clean communities, healthy families

Community Perspectives and Experiences of the Functionality and Sustainability

of Water and Hygiene Committeesin Central Côte d’Ivoire:

A Qualitative Process Evaluation

Clean Communities, Healthy Families Central Cote d’Ivoire –

2009 - 2011

Ongoing Conflict and Political Instability

Water and sanitation systems neglected and/or overwhelmed

High levels of maternal and child morbidity and mortality

Clean Communities, Healthy Families Goal –

Reduce maternal and child morbidity and mortality

Objectives –

Increase access to protected water sources

Increase access to adequate sanitation facilities

Teach and encourage members of the target population to practice proper hygiene

Clean Communities, Healthy Families

Phase 1 Hardware 36 villages in Tiébissou,

Didiévi, and Sakassou Rehabilitated 50 pumps Dug 13 wells Connected 4 HCs to

village water supply networks

Constructed 148 demonstration latrines


Building on Lessons Learned –“Hardware” is necessary, but …

Clean Communities, Healthy FamiliesWe need “software” … but what is

“software”?Address behavioral factors that influence health outcomes

Promote sustainability through community ownership and maintenance of hardware improvements


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Trained 222 members of 37 Water and Hygiene Committees

Qualitative Process Evaluation

Objective : To explore community perspectives on the functionality and sustainability of water and hygiene committees

Methods

• Submitted for ethics review to JHSPH IRB and National Committee of Ethics and Research of the Ministry of Health and Public Hygiene of Côte d’Ivoire

• Evaluation conducted in 6 program villages in Didiévi, Tiébissou, and Sakassou Health Districts (2 villages / district)

• Qualitative research methodology to elicit community perspectives and community-identified solutions

• Research activities conducted in Baoulé

Methods

• Transect walks• Focus Groups

• Committee Members• Village Leaders• Women• Men

• In-Depth Interviews

• Committee Members

Analysis

• Digital recording• Translated and transcribed focus groups and

interviews from Baoulé to French• Developed list of “codes” and “codebook”

• Applied codebook to transcripts using Atlas.ti qualitative data analysis software

• For each code or theme, identified important subthemes

Results

All committees remained active

Committees were engaged in activities such as:

Management of pump surveillance,

cost recovery, and maintenance

Hygiene promotion

Reporting on committee activities and finances to community leaders and members

Results

Perceived improvements in health and hygiene, as well as management of water resources

Dedication to sustaining the work of the committees post-intervention:

If IRC isn’t here anymore we will continue to work…because we know that as long as we do our work well and the pump is managed with the dues, we will still be able to repair the pump. The villagers will always have water because water is vital. It is because of this that we will not stop working.” President, Tiebissou 1

Results

Focus on sustainability issues related to:

Selection of committee members

Time management and motivation

Cost recovery systems and maintenance

Selection In all but one village, traditional leadership

played a central role in the choice of committee members, however full community participation (ex. democratic elections) was limited

Key Criteria for Selection Good character, ready to work as volunteer Representativeness (by akpassoua / extended

family or neighborhood) Availability Gender Permission from family

Because process led by leadership, often candidates were not aware of selection, but felt obligation to accept “work of the village”

Selection Impact of lack of

participation/representativeness

“They took them all from one neighborhood, yet the village has 5 neighborhoods. Because they come from the other neighborhood, we don’t see that they sensitize us. They sensitize the people in their neighborhood.” Leader, Tiebissou 2

“We know them, but we don’t know why they were selected or when.”Male Villager, Tiebissou 2

Selection Gender – Availability of women

“When the elders got together, they preferred that we take only men… The women, when you choose them, they will maybe say tomorrow that they don’t have the time. And so the activities of the pump won’t be well managed... Because with women it’s bothersome since the women take care of the children in the morning and wouldn’t have the time to manage their activities well. Women also need to prepare meals in the evening.” Leader, Tiebissou 2

Members generally felt that workload of committee was manageable

Sources of motivation: Seeing improvements in health and hygiene Noble self-sacrifice for “work of the village”,

clear understanding of voluntary nature at outset

Appreciation for knowledge/skills gained in training

Hope that knowledge/skills would lead to employment

Time Management and Motivation

Perceived improvements in health and hygiene

“Before, we would drink water and we didn’t know that it would cause illnesses. When your eyes would see the water, you would think that the water was clean and yet it was doing us harm. Before, we had diarrhea, epidemics of diarrhea. Now, we don’t see these epidemics anymore. We are satisfied, very satisfied. We want the project to go far and to progress here.”” Village Mechanic, Sakassou 1



Serving community, gaining skills

The day before yesterday, the pump was leaking. My colleague called me to come and tighten it and we did it. If it were before, the smallest nut and bolt to tighten, they would have made us pay dearly. So this helps us.“Mechanic, Didievi 2

Members generally felt that workload of committee was manageable

Sources of motivation: Seeing improvements in health and hygiene Noble self-sacrifice for “work of the village”, clear

understanding of voluntary nature at outset Appreciation for knowledge/skills gained in

training Hope that knowledge/skills would lead to

employment

Sources of discouragement: Feeling that work deserved remuneration Insults they received from community members

while conducting activities and lack of behavior change

Wanting more recognition from community



Lack of community support

“Every day the committee goes into each courtyard to sensitize people, to tell them to cut back the plants, to make the village clean. There are people that do it; there are people, on the other hand, that don’t do it, and on the contrary give them the cold shoulder, insult them. But it’s not because of this that the committee will get discouraged.” Female Villager, Didievi 1

“You have to be brave to hold the position of hygienist because people insult us…There is a lot of verbal abuse. The chief endures it, and so does the president of the committee.” Hygienist, Tiebissou 2

Cost Recovery and Maintenance

Community satisfaction with systems for cost recovery and management of funds

“Now if the pump breaks down there aren’t any more dues to contribute that are the cause of disputes in households. Now the committee members that were put in place repair it and we hear that the pump broke down but that it was repaired. And we are very much in joy.” Leader, Tiébissou 1



Community satisfaction with systems for cost recovery and management of funds

Increased transparency of repair process

“We didn’t know the price of the parts [for the pump] and IRC gave the prices to the committee mechanic. We can see on the paper the normal price and no longer have to dispute the price with the repairman. He can’t swindle us anymore.” Committee President, Tiébissou 2



Satisfaction with systems for cost recovery and management of funds


Limited revenues from sale of water (especially during rainy season), request income-generating activities


“There was a breakdown, [the IRC field agent] came to see…and he said 200,000F. When we look in the savings box we can’t reach 100,000F, let alone 200,000. Like that, what are we going to do to spend the 200,000F? It’s because of this that I ask that you help us financially. Ask IRC to please help us, to face up to the needs of the pump.”

Treasurer, Didievi 2


Satisfaction with systems for cost recovery and management of funds


Limited revenues from sale of water (especially during rainy season), request income-generating activities

Dissatisfaction with limited training of village-level mechanics


“We ask IRC to help us so that we can work tomorrow when IRC is no longer here. Because if IRC isn’t there, our mechanics, we will be obliged to run and fetch the artisan réparateur. Today, if there is a breakdown, our mechanics don’t know the work well. But if [they have more training] we will no longer have the need to go far. They know that it is a voluntary thing – they won’t ask for money before they go to make the repairs.”

Hygienist, Didievi 1

Discussion Water and hygiene committees are a means for

meaningfully engaging communities in key “software” elements such as hygiene promotion, ,cost-recovery, and maintenance

However, a range of factors at all levels of programming contributes to ability of water and hygiene committees to achieve sustainability

Conducting qualitative process evaluation can help to engage communities and project staff to develop richer, contextual insight into these factors and adapt strategies accordingly

Limitations Resource and security constraints limited the number of

villages included in the study and the amount of time spent per village (~6 hours)

Potential for bias due to perceived need to report certain perspectives in order to maintain/increase investment from the IRC/donors

Post-electoral conflict from 2010-2011 limited ability: to take a more iterative data analysis approach to engage in more thorough member checking to develop and more fully integrate recommendations

into ongoing programming

clean communities, healthy families

Documents

sustainability of water

healthy familiesbuilding

healthy familiesgoal

healthy familiesphase

healthy familieswe

use soap2 clean communities

community leaders

community ownership