Hygiene Practitioners Workshop

Improving our programmes for better results

2012-02-06T01:42:00.000-08:00

The 3rd regional sanitation and hygiene practitioners workshop held last week (31 Jan-2 Feb 2011) generated many inspiring and animatedinteractions. And more people have joined the discussions via the Facebook page: http://www.facebook.com/SanHyP

Discussions at the 'Dhaka adda'/ gossip corner

The overarching workshop themes were equity, monitoring and sustainability. Discussions have touched on a range of issues and challenges around these themes.

Equity is the principle of fairness. While many poilicies and WASH programmes aim to reach everyone (women and men, rich and poor, social minorities and majority groups) in practice, many people are left behind. Practicing equity and involves recognising that people are different and need different support and resources to ensure that their rights are realized (Shordt, Da Silva Wells, Krukkert 2012).

Questions related to equity included: Are we reaching the poorest and how can we do better? What could be done to improve menstrual hygiene of girls who are not-in-school? How gender sensitive are ecosan toilets? And how do women use them when they menstruate? How to reach out to men?

Building on the conclusions of the 2010 workshop, we examined a number of monitoring methods which monitor performance and use of facilities, not just counting how many 'improved' toilets have been built.

For sustainability it is crucial that we look beyond construction. Effective hygiene promotion is a key factor for achieving sustained behaviour change. But investments are also needed in ongoing monitoring of toilets and their use,solid and liquid waste disposal at village level, capacity building of local government and local small businesses. The Life Cycle Cost Approach and service levels developed by the WASHCost programme provide a useful framework to analyse spending by government and households on sanitation and the resulting levels of service.

WASHCost research in India, covering more than five thousand households, concludes that capital investments made on sanitation are often going to waste, as the toilets constructed are not being used. Once pits fill up, people often revert to open defecation. In seven out of the 21 villages studied that were declared 'Open Defecation Free', more than half the population did not use a toilet. Read the full paper 'Looking beyond capital costs - Life-cycle costing for sustainable service delivery' here

Monitoring for effectiveness

2012-02-02T22:25:00.000-08:00

There is a huge focus on construction in the WASH sector. Each country wants to meet the Millenium Development Goals (MDGs) and a tremendous increase in toilets is needed. But, construction is not the same as safe use by all family members forever. The Sustainable Sanitation and Hygiene for All (SSH4A) programme has applied a framework for performance monitoring in in 5 countries. This framework collects data on qualitative issues like the use of sanitation facilities by all family members, involvement in decisionmaking etc, and quantitative issues like how many toilets, handwashing facilities etc.
In densely populated or informal settlements, toilets for each household are often not an option. Where they exist, public toilets are often in a horrible state. Successful monitoring and management of community toilets is an area where much can be learned.

Communitee monitoring team, Delhi

Joyti Sharma of and NGO called Force India presented an approach which has been applied succesfully in in 75 slums in Delhi. Community monitoring teams of young women monitor performance of the toilet complexes on service indicators specified in their contract with the municipality. Impacts have been:

- Infrastructure improved drastically
- Community knows what to expect and what not
- Appreciative mode of operation by the monitoring teams helps improve the situation
- Proven scalability and improved sustainability

The paper titled “Improvement in community toilet complex services through community monitoring" can be downloaded here: http://www.irc.nl/page/68112

Service improvement can lead to higher revenues for the operators as well as more satisfied users. In Katmandu, Basnet Manish and Bajimaya Shreya did a survey ofpublic toilets, focusing on the ‘City Service Center (CSC)’ model and mobile toilets operating under a Public Private Partnership (PPP). They concludethat cleaner, more convenient and profitable facilities come from Build,Operate, Own and Transfer (BOOT) mechanisms under a public-private agreements.Successfultoilet complexes have other services/shops in the same complex, as well as agood location for the complex. The private operators are motivated to provide a good service and make a profit too. The paper titled “Study of different modalities of public toilets in Kathmandu Metropolitan City" can be downloaded here:http://www.irc.nl/page/68110

Join us on Facebook!

2012-01-31T19:33:00.000-08:00

Day 2 of the workshop has started. We have lots to share. Stay informed here, and like us on Facebook www.facebook.com/SanHyP so you can help expand the network and bring in more voices!

Can we make toilets spread like mobiles?

2012-01-31T19:24:00.000-08:00

Wherever we go, even to the most remote and poorest areas, people have and use mobile phones. But, we see that the same people still defecate in the bushes or use toilets that are not hygienic. Mobiles have evolved from a luxury item to a common necessity that increases your status. People aspire to having a newer model phone.

But we talk about 'latrines' and promote technologies that are old. Mobile providers use smart, agressive marketing tactics instead and sell different options to different users, old and young, poor and rich.

We need to:

understand what would motivate different groups to build, use and maintain toilets
target our messages better based on this knowledge on motivation and barriers
work on diverse technical options and their costs
provide/promote financing models with incremental upgrading options
strengthen supply-side
support sanitation business models and promote ways that sanitation can bring direct monetary benefits (re-use of waste)

The bottom line is: people will only invest in building, maintaining and upgrading their toilets if they love them. A nice toilet could be part of a more 'modern' life.So we have to be creative, innovative and make sure that the supply can meet felt demands.

Equity the principle of fairness

2012-01-31T09:26:00.000-08:00

Day 1 of the workshop brought many animated discussions, informative presentations and enthusiastic stories about the value of sharing experiences. Some people had been to the workshops in 2010 and 2008 and were motivated to come again, to be inspired and challenged, to network and improve their own practice. For others this is the first time, but their interest to learn and share resulted in lively discussions in small groups.

Equity was the cross cutting theme of the day. Across the region, the poorest are the ones who have the lowest access and use of toilets. Although there are geographic areas where sanitation coverage is extremely low, an analyis of national data done by WaterAid Bangladesh revealed that government programs don't target these areas.

In other words, despite ambitious policies, funds and efforts are often not focused on reaching the poorest and most marginalised groups. There are many questions about how to translate these ambitions into practical actions. A few of the programmes discussed today give some some pointers:

Force, an NGO in India has developed a monitoring approach for community toilet complexes which has helped improve the service provided (cleanliness, timely repairs, operation, transparency and other issues) and increased the community's awareness of their rights and obligations. This innovative and simple monitoring system strengthens the government system and is being taken to scale by the government.

In the ADB-Assisted 3rd Water and Sanitation Sector Project in Sri Lanka, vulnerable groups were identified using indicators prepared by a committee including representation from the local community based organisation and the local authority. Contributions in cash and in labour were made by local households and the poorest who could not provide either were sponsored by local 'well wishers' and the project to purchase labour from others in the community.

By all and forever

2012-01-24T09:31:00.000-08:00

It's been silent on this blog for a while. But that is going to change soon...We're getting ready for the 3rd Asia Sanitation and Hygiene practitioners workshop. This one builds on our collective learning and documentation in the 2008 and 2010 workshops and focuses on improving sustainability, equity, monitoring in Water Sanitation and Hygiene (WASH).

The workshop will be held from 31 January to 2 February 2012 in Bangladesh. Over 50 professionals from the region, from NGOs, universities, research institutes and government, will participate in this interactive event. We'll be exploring questions like: What have we learnedabout moving beyond construction to a focus on sustainable facilities andhygiene behaviours? What does it take to make sanitation a sustainable service? How to reach vulnerablegroups in practice and ensure equity in our programmes? Do we achieve what we aim to achieve and what monitoring frameworks and tools help us measure that?

Over 23 papers have been submitted and more photostories and practical lessons will be shared at the workshop. The papers can be accessed at http://www.irc.nl/page/68058

Behaviour change- 2 videos from youtube

2010-02-07T18:38:00.000-08:00

As I reflect on the workshop I am struch with how challenging achieving behaviour change is

The first video is from the Total Sanitation Campaign effort from a village in Gujarat, rehabilitated after a major earthquake there. A young man explains that though have built the toilets in each house, the men prefer going out in the open. Younger children go to school but follow their elders in going out in the open for defecation

http://www.youtube.com/watch?v=QpFuS9FUwsY

and the second is from a group working on AIDS which explains the theory of behaviour change with smoking as an example

http://www.youtube.com/watch?v=czHdKyfWNI0&NR=1

A study in Ghana -Of interest to hygiene practitioners

2010-02-07T05:34:00.000-08:00

http://www1.voanews.com/english/news/africa/decapua-ghana-sanitary-protection-1feb10-83245322.html

Water supply,sanitation and health- the link

2010-02-05T07:07:00.000-08:00

For researchers on the causal link between water supply, sanitation and health a word of advice from K.J.Nath ex-head All India Institute of Public Health Engineering

Water supply and sanitation improves health is a truth, unless you try to prove it

http://www.youtube.com/watch?v=Pg5oPiFre9M

Dhaba discussions

2010-02-03T23:58:00.000-08:00

Most interesting discussions in workshops also occur in informal spaces, as this one near the tea stall ( a roadside dhaba) involving Bangladesh, Nepal, Bhutan and India ( as a listener) shows

http://www.youtube.com/watch?v=ry9LwWRG9sM

What did the workshop mean to me? Concluding session

2010-02-03T22:20:00.000-08:00

John - The issue of gender has been re emphasised will take this back to Bhutan

Tom P. - The amount of good work by various groups is heartening. I will be the thread that links these flowers to become a garland

Andy - Bumblebee and a need to get more involved...with hygiene projects

Joep - I will break the silence on menstrual hygiene wherever possible

.. Menstrual hygiene issue will be highlighted and action initiated, reiterated for schools.

In this workshop I have learnt many ideas...that everybody is sensitive to menstrual hygiene issues is wonderful

I work on livelihoods-social development component especially handwashing, handwashing is so crucial I am proud now of my work...

Hygiene promotion is important and menstrual hygiene is the area to focus on

I will not do anything new but to do things better- Hygiene promotion framework-being developed by Wateraid will be enhanced

School hygiene is the area I will take forward

I will carry with me the image of a 12 year old girl crying and a brave woman carrying forward menstrual hygiene improvement programme

Will take to Pakistan- to a part which is a traditional society- a partnership potential with India on hygiene issues.

This workshop will play the role of a bridge between practitioners and community.

I will focus on hygiene promotion activities very,very seriously..

Ingeborg- Learnt from the mistakes told by others...will work on Hygiene promotion for men..

Context and purpose..the importance of context and the need to bring improved behaviour.

Carolyn- How can we improve our hygiene networking across groups in the world. Hygiene promotion in Stockholm,World Water week will try to raise the issue... and will work on my mental and emotional hygiene :)

Will help colleagues who are working for Hygiene for men and soap facilities for hygiene for schools.

Monitoring hygiene is crucial ..this has helped me. The momentum building on menstrual hygiene will be reinforced...

Learning perspective for me because I am from a engineering background...review monitoring framework and particularly health impact indicators- behaviour indicators.

Our work is like religion..providing water ,sanitation,hygiene...we work for people..will keep up the work

Lyn- Thanks for inviting me for a South Asian conference. WASH Phillipines coalition and South Asian practitioners will be linked ...will continue documentation of home and personal hygiene practices of over 100 ethnic groups of the Phillipines

Mariya- feedback for my paper helped in developing action plan. Last workshop was helpful...whatever message we need to give , we need to be effective...communicate message at different levels.

Dr Babar - Organistational view- will work within BRAC and ensure better facilities for women staff

Will develop a simple economic model to understand the link between health and hygiene

Am happy with the Public health aspect of the workshop...and will incorporate ideas in the ongoing programme of Water aid in Nepal

Evaluation of Watsan programmes is what i work on ..and have understood the context better..

Nga Kim Nguyen-Will use new media....

Revising the hygiene promotion strategy of organisation -- National hygiene promotion strategy (supporting government)...the workshop will help me improve my content for this.

Hygiene is the business of all - UNICEF- will use the programme to strengthen my work

Will use workshop knowledge to strengthen Wateraid Bangladesh work.

From BRAC ...my school sanitation programme work will be strengthened since I understood the importance

Disaster Environment- climate change- hygiene promotion ..will work on the linkage

Will work on Men's hygiene promotion and progress from the learnings

I have 2 daughters...I am more aware of menstrual hygiene and my field area i will implement what I have learnt..

Will work on M.H. in school and community...

Riaz- The task ahead is to establish a school-community group for effective hygiene promotion

Practice hygiene ourselves ...and taking lessons from personal to political is important..

Menstrual hygiene project (Hindi)

2010-02-03T21:04:00.000-08:00

Mariya John Fernandes, Wateraid , was asked to speak again to the whole group on the specific project taken up in Chattisgarh . The project looked at menstrual hygiene beyond simply the production of sanitary napkins. Here is her talk in Hindi this time for a more local audience

http://www.youtube.com/watch?v=5xavHSFuQ8M

Alliance for diarhoea prevention and management- India

2010-02-03T09:42:00.000-08:00

An interesting initiative with USAID with a very specific focus, to reduce the incidence of diarhoea in children less than the age of 5 years.

Depinder Singh explains in this video

http://www.youtube.com/watch?v=DzX1f6ghbU8

The 'Shiree' project- A DFID Govt of Bangladesh initiative for economic empowerment

2010-02-03T09:07:00.000-08:00

The Shiree (steps) project (www.shiree.org) seeks to lift households out of poverty.

It believes that without economic empowerment good hygiene practices cannot be sustained.

As the website states

In partnership with the Government of Bangladesh, the UK Department for International Development (DFID) has allocated 65 million British Pounds (about USD$130M) over 8 years (2008-2016) to establish and operate a Challenge Fund for the Economic Empowerment of the Poorest (EEP). The programme will focus particularly on the poorest 10% of households that other initiatives are still working to reach. The programme is a major component of DFID's portfolio of activities designed to reduce extreme poverty and vulnerability to climate change and disasters.

A small video of the presentation is here

http://www.youtube.com/watch?v=AFElyPOR1Do

Freedom of mobility: experiences from villages in the states of Madhya Pradesh & Chhattisgarh India

2010-02-03T01:01:00.000-08:00

Author: Mariya John Fernandes, Wateraid India

Maria discusses the issue of menstrual hygiene and how an experiment in Chattisgarh where women have got together to spread awareness and even make sanitary napkins themselves.

They have also worked towards designing toilets which dispose the napkins with privacy and dignity....using a sanitary pit which bio-degrades

The original paper is here http://www.irc.nl/page/51700

The video of the presentation made by Mariya with the Q and A session is here

Part 1 : http://www.youtube.com/watch?v=hTbAzHFt1t8

Part 2 : http://www.youtube.com/watch?v=x3wPC6ObjZ8

and

Part 3 : http://www.youtube.com/watch?v=OkaBgvVAyoI

Q and A and discussion

Is there a direct causal link established between reproductive tract and urinary tract infection and pond bathing?

Anecdotal evidence but no causal studies. Detailed studies needed.

Since menstrual health is not only about sanitary pads/napkins but also availability, disposal systems, etc etc what are the systemic interventions needed?

Knowledge, awareness, availability of products, disposal mechanisms many things needed . One intervention not enough.

How do we begin?

Let us look at our work places Govt. academia NGO's . Do we provide such facilities? Let us begin the change ourselves. In schools let us make sanitary facilities for availability of products/ disposal facilities and privacy all available. Think comprehensive and think with girls/women.

It was Bangladesh which spurred me to take this up in India.

Social taboos and breaking the silence is crucial. Start policy level debates, look at universal education if girls drop out during adolescence. Policy level debate is very very important. In Nepal also such work has begin.

The sanitary pads in Chattisgarh are bio degradable. They use cow dung and are able to compost it in two to three months.

More knowledge and open discussion including physiology of women...this has to happen.

Ignorance is widely prevalent on what is used to manage menstrual periods. Cloth, straw, ash, mud is all used.

Addressing adolescent girls is crucial.

Study on perception and practice of hygiene and impact on health in India- K.J Nath et al

2010-02-02T19:51:00.000-08:00

The full paper is here

http://www.irc.nl/page/51614

Snippets from the presentation by K.J.Nath on youtube is here

http://www.youtube.com/watch?v=5z5_MgLqO7c

Q and A

Related to only survey as a methodology rather than survey plus observation which would be better?

Prof Nath clarified that perception issues were based on survey questions but practices were observed ...

Can people remember disease incidence 6 months down the line?

Is not the season of the survey (winter/ monsoon) important for findings?

Interview with Kathleen Shordt

2010-02-02T05:59:00.000-08:00

Kathleen Shordt is well known in the wat-san and hygiene circles as an indefatigable worker

Here is Joep Verhagen -IRC conducting an interview of her at the Hygiene Practitioners Workshop

The video is in two parts , primarily because the time of the conversation is more than 10 minutes

http://www.youtube.com/watch?v=T_hELROwixY

and

http://www.youtube.com/watch?v=9wFpDwFVQLs

Watch and reflect what it means to bring behaviour change

Lessons from the breakout sessions

2010-02-02T02:51:00.000-08:00

The papers are here

http://www.irc.nl/page/51774

1. Use mass media

2. Look at traditional practices of communities (Bhutan learns from the Phillipines paper)

3. Great that NGO and Govt. works together

http://www.irc.nl/page/51605

1. The burden of disease in urban areas is twice that of rural areas

2. The DSK model is being scaled up by government

3. The DSK engine of growth is the' stay at home' women...these women lead the hygiene and sanitation campaign in the slums

4. The biggest challenge is migration of slum people away from the slum

5. Hardware are the motors for the software...

1. Coverage is pretty low

2. Data management is a challenge

3. Union Parishad is involved but lots of efforts still neede

4. Waste management in h.h and schools is not comprehensive enough

5. Community led technology like cheap canisters need to be considered.

1. BRAC programme 40,000 committees have been formed and leadership training given.

2. These groups are well represented

3. Does the committee do hands-on hygiene promotion? Other sub groups do the project the committees do the monitoring.

Beyond traditional KAP surveys-need for addressing other determinants of behavioral change for more effective hygiene promotion

2010-02-02T00:28:00.000-08:00

Mohammed Riaz, one of the authors, made the presentation ...

The paper is here ..http://www.irc.nl/page/51668

Q and A

Homogenity of what?

The community, socially- not economically- if homogenous has a higher capacity to receive messages through community systems. Urban areas need mass media information.

Measuring hand washing behaviour : methodoligical and validity issues

2010-02-01T22:01:00.000-08:00

Lisa Danquah - author makes the presentation

The full paper is here http://www.irc.nl/page/51625

Self reporting over reports hand-washing...based on structured observations

Field workers can provide useful information of design tools.

Q and A

Structured observations may itself influence behaviour of people

People filled in a consent form for observation

24 hour recall survey- have you used soap for the last 24 hours? For what purpose- washing clothes, bath, hand washing etc etc...

When observation at scale costs a lot such as in a 10,000 questionnaire survey this tool can be very useful...24 hour recall survey.

How do you reduce observer bias...study over a longer time frame...

Micro-biological assessment of say fingertips can also be used...but is costly and difficult..

Can you bring soap please? If it is brought within a minute it is likely being used...if not, not.

Household questionnaire may be more useful rather than individual questions...may be less over reporting.

A case study from the Phillipines- home hygiene

2010-02-01T21:22:00.000-08:00

Lyn Capistrano- Author- makes the presentation

A study on personal and home hygiene and safe water storage in the Phillippines

The paper is here www.irc.nl/.../Capistrano_PCWS_Study%20on%20personal%20and%20home%20hygiene.doc

The paper studies the Bicol ( http://en.wikipedia.org/wiki/Bicolano_people) and Waray http://en.wikipedia.org/wiki/Waray_people) people- indigenous people of the Phillippines.

The sun as a disinfectant- people bask in the sun, let in sunlight through windows.

Family centred home hygiene, sweeping the home regularly, hanging flowers in windows.

House raised with plinth to allow flood waters to pass.

Houses built with local grass and thatch, easy to rebuild after typhoon and earthquake, no hazard of heavy roofs falling and killing people.

Courtyards are swept daily and certain fallen dry leaves burnt in a corner daily to dry away mosquitoes and bugs from the home/house. The smoke also induces flowering and fruiting of certain trees.

Home hygiene is about mental and emotional hygiene. Home with harmonious relationships i very, very important. 3 generations usually live is such homes and still live harmoniously.

Taking bath, hand washing, brushing teeth, cleaning beds, getting a massage from other family members , clean sanitation.

Personal hygiene means keeping the mind and emotions clean...wonderful :)

Hand washing is a ritual since people eat with hands (rice,fish et al) and the eldest washes hands first , followed by younger people.

Local fruit is used as soap to remove smell of fish from hand and to remove bacteria too.

The food requires a lot of souring to cook fish which comes from the native fruits.

For dental hygiene guava leaves are boiled in water and used as mouth wash. Salt is also used to clean teeth plus as a gargle.

Coconut oil is used for hair growth and moisturise the skin.

Recommendations

1. Document home hygiene practices of other indigenous people and knowledge.

2. Build upon local knowledge and hygiene practices of indigenous people

3. Promote partnership between local people,local knowledge,NGO's, govt. to take forward WASH practices amongst indigenous people.

Andy Peal - Laying the foundation

2010-02-01T19:50:00.000-08:00

Hygiene promotion is the answer. One of the most cost effective interventions for reducing mortality and morbidity.

The big 3 - Hand hygiene and personal hygiene, safe disposal of faeces, safe storage of water.

Hygiene is most closely linked to MDG 4. Under five mortality rate...this has been declining steadily which is the good news.

MDG-4 is not likely to be met.

Maldives, Sri Lanka ..will definitely achieve this though.

Vietnam and Phillippines are well ahead...

Challenges to achieve MDG -4 and better hygiene practices

Cultural differences and context

Inappropriate institutional arrangements

lack of financial transparency

Lack of political will

Political instability

Natural disasters

Measure of success of WASH programmes- Should it be cost effectiveness based or rights based?

Issues for discussion

How to convert knowledge to practice?

Scaling up

Transparency-cost effectiveness

Linkage between hygiene and other sectors

Awareness of menstrual hygiene management

Who should carry out the intervetions?

Govt. NGO's both...??

Resource constraint is a huge challenge - ...from BRAC

Morbidity , especially among children, is a huge underlying iceberg below the sea...the tip is mortality ...intervention from Pakistani delegate

Sustainability of behaviour change...how is that to be monitored and understood...Richard Carter

It is also difficult to isolate the benefits of hygiene promotion...exclusively, as opposed to say nutrition improvements...that is a challenge before WASH practitioners...

Introduction and Ice breaker session-

2010-02-01T19:38:00.000-08:00

Participants introduced themselves and there are at least 8 countries here. Field practitioners, academics and support staff.

The ice breaker session was led by Carolien from WSSCC . Very interesting and the highlight of the sssion - two groups divided by those who had never defecated in the open ( a very very small group) and those who have - the vast majority.

When not a daily occurrence , a pleasant experience according to many.

Nepal's 3 representatives were distinctive as were the lone reps from Bhutan, Vietnam and the Phillippines. The Indian delegation with 4 people was quite small too...but that is O.K.of

The coordination and hospitality by BRAC is simply wonderful and all participants are well taken care of . This helps people concentrate on the work at hand.

Hygiene Practitioners Workshop Feb1 -4,2010, Rajendrapur

2010-02-01T19:16:00.000-08:00

The workshop officially began in the evening of Feb 1 4.00 p.m. A small inauguration session followed by a cultural presentation which included interesting street plays

This blog will now start to capture some interesting vignettes and ideas as they emerge through the next 3 days.

There will also be twitter postings, face-book postings and you tube videos.

The twitter hash handle is #RWHP

http://www.youtube.com/watch?v=3qViR-mwBOA&feature=player_embedded

and

http://www.youtube.com/user/zenrainman2#p/a/u/0/j1anSIkbVpE