Combining Collective and Individual   Paths to Behavior Change?             GHPN Brownbag            February 16, 2012    ...
PresentersOrlando Hernandez                     Julia Rosenbaum                                       Renny Seidel (intro)
This presentation• What is a ‘collective behavior’?• The program in Ethiopia• Results• Discussion
What is a ‘collective behavior’?
“Yo dude!!!”            Examples of group/mass behaviors:                 are there any collective?• Running for shelter d...
Characteristics of ‘collective behavior’Schaefer: spontaneous            unstructured            reaction to ambiguous sit...
At scaleHygiene and Sanitation Improvement                in the     Amhara Region of Ethiopia    through “Learning by Doi...
Start Changes at grassroots    The Districts12 Step Pathway  Broken into 3 phases  Plan  Mobilize and Act  Monitor & Evalu...
Learning by Doing Program in AmharaMulti-Stakeholder Meeting identified Common Action Agenda – brought the Whole System to...
Implementing a hybrid of …COMMUNITY-LED TOTAL BEHAVIOR CHANGE IN HYGIENE AND SANITATIONembedded in a national and regional...
COMMUNITY-LED TOTAL BEHAVIOR CHANGE      IN HYGIENE AND SANITATION• Systems Approach to Change – engaging the  multiples• ...
Characteristics of an At Scale Effort   Systems-Approach       Looks at the whole       Involves multiple sectors, acti...
Community led Total SanitationCommunities are “ignited”Total coverage, each and every member of the community shall have  ...
Disg ust   F ear   Sha me
Shit calculation   – Calculating the amount to feces produced (week, month and annually, etc.) to illustrate the magnitude...
Results    Were we effective?   Did we achieve scale?Did combining individual and    collective action work?
M&E Framework for Learning by Doing,                           AmharaSO                                 At scale of hygien...
Pre- / Post- Stratified Random Sample PRE       High       Medium              Lown=2000   (Focal)      (Direct)         (...
ETHIOPIAPractices: Access to Sanitation FacilitiesBaseline-Endline Comparison: All Respondents
Predictors of Latrine Ownership                                                    Endline    Dimensions                  ...
Presence of HWStations at Latrines                   17%                         16%
Accomplishments & Challenges 5.8 million people in Amhara Regional State reached 3.8 million more people stopped practic...
Discussion
Combining Collective and Individual  Paths to Behavior Change?
Combining Collective and Individual  Paths to Behavior Change?
Combining Collective and Individual  Paths to Behavior Change?
Combining Collective and Individual  Paths to Behavior Change?
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Combining Collective and Individual Paths to Behavior Change?

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  • One big question that we have to answer today is what is a collective behavior. Here we have a group of people with their arms up, following a banner. Is that a collective behavior? I want you to stand up, if you are able, and let’s sing together this song from the 2010 World Cup in South Africa: the waka waka song. Let’s go, get up. Here we go!!!!!!!!!!!!!!
  • OK. Thanks for your input, Here is a list of potential examples of a collective behavior:
  • Some of these examples and definitions make us think of different types of actions: Mindful, intentional collective behavior.. intentions, skills Can you move as a mass in a constructive, conserted action? Are there different determinants for collective action that for individuals? Having said that, let us more to the second part of this discussion. I am going to give Julia the floor so she can address the characteristics of a program implemented by HIP in Amhara, Ethiopia. This program uses two different strategies to get people to change their sanitation practices. It uses both a strategy to generate collective action on the part of communities, but it also uses an approach to motivate individual households to do the same.
  • Through the ‘story’ of our Learning by Doing Program in Amhara ,,,, we can examine how USAID/HIP, an AED project, together with the Water and Sanitation Programme of the World Bank, are supporting the Amhara Region of Ethiopia, a region of 20 million, to achieve universal PRACTICE of safe feces disposal and handwashing… We hope it will offer some methods, lessons and tools to implement at scale hygiene and sanitation improvement, to change behaviors at scale Program implemented by the Amhara Regional State… pioneered by the Bureau of Health in collaboration with the Federal Ministry of Health, the Regional Bureaus of Education, Water Resources, and a host of local NGO and community partners. The effort is supported by the USAID/Hygiene Improvement Project together with the Water and Sanitation Programme of the World Bank/ Africa.
  • Although we broke this process into a …. 12 Step Pathway Broken into 3 phases Planning Harness commitment from political leaders thru WSR Map, Plan together Train Mobilize and Act Mobilize & Evaluate
  • Agreed on a common action agenda…. Brining together over 100 key stakeholders… common and uncommon From a common action agenda flowed a regional BC strategy with multiple components The behavior change strategy is at the core of the learning by doing activity….
  • FIRST…. All comes together…. C…L… T…B… C… in H... And S…. … . Read slide… …. Built around the Health Extension Programme, the government's M and C health programme
  • WHAT’S DIFFERENT ABOUT THIS APPROACH?? IT’S A HYBRID OF … Systems Approach to Change – engaging the multiples Non-branded (Community-led) Total Sanitation Strengthened Home Visits Negotiation of Improved Practices/MIKIKIR
  • Difficult presentation because such a mixed audience… TS HAS AS IT’S UNDERLYING PLATFORM THAT IT TALKES 100% TOTAL BEHAVIOR CHANGE to see health impacts of sanitation, as well as other social benefits I just don’t have the air time to cover in any detail the principles and methods of total sanitation, and I’m aware that I’m speaking to a mixed audience…..of experts and practicioners, and casual ‘window shoppers’ from other sectors and approaches, who are just taking a look at various behavior change approaches…. TS leads communities through a series of activities to trigger…..
  • So they were trained in all CLTS Tools… [don’t run video] To ignite communities To commit to end open defecation
  • ………………… .. Collective commitment, collective action
  • Health Extension workers went house to house as part of their routine. “ Negotiated” Small Doable Actions – to get people started and then improve over time… As will be explained in more detail.. The emphasis was NOT on the ideal.. Rather to Start With Simple, Affordable, Replicable and Functional Technologies … and Move Up the Sanitation Ladder Emphasize Development Dignity …………. Not focus on HEALTH
  • ,… Negotiating Improved Practice… or MIKIKIR… Assessing current practice.. Working with householders to move them UP the H& S ladder… not necessarily leaping to the idea… Explain the job aid…..
  • As a testiment to scale… The National Total Sanitation Working Group formed by the Federal Ministry of Health adopted much of the CLTBCHS approach (and used soft copy of documents) To develop “the National Approach to Achieve Universal Hygiene and Sanitation” … anecdotally… we couldn’t randomly find a control group for the evaluation… No districts were ‘untouched’ …
  • This example of evaluating a Scale program - the Amhara example – shows how the elements of HIF have been used to define Intermediate Results We had a comprehensive M&E approach, but we are going to focus only on the household changes
  • RANDOM REPRESENTATIVE OF ALL OF AMHARA Combining and comparing
  • Woman between 20-40 Living in a wood/mud house in a separate compound Roof of corrugated steel (67%) or thatch (23%) Floor of dung (53%) or earth (45%) 4-7 people in house (72%) 2-4 children under 5 (70%) Most own their house and crop land Have a radio, a lamp, some cattle
  • Health Extension workers went house to house as part of their routine. “ Negotiated” Small Doable Actions – to get people started and then improve over time… As will be explained in more detail.. The emphasis was NOT on the ideal.. Rather to Start With Simple, Affordable, Replicable and Functional Technologies … and Move Up the Sanitation Ladder Emphasize Development Dignity …………. Not focus on HEALTH
  • ... implementation of “At scale” hygiene and sanitation promotion has reached some 5.8 million people in Amhara Regional State and leveraged more than $3million from development partners and donors. An end-line survey conducted in June 2010 indicates that during the period 2008-2010 alone some 4 million people have achieved ODF status (with basic latrines) in Amhara Regional State. The challenge now is to improve the quality of these latrines to acceptable standards and introduce and promote social marketing in the process. Dilemma of “attribution ” of results - the fruit of relinquishing control Quality – in a push for coverage, quality lags behind. Whether it improves over time, or stalls, still unclear. Sustainability – we think the HIF and our institution-centered approach leads to sustainable programs, but we don’t yet have the clear proof In the measurements that we have engaged in, we have encountered the dilemma of being able to attribute changes to CLTBC HS – and this is a natural consequence of relinquishing control of the program through a wide network of partners. In our Ethiopia survey, however, we have been able to attribute certain results to specific program interventions. This is an exciting discovery, but it still does not mean we can attribute the results to HIP or to USAID funding. Coverage or access is emphasized in donor objectives and thus drives the program. We see the need to emphasize quality, especially in sanitation And finally, the question of sustainability. We believe that our approach is the right one for ensuring sustainability, but this is a young program and the changes we seek to foster take time If scale, full program, no controls? Determinants focus on individual behavior, what happens when dealing with community/collective behaviors? (fear, shame and disgust universal?) Individual OR collective/community/systems? What evidence do we develop when we have integrated (community and individual) approaches?
  • ... implementation of “At scale” hygiene and sanitation promotion has reached some 5.8 million people in Amhara Regional State and leveraged more than $3million from development partners and donors. An end-line survey conducted in June 2010 indicates that during the period 2008-2010 alone some 4 million people have achieved ODF status (with basic latrines) in Amhara Regional State. The challenge now is to improve the quality of these latrines to acceptable standards and introduce and promote social marketing in the process. Dilemma of “attribution ” of results - the fruit of relinquishing control Quality – in a push for coverage, quality lags behind. Whether it improves over time, or stalls, still unclear. Sustainability – we think the HIF and our institution-centered approach leads to sustainable programs, but we don’t yet have the clear proof In the measurements that we have engaged in, we have encountered the dilemma of being able to attribute changes to CLTBC HS – and this is a natural consequence of relinquishing control of the program through a wide network of partners. In our Ethiopia survey, however, we have been able to attribute certain results to specific program interventions. This is an exciting discovery, but it still does not mean we can attribute the results to HIP or to USAID funding. Coverage or access is emphasized in donor objectives and thus drives the program. We see the need to emphasize quality, especially in sanitation And finally, the question of sustainability. We believe that our approach is the right one for ensuring sustainability, but this is a young program and the changes we seek to foster take time If scale, full program, no controls? Determinants focus on individual behavior, what happens when dealing with community/collective behaviors? (fear, shame and disgust universal?) Individual OR collective/community/systems? What evidence do we develop when we have integrated (community and individual) approaches?
  • Combining Collective and Individual Paths to Behavior Change?

    1. 1. Combining Collective and Individual Paths to Behavior Change? GHPN Brownbag February 16, 2012 Julia Rosenbaum and Orlando Hernandez
    2. 2. PresentersOrlando Hernandez Julia Rosenbaum Renny Seidel (intro)
    3. 3. This presentation• What is a ‘collective behavior’?• The program in Ethiopia• Results• Discussion
    4. 4. What is a ‘collective behavior’?
    5. 5. “Yo dude!!!” Examples of group/mass behaviors: are there any collective?• Running for shelter during the rain• Church attendance on Sunday• Labor strikes• Joining the Green Movement, joining the Tea Party• Communal protection of fish sanctuaries in fishing villages
    6. 6. Characteristics of ‘collective behavior’Schaefer: spontaneous unstructured reaction to ambiguous situation unpredictable source of social changeLe Bon: abandonment of current responsibility, surrendering to contagious crowd emotionsSearle: ‘we intend’ vs ‘I intend’ collective intentional behavior ≠ summation of individual intentional behavior…..action which is neither conforming (actors follow prevailing norms) nor deviant (actors violate those norms).
    7. 7. At scaleHygiene and Sanitation Improvement in the Amhara Region of Ethiopia through “Learning by Doing”
    8. 8. Start Changes at grassroots The Districts12 Step Pathway Broken into 3 phases Plan Mobilize and Act Monitor & Evaluate
    9. 9. Learning by Doing Program in AmharaMulti-Stakeholder Meeting identified Common Action Agenda – brought the Whole System to the Room @Regional Behavior Change Strategy• including advocacy• strengthened household visits• community ignition and action• multiplying the message with communication and media• demonstration latrines and HW stations• increased access and affordability of products through private sector involvement
    10. 10. Implementing a hybrid of …COMMUNITY-LED TOTAL BEHAVIOR CHANGE IN HYGIENE AND SANITATIONembedded in a national and regional process..• National Hygiene and Sanitation Strategy• National Protocol for Implementation of …Built around Health Extension Programme,and carried out by HEWs.. Among other actors…
    11. 11. COMMUNITY-LED TOTAL BEHAVIOR CHANGE IN HYGIENE AND SANITATION• Systems Approach to Change – engaging the multiples• (Community-led) Total Sanitation• Strengthened Home Visits Negotiation of Improved Practices/MIKIKIR• Robust WASH Friendly Schools component
    12. 12. Characteristics of an At Scale Effort Systems-Approach  Looks at the whole  Involves multiple sectors, actions, options, stakeholders Hygiene Improvement Framework  Considers hardware, promotion, institutional capacity Behavior FIRST  Focuses on consistent and correct PRACTICE of key hygiene behaviors Prioritizes sustainability Coverage
    13. 13. Community led Total SanitationCommunities are “ignited”Total coverage, each and every member of the community shall have toilet and stop open defecation. Category Users of Prevalence of Latrine (%) diarrhoea (%) Open defecation prevalent 29 38 villages Almost open defecation-free 95 26 villages Open defecation-free villages 100 7 Source: Formative research by WSP-Knowledge Links for IEC Manual in Himachal Pradesh, 2005
    14. 14. Disg ust F ear Sha me
    15. 15. Shit calculation – Calculating the amount to feces produced (week, month and annually, etc.) to illustrate the magnitude of the sanitation problem. – One ‘evacuation’ = 150 grams – Number of evacuations a day– Volume of feces per person/day – Number of people in room – Volume of feces a day, a week, a year – ? WHERE DOES IT ALL GO????
    16. 16. Results Were we effective? Did we achieve scale?Did combining individual and collective action work?
    17. 17. M&E Framework for Learning by Doing, AmharaSO At scale of hygiene and sanitation in Amhara RegionIntermediate Partnerships to Institutional capacity Hygiene and Adoption of WASH facilitate coordinated in public and civil sanitation program practices at HH andresults action at regional and society partners at woreda level institutional levels district level fostered developed expanded increased # nat’l, reg., or district level % trainees mastering # of targeted woredas that % households using policies, strategies, program knowledge/skills for newly implemented WSRs improved sanitation or projects advanced developed guidelines facilities meeting through “learning by doing” minimum standards byIllustrative initiative woredaIndicators # of woredas developing % annual budget spent by % targeted woredas % households with hw integrated annual plans with targeted woreda implementing integrated supplies at hw stations contributions form all hygiene promotion partners actions to complement hardware investments
    18. 18. Pre- / Post- Stratified Random Sample PRE High Medium Lown=2000 (Focal) (Direct) (Indirect) High Low POST (Focal) (GOE)N=1378 No real controls
    19. 19. ETHIOPIAPractices: Access to Sanitation FacilitiesBaseline-Endline Comparison: All Respondents
    20. 20. Predictors of Latrine Ownership Endline Dimensions Factors p Odds Ratio Community participated in walk of .00 2.23 Intervention shame Characteristics Household visited by health work to .05 1.75 improve sanitation Having a latrine contributes to the .00 2.6Intervention -related community’s health Perceptions Having a latrine contributes to the .00 1.8 community’s development ALL of THESE …………………………………………….. >> 8.38 **Source: Amhara LBD Evaluation Report, USAID/HIP-WSP/WB-AF, November 2010
    21. 21. Presence of HWStations at Latrines 17% 16%
    22. 22. Accomplishments & Challenges 5.8 million people in Amhara Regional State reached 3.8 million more people stopped practicing open defecation and now use a basic pit latrine Challenge is to improve the quality of these latrines to acceptable standards Develop and integrate sanitation marketing strategies Focus on promoting fixed handwashing stations (tippy tap) at latrine and ‘commonly used’ place Model being used as essential part of national scale up…
    23. 23. Discussion

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