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Report

Enabling Environment Assessment and Baseline for Scaling Up Handwashing Programs:

Peru

Michael Favin and Doris Alfaro

Global Scaling Up Handwashing Project

April 2008

This report is one in a series of products of the Water and Sanitation Program’s Scaling Up Handwashing Project funded by the Bill and Melinda Gates Foundation. The aim of the project is to test whether innovative promotional approaches can generate widespread and sustained increases in handwashing with soap at critical times among the poor and vulnerable.

This series of reports documents the findings of work in progress about handwashing with soap in order to encourage the exchange of ideas and information and to promote learning. Please send your feedback to: [email protected] .

The Water and Sanitation Program (WSP) is a multi-donor partnership of the World Bank. For more than 30 years, WSP has helped the poor gain sustained access to improved water supply and sanitation services (WSS). WSP works with governments at the local and national level in 25 countries. For more information, please visit: www.wsp.org .

Credits

Editorial Support: Hope Steele Production: Paula Carazo This report was reviewed by Rocio Florez, Lene Jensen, and Eduardo Perez.

ABOUT THE AUTHORS Michael Favin

Michael Favin has over 30 years of experience in international public health in more than 25 countries in Africa, Asia, and Latin America, and has worked periodically in environmental health since his time as a community organizer and health educator for the Peace Corps in Brazil in the early 1970s. Since joining the Manoff Group in 1987, he has served as a senior technical adviser or a consultant to numerous health and nutrition projects. For these projects and others, Mr. Favin facilitated behavior change and communication strategy design, planning, implementation, and evaluation. He has worked in many critical public health areas, including child health and nutrition, school health and nutrition, maternal and neonatal health, and environmental health and has supported innovative tool development in areas such as routine immunization, growth promotion, care-seeking, and community surveillance. Mr. Favin has written or contributed to more than 60 books, manuals and articles.

Doris Alfaro

Doris Alfaro is a communications specialist with 15 years of experience participating in and managing projects in the fields of hygiene promotion, behavioral change, social mobilization, and advocacy for local development as well as partnership building at the community level. She has coordinated, designed, and implemented communication plans for health and nutrition programs nationwide. She has been a communications consultant for the health sector in Peru, Latin America, and the Caribbean for projects in environmental and public health. She has worked with CEPIS-PAHO/WHO, PAHO, municipalities, and Ministries of Health as well as for NGOs such as CARE and PRISMA. The findings, interpretations, and conclusions expressed in this report are entirely those of the author. They do not necessarily represent the views of the International Bank for Reconstruction and Development/World Bank and its affiliated organizations or those of the Executive Directors of the World Bank or the governments they represent. The World Bank does not guarantee the accuracy of the data included in this publication and accepts no responsibility whatsoever for any consequence of their use. The boundaries, colors, denominations and other information shown on any map in the document do not imply any judgment on the part of the World Bank concerning the legal status of any territory or the endorsement or acceptance of such boundaries.

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mailto:[email protected]

http://www.wsp.org

TABLE OF CONTENTS

LIST OF ACRONYMS AND ABBREVIATIONS ………………………………………………………V

SUMMARY........................................................................................................................................1

1. BACKGROUND..............................................................................................................................3 The Global Scaling Up Handwashing Project……………………………………………………..3 The Peru Handwashing Promotion Project………………………………………………………...4 Rationale for Enabling Environment Assessment …………………………………………………5 2. ASSESSMENT METHODOLOGY....................................................................................................6 Dimension Descriptions …………………………………………………………………………...6

The Assessment Process…………………………………………………………………………...7 Feedback on the Assessment Methodology………………………………………………………11 3. MAJOR FINDINGS BY DIMENSION.............................................................................................13 Policy, Strategy, and Direction…………………………………………………………………...13 Partnerships……………………………………………………………………………………….14 Institutional Arrangements………………………………………………………………………..18 Program Methodology……………………………………………………………………………19 Implementation Capacity…………………………………………………………………………20 Availability of Products and Tools……………………………………………………………….21 Financing………………………………………………………………………………………….21 Cost-Effective Implementation…………………………………………………………………...23 Monitoring and Evaluation……………………………………………………………………….23 4. RECOMMENDATIONS BY DIMENSION........................................................................................24 Policy, Strategy, and Direction…………………………………………………………………...24 Partnerships……………………………………………………………………………………….25 Institutional Arrangements………………………………………………………………………..27 Program Methodology……………………………………………………………………………29 Implementation Capacity…………………………………………………………………………29 Availability of Products and Tools……………………………………………………………….30 Financing………………………………………………………………………………………….31 Cost-Effective Implementation…………………………………………………………………...31 Monitoring and Evaluation……………………………………………………………………….32 5. NEXT STEPS...............................................................................................................................33 APPENDIX A: SELECTED DOCUMENTS.........................................................................................34

APPENDIX B: LISTA DE ENTREVISTADOS......................................................................................36

APPENDIX C: RESUMEN DE PUNTOS IMPORTANTES DE LAS ENTREVISTAS..................................42

APPENDIX D: ENCUESTA SOBRE LAS CONDICIONES PARA LA EXPANSIÓN DEL LAVADO DE MANOS CON JABÓN: 10 RESPUESTAS.............................................................................................61

APPENDIX E: LAS CONDICIONES PARA LA EXPANSIÓN DEL LAVADO DE MANOS CON JABÓN. GUÍA DE ENTREVISTA ....................................................................................................................69

APPENDIX F: ESTUDIO DE CONDICIONES PARA LA EXPANSIÓN DEL LAVADO DE MANOS CON JABÓN (GUÍA DE ENTREVISTA PARA SOCIOS POTENCIALES) ........................................................75

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APPENDIX G: INFORME DE VIAJE A PIURA...................................................................................83

APPENDIX H: CONDICIONES PARA LA PROMOCIÓN DE LAVADO DE MANOS ................................88

APPENDIX I: SUMMARY OF MAJOR FINDINGS AND RECOMMENDATIONS BY DIMENSION.........93

APPENDIX J: MENÚ DE ACTIVIDADES PARA ALUMNOS (IDEAS PRELIMINARES)..........................97

APPENDIX K: MENÚ DE ACTIVIDADES PARA PROMOTORES DE SALUD (IDEAS PRELIMINARES).99

APPENDIX L: ACTION PLAN TO IMPROVE THE ENVIRONMENT FOR AN EXPANDED HANDWASHING PROJECT IN PERU..............................................................................................101 LIST OF FIGURES Figure 1. Partner Contributions to Interpersonal Communications……………………………...16 Figure 2. Partner Contributions to Mass Media………………………………………………….17 LIST OF TABLES Table 1. Handwashing Targets by Country……………………………………………………….4 Table 2. The Public-Private Partnership for Handwashing in Peru……………………………….4 Table 3. Dimension Addressed by Stakeholder Type …………………………………………….8 Table 4. Persons Interviewed by Organization Type…………………………………………….10 Table 5. Self-Reporting Questionnaire Responses by Organization Type………………………10 Table 6. Calendar of Assessment Team Activities, May–June, 2007…………………………...11 Table 7. Committee Participants…………………………………………………………………27

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List of Acronyms and Abbreviations CBO Community-based organization COSUDE Swiss aid organization DIRESA Regional health directorate DREA Regional education directorate FBO Faith-based organization HWWS Handwashing with soap M&E Monitoring and evaluation MIMDES Ministry of Women and Social Development MOE Ministry of Education MOH Ministry of Health MOU Memorandum of understanding NGO Nongovernmental organization PAC/SEDAPAL Program in Lima to install/improve small water systems PPPHW Public-Private Partnership for Handwashing PRONASAR National program to install/improve small water systems (Ministry of Housing) UGEL Local educational management unit USAID U.S. Agency for International Development WSP Water and Sanitation Program

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SUMMARY

To follow up country work supported by the Public-Private Partnership for Handwashing, the World Bank Water and Sanitation Program (WSP) received funding from the Bill & Melinda Gates Foundation to support projects to scale up the promotion of handwashing with soap (HWWS) in Peru, Senegal, Tanzania, and Vietnam. The major project objectives of the Handwashing Initiative are:

• inculcate the HWWS habit among millions of mothers and children in these countries, • use a strong monitoring and evaluation (M&E) component to enhance the conceptualizing and

management of such programs, • establish sustainable programs that will continue and expand after this four-year grant ends.

Enabling environment assessments were carried out in all four countries to assess current conditions for scalability and sustainability and to make recommendations for improving conditions that are not supportive. This report summarizes the study in Peru, which was carried out by an international and a national consultant during three and a half weeks in May 2007. All four county studies are following a similar methodology, developed by WSP, to examine nine dimensions of scalability/sustainability through individual and group in-depth interviews, an electronic survey in which respondents are asked to score various statements, and a review of documents (Appendix A).

A partnership of many public and private organizations has supported handwashing promotion in Peru since 2002, achieving impressive results in advocacy, partnership development, tool development, and many other areas. The Initiative supported partnership formation, mass media, and capacity building for on-the-ground promotion in 14 of Peru’s 24 regions.

Evaluation of actual impact on knowledge, attitudes, and practice regarding HWWS shows some positive and some inconclusive findings. However, the study team feels that much excellent groundwork for the expanded program in Peru has been solidly laid by efforts to date and that, in combination with strong

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political will from the national government and a certain level of guaranteed funding, the outlook for effective expansion is very good.

Nonetheless, the team has a number of suggestions, many of which expand ideas suggested by persons interviewed. Some of the key recommendations are the following:

• Plan and implement a dynamic advocacy strategy that begins immediately and that continues throughout implementation.

• Plan and implement a strong project communication strategy directed primarily to partners but also to decision makers at various levels and to the public. Materials, formats, and activities should be directly related to reaching one of the strategy’s objectives (for example, partner motivation, sharing good ideas) and audiences, which should be clearly defined.

• Develop and implement an exit strategy that includes steps for dissemination and sustainability of program activities and achievements.

• Continue to negotiate and sign more formal agreements on partners’ roles and responsibilities and develop systematic mechanisms to monitor the implementation of the agreements.

• Have the key national-level partners, including the implementing organizations (which will be contracted to manage local implementation), dedicate themselves to establishing the conditions and providing the tools and support for successful local implementation. In this decentralized vision, the team expects that key factors for program success will be strong and dedicated partnerships at local levels, with effective tools, methodologies, and support from the national level.

• Greater attention should be given to carrying out thorough regional, provincial, and district assessments of organizations, potential champions, resources, programs, and conditions and to establishing and encouraging strong local partnerships.

The assessment methodology, findings, and recommendations are documented in this report and its many appendixes (a number of which are in Spanish).

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1. BACKGROUND Funded by the Bill & Melinda Gates Foundation, the WSP Global Scaling Up Handwashing Project will follow the basic approach of the Public-Private Partnership for Handwashing (PPPHW), a global initiative established in 2001 to promote handwashing with soap at scale to reduce diarrheal and respiratory infections.1 This approach draws extensively on lessons learned from two large-scale handwashing promotion programs. Programma Saniya, implemented in Bobo-Dioulasso, Burkina Faso, showed the importance of undertaking careful consumer research at the outset of a handwashing promotion program. The Central American Handwashing for Diarrheal Disease Prevention Program showed that an effective approach to changing hygiene behaviors at large scale was to work with a broad partnership of public and private sector stakeholders that have a mutual interest in increasing handwashing with soap, to focus on the one behavior with largest potential health impact (handwashing with soap), and to promote it with cost-effective, consumer-centered marketing.

The Scaling Up Handwashing Project

In hopes of facilitating effective replication and scaling-up of future handwashing-with-soap behavior change programs, the new project will carry out a structured learning and dissemination process to develop and share evidence, practical knowledge, and tools.

Specific project objectives are to:

1. design and support the implementation of innovative, large-scale, sustainable handwashing programs in four diverse countries (Peru, Senegal, Tanzania, and Vietnam);

2. document and learn about the impact and sustainability of innovative, large-scale handwashing programs;

3. learn about the most effective and sustainable approaches to triggering, scaling-up, and sustaining handwashing behaviors;

4. promote and enable the adoption of effective handwashing programs in other countries and position handwashing as a global public health priority through the translation of results and lessons learned into effective advocacy and applied knowledge and communication products.

The project is designed to achieve key targets in each country at the end of two years of implementation. The specific handwashing targets for each country are in Table 1. The target audience is defined as poor women of childbearing age (15–49) and poor children ages 5–9.

1 Global PPPHW partners include the Water and Sanitation Program, USAID, World Bank, UNICEF, London School of Hygiene and Tropical Medicine, Centers for Disease Control, Academy for Educational Development, Water Supply and Sanitation Collaborative Council, Colgate-Palmolive, Procter & Gamble, and Unilever.

Table 1. Handwashing Targets by Country Country (population)

Target population (millions)

Estimate target population adopting HWWS at critical times

Peru (28 million) 5.10 1.30

Senegal (11 million) 1.97 0.49

Tanzania (37 million) 5.20 1.30

Vietnam (84 million) 9.20 2.30

Source: World Bank (Water and Sanitation Program). 2007. “Terms of Reference. Enabling Environment Assessment and Baseline to Scale up, Sustain and Replicate Handwashing with Soap Behavior Change Programs.” March 9.

The Peru Handwashing Promotion Project As in many countries, diarrhea and respiratory diseases are the leading causes of childhood illness and death in Peru, and malnutrition is a major underlying cause of child mortality. Handwashing with soap can significantly reduce all of these major causes of misery. Attention to hygiene and handwashing got a significant boost in Peru in the 1990s because of the cholera epidemic, but as shown by the Handwashing Initiative’s 2004 baseline, practice levels were still woefully low: 11 percent of mothers and 6 percent of children washed hands with soap before eating, and 17.6 percent of mothers and 12 percent of children after going to the bathroom.2

The public-private partnership for handwashing developed in Peru over several years, as summarized in Table 2.

Table 2. The Public-Private Partnership for Handwashing in Peru

Year Activity

2003 Advocacy, handwashing practices study, development of a business plan

2004 Efforts to secure funding, funding commitments from the Japanese Fund, USAID, WSP (the

Water and Sanitation Program), and COSUDE (Swiss aid)

2005 Selection of communication agencies, design of project strategy and work plan, first campaign

and training workshops, monitoring activities, commitment of private sector funds

2006 Training workshops and promotional activities, monitoring, financial management, international

advocacy, launching of second campaign, effort to establish local alliances, process evaluation,

design of impact evaluation

2007 Financing from the Bill & Melinda Gates Foundation secured, local alliances strengthened,

school program, mass media campaign, monitoring and evaluation

Source: Flórez P., Rocío. “Iniciativa de Lavado de Manos en el Perú.” 17 de Octubre, 2006 (PPT).

2 AB PRISMA. Estudio de comportamiento de lavador de manos con jabón en zonas periféricas del Perú. Preparado como línea de base para la Iniciativa de Lavado de Manos en el Perú, liderado por PAS-Banco Mundial. Junio 2004.

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The Peruvian program implemented activities at the national level and developed partnerships and activities in 14 of Peru’s 24 regions. Preliminary monitoring and evaluation showed mixed but promising improvements in knowledge, attitudes, and practices, particularly in handwashing before eating and preparing food.

Fostering partnerships at the national, regional, and local levels has been a key project strategy. Although this has been difficult and demanding at times, it has also been a major reason for progress. Both interpersonal communication (in schools and communities) and mass media (mostly print and radio) made important contributions to changing knowledge, attitudes, and practices. M&E studies (these and other references are listed in Appendix A) indicate that all of the communication channels used (mass media broadcasts, print materials, training teachers and students, and training health staff and volunteers) contributed to reaching the target families, and that no one channel predominated.

Rationale for Enabling Environment Assessment In each participating country, an Enabling Environment Assessment is being carried out to (1) assess the extent to which the programmatic conditions for scale up and sustainability are in place at the beginning of the project; and (2) on the basis of the assessment findings, recommend what should be done to address the gaps during project implementation. Toward the end of the project period—in about 3.5 years—a final assessment will be carried out to determine whether there is an enabling environment in place in each country that can continue after 2010 without the Gates Foundation/World Bank project assistance.

The overall handwashing project is four years in duration with three distinct phases:

• Phase I is the 1.5-year start-up period for detailed planning at the global and country level. Several assessments, including a handwashing measures study and the baseline for the impact evaluation, will be carried out during this period. The baseline assessment of enabling elements will be carried out during Phase I.

• Phase II is the 2-year implementation period. • Phase III is the 6-month wrap-up phase that will include the final evaluation and

dissemination of lessons learned. The final enabling environment assessment will take place during Phase III.

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2. ASSESSMENT METHODOLOGY In other to ensure consistency in the assessment findings, WSP constructed a conceptual framework for assessing scalability and sustainability. This framework was developed based on a review of relevant literature and discussions with key individuals.

Dimension Descriptions The framework comprises nine dimensions that are considered essential to scaling up a handwashing-with-soap behavior change program.

Policy, Strategy, and Direction: Establishing a shared vision and strategy and ensuring the political will to implement them is the starting point for scale up. Without political will and a shared vision and strategy among stakeholders at all levels, scale up will remain an elusive goal. Developing this shared vision and strategy in a collaborative manner is also the foundation for coordination and for creating motivation all levels.

Partnerships: This handwashing-with-soap program model is based on a establishing a public-private partnership. A partnership is a relationship where two or more parties, having compatible goals, form an agreement to share the work, share the risk, share the power, and share the results or proceeds. Partnerships need to be built at all levels among public, private, and NGO sectors and between communities and local governments.

Institutional Arrangements: Institutions at all levels must clearly understand their roles, responsibilities, and authority. They must also have the resources to carry out their roles. In addition to clear roles and responsibilities, institutional arrangements must include the mechanisms for actors at all levels to coordinate their activities.

Program Methodology: Handwashing-with-soap programs have a seven-step program methodology. This methodology, adapted to each country context, should be clear and agreed upon by all key stakeholders.

Implementation Capacity: In addition to clearly defined institutional roles and responsibilities, institutions at all levels must have the capacity to carry out their roles and responsibilities. Institutional capacity includes adequate human resources with the full range of skills required to carry out their functions; an “organizational home” within the institution that has the assigned responsibility; mastery of the agreed-upon program methodology, systems, and procedures required for implementation; and the ability to monitor program effectiveness and make adjustments.

Availability of Products and Tools: A handwashing-with-soap behavior-change program is predicated on the existence of the soap that responds to consumer preferences and their willingness and ability to pay for them. In addition, handwashing station supplies—that is, plastic basins, towels, and so on—need to be easily available.

Financing: This dimension is aimed at assessing the adequacy of arrangements for financing the programmatic costs. These costs include training, staff salaries, transportation, office equipment and supplies, and the development of communication and educational materials as well as programmatic line items in budgets for handwashing-promotion activities.

Cost-Effective Implementation: The potentially high costs of promoting handwashing-with-soap behavior at scale make cost-effective implementation a key element. It is essential to understand how the unit costs change as activities are scaled up. Although it will not be possible to assess the cost-effectiveness of the approach and how best to achieve economies of scale until

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the end of the project, data must still be collected during implementation to make this determination at the end of the project. Therefore, this assessment will try to ensure that information will be collected from the outset and that the capacity to collect the information is in place.

Monitoring and Evaluation: A large-scale handwashing-with-soap behavior-change program requires regular monitoring and, perhaps more importantly, the willingness and ability to use the monitoring process to make adjustments in the program. Effective monitoring will identify strengths and weaknesses in the program methodology, implementation arrangements, and cost efficiencies. Overall monitoring responsibility must be at the highest level of the program, but must be based on information collected at the local government or district level.

The Assessment Process The primary data sources comprised the main stakeholders/present partners for the in-country program work, including government agencies, international agencies, international NGOs, local NGOs, private sector organizations, and community-based organizations (CBOs) at national, regional, district, and local levels. In Peru, all members of the National Committee were sought for interviews, as well as other partners at the national level and local partners in two of the country’s 24 regions. Piura was visited as an “old” region that had participated in the Handwashing Initiative, and Arequipa as a new region that will be included in the expanded program. In the expanded program, the number of participating regions will increase to approximately 20, depending on the requirements of the M&E plan.

Secondary data sources comprised documents and additional potential implementers, such as media and ministries with no direct involvement to date. Appendix A lists the main documents consulted.

Table 3 indicates the type of stakeholders interviewed on various dimensions.

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Table 3. Dimension Addressed by Stakeholder Type Stakeholder Type

Dimension

Gov

ernm

ent

agen

cies

Inte

rnat

iona

l ag

enci

es

Inte

rnat

iona

l N

GO

s &

FBO

s Lo

cal N

GO

s &

FB

Os

Priv

ate

Sect

or

CB

Os

Med

ia

Adv

ocac

y gr

oups

Bila

tera

l pr

ojec

ts

Policy, Strategy, Direction X X X L X – – X X

Partnerships X X X X X L X X X

Institutional Arrangements X X X X – L X X X

Program Methodology X X X X X L – X –

Implementation Capacity N,D – X X X L – – –

Availability of Products & Tools – – X X X L – – –

Financing X – X – – L – – –

Cost-Effective Implementation N,D – X – – – – – –

Monitoring N,D,L

– X – X L – – –

Note: Unless otherwise noted, an X means that it is appropriate to discuss this dimension at all levels: national, regional, district, and local; — indicates that this stakeholder type was not questioned on this dimension; N = national, R = regional, D = district, L = local.

In addition to reviewing documents on the program, both interviews and self-reporting were used to solicit individuals’ knowledge and opinions. Self-reporting consisted of responding to a grading-scale questionnaire that was e-mailed to approximately 35 potential respondents, some of whom were identified at the end of the interviews with the primary informants. Self-reports allowed the triangulation of information as well as some quantitative analysis that can be easily compared to findings of the repeat of the assessment planned to take place near the end of the implementation phase.

Sampling was purposive for all primary data sources. The team strived to interview persons who had participated in the handwashing program for at least six months. They also sought a good representation of decision makers, implementers, and midline supervisors/managers from different levels of organizations involved in the program—that is, national, regional, district, and local (as indicated needed on the interview matrix of Table 3).

Targets for the minimum sample size were:

• one interview and/or self-report (electronic questionnaire) with each current partnering stakeholder at any level

• three interviews in each dimension • two self-reports in each dimension

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• two interview sets with two different present partnering agencies, within each of these two organizations, one of each work type

• one self-report set with two different present partnering agencies, within each of these two organizations, one of each work type

• two interview sets with two different present partnering agencies with one representative for each level at three levels minimum—that is, national, district, local

• one self-report set with two different present partnering agencies with one representative for each level at three levels minimum—that is, national, district, local

• three interviews with three potential partnering organizations (if appropriate).

The team conducted 35 interviews in different organizations (Appendix B). The persons interviewed were from the organizations listed in Table 4.

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Table 4. Persons Interviewed by Organization Type

Types of organizations Persons interviewed

Government agency 9

Bilateral project 3

Media company 3

Local NGO 4

Private sector 3

International agency 8

International NGO 5

TOTAL 35

Self-reporting questionnaires were sent to representatives of different institutions linked to the Handwashing Initiative, including some from the same institutions where the team interviewed. Table 5 shows the types of organizations that provided the 10 completed questionnaires.

Table 5. Self-Reporting Questionnaire Responses by Organization Type

Types of organizations Persons responding

Government agency 2

Bilateral project 3

Media company 0

Local NGO 1

Private sector 2

International agency 1

International NGO 0

Consultant 1

TOTAL 10

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The team carried out a qualitative analysis of the interviews, first by summarizing all respondents’ positive and negative comments by type of organization and dimension and also listing the respondents’ corresponding recommendations. Appendix C documents this step in the process. The team used many, but not all, of the respondents’ recommendations to develop its own recommendations. The major recommendations were then placed in an Action Plan, as required by the team’s terms of reference. The team also did a quantitative analysis of the 10 self-reports received (see Appendix D) but did not attempt a further breakdown by stakeholder type because of the relatively small number of responses.

The assessment team was comprised of one international consultant and one local consultant who worked together during the final 3.5 weeks of May 2007. Table 6 summarizes their activities in Peru.

Table 6. Calendar of Assessment Team Activities, May–June, 2007

Date Peru In-Country Activities

May 8–11 Met with country team manager (CTM) to plan the activity

Reviewed the stakeholder list and developed the interview list

Scheduled interviews

Organized logistics

Modified and translated instruments

Sent out self-report questionnaires by e-mail

Began interviews

May 14–June 1

Conducted interviews (in Lima, Piura, Arequipa)

Summarized responses

Received and tabulated self-reported questionnaires

Drafted findings, recommendations, action plan

June 4–30 Prepared and gave debriefing to global WSP team and Peru program coordinator

Read additional documents

Debriefed for global WSP and drafted this assessment report

Feedback on the Assessment Methodology The team had to make some adjustments to the general assessment methodology proposed for all four countries, starting with translating all instruments into Spanish. In addition, they found that the standard interview questionnaire contained many single questions that contained multiple issues, so they separated these out. The first few interviews showed that there were too many questions to ask knowledgeable respondents and that there was some redundancy in questions under the different dimensions. The team therefore prepared a shortened version of the interview guide to try to address these concerns. Also, the team was unsure about the degree to which it should seek information from regions that had already participated in the program compared with areas where the program would expand. In the end they visited one region of each type, but they had to prepare another version of the question guide for the new region. (Appendixes D and E contains these question guides in Spanish. Appendixes F and G contain summaries of the visits to Piura and Arequipa.)

The persons interviewed varied tremendously by level and nature of their involvement in the program. Although the methodology anticipated some of this challenge, the interviewers still had to make on-the-spot decisions on which questions were relevant to the particular respondent and

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whether the respondent should focus on the past or the future of handwashing promotion activities.

Many of the respondents of the self-reported questionnaires participated in the Initiative as local-level implementers or supervisors, so they were really not in a good position to comment on some of the broader program questions. Nonetheless, there was a fairly strong congruence in scores for the different questions, which gives some confidence regarding general opinions.

Since it is planned that this assessment will be repeated near the end of the expansion phase, the team would recommend that different versions of the question guides be prepared for representatives of key national partners, key regional partners, local implementers, and national organizations that implemented promotional activities within their own organizations.

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3. MAJOR FINDINGS BY DIMENSION Based on documents, interviews and questionnaires, the team prepared a summary of findings and recommendations in table format (see Appendix I). This section presents a narrative of key findings.

Policy, Strategy, and Direction • The National Committee served as a key venue for manifesting high-level national

commitment to promotion of HWWS. • Government and other organization officials have a strong, positive political will toward

handwashing promotion and child health, although some government officials find it hard to give these areas special attention because of so many other priorities.

• The current national administration has embraced the Initiative and seems well disposed to collaborate.

• Key partners feel that they understand the approach used in the first phase and feel ownership, but they do not yet have a good understanding of the expanded project (which is still being designed).

• There are several politically prominent national initiatives (regarding malnutrition, healthy schools, and water and sanitation) that offer natural links with handwashing.

• Although the Ministry of Health (MOH) signed a ministerial decree in 2004 in support of the Handwashing Initiative, its enthusiasm has waxed and waned with frequent changes of officials; current officials appear to be quite supportive.

• At the beginning of the Initiative, national Ministry of Education (MOE) involvement was minimal, but now the MOE is actively engaged.

There appears to be a strong and positive attitude toward the promotion of handwashing and an appreciation of its link to child health, in part due to the country’s experience with handwashing as an effective way to control cholera. This common perception of handwashing promotion as a key action for improving child health is a major factor favoring program expansion. The current national government has made a public commitment to improving health and education, and in turn to supporting several specific programs to which HWWS can directly contribute.

The handwashing program has been successful in promoting the concept that the Initiative is a true partnership of many organizations and not a program of, for example, the World Bank or the MOH alone. There has been a shared vision of the partnership that transcends any particular member, which was no doubt fostered by the National Committee (in particular), as well as the consultative committee and communication committee. At the same time, the interviews strongly indicated the need to strengthen dissemination of results and to maintain clarity regarding roles in the partnership and to nurture partners’ sense of active participation.

Important steps have been taken toward institutionalization, but much work remains to be done. The Initiative first focused on identifying and engaging with partners to form a public-private alliance, conducting a study on handwashing practices, and designing a business plan. The MOH issued Ministerial Resolution No. 062-2004 in support of the Handwashing Initiative, and in 2005 the ministry assumed a stronger leadership role with the initiation of the communication activities, providing some resources and a resolution in support of a national program of information dissemination. The MOH also established a sectoral committee comprised of key ministry offices, but its function was limited to receiving information, and it did not evolve into making proposals to strengthen the institutionalization of the Initiative.

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In some of the regions, there has been progress in institutionalizing handwashing activities into public and private institutions’ work plans (for example, Lambayeque and Ica) and into training curricula (in Cusco, for teachers). Continuing to encourage such steps is a key to sustainability of the Initiative.

Although before 2006, the MOE was not linked to the Initiative, MOE offices in various regions, provinces, and districts were active partners, taking advantage of the Initiative’s communication tools and using the training modules with children in their classrooms. Today the MOE is actively engaged in planning for the expanded phase, and it will include handwashing in schools as part of its national Social Mobilization Program. For this purpose, it has assessed and pretested the Initiative’s school materials. The current national MOE support should facilitate strong involvement of local MOE offices.

There is good political will at the regional level also, but not as strong or cohesive as the political will at the central level. The regional and provincial levels are in a transition to decentralization, in which authorities are uncertain about their functions, roles, and resources. Local decision making and regional organizations working together on a common objective are new ways of working, and local governmental units are in the process of trying to establish their regional priorities from among a plethora of needs. The regional governments are working on their development plans and documents on regional health priorities. The Initiative and its partners should work to make improving child health and reducing diarrheal diseases prominent in these plans.

At all levels, there are additional avenues for the expansion and sustainability of the project by linking it with current national political initiatives such as Reduction of Infant Malnutrition, Healthy Schools, and Water for Everyone, which do or could incorporate handwashing promotion.

Despite this positive situation, converting political will into program actions remains a challenge because, as various persons interviewed noted, it is difficult to give special attention to one particular theme such as handwashing because there are so many other public sector priorities.

Decrees published by government agencies at national, regional, and local levels are very important since they represent the main door leading to public funding of activities. They also define a period of time in which the strategy and activities will be implemented. So, as several respondents pointed out, although a decree does not guarantee further action (rules, regulations, and activities in work plans and in the field), without them there is no public spending. Following the MOH decree in 2004, the ministry financed a one-month handwashing campaign and direct consumer contact (local promotional events) in 24 regions in 2006.

Partnerships • In general this has been a successful and innovative aspect of the program, in particular

with private sector partners. • Public and private organizations have generally worked well together, but not without

some minor friction. Private partners sometimes become impatient because the public sector tends to be more formal and bureaucratic and to have more changes in personnel. Some local public officials consider private organizations to be too interested in receiving individual credit.

• Keeping key government ministries (particularly health, education, and housing) involved is essential, even though this can be difficult at times because of political changes and overburdened officials who are too busy to participate in meetings.

14


• Different partners have played very different roles, from being fully engaged as a member of the national coordinating committee to providing short-term messages on handwashing and co-financing and/or managing local activities. This is fine as long as expectations are clear.

The Initiative engaged with diverse organizations and persons, including regional and municipal governments, communication media, and health and education offices and organizations. Many partner organizations were able to insert handwashing promotion into existing strong and efficient networks. In general, the organizational partners were of three types: (1) WSP, donor organizations, and governmental organizations that managed the program (through the national committee); (2) national-level implementation partners—from various types of organizations (public and private), most of which collaborated on the basis of informal agreements and some on the basis of memoranda of understanding or contracts; and (3) regional and local implementing partners, also both public and private, and some with financial or material support from the Initiative.

The different roles of partners at the national level that the team identified include:

• providing funding (for example, the Japan Social Development Fund) • providing funding and participating in planning and management of the Initiative (for

example, COSUDE, USAID) • providing funding and participating in planning, management, and national

implementation (for example, the MOH and the MOE, more recently) • implementing communication activities directed to their personnel and customers (for

example, Belcorp, CARE) • carrying out M&E activities and playing a major role in preparing training and trainers

(as, for example, PRISMA, which worked under contract) • supporting a specific activity, such as dissemination or printing, based on its resources

(for example, Banco de Crédito, Transportes Ormeño).

At the regional level, the Initiative established strong relationships with various types of organizations, usually via the Regional Health Directorates (DIRESA), that made various contributions. Some examples are:

• providing funds and participating in the planning and management of the Initiative (for example, the Regional Government of Lambayeque)

• providing funds and participating in local planning, management, and implementation (for example, the DIRESA, Regional Education Directorate [DREA], or MOE’s Local Educational Management Unit [UGEL])

• implementing communication activities directed to their staff and beneficiaries (for example, local NGO offices)

• getting involved in a specific activity (for example, dissemination or printing) appropriate to its resources (for example, Radio PROMUDEH in San Martín).

Figures 1 and 2 show organizations that have done person-to-person promotion and mass media promotion.

15


Figure 1. Partner Contributions to Interpersonal Communications

+

PUERTA A PUERTA

Actividad / Impacto Socios

Promoción de la Salud MINSA

Ampliación de cobertura PAC SEDAPAL

Asociación de Agricultores AGAP

Desarrollo público local Programa Mi Barrio

Programa Promoción de la Salud

CARE

Venta de cosméticos Belcorp

Voluntarios Peace Corps

ONG Talleres Prisma

Talleres y réplicas Talleres itinerantes

+

Actividades de Scouts Scouts

+ +

+

+

+ +

Source: Flórez P., Rocío. “Iniciativa de Lavado de Manos en el Perú.” 17 de Octubre, 2006 [PPT]

16


Figure 2. Partner Contributions to Mass Media

MEDIOS MASIVOS

Actividad / Impacto Socios Serie Radial, avisos RPP

Circuitos interno de TV220 agencias

Banco de Crédito

Aviso en recibo de electricidad

Luz del Sur

Avisos en periódicos de circulación nacional

Expreso Extra

Circuito de TV en buses Ormeño

Circuito interno de TV, 40 agencias

Interbank

Avisos en página Web Terra

25 regiones Radios y TV Local

Aviso en recibo de agua SEDAPAL

Source: Flórez P., Rocío. “Iniciativa de Lavado de Manos en el Perú.” 17 de Octubre, 2006 [PPT].

The process of participating in such a public-private partnership has allowed government and company staff to learn about other ways of working together for public health, in a participatory way, with support that they could offer with their own resources. The public institutions, the companies, and the NGOs interviewed indicated their interest in continuing their involvement. In the case of NGOs, officials are pleased to collaborate to the extent that their goals and funding address reducing diarrhea and respiratory disease among children.

At the central level, the Initiative worked to achieve financing from the Ministry of Women and Social Development (MIMDES) for disseminating broadcast materials in the Clean Hands, Healthy Kids campaign, 15 times a day, mostly in the preferred early morning hours. This dissemination included four regions where the project was active: Ayacucho, Cusco, Lambayeque, and San Martín.

In Ayacucho, the Regional Health Council stimulated the formation of a regional Handwashing Initiative by establishing an implementation committee in which the MOH and DIRESA joined the regional government to prepare guidelines for health programs and projects. The objective of the committee is to safeguard the logic and consistency in the implementation of all health programs in the region. The local partners achieved the collaboration of the army for the temporary storage of training materials.

17


In Cusco, the provincial municipality of Canchis participated in inter-institutional agreements with the UGELs of the Ministry of Education of Cusco and Canchis to train local trainers and health promoters.

In Lambayeque, the regional government took the initiative to engage other partners, includingthe DIRESA.

In San Martín, a pa

rtnership between communications media and the water company was

ents praised the Initiative’s innovative and generally successful partnership of

d well together, some respondents did note that

rs

es

. Most collaborating companies have established units for

arly for NGOs and private organizations. ntal organizations were more formal: the MOH issued a

The pu OH did thisand another decree that established an internal sectorial committee charged with coordinating

on

ample, there are dores

established to support health communication.

Many respondpublic and private organizations, particularly in regard to support from the private sector. Although all types of partners generally workethe public sector tended to be more formal and bureaucratic and to have frequent changes of personnel, which delayed approvals of actions and materials. In general, private sector partneare more flexible, comfortable with informal arrangements, and able to act more rapidly. Most private sector companies have had a more focused participation in specific promotional activitiand have not been involved in overall planning or management. Private voluntary organizations,particularly at the local level, generally integrated handwashing promotion and/or activities and materials into their existing programs.

Most private companies that collaborated in the first phase do not appear to have been motivated by a desire to expand their sales of soap (there was only one company that was a major soap vendor) or other handwashing productssupporting socially beneficial programs—no doubt motivated by both altruism and a desire to maintain a public image of social responsibility.

Institutional Arrangements • Many respondents felt that arrangements have been informal yet have worked well based

on the basis of personal relations, particul• Arrangements with governme

ministerial decree in 2004, and some regional governments approved ordinances. Beginning in 2006, the Initiative made an effort to sign MOUs with national and local partners.

blic sector has a strong need to formalize its relationships and commitments. The M by issuing a formal ministerial regulation that promoted the Initiative within the MOH

implementation responsibility among the various offices and programs of the MOH. However, interviewees made two common points: (1) that with decentralization, national agreements would not necessarily translate to the regional level and below; and (2) that although formal agreements with government organizations were definitely desirable, they were also insufficientto ensure that the commitments would yield actions and funding in the field. The issuance of ministerial resolutions and directives contribute to the sustainability of handwashing-promotiactivities by helping to orient work to a theme, but these resolutions and directives still need to be reflected in work plans, budgets, institutional directives, and actual activities.

Initially, informal relations seemed to work quite well for private sector partners and some NGOs, but since 2006 the Initiative has negotiated and signed more formal agreements with public and private partners, a trend that most respondents feel is desirable. For exletter agreements with such groups as Ecoclubes Perú, Asociación de Gremios Agroexportadel Perú (AGAP), the regional government of Ica, Caritas Piura y Tumbes, Municipality of Surco, and Asociación Civil Pro Ica. More formal agreements are likely to facilitate the sustainability of organizational commitment, so it seems wise for the Initiative to try to make informal agreements more formal over time, appropriate to various organizations’ roles.

18


At the regional level, governmental units, including municipal governments, require a foparticipation. Although NGOs and private organizations are willing to be flexible, a move toward more formality and the generation of agreements to govern joint work does facilit

rmalized

ate

tioned the need to focus more on interpersonal communication,

The e ormative researc m relies strongly on a participatory training methodology that uses games and activities to build the

as ns,

d

for

d reinforcing information given

g as the Initiative:

ds, el and for

program implementation as well as sustainability.

Program Methodology • In general, opinions were positive; people felt that combining diverse partners’ strengths

proach. produced an effective ap• Some respondents men

while media representatives felt that mass media could play a larger role. • Many of the persons interviewed pointed out that it has been easier to generate

enthusiasm and behavior change among children than among mothers, particularly in rural areas.

P ruvian program has followed the general PPPHW methodology. Findings from fh formed the basis of a work plan for promoting behavior change. The Peruvian progra

capacity of change agents (teachers, health staff, and volunteers) and gives them motivations, resources, and information to influence mothers. Interpersonal communication is supported by print materials and complemented by mass media communication. The project managed the design, production, pretesting, and dissemination of all these communication materials.

Opinions on the project methodology are quite positive. Most people appreciate the need for diverse communication channels to effectively carry information and motivations. A few interviewees believe that the Initiative has been implemented too much like a short-term campaign and had insufficient supervision and follow-up. The team’s impression is that this wcertainly not the general situation, although it did happen in specific locations. Short campaigcentered on brief public events, are indeed popular in Peru. The strength of supervision anfollow-up seemed to depend very much on the normal working methods and resources of the local partner. In some cases this happened; in others it did not.

Regarding work at the regional and district levels, various respondents emphasized the need strong interpersonal communication in order to achieve behavior change. They view mass media as an important but supportive channel for sensitizing people anperson to person. Many respondents recommended that in the expanded program, the field staff of local partner organizations include interpersonal promotion of handwashing in the programs and plans; that is, that institutionalization goes beyond formal acknowledgment in program norms and general guidelines. This refers to the MOH at all levels, to the MOE, to the networks of women’s organizations, NGOs, and others.

Some international public health specialists question the feasibility of interpersonal communication on a large scale, but in the opinion of the interviewees and the team, this component can be affordable and feasible as lon

• stimulates the formation of strong local partnerships (of popularly respected organizations that manage cadres of change agents),

• provides strong training guidance and tools as well as job ai• contracts with implementing agencies for training teachers and health personn

post-training follow-up, and

19


• encourages the MOH and the MOE to award certificates to change agents who satisfactorily complete training on handwashing promotion and who carry out actual

Responschoolc cond phase to see if this

ase, s must master the methodology and have essential materials. Processes and

resource that public sector institutions can use at the national and local levels, adopted

e ctive in the short run, but it is not

that

vocate rial decrees, regulations, budget allocations) but at the same time work with these

ls ce of

ion of

• While the skills and systems needed to implement the program well certainly exist at the national level, a few of the persons interviewed at the national level expressed concern about capacity at the local level.

counseling on HWWS in their communities and schools.

dents judge the behavior-change methodology used to have been more effective with hildren than with mothers. It would be interesting in the se

impression is valid and, if so, why. (According to the monitoring study, 90 percent of school children talked with their families about handwashing after having sessions in school.) The November 2006 evaluation study found the impact of project activities on actual handwashingbehavior to be inconsistent and fairly modest, so it would seem advisable for the Initiative tomonitor behavior change periodically during the second phase to see if slow change is occurringor if the methodology needs strengthening in some respects in order to achieve the desired impact on practices.

To effectively apply the methodology at the national and regional levels in the expansion phimplementing agencieproducts need to be standardized, but they also need to be adaptable. Possibly the Initiative can provide standard resources with instructions for adaptation when needed because of such local factors as climate, availability of water, ways of warming water in very cold zones, and cultural factors.

For institutionalization of the at-scale program, it will be important that the methodology can serve as aformally in institutional strategies. The Initiative should meet with the persons responsible for related programs in the MOH, the MOE, and other partners to promote the use of each other’s communication materials where appropriate and possible.

The global PPPHW methodology recommends that messages focus exclusively on HWWS. Thteam feels that such a focused approach could be quite effelikely to be sustainable, because there are so many competing priorities, even within child health.On the other hand, the Initiative should work with the implementing partners to try to ensure HWWS information is not given at the same time as messages on many other topics, because this is not likely to result in people being sufficiently informed and motivated to change their practices.

The best strategy for sustainability is to integrate HWWS into many existing programs (adfor ministeprograms to make handwashing promotion more effective and receive more attention.

In general, there is NO guarantee of sustainability. However, the more that partners at all levework well together and the more the public supports these activities, the better the chansustainability. Over a period of several years, HWWS at key times could become a social norm in Peru, passed on within families and communities with little or no need for programs to promote it. In the United States, this has begun to happen with such practices as using seat belts,using designated drivers, and smoking in public only in designated areas, but some promotthe desired practices is still needed.

Implementation Capacity

20


A large-scale program requires that central planners in the public sector know enough about implemto d n

From th r

ols

r is difficult in

The Initiative generated a varihan ahan ahea /dopera, s nd television spots). These tools were developed on the basis of the

n

d the l sessions.

e financial and in-kind contributions during the first phase.

ort HWWS. m believes that some external funding is likely to be needed after 2009, mainly for g the cost of implementing agencies to support new districts and, at a lower level,

during

entation conditions to be able to make good compromises between what they would like o a d what is feasible in the field.

e interviews and the team’s analysis, it appears that the national level has capabilities foprogram design, planning, preparation of norms and supervision of activities, but not perhaps for making needed adaptations at the local level because of varying local conditions.

Availability of Products and To• Most of the training and communication materials can be used with little or no change in

the expanded program. • There is little concern with the availability of soap, although access to wate

some communities.

ety of tools to support partner organizations in promoting dw shing among poor families. These included a methodology to motivate and teach

shing through games andw d activities, modules to build capabilities of teachers and lth evelopment personnel, and communication materials (posters; reminders; a radio soap

pots, and mentions; abaseline behavioral study, and then pretested with their target audiences. Unfortunately aadministrative delay during the creative design process left little time for the complete intervention, with all of the communication channels working together.

Disseminating all of these tools was a challenge that seems to have been met. Some of the tools were managed and used directly by the Initiative, while others were offered to partner organizations that intended to use them through their own channels. The program monitoredistribution of materials as well as the use of interpersonal materials used in educationa

The monitoring study provided useful feedback on the manuals and educational materials. In general these were considered well done and effective, although people did express the need to adapt materials to the zones of the country (coast, mountains, jungle). Problems in the availability of complementary materials were also noted, and the poster picture may need to be changed to focus more on hands.

Persons interviewed expressed minimal concern about soap availability in the homes, since the baseline study (covering all regions of the country) found soap that could be used for handwashing available in 98 percent of homes (and usually in several places in the home). A few people in Arequipa, however, did mention that families in isolated mountain communities may have poor access to soap.

Respondents considered the provision of plastic washing bowls and pitchers to have been usefulin the first phase, and the team observed these being well used in schools.

Financing • Many partners mad• The general opinion is that there is potentially sufficient funding in Peru for this activity,

but that the partners need to work hard to obtain the funding to supp• The tea

coverinto support continued advocacy. However, partner contributions should increasethis phase, so the percentage of funding provided by external sources should decline.

21


As eand COshowed media.

n and/or implementation of extra workshops, in addition to those funded by the 14

ertad); Santiago (Ica), among others irecciones Regionales de Salud (Nivel Nacional); CLAS (Local Health

ional

Pri te

• to, Interbank, Banco del Trabajo Sedapal, Luz del Sur

NGOs

cavelica, Huánuco)

In g e country, particularly with the decentralization process, since the regions are gaining autonomy in preparing and budgeting for their dev p , it will be essential to identify regional priorities and then lobby (with regional presidents and others) to include handwashing

ry ons.

only for activities to promote

w

icts

a r sult of awareness-raising and advocacy activities, various donors agencies such as USAID SUDE decided to provide funding to support the Handwashing Initiative. Also, the MOH its commitment by making funds available annually for local communication and mass

In addition, the Initiative received many in-kind contributions from public, private, and civil-society organizations, which facilitated the incorporation of handwashing messages in activities of their networks to reach the public. Some made financial contributions for message disseminatioJapanese Development Fund, thus allowing the expansion of some handwashing promotion toregions. These organizations included:

Public Sector

• regional governments of Lambayeque and Ica • municipalities: Santiago de Surco (Lima); Pucallpa (Ucayali); Piura, Castilla, and

Catacaos (Piura); Trujillo (La Lib• MOH: D

Administration Committee) • MOE: Dirección Nacional de Educación Comunitaria y Ambiental; Dirección Reg

de Educación (Lima)

va Sector

• agricultural companies: Asociación de Gremios Agroexportadores del Perú (AGAP), Fundación ProIca; Gremio Pro-Citrus (Huaral), Sunshine Export (Piura) banks: Banco de Crédi

• utilities: • cosmetics companies: Belcorp

• Healthy Cities (Ucayali, Ica, Piura) • Caritas (Piura, Tumbes) • CARE (Piura, Ayacucho, Huan• Ecoclubes (Piura, Tacna)

en ral, there exists potential funding in-

elo ment plans. For the expanded handwashing program

in local plans and programs.

In addition, each year the municipal governments allocate funds through a participatobudgeting process that includes discussions with organized citizen groups and local institutiFor sustainability, it would be highly desirable for the Initiative’s implementing agencies to participate in these deliberations, since they could lobby not HWWS but also for the conditions that would support the sustainability of this and otherdesirable objectives.

The team believes that if the handwashing promotion initiative is to continue to expand to nedistricts after this second phase, external funding is still likely to be needed after 2009, mainly to cover the cost of implementing agencies that will probably be needed to support new distr

22


and also to support continued advocacy. However, the percentage of program costs contributed by national partners should continue to increase.

Cost-Effective Implementation • In the first phase, WSP and its partners collected extensive cost information and some

no attempt to calculate the cost-effectiveness of

Ana spha designe

des ate

on sessions. To maximize their use, the print materials were

t is

nt for project

wed were not very aware of the Initiative’s monitoring

• ctronic survey, respondents scored monitoring lower than any other dimension.

Wit uresp sdissem

ents to

d to

ot be lost.

t

to generalize about them in relation to the control districts. In

impact information, but there was various activities or strategies.

• The capability for collection and analysis does exist in Peru, but technical support and training will be needed for particular partners and local areas.

ly is of cost-effectiveness probably cannot be done until the final year of the expansion se, but clearly the methodology and data collection systems and procedures need to be

d sooner than that.

The partners took full advantage of the materials that were developed. For example, the episoof the radio soap opera comprise a series, but each can also be used independently to generdiscussions in group educatidistributed to local radio stations, to some municipal radio stations, and to informal communication channels. Another cost-effective action was drawing on the regional training facilitators themselves to develop training materials for use with the local facilitators.

Some local NGOs have the ability to collect and analyze information on cost and impact, but istill necessary to strengthen existing capabilities and to monitor activities.

Monitoring and Evaluation • The persons interviewed generally consider M&E to be very importa

success. • Many of the persons intervie

activities or results. On the ele

h f nding from the Japan Social Development Fund, the NGO PRISMA assumed M&E on ibilities. There were formal studies and routine monitoring, and the Initiative did

inate the findings in annual reports and other summary documents. In the electronic survey, however, M&E scored lower than other dimensions, which seems to indicate that theM&E results were not widely or well disseminated; or it may simply be that most respondthis survey collaborated at the local level and therefore were less likely to have been exposeM&E findings.

The persons interviewed indicated that M&E should be a key component in the expanded program and that the opportunity to show how well different interventions work in this type of project should n

The team feels that it is going to be a challenge to allow the local implementation flexibility thamany respondents recommend while at the same time keeping sufficient uniformity in the program districts to be able addition, the monitoring team will have to control carefully for the effects of the many existing programs and projects in both intervention and control districts.

23


4. RECOMMENDATIONS BY DIMENSION The team has a number of suggestions, many of which expand ideas suggested by persons interviewed. (In some cases, the team further developed some general suggestions from the interviewees). This section presents key recommendations by dimension. These are also described in table format in Appendix I.

Policy, Strategy, and Direction Although the attitudes of public and private officials toward handwashing are generally very positive, many still lack knowledge of the multiple benefits of HWWS. Moreover, government officials in particular must try to address many different priorities simultaneously. Therefore, the Initiative should develop an advocacy strategy—with arguments and materials for different levels and types of decision makers—that describes the importance of HWWS for reducing diarrhea, respiratory disease, and infant mortality; for preventing malnutrition; and for improving school performance, mothers’ confidence and self-esteem, and the nation’s human capital. Advocacy activities should begin as soon as possible and continue throughout the project period.

At the time of this assessment, even key partners lacked information and had differing expectations regarding the expanded handwashing program, although clearly steps were already planned to remedy this situation. Before the selection of implementation districts, the Initiative should hold individual and group meetings with the key partners to clarify their expectations and the project’s intentions and constraints (such meetings have already begun). The Initiative should prepare and disseminate a brief description of the new project that summarizes the proposed strategy and plans, making clear which features are required under the new project. Initial discussions of each partner’s role and responsibilities should also occur during these meetings, leading eventually to MOUs or other types of agreements. A similar process, managed by the implementing agencies, should be repeated at the regional, provincial, and district levels, once the intervention districts have been selected.

The National Committee has played a key role in institutionalizing HWWS by making the major programmatic decisions and being viewed by others as the face of the Initiative. It is important in the expansion phase that it continues to play this role and that its decisions are well disseminated to give orientation to regional activities.

The first phase of the Handwashing Initiative in Peru has achieved various degrees of integration with such programs as PRONASAR; PAC/SEDAPAL; the MOH’s Healthy Schools program; and, recently, the MOE’s Clean, Safe, and Healthy Schools program. The team (and many of the people interviewed) strongly support efforts to integrate with and strengthen promotion of HWWS in existing programs rather than implementing the handwashing promotion as a vertical program. This makes sense for several reasons:

Many national and local programs, some with strong political support, already include hygiene improvement and/or handwashing, so they should be quite open to making this component more effective. For example, there is a strong link between handwashing and infant nutrition, which is a priority of the president, along with other programs such as Together and Water for Everyone that are being implemented by public and private organizations.

This strategy of incorporating handwashing promotion into ongoing activities gives the best chance of institutionalization. In addition to existing programs, there is the potential of synergy of handwashing promotion with the rollout of rotavirus vaccine (since both interventions reduce diarrhea) and with planned sanitation marketing programs.

24


Taking a more vertical, campaign-type approach can generate jealousy among other programs that eventually leads to the demise of the vertical program.

In general, the team recommends a decentralized structure for this expansion phase. The national level should create supportive policies, standard tools and methods—including strong advocacy, program communication, and M&E activities—and work through the implementing agencies to establish strong coordination and clear responsibility at local levels.

The national-level public sector institutions are in the process of taking on a normative role. More and more decisions on priorities and program activities will be taken at the regional level, which will also control the resources to implement them. Given the reality of decentralization, it is important that advocacy activities designed to build and maintain support for HWWS be directed to decision makers at the regional, provincial, and district levels as well as at the national level.

In response to the past problem of frequent changes in public sector officials, it is important to promote the inclusion of HWWS in the annual work plans, guidelines, and budgets of the MOE and the MOH. Also, it is recommended to link with the National Health Council, a consultative group of the MOH that is charged with arriving at decisions via consensus and with coordinating the national Coordinated and Decentralized Health Systems. There are similar institutions at the regional level, with active civil society participation. These organizations work on health guidelines but also on implementing regulations and national plans.

Partnerships The main recommendations at the national level are to proceed with making the MOE a full national and local partner (already in progress) and also to consider adding to the coordinating committee the Ministry of Housing, as well as at least one private sector partner such as CONFIEF, which represents an array of private companies. The Initiative should engage other old and new partners with national reach through the National (consultative) Committee. It should also assess the interest of potential new partners in joining the Initiative (for example, UNICEF, PAHO, Save the Children). The existence of a certain level of guaranteed funding (from the Gates Foundation), along with concrete products (training and communication materials, handwashing kits) should help build the confidence of old and potential partners.

Although selling more soap has not been a strong motivator of private sector participation, the Initiative should meet with companies that produce soap, towels, and plastic containers to see if they would be willing to incorporate HWWS information in their advertising or packaging in the hope of expanding their markets. It can be argued that the Initiative is doing free market expansion, which they should be happy to encourage.

To achieve impact and sustainability, the Initiative should focus on establishing and strengthening partnerships at the regional, provincial, and districts levels, where the implementing agencies need to identify existing public and private coordinating groups to take on explicitly the coordination of handwashing-promotion activities. The first choice for a coordinating group should be an existing structure such as the mesa de concertación or regional multisectoral committee. It is also important, at the local level, to identify one or more HWWS champion organization or person that can identify the groups best positioned to engage other partners.

Partners at the district level should include the strongest programs and institutions in each district. A strong partner organization is one that has a good reach into communities, has built confidence among the population, and is committed to ongoing follow-up and supervision of promotion

25


activities. Each partner should be asked to commit itself to strengthen or expand attention to handwashing in its objectives and work plans. Organizations to consider include those helping install or improve water and sanitation systems, Vaso de Leche, comedores populares, and NGOs with long histories and good reputations in an area.

The WSP, the National Committee, and the implementing agencies should focus on providing guidelines, tools, and strategic technical assistance to local partnerships. To keep local partners motivated and informed, the team also recommends a strong project communication program with a newsletter, Web site, media coverage, and meetings and exchange visits that facilitate the dissemination of achievements and sharing of lessons learned (see Appendix L).

As part of the process of consolidating the public-private alliance to promote HWWS, it is recommended that WSP and/or the National Committee lay out clear organizational responsibilities, including a checklist of requirements for implementing person-to-person promotional activities, assigning roles and functions to different actors at the regional level.

At the national level, each partner should be invited to join one of the committees listed in Table 7, depending on each organization’s agreed-upon roles.

26


Table 7. Committee Participants

Type of Committee

Participants Type of Institutions Frequency

National Committee

One representative each from the MOH, the MOE, from each major donor organization, private-sector partners, and civil-society partners.

• Those providing funding and participating in planning and management of the initiative (for example, COSUDE, USAID).

• Those providing funding and participating in planning, management, and national implementation (for example, the MOE and the MOH)

Monthly meetings

Committee of Institutional Partners

Collaborating organizations that have less overall involvement (in limited geographical or functional areas)

• Those implementing communication activities directed to their personnel and customers (for example, Belcorp, CARE)

• Those involved in a specific activity, such as dissemination or printing, based on their resources (for example, Banco de Crédito, Transportes Ormeño)

Meetings every three months to receive information and exchange experiences, plus information exchange via other communication channels

In the first phase, there does not appear to have been a strong connection between the National Committee and the regional and local partnerships. The Initiative needs to clearly define and follow through on its relationship with the regional coordination committees. The project communication program (newsletter, Web site, and so on) should facilitate two-way communication.

Institutional Arrangements Although MOUs and other formal agreements are no guarantee of follow-up, they are essential for working with government agencies since they are needed for budget allocations to occur, and they may limit disruptions caused by changes in personnel. Formal agreements are particularly important with the MOH, which maintains substantial control over its local offices. The Initiative should continue to pursue such formal agreements at the national level and instruct its implementing agencies to do so at local levels.

Although it is fine initially to have less formal agreements with private and civil society partners, it the long run negotiating and signing more formal agreements is desirable because such agreements would clarify roles and expectations and support sustainability. All agreements should define roles, responsibilities, and expected contributions. Moreover, the fulfillment of all formal and informal agreements should be reviewed and documented every six months. The WSP and the MOH should be responsible for this monitoring at the national level, and the implementing agencies should have responsibility at other levels.

More formal arrangements are also needed at the regional level, not only regarding implementation guidelines but also written commitments on responsibilities and in-kind and monetary contributions. The types of organizational involvement described in the section on major findings on partnerships provide a menu of possible relations with the Initiative.

27


Program Methodology The study team feels that the expanded project can follow a very similar methodology that combines forming partnerships at every level, advocacy and institutionalization activities, and strategic communication activities that combine mass media and several channels for interpersonal communication. It should be possible to scale up interpersonal communication training and activities, since this will be done by implementing agencies, each of which will be responsible for three to five regions and selected districts within each region. A key to success will be the supervision and follow-up of the training by the local partners themselves. The team has made small suggestions for improving the methodology (for example, by suggesting handwashing-promotion activities that students and promoters can do in homes and communities, and preparing modified materials for each of the three zones in the country—see Appendixes J and K) but has not suggested major changes.

Three general suggestions from various respondents were to: (1) focus on supporting the local levels, (2) allow local partners flexibility in implementing the general strategy, and (3) urge local partners to avoid a focus on short campaigns with no clear follow-up. Such campaigns seem to be very popular in Peru, but their impact is questionable.

In the start-up period, the Initiative should develop a standard methodology and instruments for assessment visits at the provincial and district levels to identify existing activities in which handwashing promotion could be added or strengthened, and to identify the strongest partner organizations and potential HWWS champions.

Most respondents recommended that implementation emphasize interpersonal communication, but all saw a continued role for mass media. The team favors a focus on local radio in local languages and interactive formats (call-in shows, radio listening groups, and so on). It is important to ensure better coordination between mass media promotion and on-the-ground activities, so they are mutually reinforcing.

The team recommends encouraging and facilitating local partners to create opportunities for individual and group dialogue between change agents (teachers, students, health staff, health volunteers) and mothers, to give ample opportunity to explain and discuss the desired behavior changes and to jointly problem solve if there are barriers to action. Mass media should continue to support interpersonal communication by generating interest in and reminders of handwashing with soap.

What is ideal, but only possible in one-on-one or group communication, is for the change agents to ask a few assessment questions to learn what the mother or group is currently doing regarding HWWS. So, for example, if the mother is already washing her hands at key times but not using soap, the focus of the conversation would be on the importance of using soap and how this can be done by this particular mother. If the mother is washing with soap but only before preparing food, then the importance of washing of other key times would be the focus.

If feasible, it would be desirable to develop separate communication materials for the coast, mountains, and jungle areas of Peru. If this is not possible, the Initiative should encourage regions to modify materials to incorporate more appropriate images, language, and local conditions, such as limited water or cold temperatures, and counsel families on how to overcome them.

For both effectiveness and sustainability, the Initiative should encourage strengthening of handwashing promotion within existing programs such as health promotion by the MOH, Escuelas Saludables, Viviendas Saludables, Municipios Saludables, PRONASAR (new water

28


and sanitation systems), PRONOEI (preschool program), initiatives directed at malnutrition, JAAS (water and sanitation boards), NGOs doing health promotion, and so on. Although moving away from a single focus on handwashing contradicts the general PPPHW strategy, the team feels that this is the most appropriate approach for Peru as well as the one mostly likely to be sustainable. On the other hand, any particular educational opportunity should have a specific focus (on handwashing or some other topic) and be as interactive as possible, so as not to overwhelm people with too many messages and too much information all at once.

To try to build and maintain a positive program image, to motivate partners and supporters, and to share useful technical and strategic information, the Initiative needs a strong project communication program directed at both collaborating organizations and the outside world (political leaders, donors, the public). At a minimum there should be an electronic newsletter, a section on the WSP/Peru and MOH Web sites (with links to partners’ sites), and specific efforts to obtain radio and press coverage of accomplishments and activities. These communication spaces should include basic information on the program, descriptions of particularly effective/innovative strategies or activities; updates on achievements and impact; and exchanges on lessons learned. (This recommendation combines respondent and team ideas.)

The “implementing organizations” that the Initiative intends to contract to manage the program in several regions should collaborate in preparing an operational guide for the district level. The guide should propose implementation steps in a way that encourages each district to select those that are likely to be most feasible and effective.

The program should take advantage of children’s enthusiasm by suggesting activities for students to promote HWWS at home and in their communities. The Initiative should work with students, health promoters, and local organizations (soliciting and testing their ideas) to develop new activities and materials. In addition, the workshop methodology and supplementary materials should add coverage of how change agents can work with individual mothers on solving problems, such as (perceptions of) limited water, soap, or time.

Lack of compensation for transportation and food costs are said to be barriers to promoters making more home visits. Where other partners are willing to share the cost, the Initiative should contribute to the costs of such compensation at the local level.

Finally, the key partners should develop an exit strategy that addresses both sustainability and expansion issues. This might include steps to institutionalize support (funding and commitment) for HWWS in government and partner organizations, plans to expand the program into some control districts as soon as the final measurements have been completed, intensified efforts to get handwashing benefits and promotion in curricula and pre-service training, and local and national presentations on the project’s lessons learned and impact on health and malnutrition.

Implementation Capacity Considering implementation capabilities of national public sector organizations, and looking at the institutionalization of the process and human capabilities, the team recommends that the Initiative link not only with the directorate level of each ministry but also with higher levels such as ministers and vice ministers, who can instruct the ministry’s various directorates and programs to be involved. The Initiative is already working on such contacts.

All needed capacities exist in Peru, so the challenge in the expanded program is to build capacity at decentralized levels. Although regional and district levels have resources of institutions such as NGOs and some public sector units, it is evident that the large-scale program, mainly through the implementing agencies, must work intensively to strengthen local capabilities both before

29


and during implementation. Although training is the main approach, provision of materials (manuals, a district implementation guide, a newsletter, and so on), technical assistance by implementing agencies, mentoring, and exchange visits are also important. More intense support should be given to regions, provinces, districts, and municipalities where the local assessments show particular weaknesses.

WSP and other National Committee members should train key staff in the implementing agencies, who in turn should train and support persons and organizations in the regions. Training should be participatory and capacity-based and should include as much practice of skills and exercises to draw out attitudes as possible. WSP should ensure that the MOH, the MOE, and implementing organizations receive information on the most outstanding people who were trained in the first phase, since they are an excellent resource to support implementation in the regions.

The local partners should be responsible for monitoring the implementation of training skills a few months after training and then every six months after that. They should also monitor if significant numbers trained teachers or promoters have left their positions, so additional training sessions may be planned and implemented.

After their assessment of each region, province, and district where this phase will be active, the implementing agencies need to identify key leaders or “champions” who can serve as spokespersons, as well as persons who are already trained and informed about the Initiative and who can support expansion. For example, these could include the group of regional facilitators who trained many others to give training in the first phase. Most of them are regional health or education staff who have leadership capabilities.

The Initiative should encourage and facilitate the existing trend for regional partner organizations to integrate HWWS into preservice training curricula and, in addition, explore at the national level adding or strengthening coverage of the benefits of HWWS and promotion of handwashing in professional training institutions.

Availability of Products and Tools It is important that the products and tools are appropriate to the local reality at the regional and district levels—for example, illustrations should reflect coast, mountains, or jungle. If it is not possible to prepare completely different sets of materials for each geographical zone, the Initiative should support regional efforts to devise their own appropriate activities and local materials.

Except in isolated rural communities, soap availability is not a problem, but change agents in those particular communities should be trained to offer alternatives to soap, such as ash, sand, or quinoa oil (their acceptability and feasibility should be investigated first; as well as the efficacy of quinoa oil).

Difficult access to water is a problem in some communities, schools, and homes. Three potential solutions are to: (1) link handwashing promotion to existing initiatives that install or improve water systems; (2) train change agents to promote water-saving technologies such as Tippy Taps, and (3) delay working in schools and communities with poor access to water. Some persons interviewed suggested that the Initiative support encourage municipal governments to support infrastructure such as construction of water faucets near kitchens and latrines and simple systems for disposal of used water. This seems like a logical idea, as many interviewees’ suggested that handwashing stations near the kitchen and bathroom would facilitate consistent handwashing at key times.

30


Materials to support training and communication on HWWS (for the hygiene corners in schools and the training modules) should be given out in the training workshops for local facilitators and promoters, as was done in most workshops in Phase I, so that they can have the needed tools to effectively carry out their tasks related to HWWS. Although the team favors the continued provision of plastic bowls and pitchers, with an eye to sustainability, this should be made a district responsibility rather than a national one. District partners could devise a plan to have these materials donated to schools and to some or all families.

The Initiative can continue to use the existing behavior-change materials, which were prepared and approved with great effort. However, as mentioned, the team has recommended a few supplementary materials, and the widespread call for more locally appropriate versions needs to be addressed. The Initiative or its local partners should consider producing reminder materials that families can place at handwashing stations.

It is important to identify and measure the storage capacity in each intervention area because of the considerable volume of materials. Because of the ongoing changes related to decentralization, this issue needs to be followed carefully.

Financing Aiming toward sustainability, the Initiative should continue to focus during this phase on getting national and local partners to finance increasing portions of handwashing-promotion costs. To the extent possible, commitments should be included in signed MOUs whose implementation should be monitored. In order to expand into new districts at the end of this phase, it is likely that some funding from external donors will still be needed—mainly to support advocacy, program communication, implementing partners, and M&E—but the percentage of external funds should be significantly less than for the current phase. The team recommends preparation and implementation of an exit strategy so that ideally there can be a smooth transition to the following phase of handwashing promotion in Peru.

Other, specific ideas include:

• Continue to explore a co-financing agreement by the Fund of the Americas (FONDAM), which has expressed interest in supporting HWWS in Peru.

• Obtain information on USAID’s small grants program and then decide if it wants to share this with local partners.

• Lobby at all levels of government for budgetary funds directed toward handwashing or hygiene education.

• Continue to seek donated air time and publicly acknowledge the donation of free air time by private media companies.

Cost-Effective Implementation In the first phase in Peru, the Initiative collected extensive cost information. This should continue. The second phase will focus on M&E, so the Initiative should be able to combine findings on costs and on effectiveness to help formulate recommendations on adding, dropping, or changing certain program inputs. Although calculating the cost-effectiveness of certain inputs or strategies requires both art and science, making programmatic decisions on the basis of cost-effectiveness should also factor in sustainability and non-monetary costs, such as WSP time to coordinate.

In the interest of holding down costs, the use of national radio and television should be modest and directed more toward decision makers (advocacy). Local radio should be used to reinforce interpersonal activities at the local level. As much as possible, the local partners should try to

31


negotiate the inclusion of information, discussions, or contests on HWWS in existing programs, at little or no cost to the Initiative.

The Initiative’s materials appear to have been used effectively and efficiently. For example, chapters of the radio soap opera could be used independently and as a stimulus to discussions in group educational sessions. Other audiovisual materials were given to local radio stations, some municipal radios, and informal communication channels. For sustainability and replicability, the Initiative should continue to look for and utilize such opportunities to maximize human and material resources.

Monitoring and Evaluation A key to maintaining partner and public motivation is the timely dissemination of achievements and results. There was quite thorough project monitoring, but it came at the end of the first implementation phase and the findings apparently were not well disseminated—many of the persons interviewed felt that monitoring was one of the weaker aspects of the program. For the expanded program, interviewees suggested better communication of achievements, a suggestion that the team expanded into a recommendation for a strong communication program that updates partners at regular intervals on major activities, resources, innovations, and achievements, as well as on the dimensions of scalability and sustainability that this study has used.

There will be a thorough M&E program in this phase, standardized across the four countries. The team recommends that M&E be managed by a person or group connected to but separate from those managing implementation, and that findings be used to modify to program. No information should be collected unless it potentially can be used to modify the program in an important way. In general the focus should be on changes in practice and their determinants, not on changes in knowledge. Findings from M&E should be appropriately packaged and well disseminated to partners, decision makers, and the public.

32


5. NEXT STEPS Steps recommended by the study team to support program expansion and sustainability are found in Appendix L. In some cases additional detail may be found in Appendix I. Among the principal recommendations are:

• Plan and implement a dynamic advocacy strategy that begins immediately and that continues throughout implementation.

• Plan and implement a strong project communication strategy directed primarily to partners but also to decision makers at various levels and to the public. Materials, formats, and activities should be directly related to reaching one of the strategy’s objectives (for example, partner motivation, sharing good ideas) and audiences, which should be clearly defined.

• Develop and implement an exit strategy that includes steps for dissemination and sustainability of program activities and achievements.

• Continue to negotiate and sign more formal agreements on partners’ roles and responsibilities and develop systematic mechanisms to monitor the implementation of the agreements.

• Have the key national-level partners, including the implementing organizations; dedicate themselves to establishing the conditions and providing the tools and support for successful local implementation. In this decentralized vision, the team expects that key factors for program success will be strong and dedicated partnerships at local levels, with effective tools and methodologies and support from the national level.

• Great attention should be given to carrying out thorough regional, provincial, and district assessments of organizations, potential champions, resources, programs, and conditions and to establishing and supporting strong local partnerships.

Although Appendix L contains some elements of a work plan, these ideas should be considered to be no more than recommendations to the Peru country coordinator, for her to consider in consultation with in-country partners and WSP staff in Peru and Washington.

33


APPENDIX A: SELECTED DOCUMENTS AB PRISMA. 2004. Estudio de comportamiento de lavador de manos con jabón en zonas periféricas del Perú. Preparado como línea de base para la Iniciativa de Lavado de Manos en el Perú, liderado por PAS-Banco Mundial. June,

Cogswell, Lynne. 2007. “Revised PROTOCOL. Enabling Environment Assessment of HW and TSSM Programs.” World Bank (Water and Sanitation Program). April 19.

COSUDE. Brochure institucional.

Cuerpo de Paz. Brochure institucional.

Flórez P., Rocío. 2007. Informe de Implementación 2006-2007. May.

Flórez P., Rocío. 2006. “Iniciativa de Lavado de Manos en el Perú.” October 17 (PPT).

Flórez P., Rocío. 2006. “Sistematización. Período 2003-2005.” February.

Iniciativa de Lavado de Manos. 2006. Proyecto de fortalecimiento de capacidades para el cambio de comportamiento: reducción de diarrea en niños de escasos. Informe de monitoreo. November.

Iniciativa de Lavado de Manos. 2006. Proyecto de Fortalecimiento de capacidades para el cambio de comportamiento: reducción de diarrea en niños de escasos. Informe de Evaluación de Efecto. November.

Iniciativa de Lavado de Manos. No date. Módulo para facilitadotes – promotores de salud y desarrollo.

Iniciativa de Lavado de Manos. No date. Módulo para docentes del nivel inicial y primaria.

Jensen, Lene. 2007. “Quick Backgrounder on the PPPHW Approach to Handwashing Promotion.” Water and Sanitation Program/Handwashing Secretariat. April 12.

Ministerio de Vivienda, Construcción y Saneamiento, PRONASAR. 2006. Proyecto Piloto de Agua y Saneamiento en Pequeñas Ciudades. “Cuidar el Agua: La escuela en acción.” July.

Ministerio de Educación, Viceministerio de Gestión Pedagógica, Programa de Educación Ambiental. Brochure Educación Ambiental.

Ministerio de Educación, Viceministerio de Gestión Pedagógica, Programa de Educación Ambiental. “Guía instructiva de la Campaña nacional Escuelas Limpias y Saludables 2005 al 2014.”

Programa Nacional de Agua y Saneamiento Rural (PRONASAR). 2007. “Documento de Sistematización del Proyecto Piloto de Agua y Saneamiento en Pequeñas Ciudades.” January.

SEDAPAL. 2005. “Guía metodológica para la intervención técnico social en la elaboración y ejecución de proyectos condominiales de agua potable y alcantarillado.” November.

34


Sub Región de Salud Luciano Castillo Colona, Sullana. 2007. Informe de Lavado de Manos.

World Bank (Water and Sanitation Program). 2006. Grant Proposal: Scaling Up Handwashing Behavior Change. September 25.

World Bank (Water and Sanitation Program). 2007. “Terms of Reference. Enabling Environment Assessment and Baseline to Scale up, Sustain and Replicate Handwashing with Soap Behavior Change Programs.” March 9.

World Bank, BNWP, WSP Water and Sanitation Program. 2005. The Handwashing Handbook: A guide for developing a hygiene promotion program to increase handwashing with soap.

35


APPENDIX B: LISTA DE ENTREVISTADOS

LISTA DE ENTREVISTADOS

N A C I O N A L

INSTITUCION PERSONA CARGO DIRECCION TELEFONO FECHA HORA

Ministerio de Salud Beatriz Ugás

Coordinadora Comisión Nac 3156600 Jueves 31 3 p.m.

Ministerio de Educación

Armando Barrantes

Director Nacional Dirección Nacional de Educación Sanitaria y Ambiental

Van de Velde 160, San Borja Pabellón A, Tercer Piso, Of. 305

2155800 2155830 (1139) Martes 22 9 a.m.

Ministerio de Educación

Jorge Chumpitaz

Consultor Dirección Nacional Educaciòn Sanitaria y Ambiental

Van de Velde 160, San Borja Pabellón A, Tercer Piso, Of. 305

2155800 2155830 (1139) Jueves 24 11 a.m.

Ministerio de Vivienda/PRONASAR Rosa Meza

Especialista técnico UGP

Paseo de la República 3361, San Isidro

4226608 99271760 Jueves 31 9:30 a.m.

Ministerio de Vivienda/PRONASAR

Gabriela Flores

Paseo de la República 3361, San Isidro

4226608 4226585 Viernes 01 9:30 a.m.

36


R E G I O N A L


Municipalidad Piura

Giovanna Bisso

Gerente Educación, Cultura

Biblioteca Municipal de Piura

073-302525 9687691 Jueves 17 8 a.m.

Omar Palacios

Jefe de Oficina de Población, Salud e Higiene

Municipalidad de Piura

073-307775 / 073-9961239 Viernes 18 11 a.m.

Municipalidad Catacaos Deisy Chero

Presidente de la Comision de Salud, Salubridad y Saneamiento

Municipalidad de Catacaos 073-370239 Viernes 18 3 p.m.

DIRESA Piura Dr. Carlos Bayona Sub director DIRESA Piura

073-342424 341563 Jueves 17 12 m.

Red de salud Sullana

Jenny Portocarrero

Relaciones Públicas

Red de Salud Sullana Viernes 18 9 a.m.

Dirección Regional Educación Arequipa

Germán Robles

Especialista Gestión Educativa y Ambiental

Ronda Recoleta s/n

054-270975 054-252391 Lunes 28 9 a.m.

Municipalidad de Arequipa

Sonia Sánchez

Gerente Gestión Social

Calle Alvarez Tomas 304, Altos (Altos Biblioteca Municipal Arequipa)

054-229240 9862105 Lunes 28 8 a.m.

Gobierno Regional Arequipa

Dr. Aníbal Díaz

Autoridad Regional de Medio Ambiente

Calle Unión 100, Urb. Cèsar Vallejo, Dist. Paucarpata

054-463165 054461319 Martes 29 8 a.m.

DIRESA Arequipa

Haydé Rodas / Mariela Díaz

Promoción de la Salud

Av. Alcides Carrión - Hospital General Honorio Delgado 235155 Martes 29 11 a.m.

37



Bilateral Projects


USAID/Comunidades Saludables Edgar Medina Director MSH

Gonzales Prada 350 Miraflores (frente teatro Marsano) 2429800 Miércoles 16 3 p.m.

Eliana López Comunicación MSH Miércoles 16 4 p.m.

PAC SEDAPAL

Javier Acosta Sotomayor

Especialista social

Av. Nicolás Ayllón 2309, Piso 4, Ate. (Por la Clínica San Juan de Dios).

3261182 99176790 Miércoles 23 10 a.m.


Media


RPP Frida Delgado Directora

Paseo de la República 3866, San Isidro (altura Paseo de la República y Aramburú) 215-0200 Martes 22 11:45 a.m.

PERUTV Oswaldo Vizcarra

Director de Prensa

Centro Comercial Cayma Of. R2 054-252525 Martes 29 2:00 p.m.

César Portillo Gerente de Producción

38



Local NGOs


PRISMA Delia Haustein

Directora Ejecutiva

Carlos Gonzales 251, San Miguel 6165500 Viernes 11 11 a.m.

Ruth Pérez Especialista en comunicación Viernes 11 12 m

Ciudad Saludable Albina Ruiz Directora

Av. Jorge Basadre 255 Of. 401 S.I.

421-5163 92759213

ONG Labor Jorge Béjar Coordinador Arequipa

Calle Paz Soldán 307, Yanahuara

054-272883 256740 Lunes 28 3:30 p.m.

992 2496

997 8788

ONG DESCO - Arequipa Oscar Toro Coordinador

Calle Málaga Grenet 678, Umacollo 054-257043 Lunes 28 5 p.m.


Private Sector


Belcorp Daniela Barbieri

Gerente corporativo responsabilidad social

Av. Canaval y Moreyra 480 San Isidro

2113300 (1466)

Martes 15 11 a.m.

PROICA María Sonia Arenas Gerente

Av. Camino Real 456, Torre Real Piso 11 98382401 Lunes 21 11:30 a.m.

Cámara de Comercio e Industria de Arequipa

Martín Cotrina Gerente

Calle Quezada 104, Yanahuara

054-253920 254188 Lunes 28 8 a.m.

39



International Agencies


COSUDE Cesarina Quintana

OFICIAL DE PROGRAMA

Av. Salaverry 3242, S.I. 2645001

Miércoles 23 3 p.m.

Cuerpo de Paz Emilia Villanueva

Directora de Programas

Calle Vía Láctea 132, Urb. Los Granados, Surco.

617-2200 / 617-2210

Martes 15 PAS 9 a.m.

Cuerpos de Paz (Catacaos) Ana Turves Voluntaria

Plaza de Armas de Catacaos (073) 9628939

Jueves 17 10 a.m.

USAID Jaime Chang Oficina de Salud

Av. La Encalada cdra. 17 Monterrico

Viernes 11 9 a.m.

Mabe Arce Especialista en comunicaciones

Av. La Encalada cdra. 17 Monterrico

6181225 6181350 Lunes 14 4:30 p.m.

PAS Rocío Flórez Coordinadora Iniciativa LM

Alvarez Calderón 185, Piso 9 615-0685

Lunes 14 mayo 10 a.m.

WSP/PPL Iris Marmanillo

Coordinadora Perú PAS/BM


Martes 15 mayo 4 p.m.

Mercedes Zevallos

Especialista comunicación PPL


Lunes 14 mayo 3 p.m.

40


41


International NGOs


CARE Perú Lourdes Mindreau

ESPECIALISTA EN CAPACITACIÒN

Gral Santa Cruz 659 Jesús María 4317430 Lunes 21 4 p.m.

CARE Piura Carolina Aguilar

CAPACITADORA

Urb. 4 de Enero Mz E Lote 3 073-304675

Jueves 17 5:00 p.m.

FONDAM Alvaro de la Romaña ASESOR

Av. Javier Prado Este 5318 La Molina (alt. cruce Los Frutales) 4372727

Martes 22 3 p.m.

Cáritas Piura Juan Manuel Cendra

Secretario General

Calle Cusco 179 Piura 073-311203

Viernes 18 9:00 a.m.

Cáritas Arequipa

Pablo Manrique

Secretario General

Federico Barreto 146, Frente mercado Palomar 054-608800

Martes 29 9 a.m.

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dabl

e.

Age

ncia

in

tern

acio

nal

►Ex

iste

una

mar

cada

vol

unta

d po

lític

a de

la a

genc

ia.

La in

icia

tiva

tiene

una

bue

na id

entid

ad q

ue se

tra

duce

en

la e

xist

enci

a de

un

logo

. Se

iden

tific

a qu

e la

Inic

iativ

a no

es

perc

ibid

a co

mo

excl

usiv

amen

te d

e un

a or

gani

zaci

ón, s

ino

de so

cios

ig

ualit

ario

s.

►(U

SAID

) Se

ha to

mad

o la

de

cisi

ón d

e ap

oyar

anu

alm

ente

con

►Fa

ltó in

volu

crar

may

or p

artic

ipac

ión

de o

tras i

nstit

ucio

nes c

omo

UN

ICEF

, O

PS, l

as q

ue p

odría

n co

nstit

uir a

lianz

a de

sopo

rte y

no

nucl

ear.

►Fa

lta p

rese

ntar

lo q

ue se

est

á av

anza

ndo.

Es p

osib

le q

ue la

act

uaci

ón

del M

INSA

no

esté

tan

bien

des

crita

.

►La

vol

unta

d po

lític

a ha

sido

var

iabl

e de

ntro

del

MIN

SA p

orqu

e to

daví

a no

se

►El

niv

el c

entra

l tie

ne q

ue c

umpl

ir su

labo

r de

faci

litad

or c

on

herr

amie

ntas

o g

uías

esp

ecífi

cas p

ara

una

ejec

ució

n m

ás

efic

ient

e.

►Es

ta se

gund

a et

apa

no d

ebie

ra c

onst

ituirs

e en

un

mod

elo

de

inte

rven

ción

rígi

do.

Se re

quie

re u

nifo

rmid

ad, p

ero

debe

ser

flexi

ble

com

o pa

ra p

erm

itir s

egui

r inv

oluc

rand

o ot

ros s

ocio

s y

otro

s apo

rtes.

►Se

deb

e ha

cer m

ás d

isem

inac

ión

de lo

s ava

nces

y a

ctiv

idad

es

Tipo

de

inst

ituci

ón

Forta

leza

s D

ebili

dade

s R

ecom

enda

cion

es

fond

os e

xclu

siva

men

te p

ara

lava

do

de m

anos

.

►H

a te

nido

un

estil

o de

trab

ajo

info

rmal

y a

bier

to a

las

inst

ituci

ones

.

Exis

te u

n m

arca

do d

e in

teré

s de

verlo

s com

o pr

oces

os: c

omo

mec

anis

mo

de In

icia

tiva

y co

mo

alia

nza

públ

ico

priv

ada.

►Fo

rma

parte

de

un c

ompo

nent

e de

los p

rogr

amas

con

la c

omun

idad

, qu

e el

los f

inan

cian

.

►Se

ha

logr

ado

una

visi

ón

com

parti

da, d

e ta

l man

era

que

se

priv

ilegi

a la

Inic

iativ

a m

ás a

llá d

e la

pre

senc

ia in

stitu

cion

al.

►La

est

rate

gia

func

ionó

muy

bie

n co

n el

sect

or p

rivad

o.

►Se

iden

tific

ó un

a fu

erte

vol

unta

d po

lític

a en

Lam

baye

que.

►Lo

s alc

alde

s han

mos

trado

m

ucho

inte

rés p

or la

rela

ción

de

lava

do d

e m

anos

con

des

nutri

ción

y

la fa

lta d

e ca

paci

dad

hum

ana.

►La

vis

ión

ha si

do d

esar

rolla

do e

n un

a m

aner

a m

uy p

artic

ipat

iva.

ha c

onso

lidad

o un

a in

stitu

cion

aliz

ació

n

de L

M.

Esto

dep

ende

com

plet

amen

te d

e lo

s líd

eres

act

uale

s y su

opi

nión

.

►La

vol

unta

d po

lític

a ha

var

iado

m

ucho

con

los c

ambi

os d

e líd

eres

en

el

MIN

SA. ►

La In

icia

tiva

podr

ía se

r más

fu

erte

con

el s

ecto

r púb

lico.

►U

n ob

stác

ulo

es q

ue e

l per

sona

l de

MIN

SA ti

ene

dem

asia

das p

riorid

ades

y

en e

se se

ntid

o tie

nen

que

esta

r bie

n co

nven

cido

s sob

re e

l val

or d

e LM

ant

es

hace

r alg

o.

►La

est

rate

gia

no fu

ncio

nó ta

n bi

en c

on

el se

ctor

púb

lico

– es

más

difí

cil p

or lo

s ca

mbi

os fr

ecue

ntes

en

pers

onal

y la

ab

unda

ncia

de

prio

ridad

es p

ara

ello

s.

►M

ucha

s áre

as d

el M

INSA

pa

rtici

paro

n en

las d

iscu

sion

es d

e es

trate

gia.

►M

ucho

s pol

ítico

s han

cam

biad

o co

n la

s ele

ccio

nes r

ecie

ntes

, lo

que

gene

ra

una

nece

sida

d de

orie

ntac

ión

sobr

e LM

.

►A

niv

el n

acio

nal f

alta

una

est

rate

gia

inte

rsec

toria

l que

pon

e LM

den

tro d

e m

ucho

s pro

gram

as e

inic

iativ

as g

rand

es

del g

obie

rno

(sal

ud, e

duca

ción

, vi

vien

da).

►La

s res

pons

abili

dade

s del

niv

el

cent

ral y

regi

onal

est

án e

n un

cla

ro

proc

eso

de d

esce

ntra

lizac

ión,

lo q

ue c

rea

conf

usió

n.

de re

cono

cim

ient

o so

cial

es a

l sec

tor p

úblic

o y

priv

ado.

►Se

deb

iera

tend

er a

que

los i

nstru

men

tos s

e co

nvie

rtan

en

parte

de

las p

ropi

as in

stitu

cion

es.

►Se

requ

erirí

a tra

baja

r un

plan

de

abog

acía

par

a in

volu

crar

ot

ros a

ctor

es.

►Es

muy

impo

rtant

e in

stitu

cion

aliz

ar la

vado

de

man

os e

n el

M

INSA

, deb

ido

a qu

e lo

tien

e m

ás e

xplíc

ito e

n el

pla

n se

ctor

ial.

Tam

bién

es m

uy im

porta

nte

tene

r una

rela

ción

más

fo

rmal

ent

re M

INSA

y M

INED

.

►La

Inic

iativ

a de

bier

a es

tar i

nteg

rada

a p

rogr

amas

de

agua

y

sane

amie

nto

para

que

pue

da a

segu

rar s

u so

sten

ibili

dad.

►Te

nien

do e

n cu

enta

el m

omen

to p

olíti

co, l

a In

icia

tiva

debi

era

unirs

e a

la A

lianz

a co

ntra

la d

esnu

trici

ón c

róni

ca. E

l gob

iern

o es

tá m

uy c

ompr

omet

ido

a re

duci

r en

un 5

% la

des

nutri

ción

an

tes d

e 20

11.

►El

LM

ha

sido

una

exc

elen

te a

ctiv

idad

inic

ial p

ara

ayud

ar a

nu

evos

Vol

unta

rios d

el C

uerp

o de

Paz

inte

grar

se e

n su

s co

mun

idad

es y

gan

ar la

con

fianz

a de

l pue

blo.

►Su

eje

cuci

ón h

a si

do m

uy im

porta

nte

para

el a

uto-

estim

a de

m

ujer

es ru

rale

s. S

e pu

ede

usar

est

as re

sulta

dos p

ositi

vos p

ara

mot

ivar

a o

tros a

uni

rse

al p

rogr

ama.

►A

segu

rar e

l vín

culo

con

pro

gram

as c

omo

Agu

a pa

ra T

odos

(p

rogr

ama

para

guas

de

PRO

NA

SAR

).

►Es

muy

impo

rtant

e af

inar

los r

oles

y in

volu

crar

otro

s soc

ios

que

traba

jan

con

agua

y sa

neam

ient

o y/

o sa

lud

infa

ntil.

Se

podr

ía h

acer

un

mat

riz c

on to

dos l

os ro

les y

resp

onsa

bilid

ades

de

salu

d, e

duca

ción

y v

ivie

nda

a ca

da n

ivel

.

►Se

ría m

uy im

porta

nte

gana

r el a

poyo

del

Pre

side

nte

de la

R

epúb

lica,

rela

cion

ándo

lo c

on la

con

tribu

ción

a a

lcan

zar l

os

obje

tivos

del

Mile

nio.

►Pa

ra re

visa

r la

visi

ón y

est

rate

gia

los l

íder

es g

uber

nam

enta

les

tiene

n po

co ti

empo

par

a pa

rtici

par,

pero

las a

genc

ias

coop

erad

oras

pue

den

ayud

ar d

esar

rolla

r est

rate

gias

y m

étod

os a

us

ar e

n to

dos n

ivel

es.

43

Glo

bal S

calin

g U

p H

andw

ashi

ng P

roje

ct

Tipo

de

inst

ituci

ón

Forta

leza

s D

ebili

dade

s R

ecom

enda

cion

es

►Se

ría ú

til re

visa

r los

pla

nes d

e tra

nsfe

renc

ia d

e lo

s pro

gram

as

a ni

vel r

egio

nal y

loca

l.

ON

G

inte

rnac

iona

l

►Ex

iste

vol

unta

d po

lític

a e

inte

rés

por p

arte

de

CA

RE,

sobr

e to

do si

se

vinc

ula

al a

ctua

l pro

yect

o qu

e m

anej

a co

n PR

ON

ASA

R.

►Se

sien

te e

l im

pact

o de

la In

icia

tiva

Lava

do d

e M

anos

en

el n

ivel

cen

tral,

aunq

ue to

daví

a no

es s

ufic

ient

emen

te

fuer

te (C

AR

E).

►Fa

lta u

n so

porte

com

unic

acio

nal q

ue

perm

ita q

ue la

Inic

iativ

a se

a id

entif

icad

a po

r tod

os.

►Se

ría b

ueno

que

el p

rogr

ama

de la

vado

de

man

os se

de

sarr

olle

junt

o co

n ot

ro c

omo

es a

horr

o de

agu

a pa

ra a

segu

rar

su b

uen

uso.

►Es

bue

no a

prov

echa

r el c

onte

xto

que

es to

talm

ente

fa

vora

ble:

hay

inve

rsió

n de

infr

aest

ruct

ura,

hay

indi

cado

res e

n la

vado

de

man

os e

n pr

oyec

tos c

omo

PRO

NA

SAR

, vin

cula

do a

un

cam

bio

de c

ompo

rtam

ient

o.

►Se

requ

iere

man

tene

r inf

orm

adas

a la

s aut

orid

ades

loca

les

para

man

tene

r la

volu

ntad

pol

ítica

.

►Te

nien

do e

n cu

enta

que

las m

unic

ipal

idad

es m

ucha

s vec

es

no c

uent

an c

on p

erso

nal c

apac

itado

, se

debi

era

real

izar

sesi

ones

de

cap

acita

ción

, por

eje

mpl

o al

resp

onsa

ble

de la

Com

isió

n de

Sa

lud,

a lo

s equ

ipos

que

trab

ajan

sane

amie

nto

y al

equ

ipo

de

prom

oció

n co

mun

itaria

.

ON

G lo

cal

►En

el n

ivel

ope

rativ

o se

ha

vist

o qu

e el

com

prom

iso

y la

vol

unta

d so

n m

uy im

porta

ntes

(PR

ISM

A).

►

Con

solid

ar la

vol

unta

d po

lític

a en

inst

rum

ento

s ope

rativ

os,

com

o m

ejor

a en

la c

urríc

ula

esco

lar l

ocal

.

Sect

or p

rivad

o

(incl

uye

med

ios)

►Se

evi

denc

ia u

na v

olun

tad

polít

ica

muy

fuer

te d

entro

de

la

com

pañí

a. H

ay e

l sen

tido

que

muc

ha g

ente

est

á un

ida

en la

In

icia

tiva.

►La

vid

eo c

onfe

renc

ia e

n qu

e pa

rtici

pó a

lgun

os a

ctor

es d

el se

ctor

pr

ivad

o ay

udó

a ex

plic

ar la

vis

ión

y es

trate

gia

com

ún.

►Fu

erte

s com

prom

isos

de

líder

es

en Ic

a. U

na m

uest

ra e

s que

el

nuev

o pr

esid

ente

regi

onal

env

ió

una

carta

a la

Inic

iativ

a co

nfirm

ando

su c

ompr

omis

o.

►

El a

poyo

del

Pre

side

nte

Reg

iona

l es e

senc

ial,

pues

tien

e re

des p

ara

llega

r a lo

s líd

eres

com

unita

rios.

►Te

ner r

euni

ones

par

a as

egur

ar q

ue lo

s soc

ios p

rinci

pale

s en

tiend

an y

apo

yen

la m

ism

a vi

sión

.

►Pr

esta

r ate

nció

n a

los p

lane

s pol

ítico

s, au

nque

la

impl

emen

taci

ón se

a lo

prio

ritar

io.

Proy

ecto

►

En P

AC

SED

APA

L ex

iste

la

volu

ntad

pol

ítica

de

traba

jar e

l

►La

falta

de

lava

do d

e m

anos

es u

n pr

oble

ma

de d

esar

rollo

y

44

Glo

bal S

calin

g U

p H

andw

ashi

ng P

roje

ct

Tipo

de

inst

ituci

ón

Forta

leza

s D

ebili

dade

s R

ecom

enda

cion

es

bila

tera

l

tem

a, q

ue se

trad

uce

en la

ex

iste

ncia

de

este

tem

a en

la lí

nea

de b

ase.

debe

ser a

taca

do d

esde

ese

enf

oque

.

►La

Inic

iativ

a pu

ede

tene

r más

éxi

to y

sost

enib

ilida

d si

est

á

impl

emen

tada

com

o un

pro

gram

a de

des

arro

llo lo

cal,

enfo

cand

o en

un

estil

o de

vid

a sa

luda

ble;

no

com

o un

pro

gram

a se

ctor

ial d

e sa

lud.

►Se

deb

e tra

baja

r mira

ndo

a la

s Reg

ione

s, pe

ro e

nfoc

ando

en

los d

istri

tos y

com

unid

ades

.

►U

sar l

as Ju

ntas

Vec

inal

es C

omun

ales

, aho

ra fo

rmal

izad

as e

n la

ley

de d

esce

ntra

lizac

ión,

com

o la

uni

dad

de im

plem

enta

ción

lo

cal.

Alia

nzas

45

Glo

bal S

calin

g U

p H

andw

ashi

ng P

roje

ct

Tipo

de

inst

ituci

ón

Forta

leza

s D

ebili

dade

s R

ecom

enda

cion

es

Gob

iern

o

►El

pro

gram

a Es

cuel

as

Salu

dabl

es se

pla

ntea

con

tar c

on

12,0

00 e

scue

las e

n 20

07, p

or lo

qu

e se

iden

tific

a m

ucha

s po

sibi

lidad

es d

e co

labo

raci

ón.

►La

par

ticip

ació

n de

las

empr

esas

priv

adas

ha

sido

muy

im

porta

nte,

por

que

está

n as

umie

ndo

un n

uevo

rol e

n la

sa

lud

de la

pob

laci

ón.

►

Col

abor

ar c

on e

l pro

gram

a de

Viv

iend

a Sa

luda

ble,

un

ataq

ue

inte

gral

a a

gua

e hi

gien

e, in

cluy

endo

coc

inas

mej

orad

as.

►G

ener

ar e

l com

prom

iso

de M

INSA

es e

senc

ial p

ara

aspe

ctos

té

cnic

os y

nor

mat

ivos

.

►Es

impo

rtant

e tra

baja

r con

“ch

ampi

ons”

al n

ivel

técn

ico

porq

ue e

l niv

el p

olíti

co si

empr

e ca

mbi

a.

►Pr

omov

er a

lianz

as e

stra

tégi

cas c

on e

spec

ialis

tas d

e PR

ON

ASA

R p

ara

incl

uir m

etod

olog

ía la

vado

de

man

os c

omo

cond

ició

n a

sus o

pera

dore

s.

►Pa

ra fo

rtale

cer l

as a

lianz

as se

deb

iera

pre

sent

ar lo

que

se h

a ve

nido

trab

ajan

do, c

omo

expe

rienc

ia p

revi

a y

las l

ecci

ones

ap

rend

idas

par

a te

ner u

na re

troal

imen

taci

ón d

e lo

s soc

ios.

Age

ncia

in

tern

acio

nal

►La

gen

erac

ión

de a

lianz

as se

ha

dado

de

man

era

intu

itiva

, lo

grán

dose

el i

nvol

ucra

mie

nto

de

acto

res.

►Ex

istía

alg

una

conf

usió

n en

las

rela

cion

es d

e ag

enci

as p

úblic

as y

pr

ivad

as. E

l sec

tor p

úblic

o es

tá

►To

daví

a se

dep

ende

dem

asia

do d

el

equi

po n

acio

nal.

►Lo

s fre

cuen

tes c

ambi

os d

e pe

rson

al e

n el

se

ctor

púb

lico

gene

ran

retra

sos e

n la

m

arch

a de

l pro

ceso

o h

ace

que

sea

más

le

nta.

►La

Inic

iativ

a de

be id

entif

icar

un

acto

r com

prom

etid

o qu

e as

uma

la fo

rmac

ión

de la

inic

iativ

a re

gion

al, o

en

todo

cas

o un

a in

stitu

ción

loca

l que

lo a

sum

a. A

lgui

en d

ebe

apoy

ar, t

enie

ndo

en

cuen

ta q

ue u

sual

men

te la

s per

sona

s ya

está

n tra

baja

ndo

a tie

mpo

co

mpl

eto.

►D

esar

rolla

r guí

as c

on lo

s pas

os p

ara

traba

jar l

a in

icia

tiva

a

acos

tum

brad

o a

tom

ar d

irecc

ión,

pe

ro so

n lo

s otro

s soc

ios q

ue

tiene

n lo

s fon

dos.

►Es

una

exc

elen

te m

odel

o, m

uy

flexi

ble.

►La

inic

iativ

a es

”un

éxi

to”

que

mue

stra

un

esfu

erzo

uni

ficad

o pa

ra e

l des

arro

llo.

►En

el M

INSA

se id

entif

icó

muc

ho e

ntus

iasm

o; h

a to

mad

o al

gún

lider

azgo

per

o aú

n no

es

sufic

ient

e.

►El

pro

blem

a er

a qu

e m

ucha

s de

las

cont

ribuc

ione

s han

sido

muy

pun

tual

es,

sola

men

te p

ara

una

cam

paña

cor

ta, y

m

ucha

s org

aniz

acio

nes n

o m

antu

vier

on su

pa

rtici

paci

ón a

ctiv

a.

►Es

impo

rtant

e no

tar q

ua h

ay v

ario

s tip

os

de so

cios

que

jueg

an v

ario

s rol

es.

Alg

unos

so

lam

ente

hac

en su

con

tribu

ción

pun

tual

en

coo

rdin

ació

n co

n la

Alia

nza.

►El

MIN

SA n

o se

sien

te c

ómod

o co

n la

s re

laci

ones

info

rmal

es.

►La

com

unic

ació

n co

n al

guno

s soc

ios h

a si

do d

ifíci

l. A

s vec

es la

Inic

iativ

a te

nía

que

cont

inua

r lla

man

do a

MIN

SA p

ara

reci

bir u

na re

spue

sta.

►La

Inic

iativ

a no

ha

invo

lucr

ado

los

min

iste

rios d

e Ed

ucac

ión

y V

ivie

nda

sufic

ient

emen

te.

nive

l reg

iona

l, co

mo

alia

nza

públ

ico

priv

ada.

►Pa

ra e

l nue

vo p

rogr

ama

se d

ebie

ra p

ensa

r en

alia

nzas

com

o en

fe

dera

cion

es e

n qu

e la

nac

iona

l inv

oluc

ra a

las r

egio

nale

s, pe

ro

ésta

s tam

bién

son

autó

nom

as.

►Se

deb

e or

dena

r el u

so d

e he

rram

ient

as p

ara

form

ar a

lianz

as

de e

ste

tipo.

►Pa

ra la

segu

nda

fase

la e

xplo

raci

ón d

e lo

s act

ores

par

a la

al

ianz

a po

dría

ser a

lgo

plan

ifica

da.

►El

pas

o m

as im

porta

nte

es d

emos

trar e

l im

pact

o de

la

Inic

iativ

a en

dia

rrea

y d

esnu

trici

ón; l

os so

cios

nec

esita

n es

to p

ara

man

tene

rse

mot

ivad

os.

►M

uchí

sim

as o

rgan

izac

ione

s pue

de c

ompa

rtir l

a m

eta

de n

iños

sa

nos y

hac

er v

ario

s tip

os d

e co

ntrib

ucio

nes.

►Ex

iste

más

pot

enci

al e

n so

cios

del

sect

or p

rivad

o qu

e le

s in

tere

san

en c

ontri

buci

ones

soci

ales

, por

eje

mpl

o co

mpa

ñías

m

iner

as.

►Te

nien

do e

n cu

enta

el m

arco

de

la d

esce

ntra

lizac

ión,

es m

uy

impo

rtant

e in

volu

crar

los g

obie

rnos

regi

onal

es –

pro

mov

er L

M

en su

s pla

nes d

e de

sarr

ollo

, de

salu

d, d

e ed

ucac

ión.

Así

se p

uede

ga

nar m

ás a

porte

de

los m

edio

s.

►Tr

abaj

ar c

on E

scue

las S

alud

able

s.

►Se

deb

ería

invo

lucr

ar a

los l

íder

es c

omun

itario

s, qu

iene

s tie

nen

“to

tal c

redi

bilid

ad.”

►La

s Jun

tas A

dmin

istra

dora

s de

Agu

a y

Sane

amie

nto

(JA

AS)

se

ria u

na b

uena

est

ruct

ura

a in

volu

crar

.

►Lo

s líd

eres

al n

ivel

nac

iona

l y re

gion

al e

star

ían

inte

resa

dos e

n sa

ber c

omo

lava

do d

e m

anos

con

tribu

ye a

las m

etas

de

Des

arro

llo d

el M

ileni

o.

►Pa

ra m

ante

ner l

as a

lianz

as h

ay q

ue m

onito

rear

y e

valu

ar

mej

or. T

ambi

én lo

s soc

ios t

iene

n qu

e en

tend

er q

ue e

l cam

bio

de

com

porta

mie

nto

lleva

tiem

po y

tien

e qu

e se

r man

teni

do.

►Es

impo

rtant

e vi

ncul

arlo

con

pro

gram

as q

ue m

ejor

an a

cces

o a

agua

.

►U

sar u

na fi

gura

fam

osa

com

o po

rtavo

z en

radi

o y

tele

visi

ón.

►Es

nec

esar

io v

incu

lar e

l tem

a co

n sa

lud,

nut

rició

n, c

apita

l

46

Glo

bal S

calin

g U

p H

andw

ashi

ng P

roje

ct

hum

ano,

infe

ccio

nes r

espi

rato

rias.

►A

l niv

el re

gion

al, e

s ese

ncia

l ide

ntifi

car “

cham

pion

s”, p

ues

crea

r pro

pied

ad e

s crít

ico

para

firm

ar c

ompr

omis

os; p

lane

ar

junt

os y

cap

acita

r.

►La

Inic

iativ

a de

be d

ejar

que

esp

acio

par

a qu

e ca

da re

gión

de

sarr

olle

sus p

ropi

os m

étod

os.

►Es

nec

esar

io id

entif

icar

soci

os re

gion

ales

y lo

cale

s que

ya

teng

an su

s pro

gram

as q

ue ll

egan

dire

ctam

ente

al p

úblic

o.

►La

Inic

iativ

a tie

ne q

ue c

omun

icar

se m

ejor

con

sus m

iem

bros

, ta

nto

com

o co

n el

púb

lico,

por

eje

mpl

o un

a pá

gina

Web

in

tera

ctiv

a, e

stad

o de

eje

cuci

ón, i

ndic

ador

es d

e pr

ogre

so,

hist

oria

s de

éxito

, lec

cion

es a

pren

dida

s, en

tre o

tras.

►A

dem

ás d

e te

ner u

n im

pact

o en

dia

rrea

e in

fecc

ione

s re

spira

toria

s, co

nsid

erar

que

tien

e un

impa

cto

en d

esnu

trici

ón

crón

ica.

Eso

pue

de im

plic

ar m

irar o

tros a

liado

s.

ON

G

inte

rnac

iona

l

►C

olab

orar

est

rech

amen

te c

on A

gua

Para

Tod

os, q

ue y

a tie

ne

buen

os in

dica

dore

s, in

cluy

endo

la p

ráct

ica

de L

M, q

ue la

In

icia

tiva

pued

e co

mpa

rtir.

►Lo

s min

iste

rios t

iene

n qu

e te

ner v

olun

tad

de c

ompa

rtir e

l cr

édito

.

►To

das l

as o

rgan

izac

ione

s tie

nen

que

sent

ir qu

e la

Inic

iativ

a es

de

ella

s.

ON

G lo

cal

►El

rol y

resp

onsa

bilid

ad d

e lo

s m

iem

bros

de

la In

icia

tiva

es m

uy

clar

a.

►La

s alia

nzas

son

difíc

iles p

ero

son

impo

rtant

es p

ara

la

sost

enib

ilida

d.

►N

o se

iden

tific

ó al

Min

iste

rio d

e la

M

ujer

y e

l Des

arro

llo S

ocia

l (M

IMD

ES),

con

el P

rogr

ama

Junt

os, q

ue ti

ene

una

inte

rven

ción

en

210

dist

ritos

, cuy

o ob

jetiv

o es

dis

min

uir l

a de

snut

rició

n cr

ónic

a, si

endo

la

vado

de

man

os u

n co

mpo

nent

e.

►Se

pus

o de

relie

ve e

l aso

cio,

per

o to

daví

a es

muy

nue

vo p

ara

las R

egio

nes.

►La

bús

qued

a de

alia

nzas

deb

iera

ser u

n po

co m

ás si

stem

átic

a.

►La

Mes

a de

Con

certa

ción

de

Luch

a co

ntra

la P

obre

za p

uede

se

r en

algu

nos l

ugar

es u

na p

lata

form

a pa

ra la

con

stru

cció

n de

la

Inic

iativ

a de

Lav

ado

de M

anos

.

►Se

ría im

porta

nte

traba

jar c

on e

l MIM

DES

[otra

s per

sona

s di

cen

que

no, p

orqu

e ha

sido

dem

asia

do p

oliti

zado

].

►Id

entif

icar

una

est

rate

gia

que

orie

nte

la d

ecis

ión

de tr

abaj

ar e

n al

ianz

as h

acia

alg

o m

ás c

orpo

rativ

o qu

e de

per

sona

s.

Sect

or

priv

ado

►PR

OIC

A y

a es

una

alia

nza

de 4

em

pres

as y

trab

aja

en a

lianz

a co

n va

rios g

obie

rnos

loca

les.

►H

a si

do u

na e

xper

ienc

ia m

uy

►La

alia

nza

en IC

A n

o in

cluy

e a

ON

Gs,

pero

PR

OIC

A m

ism

a se

con

vier

te e

n O

NG

. Q

uier

en h

acer

alia

nzas

con

med

ios

mas

ivos

loca

les.

►H

acer

con

tact

o co

n la

s muc

has o

rgan

izac

ione

s que

ya

tiene

n pr

ogra

mas

diri

gido

s a n

iños

, dia

rrea

, des

nutri

ción

.

►H

acer

más

alia

nzas

con

com

pañí

as p

rivad

as y

ON

Gs.

47

Glo

bal S

calin

g U

p H

andw

ashi

ng P

roje

ct

inte

resa

nte

pues

ha

perm

itido

la

parti

cipa

ción

del

sect

or p

úblic

o y

priv

ado

desd

e su

pro

pio

apor

te,

sin

cond

icio

nar l

a pa

rtici

paci

ón.

►PE

RU

TV h

a es

tado

ac

ostu

mbr

ado

a ap

oyar

y

parti

cipa

r en

alia

nzas

con

otra

s in

stitu

cion

es.

►Fo

rtale

cer l

os e

quip

os d

e tra

bajo

en

Ica

(PR

OIC

A y

otro

s so

cios

) par

a ha

cer m

ejor

segu

imie

nto;

form

ar u

na c

omis

ión

sobr

e La

vado

de

man

os.

►G

anar

el a

poyo

del

MIN

SA e

s ese

ncia

l, au

nque

las a

utor

idad

es

cam

bian

frec

uent

emen

te.

►Ex

iste

un

espa

cio

que

la In

icia

tiva

debi

era

busc

ar v

incu

lado

a

los e

spac

ios r

egio

nale

s, co

mo

la C

oord

inad

ora

de P

resi

dent

es

Reg

iona

les (

RPP

).

►A

sí ta

mbi

én se

pod

ría b

usca

r a la

em

pres

a pr

ivad

a ag

rupa

da,

con

el G

rupo

Em

pres

ario

s por

la E

duca

ción

que

CO

NFI

EP e

stá

fom

enta

ndo

y m

apea

ndo.

Proy

ecto

bi

late

ral

►La

gen

erac

ión

de a

lianz

as lo

cale

s se

hace

más

fuer

te c

uand

o ex

iste

una

obr

a de

infr

aest

ruct

ura

y un

a di

strib

ució

n de

role

s muy

cl

ara

(PA

C).

Acu

erdo

s ins

tituc

iona

les

48

Glo

bal S

calin

g U

p H

andw

ashi

ng P

roje

ct

Tipo

de

inst

ituci

ón

Forta

leza

s D

ebili

dade

s R

ecom

enda

cion

es

Gob

iern

o

►La

Dire

cció

n N

acio

nal d

e Ed

ucac

ión

Com

unita

ria y

A

mbi

enta

l est

á ab

ierta

a re

aliz

ar

una

dire

ctiv

a qu

e de

scrib

e su

co

labo

raci

ón c

on la

Inic

iativ

a.

►A

par

tir d

e lo

s lin

eam

ient

os d

e Pr

omoc

ión

de S

alud

se u

tiliz

an la

s lám

inas

de

salu

d e

higi

ene,

que

resp

onde

tam

bién

a

la in

cide

ncia

de

la In

icia

tiva,

per

o lo

ut

iliza

n si

n cr

iterio

de

uso

(lo u

san

tam

bién

en

esc

uela

s que

no

cuen

tan

con

serv

icio

de

agua

y d

esag

üe).

►N

o se

ha

info

rmad

o a

las i

nstit

ucio

nes d

e lo

logr

ado,

par

a lo

grar

reite

rar l

os

acue

rdos

.

►Lo

s acu

erdo

s loc

ales

deb

en p

artir

del

aná

lisis

de

los P

lane

s R

egio

nale

s de

Salu

d o

de la

s prio

ridad

es id

entif

icad

as p

or e

l C

onse

jo R

egio

nal d

e Sa

lud

(mun

icip

alid

ad P

iura

).

►Es

tabl

ecer

acu

erdo

s for

mal

es c

on M

inis

terio

de

Viv

iend

a y

los

prog

ram

as d

e ag

ua y

sane

amie

nto,

vin

culá

ndol

o a

la In

icia

tiva

de

Lava

do d

e M

anos

.

►Tr

abaj

ar a

cuer

dos c

on m

unic

ipal

idad

es p

ara

que

prio

ricen

ag

ua y

sane

amie

nto

en e

scue

las (

PRO

MSA

Are

quip

a).

►Ev

alua

r si e

l Com

ité R

egio

nal M

ultis

ecto

rial p

odría

ser l

a in

stan

cia

de a

poyo

a la

Inic

iativ

a en

la R

egió

n A

requ

ipa.

►El

MIN

SA e

stá

pens

ando

en

com

ités d

esce

ntra

lizad

os p

or

Reg

ione

s o M

acro

Reg

ione

s, qu

e te

ngan

aut

onom

ía y

le

gitim

idad

.

►En

el C

omité

Nac

iona

l tam

bién

deb

iera

par

ticip

ar e

l sec

tor

priv

ado.

Age

ncia

in

tern

acio

nal

►Se

ha

man

ejad

o bi

en.

No

ha

sido

tan

form

al y

ha

perm

itido

que

►

Con

exc

epci

ón d

el se

ctor

púb

lico,

los

soci

os tr

ajer

on su

s pro

pios

recu

rsos

. ►

Podr

ía tr

abaj

arse

un

map

a de

rela

cion

es m

ás v

isua

l que

es

tabl

ezca

dón

de e

stá

ubic

ado

cada

act

or e

n el

sist

ema

y qu

é

los p

roce

sos s

ean

más

flui

dos.

►H

ay c

apac

idad

de

adap

taci

ón a

la

s nec

esid

ades

de

cada

in

stitu

ción

. Si

se n

eces

ita m

ás

form

alid

ad (D

ISA

S,

mun

icip

alid

ades

) se

ha tr

abaj

ado

en e

se se

ntid

o.

►A

l niv

el lo

cal,

fuer

on a

cuer

dos

táci

tos y

func

iona

ron

bien

sin

muy

ay

uda

de fu

era.

►H

a si

do u

n en

foqu

e de

sde

el

inic

io.

Por e

so la

Inic

iativ

a no

es

perc

ibid

a co

mo

prog

ram

a de

l BM

si

no c

omo

una

inic

iativ

a de

l Per

ú.

►La

nue

va a

dmin

istra

ción

gu

bern

amen

tal h

a ac

epta

do la

In

icia

tiva,

y h

ay u

n in

teré

s muc

ho

más

fuer

te d

el M

INED

U.

►M

ás so

cios

tien

en in

teré

s en

mej

orar

la c

alid

ad d

e vi

da d

e fa

mili

as p

obre

s, al

guna

s es

pecí

ficam

ente

en

redu

cir l

a di

arre

a.

►El

MIN

SA h

a te

nido

una

pa

rtici

paci

ón a

decu

ada.

►Ex

istió

con

fusi

ón d

uran

te e

l pro

ceso

po

rque

el M

INSA

insi

stió

en

acue

rdos

más

fo

rmal

es.

►A

unqu

e m

ucho

s gob

iern

os re

gion

ales

tie

nen

fond

os, n

o sa

ben

bien

com

o ga

star

los e

ficie

ntem

ente

(el g

obie

rno

ha

gast

ado

12%

de

sus a

sign

acio

nes e

ste

año)

.

►En

muc

hos c

asos

la p

artic

ipac

ión

activ

a de

una

inst

ituci

ón n

o es

tant

o po

r las

met

as

de la

inst

ituci

ón, s

ino

por e

l int

erés

fuer

te

de u

na o

dos

per

sona

s de

influ

enci

a (f

acto

r cl

ave

es m

as p

erso

nalis

ta).

►Fa

ltaría

invo

lucr

ar e

duca

ción

y v

ivie

nda

al n

ivel

nac

iona

l.

►Lo

s acu

erdo

s ins

tituc

iona

les p

odría

n se

r m

ás c

laro

s. P

or e

jem

plo

cuan

do la

s ca

mpa

ñas d

e co

mun

icac

ión

com

enza

ron,

va

rias o

rgan

izac

ione

s se

sint

iero

n ce

losa

s qu

e no

era

n pa

rte.

prod

uce

cada

alia

nza.

►C

on e

l Cue

rpo

de P

az se

lleg

ó a

acue

rdo

y ah

ora

debe

ría

firm

arse

.

►Pa

ra m

ante

ner e

l ent

usia

smo

hay

que

med

ir y

divu

lgar

los

resu

ltado

s, de

mod

o qu

e la

gen

te p

ueda

n te

ner c

onfia

nza

que

sus

esfu

erzo

s hac

en u

na d

ifere

ncia

.

►Es

impo

rtant

e te

ner u

n co

mpr

omis

o in

stitu

cion

al e

scrit

o,

espe

cial

men

te p

ara

soci

os d

onde

el p

erso

nal c

ambi

a fr

ecue

ntem

ente

.

►Es

tabl

ecer

com

ités r

egio

nale

s que

pue

den

coor

dina

r lav

ado

de

man

os e

n su

regi

ón y

tam

bién

diri

girs

e a

otra

s ini

ciat

ivas

a la

rgo

plaz

o.

►H

ay c

ampo

par

a m

ás in

volu

cram

ient

o de

em

pres

as p

rivad

as e

n la

s reg

ione

s y d

e O

NG

s.

►C

onst

ruir

una

plat

afor

ma

de d

iscu

sión

par

a co

mpa

rtir

lecc

ione

s apr

endi

das s

obre

agu

a y

sane

amie

nto,

así

com

o pr

omoc

ión

de h

igie

ne.

ON

G

inte

rnac

iona

l

►Lo

s acu

erdo

s nac

iona

les n

o so

n im

porta

ntes

si la

s alia

nzas

no

func

iona

n al

niv

el lo

cal.

ON

G L

ocal

►Se

nec

esita

n pr

oced

imie

ntos

cla

ros,

un p

aso

por p

aso.

►A

prov

echa

r el p

oten

cial

que

tien

en lo

s con

veni

os sa

lud-

educ

ació

n re

gion

al.

►Pa

ra la

sigu

ient

e fa

se p

rom

over

acu

erdo

s con

una

serie

de

inst

anci

as c

omo

Con

sejo

Nac

iona

l de

Salu

d, F

OR

OSA

LUD

, do

nde

se id

entif

ique

n a

cole

ctiv

os q

ue tr

abaj

an p

or sa

lud.

►Se

reco

mie

nda

que

los a

cuer

dos c

on la

s mun

icip

alid

ades

sean

in

depe

ndie

ntes

, de

man

era

que

le d

é va

lora

ción

al a

cuer

do.

►Te

ner c

uida

do c

on a

lgun

as in

stitu

cion

es u

ON

Gs l

ocal

es q

ue

parti

cipe

n, p

orqu

e pu

eden

est

ar e

n co

nflic

to c

on e

l sec

tor

49

Glo

bal S

calin

g U

p H

andw

ashi

ng P

roje

ct

priv

ado.

Sect

or

Priv

ado

►En

Ica

han

traba

jado

bie

n in

form

alm

ente

.

►En

Ica

cree

impo

rtant

e pa

ra so

sten

ibili

dad

form

aliz

ar lo

s co

mpr

omis

os d

e va

rias u

nida

des g

uber

nam

enta

les.

►Se

ría ú

til o

rient

ar a

los f

unci

onar

ios c

lave

s sob

re su

s rol

es y

fu

ncio

nes e

n re

laci

ón a

lava

do d

e m

anos

.

Proy

ecto

bi

late

ral

►La

s org

aniz

acio

nes n

o gu

bern

amen

tale

s hac

en lo

que

pr

omet

en.

►La

s alia

nzas

son

nece

saria

s e

impo

rtant

es p

ero

los s

ocio

s tie

nen

que

cont

ribui

r más

que

pal

abra

s lin

das.

►To

daví

a la

s aut

orid

ades

regi

onal

es fa

ltan

un b

uen

ente

ndim

ient

o de

la im

porta

ncia

de

lava

do d

e m

anos

.

►Fo

rmar

alia

nzas

más

am

plia

s en

el n

ivel

nac

iona

l, re

gion

al y

di

strit

al.

Cad

a so

cio

naci

onal

pue

de in

volu

crar

sus r

edes

loca

les.

►H

acer

todo

lo p

osib

le p

ara

que

los P

resi

dent

es R

egio

nale

s as

uman

su re

spon

sabi

lidad

hac

ia la

vado

de

man

os y

otro

s as

pect

os d

e un

a vi

da sa

luda

ble.

►Pa

rtici

par e

n un

gra

n es

fuer

zo n

acio

nal d

e m

ejor

ar e

l est

ilo d

e vi

da d

e fa

mili

as.

Met

odol

ogía

del

pro

gram

a Ti

po d

e R

espo

nd.

Forta

leza

s D

ebili

dade

s R

ecom

enda

cion

es

Gob

iern

o

►El

MIN

SA c

onsi

dera

que

los

prod

ucto

s de

la In

icia

tiva

fuer

on

buen

os, p

ero

siem

pre

cons

ider

ando

el a

spec

to d

e di

strib

ució

n.

►Se

sint

ió q

ue a

lgun

as a

ctiv

idad

es se

tra

baja

ron

en fu

nció

n a

la d

eman

da.

►Es

impo

rtant

e tra

baja

r el n

ivel

regi

onal

des

de u

n pr

inci

pio,

de

sde

la se

nsib

iliza

ción

, par

a qu

e en

las r

egio

nes s

e si

enta

n “p

arte

de

”.

►Su

gier

e qu

e se

real

icen

dia

gnós

ticos

par

ticip

ativ

os lo

cale

s, vi

ncul

ando

a d

esar

rollo

hum

ano,

cal

idad

de

vida

. Po

ner e

n ev

iden

cia

que

esta

Inic

iativ

a co

ntrib

uye

a la

nut

rició

n in

fant

il, a

la

desc

entra

lizac

ión

y a

tene

r fam

ilias

salu

dabl

es.

►N

o es

reco

men

dabl

e pr

omov

er la

vado

de

man

os d

onde

muc

ha

gent

e no

tien

e bu

en a

cces

o a

agua

. El i

mpa

cto

será

lim

itado

en

esta

s áre

as.

►Se

deb

iera

con

tar c

on u

n ej

érci

to d

e su

perv

isor

es q

ue a

segu

ren

que

las a

ctiv

idad

es se

real

icen

par

a qu

e sa

lud

y ed

ucac

ión

lo

haga

n. E

s al p

rinci

pio,

lueg

o ya

se c

onvi

erte

en

una

prác

tica.

►In

cent

ivar

a la

gen

te c

on v

isita

s o v

iaje

s de

inte

rcam

bio

de

expe

rienc

ias.

►Ev

alua

r la

expe

rienc

ia P

RO

NA

SAR

en

el á

rea

rura

l: es

más

fá

cil p

rom

over

la p

ráct

ica

en la

cos

ta q

ue e

n zo

nas m

ás a

rrib

a de

50

Glo

bal S

calin

g U

p H

andw

ashi

ng P

roje

ct

los 3

,500

msn

m, d

ebid

o al

clim

a. H

ay q

ue p

ensa

r en

tecn

olog

ías

alte

rnat

ivas

que

faci

liten

subi

r la

tem

pera

tura

del

agu

a.

►Su

gier

e tra

baja

r con

los a

ctor

es lo

cale

s cla

ves y

púb

lico

obje

tivo,

más

que

a lo

s soc

ios.

Age

ncia

in

tern

acio

nal

►Fu

ncio

nó b

ien,

aun

que

un p

oco

lent

o.

►En

gen

eral

los c

omité

s fu

ncio

naro

n m

uy b

ien;

gan

aron

va

rios t

ipos

de

peric

ia y

muc

hos

cont

acto

s de

valo

r. Lo

s mie

mbr

os

apre

ndie

ron

uno

del o

tro.

►La

met

odol

ogía

ha

func

iona

do

bien

.

►Fa

ltó a

rticu

laci

ón e

ntre

la d

ifusi

ón

mas

iva

y el

eng

anch

e co

n la

s acc

ione

s in

terp

erso

nale

s.

►Es

tand

ariz

ar m

ás la

met

odol

ogía

con

pro

ceso

s y p

rodu

ctos

más

es

tand

ariz

ados

. Que

exi

sta

un m

enú

de p

osib

les a

ctiv

idad

es q

ue

faci

lite

la d

ecis

ión

de lo

s nue

vos a

liado

s y su

incl

usió

n en

una

m

atriz

de

mon

itore

o.

►Se

requ

iere

con

side

rar e

quip

os d

e tra

bajo

des

cent

raliz

ados

par

a el

pro

gram

a.

►M

edio

s mas

ivos

pue

den

ser m

ás a

gres

ivos

en

ofre

cer t

iem

po e

n ra

dio

y te

levi

sión

.

►La

com

unic

ació

n in

terp

erso

nal d

ebie

ra e

star

uni

da a

inic

iativ

as

y he

rram

ient

as e

xist

ente

s, po

r eje

mpl

o, M

unic

ipio

s Sal

udab

les,

Escu

elas

Sal

udab

les.

►U

na e

stra

tegi

a im

porta

nte

es c

apac

itaci

ón d

e líd

eres

loca

les

com

o al

cald

es p

orqu

e la

pob

laci

ón si

gue

sus c

onse

jos.

Los n

iños

ta

mbi

én p

uede

n se

r age

ntes

de

cam

bio

efec

tivos

.

►Se

nec

esita

una

fase

de

sens

ibili

zaci

ón e

n to

das l

as re

gion

es

nuev

as. H

ay q

ue se

ntar

se c

on lo

s dire

ctor

es d

e sa

lud

y m

ostra

r ci

fras

sobr

e co

mo

pued

en re

duci

r la

diar

rea.

Pos

ible

men

te

prep

arar

un

vide

o o

docu

men

to c

on te

stim

onio

s de

líder

es d

e la

s re

gion

es y

a tra

baja

das.

►Lo

s fon

dos d

e G

ates

deb

en ir

a lo

s ope

rado

res l

as a

genc

ias

ejec

utor

as, i

nclu

yend

o la

enc

arga

da d

e m

onito

reo

y ev

alua

ción

, no

al M

INSA

y lo

s soc

ios.

►Se

deb

iera

dar

más

énf

asis

en

com

unic

ació

n in

terp

erso

nal;

dise

ñar o

tras a

ctiv

idad

es p

ara

forta

lece

r act

ivid

ades

in

terp

erso

nale

s.

►To

dos l

os so

cios

prin

cipa

les t

iene

n qu

e te

ner l

a op

ortu

nida

d de

en

tend

er, h

acer

suge

renc

ias y

ace

ptar

la m

etod

olog

ía p

ara

la n

ueva

fa

se.

►La

s act

ivid

ades

han

sido

muy

pun

tual

es. S

e ne

cesi

ta u

na

revi

sión

est

raté

gica

de

la In

icia

tiva

para

pen

sar m

ás a

l lar

go p

lazo

y

en té

rmin

os d

e in

stitu

cion

aliz

ació

n.

ON

G

►A

bord

a bi

en lo

s asp

ecto

s bá

sico

s y ti

ene

una

man

era

sim

ple

►

Se n

eces

ita a

just

ar la

s exp

ecta

tivas

par

a ár

eas c

on d

ifere

ncia

s en

51

Glo

bal S

calin

g U

p H

andw

ashi

ng P

roje

ct

inte

rnac

iona

l

de h

acer

ent

ende

r los

men

saje

s, lo

qu

e lo

hac

e m

uy re

plic

able

. al

tura

, tem

pera

tura

, cul

tura

.

►Se

nec

esita

hac

er m

ás v

isib

le e

l tem

a co

n es

paci

os e

n te

levi

sión

.

►Pa

ra o

bten

er a

poyo

y p

artic

ipac

ión

grat

uita

de

otra

s in

stitu

cion

es, e

s nec

esar

io id

entif

icar

sus p

riorid

ades

y

enga

ncha

rlas a

lava

do d

e m

anos

. Por

eje

mpl

o C

árita

s Piu

ra lo

en

ganc

hó c

on su

eje

aho

rro

del a

gua.

►En

zon

as d

onde

no

hay

faci

litad

de

cont

ar c

on a

gua,

se p

uede

tra

baja

r adi

cion

alm

ente

el u

so q

ue se

pue

de d

ar a

l agu

a ja

bono

sa

desp

ués d

e la

vars

e la

s man

os, c

omo

echa

rla a

l sue

lo p

ara

que

no

leva

nte

polv

o.

ON

G L

ocal

►Lo

s inc

entiv

os q

ue p

odría

n ap

oyar

la im

plem

enta

ción

del

pr

ogra

ma

son:

cos

to re

unio

nes d

e se

nsib

iliza

ción

, cer

tific

ació

n of

icia

l par

a op

erad

ores

coo

rdin

ando

con

edu

caci

ón y

salu

d, lo

gos

inst

ituci

onal

es e

n lo

s mat

eria

les y

pre

mia

ción

a lo

s act

ores

que

ha

n lo

grad

o m

ejor

es re

sulta

dos.

►En

las c

omun

idad

es id

entif

icar

al l

íder

, que

muc

has v

eces

es e

l m

édic

o, p

ara

que

ejec

ute

la p

ráct

ica

con

las m

ism

as p

erso

nas.

La

prác

tica

mis

ma

con

ello

s les

gen

era

una

sens

ació

n de

aut

oest

ima.

(L

abor

de

Are

quip

a).

Sect

or

priv

ado

►M

uy p

artic

ipat

iva

y m

otiv

ador

a.

Apr

opia

da p

ara

la c

ultu

ra, p

ues

fue

muy

vis

ual y

ver

bal.

►El

éxi

to d

e la

Inic

iativ

a es

que

ha

logr

ado

cosa

s con

cret

as:

inve

stig

acio

nes,

man

uale

s, ac

tivid

ades

en

man

uale

s, m

ater

ial

audi

ovis

ual.

►

Se d

ebe

dar m

ás a

poyo

en

mon

itore

o.

►U

sar R

PP p

ara

alca

nzar

toda

s par

tes d

el p

rogr

ama;

es u

n fu

ente

m

uy c

onfia

ble

y sa

lud

y nu

trici

ón so

n de

muc

ha in

teré

s pop

ular

.

►Ta

mbi

én se

pro

pone

trab

ajar

lo m

asiv

o co

n un

men

saje

sim

ple

y la

pro

fund

izac

ión

de c

onte

nido

s se

traba

je d

esde

pro

gram

as c

omo

cons

ulto

rios d

ifere

ntes

a d

ifere

ntes

púb

licos

, urb

ano

mar

gina

l, ot

ro ru

ral e

n qu

e se

pod

ría p

oner

a h

abla

r a lo

s pro

mot

ores

.

►Pa

ra se

nsib

iliza

ción

se p

uede

abo

rdar

des

de p

rogr

amas

TV

co

mo

espa

cio

“cab

ildo

abie

rto”

que

pobl

ació

n pu

ede

hace

r re

clam

os y

pre

gunt

as y

el f

in d

e se

man

a va

el a

lcal

de a

dar

re

spue

sta

a in

quie

tude

s.

Proy

ecto

bi

late

ral

►M

uy b

uena

rela

cion

es

info

rmal

es.

►Lo

s líd

eres

regi

onal

es d

an a

poyo

ve

rbal

per

o no

lo si

gue

con

acci

ón.

►En

Aya

cuch

o hu

bo a

vanc

es e

n co

noci

mie

nto

y ac

titud

es p

ero

poco

en

prác

ticas

.

►Tr

abaj

ar m

ucho

más

por

com

unic

ació

n in

terp

erso

nal,

espe

cial

men

te e

l tip

o qu

e es

timul

a a

la c

omun

idad

a re

fleja

r sob

re

sus p

robl

emas

y p

ropo

ner e

impl

emen

tar s

oluc

ione

s. N

o de

pend

e en

med

ios m

asiv

os.

►C

ada

regi

ón d

ebe

elab

orar

su p

ropi

o pl

an d

e co

mun

icac

ión

y m

ater

iale

s.

52

Glo

bal S

calin

g U

p H

andw

ashi

ng P

roje

ct

►M

ás a

llá d

e lo

s con

veni

os, s

e ne

cesi

ta b

uena

vol

unta

d.

►D

ar m

ás re

spon

sabi

lidad

de

plan

ifica

r e im

plem

enta

r a la

s or

gani

zaci

ones

y e

stru

ctur

as lo

cale

s. Tr

abaj

ar m

ucho

más

con

los

gobi

erno

s dis

trita

les,

que

tiene

n m

ayor

con

tact

o co

n fa

mili

as.

►C

ombi

nar l

a pr

omoc

ión

de la

vado

de

man

os c

on p

rogr

amas

que

m

ejor

an la

infr

aest

ruct

ura

de a

gua

y sa

neam

ient

o.

►El

púb

lico

tiene

más

con

fianz

a en

las o

rgan

izac

ione

s que

dan

pr

omoc

ión

porq

ue y

a ha

n ay

udad

o co

n in

frae

stru

ctur

a.

►Tr

abaj

ar c

on lo

s niñ

os, q

ue ti

enen

ent

usia

smo

y qu

e so

n m

ás

abie

rtos a

cam

biar

. Usa

r mús

ica,

dra

ma,

y o

tras t

radi

cion

es p

ara

crea

r int

erés

.

Cap

acid

ad d

e ej

ecuc

ión

53

Glo

bal S

calin

g U

p H

andw

ashi

ng P

roje

ct

Tipo

de

Res

pond

. Fo

rtale

zas

Deb

ilida

des

Rec

omen

daci

ones

Gob

iern

o ►

El M

inis

terio

de

Viv

iend

a a

travé

s de

sus p

rogr

amas

PR

ON

ASA

R e

n zo

nas r

ural

es y

pe

queñ

as c

iuda

des t

iene

as

egur

ado

fond

os h

asta

el 2

008

y se

est

á pl

anifi

cand

o la

co

nvoc

ator

ia p

ara

el si

guie

nte

año.

►D

esde

el M

INSA

se id

entif

ica

que

hubo

cap

acid

ad d

e ej

ecut

ar la

s ac

cion

es d

e la

Inic

iativ

a,

logr

ándo

se e

labo

rar m

ater

iale

s y

prod

ucto

s com

unic

acio

nale

s, ta

llere

s rea

lizad

os y

per

sona

l ca

paci

tado

.

►H

ubie

ra si

do n

eces

ario

más

acc

ione

s de

supe

rvis

ión

y m

onito

reo.

►

Con

side

rar a

los o

pera

dore

s de

PRO

NA

SAR

com

o po

sibl

es

alia

dos e

n lo

s com

ités r

egio

nale

s o d

istri

tale

s.

►Es

bue

no q

ue p

ara

esta

segu

nda

fase

se c

onte

mpl

e m

edic

ión

de

impa

cto,

ade

más

de

resu

ltado

s.

Age

ncia

in

tern

acio

nal

►

El M

INSA

es m

uy je

rárq

uico

, pue

s el

pers

onal

nec

esita

órd

enes

de

arrib

a an

tes

de a

ctua

r.

►Fa

lta c

onfir

mar

que

todo

s los

act

ores

es

tén

inte

gran

do su

s act

ivid

ades

.

►To

daví

a no

se h

a lo

grad

o qu

e lo

s go

bier

nos r

egio

nale

s pub

lique

n la

s

►Es

nec

esar

io tr

abaj

ar e

n el

niv

el lo

cal,

pero

tien

e un

a tre

men

da

nece

sida

d de

forta

lece

r sus

cap

acid

ades

y p

or e

llos q

uizá

s sea

ne

cesa

rio e

mpe

zar p

or a

hí.

►La

est

rate

gia

es id

entif

icar

y c

ontra

tar v

aria

s org

aniz

acio

nes q

ue

pued

en, c

ada

una,

man

ejar

la im

plem

enta

ción

en

3 a

5 re

gion

es.

►El

asp

ecto

cla

ve e

s man

tene

r el e

ntus

iasm

o de

los s

ocio

s; c

on

eso

van

a pr

ovee

r los

fond

os y

otro

s rec

urso

s com

o el

tiem

po d

e

orde

nanz

as so

bre

lava

do d

e m

anos

. Est

o es

un

decr

eto

sobr

e la

Inic

iativ

a qu

e se

ne

cesi

ta p

ara

tene

r fon

dos d

irigi

dos a

la

vado

man

os e

n el

pre

supu

esto

regi

onal

.

►La

s cap

acid

ades

exi

sten

per

o la

In

icia

tiva

no h

a ap

rove

chad

o de

muc

hos

opor

tuni

dade

s de

invo

lucr

ar la

vado

de

man

os e

n lo

s pla

nes d

e tra

bajo

de

vario

s pr

ogra

mas

. N

o ga

nara

muc

ha a

tenc

ión

en

agen

cias

gub

erna

men

tale

s com

o un

a co

sa

extra

.

sus p

rofe

sion

ales

.

►Es

pos

ible

que

tien

e qu

e ad

ecua

rse

al ri

tmo

del s

ecto

r púb

lico

(más

lent

o).

ON

G

inte

rnac

iona

l

►Es

inte

resa

nte

eval

uar l

a ca

paci

dad

de c

onvo

cato

ria q

ue p

uede

te

ner u

na in

stitu

ción

, más

allá

de

la fi

rma

de u

n co

ntra

to. A

lgun

as,

tal c

omo

Cár

itas,

pued

en m

ovili

zar l

íder

es c

ateq

uist

as.

ON

G lo

cal

►Ex

istió

cap

acid

ad d

e la

in

stitu

ción

par

a di

seña

r las

es

trate

gias

, met

odol

ogía

s y

aplic

arla

s.

►La

vin

cula

ción

de

quie

nes o

pera

n co

n la

s alia

nzas

regi

onal

es fu

e m

uy b

ásic

a.

►En

fatiz

ar e

l pro

gram

a en

el n

ivel

regi

onal

y lo

cal,

más

que

en

el

naci

onal

. Est

e úl

timo

pued

e es

tar v

incu

lado

o m

uy c

erca

no a

l as

pect

o po

lític

o.

►A

dem

ás d

e la

alia

nza

públ

ico

priv

ada

que

orie

nta

este

trab

ajo,

se

deb

ería

n id

entif

icar

gru

pos d

e so

porte

o e

spec

ializ

ados

que

ap

oyen

las a

ctiv

idad

es y

le d

en so

sten

ibili

dad

(PR

ISM

A).

►La

vin

cula

ción

del

MIN

SA d

ebe

esta

r com

prom

etid

o m

ás a

llá

de P

rom

oció

n de

la S

alud

, par

a lo

grar

com

o la

s cam

paña

s de

vacu

naci

ón e

n qu

e se

ded

ican

a e

so p

or u

no o

dos

mes

es.

Sect

or

priv

ado

Proy

ecto

bi

late

ral

►Si

el p

rogr

ama

se e

jecu

ta e

n Li

ma,

se p

uede

trab

ajar

en

cola

bora

ción

con

los c

onso

rcio

s ya

form

ados

por

PA

C S

edap

al.

54

Glo

bal S

calin

g U

p H

andw

ashi

ng P

roje

ct

Dis

poni

bilid

ad d

e pr

oduc

tos y

her

ram

ient

as

Tipo

de

Res

pond

. Fo

rtale

zas

Deb

ilida

des

Rec

omen

daci

ones

Gob

iern

o

►Se

est

á ev

alua

ndo

la p

ropu

esta

té

cnic

a de

ace

rcar

una

zon

a de

la

vado

a la

s let

rinas

que

PR

ON

ASA

R p

rom

over

ía.

►El

jabó

n no

con

stitu

ye u

n pr

oble

ma

ni e

n la

s zon

as ru

rale

s, pu

es si

empr

e ex

iste

.

►Lo

s pro

mot

ores

muc

has v

eces

se

cans

an d

e ap

oyar

por

que

no re

cibe

n in

cent

ivos

. (PR

OM

SA A

requ

ipa)

►La

dis

poni

bilid

ad d

e zo

nas d

e la

vado

y

de a

gua

sí p

uede

con

stitu

ir un

pro

blem

a pa

ra la

pro

moc

ión

de la

prá

ctic

a.

►Pr

omov

er la

par

ticip

ació

n de

pro

mot

ores

de

salu

d co

n la

en

trega

de

ince

ntiv

os c

omo

chal

ecos

, mat

eria

les y

gor

ros.

►En

pro

yect

os q

ue c

onsi

dere

n in

frae

stru

ctur

a, a

cerc

ar la

zon

a de

la

vado

y n

o só

lo e

l jab

ón a

la le

trina

y o

tro a

la c

ocin

a pa

ra

faci

litar

la a

dopc

ión

de la

prá

ctic

a.

Age

ncia

in

tern

acio

nal

►M

as d

e 90

% d

e la

s fam

ilias

se

disp

onen

de

jabó

n qu

e pu

ede

ser

usad

o pa

ra la

vado

de

man

os.

►Pf

izer

ha

dona

do ja

bón

a lo

s V

olun

tario

s de

Cue

rpos

de

Paz.

►A

lrede

dor d

e 1/

3 de

fam

ilias

no

tiene

fá

cil a

cces

o al

agu

a.

►Se

pue

de so

licita

r don

acio

nes d

e ja

bón

de lo

s hot

eles

en

las

ciud

ades

más

gra

ndes

par

a se

r don

ados

a la

s fam

ilias

más

pob

res.

►Se

pue

de p

rom

over

que

las f

amili

as c

on d

ifíci

l acc

eso

prep

aren

y

usen

Tip

py T

aps p

ara

pode

r lav

ar la

s man

os c

on p

oca

agua

.

►D

esar

rolla

r est

rate

gias

dis

tinta

s par

a co

sta,

sier

ra, s

elva

, así

co

mo

man

uale

s sob

re la

vado

de

man

os p

ara

prof

esio

nale

s de

salu

d.

ON

G

inte

rnac

iona

l

►Se

requ

iere

ele

men

tos d

e m

onito

reo

que

faci

lite

a la

s in

stitu

cion

es q

ue a

poya

n có

mo

med

ir la

s cap

acita

cion

es

efec

tuad

as y

su c

alid

ad (C

árita

s Piu

ra).

ON

G

loca

l

►Pa

ra e

l nue

vo p

rogr

ama

se d

ebie

ra a

segu

rar l

a en

trega

de

mat

eria

les c

on la

eje

cuci

ón d

e la

s act

ivid

ades

de

com

unic

ació

n y

forta

leci

mie

nto

de c

apac

idad

es.

Sect

or

priv

ado

►U

sar m

ás ra

dio

y m

enos

mat

eria

l im

pres

o.

►Se

nec

esita

agr

egar

nue

vas m

ensa

jes e

info

rmac

ión

para

m

ante

ner e

l cam

bio

de c

ompo

rtam

ient

o y

faci

litar

lo d

onde

exi

stan

ba

rrer

as. P

or e

jem

plo,

est

rate

gias

cua

ndo

falta

agu

a.

►Se

nec

esita

ada

ptar

los m

ater

iale

s par

a la

regi

ón (i

diom

a e

imág

enes

).

►N

o de

be se

r una

bar

rera

si la

gen

te u

sa su

cre

ativ

idad

; com

o vi

ncul

ar la

vado

de

man

os c

on te

mas

com

o ag

ua se

gura

y

abas

teci

mie

nto

de a

gua.

Proy

ecto

bi

late

ral

55

Glo

bal S

calin

g U

p H

andw

ashi

ng P

roje

ct

Fina

ncia

mie

nto

Tipo

de

Res

pond

. Fo

rtale

zas

Deb

ilida

des

Rec

omen

daci

ones

Gob

iern

o

►FO

ND

AM

tien

e 4

tipos

de

finan

ciam

ient

o pa

ra p

rogr

amas

co

mo

lava

do d

e m

anos

: co

ncur

sos,

co-f

inan

ciam

ient

o,

proy

ecto

s esp

ecia

les (

chic

os),

y pr

oyec

tos d

e de

sarr

ollo

in

nova

dore

s. Ti

enen

sus

prio

ridad

es g

eogr

áfic

as y

técn

icas

.

►

El M

INSA

con

side

ra q

ue la

fuer

za e

stá

en lo

s gob

iern

os

regi

onal

es, c

on e

l pro

ceso

de

desc

entra

lizac

ión,

pue

s aho

ra

disp

onen

de

fond

os y

deb

iera

n pr

ioriz

ar e

ste

tem

a.

►Ex

plor

ar m

ayor

fina

ncia

mie

nto

para

est

e pr

ogra

ma.

►Id

entif

icar

el f

inan

ciam

ient

o de

pro

yect

os d

e ag

ua y

sa

neam

ient

o pa

ra p

oder

vin

cula

rlos.

Age

ncia

in

tern

acio

nal

►

Aún

cua

ndo

tiene

los f

ondo

s las

en

tidad

es g

uber

nam

enta

les t

iene

n qu

e pa

sar p

or p

roce

sos b

uroc

rátic

os p

esad

os

para

gas

tarlo

s.

►M

ás fo

ndos

deb

en e

star

dis

poni

bles

del

sect

or p

rivad

o y

de

agen

cias

inte

rnac

iona

les c

omo

UN

ICEF

y S

AV

E qu

e tra

baja

n a

favo

r de

los n

iños

.

►U

SAID

tien

e un

pro

gram

a de

don

acio

nes p

eque

ñas (

smal

l gr

ants

) que

pue

de a

poya

r pro

yect

os c

omun

itario

s con

has

ta

$2,0

00.

►D

ebe

exis

tir su

ficie

ntes

fond

os e

n lo

s gob

iern

os re

gion

ales

do

nde

reci

ben

cano

n de

l las

em

pres

as m

iner

as. P

ara

las o

tras

regi

ones

seria

bue

no h

acer

abo

gací

a co

n el

Pre

side

nte

Reg

iona

l pa

ra d

ispo

ner d

e al

guno

s rec

urso

s.

ON

G

inte

rnac

iona

l

ON

G lo

cal

►Pa

ra q

ue h

aya

deci

sión

de

apoy

ar in

clus

ive

finan

cier

amen

te se

re

quie

re e

ntra

r por

la n

ueva

Ger

enci

a R

egio

nal d

e Ed

ucac

ión,

que

es

tá m

uy c

erca

na a

orie

ntar

la v

olun

tad

polít

ica

del g

obie

rno

regi

onal

. (La

bor)

►C

uand

o el

pro

yect

o se

pre

sent

e a

la R

egió

n se

deb

e so

licita

r que

se

a un

pro

yect

o es

peci

al y

que

teng

a au

tono

mía

en

el m

anej

o pr

esup

uest

al, o

rgan

izac

iona

l e in

stitu

cion

al.

Sect

or

priv

ado

Proy

ecto

56

Glo

bal S

calin

g U

p H

andw

ashi

ng P

roje

ct

bila

tera

l

Cos

to e

ficie

ncia

de

la e

jecu

ción

Ti

po d

e R

espo

nd.

Forta

leza

s D

ebili

dade

s R

ecom

enda

cion

es

Gob

iern

o

Age

ncia

in

tern

acio

nal

►El

pro

ceso

ha

sido

bie

n do

cum

enta

do e

n té

rmin

os d

e co

stos

e im

pact

o; p

ero

no

espe

cífic

amen

te e

n té

rmin

os d

e co

sto-

efec

tivid

ad d

e va

rias

activ

idad

es, m

ater

iale

s, et

c.

►

Es la

resp

onsa

bilid

ad d

el e

quip

o de

mon

itore

o y

eval

uaci

ón.

ON

G

inte

rnac

iona

l

ON

G L

ocal

Sect

or p

rivad

o

Proy

ecto

bi

late

ral

Mon

itore

o Ti

po d

e R

espo

nd.

Forta

leza

s D

ebili

dade

s R

ecom

enda

cion

es

Gob

iern

o

►Es

cuel

as S

alud

able

s ha

desa

rrol

lado

una

tabl

a de

in

dica

dore

s que

est

á en

el p

roce

so

de a

prob

ació

n fin

al.

►

Es im

porta

nte

que

esté

des

arro

llada

des

de e

l dis

eño

del

proy

ecto

, con

inst

rum

ento

s pre

ciso

s y p

rese

ntad

os a

los s

ocio

s.

57

Glo

bal S

calin

g U

p H

andw

ashi

ng P

roje

ct

Age

ncia

in

tern

acio

nal

►La

líne

a de

bas

e y

su re

petic

ión

fuer

on b

ien

hech

os, l

o qu

e co

nstit

uye

un a

spec

to

sobr

esal

ient

e de

l pro

gram

a.

►PR

ISM

A re

aliz

o in

form

es

perió

dico

s; lo

s soc

ios m

onito

rean

su

s act

ivid

ades

; las

inst

ituci

ones

qu

e re

plic

an ta

llere

s env

ían

info

rmes

(RPP

, CA

RE,

etc

.)

►M

ucha

s act

ivid

ades

no

han

sido

ev

alua

das.

►H

a si

do u

n po

co a

usen

te p

ero

ha

mej

orad

o re

cien

tem

ente

.

►Pr

omov

er e

l mon

itore

o y

la e

valu

ació

n de

las a

ctiv

idad

es,

capa

cita

ndo

a lo

s soc

ios e

n es

te a

spec

to y

dot

ando

de

herr

amie

ntas

sim

ples

de

mon

itore

o.

►U

sar i

ndic

ador

es m

ás se

nsib

les,

sim

plifi

car l

os in

stru

men

tos,

no re

coge

r tan

tos d

atos

y h

acer

más

obs

erva

cion

es.

►Pu

blic

ar la

eva

luac

ión.

►H

ay q

ue p

repa

rar u

n pl

an d

e m

onito

reo

que

expl

ique

bie

n su

re

laci

ón c

on la

eva

luac

ión

de im

pact

o. H

ay q

ue in

clui

r re

quer

imie

ntos

de

info

rmes

en

los c

ontra

tos c

on a

genc

ias

impl

emen

tado

tes.

►Se

nec

esita

may

or m

onito

reo

y m

edic

ión

de re

sulta

dos.

ON

G

inte

rnac

iona

l

►D

ebie

ra p

rom

over

se la

par

ticip

ació

n de

la p

obla

ción

a tr

avés

de

un

mon

itore

o pa

rtici

pativ

o m

uy v

isua

l que

per

mita

med

ir la

s co

ndic

ione

s gen

eral

es y

las c

rític

as. L

a es

cuel

a de

bier

a se

r un

espa

cio

de m

edic

ión

nece

sario

.

ON

G lo

cal

Sect

or p

rivad

o

►N

o se

ha

real

izad

o m

onito

reo

de la

s ac

tivid

ades

de

Bel

corp

.

►El

pro

ceso

de

revi

sión

de

indi

cado

res d

e m

onito

reo

y ev

alua

ción

pod

ría se

r ela

bora

do y

/o re

visa

do c

onju

ntam

ente

(R

PP).

►Lo

s res

ulta

dos d

el m

onito

reo

y ev

alua

ción

deb

en se

r tra

baja

dos y

com

parti

dos c

on to

dos l

os so

cios

de

la In

icia

tiva.

Proy

ecto

bi

late

ral

58

Glo

bal S

calin

g U

p H

andw

ashi

ng P

roje

ct

Fact

ores

más

impo

rtant

es p

ara

las c

ondi

cion

es d

e éx

ito

GO

BIE

RN

O

La c

onst

rucc

ión

conj

unta

de

la p

ropu

esta

faci

litar

ía q

ue lo

s act

ores

nac

iona

les y

regi

onal

es se

apr

opie

n de

la p

ropu

esta

, pon

iend

o en

evi

denc

ia q

ue

son

parte

del

pro

blem

a y

de la

resp

uest

a.

Ase

gura

r que

las z

onas

de

lava

do c

omo

infr

aest

ruct

ura

exis

tan

o se

pro

mue

va su

con

stru

cció

n pa

ra fa

cilit

ar la

prá

ctic

a.

Rev

isar

las c

ondi

cion

es d

e la

vado

en

zona

s de

altu

ra, m

ayor

a 3

,500

msn

m

Tene

r en

eval

uaci

ón q

ue c

uand

o ex

iste

cañ

o fa

cilit

a m

ás la

prá

ctic

a, q

ue e

ntre

gand

o la

vato

rios y

jarr

as.

PRO

GR

AM

A IN

TER

-GU

BER

NA

MEN

TAL

Foca

lizar

; ase

gura

r que

las á

reas

del

pro

gram

a tie

ne a

cces

o a

agua

.

Ant

es d

e im

plem

enta

r, da

r la

opor

tuni

dad

para

los b

enef

icia

ros e

xplic

ar su

s vid

as, e

sper

anza

s, de

seos

.

Aju

star

los p

rodu

ctos

o se

rvic

ios p

ara

resp

onde

r; us

ar ra

dio

loca

l, te

atro

pop

ular

, títe

res p

ara

los n

iños

, no

TV.

Emiti

r en

hora

s par

a el

luga

r (5/

6 a.

m. e

n el

cam

po) c

on p

rodu

ctos

ade

cuad

os a

los p

adro

nes c

ultu

rale

s de

cada

regi

ón.

AG

ENC

IA IN

TER

NA

CIO

NA

L

Mej

or d

efin

ició

n de

una

est

rate

gia

que

colo

ca la

vado

de

man

os d

entro

de

muc

has o

tras i

nici

ativ

as re

laci

onad

o co

n ag

ua y

sane

amie

nto

y sa

lud

infa

ntil

a to

dos n

ivel

es.

Plan

ifica

ción

par

ticip

ativ

a en

todo

s niv

eles

.

Inst

ituci

onal

izar

la p

rom

oció

n de

lava

do d

e m

anos

.

No

tene

r una

inte

rven

ción

ais

lada

—ha

cer c

omo

parte

de

un p

aque

te d

e in

terv

enci

ones

par

a di

smin

uir l

a di

arre

a.

No

se c

rea

hábi

tos n

uevo

s sol

amen

te c

on c

ampa

ñas—

nece

sita

una

inte

rven

ción

sost

enid

a.

Hac

er a

lianz

as a

par

tir d

e in

icia

tivas

exi

sten

tes;

uni

éndo

lo c

on e

l int

erés

en

dism

inui

r la

desn

utric

ión.

Mon

itore

o y

eval

uaci

ón e

s sum

amen

te im

porta

nte.

La

Alia

nza

debe

apo

yar l

os so

cios

en

esto

, dan

do h

erra

mie

ntas

y a

yuda

técn

ica.

Por

ello

se

nece

sita

coo

rdin

ar m

ejor

la h

ora

de la

s acc

ione

s de

muc

hos s

ocio

s par

a qu

e se

apo

yen

mej

or u

na a

otra

.

Rea

lizar

un

buen

esf

uerz

a de

cre

ar v

olun

tad

polít

ica;

difu

sión

de

resu

ltado

s; u

sar m

ucha

s can

ales

con

los m

ism

os m

ensa

jes.

Incl

uir e

l men

saje

de

pone

r jab

ón e

n to

dos l

ugar

es d

onde

se la

van

las m

anos

; usa

r la

repe

tició

n de

men

saje

s per

sona

a p

erso

na.

Se n

eces

ita u

n bu

en d

iseñ

o pa

ra u

na e

jecu

ción

real

ista

.

Se n

eces

ita u

na b

uena

com

unic

ació

n en

tre lo

s muc

hos s

ocio

s, co

n un

com

ité n

acio

nal q

ue tr

abaj

a bi

en y

pue

de re

solv

er p

robl

emas

.

Iden

tific

ar 3

a 5

org

aniz

acio

nes q

ue p

ueda

n m

anej

ar la

impl

emen

taci

ón e

n la

s reg

ione

s.

Hac

er b

ueno

s ase

sora

mie

ntos

regi

onal

es p

ara

iden

tific

ar lo

s soc

ios,

prog

ram

as y

est

ruct

uras

mej

ores

.

Tene

r fle

xibi

lidad

aju

star

el p

rogr

ama

a la

s rea

lidad

es e

n el

cam

po y

no

tene

r que

segu

ir la

met

odol

ogía

glo

bal c

uand

o no

func

iona

bie

n aq

uí; n

o 59

Glo

bal S

calin

g U

p H

andw

ashi

ng P

roje

ct

deja

r los

requ

erim

ient

os d

e m

onito

reo

y ev

alua

ción

con

dici

onen

la e

jecu

ción

.

ON

G IN

TER

NA

CIO

NA

L

Sim

plic

idad

; cla

ridad

de

role

s; m

ecan

ism

os d

e re

cono

cim

ient

o; re

troal

imen

taci

ón o

portu

na.

Pens

ar n

o en

una

cam

paña

sino

en

activ

idad

es c

ontin

uas.

Se n

eces

ita b

uena

s alia

nzas

, fin

anci

amie

nto,

recu

rsos

hum

anos

, un

sím

bolo

uni

ficad

or.

La In

icia

tiva

tiene

que

gen

eral

opi

nión

pub

lica

favo

rabl

e.

Bus

car l

a re

laci

ón c

on la

s16

min

eras

que

est

án o

rient

ando

sus a

ccio

nes d

e re

spon

sabi

lidad

soci

al, a

trav

és d

e la

cre

ació

n de

Fun

daci

ones

.

ON

G L

OC

AL

La a

lianz

a pú

blic

o/pr

ivad

a es

ese

ncia

l por

que

el se

ctor

púb

lico

solo

no

pued

e te

ner l

os re

sulta

dos.

Trab

ajar

lo m

ás p

osib

le a

l niv

el lo

cal.

Expl

orar

las m

esas

de

conc

erta

ción

com

o al

ianz

as lo

cale

s que

ya

exis

tan.

Tene

r un

enfo

que

más

am

plio

hac

ia d

esnu

trici

ón y

pob

reza

.

SEC

TOR

PR

IVA

DO

Prov

eer e

vide

ncia

que

los c

ambi

os d

e co

mpo

rtam

ient

o es

tán

acon

teci

endo

.

Trab

ajar

más

con

com

unic

ació

n al

tern

ativ

a co

mo

pasa

calle

, tea

tro, t

ítere

s.

Hac

er u

na lí

nea

de b

ase.

Ayu

dar a

todo

s con

mon

itore

o.

PRO

YEC

TO B

ILA

TER

AL

La In

icia

tiva

tiene

que

hac

er m

ucho

s esf

uerz

os a

cre

ar c

ompr

omis

os y

col

abor

ació

n al

niv

el re

gion

al y

dis

trita

l por

muc

hos s

ocio

s de

vario

s sec

tore

s.

Tien

e qu

e aj

usta

r la

prom

oció

n de

pend

iend

o en

el a

cces

o a

agua

que

las f

amili

as ti

enen

.

Junt

ar p

rom

oció

n de

lava

do d

e m

anos

con

pro

gram

as d

e in

frae

stru

ctur

a de

agu

a y

sane

amie

nto

pued

e se

r muy

efe

ctiv

o po

rque

los m

ejor

amie

ntos

fís

icos

cre

an c

onfia

nza

de la

pob

laci

ón a

la o

rgan

izac

ión

ejec

utor

a.

Sour

ce: S

umm

ary

of th

e te

am’s

inte

rvie

ws i

n Pe

ru.

60

Glo

bal S

calin

g U

p H

andw

ashi

ng P

roje

ct

APP

END

IX D

: EN

CU

ESTA

SO

BR

E LA

S C

ON

DIC

ION

ES P

AR

A LA

EXP

AN

SIÓ

N D

EL L

AVA

DO

D

E M

AN

OS

CO

N J

AB

ÓN

: 10

RES

PUES

TAS

N

ombr

e de

la o

rgan

izac

ión:

Fe

cha

H

ace

cuán

to ti

empo

est

á in

volu

crad

o en

est

e pr

ogra

ma?

__

2__E

ntre

6 m

eses

y u

n añ

o

__

2__

entre

1 y

2 a

ños

__

_5__

Más

de

1 añ

o

C

uál e

s su

pape

l en

su o

rgan

izac

ión?

__

5_ to

mad

or d

e de

cisi

ones

_

__3_

ejec

utor

_

_3__

supe

rvis

or/g

eren

te

____

3___

____

__ o

tro

A

qué

niv

el se

ha

vinc

ulad

o co

n el

pro

gram

a?

__

1_ n

acio

nal

__

3_re

gion

al

___

3_ p

rovi

ncia

l _

_6__

dis

trita

l

__4_

loca

l _

____

1___

____

_ ot

ro

In

stru

ccio

nes:

M

aque

con

"X"

el n

umer

o qu

e m

ejor

refle

ja su

resp

uest

a a

cada

pre

gunt

a o

fras

e.

I. PO

LÍTI

CA

, EST

RA

TEG

IA, Y

DIR

ECC

IÓN

La

inic

iativ

a de

lava

do d

e m

anos

, inc

luye

ndo

el

prog

ram

a:

Se n

eces

ita

mej

orar

muc

ho

Exce

lent

e

en e

sta

área

1 Ti

ene

una

met

a y

obje

tivos

cla

ros y

ent

endi

bles

en

todo

s 0

1 1

6 2

61

Glo

bal S

calin

g U

p H

andw

ashi

ng P

roje

ct

los n

ivel

es

2 H

a es

tabl

ecid

o un

vis

ión

y es

trate

gia

com

parti

das

0 0

3 7

0

3 Es

tabl

ece

hito

s y a

lianz

as q

ue a

poya

n su

s obj

etiv

os

0 1

1 4

4

4 H

a tra

baja

do e

n pr

o de

est

able

cer p

olíti

cas f

avor

able

s 0

1 2

5 2

5 Ti

ene

un p

lan

com

plet

o fo

rmul

ado

0 0

3 5

2

6 Ti

ene

mie

mbr

os q

ue e

ntie

nden

su e

stra

tegi

a de

larz

o pl

azo

0 1

0 7

2

7 Ti

ene

un p

lan

form

ulad

o pa

ra g

uiar

sus e

sfue

rzos

. 0

0 3

5 2

8 Ti

ene

polít

icas

y p

roce

dim

ient

os q

ue h

ace

posi

ble

cam

biar

la m

aner

a có

mo

se h

acía

n la

s cos

as

0 1

2 4

3

9 Ti

ene

una

visi

ón q

ue e

s com

pren

dida

en

todo

s los

niv

eles

0

0 4

5 1

10

Se d

esta

can

los e

sfue

rzos

exi

toso

s que

pue

den

ayud

ar a

re

forz

ar la

vis

ión

0 1

2 5

2

11

Tien

e lín

eas d

e au

torid

ad c

lara

s 0

1 1

6 2

12

Pued

e im

plem

enta

r su

visi

ón d

e m

aner

a ef

ectiv

a 0

0 3

4 3

13

Pued

e lle

var s

u vi

sión

a su

s mie

mbr

os y

sus c

omun

idad

es

0 0

2 6

2

II.

ALI

AN

ZAS

Es

tá sa

tisfe

cho

con

que

el p

rogr

ama,

por

que

…

Insa

tisfe

cho

Alg

o in

satis

fech

o N

eutra

l Sa

tisfe

cho

Muy

satis

fech

o

1 Ti

ene

la c

apac

idad

de

ofre

cer e

l apo

yo re

quer

ido

por s

us

mie

mbr

os p

ara

impl

emen

tar e

l pro

gram

a?

0 1

1 5

3

62

Glo

bal S

calin

g U

p H

andw

ashi

ng P

roje

ct

2 C

uent

a co

n la

coo

pera

ción

y a

poyo

de

sus m

iem

bros

? 0

1 1

6 2

3 Ti

ene

ampl

ios c

onta

ctos

que

pue

de m

otiv

ar a

ayu

dar l

a in

icia

tiva,

p.e

. ado

gado

s, ba

nque

ros,

etc.

? 0

2 5

0 3

4 Ti

ene

vario

s con

tact

os fu

erte

s en

la e

mpr

esa

priv

ada?

0

3 2

2 3

5 Ti

ene

vario

s con

tact

os fu

erte

s con

ON

Gs,

grup

os

soci

ales

? 1

1 1

3 4

6 Ti

ene

vario

s con

tact

os fu

erte

s en

el se

ctor

gu

bern

amen

tal?

0

1 3

2 4

7 B

usca

act

ivam

ente

con

segu

ir nu

evos

con

tact

os e

n el

tra

nscu

rso

del t

iem

po?

1 0

3 4

2

8 U

tiliz

a su

s con

tact

os y

rela

cion

es?

1 0

3 3

3

9 A

ctúa

en

una

man

era

abie

rta e

incl

usiv

a?

0 1

2 5

2

10

Es e

ficie

nte

y pr

oduc

tivo,

enf

ocad

o en

resu

ltado

s?

0 1

2 5

2

11

Se a

segu

ra q

ue se

dis

pong

a de

sufic

ient

es re

curs

os p

ara

que

los m

iem

bros

alc

ance

n su

s obj

etiv

os?

0 1

1 5

3

12

Brin

da su

ficie

nte

orie

ntac

ión

a su

s mie

mbr

os?

0 1

2 5

2

En

est

e pr

ogra

ma,

Tota

lmen

te

en d

es-

acue

rdo

En

desa

cuer

do

Neu

tral

De

acue

rdo

Fuer

tem

ente

de a

cuer

do

13

La c

olab

orac

ión

y el

sent

ido

de e

quip

o ju

egan

un

pape

l im

porta

nt e

n el

des

arro

llo d

el p

rogr

ama.

0

0 1

4 5

14

Los m

iem

bros

est

án in

volu

crad

os e

n en

cont

rar s

oluc

ione

s a

los d

esaf

ios d

el p

rogr

ama.

0

0 3

4 3

15

El a

pren

diza

je e

s par

te d

el tr

abaj

o y

lueg

o se

con

vier

ten

en ta

reas

de

rutin

a 0

0 3

4 3

63

Glo

bal S

calin

g U

p H

andw

ashi

ng P

roje

ct

16

Se fo

men

ta e

quip

os c

on re

pres

enta

ción

de

vario

s se

ctor

es.

0 0

1 6

3

17

Los m

iem

bros

est

án in

volu

crad

os e

n en

cont

rar s

oluc

ione

s a

los d

esaf

ios d

el p

rogr

ama.

0

0 2

5 2

18

Se c

ompa

rte e

l cré

dito

del

éxi

to

0 0

2 3

5

19

Los s

ocio

s se

bene

fican

con

la c

olab

orac

ión.

0

0 1

5 4

III.

AC

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69


APPENDIX E: LAS CONDICIONES PARA LA EXPANSIÓN DEL LAVADO DE MANOS CON JABÓN. GUÍA DE ENTREVISTA

Fecha de la entrevista ____________________________________________________

Nombre del entrevistador _________________________________________________

Nombre del entrevistado __________________________________________________

Cargo __________________________________________________________________

Rol del entrevistado (tomador de decisión, ejecutor, supervisor)

________________________________________________________________________

Tipo de organización (sector público, privado, ONG) __________________________

Alcance de la organización (nacional, varias regiones, regional, distrital, comunal)

________________________________________________________________________

Introducción (5 minutos)

Introducción

Agradecimiento por el tiempo otorgado

Propósito de la entrevista

Explicación de la confidencialidad de la entrevista, no se usará el nombre u otro dato de identificación

Información de la existencia de preguntas.

Apertura (10 minutos)

Solicitar información acerca de la importancia de lavado de manos

Solicitar información acerca de la institución a la que pertenece, lo que hace en relación a lavado de manos y los planes que tienen respecto a este tema.

Nota importante: Aclare si la pregunta se refiere al nivel nacional, regional, o local o a varios niveles.

Política, estrategia y dirección (Gobierno, Agencia Int., ONG Int., ONG Local, Sec. Privado, Proj. Bilat.)

►Qué tan sólida ha sido la voluntad política (nacional, regional, local) para promover el lavado de manos?

► Qué sugerencias tendría para mejorarla en un programa a escala ampliada?

►¿En su opinión cuánto ha dispuesto la Iniciativa de una visión y estrategia compartida que asegure la voluntad política? Explique.

►¿Tiene Ud. sugerencias sobre cómo este aspecto podría ser fortalecido en el programa expandido?

►Esta visión y estrategia fue desarrollado de una manera participativa?

►¿Tiene Ud. sugerencias sobre como este aspecto puede ser fortalecido en el programa expandido?

Alianzas (Gobierno, Agencia Int., ONG Int., ONG Local, Sec. Privado, CBOs, Media, Proj. Bilat.)

►¿Cuán efectivas han sido las alianzas público privadas al nivel nacional y regional?

►¿Cree Ud. que los miembros de la alianza han tenido metas complementarias y cómo han funcionado?

►¿Cree Ud. que los miembros han compartido los riesgos, el poder, así como los resultados o procesos?

70


►¿Las alianzas han sido construidas en todos los niveles entre los sectores público, privado y ONGs?

►¿Tiene Ud. sugerencias sobre como estas alianzas pueden ser fortalecido en el programa expandido?

3. Acuerdos institucionales (Gobierno, Agencia Int., ONG Int., ONG Local, CBOs, Media, Proj. Bilat.)

►¿Cree que las instituciones que participan en la Iniciativa de Lavado de Manos en todos los niveles claramente entienden sus roles, responsabilidades y autoridad?

►¿Cree que los socios contaron con los recursos para llevar a cabo sus roles?

►Cree que los socios para un programa a escala ampliada podrían contar con los recursos necesarios?

►¿Tiene Ud. sugerencias sobre cómo se puede disponer de mas recursos para complementar el financiamiento de Gates en el programa a escala ampliada?

►¿Cuán adecuados han sido los acuerdos institucionales en definir los mecanismos o procedimientos para los actores coordinar sus actividades?

►¿Tiene Ud. sugerencias sobre cómo este aspecto puede ser fortalecido en el programa a escala ampliada?

Metodología del programa (Gobierno, Agencia Int., ONG Int., ONG Local, CBOs, Media)

La metodología del programa consiste en las reglas del programa, actividades específicas y su secuencia y cronograma.

71


► ¿Qué opina sobre la metodología de trabajo de la Iniciativa?

►¿Tiene Ud. sugerencias sobre cómo mejorar la metodología en el programa a escala ampliada?

►¿Cree Ud. que la metodología ha sido clara y acordada por los socios?

►¿Tiene Ud. sugerencias sobre como tener certeza que la metodología es clara y acordada por los socios en el programa a escala ampliada?

Capacidad de ejecución (Gobierno, ONG Int., ONG Local, Sec. Privado, CBOs)

En la capacidad institucional se considera aspectos como recursos humanos con las capacidades y habilidades requeridas para ejecutar sus funciones, una estructura organizacional dentro de la institución, un manejo de la metodología acordada, sistemas y procedimientos requeridos para su implementación y la habilidad para monitorear el programa y hacer los ajustes oportunos.

►¿Cree Ud. que al nivel nacional los socios de la Iniciativa han tenido la capacidad institucional para llevar a cabo sus roles y responsabilidades?

►¿Cree Ud. que al nivel regional los socios de la Iniciativa han tenido la capacidad institucional para llevar a cabo sus roles y responsabilidades?

►¿En el programa a escala ampliada, cree Ud. que hay uno o más aspectos de capacidad institucional que se necesita fortalecer en cualquier nivel?

►[Si sí] ¿qué sugerencias tendría al respeto?

6. Disponibilidad de productos y herramientas (ONG Int., ONG Local, Sec. Privado, CBOs)

►¿Cree Ud. que la Iniciativa ha provisto de los productos y herramientas que respondan a las preferencias del público objetivo y su decisión y habilidad para pagar por ellos?

72


►¿En el programa a escala ampliada, cree Ud. que hay uno o más aspectos de productos apropiados que se necesitará fortalecer en cualquier nivel?

►[Si sí] ¿qué sugerencias tendría al respeto?

Financiamiento (Gobierno, ONG Int., CBOs)

►¿Han sido suficientes los acuerdos para el financiamiento de los costos del programa?

►¿Tiene Ud. sugerencias sobre como se puede disponer de mas recursos para complementar el financiamiento de Gates en el programa expandido?

Costo eficiencia de la ejecución (Gobierno, ONG Int.)

►¿Los socios han tenido los sistemas y procedimientos para recoger y analizar la información requerida para un análisis de costo eficiencia?

►¿Tiene Ud. sugerencias sobre cómo se puede fortalecer esta capacidad en el programa a escala ampliada?

Monitoreo (Gobierno, ONG Int., Sec. Privado, CBOs)

Un monitoreo eficiente permite identificar las fortalezas y debilidades en la metodología del programa, su ejecución y costo-eficiencia.

►¿Cómo ha sido el proceso de monitoreo en la Iniciativa?

►¿La responsabilidad ha sido clara?

►¿Tiene Ud. sugerencias sobre cómo se puede fortalecer esta capacidad en el programa a escala ampliada?

73


►¿Tiene Ud. sugerencias sobre como se puede tener suficiente capacidad de recoger información recogida en el nivel comunitario o distrital?

Cierre (5 minutos)

¿Cuál sería el factor más importante que permitiría que el proyecto logre sus objetivos?

¿Cuál sería el aspecto clave que debiera realizarse con el fin de generar las condiciones para que el proyecto tenga éxito y se pueda trabajar a escala ampliada?

¿Hay una o dos otras personas en [la organización] que pudieran responder a unas preguntas sobre el tema por correo electrónico? Ellos pueden hacerlo en 10 a 15 minutos. Podría darme sus direcciones de correo electrónico?

Nombre Cargo Correo electrónico

Gracias por su tiempo.

74


APPENDIX F: ESTUDIO DE CONDICIONES PARA LA EXPANSIÓN DEL LAVADO DE MANOS CON JABÓN (GUÍA DE ENTREVISTA

PARA SOCIOS POTENCIALES) Primera versión en español

Este cuestionario ha sido creado para ser usado por el equipo del estudio de condiciones para la expansión de lavado de manos con jabón.

Fecha de la entrevista

____________________________________________________

Nombre del entrevistador

_____________________________________________________

Nombre del entrevistado

_____________________________________________________

Cargo

______________________________________________________

Rol del entrevistado (tomador de decisión, ejecutor, supervisor)

______________________________________________________

Tipo de organización (sector público, privado, ONG)

______________________________________________________

Alcance de la organización (nacional, varias regiones, regional, distrital, comunal)

______________________________________________________

Introducción (5 minutos)

Introducción

Agradecimiento por el tiempo otorgado

75


Propósito de la entrevista

Explicación de la confidencialidad de la entrevista, no se usará el nombre u otro dato de identificación

Información de la existencia de preguntas.

Apertura (10 minutos)

Solicitar información acerca de la importancia de lavado de manos

Solicitar información acerca de la institución a la que pertenece, lo que hace en relación a lavado de manos y los planes que tienen respecto a este tema.

Dimensiones de la entrevista (50 – 60 minutos)

Usar el cuestionario anexo.

Encuestas (10 -15 minutes)

Usar en la medida de las posibilidades de los actores.

Política, estrategia y dirección (Gobierno, Agencia Int., ONG Int., ONG Local, Sec. Privado, Proj. Bilat.)

¿Qué tan conscientes están los tomadores de decisión sobre la importancia del lavado de manos con jabón en reducir la diarrea y las infecciones respiratorias agudas?

¿Sabe qué dicen los resultados de los estudios de lavado de manos con jabón? En caso sea así, qué recuerda? (Si no sabe, explíqueselo).

¿En qué medida existe una voluntad política para promover el lavado de manos con jabón (en el nivel apropiado al entrevistado)?

¿Conoce usted algún decreto o política o norma que el gobierno o las organizaciones privadas hayan efectuado para promover lavado de manos en esta región. Si no es así, piensa que estas políticas serían posibles de efectuarse?

¿Su organización ha participado en programas de salud infantil en esta Región? 76


¿Su organización ha participado en la promoción de lavado de manos en esta región? Si es así, por favor descríbalo y explique qué tan exitoso ha sido.

¿Qué tan importante es la promoción de lavado de manos en su organización, comparado con otras iniciativas de salud?

Si varias organizaciones se reunirían en una iniciativa de promoción de lavado de manos, ¿quiénes serían los decidores y de quién se requeriría apoyo?

Agradeceríamos nos indique qué organizaciones, individuos o agencias podrían actuar como catalizadores o líderes de la promoción de lavado de manos en la región. Voy a mencionar varios tipos de organizaciones. Para cada tipo, mencione cuáles piensa podrían ser las más interesadas y con recursos para contribuir a la promoción de lavado de manos.

Actividades o contribución financiera actual a lavado de manos

Tipo de recurso que podría dar en apoyo a la iniciativa

Sector público

ONGs

Sector privado

77


Actividades o contribución financiera actual a lavado de manos

Tipo de recurso que podría dar en apoyo a la iniciativa

Medios de comunicación

Otros proyectos de agua y salud

Organizaciones de base

Alianzas (Gobierno, Agencia Int., ONG Int., ONG local, Sector privado, medios de comunicación, proyectos bilaterales).

¿Existen diferentes tipos de organización en la Región que estén interesados y tengan las capacidades para trabajar como socios en programas que beneficien a las madres y los niños? Dé ejemplos.

78


¿Cómo describiría la calidad de las alianzas entre los gobiernos locales y las ONGs? ¿Cómo podría mejorarse?

¿En qué medida los roles, responsabilidades y expectativas están claras y acordadas en estas alianzas?

¿Cómo describiría las relaciones que se establecen entre las ONGs y las comunidades en que trabajan? ¿Cómo podrían mejorarse?

¿Qué alianzas en esta Región supo utilizar el potencial de las alianzas estratégicas entre el sector público, privado, las ONGs y las organizaciones en el nivel local y nacional? Si es así, ¿cómo se llegó a realizar? ¿Qué necesitaría ser explorado?

Acuerdos institucionales (Gobierno, Agencia internacional, ONG internacional, ONG local, organizaciones de base, medios de comunicación, proyectos bilaterales)

¿Hay ejemplos de alianzas establecidas con objetivos en salud? Si es así, ¿qué tan bien los diferentes grupos trabajaron en….

Planificación

Ejecución

Capacitación

Monitoreo y evaluación?

¿En qué medida los acuerdos estuvieron claramente definidos?

¿Tiene mecanismos establecidos para coordinación entre los socios más importantes? Si es así, ¿cómo están trabajando estos mecanismos? ¿Cómo podrían mejorarse?

¿Tiene idea en cómo establecer o mejorar los mecanismos de coordinación entre las diferentes organizaciones y niveles de ejecución para un programa de lavado de manos a escala ampliada?

79


Capacidad de ejecución (Gobierno, ONG internacional, ONG local, sector privado, organizaciones de base)

¿Qué habilidades, métodos, herramientas y recursos humanos piensa que podría requerirse para ejecutar un programa de lavado de manos en esta Región?

¿Qué recursos ya existen localmente, de manera que pueda apoyar la capacidad requerida? Qué está faltando?

Financiero

Bienes

Humanos

Capacitación

Tecnología

Otro

¿En qué medida existe una adecuada capacidad para planificar y ejecutar promoción de la higiene el sector público?

¿Y entre las ONGs?

¿Entre otros grupos o socios?

Por favor describa un programa de promoción de higiene o salud en esta Región que considere exitoso? ¿Qué lo hizo exitoso?

¿Cómo se involucró al sector privado (agencias de publicidad, etc.) en el programa de salud o higiene?

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Para usar SOLO en caso que se necesite continuar con la entrevista:

¿Hay capacidad desarrollada en el nivel local para abordar la ejecución del programa y monitorear los cambios a nivel de los hogares y comunidad? Si es así, describa.

¿En qué medida existe una adecuada capacidad en el sector privado para otorgar bienes y servicios y responder a las preferencias de los consumidores?

¿Será el sector privado capaz de responder a la demanda creciente en tanto el programa de lavado de manos se desarrolle en gran escala?

Disponibilidad de productos y herramientas (ONG internacionales, ONG locales, sector privado, organizaciones de base)

¿En qué medida las siguientes dimensiones de mercadeo de lavado de manos necesitarían ser fortalecidas?

Producto: ¿Qué productos que lavado de manos con jabón están disponibles, dónde y cómo? Se consideran productos al jabón, recipientes para almacenar agua, elementos para tener agua segura. ¿En qué medida siente que esos productos ofrecidos responden a la demanda del consumidor?

Precio: ¿En qué medida la gente de menores recursos tiene dinero para comprar productos para lavarse las manos con jabón? ¿El costo de los productos corresponden a la capacidad y deseo de pago del público?

Ubicación: ¿Qué tan disponibles están los elementos esenciales cerca de las comunidades pobres? ¿Qué cadenas de producción han sido establecidas para responder a la demanda de los hogares?

¿Existen planes en la actualidad que puedan fortalecer las dimensiones de producto, precio y ubicación?

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¿En qué medida es común la preparación de jabón en algunas áreas? ¿Existen programas que promuevan el uso de este tipo de jabón para lavado de manos?

Financiamiento (Gobierno, ONG internacionales, organizaciones de base)

¿Qué organizaciones posiblemente podrían contribuir al financiamiento de los costos programáticos de implementar un programa de lavado de manos a escala ampliada? (Costos como salario de personal, capacitación, transporte, etc.)

¿En qué medida las actividades de promoción ya están incluidas en los presupuestos regionales, provinciales y distritales?

¿Cómo han contribuido los socios del sector privado a las campañas públicas de salud?, ¿con dinero en efectivo o en servicios?

Monitoreo (Gobierno, ONG internacional, sector privado, organizaciones de base)

¿Existen en la actualidad programas en esta región que tengan un buen proceso de monitoreo para medir la efectividad de los programas y sus resultados? Si es así, ¿cómo lo hacen?

¿Qué instituciones del sector público, privado y las ONGs están presentes para conducir varios tipos de estudios (cualitativo, cuantitativo, etc.), y cuál es su capacidad (en términos de habilidades técnicas que podrían están disponibles para lavado de manos con jabón?

¿Qué mejoras técnicas, administrativas o financieras son necesarias para asegurar que los actuales sistemas de monitoreo son adecuados para apoyar un programa a gran escala?

¿Cuáles serían los costos de estas mejoras?

¿Qué incentivos se requieren para lograr el enganche y la diseminación de los resultados de las actividades de monitoreo? ¿Qué podría fortalecer la valoración del monitoreo?

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APPENDIX G: INFORME DE VIAJE A PIURA

Fecha 17 y 18 de mayo del 2007

Realizado por Mike Favin

Consultor internacional

Doris Alfaro

Consultora local

Instituciones entrevistadas Giovanna Bisso

Gerente de Educación y Cultura


Teodora Miranda

Coordinadora de PRONOEI

Ana Turves

Participante Cuerpos de Paz en Catacaos

Omar Palacios

Jefe de la Oficina de Población, Salud e Higiene


Dr. Carlos Bayona

Sub Director

DIRESA Piura

Carolina Aguilar

Encargada área social

CARE Piura

Juan Manuel Cendra

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Secretario General

Cáritas Piura

Deysi Cheros

Presidente Comisión salud, salubridad y saneamiento

Municipalidad distrital de Catacaos

Eleuteria Cruz

Jefa Asuntos comunales y sociales

Municipalidad distrital de Catacaos

Jenny Portocarrero

Relaciones Públicas

Sub Región Salud Sullana

Principales hallazgos por tipo de institución

Sector salud

Existe un marcado interés por participar en acciones vinculadas a la Iniciativa de Lavado de Manos.

No ha sido evidente un involucramiento directo de la DIRESA con la Iniciativa, aunque sí conoce de la realización de actividades que sí se han realizado en la Región.

Existe un nicho interesante a partir de Escuelas Saludables y dentro de las campañas de promoción de la salud en las escuelas.

Se puso en evidencia la necesidad de dar incentivos (como capacitación, certificados o movilidad) a los promotores de salud para asegurar la llegada continua a la población.

No es difícil asegurar la voluntad política para lavado de manos. El Presidente Regional apoya muchas iniciativas de salud y existen ordenanzas relacionadas a disminuir la desnutrición crónica o a mejorar la gestión del Vaso de Leche.

Las autoridades recuerdan mucho la importancia del lavado de manos durante la epidemia del cólera.

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Sería importante buscar involucramiento con MINED y con el Programa Juntos que trabaja en regiones de extrema pobreza y está apoyando en solventar un profesional en cada establecimiento de salud (54 profesionales), con fondos de la Presidencia de Consejo de Ministros.

La elaboración y aprobación del Plan Regional Concertado de Salud constituye una oportunidad para que el tema sea asumido por todas las instituciones de la Región. Están empezando a trabajar este proceso.

Gobierno municipal provincial

Existe una marcada diferencia entre el involucramiento de la Municipalidad de Piura de la Oficina de Salud, Población y Ambiente, frente a la Gerente de Educación y Cultura.

En el primer caso se realizó una capacitación al personal de la municipalidad, pero no se realizó seguimiento posterior.

Se señaló que no existiría ningún problema en involucrar al alcalde.

Les pareció muy adecuada la dinámica y el enfoque participativo del taller.

Se sugirió trabajar una coordinación posterior a través del programa de Municipios Saludables.

En el segundo caso, ha sido muy interesante el trabajo en capacitación con los PRONOEI, llegando a 1,273 niños menores 5 años.

La metodología fue muy aceptada por las promotoras de los PRONOEI y han trabajado las seis sesiones, aunque señalan que requerirían un refuerzo.

Los salones de los PRONOEI tienen sus rincones de aseo instalados.

Sugieren que al inicio se considere siempre una sensibilización a las personas que serían las encargadas de realizar el seguimiento.

Sugieren que se trabajen campañas agresivas, en que el mensaje llegue por todos lados y de manera muy lúdica, como canciones.

Gobierno municipal distrital

Trabajó de manera consensuada con las líderes del Vaso de Leche (cada uno entre 30 – 50 miembros), a quienes se les encargó la capacitación, así como el monitoreo en cada grupo y comedor popular.

Acostumbran trabajar en alianzas con el sector público y privado en el distrito.

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Refuerzan la práctica con el lavado de manos antes de comer en los comedores y antes de recibir los alimentos en las reuniones del Vaso de Leche.

Han trabajado con incentivos como entrega de ropa a madres.

Sugieren que se establezcan fichas y guías para saber cómo hacer un monitoreo más cercano y eficiente.

Encuentran que puede ser más interesante trabajar con niños, quienes pueden asumir muchos comportamientos.

Agencia internacional

A partir de una capacitación de pocas horas se abocó a trabajar con las familias de una comunidad en Catacaos.

Funcionó lavado de manos cuando lo vinculó a un proyecto concreto, como de cocinas mejoradas. Para recibir la cocina la familia debía saber los momentos críticos de lavado de manos.

Encontró más entusiasmo y posibilidad de trabajar este tema con los niños y las profesoras.

Sugeriría capacitar a los que trabajan con población qué aspectos o respuestas dar para motivar más.

ONG Internacional

La supervisión del proyecto que realizan con PRONASAR muestra que alrededor del 30% de las familias saben los 5 momentos críticos, frente a un 0% inicial, y el 35% aplica la técnica correcta de lavado de manos, a través de la observación (agua a chorro, lavado con jabón, secado con toalla).

Se ha podido definir roles y planes de trabajo con los establecimientos de salud y escuelas.

Un aspecto a considerar que han sabido mantener a las municipalidades totalmente informadas de los avances.

Contar con un equipo de capacitadores pagados por el proyecto facilita la promoción de la práctica en las familias (1 x 300 familias).

Se consideró necesario incluir el secado con toalla como un tema adicional (por la existencia de mucho polvo en la zona).

Sugieren que los videos sean más cercanos a la realidad socio cultural de las zonas.

Indican que debiera trabajarse un material que quede en las familias.

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Recomienda que primero se fortalezcan las capacidades de las personas que trabajarán lavado de manos con la población.

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APPENDIX H: CONDICIONES PARA LA PROMOCIÓN DE LAVADO DE MANOS

Informe de viaje a Arequipa

Fecha 28 y 29 de Mayo del 2007

Realizado por Mike Favin

Consultor internacional

Doris Alfaro

Consultora local

Instituciones entrevistadas Germán Robles

Especialista Gestión Educativa y Ambiental

Dirección Regional Educación Arequipa

Sonia Sánchez

Gerente Gestión Social

Municipalidad de Arequipa

Aníbal Díaz

Autoridad Regional de Medio Ambiente

Gobierno Regional de Arequipa

Haydee Rodas

Mariela Díaz

Lourdes Benavides

Zula Carpio

Mary Ann Zeballón

Promoción de la Salud

DIRESA Arequipa

Oswaldo Vizcarra

Director de Prensa

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César Portillo

Gerente de Producción

Jorge Béjar

Coordinador Arequipa

ONG Labor

Oscar Toro

Coordinador Arequipa

ONG DESCO

Martín Cotrina

Gerente

Cámara de Comercio e Industria de Arequipa

Pablo Manrique

Secretario General

Cáritas Arequipa

Resumen

El viaje se realizó en un momento clave de la reorganización del gobierno regional y por ende de las instituciones de salud y educación. En el marco de la descentralización, Arequipa es la primera Región que ha decidido eliminar la gerencia de desarrollo social para convertir la DIRESA en Gerencia de Salud y la DREA en Gerencia de Educación. La intención es evitar duplicidades de funciones y áreas y tener más posibilidad de implementar programas, con menos carga burocrática.

Un aspecto a considerar es que el 80% de la población de la Región se encuentra en Arequipa, con facilidades de accesibilidad y el 20% restante está en las otras 7 provincias, siendo algunas muy lejanas. Sin embargo, existen comunidades andinas distantes que requieren con urgencia programas de desarrollo social y económico.

La recomendación sería que la Iniciativa trabaje en ambos tipos de áreas. En las rurales sería interesante que se enganche a programas u ONG existentes.

Respecto al interés por participar en la Iniciativa Lavado de Manos, es muy positiva la reacción de los representantes de las instituciones aunque el conocimiento sobre los beneficios sea todavía

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muy limitado. Todos creen que la Iniciativa podría ser incluida en actividades existentes como proceso, sin pensar en campaña, lo cual es alentador.

Ninguno de los entrevistados pudo brindar un ejemplo de un programa efectivo de cambio de comportamiento en la Región.

Un tema de discusión con varios de los entrevistas fue respecto a la existencia de un grupo de coordinación interinstitucional que pudiera asumir la coordinación de lavado de manos. El CIIMSA (Comité inter institucional de mejoramiento de la salud ambiental) es una posibilidad, aunque el liderazgo y la promoción está a cargo de una ONG. Es posible que sea mejor trabajar con un comité liderado por el Gobierno Regional, sobre todo vinculado a las gerencias de salud o educación. Nos indicaron que por norma existen comités multisectoriales regionales, provinciales y distritales, aunque sus intereses son muy generales.

Los programas de Cáritas y la actitud empresarial de su director regional causaron buena impresión. En todo caso, se recomienda que la Iniciativa evalúe su participación en esta Región y posiblemente en otras donde tenga programas fuertes.

La empresa de televisión regional que está llegando a todo el país vía satélite es Perú TV, quienes señalaron su voluntad de colaborar con un presupuesto razonable. La programación podría estar dirigida a tomadores de decisión, además de involucrar lavado de manos en sus programas existentes.

Si bien no se pudo conseguir una entrevista con funcionarios de la minera Cerro Verde, ellos han establecido un contacto vía correo electrónico y se les ha pedido una cita cuando vengan a Lima.

Principales hallazgos por tipo de institución

Salud

Lavado de manos es uno de los temas que forma parte del programa de salud e higiene en Escuelas Saludables, trabajando con 322 en Arequipa. Cuentan con un convenio entre DIRESA y la DREA. Utilizan el juego de láminas que ha elaborado Promoción de Salud desde el nivel central (10 láminas sobre cada uno de los 6 temas), siendo uno de los temas higiene y ambiente, entregándose un juego para cada una de las escuelas.

Señalan que el problema es que muchas de las escuelas no cuentan con agua o servicios higiénicos porque dependen de las municipalidades para dotarlos de servicios (este hecho pone en evidencia la necesidad de vincularse con socios que faciliten estos servicios).

Cuentan con un Comité Multisectorial Regional (salud, educación, agricultura, vivienda, policía), en que cada institución señala lo que puede trabajar en función a un tema específico, pero no hay cultura de trabajo estableciendo sinergias en las mismas actividades. En las provincias y distritos debieran tener comités similares.

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En todo Arequipa cuentan con 2,800 promotores, los que necesitan incentivos y materiales para seguir trabajando y evitar la deserción. Los materiales tendrían que servir para su identificación como chaleco, sombrero, material educativo.

Sugieren que se trabajen materiales como rotafolio, que se enseñe por televisión y que se promueva el intercambio de experiencias.

Educación

Abordan las áreas de prevención como violencia, drogas, prácticas de salud incluyendo lavado de manos. Algunas aulas cuentan con rincón de aseo, pero no son muchas. Su programa tiene una hora de tutoría semanal en cada aula y cuenta con un documento oficial que define su trabajo, incluyendo salud corporal y mental.

Las asociaciones de padres de familia (APAFA) funcionan bien en algunas escuelas, pero en otras han generado conflicto con las administraciones. Las APAFA funcionan mejor en escuelas privadas.

Colaboran bien con la DIRESA en el marco del Programa Escuelas Saludables.

Gobierno municipal

La Gerencia de Gestión Social se orienta a trabajar con las poblaciones más pobres, especialmente las de zonas urbano marginales y rurales, en áreas como alimentación, capacitación, organización de asociaciones culturales y recreativas. Cuentan con un centro de atención médica en el mercado, pero no desarrolla actividades específicas de promoción de la salud.

Identifica que los mejores espacios para hacer acciones de lavado de manos podrían ser los 309 comedores populares que benefician a más de 15,400 beneficiarios.

Autoridad Regional de Medio ambiente

Consideran que la falta de servicios de agua puede ser una barrera para lavado de manos en áreas rurales y es por ello podría ser que el Programa de Escuelas Saludables se circunscriba a la provincia de Arequipa, donde se ubica al 80% de 1´170,000 personas, de la cual el 50% es urbano marginal.

Su oficina podría promover lavado de manos en restaurantes y en la industria alimentaria.

Señaló la existencia de un Comité Regional de Salud en que se invitan a instituciones relacionadas, como educación, municipalidades, instituciones de enseñanza médica, Cruz Roja, entre otros. Asimismo, existe un comité equivalente para educación.

Sugiere que con el personal de salud se realicen charlas en las salas de espera de los hospitales y se aproveche la movilización de vacunación en su llegada casa a casa para promover lavado de manos.

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Puso de relieve la necesidad de que se cuenten con fondos para contratar un contingente de supervisores que aseguren que las personas que sean capacitadas cumplan con sus tareas en los hogares.

ONGs

Las ONG tienen vinculación con los sectores, en función del objetivo del proyecto, aunque no es siempre fácil por la burocracia existente, perdiendo muchas veces su sentido técnico por el político.

Se recalcó la necesidad de promover una voluntad política manifiesta desde el gobierno regional, debido a los índices de diarrea en la Región y los gastos que se generan para su tratamiento.

Sugirieron orientar el programa hacia las escuelas y los clubes de madres, pues algunos de estos últimos son fuertes.

Estiman importante conversar con las empresas mineras, teniendo en cuenta la tendencia a la formación de Fundaciones para derivar fondos para desarrollo social.

Medio de comunicación

Buscan ser una propuesta alternativa al enfoque nacional de los medios que se emiten desde Lima, priorizando un enfoque regional. Trabajan noticieros, programas de análisis político, de entretenimiento, magazines incluyendo consultorio médicos y de concurso con feedback masivo a través de cartas o teléfono.

Cuenta con un programa interesante (Cabildo Abierto) que promueve la participación de la población durante una semana y el fin de semana las autoridades municipales van al programa y responden a las preguntas planteadas por la población.

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APPENDIX I: SUMMARY OF MAJOR FINDINGS AND RECOMMENDATIONS BY DIMENSION

The following table summarizes major findings and recommendations. Readers interested in more detail should also consult Appendix C, which contains all of the recommendations (in Spanish) made by persons interviewed. Although the team agrees with the most of those recommendations, for this document it selected the ones it considered the most important. While virtually all of the recommendations listed in this document were made by the persons interviewed, those ideas that the study team developed further are marked with an asterisk.

Dimensions Major Findings Major Recommendations

Policy, Strategy, and Direction

►There is generally strong, positive political will toward handwashing promotion and child health among organizations and government officials, although some government officials find it hard to give it much attention because of so many other priorities.

►The new national administration has accepted the Initiative and seems well disposed to collaborate.

►Key partners feel that they understand the approach used in the first phase and feel ownership, but they do not yet have a good understanding of the expanded project (which is still being designed).

►There are several politically prominent national initiatives (re: malnutrition, healthy schools, water and sanitation) that offer natural links with handwashing.

►Although the MOH signed a ministerial decree in support of the Handwashing Initiative, its enthusiasm has waxed and waned with frequent changes of officials; current officials appear to be quite supportive.

►At the beginning of the Initiative, national MOE involvement was minimal, but now the MOE is actively engaged.

►Many officials remember the role of handwashing during the cholera epidemic and are therefore well disposed to support the Initiative.

►Although the attitudes of public and private officials towavery positive, many still lack knowledge of the multiple bengovernment officials in particular must try to simultaneouslpriorities. Therefore, the Initiative should develop an advocand materials for different levels of decision makers, that deHWWS for reducing diarrhea, respiratory disease, and infanmalnutrition; and for improving school performance, motheand the nation’s human capital. Advocacy activities should and continue throughout the project period.

►In addition, it appears that even key partners lack informaexpectations regarding the expanded handwashing programthat, before the selection of districts and implementation, thgroup meetings with the key partners to clarify their expectaintentions and constraints. In preparation for these meetingsand disseminate a brief description on the new project that sstrategy and plans, making clear which features are requireddiscussions of each partner’s role and responsibilities shoulmeetings, leading eventually to MOUs or similar agreement

►A similar process, managed by the implementing agencieregional, provincial, and district levels once the intervention

Partnerships ►In general this has been a successful and innovative aspect of the program, in particular with private sector partners.

►The process of public and private organizations working together has not always gone smoothly. The public sector tends to be more formal and bureaucratic and to have more changes in personnel.

►Different partners play very different roles, from being fully engaged as a member of the coordinating committee

►Consideration should be given to inviting the MOE's envthe MOH’s PRONASAR (small water systems) program to Committee. (The MOE already has been invited.) It would aprivate sector partner such as the CONFIEF, an association

►Assess the interest of potential new partners in joining thUNICEF, PAHO, Save the Children, and so on).

► WSP, the National Committee, and the implementing agproviding guidelines, tools, and strategic technical assistanc

►To achieve impact and sustainability, work hard to establ

to providing short-term messages on handwashing and co-financing or managing local activities. This is fine as long as expectations are clear.

►Keeping key government ministries (particularly health, education, and housing) involved is essential, even though this can be difficult at times because of political changes and overburdened officials who are too busy to participate in meetings.

district level.

►Partners at the district level should include the strongest pdistrict. A strong partner organization is one that has good rbuilt confidence among the population, and is committed tosupervision of promotion activities. Each partner should be strengthen/expand attention to handwashing in its objectiveto consider include those helping install or improve water anLeche, comedores populares, and NGOs with long historiesarea.

►The Initiative and implementing agencies should work atdistrict levels to have an existing public-private coordinatiothe handwashing activities, such as the mesa de concertaciócommittee.

Institutional Arrange-ments

►Many respondents felt that arrangements have been informal yet have worked well based on personal relations, particularly for NGOs and private organizations.

►Arrangements with governmental organizations were more formal: the MOH issued a ministerial decree in 2004, and some regional governments approved ordinances. Beginning in 2006, the Initiative made an effort to sign MOUs with key national and local partners.

►Although MOUs and other formal agreements are no guaessential for working with government agencies, since they allocations to occur, and they may limit disruptions caused Formal agreements are particularly important with the MOHcontrol over its local offices. The Initiative should continue agreements at the national level and require its implementinlevels.*

►Although it is fine initially to work less formally with priit the long run negotiating and signing more formal agreemeagreements would clarify roles and expectations and suppor

► WSP and the implementing agencies should periodicallythese agreements.*

Program Methodology

► In general, opinions were positive; people felt that combining diverse partners’ strengths produced an effective approach.

►Some mentioned that the Initiative took too much of a campaign approach, without follow-up in some places, and with insufficient concern for institutionalization.

►Some respondents mentioned the need to focus more on interpersonal communication, while media representatives felt that mass media could play a larger role.

►Several of the persons interviewed pointed out that it has been much easier to generate enthusiasm and behavior change among children than among mothers, particularly in rural areas.

►Three general suggestions from various respondents werelocal levels, (2) to allow local partners flexibility in implem(3) to urge local partners to avoid a focus on short campaigncampaigns seem to be very popular in Peru, but their impac

►Develop a standard methodology and instruments for assand district levels to identify existing activities in which hanadded or strengthened and to identify the strongest partner oHWWS champions.*

►Most respondents recommended that implementation empcommunication. Use mass media when possible, emphasizinand interactive formats* (call-in shows, radio listening groupossible to ensure that there is good coordination between mthe-field activities so they are mutually reinforcing.

►If possible, develop separate communication materials fojungle areas of Peru. Encourage regions to modify materialsappropriate images, language, and so on. Recognize local bcold temperatures, and counsel families* on how to overcom

►For both effectiveness and sustainability, the Initiative shof handwashing promotion within existing programs such aMOH, Escuelas Saludables, Viviendas Saludables, Municip(new water and sanitation systems), PRONOEI (preschool),malnutrition, JAAS (water and sanitation boards), NGOs doon. Although moving away from a single focus on handwasPPPHW strategy, the team feels that this is the most appropas the one mostly likely to be sustainable. On the other hand

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opportunity should be as focused and interactive as possible

►To try to build and maintain a positive program image, tosupporters, and to share useful technical and strategic informstrong project communication program directed at both colloutside world (political leaders, donors, and the public). At electronic newsletter, a section on the WSP/Peru and MOH partners’ sites), and specific efforts to obtain radio and presand activities. These communication spaces should include program, descriptions of particularly effective or innovativeon achievements and impact; and exchanges on lessons learcombines respondent and team opinions.)

►The Initiative intends to contract several “implementing othe program in several regions. These organizations should operational guide for the district level. The guide should proway that encourages each district to select those that are likeeffective.

►The program should take advantage of children’s enthusistudents to promote HWWS at home and in their communitdevelop such materials with suggestions for students and hepartners to invent additional ideas. In addition, the workshosupplementary materials should put a greater emphasis on hwith individual mothers on solving problems, such as (perceor time.*

►Lack of compensation for transportation and food costs apromoters making more home visits. Where other partners aInitiative should contribute to the costs of such compensatio

►The key partners should develop an exit strategy that addexpansion issues. This might include steps to institutionalizcommitment) for HWWS in government and partner organiprogram into some control districts as soon as the final meacompleted, and local and national presentations on the projeon health and malnutrition.

Implementa-tion Capacity

►Although the skills and systems needed to implement the program well certainly exist at the national level, there was some concern about capacity at the local level.

►Develop implementation guidelines and tools to support iand district levels.

►Where the local assessments show particular weaknessesagency should provide training, mentoring and exchange vitechnical assistance.

Availability of Products and Tools

►There is little concern with the availability of soap, although access to water is difficult in some communities.

►Respondents considered the provision of plastic washing bowls and pitchers to have been useful in the first phase.

►Ideas mentioned were to collect soap bars from hotels in the poorest communities; promote Tippy Taps and similar wneeded; promote hand-drying on clean cloths or towels in dwould not be recommended); and promote use of ash, sand,available.

►Local change agents should be prepared to counsel familiand, where needed, local partners should address shortages.

►Partners at the district level should consider purchasing aand even soap to the poorest families. The national level mithese items in order to obtain lower prices.*

Financing ►Many partners made financial and in-kind contributions during the first phase.

►Continue to explore a co-financing agreement by the Funwhich has expressed interest in supporting HWWS in Peru.

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►The general opinion is that there is potentially sufficient funding in Peru for this activity but that the partners need to work hard to actually obtain the funding to support HWWS.

►The team believes that external funding is likely to still be needed at the end of this phase, mainly for covering the cost of implementing agencies supporting new districts and, at a much lower level, to support continued advocacy. However, partner contributions should increase in this phase, so the percentage of funding provided by external sources should decline.*

►Obtain information on USAID’s small grants program anpartners.

►Lobby national and regional government officials for budhandwashing or hygiene education.

►Continue to seek donated air time and publicly acknowleby private media companies.

Cost-Effective Implementa-tion

►The first phase collected extensive cost information and some impact information, but there was no attempt to calculate the cost-effectiveness of various activities or strategies.

►The capability for collection and analysis does exist in Peru, but technical support and training will be needed for particular partners and local areas.

►The Initiative needs to identify its needs and contract indimeet them.*

Monitoring and Evaluation

►Persons interviewed generally consider M&E to be very important; many are not very aware of monitoring activities or results.

►On the electronic survey, respondents scored monitoring lower than any other dimension.

►It is going to be a challenge to allow the local implementation flexibility that many respondents recommend while at the same time keeping sufficient uniformity in the program districts to be able to generalize about them in relation to the control districts. The monitoring team will have to carefully control for the effects of the many existing programs and projects in both intervention and control districts.*

►The M&E functions are very important in this program, bthe responsibility of persons outside of the central manageminterfere with their ability to manage implementation.*

►A key to maintaining partner and public motivation is theachievements and results (see suggestions for project comm

96


APPENDIX J: MENÚ DE ACTIVIDADES PARA ALUMNOS (IDEAS PRELIMINARES) En casa:

1) Aplique una encuesta en casa sobre las condiciones para LM con jabón en momentos críticos:

Hay jabón para lavar?

Hay agua para lavar?

Hay toallas o trapos para secar las manos?

Hay lugares con agua, jabón, toalla o trapo limpio cerca de donde ir al baño y donde prepara la comida?

Producto: Las preguntas y respuestas.

Note: Si falta buenas condiciones se debe repetir la encuesta una semana después.

2) Dé una clase a su familia sobre como lavar las manos bien (con agua corriente o echado; jabón, cenizas, o óleo de quinua; frotando los dedos muy bien; secando en una toalla o trapo limpio (o no aire libre se es una zona de poco polvo). El día después, dar un “examen” a su madre y hermanos de 5 a 9 años para ver si saben lavar correctamente. Si no, explique como puede mejorar.

Producto: Un pequeño informe sobre la experiencia.

3) Dé una clase a su madre sobre los momentos críticos para lavar: después de ir al baño, después de cambiar el pañal o tener cualquier contacto con heces; antes de preparar la comida. El día después de la “clase” dar un examen a su madre para ver cuantos momentos críticos ella recuerda. Si ella no sabe todos, explique lo que falta.

Producto: Un pequeño informe sobre la experiencia.

4) Construye un aparato simple que se deja lavar las manos sin gastar mucha agua. Puede usar su propio diseño o uno de los siguientes diseños (véa los dibujos abajo):

Tome una lata o recipiente de plástico con forma similar a una lata. Hace un hueco pequeño al fundo del lado de la lata. Ligar una cuerda al parte superior de la lata para poder colgarla en un lugar apropiado para lavar manos. Para usar el aparato, hay solo que echar un poco de agua en la lata, y puede usar el agua que sale por el hueco para lavar las manos con jabón.

Un otro diseño usa una calabaza o botella plástico con pico. Ligar una cuerda para poder colgar la vasija de un árbol o la casa. Llénela con agua, y cuando quiere lavar las manos simplemente derríbela una vez para lavar y una segunda vez para echar los burbujas y sucio.

97


Producto: El aparto pronto para ligar y usar.

Source: Salubritas 9: 4 (December 1986) (left); M. Ponga for SANRU (middle and right).

En la comunidad:

La próxima vez que haya alguna fiesta o evento publico en su comunidad, 5 a 10 estudiantes pueden organizar una esquina educativa sobre lavado de manos con jabón. Pueden cantar las canciones que aprendieron en clase. Pueden demostrar la técnica correcta de lavar. Un estudiante puede explicar los beneficios para la salud (proteger contra diarrea, infecciones respiratorias, y desnutrición). Otro puede explicar los momentos críticos. Si quiere, pueden preparar afiches u otros materiales.

Producto: Un pequeño informe sobre la experiencia, incluyendo el número de personas que asistieron, lo que los estudiantes hicieron, y la respuesta de la comunidad.

98


APPENDIX K: MENÚ DE ACTIVIDADES PARA PROMOTORES DE SALUD (IDEAS PRELIMINARES)

Estas ideas son para un promotor en su comunidad o para un grupo de promotores en una comunidad. Puede combinar varias ideas si quiere, por ejemplo, 2 y 3, o 2, 3, y 4.

1) Aplique una encuesta en las casas sobre las condiciones para LM con jabón en momentos críticos:

Hay jabón para lavar?

Hay agua para lavar?

Hay toallas o trapos para secar las manos?

Hay lugares con agua, jabón, toalla o trapo limpio cerca de donde ir al baño y donde prepara la comida?

Primero, haga una pregunta. Entonces, pregunte si puede mirar (el jabón etc.).

Después de hacer las preguntas, explique sobre los beneficios de lavado de manos (proteger contra diarrea, infecciones respiratorias, y desnutrición).

Al terminar todas las familias, haga un análisis si puede. Cuántas familias hay y cuántas tienen jabón, etc.

Aplique la encuesta de nuevo un mes o mas después y comparar los resultados.

2) Enseñe a una familia o a un grupo de madres y otros familiares sobre como lavar las manos correctamente (con agua corriente o echado; jabón, cenizas, o óleo de quinua; frotando los dedos muy bien; secando en una toalla o trapo limpio (o no aire libre se es una zona de poco polvo). Después de explicar y demostrar la técnica correcta, pida a cada participante mostrar la técnica correcta. Después de cada vez, pregunte al grupo para sugerencias sobre como la persona puede mejor su técnica.

3) Enseñe a una familia o a un grupo de madres y otros familiares sobre los momentos críticos para lavar: después de ir al baño, después de cambiar el pañal o tener cualquier contacto con heces; antes de preparar la comida. Pida el grupo que repita los momentos, y después pida cada individuo.

4) Ayude a las familias que carecen de agua construir un aparato simple que se deja lavar las manos sin gastar mucha agua. Puede usar su propio diseño o uno de los siguientes diseños (véa los dibujos abajo):

Tome una lata o recipiente de plástico con forma similar a una lata. Hace un hueco pequeño al fundo del lado de la lata. Ligar una cuerda al parte superior de la lata para poder colgarla en un

99



5) La próxima vez que haya alguna fiesta o evento publico en su comunidad, organice una esquina educativa sobre lavado de manos con jabón. Puede demostrar la técnica correcta de lavar; explicar los beneficios para la salud (proteger contra diarrea, infecciones respiratorias, y desnutrición); y explicar los momentos críticos. Si quiere, pueden preparar afiches u otros materiales.

Source: Salubritas 9: 4 (December 1986) (left); M. Ponga for SANRU (middle and right).

Un otro diseño usa una calabaza o botella plástico con pico. Ligar una cuerda para poder colgar la vasija de un árbol o la casa. Llénela con agua, y cuando quiere lavar las manos simplemente derríbela una vez para lavar y una segunda vez para echar los burbujas y sucio.

lugar apropiado para lavar manos. Para usar el aparato, hay solo que echar un poco de agua en la lata, y puede usar el agua que sale por el hueco para lavar las manos con jabón.

100

101

Glo

bal S

calin

g U

p H

andw

ashi

ng P

roje

ct

APP

END

IX L

: AC

TIO

N P

LAN

TO

IMPR

OVE

TH

E EN

VIR

ON

MEN

T FO

R A

N E

XPA

ND

ED

HA

ND

WA

SHIN

G P

RO

JEC

T IN

PER

U

Cur

rent

Situ

atio

n O

bjec

tive

Stra

tegy

R

ecom

men

ded

Step

s and

Tim

ing

Phas

e I:

12/0

6–8/

07, P

hase

II: 9

/07–

8/08

,

Phas

e II

I: 9–

12/0

8

Expe

cted

Impl

emen

tatio

n C

halle

nges

Sk

ills a

nd

Expe

rtise

Polit

ical

supp

ort

The

attit

udes

of

publ

ic a

nd p

rivat

e of

ficia

ls to

war

d ha

ndw

ashi

ng a

re

gene

rally

ver

y po

sitiv

e (m

any

reca

ll ho

w

impo

rtant

ha

ndw

ashi

ng w

as

in th

e co

ntro

l of

chol

era)

, but

m

any

still

lack

kn

owle

dge

of th

e m

ultip

le b

enef

its

of H

WW

S.

Mor

eove

r, go

vern

men

t of

ficia

ls in

pa

rticu

lar a

re

unde

r pre

ssur

e to

ad

dres

s num

erou

s pr

iorit

ies.

The

curr

ent

Bui

ld d

ecis

ion

mak

ers’

supp

ort

for H

WW

S as

a

long

-term

pr

iorit

y as

sh

own

by th

eir:

►de

votin

g tim

e to

han

dwas

hing

pl

ans a

nd

prog

ram

s, ►

com

mitt

ing

to

hand

was

hing

pr

omot

ion

in

offic

ial

docu

men

ts,

►al

loca

ting

fund

s,

►in

clud

ing

HW

WS

activ

ities

in

wor

k pl

ans.

Prep

are

and

impl

emen

t an

advo

cacy

stra

tegy

dire

cted

to

off

icia

ls a

t the

nat

iona

l, re

gion

al, p

rovi

ncia

l, an

d di

stric

t lev

els.

The

stra

tegy

sh

ould

dis

sem

inat

e ar

gum

ents

and

mat

eria

ls fo

r di

ffer

ent l

evel

s of d

ecis

ion

mak

ers t

hat s

how

the

impo

rtanc

e of

HW

WS

for

redu

cing

dia

rrhe

a,

resp

irato

ry d

isea

se, a

nd

infa

nt m

orta

lity;

pre

vent

ing

mal

nutri

tion;

and

impr

ovin

g sc

hool

per

form

ance

, m

othe

rs’ c

onfid

ence

and

se

lf-es

teem

, and

the

natio

n’s h

uman

cap

ital.

Mat

eria

ls a

nd in

terp

erso

nal

com

mun

icat

ion

shou

ld

show

how

HW

WS

can

easi

ly fi

t int

o ex

istin

g ob

ject

ives

and

pla

ns. T

ry to

ob

tain

free

don

ated

mas

s m

edia

cov

erag

e. M

eet w

ith

►D

raft

an a

dvoc

acy

stra

tegy

(Pha

se I)

.

►Se

nd d

raft

to p

artn

ers f

or c

omm

ents

; m

eet w

ith n

atio

nal p

artn

ers t

o di

scus

s (P

hase

I).

►D

raft,

pre

test

, and

fina

lize

mat

eria

ls;

mak

e pr

intin

g, b

road

cast

ing,

di

ssem

inat

ing

arra

ngem

ents

; ide

ntify

ad

voca

cy c

ham

pion

s dur

ing

regi

onal

/ pr

ovin

cial

/dis

trict

ass

essm

ents

(Pha

se

I/ear

ly P

hase

II).

►M

onito

r to

ensu

re th

at th

e na

tiona

l an

d re

gion

al c

oord

inat

ion

com

mitt

ees

are

givi

ng a

ttent

ion

to a

dvoc

acy

(Pha

ses I

I and

III)

.

►In

tens

e im

plem

enta

tion

(incl

udin

g try

ing

to a

dd H

WW

S to

bro

ader

ad

voca

cy e

vent

s). G

ive

spec

ial f

ocus

to

regi

onal

pre

side

nts (

early

Pha

se II

).

►Le

ss in

tens

e im

plem

enta

tion

(incl

udin

g ke

epin

g al

ert f

or

Two

mai

n ch

alle

nges

are

to

(1) d

evel

op a

nd im

plem

ent a

st

rate

gy th

at a

ppro

pria

tely

ad

dres

ses t

he d

iver

sity

of

lead

ers o

f diff

eren

t typ

es o

f or

gani

zatio

ns w

orki

ng a

t di

ffer

ent l

evel

s, an

d (2

) to

conv

ince

lead

ers t

o gi

ve

suff

icie

nt su

ppor

t to

HW

WS

at th

e sa

me

time

that

they

ar

e be

ing

pres

sure

d to

atte

nd

to m

any

othe

r dev

elop

men

t pr

iorit

ies.

►A

bilit

y to

de

velo

p an

d m

anag

e a

com

plex

, m

ultil

evel

ad

voca

cy a

ctiv

ity.

►A

bilit

y to

pe

riodi

cally

inse

rt fr

esh

idea

s, m

ater

ials

, and

ac

tiviti

es o

ver

time;

this

is a

n on

goin

g ac

tivity

, no

t jus

t a sh

ort-

term

cam

paig

n.

►A

bilit

y to

ne

gotia

te a

nd

man

age

mas

s m

edia

co

ntrib

utio

ns.

►A

bilit

y to

pe

riodi

cally

m

onito

r and

mak

e ap

prop

riate

ad

just

men

ts.

gove

rnm

ent’s

fo

cus o

n he

alth

an

d ed

ucat

ion

is a

po

sitiv

e fa

ctor

.

the

lead

ing

polit

ical

ca

ndid

ates

dur

ing

elec

tora

l ca

mpa

igns

to a

sk th

em to

m

ake

a pu

blic

com

mitm

ent

to im

prov

ing

child

hea

lth

and

nutri

tion

and

to H

WW

S sp

ecifi

cally

. The

im

plem

entin

g ag

enci

es

(con

tract

ed b

y W

SP) w

ould

ha

ve m

ajor

impl

emen

tatio

n re

spon

sibi

lity

at th

e re

gion

al, p

rovi

ncia

l, an

d di

stric

t lev

els.

oppo

rtuni

ties t

o ad

d H

WW

S to

bro

ader

ad

voca

cy e

vent

s) (P

hase

s II a

nd II

I).

►M

eet t

o re

view

impl

emen

tatio

n pr

ogre

ss a

nd re

sults

(eve

ry 6

mon

ths,

Phas

es II

and

III)

.

Und

erst

andi

ng

and

expe

ctat

ions

Alth

ough

man

y pe

ople

pra

ise

the

open

and

co

llabo

rativ

e m

anag

emen

t in

the

proj

ect,

it ap

pear

s tha

t eve

n so

me

key

partn

ers

lack

a g

ood

unde

rsta

ndin

g of

th

e ex

pand

ed

proj

ect.

Prov

ide

oppo

rtuni

ties f

or

partn

ers t

o ha

ve

inpu

t int

o th

e pr

ojec

t stra

tegy

an

d pl

ans;

and

fo

r the

m to

un

ders

tand

the

met

hodo

logy

, pl

ans,

and

thei

r ro

les.

Circ

ulat

e dr

aft d

ocum

ents

an

d ho

ld m

eetin

gs to

obt

ain

partn

er su

gges

tions

and

cl

arify

role

s and

ex

pect

atio

ns.

►Pr

epar

e an

d di

ssem

inat

e a

brie

f de

scrip

tion

on th

e ne

w p

roje

ct th

at

sum

mar

izes

the

prop

osed

stra

tegy

and

pl

ans,

mak

ing

clea

r whi

ch fe

atur

es a

re

requ

ired

unde

r the

Gat

es g

rant

(Pha

se

I)

►H

old

indi

vidu

al a

nd g

roup

mee

tings

w

ith th

e ke

y pa

rtner

s to

clar

ify th

eir

expe

ctat

ions

and

the

proj

ect’s

in

tent

ions

and

con

stra

ints

. Ini

tial

disc

ussi

ons o

f eac

h pa

rtner

’s ro

les a

nd

resp

onsi

bilit

ies s

houl

d al

so o

ccur

du

ring

thes

e m

eetin

gs, l

eadi

ng

even

tual

ly to

MO

Us o

r sim

ilar

agre

emen

ts (P

hase

I). (

This

pro

cess

has

be

gun

with

the

MO

E.)

►In

abb

revi

ated

form

, rep

eat t

his

proc

ess a

t the

regi

onal

, pro

vinc

ial,

and

dist

rict l

evel

s, on

ce th

e in

terv

entio

n di

stric

ts h

ave

been

sele

cted

(Pha

se I

and

early

Pha

se II

).

►Th

e m

ain

chal

leng

e is

si

mpl

y fo

r WSP

staf

f to

find

the

time

durin

g th

is b

usy

perio

d to

hav

e ad

equa

te

two-

way

com

mun

icat

ion

with

key

par

tner

s. ►

Ano

ther

cha

lleng

e is

to b

e ab

le to

repe

at si

mila

r pr

oces

ses a

t the

regi

onal

le

vel a

nd b

elow

. Thi

s re

spon

sibi

lity

may

be

shar

ed

betw

een

WSP

and

the

impl

emen

ting

agen

cies

that

it

cont

ract

s. D

ecen

traliz

atio

n in

the

publ

ic se

ctor

cre

ates

the

need

for i

nten

se w

ork

at th

e re

gion

al le

vel a

nd b

elow

. ►

A fi

nal c

halle

nge

will

be

to n

egot

iate

cle

ar ro

les a

nd

resp

onsi

bilit

ies a

t the

sub-

natio

nal l

evel

with

or

gani

zatio

ns th

at a

lread

y ha

ve a

ctiv

e pr

ogra

ms a

nd

WSP

has

the

proj

ect

man

agem

ent

expe

rienc

e an

d ne

gotia

tion

and

othe

r exp

ertis

e re

quire

d.

102

Glo

bal S

calin

g U

p H

andw

ashi

ng P

roje

ct

man

y pr

iorit

ies.

Stro

ng

partn

ersh

ips

In g

ener

al, p

ublic

-pr

ivat

e al

lianc

es

have

bee

n a

succ

essf

ul a

nd

inno

vativ

e as

pect

of

the

prog

ram

. A

ddin

g a

few

new

na

tiona

l par

tner

s m

ight

stre

ngth

en

the

prog

ram

. Th

ere

has b

een

min

or, t

empo

rary

te

nsio

n be

twee

n pu

blic

and

priv

ate

orga

niza

tions

, be

caus

e th

e pu

blic

se

ctor

tend

s to

be

mor

e fo

rmal

.

Stro

nger

al

lianc

es a

re

need

ed,

parti

cula

rly w

ith

partn

ers t

hat c

an

mak

e st

rate

gic

cont

ribut

ions

.

Stre

ngth

en a

llian

ces a

t all

leve

ls w

ith p

artn

ers t

hat

have

bot

h th

e re

sour

ces a

nd

desi

re to

con

tribu

te. G

ive

parti

cula

r atte

ntio

n to

di

stric

t-lev

el p

artn

ersh

ips

that

incl

ude

orga

niza

tions

th

at e

njoy

pop

ular

co

nfid

ence

and

that

are

co

mm

itted

to o

ngoi

ng

follo

w-u

p an

d su

perv

isio

n of

HW

WS

prom

otio

n ac

tiviti

es.

►In

vite

the

MO

E (e

nviro

nmen

tal

heal

th d

ivis

ion)

, and

the

MO

H

(PR

ON

ASA

R),

and

poss

ibly

a

repr

esen

tativ

e of

CO

NFI

EP to

join

the

coor

dina

ting

com

mitt

ee (P

hase

I).

►A

dd H

WW

S to

the

agen

da o

f an

exis

ting

coor

dina

ting

grou

p in

eac

h pa

rtici

patin

g re

gion

, pro

vinc

e, a

nd

dist

rict (

early

Pha

se II

). ►

Seek

incl

usio

n of

the

stro

nges

t pr

ogra

ms/

inst

itutio

ns in

eac

h di

stric

t. A

st

rong

par

tner

org

aniz

atio

n is

one

that

ha

s goo

d re

ach

into

com

mun

ities

, tha

t ha

s bui

lt co

nfid

ence

am

ong

the

popu

latio

n, a

nd th

at is

com

mitt

ed to

on

goin

g fo

llow

-up

and

supe

rvis

ion

of

prom

otio

n ac

tiviti

es. P

artic

ular

targ

ets

of o

ppor

tuni

ty a

re th

ose

orga

niza

tions

th

at su

ppor

t wat

er a

nd sa

nita

tion

in

fras

truct

ure

impr

ovem

ents

in th

e pr

ojec

t dis

trict

s (ea

rly P

hase

II).

►D

evel

op, p

rete

st, a

nd fi

naliz

e gu

idel

ines

and

tool

s for

loca

l pa

rtner

ship

s (ea

rly P

hase

II)

Cha

lleng

es in

clud

e:

►in

vitin

g th

e rig

ht p

artn

ers

and

indi

vidu

als t

o pl

ay k

ey

role

s ►

addi

ng H

WW

S co

ordi

natio

n to

alre

ady

full

agen

das o

f coo

rdin

atin

g gr

oups

►

iden

tifyi

ng th

e st

rong

est

partn

ers i

n ea

ch d

istri

ct

►de

velo

ping

gui

delin

es a

nd

tool

s tha

t are

eas

y to

use

and

ad

apt i

n a

varie

ty o

f set

tings

an

d co

nditi

ons

►ge

tting

suff

icie

nt

atte

ntio

n an

d pa

rtici

patio

n of

key

gov

ernm

ent o

ffic

ials

, m

any

of w

hom

are

ov

erw

helm

ed w

ith

com

petin

g pr

iorit

ies.

►Ex

celle

nt

anal

ytic

al a

nd

com

mun

icat

ion

skill

s, as

wel

l as a

th

orou

gh

unde

rsta

ndin

g of

th

e In

itiat

ive

and

its m

etho

dolo

gy.

►A

bilit

y to

id

entif

y an

d ac

cura

tely

ass

ess

pote

ntia

l par

tner

s, th

eir r

esou

rces

, and

th

eir t

rue

inte

rest

in

colla

bora

ting.

Partn

ersh

ips

Som

e pa

rtner

s no

te th

e la

ck o

f re

gula

r co

mm

unic

atio

n fr

om th

e In

itiat

ive

abou

t its

ac

tiviti

es,

prog

ress

and

im

pact

.

►K

eep

partn

ers

mot

ivat

ed a

nd

enga

ged

thro

ugho

ut th

e pr

ojec

t per

iod.

►

Rec

ogni

ze

thei

r or

gani

zatio

nal

cont

ribut

ions

. ►

Col

lect

and

sh

are

tool

s and

le

sson

s lea

rned

th

at c

an

impr

ove

the

effe

ctiv

enes

s of

Dev

elop

and

mai

ntai

n a

stro

ng p

roje

ct

com

mun

icat

ion

prog

ram

di

rect

ed a

t bot

h co

llabo

ratin

g or

gani

zatio

ns

and

the

outs

ide

wor

ld

(pol

itica

l lea

ders

, don

ors,

the

publ

ic) i

n or

der t

o m

aint

ain

a po

sitiv

e pr

ogra

m

imag

e, m

otiv

ate

partn

ers

and

supp

orte

rs, a

nd sh

are

usef

ul te

chni

cal a

nd

stra

tegi

c in

form

atio

n.

►D

raft

a pr

ojec

t com

mun

icat

ion

stra

tegy

. At a

min

imum

ther

e sh

ould

be

an e

lect

roni

c ne

wsl

ette

r (fe

atur

ing

a pa

rtner

or d

istri

ct o

f the

mon

th o

r qu

arte

r), a

sect

ion

on W

SP &

/or M

OH

W

eb si

tes (

with

link

s to

partn

ers’

site

s),

and

radi

o an

d pr

ess c

over

age

of

acco

mpl

ishm

ents

and

act

iviti

es. T

hese

co

mm

unic

atio

n sp

aces

shou

ld in

clud

e ba

sic

info

rmat

ion

on th

e pr

ogra

m,

desc

riptio

ns o

f par

ticul

arly

eff

ectiv

e or

in

nova

tive

stra

tegi

es o

r act

iviti

es;

exch

ange

s (m

eetin

gs, v

isits

) on

less

ons

lear

ned,

M&

E, a

nd c

ost-e

ffec

tiven

ess

►K

eep

thes

e ac

tiviti

es

stra

tegi

cally

focu

sed,

that

is,

dire

cted

tow

ard

clea

rly

defin

ed a

udie

nces

and

ob

ject

ives

. ►

Prov

ide

info

rmat

ion

in

appr

opria

te d

etai

l and

fo

rmat

s. ►

Col

lect

goo

d in

form

atio

n fr

om p

eopl

e in

the

field

who

ar

e to

o bu

sy w

ith

impl

emen

tatio

n to

sit b

ack

and

refle

ct a

nd d

ocum

ent

activ

ities

. ►

Find

cha

nnel

s to

reac

h

►C

apab

ility

to

desi

gn a

nd

impl

emen

t stra

tegi

c co

mm

unic

atio

n ac

tiviti

es, n

ot

mer

ely

activ

ities

th

at m

ake

a lo

t of

nois

e bu

t with

no

clea

r pur

pose

. ►

Abi

lity

to

mon

itor a

ctiv

ities

an

d im

pact

and

to

mak

e ne

eded

ad

just

men

ts.

►R

espo

nsib

ility

10

3

Glo

bal S

calin

g U

p H

andw

ashi

ng P

roje

ct

activ

ities

. in

form

atio

n (P

hase

I).

►Se

nd d

raft

stra

tegy

to p

artn

ers f

or

com

men

ts; s

olic

it th

eir c

omm

ents

and

su

gges

tions

(Pha

se I)

. ►

Shar

e th

e pr

ojec

t com

mun

icat

ion

stra

tegy

with

the

impl

emen

ting

agen

cies

and

incl

ude

in th

eir t

erm

s of

refe

renc

e th

eir t

asks

in im

plem

entin

g th

e st

rate

gy a

t the

loca

l lev

el in

supp

ort

of n

atio

nal a

ctiv

ities

(ear

ly P

hase

II).

►Im

plem

ent t

he st

rate

gy (P

hase

s II

and

III)

. ►

Rev

iew

impl

emen

tatio

n pr

ogre

ss a

nd

resu

lts (e

very

6 m

onth

s dur

ing

Phas

es

II a

nd II

I).

peop

le a

nd o

rgan

izat

ions

at

the

loca

l lev

el, i

n m

ore

isol

ated

dis

trict

s tha

t lac

k ac

cess

to th

e In

tern

et.

shou

ld b

e sh

ared

by

WSP

, the

na

tiona

l co

mm

unic

atio

n su

bcom

mitt

ee, a

nd

poss

ibly

con

tract

ed

indi

vidu

als o

r gr

oups

.

Inst

itutio

nal

arra

ngem

ents

Mos

t ar

rang

emen

ts

have

bee

n in

form

al, y

et th

ey

have

wor

ked

wel

l ba

sed

on p

erso

nal

rela

tions

, pa

rticu

larly

for

NG

Os a

nd p

rivat

e or

gani

zatio

ns.

Non

ethe

less

, m

any

partn

ers f

eel

that

mor

e fo

rmal

re

latio

ns w

ould

he

lp w

ith c

lear

er

unde

rsta

ndin

gs o

f th

e pr

ogra

m a

nd

role

s and

re

spon

sibi

litie

s in

the

expa

nded

►A

chie

ve

clea

rer

defin

ition

and

co

mm

itmen

t to

role

s and

re

spon

sibi

litie

s of

par

tner

s at a

ll le

vels

. ►

Faci

litat

e su

stai

nabi

lity

of

orga

niza

tiona

l co

mm

itmen

ts to

H

WW

S.

Alth

ough

MO

Us a

nd o

ther

fo

rmal

agr

eem

ents

are

no

guar

ante

e of

follo

w-u

p, th

ey

are

very

impo

rtant

, pa

rticu

larly

for w

orki

ng

with

gov

ernm

ent a

genc

ies.

They

shou

ld a

lso

faci

litat

e lo

nger

-term

com

mitm

ents

fr

om N

GO

s and

oth

er

priv

ate

partn

ers.

Ther

efor

e,

the

Initi

ativ

e sh

ould

ac

tivel

y pu

rsue

at l

east

se

mi-f

orm

al a

gree

men

ts a

t al

l lev

els.

►M

eet w

ith p

artn

ers a

nd re

ach

agre

emen

ts o

n th

eir e

xpec

ted

role

s and

re

spon

sibi

litie

s at t

he n

atio

nal l

evel

. Fo

r gov

ernm

ent a

genc

ies a

nd o

ther

pa

rtner

s tha

t so

desi

re, p

repa

re a

nd si

gn

MO

Us d

escr

ibin

g th

e ag

reem

ents

. For

ot

her p

artn

ers,

the

WSP

can

sim

ply

prep

are

a le

tter t

o th

e or

gani

zatio

n de

scrib

ing

expe

cted

role

s and

re

spon

sibi

litie

s (Ph

ase

I, ea

rly P

hase

II

). ►

Enga

ge w

ith p

artn

ers w

ith in

form

al

agre

emen

ts to

try

to m

ove

them

to

mak

e fo

rmal

com

mitm

ents

(Pha

se II

). ►

At t

he re

gion

al, p

rovi

ncia

l, an

d di

stric

t lev

els,

the

coor

dina

ting

grou

ps

shou

ld p

repa

re a

brie

f doc

umen

t on

HW

WS

activ

ities

that

des

crib

es th

e ex

pect

ed ro

le o

f maj

or p

artn

ers.

The

mem

bers

shou

ld a

ppro

ve th

is d

ocum

ent

(ear

ly P

hase

II).

(Thi

s doc

umen

t sho

uld

be c

onsi

dere

d th

e co

ncep

tual

fr

amew

ork

for d

evel

opm

ent o

f the

H

WW

S w

ork

plan

s at t

he lo

cal l

evel

s.)

►N

egot

iatin

g an

d ge

tting

M

OU

s sig

ned

is li

kely

to b

e m

ore

diff

icul

t the

mor

e bu

reau

crat

ic th

e or

gani

za-

tion

is. T

here

cou

ld e

asily

be

setb

acks

if k

ey p

erso

nnel

ch

ange

. ►

The

perio

dic

revi

ews o

f M

OU

s cou

ld c

ause

ill

feel

ings

unl

ess d

one

in a

sp

irit o

f wor

king

toge

ther

to

achi

eve

the

mos

t pos

sibl

e in

th

e ex

istin

g ci

rcum

stan

ces.

Neg

otia

tion

and

inte

rper

sona

l ski

lls

are

need

ed, a

s wel

l as

the

abili

ty to

cr

aft a

gree

men

ts

that

are

at t

he ri

ght

leve

l of s

peci

ficity

. W

SP p

osse

sses

su

ch sk

ills.

104

Glo

bal S

calin

g U

p H

andw

ashi

ng P

roje

ct

prog

ram

. ►

Coo

rdin

atin

g gr

oups

shou

ld re

view

M

OU

s and

com

mitt

ee d

ocum

ents

eve

ry

6 m

onth

s to

asse

ss to

deg

ree

to w

hich

th

ey a

re b

eing

impl

emen

ted,

bar

riers

to

impl

emen

tatio

n an

d ho

w th

ese

may

be

reso

lved

, and

any

nee

ded

revi

sion

s in

role

s and

resp

onsi

bilit

ies (

Phas

es II

and

II

I).

Prog

ram

m

etho

dolo

gy

Alth

ough

re

spon

dent

s fee

l th

at m

ost a

spec

ts

of th

e pi

lot

met

hodo

logy

w

orke

d w

ell,

som

e fe

lt th

ere

was

too

muc

h re

lianc

e on

mas

s m

edia

and

a

cam

paig

n ap

proa

ch w

ith

unce

rtain

follo

w-

up.

The

gene

ral

obje

ctiv

e is

to

achi

eve

good

im

pact

on

the

prac

tice

of

HW

WS

at

criti

cal t

imes

in

the

shor

t run

, by

usin

g an

ap

proa

ch th

at

can

be su

stai

ned

and

inst

itutio

naliz

ed.

The

basi

c st

rate

gy is

a

dece

ntra

lized

one

in w

hich

th

e na

tiona

l lev

el p

repa

res

usef

ul to

ols a

nd g

uide

lines

an

d ai

ms t

o st

imul

ate

stro

ng

loca

l par

tner

ship

s, an

d th

en

prov

ides

stra

tegi

c su

ppor

t as

nee

ded

to lo

cal l

evel

s. B

uild

stro

ng a

llian

ces f

irst,

at a

ll le

vels

, beg

inni

ng w

ith

the

impl

emen

tatio

n of

the

advo

cacy

stra

tegy

and

of a

th

orou

gh a

sses

smen

t pr

oces

s at r

egio

nal,

prov

inci

al, a

nd d

istri

ct

leve

ls. A

maj

or p

roje

ct

obje

ctiv

e sh

ould

be

to b

uild

pr

omot

ion

of H

WW

S in

to

ongo

ing,

per

man

ent

activ

ities

of a

genc

ies a

nd

prog

ram

s, as

indi

cate

d by

of

ficia

l dire

ctiv

es, w

ork

plan

s, an

d bu

dget

al

loca

tions

. Foc

us o

n in

terp

erso

nal

com

mun

icat

ion

loca

l rad

io

(inte

ract

ive

form

ats)

and

gr

oup

activ

ities

.

►D

evel

op m

etho

dolo

gy a

nd

inst

rum

ents

for a

sses

smen

t vis

its a

t the

pr

ovin

cial

and

dis

trict

leve

ls th

at w

ill

supp

ort i

dent

ifica

tion

of e

xist

ing

activ

ities

in w

hich

han

dwas

hing

pr

omot

ion

coul

d be

add

ed o

r st

reng

then

ed a

nd th

e st

rong

est a

nd

mos

t col

labo

rativ

e pa

rtner

or

gani

zatio

ns a

nd H

WW

S ch

ampi

ons

(Pha

se I)

. ►

At t

he n

atio

nal l

evel

, dev

elop

, pr

etes

t, an

d fin

aliz

e co

mm

unic

atio

n an

d tra

inin

g m

ater

ials

for t

he c

oast

, m

ount

ains

, and

jung

le a

reas

of P

eru

(ear

ly P

hase

II).

►D

evel

op a

n op

erat

iona

l gui

de fo

r the

di

stric

t lev

el (e

arly

Pha

se II

). ►

Mak

e a

few

smal

l add

ition

s to

the

wor

ksho

p m

etho

dolo

gy a

nd

supp

lem

enta

ry m

ater

ials

: (1)

put

gr

eate

r em

phas

is o

n ho

w p

erso

ns

prom

otin

g H

WW

S ca

n w

ork

with

in

divi

dual

mot

hers

on

solv

ing

prob

lem

s … su

ch a

s (pe

rcep

tions

of)

lim

ited

wat

er, s

oap,

or t

ime;

and

(2)

inco

rpor

ate

idea

s for

wha

t stu

dent

s and

he

alth

pro

mot

ers c

an d

o in

hom

es a

nd

com

mun

ities

to m

otiv

ate,

teac

h, a

nd

faci

litat

e H

WW

S (e

arly

Pha

se II

).

►To

man

age

and

supp

ort

prog

ram

act

iviti

es in

so

man

y di

vers

e di

stric

ts, w

ith

diff

eren

t cha

lleng

es a

nd

reso

urce

s, sc

atte

red

all o

ver

the

coun

try. T

his r

equi

res

exce

llent

com

mun

icat

ion

and

a na

tiona

l pro

gram

ca

pabl

e of

supp

ortin

g bu

t no

t try

ing

to c

ontro

l dis

trict

ac

tiviti

es.

►In

som

e di

stric

ts, p

over

ty,

isol

atio

n, c

limat

ic a

nd

geog

raph

ical

con

ditio

ns,

lack

of a

cces

s to

wat

er a

nd

to m

ass m

edia

, and

so o

n w

ill m

ake

impl

emen

tatio

n m

ore

diff

icul

t. ►

Loca

l eff

ectiv

enes

s will

be

ver

y de

pend

ent o

n th

e st

reng

th o

f loc

al p

artn

ers,

thei

r rep

utat

ions

and

ab

ilitie

s to

reac

h an

d in

fluen

ce fa

mili

es in

the

com

mun

ities

whe

re th

ey

wor

k.

Des

igni

ng a

nd

impl

emen

ting

the

prog

ram

m

etho

dolo

gy w

ill

requ

ire a

rang

e of

co

mm

unic

atio

n,

man

ager

ial,

and

polit

ical

skill

s.

Alth

ough

thes

e ce

rtain

ly e

xist

w

ithin

the

WSP

an

d its

par

tner

s, th

is is

a c

ompl

ex

proj

ect t

o m

anag

e si

nce—

give

n th

e m

ultip

licity

of

partn

ers a

nd

varie

ty o

f loc

al

setti

ngs—

it m

ust

be d

one

in a

de

cent

raliz

ed

man

ner.

A fi

nal

chal

leng

e is

to

avoi

d de

votin

g tim

e an

d ef

fort

to

com

mun

icat

ion

activ

ities

that

re

min

d pe

ople

ab

out H

WW

S te

mpo

raril

y bu

t th

at h

ave

no

105

Glo

bal S

calin

g U

p H

andw

ashi

ng P

roje

ct

follo

w-u

p.

Impl

emen

tatio

n ca

paci

ty

Whi

le th

e sk

ills

and

syst

ems

need

ed to

im

plem

ent t

he

prog

ram

wel

l ce

rtain

ly e

xist

at

the

natio

nal l

evel

, th

ere

is so

me

conc

ern

abou

t ca

paci

ty a

t the

lo

cal l

evel

.

Impr

oved

loca

l im

plem

enta

tion

capa

city

.

Impr

ove

the

impl

emen

tatio

n ca

paci

ty in

regi

ons,

prov

ince

s, an

d di

stric

ts th

at

have

wea

k ca

paci

ty.

►A

s par

ts o

f reg

iona

l, pr

ovin

cial

, and

di

stric

t ass

essm

ents

, ass

ess l

ocal

im

plem

enta

tion

capa

city

(ear

ly P

hase

II

). ►

Whe

re th

e lo

cal a

sses

smen

ts sh

ow

parti

cula

r wea

knes

ses,

prov

ide

train

ing

and

men

torin

g an

d ex

chan

ge v

isits

with

pi

lot d

istri

cts w

ith e

ffec

tive

prog

ram

s (P

hase

II).

►D

evel

op im

plem

enta

tion

guid

elin

es

and

tool

s to

supp

ort i

mpl

emen

tatio

n at

th

e pr

ovin

cial

and

dis

trict

leve

ls (e

arly

Ph

ase

II).

►To

est

ablis

h an

d im

plem

ent m

echa

nism

s tha

t w

ill d

etec

t and

feed

back

lo

cal n

eeds

for c

apac

ity

supp

ort.

►To

pro

vide

app

ropr

iate

an

d ef

fect

ive

supp

ort i

n a

timel

y m

anne

r. Th

e W

SP

and

its m

ain

partn

ers,

incl

udin

g th

e im

plem

entin

g ag

enci

es, s

houl

d sh

are

this

re

spon

sibi

lity.

The

skill

s nee

ded

are

thos

e re

quire

d to

est

ablis

h a

mon

itorin

g an

d fe

edba

ck sy

stem

, as

wel

l as a

var

iety

of

cap

acity

bu

ildin

g sk

ills,

rang

ing

from

co

nduc

ting

good

ne

eds a

sses

smen

ts

to m

akin

g go

od

choi

ces o

n m

odes

of

cap

acity

bu

ildin

g an

d im

plem

entin

g th

ose

actio

ns.

Fina

ncin

g

Ther

e ar

e m

any

pote

ntia

l sou

rces

of

fund

ing

and

in-

kind

co

ntrib

utio

ns,

alth

ough

ac

cess

ing

them

w

ill re

quire

eff

ort.

Som

e go

vern

men

t pr

ogra

ms h

ave

limite

d im

plem

enta

tion

fund

ing.

Secu

re

addi

tiona

l fin

anci

al a

nd in

-ki

nd re

sour

ces

at th

e na

tiona

l an

d lo

cal l

evel

s fo

r thi

s pha

se

and

beyo

nd.

►Ex

plor

e po

ssib

ilitie

s for

na

tiona

l and

loca

l fin

anci

ng,

and

publ

icly

ack

now

ledg

e co

ntrib

utio

ns.

►Lo

bby

for b

udge

tary

co

mm

itmen

ts b

eyon

d th

is

phas

e.

►C

ontin

ue to

exp

lore

a c

o-fin

anci

ng

agre

emen

t by

the

Fund

of t

he A

mer

icas

(F

ON

DA

M),

whi

ch h

as e

xpre

ssed

in

tere

st in

supp

ortin

g H

WW

S in

Per

u (P

hase

I).

►O

btai

n in

form

atio

n on

USA

ID’s

sm

all g

rant

s pro

gram

and

then

dec

ide

whe

ther

to sh

are

this

with

loca

l pa

rtner

s (Ph

ase

I, ea

rly P

hase

II).

►A

s par

t of a

dvoc

acy

activ

ities

, lob

by

at a

ll le

vels

of g

over

nmen

t for

bu

dget

ary

fund

s dire

cted

tow

ard

hand

was

hing

or h

ygie

ne.

►M

onito

r the

ext

ent t

o w

hich

the

partn

er o

rgan

izat

ions

hav

e in

clud

ed

fund

s for

the

prom

otio

n of

HW

WS

or

prov

isio

n of

wat

er in

thei

r ann

ual

budg

ets.

►G

ive

publ

ic re

cogn

ition

for f

ree

air

time

and

othe

r con

tribu

tions

from

pr

ivat

e co

mpa

nies

, on

Web

pag

e, in

►It

is d

iffic

ult t

o pr

edic

t w

hat c

halle

nges

may

aris

e,

but i

n ge

nera

l fun

ding

ag

enci

es a

nd p

rogr

ams h

ave

thei

r ow

n un

ique

re

quire

men

ts, w

hich

may

or

may

not

fit w

ell w

ith th

e pl

anne

d ac

tiviti

es a

nd ti

me

line

of th

e H

andw

ashi

ng

Initi

ativ

e.

►In

-kin

d co

ntrib

utio

ns

from

the

priv

ate

sect

or a

re

rela

tivel

y ea

sy to

obt

ain;

fo

cus o

n th

ose

that

are

mos

t lik

ely

to e

ffec

tivel

y su

ppor

t H

WW

S.

►G

over

nmen

t age

ncie

s m

ay b

e re

luct

ant t

o co

mm

it fu

nds t

o su

ch a

nar

row

ob

ject

ive.

The

skill

s nee

ded

are

basi

cally

di

plom

atic

and

in

terp

erso

nal,

as

wel

l as t

he a

bilit

y to

writ

e ap

prop

riate

pr

opos

als.

WSP

an

d its

par

tner

s po

sses

s the

se sk

ills.

Wha

t may

be

lack

ing

is su

ffic

ient

tim

e.

106

Glo

bal S

calin

g U

p H

andw

ashi

ng P

roje

ct

new

slet

ter,

and

so o

n (P

hase

s II a

nd

III)

. C

ost-e

ffec

tive

impl

emen

tatio

n ►

The

pilo

t pr

ojec

t col

lect

ed

exte

nsiv

e co

st

info

rmat

ion

and

som

e im

pact

in

form

atio

n, b

ut

ther

e w

as n

o at

tem

pt to

ca

lcul

ate

the

cost

-ef

fect

iven

ess o

f va

rious

act

iviti

es

or st

rate

gies

. ►

The

capa

bilit

y fo

r col

lect

ion

and

anal

ysis

doe

s exi

st

in P

eru.

With

out o

ver-

burd

enin

g pa

rtner

s, co

llect

an

d us

e co

st a

nd

effe

ctiv

e-ne

ss

info

rmat

ion

to

impr

ove

this

an

d fu

ture

pr

ojec

ts.

Def

inin

g da

ta c

olle

ctio

n an

d an

alys

is p

roce

dure

s sho

uld

be th

e ta

sk o

f the

M&

E gr

oup.

Step

s sho

uld

be d

efin

ed b

y th

e W

SP

with

the

exec

utiv

e co

mm

ittee

. Th

e m

ain

chal

leng

e is

to

colle

ct, a

naly

ze, a

nd u

se

esse

ntia

l inf

orm

atio

n,

with

out o

verb

urde

ning

pe

rson

s in

the

field

who

ne

ed to

focu

s on

impl

emen

tatio

n.

Skill

s nee

ded

are

the

abili

ty to

co

ncep

tual

ize

esse

ntia

l nee

ds a

nd

deci

de h

ow to

co

llect

nee

ded

info

rmat

ion

in a

m

anne

r tha

t lea

st

burd

ens f

ield

pe

ople

; als

o ne

eded

ar

e an

alyt

ical

skill

s an

d th

e ab

ility

to

shar

e, d

iscu

ss, a

nd

use

the

resu

lts b

oth

to im

prov

e th

e Pe

ru

prog

ram

and

si

mila

r pro

gram

s.

M&

E

Pers

ons

inte

rvie

wed

ge

nera

lly c

onsi

der

mon

itorin

g an

d ev

alua

tion

to b

e ve

ry im

porta

nt

and

to h

ave

rece

ived

in

suff

icie

nt

atte

ntio

n in

the

pilo

t pha

se. T

he

real

pro

blem

may

ha

ve b

een

insu

ffic

ient

di

ssem

inat

ion.

Mea

sure

impa

ct

on b

ehav

ior a

nd,

to th

e ex

tent

po

ssib

le, t

he

stra

tegi

es a

nd

inpu

ts m

ost

clos

ely

asso

ciat

ed w

ith

impa

ct; u

se th

is

info

rmat

ion

to

impr

ove

this

an

d fu

ture

pr

ojec

ts.

Def

inin

g da

ta c

olle

ctio

n an

d an

alys

is p

roce

dure

s sho

uld

be th

e ta

sk o

f the

M&

E gr

oup.

Step

s sho

uld

be d

efin

ed b

y W

SP w

ith

the

exec

utiv

e co

mm

ittee

. Th

e m

ain

chal

leng

e is

to

colle

ct, a

naly

ze, a

nd u

se

esse

ntia

l inf

orm

atio

n,

with

out o

verb

urde

ning

pe

rson

s in

the

field

who

ne

ed to

focu

s on

impl

emen

tatio

n.

Skill

s nee

ded

are

the

abili

ty to

co

ncep

tual

ize

esse

ntia

l nee

ds a

nd

deci

de h

ow to

co

llect

nee

ded

info

rmat

ion

in a

m

anne

r tha

t lea

st

burd

ens f

ield

pe

ople

; as a

lso

need

ed a

re

anal

ytic

al sk

ills,

and

the

abili

ty to

sh

are,

dis

cuss

, and

us

e th

e re

sults

bot

h to

impr

ove

the

Peru

pr

ogra

m a

nd

sim

ilar p

rogr

ams.

107

Glo

bal S

calin

g U

p H

andw

ashi

ng P

roje

ct

108

Glo

bal S

calin

g U

p H

andw

ashi

ng P

roje

ct

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