improving hygiene at scale. overview definition principles process results timeframe characteristics...
TRANSCRIPT
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Improving Hygiene at Scale
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Overview
• Definition
• Principles
• Process
• Results
• Timeframe
• Characteristics
• Phases
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What is Scale?
Coordinated actions of all stakeholders working toward a common goal to
significantly reduce disease rates in large numbers of affected people
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Scale Principles
• Participatory• Process-oriented • Negotiation• Informed decision-making• Acknowledging & valuing
Moving forward together in partnership
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Process
Reduce Diarrheal Disease
1. MAP
3. STRATEGIZE5. MONITOR
6. VALUE
4. ACT
2. PARTNER
1. Map the context & detail the stakeholders in all sectors, the levels at which they work, the networks & relationships that already exist & examine patterns of individual &
institutional behaviors.
2. Leverage partnerships, strengthen
existing networks & relationships, & create
new, non-traditional ones.
3. Develop a common goal &
delineate a behavior change
strategy.
4. Implement activities & interventions detailed in the
strategy around the common goal in a concerted & overlapping way.
5. Track the progress of
interventions to make adjustments,
adaptations & changes as
needed.
6. Assess the outcomes & impact of the scale effort.
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Expected Results
• Increased percentage of targeted audience adopting and sustaining key improved practices
• Reduced number of diarrheal diseases cases
• Reduced percentage of children under 5 dying of diarrheal disease
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Timeframe
• Map, Partner, Strategize – 8 to 15 months
• Act – 1 to 3 years
• Monitor – during action
• Value – at least yearly during action
TOTAL Length Required – 3 to 5 years
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Characteristics of a Scale Effort
Systems-Approach Behavior FIRST Multiples Institutionalization Hygiene Improvement Framework. Coverage
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Systems-Approach
Emphasize:• relationships and
patterns of behavior• that a small event in 1
sector can have a tremendous impact elsewhere
• key influence points
Examine: • the WHOLE• relationships• degrees of freedom• mainstreaming• patterns• commonalities• opportunities
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Behavior First
• Focus on improving key individual hygiene practices
• Identify, promote and facilitate improved practices
• Design interventions that motivate and facilitate these improved practices
Practices that people are willing and able to
practice
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Multiples
• Multiple interventions
• Multiple levels
• Multiple stakeholders
• Multiple options
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Institutionalization
Any organized stakeholder group
• Institutional policy adjustments • Human resources, budget and integration
commitments • Continued support for activities “political will”• Heart of sustainability • Institutional behavior change desired
“Making something a new routine”
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Hygiene Improvement Framework (HIF)
• Communication• Social mobilization• Community participation• Social marketing• Training
HygienePromotion• Water Supply
• Sanitation systems• Available Household
Technologies and Materials
Access to Hardware
• Policy improvement• Institutional strengthening• Financing and cost-recovery• Cross-sectoral coordination• Partnerships
Enabling Environment
Hygiene Improvement
Diarrheal Disease Prevention
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Coverage
QUANTITY
Ensure Large-Scale through:
• Health impact realized• Total population
covered and/or• Geographic area(s)
covered
QUALITY
Ensure Sustainability by:• Intervention
concentration• Activity saturation• Systems interaction• Institutionalization• Critical mass
behavioral impact
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Well Construction
Handwashing Promotion
Latrine Construction
Hygiene Advocacy
Traditional Coverage
Focus on Geographic and Population Coverage
Scattered, dispersed, stand-alone
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Scale CoverageConcentrate, saturate,
interact
Using a systems-approach, focus on Geographic Area, Population, AND Multiples.
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Wells Handwashing Latrines Advocacy
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Appropriate Approaches to Promotion
Needed Infrastructure, Products, & Services
Supportive Environment
Ensuring all the necessary elements, increases
likelihood of behavior
change and the sustainability of
the practice.
Maximum potential for
change exists here.
Increase the Likelihood of Improved Practice Adoption
& Sustainability
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Map, Partner, Strategize
Preparation Phase:• Mapping• Partnering• Intervention zone(s) determination• ‘Whole system in a room’ process• Formative research (as needed)• Behavior change (BC) strategy development• Effort index design• Resource identification
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Solid Preparation is ESSENTIAL!
• Understand the context through mapping
• Clarify present partner roles
• Agree on geographic coverage
• Understand behavior change approaches used
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Mapping
• WHAT – Understand the setting in which the effort will take
place
• WHY– Take a systems-wide look to effectively assess
options and implications of decisions
• HOW – Mapping:– Geographic– Dimensional– Associative
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Issues to Map
• Water sources, access, quality & supply
• Sanitation access, quality & supply
• Partner areas of intervention & activities
• Partner relationships• Geographic location of
institutional staff and kinds of interventions
• Geographic areas of greatest need including health and non-health platforms
• Existing infrastructures, e.g. clinics, churches,
• SES indicators, e.g. income, gender, etc.
• Capabilities of ancillary agencies, e.g. universities, colleges, market places, roads, railroads, schools
• Market paths & streams per needed product
• Communication channels
• Donor program support
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DRC – Before: Stakeholder Relationships
SANRU
MOHMOW
Health Ctrs
DistHealth
Village Chiefs
USAID
Mobilizers
DistWS
Water Cmt
Village Cmt
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DRC – After
MOWMOH USAID
SANRU
Water Cmte
Health Ctrs
Mobilizers
DistWS
EZdS Village Chiefs
MOE
3 NGOs
2 CSOs
DANIDAWB
DistEd
DistHeatlh
MOEnv
DistEnvVillage Cmt
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Partnering Who & How
WHO:
• Start with stakeholders directly related to issue• Expand to:
– other channels of influence – groups with potential long-term impact– all possible information channels
HOW:
• Make individual relationships within these groups, not just institutional relationships.
• Treat each group with respect.
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Partnering Systems Examination
Examine the systems and ask:
“What needs to be done to turn you into a partner with an active or passive influence
on the targeted audience?”
Training? Institutional strengthening?Capacity building?Expansion of reach?Other?
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Intervention Zone Determination
• Consider systems-approach & Scale multiples• Examine appropriate, relevant statistics:
– Number of children under 5– Diarrhea disease prevalence in under 5s– Access to water– Access to sanitation
• Detail geographically where partners are working
• Examine types of interventions by partner• Choose together
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Whole System in a Room Process
• Focus on the past
• Focus on the present
• Focus on the future
• Formulate common ground
• Make broad commitments
• Formulate action plans
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Media
CSOs
Educational Institutions
Commercial Businesses
MothersGovernment
Ministries
Donors/Funders
Religious Groups
NGOs
Develop Orgs
R&D Institutions
Using Hygiene
Improvement to reduce diarrheal diseases
Whole System for HI could include:
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Research & Experience
• Form basis for key behaviors
• Allow for community involvement
Behavior Analysis & Intervention Design
• Analyze behaviors & identify feasible with specific audience
• Develop broad activities for overarching intervention areas
• Make/Get specific commitments for interventions & activities
• Encourage continued community involvement
BCS Development Process
Strategy Design
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Behavior Change Strategy
A. Behavior Analysis : actual desired feasible
B. Delineation of Overarching Intervention Areas :1. Communication2. Training3. Infrastructure/Service Improvements4. Products/Equipment5. Policy/Advocacy6. Mobilization7. Financing
Based on motivators & barriers
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Behavior Analysis
Desired Actual Motivators Barriers Feasible
Diarrheal Diseases Wash hands with soap & water and towel dry at 5 critical times.
Wash hands occasionally without soap/ ashes, with used, dirty water and dry on dirty clothing.
•Access to safe water source
•Access to soap
•Clear understanding of importance
•Knowledge of steps required
•Support from immediate community
•No access to safe water sources
•Limited access to products needed
•Feel unimportant or unnecessary
•No community agents to help with questions or concerns
Wash your hands with soap & clean water and air dry before eating.
Audience: Mothers aged 18 to 30
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Communication Activities
Training Activities
Infrastructure Activities
Product Activities
Policy Activities
Mobilization Activities
Financing Schemes
Encourage mothers aged 18-30 to wash hands before eating with soap & clean water & air dry.
Demos
Flipcharts
Experience of “healthy families”
Manuals
Complete education kit
Educational games
Theatre, songs
Train agents:
Proper hand washing
Basic water issues
How to conduct community meeting
Train community members:
Pump repair
Soap making
Provision of adequate safe water sources
Soap
Basins
Soap making kits
Wagons
Advocacy on hand washing
Inclusion of govt. in activities
Contest for “clean family”
Support associations
Creation of water committees
Community participation in decision making
Delineation of Interventions
Voucher system
WATSAN collection
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Act
Implementation Phase:• Systematic roll-out of
hardware, promotion, and enabling environment interventions
• Assistance in implementing “mix” of behavior change approaches
• Technical assistance
Plan Development
• Prepare implementation plans for interventions and intervention activities
• Develop clear management and roll out plan
• Implement
• Keep the community involved
Implementation
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Management Plan
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Roll Out Plan
• Timing is essential
• Activities are interdependent
• Activities and actions build on other activities and actions
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Monitor
Monitoring Phase:
•Roll out on schedule
•Coverage and overlaps happening
•“Must do’s” occurring
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Value
Evaluation Phase:•Sustainability•Integration•Partnerships•Improved practices•Desired impact
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WHAT• Indices to describe the types of program efforts and
monitor them over time. • A composite index designed to:
– measure commitment and program effort– capture inputs and outputs
• A score made up of 3 main components (HIF) of an effective response:– access to hardware– enabling environment– hygiene promotion
WHY• Standard measures needed to quantify the nature
strength of efforts/activities.
Hygiene Effort Index
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HIF Component
Sub-component
When Did Benefit Occur
Beneficiary Level
Attributes to Assess
Access to Hardware
Sanitation
New Access
HouseholdIncrease the percentage of households with new access to improved sanitation facility
CommunityIncrease the percentage of communities with new access to improved sanitation facilities
SchoolIncrease the percentage of public and private schools with newly established handwashing stations near toilets/latrines in rural and peri-urban areas
Renovated Access
HouseholdIncrease the percentage of household with renovated access to (improved) sanitation systems
CommunityIncrease the number of communities with improved access to sanitation systems
SchoolIncrease the percentage of public and private schools with renovated handwashing stations near toilets/latrines in rural and periurban areas
How