Planning Behaviour Change: Chances and Challenges

Planning Behaviour Change:
Chances and Challenges
Dr. Christine Sijbesma, IRC
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Illustration: NEWAH, Nepal

Why plan to promote good practices?
Sewerage can cost as much as US$ 270
per Disability-Adjusted Life Year averted
Piped house connections cost US$ 223
A hand pumps program costs US$ 94
Promoting basic sanitation costs US$ 11
Promoting hygiene costs < US$ 5
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Session 1A2C – Planning for sustainable behaviour change

“In places with poor water supply, sanitation & hygiene, basic public health interventions are extremely cost-effective, and hygiene improvements most of all” (Jamison et al, 2006)
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But: Impacts on health need a CRITICAL MASS of good practices!
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Practical Planning Tool: FOAMS (adjusted from WSP)
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Focus practices WHAT to practice?
Handwashing + soap lessens diarrhoea 45%, ARI 23%, neonatal death 40-44% . Substitutes also work (Hoque et al, 1995)
2) Toilet use ->32% lower diarrhoea
(WHO, 2008)
Safe drinking water chain management : 35-47% reduction diarrhoea (UNICEF, 2008)
Under-researched: infants’ faecal-oral chain management
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Focus Groups : WHO to practice?
HWWS: esp. caregivers of children under five (mothers/grandparents) and birth attendants
Toilets: men, children under 12 and adolescent boys ‘ since women, adolescent girls use most
Safe drinking water chain management – source to cup: women primary role , men gender support role
Under-researched: caregivers infants’ faecal-oral chain management (Cairncross et al 2010)
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Opportunity: WHEN can practice?
Good promotion program, with own objectives, budget, staff, skills? Necessities to practice present (e.g. water, soap)? Social/gender relations enable practice? E.g. in water-scarce area in Tanzania mothers-in-law & husbands did not allow extra water use to wash children’s faces to prevent eye infections and blindness
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Ability: How will they practice?
Do people have the required time, money, equipment ( or alternatives ) time, skills, knowledge to practice? E.g. handwashing by pouring instead of in same bowl, with women and young children (who have most risks) last in hierarchy
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Motivation: WHY practice?
What triggers certain groups to adopt certain practices? E.g. in Niger, 36 reasons for toilet use, 1 was better health.... Mostly socio-cultural & economic: convenience, privacy, safety, status (e.g. ‘star’ home in Sri Lanka), time saving, witchcraft prevention Different groups have different triggers, so formative research is needed to plan effective messages
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Sustained: HOW LONG is practice?
Comparative study in six countries:
After 1 year only 1 of 17 practices had faded
At longer interval 2 of 25 dropped significantly
Access to water made no difference
Better educated women= better practice
In India men sustained HWWS and toilet
use less than women, yet most programs
targeted women
SEUF
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Five key lessons
FOAMS analysis of cases at Hygiene Workshop Melbourne 2010 :
Know your Focus Groups
Prioritise Focus practices and avoid overload
Ensure Opportunity for change at community & institutional level
Motivate good behaviours through all drivers. Health is “Mekka”, but many roads lead to it - Health goal itself is seldom a strong trigger
Determine if practice is Sustained
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