WASH 2011 conference: Dr. Christine Sijbesma, IRC

1. Planning Behaviour Change: Chances and Challenges Dr. Christine Sijbesma, IRC 1 Illustration: NEWAH, Nepal

3. A hand pumps program costs US$ 94

4. Promoting basic sanitation costs US$ 11

5. Promoting hygiene costs < US$ 52 Session 1A2C – Planning for sustainable behaviour change

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) Session 1A2C – Planning for sustainable behaviour change 3

7. But: Impacts on health need a CRITICAL MASS of good practices! 4 Session 1A2C – Planning for sustainable behaviour change

8. Practical Planning Tool: FOAMS (adjusted from WSP) 5

9. Focus practices WHAT to practice? Handwashing + soap lessens diarrhoea 45%, ARI 23%, neonatal death 40-44% . Substitutes also work (Hoque et al, 1995) 2) Toilet use ->32% lower diarrhoea (WHO, 2008) Safe drinking water chain management : 35-47% reduction diarrhoea (UNICEF, 2008) Under-researched: infants’ faecal-oral chain management 6

10. Focus Groups : WHO to practice? HWWS: esp. caregivers of children under five (mothers/grandparents) and birth attendants Toilets: men, children under 12 and adolescent boys ‘ since women, adolescent girls use most Safe drinking water chain management – source to cup: women primary role , men gender support role Under-researched: caregivers infants’ faecal-oral chain management (Cairncross et al 2010) Session 1A2C – Planning for sustainable behaviour change 7

11. Opportunity: WHEN can practice? 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 8 Session 1A2C – Planning for sustainable behaviour change

12. Ability: How will they practice? 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 9 Session 1A2C – Planning for sustainable behaviour change

13. Motivation: WHY practice? 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 10 Session 1A2C – Planning for sustainable behaviour change

15. At longer interval 2 of 25 dropped significantly

16. Access to water made no difference

17. Better educated women= better practice

18. In India men sustained HWWS and toilet use less than women, yet most programs targeted women SEUF 11

19. Five key lessons FOAMS analysis of cases at Hygiene Workshop Melbourne 2010 : Know your Focus Groups Prioritise Focus practices and avoid overload Ensure Opportunity for change at community & institutional level Motivate good behaviours through all drivers. Health is “Mekka”, but many roads lead to it - Health goal itself is seldom a strong trigger Determine if practice is Sustained 12 Session 1A2C – Planning for sustainable behaviour change