Behaviour change- 2 videos from youtube

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

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

Water supply,sanitation and health- the link

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

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

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)

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

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

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

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

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

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

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

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

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

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

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-

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

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