Volunteering for WASH Behaviour Improvements

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WASH 2011 conference: Ivo Guterres, Environmental Health Department Head
Heather Moran, Behaviour Change Communication Advisor, BESIK
Ministry of Health, Timor-Leste

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  • This presentation is a summary of findings from a case study on how the ministry of health is promoting hygiene behaviour improvements in Timor.
  • Three main strategies to promote healthy WASH behaviours at the community level.
  • To scale up primary health care and promotion throughout Timor, the MoH developed SISCa. On a monthly basis clinic staff mobilize to deliver services to the community level. Community leaders and family health promoters are responsible for organizing a location for the services and for mobilizing community members to attend. SISCa has effectively increased rural community access to health services in an affordable manner. However, the programme has also requires large inputs of human and financial resources.
  • SISCas are composed of six tables of integrated health services. Our program targets Table 4 and Table 6 to promote WASH behaviour improvements.
  • PSFs play a key role in ensuring effective delivery of SISCa and for extending WASH behaviour promotion to the community level.
  • Because district health services do not always have the resources to provide the suppport and management to PSFs, partners provide additional support that has increased effectiveness of SISCa and PSFs. Maria, a single mother in Oecusse, learned about the importance of sanitation and handwashing during WASH behaviour change communication trainings with the MoH and the WASH partner. She soon returned to her community and worked with her children to build a latrine and a homemade handwashing facility. Role modeling WASH behaviours has made her a more effective promoter in her community.
  • PSF, Carmelinda Pasquela in Lautem District, engages community members in handwashing improvements through her soap making and selling activities. While marketing the soap during SISCas and household promotional visits, Carmelinda also helps community members think about how they can make handwashing facilities using local resources. Carmelinda and her PSF colleagues feel that the revenue made from the soap sales adds incentive and motivation for their HWWS promotion work.
  • Implementation of the PSF program has been challenging considering the high level of support that is needed to manage and motivate the volunteers. Partners have played a key role in providing supportive supervision and management to PSFs in situations where the district health services do not have the resources to do so. This additional support has resulted in innovative implementation of PSF responsibilities, which the MoH can use for improving programs in other districts.Know that health staff can’t reach everyone – work through volunteers and support from NGOs
  • Interpersonal BC negotiation works because it focuses on specific needs of individuals. However, much of the negotiation has focused on health messages, which we have seen doesn’t always motivate changes in behaviour. The MoH is focusing now on messages that appeal to the ‘disgust’ trigger and the ‘nuture’ trigger. Behaviour change takes a long time and requires that health personnel, NGOs, and volunteers are supporting community members to identify barriers that prevent them from practicing key behaviours and to help the community members resolve these barriers. However, this requires that there are NGOs or active PSFs in all communities. Clearly this will not reach the entire population. So the MoH is expanding the reach of the messages through other channels.
  • MoH is now ensuring that all partners engaged in WASH behaviour promotion are using the same motivational messages. To complement their community based work and scale up the reach of the messages, the MoH is also beginning to use mass media channels to promote the messages.
  • Volunteering for WASH Behaviour Improvements

    1. 1. Volunteering for WASH Behaviour Improvements<br />Ivo Guterres, Environmental Health Department Head<br />Heather Moran, Behaviour Change Communication Advisor, BESIK<br />Ministry of Health, Timor-Leste<br />17 May 2011<br />
    2. 2. Background<br />Timor Population<br />Around 1 million distributed over<br />13 districts<br />65 sub-districts<br />442 sucos<br />2,225 aldeias<br />70% rural<br />Rural Literacy<br />75% males <br />62% females<br />Water & Sanitation<br />56% access to safe drinking water<br />35% travel over 30mins<br />34% coverage with improved sanitation<br />Communications<br />Over half households listen to radio weekly<br />Almost half view TV weekly<br />Timor Telecom over 50% population <br />
    3. 3. Background Continued<br />Child Mortality in Timor-Leste: 64/1000<br />70% child deaths occur in the first year of life<br />Infant mortality rate of 45/1000<br />In 2009 DHS: <br />25% children had experienced fever in last 2 weeks<br />16% had had diarrhoea<br />2% had experienced ARI symptoms <br />58% children were stunted<br />45% were underweight<br />19% showed signs of wasting <br />Risk of child death double in rural to urban areas <br />
    4. 4. Extending Effective WASH Promotion into the Community<br />SISCa (Integrated Community Health Services) - ‘From, with, and to the community’<br />Family Health Promoters<br />Taking a behaviour change approach to promote improvements in key WASH practices :<br />Handwashing with soap at critical times<br />Safe management of water from source to mouth (consumption)<br />Safe disposal of adult and child faeces<br />
    5. 5. SISCa<br />
    6. 6. SISCa<br />Table 1 – Community Registration<br />Personal counseling and promotion regarding:<br /><ul><li>Handwashing with soap
    7. 7. Building HW facilities from local resources
    8. 8. Sanitation
    9. 9. HH handling and storage of drinking water
    10. 10. KUBASA – Monitoring </li></ul>Table 2 - Nutrition<br />Table 3 – Maternal and Child Health<br />Table 4 – Environmental Health<br />Monthly Health Promotion Topics / Activities, including:<br /><ul><li>Handwashing demonstrations and games exploring routes of transmission
    11. 11. Personal hygiene
    12. 12. Household sanitation</li></ul>Table 5 – General Consultations<br />Table 6 – Health Promotion<br />
    13. 13. Family Health Promoters - PSFs<br />Community nominated volunteers<br />Mobilize communities to participate in SISCa<br />Assist the implementation of SISCa<br />Conduct house-to-house environmental health monitoring (KUBASA) and negotiation of WASH behaviours<br />Challenges<br />Requires large amount of support and supervision<br />Ongoing capacity development to ensure PSFs have skills and confidence to negotiate BC – on the job training<br />Good relationship with the community to be effective<br />
    14. 14. Case Study: Role Modeling in Communities <br /><ul><li>PSFs trained in interpersonal BC negotiation
    15. 15. Identifying barriers to change
    16. 16. Working with community members to resolve problems
    17. 17. PSFs role model target behaviours at the community level
    18. 18. Support from local NGO has equipped PSFs with technical skills as well as motivation to engage community members around WASH behaviours</li></li></ul><li>Case Study: Soap social marketing and HWWS promotion<br /><ul><li>PSFs received additional support from a health NGO in target areas. Model is currently being scaled up into other areas.
    19. 19. Trained PSFs to make and market soap
    20. 20. PSFs sell soap at SISCa and when promoting the HWWS from door to door
    21. 21. Increasing access to soap
    22. 22. Helping hhs build HW facilities out of local resources
    23. 23. Incentive for PSFs
    24. 24. Ongoing support from NGO provides supportive supervision to improve PSF skills and organize activities</li></li></ul><li>CREATIVE HANDWASHING FACILITIES<br />
    25. 25. WASH Behaviour Improvements Lessons Learned<br />Family Health Promoters<br />Volunteers can effectively be used to scale up BC negotiation at the community level<br />Supportive Supervision<br />Ongoing capacity building<br />Partners can support district health services <br />Interpersonal BC negotiation identify specific barriers and help community members explore ways for resolving<br />
    26. 26. WASH Behaviour Improvements Lessons Learned<br />Behaviour Change Approach<br />Emphasis on ‘functional’ health messages doesn’t change behaviours – focusing more on ‘motivational’ messages<br />Focus on interpersonal BC negotiation depends on in-community presence<br />Monitoring systems for behaviour change need to be improved<br />
    27. 27. Moving Forward<br />Increasing impact of promotion through a set of united cross agency motivational messages<br />Increasing reach of promotion by complementing community-based activities with development of mass media campaign<br />Exploring Public-Private Partnerships to enhance skills and expand reach<br />
    28. 28. OBRIGADO!<br />THANK YOU!<br />

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