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WASH Debate: Building institutional capacity for behaviour change & sanitation programming - Dr. Lina Taing

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WASH Debate: Building institutional capacity for behaviour change & sanitation programming - Dr. Lina Taing

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The aim of this WASH debate - jointly organised by IRC and IHE Delft - is to bring greater attention to the variety of behaviours that make up good sanitation, and the range of actors involved in keeping a toilet functional and an environment clean. Specifically it will focus on questions such as:
- How can CLTS be best combined with other sanitation approaches?
- And, in situations where CLTS might be mismatched for local contexts, what alternative methods can be applied to effect change?
- How can the capacity for behaviour change and sanitation programming be institutionalised?

The aim of this WASH debate - jointly organised by IRC and IHE Delft - is to bring greater attention to the variety of behaviours that make up good sanitation, and the range of actors involved in keeping a toilet functional and an environment clean. Specifically it will focus on questions such as:
- How can CLTS be best combined with other sanitation approaches?
- And, in situations where CLTS might be mismatched for local contexts, what alternative methods can be applied to effect change?
- How can the capacity for behaviour change and sanitation programming be institutionalised?

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WASH Debate: Building institutional capacity for behaviour change & sanitation programming - Dr. Lina Taing

  1. 1. Lina Taing, PhD IRC WASH Debate 11 September 2018 Extending the playing field: The significance of institutions in instituting sanitation change
  2. 2. MSc Sanitation: Behaviour Change & Advocacy module 2 Two-week course : • Highlights significance of behavioural change across the sanitation value chain; & • Challenges erroneous notions of behaviour being rational, & education being the best way to induce change.
  3. 3. Sanitation: Traditional programming 3 Source(s): WASH schools photo - http://www.checkoutforchildren.org/blog/2015/2/3/katherines-story-promoting-wash-at-school
  4. 4. Sanitation: People & behaviours across the chain 4 Source(s): Global Handwashing Day figure - https://en.wikipedia.org/wiki/Global_Handwashing_Day; Sanitation value chain figure - https://commons.wikimedia.org/wiki/File:Sanitation_Value_Chain.jpg
  5. 5. Common FSM business model example: Emptying focus 5 Source(s): p. 22 of Rao KC, Kvarnström E, Di Mario L, et al. (2016) Business Models for Fecal Sludge Management About the Resource Recovery and Reuse Series. Colombo. Available at: http://www.iwmi.cgiar.org/Publications/wle/rrr/resource_recovery_and_reuse-series_6.pdf
  6. 6. Diverse range of sanitation actors 6 Source(s): p. 13 of Rao KC, Kvarnström E, Di Mario L, et al. (2016) Business Models for Fecal Sludge Management About the Resource Recovery and Reuse Series. Colombo. Available at: http://www.iwmi.cgiar.org/Publications/wle/rrr/resource_recovery_and_reuse-series_6.pdf
  7. 7. Simiyu et al. (2017) • Shared sanitation quality in Kisumu informal settlements (Kenya) • Comparative case study (2014) • Quality determinants: – Number of households sharing a toilet – Defined management systems cooperation – Collective decision making – Social norms Winter et al. (2018) • Women’s sanitation use in 14 sub-Saharan African countries • Demographic & Health surveys (2008-14) • Use determinants variation between countries/contexts: – Individual: water source access, education, family size, age, female household head, marital status, wealth – Neighbourhood: poverty, ethnic diversity, urbanisation Behavioural determinants significance 7 Source(s):Simiyu S, Swilling M, Cairncross S, et al. (2017) Determinants of quality of shared sanitation facilities in informal settlements: case study of Kisumu, Kenya. BMC Public Health 17(1). BMC Public Health: 68. DOI: http://doi.org/10.1186/s12889-016-4009-6; Winter S, Dreibelbis R and Barchi F (2018) Context matters: a multicountry analysis of individual- and neighbourhood-level factors associated with women’s sanitation use in sub-Saharan Africa. Tropical Medicine and International Health 23(2): 173–192. DOI: http://doi.org/10.1111/tmi.13016.
  8. 8. 8 Behaviour Change Wheel (BCW) Source(s): Michie S, Atkins L and West R (2014) The Behaviour Change Wheel: A Guide to Designing Interventions. London: Silverback Publishing.
  9. 9. 9 Intervention function Policy categories Comm./ Marketing Guidelines Fiscal measures Regulation Legislation Env./social planning Service provision Education      Persuasion      Incentivisation       Coercion       Training      Restriction    Environmental restructuring      Modelling   Enablement       Source(s): Adapted from p. 248-249 of Michie S, Atkins L and West R (2014) The Behaviour Change Wheel: A Guide to Designing Interventions. London: Silverback Publishing Behaviour Change Wheel: Intervention & policy links
  10. 10. Conclusion 10 (1) Broadening the target audience to reflect the entire sanitation value chain (3) Applying different types of strategies to elicit change (2) Supporting programming & conducting research on various sanitation behaviour determinants & indicators Institutions can extend the playing field to institute sanitation behavioural changes by:
  11. 11. Except where otherwise noted, this work is licensed under http://creativecommons.org/licenses/by-nc-sa/4.0/ Sources are noted in the bottom-left of slides. This material was developed and/or made available under the project Accelerating the Impact of Education and Training on Non-sewered Sanitation (OPP1157500) funded by the Bill & Melinda Gates Foundation (BMGF). The content is subject to free unlimited access and use, consistent with BMGF’s commitment to ensure open access to information and knowledge. Therefore, sharing (to copy and redistribute the material in any medium or format) and adapting (transforming, and building upon the material for any purpose) under condition that appropriate credit to author(s) is provided is allowed. Although care was taken to ensure the integrity and quality of these materials and information, no responsibility is assumed by the author(s) or IHE Delft for any damage to property or persons as a result of use of these materials and/or the information contained herein. References

Editor's Notes

  • Before I delve into the significance of institutions like the Dutch Ministry of Foreign Affairs or governments in developing contexts in instituting sanitation change, I'd like to briefly explain why the panelists were gathered together to begin with. 
  • I'm a part of a team of enthusiastic sanitation professionals at IHE Delft. In April this year, we launched an interdisciplinary MSc focused on Sanitation with the generous support of the Bill and Melinda Gates Foundation. 

    I am responsible for the Behaviour Change and Advocacy Module, which I teach alongside a wonderful cohort of practitioners that have experience working around the globe:
    Antoinette Kome, the Global Sanitation Lead from SNV;
    Dr Kamal Kar, the pioneer of CLTS and institutional triggering; &
    Dr Om Prasad Gautam, a behaviour scientist and Global Hygiene Manager for WaterAid UK. 

    I’d like to similarly stress the key messages from this module to everyone gathered here today.
  • In behaviour change programming in the sanitation sector, we traditionally have focused on the USERS and their HYGIENE behaviour in eliciting change.

    Specifically, we’ve focused primarily on HANDWASHING, which we’d encourage via Information, Education and Communications (IEC) campaigns.

    Think about it: How many campaigns have you worked on where toilets were built, and the behaviour programming (if any took place) utilised education/awareness raising to promote washing one’s hands after urinating or defecating?

    In these programmes, we focused on the users, putting responsibility for sanitation behaviours primarily on them.
  • CLTS significantly helped broaden this narrow purview, by also highlighting the importance of LATRINE BUILDING, USE and GENERAL SANITATION DEMAND CREATION.

    Though the focus of change programming again is primarily at the user level, and we are only focusing on the first part of the sanitation value chain: containment.

    While Dr Kar’s new institutional triggering method broadens the purview beyond users by including the critical stakeholders of institutions in sanitation change, I want to highlight that we – as WASH professionals – cannot forget that there are more people and behaviours across the sanitation value chain that are still overlooked.

    Overlooking other actors is ESPECIALLY problematic in the non-sewered sanitation value chain.
  • Take safe emptying of faecal sludge, for example.

    The offensive today commonly comprises of PRIVATE ENTREPRENEUERS (denoted in this graphic in purple), to ensure the safe emptying, transport and disposal of faecal sludge that does not endanger human or environmental health.

    Safe emptying behaviours ARE NOT dependent only on either users’ or private entrepreneurs’ behaviours.

    In this example, you can’t ignore the significant role that GOVERNMENT INSTITUTIONS (depicted in blue) play in helping to develop policies, affordable tariffs or subsidies & standard operating procedures; helping to build business demand and treatment facilities; and crafting regulations for compliance.

    We can’t expect users or private entrepreneurs to do that – as this ties in with the broader sanitation value chain. Without safe emptying, we can’t progress to treatment and ultimately reuse.




  • So this is my first key takeaway message I want to make about extending the playing field:

    To improve the non-sewered sanitation value chain, the ‘offensive’ cannot just be limited to USERS anymore.

    As Rao et al (2016) indicate in this figure, sanitation services involves a diverse range of actors; it’s incredibly complex.

    And various combinations of these actors might be a part of a ‘defensive’ in change programming design.

  • Given the range of behaviours and actors in sanitation programming, we hence have to be very specific when IDing the offensive.
    The offensive will specific to the TYPE of behaviour we are targeting – in particular, its determinants.
    A determinant influences a behaviour. So this means it can be a motivation, an attitude, a norm, a habit, etc.
    Each behaviour has context-specific determinants.

    Given that we’ve focused primarily on users’ handwashing and toilet use, there’s limited research on determinants across the sanitation value chain. So my apologies – the example I’ll use from Simiyu and Winter look at determinants affecting whether HHs clean their shared facilities, or whether women use sanitation facilities.

    The key things to bear in mind here are that there’s a range of determinants. As Dr Gautam noted, It’s important to bear in mind that you can’t apply the same methods for these determinants – even if they have the same outcome (i.e. the behaviour).

    In addition, given the significance of determinants in tailoring targeted behavioural programming, we – as WASH professionals – need to broaden our knowledge of determinants beyond HHs’ handwashing and containment if we truly want to institute change across the sanitation value chain. This is my 2nd takeaway message that I hope to pass on today.
  • And my last key takeaway message I want to make about extending the playing field: we need to adopt more strategies to beget behavioural changes across the sanitation value chain.

    Michie et al of the University College London do a great job of summarising the various interventions we can potentially apply when trying to address behaviour.

    In this figure, we have the behavioural determinants and the behaviour itself in the hub; and it’s surrounded by 9 different types of inteventions we can possibly apply based on policy objectives we adopt.
  • So I want end this presentation by highlighting, WE CAN DO MORE than IEC campaigns to improve sanitation outcomes.

    Aside from extending our target audience, we can tailor change programming according to policy objectives and interventions we determine to be most appropriate for instituting behavioural changes across the sanitation chain.

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