55 May 11 2012 An Update on Sludge Management
Issue 54 May 4 2012 Focus on Self Supply
Issue 53 April 27 2012 Focus on Cookstove Adoption
Issue 52 April 20 2012 Focus on Small-Scale WASH Service Providers
Issue 51 April 13 2012 A Hygiene Behavior Update
Issue 50 April 6 2012 Focus on the Informal Sector and Solid Waste Management
Issue 49 March 30 2012 Focus on Nanotechnology
Issue 48 March 23 2012 Focus on Urban Health
Issue 46 March 8 2012 Gender Considerations for WASH and IAP
Issue 45 March 2 2012 A Focus on Multiple-Use Water Services (MUS)
Issue 44 February 24 2012 A Focus on Adoption of WASH and IAP Interventions
Issue 43 February 17 2012 A Focus on Ecological Sanitation
Issue 42 February 10 2012 WASH and Neglected Tropical Diseases
Issue 41 February 3 2012 Year in Review, Household Water Treatment & Safe Storage
Issue 40 January 27 2012 Health Impacts of WASH and IAP Interventions from 2011
Issue 39 January 20 2012 Year in Review – 10 Key Studies on CLTS from 2011
Issue 37 January 6 2012 Focus on WASH and IAP Technologies

2011

Issue 36 December 16 2011 Focus on Financing Examples for WASH and IAP Interventions
Issue 35 December 9 2011 Focus on Water Safety Plans
Issue 34 December 2 2011 Focus on Rainwater Harvesting
Issue 33 November 18 2011 Focus on World Toilet Day and Communal Sanitation
Issue 32 November 11 2011 Focus on the Prevention of Pneumonia

Issue 31 November 4 2011 Focus on Water Point Mapping
Issue 30 October 28 2011 Focus on Menstrual Hygiene Management

Issue 29 October 21 2011 Focus on Carrying Water
Issue 28 October 14 2011 Focus on WASH and Climate Change
Issue 27 October 7 2011 Focus on Hand Washing
Issue 26 September 30 2011 Focus on WASH and Humanitarian Assistance
Issue 25 September 23 2011 Focus on Sanitation Marketing
Issue 24 September 9 2011 Focus on Reuse in Sanitation
Issue 23 September 2 2011 Focus on WASH for the Disabled
Issue 21 August 19 2011 Focus on Sludge Management
Issue 20 August 12 2011 Focus on Cholera Prevention and Control
Issue 19 August 5 2011 Focus on Indoor Air Quality (IAQ)
Issue 18 July 29 2011 Focus on Prevention and Treatment of Diarrhea
Issue 17 July 22 2011 Focus on Drinking Water Quality
Issue 16 July 15 2011 Focus on HIV AIDS and WASH
Issue 15 July 8 2011 Focus on Marketing Approaches
Issue 14 July 1 2011 Focus on Household Water Treatment and Safe Storage
Issue 13 June 24 2011 Focus on Hygiene Behavior
Issue 12 June 17 2011 Focus on Mobile Technologies
Issue 11 June 10 2011 Focus on Monitoring and Evaluation
Issue 11 June 3 2011 Focus on the Health Impacts of WASH Interventions
Issue 9 May 27 2011 Focus on Financing
Issue 8 May 20 2011 Focus on WASH and Urban Issues
Issue 8 May 13 2011 Focus on Community-Led Total Sanitation

Issue 7 May 6 2011 Focus on Gender & WASH
Issue 6 April 29 2011 Focus on the Integration of IAQ WASH and Schools
Issue 5 April 22, 2011 Focus on the Integration of WASH and IAQ
Issue 4 April 15, 2011 Focus on Household Water Treatment and Safe Storage
Issue 3 April 8, 2011 Focus on Handwashing
Issue 2 April 1 2011 Focus on Sanitation

Issue 1 March 1 2011 Welcome to Washplus Updates

Voices from Bangladesh: Reflections on SACOSAN VI

Reblogged from PPPHW blog.

julia rosenbaumBy Julia Rosenbaum, Senior Behavior Change Advisor USAID/WASHplus Project

I recently attended the 6th South Asian Conference on Sanitation (SACOSAN VI), held in Dhaka, Bangladesh. Given the clear ties between sanitation and hygiene, I was asked to provide commentary on the prevalence and discussion around hygiene at SACOSAN. A commentary on hygiene, however, first begs the question, “What is hygiene?”, as it means many things to many sacosanpeople. To some, hygiene pertains exclusively to handwashing with soap. To others, it includes food hygiene and treatment and safe storage of household water. To others, still, it means any “software” or promotional aspect of within water, sanitation, and hygiene (WASH) generally, such as behavior change. It is fair to generalize that hygiene was comprehensively defined at SACOSAN including the “software” side of WASH, specifically regarding sanitation, handwashing, and menstrual hygiene management.

A major theme throughout the conference was a renewed call for representation and inclusion through the human right to sanitation. This was true in terms of hygiene, too.

Representation and inclusion were perhaps best represented in a session that highlighted a new publication and spotlighted issues facing women, adolescent girls, the elderly, persons with disabilities, and those in the sanitation workforce. Leave No One Behind, a stunning new publication of Freshwater Action Network South Asia and the Water Supply and Sanitation Collaborative Council, seeks to give voice to those too often neglected and excluded from both political processes and access to sanitation and hygiene services. The objective of the publication and the initiative is to assure inclusion and representation, considered essential to achieving the newly agreed upon Sustainable Development Goals.

The session corresponding with the Leave No One Behind report illuminated the tremendous obstacles and humiliation suffered by these individuals and the corresponding consequences—including indignities, poorer health, and safety concerns. Yet, despite the many conversations about access, what was most poignant to me was the overall inaccessibility of the conference center despite efforts to find a more accessible venue. Clearly, in many contexts, access needs to be better ensured and not merely discussed. While the focus of this session was to highlight the “voices” of those featured in the report, there was a striking absence of positive examples and best practices that have been refined over the past decade and do provide access to many who might otherwise be left behind. Showcasing ways that access can be achieved—for instance, displays of simple latrine and handwashing station modifications to allow access to the differently abled, the elderly, the deaf, blind, and mute—or outlining inclusion strategies and approaches gaining prominence could have prompted session participants to not merely discuss the need for inclusion but also inspired action.

While I wish that the accessibility issues faced by participants had been addressed, there were many highlights of the conference. It was heartening to see participants spontaneously organize a special side session on menstrual hygiene management (MHM), as it was not prominently included in the program. Facilitated by WaterAid and featuring a wide range of panelists including government officials, global leaders, and community representatives, this lively session filled a gap and helped to prioritize menstrual hygiene management in the SACOSAN declaration and commitments.

The meeting’s hygiene promotion session was coordinated by the Afghani Delegation. The four technical papers that comprised this session—including one co-authored by USAID/WASHplus—comprehensively defined hygiene promotion. As a result, there was a large focus on sanitation best practice and innovation, such as improving sanitation and hygiene (mostly handwashing) practices in geographically-challenged areas, fostering strategies to improve sanitation coverage and developing approaches to improving sanitation practice (i.e., latrine use) and consistent and correct handwashing with soap. A forth session focused on MHM, and boldly shared the failures attributed to not thoroughly consulting with school girls and administration, as well as successes.

Hygiene was also prominent in a plenary session chaired by BBC Media Action (formerly BBC World Service Trust). Via a provocative video presentation, behavior change specialist Dr. Val Curtis with the London School of Hygiene and Tropical Medicine, highlighted three elements—surprise, revaluation, and performance—as fundamental and effective at improving WASH. This video was followed by prominent national journalists who discussed how to get the public to engage in topics considered unpleasant and often taboo by capturing audience attention and greater media visibility.

The linkages between sanitation and hygiene are clear, and it is encouraging that hygiene was featured prominently in the meeting’s Declaration and Commitments where every mention of sanitation included “… and hygiene”. I am hopeful that the calls for representation and inclusion of the vulnerable and underserved that were made during SACOSAN will lead to a truly enabling environment, and that we will learn from our oversights and collaborate going forward to improve access to sanitation and hygiene for all.

Celebrate Global Handwashing Day: Raise a Hand for Hygiene!

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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.

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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.
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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.
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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.

Celebrating World Health Day: Why Food Hygiene Matters

You are what you eat

It is estimated that 2 million deaths occur every year from contaminated food or drinking water. Diarrheal disease alone kills an estimated 1.5 million children annually, and most of these cases are attributed to contaminated food or drinking water, according to the World Health Organization (WHO). 

In Uganda, the WASHplus project worked closely with USAID implementing partners including Community Connector, SPRING, STAR-SW, FANTA, and others to integrate WASH and aspects of food hygiene, among other interventions, into HIV care and support. WASHplus developed a series of job aids to support outreach workers and clinical counselors to integrate WASH into their home-based and clinical practice. The job aids are available in English, and two local languages, Rukiga and Rufumbira. Also, notable in WASHplus’s work in Uganda is the application of the small doable action approach to food hygiene to address local challenges of keeping food safe.

Resources developed by WASHplus are provided below.

Integrating Safe Water, Sanitation, and Hygiene into Infant and Child Nutrition Programmes. A Training Resource Pack for Uganda, 2014.

Integrating Safe Water, Sanitation, and Hygiene into Infant and Child Nutrition Programmmes

In Uganda, the WASHplus project is integrating WASH into to Nutrition and Feed the Future Programming. Integrating WASH into nutrition focuses on the importance of improving household sanitation and nutritional needs in a child’s first 1,000 days. By building capacity of implementing partners and district focal and community resource personnel, WASHplus facilitated the integration of WASH into clinical nutrition assessment, home visits with householders of small children and families affected by HIV, and through community mobilization campaigns. For example, Community Connector now not only includes WASH as part of the model homes in its 1,000 days campaign, the project included WASH in its community drama initiatives, radio talk show, behavior change communication materials, and field day exhibition, which emphasized the integration of nutrition, agriculture, income, and WASH. Integrating WASH into the District Nutrition Coordination Committees further emphasized the importance of WASH and nutrition integration during the budgeting process, implementation, and supervision of district efforts to fight undernutrition.

Small Doable Actions for Improving Household Water, Sanitation, and Hygiene Practices. Job Aids for Village Health Teams, Peer Educators, and their Supervisors (English, RufumbiraRukiga), 2104.

Small Doable Actions for Improving Household Water, Sanitation, and Hygiene Practices -Job Aids for Village Health Teams_Peer Educators_Supervisors

Small Doable Actions for keeping food safe

Working with SPRING, WASHplus created the first-ever job aids promoting small doable actions for food hygiene, based on the World Health Organization’s “Five Keys to Safer Food.” The job aids address issues of food safety during preparation, serving, and related to storage. This initiative directly addressed the contribution of poor food handling in spreading contamination that leads to diarrhea. Other job aids highlight safe disposal of infant and animal/poultry feces, which may be significant contributors of undernutrition and inhibitors of growth according to a growing evidence base. Feces from these sources find their way to a child’s mouth through food or water contamination or through direct ingestion, causing diarrhea, enteropathy, and contributing to the excessive growth stunting documented in the region.

Additional WASHplus Resources

You Are What You Eat: Why Food Hygiene Matters for Child Growth. Julia Rosenbaum, FHI 360/Deputy Director of the USAID funded WASHplus Project, and Merri Weinger, USAID/Bureau for Global Health/Environmental Health Team leader. A presentation at the USAID Mini-University, March 2015.

Why WASH Matters for Improved Child Health, Nutrition & Growth: A Knowledge Sharing Event. Julia Rosenbaum, FHI 360/Deputy Director of the USAID funded WASHplus Project, June 2014.

Hygiene Intervention Reduces Contamination of Weaning Food in Bangladesh, Islam et. al. Tropical Medicine and International Health, Volume 18, no 3, pages 250–258, March 2013.

From triggering behaviour change to sustaining it: Interview with Julia Rosenbaum

julia rosenbaum An interview with Julia Rosenbaum, Deputy Director and Behavior Change Advisor of the  WASHplus Project, conducted by Carmen da Silva Wells, Programme Officer with IRC, at  the 5th WASH Sustainability Forum in Amsterdam. This blog post is authored by Carmen  da Silva Wells, and published on June 29, 2014 on the IRC website here.

 This week, the 5th WASH Sustainability Forum will bring together representatives from civil  society, government, universities and the private sector eager to share ideas on how to  make our investments and efforts in water sanitation and hygiene have sustainable results.

Water, Sanitation, and Hygiene will each be explored as separate ‘tracks’ at the Forum. I spoke to Julia Rosenbaum, who leads the Handwashing/Hygiene track and is Senior Behaviour Change Advisor for WASHplus, a five-year project funded by USAID and managed by FHI 360 . At the Forum she will guide sector experts to take stock of what tools exist, and brainstorm the sort of tools that would be most helpful to support sustainable handwashing and household water safety. A panel discussion will bring in private sector expertise on behaviour change.

What do we mean when we talk about sustainability in handwashing and hygiene?

“The hygiene track focuses on handwashing with soap and household drinking water treatment, safe handling and storage. On these issues, sustainability is all about sustaining consistent and correct practice – or sustained behaviour change. Individual behaviours are actually the bottom line for all sustainable WASH improvements.

In order to plan and implement hygiene interventions with lasting impacts we need to better understand what triggers behaviour change and motivates people to sustain hygienic behaviours. There is limited conclusive evidence on hygiene behaviour change, but we do know that people are motivated by other factors than health or fear of disease, the things WASH and health practitioners often focus on.

Julia 5th WASH forum quote

For water treatment, people’s estimation of their ability to do something different, costs related to the new behaviour and the taste of treated water are key drivers. Social aspects of behaviour change should not be underestimated either. Group norms and peer support such as regular house visits by community health workers to follow up have all been shown to be influential in getting people to treat their water. Besides social factors, knowledge and the hardware, sustained behaviour change requires a long term commitment and resources beyond the project duration.”

The Triple-S tools mapping study found that more sustainability tools have been developed for water supply than for sanitation and hygiene. Despite an extensive search and engagement with relevant networks, you have found very few tools that address sustainability in handwashing and hygiene. What tools are there?

“Currently there are a few tools that monitor sustainability in handwashing and hygiene, but it is an area that is open for development! We hope the Forum will be an opportunity for sharing ideas and generating enthusiasm to take up the challenge to help develop such tools.”

It is critical to gather clear evidence of which elements support the consistent and correct practice of the behaviours over time. Beyond tools, a key challenge for the WASH sector as a whole is moving away from a project orientation: Interventions are donor driven and projects have a limited funding time frame, so funding to conduct any sort of sustainability assessment dries up before sustainability can be assessed.

Civil society, governments and the private sector all have a key role to play in supporting individuals and households to practice safe hygiene.The kick-off event organised by RAIN on working with governments underscored the importance of engaging government and ensuring that there are financial commitments towards sustaining change after projects end.

 

African EduWeek 2014: Expert Interview with Justin Lupele

lupele_justin_2013_200x220 An interview with Dr. Justin Lupele, Chief of Party, WASH Project in Zambia.  He is part of an  expert panel at the upcoming 2014 African EduWeek on “Educating in today’s social and  economic climate: Best approaches for educational challenges.”  This interview first appeared on the African EduWeek 2014 website here.

1)    Please can you give us some background on your organisation and your role? SPLASH is a five-year USAID-funded project that aims to reach 246,000 primary school pupils in four districts of Eastern Province, Zambia (Mambwe, Chipata, Lundazi, and Chadiza). SPLASH is implemented by WASHplus, which is managed by FHI 360 as a prime and CARE as a sub-grantee. The project works within the Ministry of Education, Science, Vocational Training, and Early Education (MESVTEE) and other line ministries such as Ministry of Local Government and Housing (MLGH) and Ministry of Health (MOH). SPLASH’s overall objective is to sustainably improve access to safe water, adequate sanitation, hygiene information and health practices to improve learning environments and educational performance in basic schools.  The overall objective will be achieved by means of the following five key task areas:

  1. Install and rehabilitate improved WASH infrastructure in schools using a service-delivery framework
  2. Improve hygiene behaviors and health of learners and teachers and subsequently their communities
  3. Strengthen local governance and coordination of WASH in Schools through the involvement of multiple stakeholders
  4. Engage those who set policies at the national, provincial, and district levels to support WASH in Schools
  5. Strengthen the capacity of small-scale service providers and the private sector to deliver WASH goods and services on a sustainable basis.

I am the Chief of Party/Project Director.

2)    What education focused projects are you involved in that you are particularly excited about? The project is involved in hygiene education. I am particularly interested in menstrual hygiene management education. Through this programme we are enabling hundreds of girl children that have reached puberty to attend class as we encourage the provision of sanitary towels and washrooms for girls to manage their menses and continue to attend classes.

3)    What in your view are the main challenges in education in Africa? The main challenge of education in Africa is the low investment by most countries. The national budgets on education are very low – in most cases less than 20% of the total budget. Deployment of qualified teachers, often trained at the country’s expense is another challenge. In the efforts of reducing wage bills, trained teachers are not being employed. This results in having schools that are managed by untrained teachers. HIV/AIDS has also contributed to the attrition of teachers.

4)    What surprises you about your work? I am surprised at my work that ministries of education in Africa and other discussions around quality of education do not tackle water and sanitation as one of the factors that contribute to education quality.

5)    You are part of an expert panel on socio-economic issues in the education at African EduWeek.  What will be your message at EduWeek this year? My message will be to urge participants and governments in Africa to look at education quality holistically and to invest in water, sanitation and hygiene education. 6)    What are you most looking forward to at African EduWeek? I am looking forward to learning from others, insights on how to improve learner attendance, especially girl children in rural Africa, and ways of lobbying governments to increase funding to education.