Changing WASH Practices in Southwest Bangladesh– One Small Doable Action at a Time

WASHplus’s Julia Rosenbaum co-presented a paper on “Changing WASH Practices in Southwest Bangladesh– One Small Doable Action at a Time” at SACOSAN 6 in Dhaka in January 2016. An abstract for the paper is provide below. Read the paper here.

Abstract: The global USAID WASHplus Project successfully increased access to water, sanitation and hygiene by applying a comprehensive and innovative approach in hard-to-reach areas of southwest Bangladesh. Rather than promoting ideal water, sanitation and hygiene (WASH) infrastructure and behavioral improvements, households were encouraged to take ‘small doable actions’ – feasible yet effective improvements – that moved toward the ideal practice. Through taking this approach, the project met and surpassed all project targets before the end of the project period. Project implementers worked with community members to develop age-specific behaviors for safely disposing infant and child feces and also for patching leaky latrines that dump feces back into the environment.

Citation: Rosenbaum, Hussain, Ferdous, and Islam, January 2016, Changing WASH Practices in Southwest Bangladesh– One Small Doable Action at a Time, FHI 360/Bangladesh, WASHplus Project, WaterAid/Bangladesh,  SACOSAN 6, Dhaka, Bangladesh.

 

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When ODF is Not Enough: Presentatgion on at SACOSAN 6

When ODF is Not Enough: Using a Small Doable Actions Approach to Complement CLTS
and Get Faeces out of the Environment in Southwest Bangladesh,” Presentation by Julia Rosenbaum, Khairul Islam, Muhammad Faruqe Hussain, and Selina Ferdous, SACOSAN 6, January 2016, Dhaka, Bangladesh. See the presentation slides here.

Rosenbaum_Sacosan 6_PPT.png

See the presentation slides here.

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.

 

Bangladesh: Safe Infant Feces Disposal and Job Aids 

 

Bangladesh

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

Handwashing Resources from WASHplus

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

HANDWASHING RESOURCES

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

habitHandwashing and the Science of Habit, Webinar, 2014.  This webinar emphasizes ways to apply the basic science of habit and behavior change to real world health interventions and program delivery, with a focus on behavior change for handwashing with soap.

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

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

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

Global Handwashing Day is for all of us!

Oct 15 is Global Handwashing Day

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

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

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

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

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

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

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

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

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

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.