Handwashing behaviour change in Nigeria

Intervention design, outcome evaluation and comparative analysis of handwashing promotion approaches in a large-scale sanitation promotion programme
Water Supply and Sanitation Collaborative Council and London School of Hygiene and Tropical Medicine

Previous Think Tank

Little hard evidence on handwashing promotion programmes that work at scale. Lack of evidence on how to effectively integrate handwashing promotion into sanitation promotion interventions

WSSCC: aims to contribute to sector knowledge gaps through learning and applied research partnerships
Global Sanitation Fund: targets large numbers of people to attain saniation and hygiene making it their choice

GSF results overview 30 June 2013

Common GSF programme features

Working at scale in entire regions Supporting existing, successful approaches CLTS solutions or local equivalent Participatory hygiene promotion

Sanitation marketing Creative use of media Mobilizing local government

Collaboration and leveraging other resources

Learning and sharing agenda

Partnership with LSHTM Objectives

To increase sector learning and performance by generating and documenting rigorous evidence for the effectiveness of 1 or more interventions that could be used to promote handwashing with soap at scale in the context of a sanitation intervention. To develop and demonstrate an effective intervention for promoting handwashing with soap at scale in the context of ongoing sanitation promotion through community led total sanitation (CLTS) in Nigeria.

Sanitation and handwashing in Nigeria

National Strategy to achieve Total Sanitation Key approach: CLTS Some states introduced HIF, with help from UNICEF

Very little data on handwashing, but part of ODF verification

Communities practicing safe water handling at home.

ODF protocols and indicators

By-laws imposed at Local Government/community level to prohibit OD The community must be visibly clean no garbage or flies

X X X X
X X X X

X X X X X

Secondary Indicators

All latrines must have sanitary bins All latrines must have a tight fitting cover

X X

Institutional WASH facilities (schools and health centres) must also be present

WASH Committee, Community Action Plan and/or other community M&E structure present Each member of the community understands the need to contain excreta

Each household has access to a shared latrine Childrens faeces are disposed of effectively

Each household has access to HWWS facilities All latrines must be fully functional and clean Each household has access to their own latrine Environment is completely 100% ODF

Chad Cote dIvoire Ethiopia Ghana Kenya Madagascar Malawi Mali Mozambique Niger Nigeria Sierra Leone Somalia (proposed) Togo Country

Source: Bevan & Thomas, 2013

X
Primary Indicators

X X X X X X X

X X

X X X X X X X X

X X X X X

X X

X X X

X X

X X

X X X

X X

Questions
How many behaviours can one change at once? How to time a handwashing intervention vis-a-vis CLTS? How to design an intervention for scale? For habit creation?

RUSHPIN
Aim: serve as catalyst to achieve first two ODF states in Nigeria Benue state: 3+3 LGAs (Agatu, Gwer East, Logo) Crossriver State: 3+3 LGAs (Abi, Bekwara, Obanliku) Target: 90% handwashing at critical times
Executing Agency: Concern Universal Implementing Agencies: LGA WASH Units, State level Rural Water and Sanitation Agencies

Design
Use Super Amma experience Design an intervention that can be integrated into delivery and budgets of current interventions Do a trial run within 1 LGA, with three arms:
CLTS triggering and follow up CLTS triggering and follow up + HIF CLTS triggering and follow up + intervention

Opportunities and challenges

Most LGA WASH Units have a Senior Health Extension Worker often leading Frequently mentioned challenge: Absense of clear, reliable and affordable monitoring indicators and methodologies that can show progress in behaviour change over time and can easily be incorporated into programme design and follow up

Thank you!

Carolien.vandervoorden@wsscc.org www.wsscc.org