Sundara Fund: Attacking Hygiene Inequality Through Innovative Hand-Washing

Sundara Fund: Attacking Hygiene Inequality Through Innovative Hand-Washing | Source: Browngirl Magazine, July 8 2016 |

[Photo Courtesy of Sundara Fund]

The impetus for launching Sundara was born back in 2013 when founder Erin Zaikis was working with organizations and schools fighting child trafficking in rural northern Thailand, on the border of Myanmar. During one school visit, she watched as teenage children entered and left the restroom without washing their hands.

Making the several-hour trek to the closest store that sold soap, she bought roughly 150 bars costing $30. “Cigarettes were much more expensive, but cigarettes were bought by almost everyone in the community…The problem did not lie in the cost of soap, but rather the education,” Zaikis says.

While conducting an impromptu hand-washing workshop at a school one day, she “watched in horror” as one child tried to bite the soap, some scratching it with their nails, and yet others smacking their faces with it—unsure of what to do.

Zaikis says, “Here I was, meeting children who had lived their whole lives without something I took for granted every single day of mine. Reeling from the inequality of this situation and feeling like no one else was putting attention on it, I decided I had to help.”

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Drivers of sustained hygiene behaviour change: A case study from mid-western Nepal

Drivers of sustained hygiene behaviour change: A case study from mid-western Nepal. Social Science & Medicine, August 2016.

• Abstract/order info

Authors: Celia McMichael, Priscilla Robinson

Behaviour change is central to the prevention of many population health problems, yet it is typically difficult to initiate and sustain. This paper reports on an evaluation of a water, sanitation and hygiene (WASH) intervention in mid-western Nepal, with particular focus on the drivers and barriers for handwashing with soap/ash and elimination of open defecation.

The research was conducted during October–November 2014, two and half years following the intervention’s end-point. Qualitative data were collected from the target community (n = 112) via group discussions, interviews and drawings/stories of ‘most significant change’. Households’ handwashing/water facilities and toilets were observed.

Analysis was informed by a model that highlights environmental, psychosocial and technological factors that shape hygiene behaviours across multiple levels, from the habitual to the structural (Dreibelbis et al. 2013). Findings indicate the intervention has supported development of new norms around hygiene behaviours.

Key drivers of sustained hygiene behaviour were habit formation, emotional drivers (e.g. disgust, affiliation), and collective action and civic pride; key constraints included water scarcity and socio-economic disadvantage. Identifying and responding to the drivers and constraints of hygiene behaviour change in specific contexts is critical to sustained behaviour change and population health impact.

Handwashing, sanitation and family planning practices are the strongest underlying determinants of child stunting in rural India

Handwashing, sanitation and family planning practices are the strongest underlying determinants of child stunting in rural indigenous communities of Jharkhand and Odisha, Eastern India: a cross-sectional study. Maternal & Child Nutrition, June 2016.

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Authors: Jennifer Saxton, Shibanand Rath, et. al.

The World Health Organisation has called for global action to reduce child stunting by 40% by 2025. One third of the world’s stunted children live in India, and children belonging to rural indigenous communities are the worst affected. We sought to identify the strongest determinants of stunting among indigenous children in rural Jharkhand and Odisha, India, to highlight key areas for intervention.

We analysed data from 1227 children aged 6–23.99 months and their mothers, collected in 2010 from 18 clusters of villages with a high proportion of people from indigenous groups in three districts. We measured height and weight of mothers and children, and captured data on various basic, underlying and immediate determinants of undernutrition. We used Generalised Estimating Equations to identify individual determinants associated with children’s height-for-age z-score (HAZ; p < 0.10); we included these in a multivariable model to identify the strongest HAZ determinants using backwards stepwise methods.

In the adjusted model, the strongest protective factors for linear growth included cooking outdoors rather than indoors (HAZ +0.66), birth spacing ≥24 months (HAZ +0.40), and handwashing with a cleansing agent (HAZ +0.32). The strongest risk factors were later birth order (HAZ −0.38) and repeated diarrhoeal infection (HAZ −0.23).

Our results suggest multiple risk factors for linear growth faltering in indigenous communities in Jharkhand and Odisha. Interventions that could improve children’s growth include reducing exposure to indoor air pollution, increasing access to family planning, reducing diarrhoeal infections, improving handwashing practices, increasing access to income and strengthening health and sanitation infrastructure.

Beyond hardware: how a portable sink can inspire behaviour change

Beyond hardware: how a portable sink can inspire behaviour change by Geoff Revell at WaterSHED | Source: WaterAid Blog, June 29, 2016 |

Despite having a cheap and simple fix that could prevent millions of deaths, how to encourage handwashing has puzzled WASH sector experts for years. The rate of handwashing with soap after using the toilet is still estimated to be only 16%. So how do we get people to wash their hands? Geoff Revell, Program Director at WaterAid partner NGO WaterSHED, explains how development of the HappyTap sheds light on new ways to target behaviour. 

Children using a Happy Tap at school in Ben Tre province, Vietnam.

Awareness campaigns have long been the mainstay of public health efforts to improve handwashing, but on their own they are typically unsuccessful. A multi-year, large-scale behaviour-change campaign in Vietnam, led by World Bank and funded by the Bill & Melinda Gates Foundation, put the challenge in focus. The evaluation of the campaign concluded: ‘the intervention led to an increase in knowledge’, but ‘handwashing with soap behavior in the target population has not changed substantially as a result of the intervention, and thus no health or productivity impacts are found’.

Unfortunately, there is a persistent gap between knowledge and action; after years of education and promotion, many families understand when and why to wash their hands, but still aren’t doing it. Various studies, including one from Kyrgyzstan, have shown a link between the presence of handwashing facilities and rates of handwashing, suggesting a possible causal relationship. But is having more sanitary hardware enough to get people to routinely wash their hands?

Bridging the adoption gap

It’s unlikely that any single intervention would be a silver bullet. However, although sanitary hardware might help improve rates of washing, we can go beyond the physical hardware and use facilities to reinforce and build on awareness. The HappyTap is the first such hardware designed with behaviour change front and centre. It’s a portable sink that not only delivers functionality, but also inspires change.

How can a handwashing station be more than the sum of its parts? Three crucial elements in the design and marketing help boost its success.

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Handwashing With a Water-Efficient Tap and Low-Cost Foaming Soap: The Povu Poa “Cool Foam” System in Kenya

Handwashing With a Water-Efficient Tap and Low-Cost Foaming Soap: The Povu Poa “Cool Foam” System in Kenya. Global Health: Science and Practice, June 2016.

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Authors: Jaynie Whinnery, Gauthami Penakalapati, Rachel Steinacher, Noel Wilson, Clair Null, Amy J Pickering.

The new handwashing system, designed with end user input, features an economical foaming soap dispenser and a hygienic, water-efficient tap for use in household and institutional settings that lack reliable access to piped water.

Cost of the soap and water needed for use is less than US$0.10 per 100 handwash uses, compared with US$0.20–$0.44 for conventional handwashing stations used in Kenya.

KEY PRODUCT FEATURES OF THE POVU POA HANDWASHING SYSTEM

• Soap security: The soap foamer is attached to the system, preventing theft
• Affordability: Just 5 g of powdered or liquid soap mixed with 250 mL of water can provide 100 uses for US$0.10 (cost includes soap and water).
• Hygienic: The innovative swing-tap design is bidirectional and can be used with the back of the hand or wrist, limiting recontamination of hands after handwashing.
• Water-frugality: The water flow is sufficient for handwashing while providing a 30-77% reduction in water usage compared with conventional methods.
• Scalability: Components are specifically designed for low-cost mass production and deployment, estimated at US$12 per unit.
• Adaptable: The 2 handwashing station configurations can be adapted to meet different needs and preferences and can be used in households and institutional settings, such as schools and health centers.

WASH Innovation Award Winners

Congratulations to the winners and finalists of the inaugural DFAT-sponsored Civil Society Innovation Award 2016, which was announced at the WASH Futures Conference Dinner 2016.  | Source: Civil Society WASH Fund, May 2016 |

First place went to Save the Children – Nudging handwashing among primary school students in Bangladesh. Kamal Hossain from Save the Children Bangladesh was excited to receive the award in person from Anne Joselin, DFAT. Save the Children’s innovation to improve hand-washing in schools uses environmental cues and nudges. It is more cost effective than hygiene communication programs and has shown positive results in changing and sustaining behaviour change amongst school children. Watch the winning video here

Second place was awarded to Water for People! in Uganda for their submission, Low cost solutions for Faecal Sludge Management. Water for People! have shown their work innovating at many stages of the sanitation chain, from low cost modular toilet design, pit emptying and faecal sludge treatment and reuse. Their holistic approach to sanitation and faecal sludge management (FSM) are impacting many peoples’ lives, particularly in the slums of Kampala. Watch the video here. 

Third runner up was Wetlands Work! Cambodia for the HandyPod – Sanitation solutions for floating communities in Cambodia. The Handy Pod is a floating toilet design suitable for the communities of the Tonle Sap lake area and uses wetlands treatment technology. Watch the video here.  

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Disgust, Shame, and Soapy Water: Tests of Novel Interventions to Promote Safe Water and Hygiene

Disgust, Shame, and Soapy Water: Tests of Novel Interventions to Promote Safe Water and Hygiene.  Journal of the Association of Environmental and Resource Economists 3, no. 2 (June 2016): 321-359. Authors: Raymond P. Guiteras, David I. Levine, Stephen P. Luby, et al.

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Lack of access to clean water is among the most pressing environmental problems in developing countries, where diarrheal disease kills nearly 700,000 children per year. While inexpensive and effective practices such as chlorination and hand washing with soap exist, efforts to motivate their use by emphasizing health benefits have seen only limited success.

This paper measures the effect of messages appealing to negative emotions (disgust at consumption of human feces) and social pressure (shame at being seen consuming human feces) on hand-washing behavior and use of and willingness to pay for water chlorination among residents of slum compounds in Dhaka, Bangladesh.

Neither the traditional, health-based message nor the new disgust-and-shame message led to high levels of chlorination during a free trial, nor to high willingness to pay for the chlorine at the end of the free trial. Provision of low-cost hand-washing facilities did increase hand washing, although the effect size is modest.