Category Archives: Hygiene Promotion

World Bank targets smarter sanitation communication for rural Ethiopia

By Peter McIntyre, IRC Associate

The World Bank in Ethiopia has commissioned a rapid survey of what motivates people to upgrade their latrines, with the aim of delivering behaviour change communication materials with greater impact.

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Sanitation rapid survey launch meeting Addis Abeba, 23 March 2017 (Photo: Sirak Wondimu)

The survey is being conducted in four regions, with the main target audiences being adult women, male heads of households, opinion leaders and existing sanitation businesses.

The aim is to pilot and produce materials that emphasise the dignity, prestige and status of having improved sanitation, rather than focusing only on health messages.

The WB decided a new approach was needed after Demographic and Health Survey (DHS) figures for 2016 suggested that only 4% of rural households in Ethiopia have improved toilets facilities while a further 2% have facilities that would be considered improved if they were not shared. This is well below the Joint Monitoring Program figure of 28% for improved latrines (although we understand this may be revised down to around 14%). Indeed, according to DHS, although access to some form of sanitation has risen, access to an improved latrine has declined in percentage terms over the past ten years. Most latrines in rural areas (55%) do not have an effective slab or lid while more than a third of rural households (39%) practise open defecation.

The Government of Ethiopia has a flagship programme to increase use of improved latrines to 82% by 2020.

At a launch meeting in Addis on 23 March 2017, social market consultant, Addis Meleskachew, said that this initiative will develop a memorable brand for marketing materials that will encourage the private sector to provide materials and will attract rural families to buy them.

Dagnew Tadesse,Hygiene and Environmental Health Case Team Leader for Ministry of Health, welcomed the initiative to attract business but emphasised that the GoE approach is based on a comprehensive health education strategy with multiple messages including hygiene awareness, handwashing and safe food, and said that these important messages should not be abandoned.

Jane Bevan, rural WASH Manager at UNICEF Ethiopia offered to share extensive data that UNICEF has collected for its country programme on attitudes to sanitation, which has identified the high cost of concrete slabs as a significant obstacle. She presented examples of low cost options for upgrading sanitation in a pilot project in Tigray region. It was agreed to collate all existing KAP studies and relevant data including research by SNV.

Monte Achenbach from PSI and John Butterworth from IRC spoke about the work being started by USAID Transform WASH to market innovative sanitation models. John Butterworth said there is a need to make people aware of what is available and to get materials to where they are needed.

The World Bank research is being conducted by 251 Communications.

This blog was originally posted on 5 April 2017 on the IRC website.

Swachh Bharat Mission Hygiene Index

Swachh Bharat Mission Hygiene Index

Since the announcement of the Swachh Bharat Abhiyan two-and-a-half years ago, individuals, communities and government bodies have busied themselves in a flurry of activity to realise the dream of a clean and sanitary India. swach2

While someone is trying to bring toilets to a remote village, someone else is trying to clean a river, while others are simply trying to build toilets for their own households.

This is the true story of the ambitious Swachh India campaign—a recognition that the country will never be truly ‘swachh’ until all stakeholders, from the government to corporates to each and every citizen, participate and do their bit.

To maintain the momentum and keep these efforts on track, constant evaluation is needed. And this is where the Hygiene Index comes in.

Read More: Swachh Hygiene Index: How Close Are We To The Dream Of A Swachh Bharat?

The Hygiene Index has been developed in support of the Swachh Bharat Mission, and evaluates various parameters that can help nudge cities in the direction of better sanitation and hygiene.

Read more.

WHO Trachoma Fact sheet, April 2017

WHO Trachoma Fact sheet, April 2017.

Key facts

  • Trachoma is a disease of the eye caused by infection with the bacterium Chlamydia trachomatis.
  • It is known to be a public health problem in 42 countries, and is responsible for the blindness or visual impairment of about 1.9 million people. Nearly 182 million people live in trachoma endemic areas and are at risk of trachoma blindness.
  • Blindness from trachoma is irreversible.
  • Infection spreads through personal contact (via hands, clothes or bedding) and by flies that have been in contact with discharge from the eyes or nose of an infected person. With repeated episodes of infection over many years, the eyelashes may be drawn in so that they rub on the surface of the eye, with pain and discomfort and permanent damage to the cornea.
  • The World Health Assembly adopted resolution WHA51.11 in 1998, targeting the global elimination of trachoma as a public health problem.
  • The elimination strategy is encapsulated by the acronym “SAFE”: Surgery for advanced disease, Antibiotics to clear C. trachomatis infection, Facial cleanliness and Environmental improvement to reduce transmission.
  • In 2016, more than 260 000 people received surgical treatment for advanced trachoma, and 86 million people were treated with antibiotics. Global-level antibiotic coverage was 47%, a considerable increase compared to the 29% coverage achieved in 2015.

12th SuSanA Thematic Discussion: “Menstrual Hygiene Management (MHM) in Schools – A neglected issue”

While nowadays the topic of MHM is gaining more and more attention, it has widely been neglected in the past. SDG4 (education), SDG5 (gender equality) and SDG6 (water and sanitation) require female friendly sanitation facilities and available informational materials at schools around the globe.

Taking into account the magnitude of the population affected by issues around MHM, schools provide an ideal environment to reach girls as well as young women and to address taboos and misconceptions in a culturally sensitive manner.

The question, however, is how to approach the topic in a culturally sensitive manner?

Running for two weeks from today (March 27 until April 09) the discussion on the SuSanA forum will look at two areas:

Week 1: Breaking the taboo around MHM                                           Thematic Lead: Dr. Marni Sommer (Associate Professor, Columbia University Mailman School of Public Health)

 Week 2: Infrastructural barriers and how to monitor MHM            Thematic Lead: Thérèse Mahon (Regional Programme Manager South Asia, WaterAid)

During the discussion, regular summaries of forum entries will be posted to keep you updated on our conversation.

Coordination on behalf of the SuSanA secretariat for this thematic discussion will be carried out by Dr. Bella Monse, Jan Schlenk and Mintje Büürma. For any questions, you can post on the forum or contact us directly at info@susana.org.

To join the discussion, follow: http://bit.ly/2nZn4n6

And to read the first contribution by Marni Sommer, click on: http://bit.ly/2n9JLkv

Recently published handwashing studies

1 – Trop Med Int Health. 2017 Feb 28. doi: 10.1111/tmi.12861. [Epub ahead of print]

Does targeting children with hygiene promotion messages work? The effect of handwashing promotion targeted at children, on diarrhoea, soil-transmitted helminth infections and behaviour change, in low- and middle-income countries.

OBJECTIVES: To synthesise evidence on the effect of handwashing promotion interventions targeting children, on diarrhoea, soil-transmitted helminth infection and handwashing behaviour, in low and middle income country settings.

RESULTS: Eight studies were included in this review: seven cluster-randomised controlled trials and one cluster non-randomised controlled trial. All eight studies targeted children aged 5-12 attending primary school but were heterogeneous for both the type of intervention and the reported outcomes so results were synthesised qualitatively. None of the studies were of high quality and the large majority were at high risk of bias. The reported effect of child-targeted handwashing interventions on our outcomes of interest varied between studies. Of the different interventions reported, no one approach to promoting handwashing among children appeared most effective.

CONCLUSION: Our review found very few studies that evaluated handwashing interventions targeting children and all had various methodological limitations. It is plausible that interventions which succeed in changing children’s handwashing practices will lead to significant health impacts given that much of the attributable disease burden is concentrated in that age group. The current paucity of evidence in this area however does not permit any recommendations to be made as to the most effective route to increasing handwashing with soap practice among children in LMIC. This article is protected by copyright. All rights reserved.

2 – Am J Infect Control. 2017 Feb 24. pii: S0196-6553(17)30041-X. doi: 10.1016/j.ajic.2017.01.018. [Epub ahead of print]

The effect of hand-hygiene interventions on infectious disease-associated absenteeism in elementary schools: A systematic literature review.

BACKGROUND: Hand-hygiene interventions are widely used in schools but their effect on reducing absenteeism is not well known.

RESULTS: Our review indicated evidence is available to show hand-hygiene interventions had an effect on reducing acute gastrointestinal illness-associated absenteeism but inadequate evidence is available to show an effect on respiratory illness-associated absenteeism.

CONCLUSIONS: The methodologic quality assessment of eligible studies revealed common design flaws, such as lack of randomization, blinding, and attrition, which must be addressed in future studies to strengthen the evidence base on the effect of hand-hygiene interventions on school absenteeism.

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Changing behaviours: there is no quick fix!

Experts come up with better ways to promote sanitation in India.

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School toilets, West Bengal, India, Photo: Stef Smits/India

India is home to the largest numbers of open defecators in the world. Over the last few decades the government has implemented national programmes, which attempted to address this complex challenge. The demand for sanitation, meaning a genuine demand for toilets and actual use, hasn’t been encouraging. In October 2014, the government launched the Swachh Bharat Mission (SBM), a national programme to eliminate open defecation by 2019. SBM has a rural (gramin) and an urban subcomponent.

Dialogue on behaviour change communication

On 23 September 2016, experts met in New Delhi to discuss how behaviour change communication (BCC) can best help to achieve India’s sanitation goals. They were invited by the India Sanitation Coalition, TARU and IRC to take part in “Insights: WASH Dialogues on Sanitation Promotion and Behavioural Science“.

When we set out to improve life for others without a fundamental understanding of their point of view and quality of experience, we do more harm than good (Lauren Reichelt, 2011)

Sector experts and experts involved in Corporate Social Responsibility (CSR) initiatives in sanitation, argued that it is crucial not just to look at how behaviour change interventions work, but also to understand what doesn’t work. There is general agreement that “soft interventions” are important at the community level to ensure that toilets are not just built but also used. Despite all the investments in sanitation over the years, little has been achieved in sanitation. There seems to be a gap between the planning of behaviour change communication interventions and how they are actually implemented.

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The Role of WASH in Healthcare Settings to Reduce Transmission of Antimicrobial Resistance

The Role of Water, Sanitation and Hygiene (WASH) in Healthcare Settings to Reduce Transmission of Antimicrobial Resistance. Antimicrobial Resistance Control, July 2016.

This article by USAID’s Rochelle Rainey and Merri Weinger concludes that antimicrobial resistance is a multisectoral problem that requires a comprehensive strategy, including WASH improvements, to prevent emergence and transmission.

The lack of safe water, functional toilets, and handwashing facilities in healthcare settings poses significant health risks to patients, healthcare workers and nearby communities. The ongoing global problem of health facility-acquired infections (HAI) has highlighted the consequences of the lack of water and sanitation facilities and practice of key hygiene behaviours.

Antimicrobial resistance (AMR) is a multisectoral problem that requires a comprehensive strategy, including WASH improvements, to prevent emergence and transmission. Hand hygiene has been cited as the single most important practice to reduce HAI, and improved hand hygiene practices have been associated with a sustained decrease in the incidence of antimicrobial-resistant infections in healthcare settings.

WASH also plays a role in the cleaning of surfaces and bedding for preventing transmission of HAI. Leadership and commitment is needed from governments, international and local organizations, donors and civil society to implement the global action plan to achieve universal access to WASH in healthcare facilities.