Session FT 3.22
Hygiene promotion : improving the state of the art
Hygiene Promotion: Improving State of the Art, took a closer look at three hygiene improvement interventions that have been shown to have a high impact on diarrhoeal disease reduction. Diarrhoea, largely resulting from unsafe water, inadequate sanitation and poor hygiene, is the second most serious killer of children under five, accounting for nearly one fifth of all child deaths.
However, up to two thirds of all diarrhea incidence in children could be prevented with improvement of three key hygiene practices: washing hands with soap, disposing human feces safely, treating and safely storing drinking water in the household
To reduce diarrheal morbidity, the partners on this panel and many others have adopted an integrated approach that combines access to hardware, hygiene promotion and an enabling environment through policy improvement, public-private partnerships and institutional strengthening.
The session chair remarked that we have come a long way in terms of improving the state of the art in hygiene promotion – but the next few years will present an even greater challenge. Although there has been a significant infusion of new funds into construction of water and sanitation systems in an effort to meet the MDGS by 2015, we know that this technology alone will not be sufficient to change complex behavioural practices - such as effective use of sanitation facilities and handwashing with soap. As we move from pilot programmes to implementation of projects at large scale, we need to optimize integration between technologies and programs targeting information, education and social mobilisation toward collective hygiene behaviour change.
- Community already knows its health problems and challenges, but needs practical solutions to address these challenges. .
- Increased access and demand improve utilization.
- Universal health service coverage does not necessarily require parallel economic development.
- It is important to move away from upfront subsidies for hygiene and sanitation improvement.
- To address the supply side of the market, there is the need to expand technology options, choice and range of costs.
- Qualitative research is necessary to support and interpret quantitative findings and there is a need to measure ACTUAL behaviour change
- Rethinking sanitation in terms of understanding the motivations and constraints of households and the delivery and marketing of sanitation as consumer products and services that households must want and pay for is an important paradigm shift for changing the way business has been done in sanitation.
- There is a need to address the concern of supply keeping pace with demand, coordinating effective service delivery as a successful model will become demand driven and demand from the community can become more than the district support capacity.
- In a successful model, community motivation to carry out material and construction management does become very high.
- There is a need to support and empower the industry of masons and make them to be proud of their work building latrines.
- Mass Media as a key communications channel can affect behaviour change, but it is important to get the message right and complement with interpersonal communication approaches at the community level.
- An action oriented approach gives results and broad community mobilization is a largely untapped resource that is needed to meet the MDGs
- Accountability and responsibility within the community can help ensure results and political commitment matters
- There is a need to build capacity of NGOs and/or support training organizations with a cadre of catalysts for mobilization and scaling up.
- There is a need for increased capacity for policy engagement and mobilization of policy makers
Orientations for action
It is important to move away from a supply led household-by-household campaign and focus on ‘Triggering’ behavior change for the collective, and not simply for individuals. In a successful model, community motivation to carry out material and construction management and adoptimproved hygiene practices is very high.
Local Actions presented
Sanitation Revolution and WASH Movement in Ethiopia
Ms. Therese Dooley, UNICEF Ethiopia
In the Amhara Region which has a population of 19 Million, 89,910 children continue to die each year from sanitation related diseases. Before the new sanitation initiative was implemented, approximately 100 latrines were constructed per year per district. Since 2003/4, the average number of latrines constructed per district has increased to 26,400 per year. By 2015, 2.2 million latrines will be needed to reach the MDG’s. The project works to create demand, increase knowledge and understanding about the benefits of improved sanitation, while creating an enabling environment with improved access. Social change is needed to generate a willingness to pay. Today, some villages are 100% sanitised. Schools are the focal point and community leaders are involved. An integrated approach is necessary to ensure that sanitation is everyone’s business and that appropriate technologies are used.
Total Sanitation in South Asia
Mr. Ede Ijjasz, Water and Sanitation Program (WSP)
Traditionally, sanitation in rural India relied heavily on high levels of subsidies for latrine construction, however, the 2001 census estimated that only 22% of households had sanitation facilities. There is a lot of evidence to support the notion that the reason for people defecating in the open is NOT’ only due to a lack of toilets. Based on an increasing body of evidence, enhanced usage of toilets by individual households is not sufficient to deliver public health outcomes in a fecally contaminated environment. There is the need to promote an ‘open defecation free’ environment and NOT just create a landscape of toilets. ‘Open Defecation Free’ includes safe confinement of excreta and maintaining personal hygiene by a community motivated by the need for good public health outcomes. Community-led Total sanitation (CLTS) is an approach that moves away from the promotion of sanitation at the household level with individual hardware subsidy and focuses on outcomes of defecation-free communities by triggering collective behavior for the community as a whole.
The concept is to move away from a supply led household-by-household campaign and focus on ‘Triggering’ behavior change for the collective, and not simply for individuals. Local governments set up appropriate institutional frameworks that address implementation of CLTS at scale with sustainable impact including subsidy policies to provide supportive incentives geared to reinforce collective action and support an enabling environment to strengthen the supply chain (domestic providers of a broader range of appropriate sanitation solutions) to respond to demand.
Consumer preferences in point-of-use water disinfection: An example from Nepal
Mr. Camille Saadé, the Hygiene Improvement Project (HIP) and the POUZN Project
The role of consumer and behavioral research in formulating a Point-of-Use Marketing Strategy has been documented by the Nepal Consumer Preference Study. Consumer experience with five water disinfection methods were evaluated over time looking at satisfaction with the methods across a range of characteristics and criteria: taste, smell, effort, perceived value, and others. The study also tested for household effectiveness and key behavioural issues related to the the various methods.Four key points were identified:
I. It is important to collect this information which will be turned into tool for field use in the design of effective programming – addressing different barriers and motivators to use at every stage of the way. Behavioral issues should be considered from trial, to adoption, to correct and consistent use over time since sustainability continues to be a challenge in many of our programs.
II. Perceived need is an issue that will affect demand. It is important to provide baseline health messages on the rationale for use of POU products. Messages should emphasize the following key points: Diarrhoea is a disease; Diarrhoea can be prevented; Contaminated water can cause diarrhoea; Diarrrhoea is preventable by treatment & safe storage of water in the household.
III. Identify behavioural approaches that have worked. Examples are building a network of community distributors; following up in the home, promoting frequent testing, identifying visual cues, such as tests of bacterial indicators to track use; ensuring consistent messaging through multiple channels such as clinicians, field agents, community volunteers and multiple entry points.
IV. The importance of focusing on the behavioural issues of POU as a Project goes to scale. One indicator of scale will be number of products sold at greater geographical scale, but attention must also be focused on whether these products being used correctly, consistently and sustainably over time.
Truly Clean Hands The Flagship Public Private Handwashing Partnership in Ghana
Ms. Beth Scott, London School of Hygiene and Tropical Medicine
Diarrhoeal disease is the biggest cause of morbidity and mortality in children in Ghana. Handwashing with soap can reduce diarrhoea risk by almost half. A public-private partnership to promote handwashing with soap was set up across the country. Using mass media, direct community contact and district level activities, the programme reached over 71% of the population and significantly improved reported handwashing behaviour in mothers and children. Many lessons were learned from working with industry, such as how to build a communications programme on the basis of a scientific understanding of consumer motivation and to use indutrial strength marketing and professional programme management skills. Partnership building and maintenence was a significant cost. The lessons learnt are now being applied in many other countries.