Through the ‘story’ of our Learning by Doing Program in Amhara ,,,, we can examine how USAID/HIP, an AED project and the WASHplus predecesor 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.
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
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…..
Results Were we effective? Did we achieve scale? Did combining individual and collective action work? 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 Only about 30% of these meet minimum standards Distance from house or water source Covered pit Washable plat Superstructure that provides privacy
5.8 million people in Amhara Regional State reached 2.8 million more people stopped practicing open defecation and now use a basic pit latrine US$ 3 million leverage from development partners and donors
AfricaSan 2011, Rwanda: Behaviour change session - Julia Rosenbaum, WASHplus Project in Ethiopia, USAID
Julia Rosenbaum, WASHplus (FHI 360) Kebede Faris, Water and Sanitation Program/ World Bank-AF Asrat Genet , BoH/Amhara (WSP) Orlando Hernandez, WASHplus (FHI 360) Belete Muluneh, WSP/WB (now UNICEF)) Applying a Mix of Community-led and Household-level WASH Innovations to Improve WASH, Reduce Diarrheal Disease and Strengthen Health Systems Making ‘what works’ work: Changing behaviour in sanitation and hygiene, AfricaSan, 20 July 2011
<ul><li>At scale </li></ul><ul><li>Hygiene and Sanitation Improvement in the </li></ul><ul><li>Amhara Region of Ethiopia </li></ul><ul><li>through “Learning by Doing” </li></ul>
<ul><li>Community-led Total Behaviour Change in Hygiene and Sanitation </li></ul><ul><li>Embedded in a national and regional process </li></ul><ul><li>National Hygiene and Sanitation Strategy </li></ul><ul><li>Built around Health Extension Programme </li></ul><ul><li>Carried out by Health Extension Workers </li></ul><ul><li>Supported by “the whole system” </li></ul><ul><li>Emphasis on bridging and bonding </li></ul>Implementing a hybrid of …
<ul><li>Systems Approach to Change – engaging the multiples </li></ul><ul><li>(Community-led) Total Sanitation </li></ul><ul><li>Strengthened Home Visits Negotiation of Improved Practices </li></ul><ul><li>Robust WASH Friendly Schools component </li></ul><ul><li>Investment in building capacity of health and other sector cadres </li></ul>
Predictors of Latrine Ownership Endline **Source: Amhara LBD Evaluation Report, USAID/HIP-WSP/WB-AF, November 2010 Dimensions Factors p Odds Ratio Intervention Characteristics Community participated in walk of shame .00 2.23 Household visited by health work to improve sanitation .05 1.75 Intervention -related Perceptions Having a latrine contributes to the community’s health .00 2.6 Having a latrine contributes to the community’s development .00 1.8 ALL of THESE …………………………………………… .. >> 8.38
<ul><li>Contact Information </li></ul><ul><ul><ul><li>Julia Rosenbaum </li></ul></ul></ul><ul><ul><ul><li>[email_address] </li></ul></ul></ul>