Changing The Currency


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Helping the poor afford better health.

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  • Some of you may be asking “Why do we need another form of currency to purchase safe water?”
  • At incomes of less than 50 cents a day, pecuniary means are unrealistic! Buy-in does add to sustainability but the form of buy-in needs to be flexible. It is worth noting with this slide that the population in Myanmar that relies solely on contaminated surface sources for their drinking water supply exceeds the entire population of Cambodia and is four times greater than the population of Laos.
  • Another reason that we developed this method for beneficiary buy in was because we experienced some very high abandonment rates of CWFs after distribution in the tsunami regions of Thailand. Directly following that experience, we attended the 2005 HWTS conference and Han Heinen laid a little wisdom on us. We took that wisdom home with us and built Thirst Aid around it, and, while it took us 2 years and one cyclone to get funding for the project, we finally did.
  • For a little background, TA has a rather unique role in Myanmar. We are not for the most part implementers, rather we are simply facilitators, there to make it easy for NGOs to purchase CWFs and to do so with the confidence that what they’re purchasing and distributing is a water filter and not a clay pot, and also so that they don’t all have to create their own education programs – a particularly onerous task in MM.
  • Relative to ease of adoption – we wanted to find a way for beneficiaries to take ownership without requiring the use of their limited monetary resources. We also wanted to make the most of what was available – when you only have $3 per head in annual humanitarian aid you really want to stretch it, and lastly, we wanted to develop a program that would work and help to provide health gains regardless of the technology
  • By assigning a value to education and accepting it as a form of currency.
  • Okay, show of hands - who amongst us here would knowingly give contaminated water to a child? (Show a bottle of ugly water?) Uh huh, that’s what I thought! Is this because you have a water filter, dilute chlorine or a flocculant in your home or is it because you’re educated? It’s because your educated isn’t it? And even if all you had was contaminated water you’d figure out a way to improve it. All the technology in the world isn’t going to help unless the beneficiaries are inspired to use it.
  • And it was on this notion that Thirst-Ed was born.
  • We developed programs for schools
  • We did outreach in communities
  • We went door to do for individual instruction
  • And we worked with NGOs to train their staff
  • In essence, the theme was the same regardless of the audience. Educate, test, reward. No diploma, no filter. Hence even if you’re rich, you’re not going to get a free filter. Now we did find, that since the filters had a perceived value, that the wealthier residents of the cyclone region were purchasing ceramic filters from beneficiaries and a sort of black market developed for them – of note is that they typically sold for more than the NGOs were buying them for!
  • Worth mentioning is that we’re also working on a non-ceramic water filter intervention where we’ll simply be distributing improved water and for this we’ll substitute water coupons for diplomas
  • NGOs are the biggest hurtle to behavior change! Talk about stubborn people set in their ways! When it comes to inspiring behavior change give me a villager who has just been traumatized by a cyclone any day! A lot of CWFs were purchased in response to Cyclone Nargis but not all went out with proper education!
  • I think the reason for this is that when you have 3 million dollars to spend on Water and Sanitation and only 3 months to do so – you look for high dollar items that are easy to get out in the field. Education takes time and because of this many NGOs balked at the education first approach yet disasters are the perfect time to teach! There are so many open minds when there are bodies floating by daily. The cynic in me also knows that CWFs make a wonderful canvas and photo op for NGO logos, also contributing to the uptake of this product. The money spent on logo stickers alone could easily have provided safe water for another hundred thousand people!
  • 110,000 CWFs were distributed in the 14 months that followed Nargis – I think that’s unprecedented. This made for some very fertile ground for the study of behavior change.
  • For the purpose of this report we’ll compare 4 different NGOs with 4 different methods of implementation. Read the slide.
  • The results were a little surprising to me only in that I expected a greater difference between groups C and D, however there were variables that might explain this which I’ll get to a few slides down the road. Group A on the other hand was no surprise at all, half the beneficiaries didn’t even know what the filter did after receiving it.
  • Read the slide
  • Read the slide
  • Education is never lost or wasted and it cannot be taken by corrupt officials or converted to cash and used for other purposes. Education cannot be eaten by termites, damaged by storms, or left behind when people move. It is lasting, easily transferred and increases in value as it is shared. 300 Community Health Educators associated with CWFs alone
  • Begin by reading slide down to Han. Fiscal losses after the Nargis interventions incurred on CWFs alone could realistically be estimated at 1 million between capital investments and program costs. That’s really a shame in a place as poor as Myanmar!
  • Read the slide
  • Read the slide plus - We all know that buy in is necessary – but how we buy in, what we contribute, can vary greatly.
  • Changing The Currency

    1. 2. Changing The Currency By Which Safe Water Is Purchased
    2. 3. Annual Per Capita Humanitarian Aid Funding Myanmar $3 Laos $67 Cambodia $47 Vietnam $29 Average Per Capita Annual Income Myanmar $130 Laos $580 Cambodia $540 Vietnam $790 Why?
    3. 4. And because at the 2005 HWTS Conference in Bangkok , Han Heijnen said: <ul><li>&quot;Education, training, and programmatic support to promote behavior change may be 90% of the issue in household water treatment and safe storage…….” </li></ul>
    4. 5. Background Thirst-Aid’s role in Myanmar Knowledge Transfer Scale-up QC Facilitate Ease of Adoption
    5. 6. Program Goals <ul><li>Develop a non-pecuniary means for beneficiaries to buy safe water. </li></ul><ul><li>Leverage available funding by increasing sustained use of HWTS technologies. </li></ul><ul><li>Effect positive and lasting behavior change relative to improved hygiene and safe water practices regardless of technology. </li></ul>
    6. 7. How? <ul><li>By promoting education and </li></ul><ul><li>knowledge as the principal tools </li></ul><ul><li>for safe-water intervention. </li></ul><ul><li>By assigning a value to education. </li></ul><ul><li>By making safe water and </li></ul><ul><li>improved hygiene </li></ul><ul><li>education accessible. </li></ul>
    7. 8. In short, we based the program on the assumption that: “ Educated people do not willing and knowingly drink contaminated water – much less give it to their children .”
    8. 9. Thirst-Ed
    9. 16. What Did We Learn? <ul><li>Behavior change begins at home! </li></ul><ul><li>Little did we know that the </li></ul><ul><li>biggest barrier to </li></ul><ul><li>behavior change </li></ul><ul><li>was going to be NGOs! </li></ul>
    10. 18. 110,000 CWFs were purchased and distributed in the 14 months following Cyclone Nargis <ul><li>Pre-distribution education varied greatly </li></ul><ul><li>Follow-up education, reinforcement </li></ul><ul><li>and monitoring practices varied greatly </li></ul><ul><li>Results varied greatly </li></ul>
    11. 19. NGO A – Zero pre-distribution education NGO B – Group classes, 10 to 20 people each, 20 to 30 minutes, no diploma required NGO C – Group classes, 10 to 20 people each, 20 to 30 minutes, diploma required. NGO D – Individual instruction – 45 min to 1 hr. per beneficiary, diploma required.
    12. 21. Contributing variables: NGOs A and D – Sample size of 400/500 HH, 90/100% coverage, filters had been in use for 12 months or more. NGOs B and C – Sample size of 43/56 HH, randomly selected, filters had been in use for only 6 months. Time of implementation post-cyclone.
    13. 22. <ul><li>Downside: </li></ul><ul><li>Education and follow-up </li></ul><ul><li>are time consuming and add </li></ul><ul><li>to initial costs. </li></ul><ul><li>Difficult to put a logo </li></ul><ul><li>on education </li></ul>
    14. 23. <ul><li>Benefits: </li></ul><ul><li>Education is a sound investment. </li></ul><ul><li>Education is never lost or wasted. </li></ul><ul><li>Education on improved hygiene alone is </li></ul><ul><li>known to produce positive health gains. </li></ul><ul><li>Education creates more jobs </li></ul>
    15. 24. Assumption The fiscal losses incurred due to product abandonment could be greatly reduced by following Han’s advice and investing more in education, training, and programmatic support.
    16. 25. Conclusions: There is a direct association between time spent educating beneficiaries and sustained use.
    17. 26. Using education as a currency appears to be as effective as monetary input, plus it has the added value that simply education alone can bring.
    18. 27. Thank You! <ul><li>Questions? </li></ul>