The usefulness of a handwashing proxy in large household surveys

WASHplus’s Monitoring, Evaluation, Research, and Learning Advisor, Orlando Hernandez, co-authored a paper on the usefulness of a handwashing proxy in large household surveys. An abstract of the paper is provided below.

“Handwashing with soap is a cost-effective way of reducing diarrheal disease mortality in children under 5. Tracking this practice among child caretakers is a challenge, as the gold standard method – structured observations – is cumbersome, costly, and conducive to over-performance. The water, sanitation, and hygiene (WASH) field needs a valid, reliable proxy to track handwashing with soap in large surveys. This proxy is crucial as the new 2015–2030 Sustainable Development Goals (SDGs) may track hygiene. Using data from the Multiple Indicators Cluster Survey (MICS) and the Demographic Health Survey (DHS) from five countries, we conducted multivariate analyses to explore an association between the presence of functional handwashing stations (HWSs), (together with needed supplies) and the likelihood of lower reports of child diarrheal disease. A limited to moderate association exists in three of the five countries considered characterized by comparable rates of childhood diarrhea: Malawi, Sierra Leone, and Zimbabwe. The relationship was detected when controlling for potential confounding factors (other WASH elements, socio-demographic factors, nutrition practices, and immunization status) and when accounting for cluster effects. The likelihood of reported diarrhea among children under 5 increases when there is no HWS, just a handwashing device with no supplies or only water or only soap. The relationship is moderate in Malawi and less strong in Sierra Leone and Zimbabwe. No relationship was found in Ethiopia and Ghana. Further exploration of the usefulness of this proxy in other African and non-African contexts is warranted.”

Read the paper here.

Citation: Victoria Shelus and Orlando L. Hernandez, The usefulness of a handwashing proxy in large household surveys, Available Online 20 August 2015, DOI: 10.2166/washdev.2015.184

 

 

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Lessons From Zaragoza: Indicators, Integration, And Human Rights For Hygiene Post-2015

Woodburn_Hanna_2014This post, authored by Hanna Woodburn, has been reblogged from the Global Public-Private Partnership for Handwashing (PPPHW) website.

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We are only a few weeks into 2015, but the Global Public-Private Partnership for Handwashing and other actors within the international development community have been anticipating this landmark year for quite some time. Later this year, the Member States of the United Nations will agree upon a new set of global, Sustainable Development Goals (SDGs) to replace the expiring Millennium Development Goals. To learn, collaborate, and strategize, the UN-Water organization convened key water, sanitation, and hygiene (WASH) sector actors in Zaragoza, Spain. The gathered experts, including the PPPHW, attended and participated in discussions around what tools and challenges face implementation of the proposed SDG for water (to view this goal, please see Goal 6 on page 12 of this document).

At this conference we learned about the role of various stakeholder groups, such as business, governments, civil society, and academia, in addressing the challenges of implementing a water SDG. We advocated for hygiene where it was absent, and came away with a new appreciation for the role that integration will play in driving forward progress on WASH in the post-2015 era.

As we look toward the remaining months of 2015 and what needs to be accomplished in terms of advocating for a comprehensive WASH goal, complete with targets and indicators for hygiene, it is clear that there are specific areas where the PPPHW and hygiene supporters can be engaged.

First, indicators will be the way forward in advocacy and ensuring that all components of WASH receive their due recognition within the SDGs. Indicators will need to be measurable, actionable, and ambitious. Without an indicator for hygiene we will not know the progress made on this crucial public health intervention.

Second, at the planning, stakeholder, and programmatic levels, integration will become increasingly important to address the myriad and interrelated challenges facing global health and development. WASH does not exist in a silo. The benefits from good hygiene services and behaviors, for example, range from improving health and nutrition to reducing inequities and improving school attendance. As such, broad collaboration will help ensure that the benefits from WASH are fully realized.

Finally, but not least, the human rights approach toward water and sanitation (articulated here), will continue to be used to frame the importance of access to these life-saving services. The key elements of such an approach are equality and nondiscrimination; participation and inclusion; and accountability and the rule of law. Hygiene is, and should be, covered under the umbrella of the human rights approach, but we need to make this association clearer.

We know that WASH is going to be essential to making progress on the SDGs, that there are tools that can help achieve the proposed water goal, but we also know that there is much work to be done in the meantime, particularly around ensuring that hygiene does not fall off the agenda. The PPPHW is committed to continued advocacy around these efforts, and we hope you will join us. Sign up for our email list, learn more about the conference here, and learn what goals, targets, and indicators the WASH sector are supporting here. The challenges are large, but not insurmountable. Overcoming them will both save lives, and ensure a healthier, more productive world Post-2015. Together we can help make this vision become a reality.

About the Global Public Public-Private Partnership for Handwashing: The Global Public-Private Partnership 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.