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Planning Behaviour Change: Chances and Challenges


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WASH 2011 conference: Dr. Christine Sijbesma, IRC

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Planning Behaviour Change: Chances and Challenges

  1. 1. Planning Behaviour Change: <br />Chances and Challenges<br />Dr. Christine Sijbesma, IRC<br />1<br />Illustration: NEWAH, Nepal<br />
  2. 2. Why plan to promote good practices?<br /><ul><li>Sewerage can cost as much as US$ 270</li></ul> per Disability-Adjusted Life Year averted<br /><ul><li> Piped house connections cost US$ 223
  3. 3. A hand pumps program costs US$ 94
  4. 4. Promoting basic sanitation costs US$ 11
  5. 5. Promoting hygiene costs < US$ 5</li></ul>2<br />Session 1A2C – Planning for sustainable behaviour change<br />
  6. 6. “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)<br />Session 1A2C – Planning for sustainable behaviour change<br />3<br />
  7. 7. But: Impacts on health need a CRITICAL MASS of good practices! <br />4<br />Session 1A2C – Planning for sustainable behaviour change<br />
  8. 8. Practical Planning Tool: FOAMS (adjusted from WSP)<br />5<br />
  9. 9. Focus practices WHAT to practice?<br />Handwashing + soap lessens diarrhoea 45%, ARI 23%, neonatal death 40-44% . Substitutes also work (Hoque et al, 1995)<br />2) Toilet use ->32% lower diarrhoea <br /> (WHO, 2008)<br />Safe drinking water chain management : 35-47% reduction diarrhoea (UNICEF, 2008) <br />Under-researched: infants’ faecal-oral chain management <br />6<br />
  10. 10. Focus Groups : WHO to practice?<br />HWWS: esp. caregivers of children under five (mothers/grandparents) and birth attendants <br />Toilets: men, children under 12 and adolescent boys ‘ since women, adolescent girls use most<br />Safe drinking water chain management – source to cup: women primary role , men gender support role <br />Under-researched: caregivers infants’ faecal-oral chain management (Cairncross et al 2010)<br />Session 1A2C – Planning for sustainable behaviour change<br />7<br />
  11. 11. Opportunity: WHEN can practice?<br />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<br />8<br />Session 1A2C – Planning for sustainable behaviour change<br />
  12. 12. Ability: How will they practice?<br />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 <br />9<br />Session 1A2C – Planning for sustainable behaviour change<br />
  13. 13. Motivation: WHY practice?<br />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<br />10<br />Session 1A2C – Planning for sustainable behaviour change<br />
  14. 14. Sustained: HOW LONG is practice?<br />Comparative study in six countries:<br /><ul><li> After 1 year only 1 of 17 practices had faded
  15. 15. At longer interval 2 of 25 dropped significantly
  16. 16. Access to water made no difference
  17. 17. Better educated women= better practice
  18. 18. In India men sustained HWWS and toilet </li></ul> use less than women, yet most programs <br /> targeted women<br />SEUF<br />11<br />
  19. 19. Five key lessons <br />FOAMS analysis of cases at Hygiene Workshop Melbourne 2010 :<br />Know your Focus Groups<br />Prioritise Focus practices and avoid overload<br />Ensure Opportunity for change at community & institutional level<br />Motivate good behaviours through all drivers. Health is “Mekka”, but many roads lead to it - Health goal itself is seldom a strong trigger<br />Determine if practice is Sustained <br />12<br />Session 1A2C – Planning for sustainable behaviour change<br />