March 2, 2010 Welcome to HIP’s Webinar on Access and Behavioral Outcome Indicators for Water, Sanitation, and Hygiene Presenter: Orlando Hernandez , HIP monitoring and evaluation specialist If you have any technical issues during this presentation, contact [email_address] , tel. 202-884-8358

Organization of presentation Who is the manual for? How was the manual developed? What does the manual include? Limitations of the manual. How can I use the manual? How can I get the manual?

Who is the manual for?

How was the manual developed?

What does the manual include?

Limitations of the manual.

How can I use the manual?

How can I get the manual?

Who is it for? Program planners, managers and evaluators designing, implementing or evaluating water, sanitation and hygiene (WASH) interventions Donor agencies, USAID staff, different levels of government in developing countries, international organizations, NGOs, community organizations

Program planners, managers and evaluators designing, implementing or evaluating water, sanitation and hygiene (WASH) interventions

Donor agencies, USAID staff, different levels of government in developing countries, international organizations, NGOs, community organizations

How was the manual developed? Manual is evidence-based and related to reliable and valid measurement of hygiene practices to prevent diarrheal disease in children under 5 Concerns about what to measure and how to measure access and hygiene practices Key players in WASH field: academia, donor and implementation agencies

Manual is evidence-based and related to reliable and valid measurement of hygiene practices to prevent diarrheal disease in children under 5

Concerns about what to measure and how to measure access and hygiene practices

Key players in WASH field: academia, donor and implementation agencies

How was the manual developed? Abt Associates AED ARD Centers for Disease Control Water Supply and Sanitation Collaborative Council IFC Macro IRC International Water and Sanitation Centre London School of Hygiene and Tropical Medicine The Manoff Group Massachusetts Institute of Technology Public Private Partnership for Handwashing, WSP Population Services International UNICEF

Abt Associates

AED

ARD

Centers for Disease Control

Water Supply and Sanitation Collaborative Council

IFC Macro

IRC International Water and Sanitation Centre

London School of Hygiene and Tropical Medicine

The Manoff Group

Massachusetts Institute of Technology

Public Private Partnership for Handwashing, WSP

Population Services International

UNICEF

What does the manual include? Access to water and sanitation Behavioral outcomes associated with hygiene practices: Household water treatment and safe storage Handwashing with soap at critical moments Use and maintenance of facilities to dispose of human excreta Essential vs. expanded indicators

Access to water and sanitation

Behavioral outcomes associated with hygiene practices:

Household water treatment and safe storage

Handwashing with soap at critical moments

Use and maintenance of facilities to dispose of human excreta

Essential vs. expanded indicators

What does the manual include? Table 1 : List of Access and Behavioral Outcome Indicators (Essential Indicators) Hygiene Content Area Indicator Access to Water Supply and Use of Household Water Treatment Technologies and Safe Storage WA1. % of households that use an improved drinking water source (urban and rural) WA8. % of households practicing correct use of recommended household water treatment technologies WA10. % of households storing treated water in safe storage containers Hand Washing with Soap at Critical Moments HW2. % of households with soap and water at a hand washing station commonly used by family members HW3. % of households with soap and water at a hand washing station inside or within 10 paces of latrines Access to and Use of Sanitary Facilities for the Disposal of Human Excreta SAN 1. % of households with access to an improved sanitation facility (urban and rural) SAN 5. % of households using the available (improved) sanitation facility SAN8. # of communities achieving open defecation free status

What does the manual include? Hygiene Content Area Indicator Access to Water Supply and Use of Household Water Treatment Technologies and Safe Storage WA1. % of households that use an improved drinking water source (urban and rural) WA2. % of households with access to improved drinking water sources from a recommended provider WA3. % of households spending up to 30 minutes to collect drinking water from an improved source WA4. % of respondents who agree that their drinking water needs to be treated at home WA5. % of respondents who believe others treat drinking water at home WA6. % of respondents that feel confident they can improve the quality of their drinking water WA7. % of respondents who know at least one location where they can obtain recommended household water treatment product(s) WA8. % of households practicing correct use of recommended household water treatment technologies WA9. % of households practicing sustained use of recommended household water treatment technologies WA10. % of households storing treated water in safe storage containers WA11. % of households with negative test for E. coli in drinking water at the point of use WA12 . % of households with positive chlorine residual in drinking water treated with a chlorine product

What does the manual include? Hygiene Content Area Indicator Hand Washing with Soap at Critical Moments HW1. % of respondents who know all critical moments for hand washing HW2. % of households with soap and water at a hand washing station commonly used by family members HW3. % of households with soap and water at a hand washing station inside or within 10 paces of latrines HW4. % of households with soap or locally available cleansing agent for hand washing anywhere in the household

What does the manual include? Hygiene Content Area Indicator Access to and Use of Sanitary Facilities for the Disposal of Human Excreta SAN1. % of households with access to an improved sanitation facility (urban and rural) SAN2. % of households with reliable access to sanitary facilities SAN3. % of households spending less than 10 minutes to travel to public or shared facilities SAN4. % of children <36 (or 60) months whose feces were disposed of safely SAN5. % of households using the available (improved) sanitation facility SAN6. % of households with sanitary facilities that practice adequate cleanliness to encourage use SAN7. % of households with sanitary facilities that practice adequate maintenance to keep them operational SAN8. # of communities achieving open defecation free status SAN9. % of communities that are maintaining their open defecation free status

How is the manual organized? Water, hand washing with soap and disposal of human excreta Each indicator includes: Rationale/critical assumptions Data source Data analysis Issues/limitations Target setting Questions added to surveys Procedure to calculate the indicator

Water, hand washing with soap and disposal of human excreta

Each indicator includes:

Rationale/critical assumptions

Data source

Data analysis

Issues/limitations

Target setting

Questions added to surveys

Procedure to calculate the indicator

CONTENT : ACCESS TO WATER SUPPLY USE OF HOUSEHOLD WATER TREATMENT TECHNOLOGIES STORAGE Indicator WA3: % of households spending up to 30 minutes to collect water from an improved source Rationale/Critical Assumptions for Indicator: The amount of time spent fetching water will have implications for the amount of water that a household makes available to its members. The longer the time invested in fetching water, the less chance a family has to acquire enough water to satisfy household water per capita needs. UNICEF and WHO (2008) suggest that when the time invested in going to the source, collecting water, and returning to the household is between three and 30 minutes, the amount of water collected may vary between 15 and 25 liters per person per day. This range is considered suitable for a person to meet basic needs. The international community assumes that if the time invested in fetching water is longer the less time families take to fetch water, the better. Data Source: Household survey Data Analysis : Analysis may be done by geographic area (urban and rural) or by administrative unit of interest (region, district, and municipality). Issues/Limitations: The sense of time may vary from culture to culture and the concept of minutes may not be commonly used among informants. Example of Target Setting: Results Data Baseline Year 1 Year 2 Year 3 Year 4 Planned 45% Actual 50% 55% 65% Questions that may be used to measure the indicator include the following: WAQ6. How much times does it take on average to go to the drinking water source, get water and come back? 30 minutes or less………1 31 to 60 minutes………..2 61 to 180 minutes………3 More than 3 hours……...4 Does not know………….5 Indicator Calculation : Numerator : # of households providing an Answer 1 to Question WAQ6 Denominator : # of households with answers 1 through 3, 7 to 10, 12 and 16 to Q WAQ1

How can I use this manual? Which indicators are useful for my program? What targets can we set for each year? How do I modify my intervention if my targets are not reached?

Which indicators are useful for my program?

What targets can we set for each year?

How do I modify my intervention if my targets are not reached?

How can I use this manual? Access to sanitation, Madagascar P e r c e n t

How can I use this manual? Handwashing supplies at commonly used station/device, Madagascar P e r c e n t

Limitations of the manual Settled populations, adjustments for nomadic or displaced No guidance specific methodological issues: sampling or instrument design, pretesting and implementation No guidance on training enumerators or supervisors No sanitation marketing indicators

Settled populations, adjustments for nomadic or displaced

No guidance specific methodological issues: sampling or instrument design, pretesting and implementation

No guidance on training enumerators or supervisors

No sanitation marketing indicators

How can I get the manual? Download it from HIP’s website at: http://www.hip.watsan.net/page/4148 Send comments and questions to Orlando Hernandez [email_address] +1 202 884 8619

Download it from HIP’s website at:

http://www.hip.watsan.net/page/4148

Send comments and questions to Orlando Hernandez

[email_address]

+1 202 884 8619

Question 1 Are the Madagascar data national, or for a smaller project area?

Are the Madagascar data national, or for a smaller project area?

Question 2 How would you pick indicators to apply to your program?

How would you pick indicators to apply to your program?

Question 3 The calculations are a bit complicated. Is there a simple data entry or calculator tool plan?

The calculations are a bit complicated. Is there a simple data entry or calculator tool plan?

Question 4 On p. 59 of the indicators manual, safe disposal doesn’t mention ecosan toilets, nor are there any indicators for this. Is there any reason why?

On p. 59 of the indicators manual, safe disposal doesn’t mention ecosan toilets, nor are there any indicators for this. Is there any reason why?

Question 5 In reference to sanitation marketing, program indicators, could you comment a bit more on challenges with including these indicators in the manual, and what areas still need research?

In reference to sanitation marketing, program indicators, could you comment a bit more on challenges with including these indicators in the manual, and what areas still need research?

Question 6 Does HIP have any plans to develop a guiding document on measuring hygiene improvement with displaced populations?

Does HIP have any plans to develop a guiding document on measuring hygiene improvement with displaced populations?

Question 7 Why not mention hand washing with ash as an appropriate technique?

Why not mention hand washing with ash as an appropriate technique?

Question 8 Could you share with us the best systematic monitoring methods for behavior change, other than formative research? Is it feasible to establish baseline data using proposed indicators for behaviors?

Could you share with us the best systematic monitoring methods for behavior change, other than formative research? Is it feasible to establish baseline data using proposed indicators for behaviors?

Question 9 Do you think the indicators on water supply are too heavily focused on point of use? There are three indicators for water supply, nothing on community management, tariffs, or technical support, and nine indicators for point of use (POU).

Do you think the indicators on water supply are too heavily focused on point of use? There are three indicators for water supply, nothing on community management, tariffs, or technical support, and nine indicators for point of use (POU).

Question 10 Are there other indicators that relate to the management of water supply for water committees?

Are there other indicators that relate to the management of water supply for water committees?

Question 11 What is the connection between this publication and the guidelines for household and community levels produced by the EHP project?

What is the connection between this publication and the guidelines for household and community levels produced by the EHP project?

Question 12 I understand the indicator for hand washing supplies plus station device has been tested for inclusion in the manual. What did the testing say about the relation between the proxy trends as presented on the slide, and actual hand washing at critical times?

I understand the indicator for hand washing supplies plus station device has been tested for inclusion in the manual. What did the testing say about the relation between the proxy trends as presented on the slide, and actual hand washing at critical times?

Question 13 Are there any national monitoring systems, such as health or education management information systems, which reflect the hygiene practices?

Are there any national monitoring systems, such as health or education management information systems, which reflect the hygiene practices?

Question 14 Regarding sanitation marketing -- did you mention that you were looking into a WSP program in Peru to establish indicators?

Regarding sanitation marketing -- did you mention that you were looking into a WSP program in Peru to establish indicators?

Question 15 Regarding p. 48 of the manual – You included all cleansing agents to be counted for indicator HW3, but the indicator statement is actually only applied for soap. Why not change the language to “cleansing agent”?

Regarding p. 48 of the manual – You included all cleansing agents to be counted for indicator HW3, but the indicator statement is actually only applied for soap. Why not change the language to “cleansing agent”?

Question 16 Regarding essential indicators – Besides the hygiene behavior mentioned in essential indicators, what other hygiene behaviors might a WASH program want to measure?

Regarding essential indicators – Besides the hygiene behavior mentioned in essential indicators, what other hygiene behaviors might a WASH program want to measure?

Question 17 Are you aware of a similar manual or document with behavioral outcome indicators for WASH in schools, specifically?

Are you aware of a similar manual or document with behavioral outcome indicators for WASH in schools, specifically?

Question 18 Has the Community-led Total Sanitation (CLTS) approach been officially adopted by USAID/HIP?

Has the Community-led Total Sanitation (CLTS) approach been officially adopted by USAID/HIP?

Question 19 What other aspects of hygiene behaviors can you measure?

What other aspects of hygiene behaviors can you measure?

Question 20 Will the presentation be available online?

Will the presentation be available online?

Question 21 Will this manual be adopted to emergency situations, such as Haiti?

Will this manual be adopted to emergency situations, such as Haiti?

Thank You! For additional information on the Hygiene Improvement Project, please see our website, at http://www.hip.watsan.net . If you have specific questions about the Indicators Manual, please contact Orlando Hernandez at [email_address] .

For additional information on the Hygiene Improvement Project, please see our website, at http://www.hip.watsan.net .

If you have specific questions about the Indicators Manual, please contact Orlando Hernandez at [email_address] .