AfricaSan 2011, Rwanda: Behaviour change session - Julia Rosenbaum, WASHplus Project in Ethiopia, USAID
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The document discusses hygiene and sanitation improvement efforts in the Amhara region of Ethiopia using community-led total sanitation approaches. A mix of community-led and household innovations were applied to improve WASH practices and reduce diarrheal disease while strengthening health systems. The program was embedded in Ethiopia's national hygiene and sanitation strategy and health extension program and emphasized community participation, behavior change techniques like shame walks, and capacity building of local cadres. Evaluation found improvements in sanitation access and handwashing knowledge from baseline to endline surveys.
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AfricaSan 2011, Rwanda: Behaviour change session - Julia Rosenbaum, WASHplus Project in Ethiopia, USAID
- 1. 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
- 6. Negotiation of Improved Practices or Small Doable Actions
- 8. Practices: Access to Sanitation Facilities Baseline-Endline Comparison: All Respondents **Source: Amhara LBD Evaluation Report, USAID/HIP-WSP/WB-AF, November 2010
- 9. ETHIOPIA Knowledge of When to Wash Hands 2008 Baseline 2010 Endline Survey
- 10. Presence of HW Stations at Latrines 17% 16%
- 11. 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
Editor's Notes
- 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