improving hygiene at scale madagascar may to november 2005
TRANSCRIPT
Improving Hygiene at Scale
Madagascar May to November 2005
Overview
DefinitionProcessCharacteristicsResultsSteps
HIP is:
• a 5-year USAID-funded project (until 2009), • led by AED, partnered with ARD, IRC
Netherlands, and Manoff and resource-partnered with Aga Khan Foundation, Hindustan Lever and IRC NY,
• designed to achieve at-scale hygiene improvement
• in 5 countries and through selected, strategic activities,
• which are centered on the key hygiene practices of hand washing, safe feces disposal, and water at point-of-use.
• At-scale country implementation• Integration of hygiene into health and non-
health platforms• Global leadership and advocacy around
hygiene improvement• Support and liaison to PVOs, NGOs, and
networks• Knowledge management to share best
practices
through 5 key tasks:
What is Scale?
Coordinated actions of all stakeholders working on a common goal to the benefit of
large numbers of affected people that significantly reduce disease rates.
Process
Reduce Diarrheal
Disease in Madagascar
1. MAP
3. STRATEGIZE5. MONITOR
6. VALUE
4. ACT
2. PARTNER
1. Map the context & detail the stakeholders in all sectors, the levels at which they work, the networks & relationships that already exist & examine patterns of individual &
institutional behaviors.
2. Leverage partnerships, strengthen
existing networks & relationships, & create
new, non-traditional ones.
3. Develop a common goal &
delineate a behavior change
strategy.
4. Implement activities & interventions detailed in the
strategy around the common goal in a concerted & overlapping way.
5. Track the progress of
interventions to make adjustments,
adaptations & changes as
needed.
6. Assess the outcomes & impact of the scale effort.
Characteristics of a Scale Effort
A. Considering Behavior FIRST is key.
B. A principle of Multiples is fundamental.
C. A Systems-Approach is instrumental.
D. Institutionalization is essential.
E. Intervention types needed are based on the Hygiene Improvement Framework.
F. Both quantity & quality define Coverage.
A. Behavior First
• Focus on improving key individual hygiene practices:– Hand washing with soap– Safe feces disposal– Water at point-of use
• Identify, promote and facilitate improved practices that people are willing and able to practice
• Design program interventions that motivate and facilitate these improved practices
B. Multiples
• Multiple interventions
• Multiple levels
• Multiple stakeholders
• Multiple options
C. Systems-Approach
Emphasize:• Relationships and
patterns of behavior• that a small event in 1
sector can have a tremendous impact elsewhere
• key influence points
Examine: • the WHOLE• relationships• degrees of freedom• mainstreaming• commonalities• opportunities
D. Institutionalization
What is Institutionalization?• Institutions are any organized stakeholder group, e.g.,
government, schools, clinics, NGO’s, CSOs, CBOs, faith groups
Institutionalization is:• More than the sum of training, and/or implementation of
field activities• Institutional policy adjustments, human resources,
budget and integration commitments sufficient to ensure continued support for activities “political will”
• Heart of program sustainability and the behavior change sought at the institutional level “making something a new routine”
E. Hygiene Improvement Framework (HIF)
Intervention Types:• Communication• Social mobilization• Community participation• Social marketing• Training
HygienePromotionIntervention Types:
• Water Supply• Sanitation systems• Available Household
Technologies and Materials
Access to Hardware
Intervention Types:• Policy improvement• Institutional strengthening• Financing and cost-recovery• Cross-sectoral coordination• Partnerships
Enabling Environment
Hygiene Improvement
Diarrheal Disease Prevention
F. Coverage
QUANTITY - Scale because of:
• Health impact realized
• Total population covered and/or
• Geographic area(s) covered
QUALITY - Sustainable because of:
• Intervention concentration
• Activity saturation• Systems interaction• Institutionalization
realized• Behavioral impact
achieved
Well Construction
Handwashing Promotion
Latrine Construction
Hygiene Advocacy
Traditional Coverage
Focus on Geographic and Population Coverage
Scattered, dispersed, stand-alone
Scale CoverageConcentrate, saturate,
interact
Using a systems-approach, focus on Geographic Area, Population, AND Multiples.
Wells Handwashing Latrines Advocacy
Appropriate Approaches to Promotion
Needed Infrastructure, Products, & Services
Supportive Environment
Ensuring all the necessary elements, increases
likelihood of behavior
change and the sustainability of
the practice.
Maximum potential for
change exists here.
Increase the Likelihood of Improved Practice Adoption
& Sustainability
Results
• Increased #/% of targeted audience adopting and sustaining key improved practices
• Reduced # of diarrheal diseases cases (morbidity)
• Reduced % of children under 5 dying of diarrheal disease (mortality)
• Preparation – (1) map, (2) partner, (3) strategize
• Implementation – (4) act
• Monitoring – (5) monitor
• Valorization – (6) value
Steps
Prep Activities
• Mapping• Coverage determination• ‘Whole system in a room’ process• Formative research • Behavior change (BC) strategy
development• Effort index design• Resource identification
Implementation
• Systematic roll-out of hardware, promotion, and enabling environment interventions
• Assistance in implementing “mix” of behavior change approaches
• Technical assistance
Monitoring & Valorization
Monitoring•Roll out on schedule•Coverage and overlaps happening•“Must do’s” occurring
Valorization (interim, yearly and final):•Sustainability•Integration•Partnerships•Improved practices•Desired impact
Timeframe
• Preparation – 8 to 15 months
• Execution – 1 to 3 years
• Monitoring – during execution
• Valorization – at least yearly during execution and at “end” of effort
TOTAL Length Required – 3 to 5 years
Scale Effort Preparation
Solid Preparation is ESSENTIAL!
What must we know to get started?a. Context
b. Present Partner Roles and Responsibilities
c. Acceptable Geographic Coverage
d. Behavior Change Approaches
Context
• WHAT – Understand the setting in which the effort will take
place
• WHY– Take a systems-wide look to effectively assess
options and implications of decisions
• HOW – Mapping:– Geographic– Dimensional– Associative
Issues to Map• Water sources, access, quality & supply• Sanitation access, quality & supply• Partner areas of intervention & activities• Partner relationships• Geographic location of institutional staff and kinds of
interventions• Geographic areas of greatest need including health and non-
health platforms• Existing infrastructures, e.g. clinics, churches, etc.• SES indicators, e.g. income, gender, etc.• Geographic areas and capabilities of ancillary agencies, e.g.
universities, colleges, market places, roads, railroads, schools, etc…
• Market paths & streams per needed product• Communication channels and patterns of influence• Donor program support
Map Relationships
What needs to be examined?
• Existing partners/ships
• Communication between these partners
• Potential partners/ships
DRC – Before: Stakeholder Relationships
SANRU
MOHMOW
Health Ctrs
DistHealth
Village Chiefs
USAID
Mobilizers
DistWS
Water Cmt
Village Cmt
DRC – After
MOWMOH USAID
SANRU
Water Cmte
Health Ctrs
Mobilizers
DistWS
EZdS Village Chiefs
MOE
3 NGOs
2 CSOs
DANIDAWB
DistEd
DistHeatlh
MOEnv
DistEnvVillage Cmt
WEPIA Map at Start
Ministry of Water
WEPIA
+
3 People
JES/NGORSCN/NGO
USAID
Funding
WEPIAAED/COP +
3 staff
2 NGOs
US Study Tours
USAID Funding
Grant Agreements
3 Engineers
Media Specialist
US Experts
Web-BasedCurric. /CD Dev.
Private Schools
& Teachers
Ministry of Education
Curric. Reform
In 5 subjectsGrades 1-11.
Ministry of Water
Coordination
WDM Intrnt’l Conference—
Municipal/ProvincialOfficials
Faith-BasedSchool
Systems
Students in 23 private schools
5,000 home audits
Teachers in 5 gradesIn 23 pvt.schools
68 NGOs capacity bldg.
B.A degree program in Non-profit
manangement
US Indiana UnivPhilanthropy Dept..
Municipality PrivateSector Policy Changes
in Agric./Outdoor Use of Water.
Policy changes construction code
Ministry ofPublic
Works & Housing
SaleswomenOf water saving
devices
PlumbingPolicy
JISM
CSBELandscaping for six public demo.
parks
10 USUniversities
JUST Univ. Master’s Program /
Munic. YouthTraining
ArtMuseum
Municipality
Women’sNGO
VocationalSchool
CurriculumPlumbing trng.
10 USAgencies
AWWA
IWRA
Utilities
H.M.Office—
King
Ministryof Religious
Affairs
Imam trng. &Mosque
Programs
WaethatMosque Prog.
OutreachVocational
School
Water AuditsTraining—
Renovation of 760 Bldgs & All
Public Ministries
Munic.Mayors programIRC Private
SectorEval. Firm
Ministry of PlanningGrants
9 Governors &Eng. Staff
CommunityGrants /95 CBOs
MajorBroadcast &
PrintJournalists trnd.
Ref. materials
Press Releases /Materials
Int’lJournalists
RegionalJournalists
Ad AgencyMedia
Campaigns
Aqaba Economic
Zone AqabaSchools Busines
sindustry
Teachers
JREDS
Women’s Groups
Youth Groups
Shigera village& 5 community
Buildings renovated
ProvincialGovernor/Municipal
Mayors/municpalengineers
Philadelphia Univ.for NGO trng.
Env.NGO RSCNCurric. Dev.
WEPIA Map atEnd of Year 5
Map Interventions
1. Infrastructure2. Products3. Mass media4. Print materials5. Interpersonal
communication6. Traditional
communication7. Training8. PHAST9. Social Marketing
10.Community/social mobilization
11.Policy12.Advocacy13. Institutional strengthening14.Financing15.Cost Recovery16. Inter-sectoral coordination17.Public/private partnerships18.Other
What needs to be detailed?
Socios Departamentos / Provincias
MINSAEstrategias nacionales de promoción de la salud
Banco de Crédito (Programa Escolar)
Programa Escolar a través de colegios de Fe y Alegría
Backus - Programa escolar propio
Programa de Liderazgo - Lima, Chiclayo, Trujillo, Pucallpa, Arequipa y Cusco
Banco de Materiales – Mi Barrio
Programa de Mejoramiento Distrital en 10 Regiones
CARE
Programas de Promoción de la Salud: Ancash, Ayacucho, Cajamarca, Callao, Lima, Loreto, Piura y Puno.
Colgate Programa Escolar en Lima
Ebel Venta directa de cosméticos
Cuerpos de PazVoluntarios en trabajo comunitario: Salud y Medio Ambiente
PrismaONG: 70 Talleres para profesionales de salud y profesores
Scouts del Perú Cruzada Scout
Intervention TypeInterpersonal Communication
October 2005 – December 2006
What is a Partnership?
• A relationship where two or more parties, having compatible goals, form an agreement to share the work, share the risk and share the results
• The sharing of decision-making, risks, power, benefits and burdens and adds value to each partner's respective services, products or situations
• Give and take
Partnering – Who & How
WHO:• Start with stakeholders directly related to issue—water &
sanitation, health & hygiene, private & public, donors & implementers
• Expand to (systems-approach): – other channels of influence, e.g. faith-based groups, women’s
groups, local & national associations, farmer’s groups, youth groups
– groups with potential long-term impact, e.g. schools– all possible information channels, e.g. journalists
HOW:• Make individual relationships within these groups not just
institutional relationships. • Treat each group with respect.
Partnering – Systems Examination
Examine the systems and ask:
“What needs to be done to turn you into a partner with an active or passive influence on the targeted
audience?”
Training? Institutional strengthening? Capacity building? Expansion of reach? Other?
Partnering – Roles & Responsibilities
As Effective Partners, What Must We Do?CommunicateCollaborateCoordinateCompromiseCombine
WHY to ensure scale coverage and overlap of hardware, hygiene promotion, and enabling
environment interventions (HIF)
Acceptable Geographic Coverage
How does the partnership choose its intervention zones? • Examine appropriate, relevant statistics:
– Number of children under 5– Diarrhea disease prevalence in under 5s– Access to water– Access to sanitation
• Detail geographically where partners are working
• Using “interventions maps,” examine what types of interventions partners are carrying out where they work
Province de Antsiranana:- Pop = 1,888,425- < 5 ans = 8%/151,074- < 5 ans PdD = 8%/12,86- Accès à l’Eau = 12%/283,264- Accès à l’Assainissement = 28%/528,759
Province de Toamasina:- Pop = 2,593,063- < 5 ans = 18%/466,751- < 5 ans PdD = 11%/51,323- Accès à l’Eau = 19%/494,682- Accès à l’Assainissement = 42%/1,089,086
Province de Tana:- Pop = 4,580,788- < 5 ans = 27%/1,236,813- < 5 ans PdD = 7%/86,577- Accès à l’Eau = 41%/1,878,123- Accès à l’Assainissement = 77%/3,527,207
Province de Fianarantsoa:- Pop = 3,366,291- < 5 ans = 18%/605,932- < 5 ans PdD = 6%/36,355- Accès à l’Eau = 18%/605,932- Accès à l’Assainissement = 30%/1,009,887
Province de Mahajanga:- Pop = 1,733,917- < 5 ans = 12%/208,070- < 5 ans PdD = 11%/22,888- Accès à l’Eau = 20%/416,140- Accès à l’Assainissement = 20%/346,783
Province de Toliara:- Pop = 2,229,550- < 5 ans = 17%/379,024- < 5 ans PdD = 21%/79,594- Accès à l’Eau = 26%/579,594- Accès à l’Assainissement = 16%/356,728
Madagascar Stats
Province of Antsiranana: - # of players in W = 10- # of players in S = 1- # of players in H = 5
Province of Toamasina:- # of players in W = 21- # of players in S = 20- # of players in H = 12
Province of Tana:- # of players in W = 20- # of players in S = 17- # of players in H = 14
Province of Fianarantsoa:- # of players in W = 20- # of players in S = 11- # of players in H = 16
Province of Mahajanga:- # of players in W = 13- # of players in S = 3- # of players in H = 7
Province of Toliara:- # of players in W = 21 - # of players in S = 21-- # of players in H = 18
Madagascar Players(25 out of possible 105 organizations represented)
Behavior Change Approaches
IN COVERAGE AREAS, What needs to be examined?
• Social Change Approaches• Individual Change Approaches
How does each need to be examined?• What is being used?• What has proven to be effective?• What are current practices?• What are desired practices?