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A multi prong beneficiaries focused approach to promote increase in hand washing–field trails in rural Bangladesh

Final Report

Submitted by

Nazrul Smriti Sangsad-NSS


Project on

A multi prong beneficiaries focused approach to promote increase in hand washing–field trails in rural Bangladesh

Funded by

Oxfam Bangladesh

Implemented by Nazrul Smriti Sangsad-NSS Sweden Palace, Pallabi Residential Area Amtali, Barguna, Bangladesh Web: www.nssngo.org, E-mail: nssngo@gmail.com Cell: +8801712795359


FOREWORD The socioeconomic status of individuals and communities pragmatically involved with their health. Indeed improvement i n health is expected to follow socioeconomic development. This hypothesis has rarely been tested. Even less understood are the processes and mechanisms by which the changes are brought about. This is a unique opportunity for NSS to study on handwashing behavior through implementing the project at Gulishakhali and Arpangashia Union Parishads under Amtali Upazila of Barguna district and this is the first time initiative in this area. We are very much grateful to Oxfam GB for supporting us for such type of idea. This working paper has been initiated to share the result of the project. This is an important endeavor for next initiatives. We will appreciate critical comments.

Shahabuddin Panna Executive Director NSS

ACKNOWLEDGEMENTS This paper has been prepared with the auspices of Oxfam Bangladesh. We are indebted to Mr. Golam Morshed-PHP, Mr. Ruhul Amin-PHE of Oxfam Bangladesh for their sincere and valued technical support to us to conduct the research work. Besides Mr. Ehsanul Habib-PC, Mr. Sujan Ali Mandol-PHE, Mr. Hasan Ul-Banna-PHP, Ms. Zobaida Nahar, Ms. Ismat Ara Koly, Ms. Radha Rani, Mr. Khokon Das successfully completed their assignments. We are also appreciating Mr. Mahmudul Hasan who also provided financial, administrative and logistics management support to finish the initiative in due time.

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TABLE OF CONTENTS Foreword……………………………………………………………………………………………………………. Acknowledgement……………………………………………………………………………………………… About the Organization……………………………………………………………………………………… Executive Summary…………………………………………………………………………………………… Hypothesis…………………………………………………………………………………………………………. Key Findings……………………………………………………………………………………………………….. About the project……………………………………………………………………………………………….. Methodology………………………………………………………………………………………………………. Working Area…………………………………………………………………………………………………….. Hand Washing devices at HH Level…………………………………………………………………….. Hand washing agent-Ash dome at schools compound……………………………………….. IEC and hygiene promotion tools……………………………………………………………………….. Child group Campaign………………………………………………………………………………………… School hygiene and campaign……………………………………………………………………………. Hand washing facilities with gender sensitive latrine at school………………………….. HP Session at community level by village volunteer…………………………………………… Global Hand Washing Day Observation……………………………………………………………… Women’s WASH Platform (WWP)………………………………………………………………………. Baseline Survey………………………………………………………………………………………………….. Midterm Survey…………………………………………………………………………………………………. End line survey…………………………………………………………………………………………………… Data Management…………………………………………………………………………………………….. Data analysis on hand washing practice…………………………………………………………….. Changes…………………………………………………………………………………………………………….. Constraints…………………………………………………………………………………………………………. Recommendations………………………………………………………………………………………………

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i i iii iv iv v 1 2 3 5 6 6 7 7 8 8 9 9 9 10 10 10 10 18 19 20


1. ABOUT THE ORGANIZATION Nazrul Smriti Sangsad-NSS, a social development organization established in 1977 after the name of Nazrul Islam, a progressive student leader of Barisal B.M College and a journalist of the Daily Ittefaq who was fighting against poverty and for a society where equal rights will be practiced. To make his dream happen a young, sincere and committed group with full of dedication has started interventions in 2000 to serve the drawback and vulnerable rural people with special attention to women and children.

1.1 VISION A dynamic society influencing policies and actions at all levels where people can practice their equal rights and opportunities.

1.2 MISSION The mission of NSS is to strengthen civil society partnership by enhancing, contributing to policy and stimulating action. Empowerment and capacity building of poor marginalized, ethnic minority and underprivileged people for ensuring participation in policy making process as well as in power structure by improving their socio-economic state. It also emphasizes the gender equity, access and ownership over public resources, transparency and accountability in LGI and CSDI with special attention to basic human rights and rule of law. It promotes indigenous knowledge, best practices, innovative technology for livelihood, democratic values and mobilization of local resources. Organizing social mobilization and policy advocacy at different level to ensure peoples interest in national and global issues and enactment of pro-poor laws and policies.

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EXECUTIVE SUMMARY The primary aim is to identify the most effective approach or combination of approaches to increase uptake of hand washing in rural Bangladesh. The key expected outcome is an effective approach or combination that can speed up increase in uptake of hand washing significantly. The overall objective of the study was to evaluate the impact of the project on handwashing, hygiene and sanitation knowledge and practice of people in the intervention areas compared with the baseline status. A comparative analysis of the baseline, midline and end-line status may reflect the effects of the project implemented by NSS. This may also provide necessary feedback for scaling up and redesigning of the program in near future. The key research questions are: What is the percentage sustainable increase of hand washing practice by the targeted women and children using each of the approaches? What approach or combination of approaches gives best increase?

HYPOTHESIS Null Hypothesis – Combination approaches of hygiene promotion is effective in increasing sustainable hand washing. Alternative Hypothesis – A single approach of hygiene promotion is effective in increasing hand washing.

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KEY FINDINGS Study results reveal that after one year of intervention, knowledge about hand washing, water hygiene and sanitation have increased and water-borne diseases have decreased significantly. This was also reflected in practice. Hand washing practice with soap have increased after defecation 78%, before eating by 78%, after cleaning baby’s feces 75%, before feeding children by 76%, before serving food by 71% and after handling cattle’s wastages 64%. Knowledge about the rules of maintaining go o d health increased significantly. However, compared to the baseline, more people reported that they are using ash and soap, using hand washing devices, carrying water pot with right hand during commuting to and from latrine, wearing slippers while using latrine and washing hands with soap after defecation. Improved hygienic practices were observed during physical verification in the midline and end line. Soaps, slippers and sufficient water preservation were found near latrines in increased proportion compared to the baseline and midline. Andy handy the handwashing devices were not user friendly yet matir kalsi (clay pitcher) device was affordable and easy to use. Wooden structured devices were not durable than those were made with brick and concrete. Plastic bucket with plastic basin or Plastic bucket with brick stand and small platform type devices were more preferable and sustainable. Children were the changing agent in this case and they contributed a lot for changing behavior.

CONCLUSION The study found significant improvement in hygiene knowledge and practice after fourteen months of implementation o f t h e program. However, a gap still exists between knowledge and practice regarding washing hand before and after eating though data indicated a reduction in this gap. Accelerated and sustained inputs of program are needed to further reduce this gap.

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A multi prong beneficiaries focused approach to promote increase in hand washing–field trails in rural Bangladesh

1. ABOUT THE PROJECT NSS has completed a research project on “A multi prong beneficiaries focused approach to promote increase in hand washing–field trails in rural Bangladesh”. The project duration was 14 months starting from July 2011 and ending in September 2012. This project is based on a Participatory Action Research design. The main aim is to carry out field trials of various community-based and culturally sensitive approaches and identify the most effective approach/combination of approaches to increase uptake of hand washing in rural Bangladesh. The project was centred on working with women and children in 10 remote villages of Amtali upazila at Barguna district. The key approaches were trialled and were based on self mobilisation and cascade messaging by women and children. The included ignition/triggering adapted from CLTS, child to child (C to C), child to parent, child to community, play and learn, fun and learn, women’s WASH platform, women’s friend chain and motivating husband community mobilisation and hygiene education approaches. During these trials different hand washing devices were piloted. Data were collected at every stage using a pre-developed research/implementation protocol. The key expected out is an effective approach/combination that can speed up increase in uptake of hand washing significantly.

1.1 OBJECTIVES OF THE PROJECT The primary aim is to identify the most effective approach/combination of approaches to increase uptake of hand washing in rural Bangladesh focusing on health and nutrition. The key expected outcome is an effective approach/combination that can speed up increase in uptake of hand washing significantly with a view to reduce multination at household level. The key research question is: • What is the percentage of sustainable increase of hand washing practice by the targeted women and children using each of the approaches? • What approach or combinations of approaches give the best increase?

1.2 ROCESS OF THE STUDY The key steps of the study were included the following         

Designing Baseline KAP survey Selection/formation of children group, women wash platform Random selections of 500HHs from intervention villages for hand wash device distribution Hand wash promotion using different approaches at HH level and school level Construction of school latrines with hand wash facilities Installation of ash dome Day to day monitoring Orientation of health and nutrition Mid-term data collection ~1~


A multi prong beneficiaries focused approach to promote increase in hand washing–field trails in rural Bangladesh

2. METHODOLOGY The innovation is about introducing and systematically studying effectiveness of community-based and culturally-sensitive approaches as an alternative to promote hand washing through a Participatory Action Research approach. The main target groups for the project were women and Children in 10 villages at Amtali Upazila of Barguna district. Women’s WASH Platform (WWP), a very new concept in Bangladesh that Oxfam has piloted in another project. The women groups identified the problems, planned for solution, implement the planned activities and did the self monitoring as well. The difference compare to other study was that the women managed all financial activities. Children group was the main strength of project. Child to Child (C-to-C) and Child to parents (C-to-Parents) did all motivational activities. The difference in the project was that the children made plan themselves and implement it. E.g. fun and learn and puppet show. Self mobilized and empowered children and women group and the community triggered the approach. CLTS approach was the base for piloting different types of hand washing devices e.g. tipi-tap with innovation. The project tested the suitability of ash as an alternative to soap for hand wash. The intervention approaches – Cluster–1 (2 villages): All hardware and software (women and children) Cluster–2 (2 villages): All hardware and software (only children related activities) Cluster–3 (2 villages): All hardware and software (only women related activities) Cluster–4 (2 villages): All software and no hardware Cluster–5 (2 villages): Control (no hardware and no software only data collection to compare with others).

2.1 Overall Sample Size Systematic sampling method was used in this study. Samples of 500 households were targeted in the study. The total numbers of households in the study location were 8,620. The sample interval was 17 households. The first household was selected by lottery and then every 17th household was surveyed.

2.2 Data Collection Baseline: A baseline (KAP) survey on WASH, incorporating basic socio-economic data, was conducted in ten villages, five at Gulishakhali Union Parishad and five at Arpagashia Union Parishad before implementing the intervention. A questionnaire was developed in this regard. Other methodology was adapted like – • Structured observations and spot checks through checklist were used to compare reported opinion with actual use of hand washing devices. • CHV Monitoring was done on monthly basis using monitoring sheets • Focused Group Discussions to probe emerging issues. • Focused Group Discussions to evaluate the intervention • Pre and post Implementation hand wash practice (hand washing using existing devices/methods and knowledge) was taken.

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A multi prong beneficiaries focused approach to promote increase in hand washing–field trails in rural Bangladesh

Mid-term: A mid-term evaluation was undertaken to understand the trend of implementation and the impact of the initiative. Final: Final data was collected using all tools and methodology used during baseline to understand the outcome to determine the result of the project.

2.3 Data Analysis Analysis of data was involved coding open-ended questions, data cleaning and entry. Both quantitative and qualitative methods were used to analyze the raw data. Quantitative data obtained from the checklists was analyzed using statistical package for social studies (SPSS software) package. Context analysis was used to analyze qualitative data.

3- WORKING AREA In order to conduct the study two union Parishads were chosen and under each union five villages were targeted for the purpose. The following table shows the places where the study works have been done: Name of Union Woking Households Population Parishad Villages covered Male Female Total

Arpangashia

Gulishakhali

Total

Pasurbunia Baliatali Ghopkhali Arpangashia Tarikata Haridrabaria Gulishakhali Dalachara Gozkhali Angulkata

120 860 625 1,150 770 921 1,266 1,050 1,156 702 8,620

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302 2,201 1,520 2,370 1,756 2,534 3,119 2,027 2,973 2,380 21,182

274 1,924 1,677 2,228 1,743 2,697 2,937 2,154 2,881 2,593 21,108

576 4,325 3,197 4,598 3,399 5,231 6,056 4,180 5,854 3,973 41,389


A multi prong beneficiaries focused approach to promote increase in hand washing–field trails in rural Bangladesh

3.1 WORKING LOCATION MAP

Gulishakhali

Arpangashia

The above map indicates the working area of our project. The villages covered under Arpangashia Union are Pasurbunia, Baliatali, Ghopkhali, Arpagashia and Tarikata. Under Gulishakhali Union the villages were Haridrabaria, Gulishakhali, Dalachara, Gozkhali and Angulkata. Both of the unions are situated on the mighty river Payra. These unions are in disaster threatened. People have no significant access to the govt services. On the other hand no NGO is working on domestic hygiene and sanitation. People are not conscious about their rights from the state. A major portion of them lacks in education. Poverty is also dominating. Local Govt. infrastructure is not adequate to meet the need of inhabitants. Safe water points are scattered and most of the people use unsafe water for cooking and cleaning utensils.

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A multi prong beneficiaries focused approach to promote increase in hand washing–field trails in rural Bangladesh

4. ACTIVITIES The following table represents the activities which were done under the project to study the changes in hand washing practice and behaviour of hygiene.

Clusters

Villages

Cluster-1

Baliatali Gulishakhali

Cluster-2

Pasurbunia Dalachara

Cluster-3

Ghopkhali Gozkhali

Cluster-4

Arpangashia Haridrabaria

Cluster-5

Tarikata Angulkata

Activities School Latrine School HP Courtyard Session HW Device Women WASH Platform School Hygiene Promotion Courtyard Session HW Device Ash Dome Child-to-Child Group Courtyard Session HW Device Women WASH Platform Child-to-Child Group Courtyard Session HW Device No activities

4.1 Hand washing devices at HH Level A sum total of 529 hand washing devices were distributed in household level. The main objective of providing the devices was to increase hand washing practice in their day to day life. The recipients were oriented about the usage of the devices. Devices were designed with low cost indigenous materials which are locally available. Clay pitchers (locally known as matir kalsi) were used to prepare hand washing devices. Economy plastic water taps were fixed at the end of the pitcher to regulate water flow. Wood or bamboo stands were used to install the devices. Besides the clay pitcher devices, some brick and concrete devices were built. Community people also made some innovation devices using discarded plastic bottles. Result: Tendency of washing hands and faces, rising from bed in the morning, after toilet, before eating, after cleaning baby’s feces, before feeding baby and before cooking have grown up. Waterborne diseases have been reduced. Small children find it amusing to wash hands as one of the integral parts of their day-to-day life. Children are conscious enough to follow the regularities than the elder people.

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A multi prong beneficiaries focused approach to promote increase in hand washing–field trails in rural Bangladesh

4.2 Hand Washing Agent-Ash Dome In order to promote hand washing practice at institutional level as well hygiene promotion, four gender friendly sanitary latrines and wash rooms were constructed with ash dome in the premises of the following institutions: • • • •

Baliatali Registered Primary School – Baliatali, Arpangashia Union Ghopkhali Ebtadai Madrasa – Ghopkhali, Arpangashia Union Gulishakhali Junior School – Gulishakhali Union Haridrabaria DS Dakhil Madrasa – Gulishakhali Union

Ash domes were constructed near gender sensitive latrines so that the students can easily wash their hands using ash after returning from toilet. As ash is very easy to collect from house and it has no exchange value in rural area that’s why it has been chosen as no cost cleaning agent. Result: Boys and girls are using ash for washing their hands after defecation. As is available in village and it needs no exchange value. Teachers and students are using sanitary latrines with full satisfaction and gender sensitization has been ensured.

4.3 IEC and Hygiene Promotion Tools Different types of IEC and hygiene promotion tools like; leaflets, flip charts, posters and hygiene promotion tools were used for behavioral changes in handwashing and hygiene. While conducting hygiene sessions the Community Health Volunteers (CHV) used leaflets, fillip charts and posters. Besides, eight giant ludos (a playing chart) on WASH and Nutrition’s were distributed amongst the children of C to C group as one of their IEC materials. Result: Children are using these as learning materials for hygiene and sanitation through playing ludo. IEC materials and hygiene promotion tools has attracted children, women and men to make them understand about the importance of hand washing and nutritional.

4.4 Child Group Formation Children were indicated as strong change agent so under the project one of the important works was to form children groups. Four children groups were formed during the intervention. Result: Children have become united and they are playing good role as change agent. ~6~


A multi prong beneficiaries focused approach to promote increase in hand washing–field trails in rural Bangladesh

4.5 Child Group Campaign Children can emulate new thing very easily and that’s why they have been chosen as strong change agents. In this connection child group campaign programs like; Child to Child, Child to Parent, Fun and Learn, Play and learn were added to change behaviors through entertainment and playing. A good platform has been created to aware mass people by the children. They are enjoying the campaign as one of the cultural initiatives. Small children who are the members of these groups can easily facilitate how to wash hands safely, what is safe water, why should they use safe water, what are the effects of using open latrine, eating open food, not brushing teeth etc. Parents have learnt from their children how to wash hands properly. As one of the part of the campaign colorful rallies were done and shouting slogan like; “Baccha der mongole, hagbona ar jongole”–[We will not go to jungle to toilet for our children’s safety]. This slogan has inspired older people in changing their practice of defecating in open space. During the project period 52 Child Group Campaigns were targeted and achieved. Parents could realize the significance and they also participated with their children. This group played a vital role as change maker in hand washing as well as other hygiene promotion. This initiative was one of the best for changing behavior and practice in household level. The Community Health Volunteers (CHVs) also did a good deal in community through facilitating WASH at household level. Some innovations were found amongst the children playing roles in drama on hand washing and hygiene practices. A children platform has been created through this intervention and they are more collective than before. They are capable to conduct session on WASH and the children are realizing it as one of the integral parts of their daily life.

4.6 School Hygiene and Campaign Students at village schools do not have opportunity like the students at urban areas. Traditional education curriculum has given less priority in hygiene. Under the project activities 52 school hygiene sessions were targeted and the achievement was 100%. A sum total of 5,265 students have participated in school hygiene sessions. Out of them 2325 were boys and 2502 girls. The schools covered were Haridrabaria DS Dakhil Madrasa, Ghopkhali Madrasa, Baliatali RNGP and Gulishakhali Junior High School. Quiz competition were included in those school hygiene sessions.

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A multi prong beneficiaries focused approach to promote increase in hand washing–field trails in rural Bangladesh

4.7 Hand washing facilities with gender sensitive latrine at school Gender sensitive school latrines were constructed in school premises. A sum total of 762 students are enjoying the befit of gender sensitive sanitary latrines in four schools like; i) Baliatali Registered Primary School, Baliatali, under Arpangashia union, ii) Ghopkhali Ebtadai Madrasa, Ghopkhali, iii) Gulishakhali Junior School and iii) Haridrabaria DS Dakhil Madrasa. Teachers and students are happy with the latrines in their school premises. Due to this intervention the hygiene and sanitation practice has been increased.

4.8 HP session at community level by village volunteer (16 volunteers)

The above chat shows hand washing practice at six critical moments in 1600 households under 4 four clusters in the working areas. Community Health Volunteers (CHVs) were selected from community and they were oriented. The main objective of the hygiene promotion session was to increase hand washing practice in order to reduce diseases. 416 hygiene promotion sessions were targeted to be done by the volunteers at community level and the achievement was 100%. A sum total of 13,644 received the session. Out of these 1,674 were male, 7,983 were female and 3,977 were girls and boys. The participants have been aware on hand washing, environmental hygiene, personal hygiene, safe water and its usage. All these were done by Community Health Volunteers (CHV) at community level. CHVs collected data using a monitoring sheet to monitor hand washing at community level. In each month the CHVs filled up 1800 HH level monitoring sheets through house hold visits. Cluster wise was collected, recorded and processed for analysis.

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A multi prong beneficiaries focused approach to promote increase in hand washing–field trails in rural Bangladesh

4.9 Global Hand Washing Day Observation Global hand washing day was observed on 25th October 2011 at Gozkhali Secondary School, Gozkhali and Arpangashia Secondary School, Arpangashia consecutively. Students of both schools participated in the program. The events included; rally, discussions, quiz contest, drama and demo hand washing in effective way. Prizes were given to the students who participated in the quiz contest. People came to learn about the significance of hand washing.

4.10 Women’s WASH Platform (WWP) Rural women traditionally lack in hygiene and sanitation due to having there no facilities of washing rooms or bath rooms instead they use open space. In order to change the practice and behavior, 30 women washing platforms were installed on experimental basis. In this connection groups were formed and sites of WWP were selected by the community following the criteria like; availability of water through all the year round, near big pond or tube well and most of the women might have access to it. The positive results are that the rural women have understood the importance of such wash platform and at the same time they think it a secured place for washing and changing cloths. Being inspired one woman constructed a platform by her own initiative. The following table shows the status of WWP.

Name of Unions

Name of Villages

# WWP

Arpangashia

Arpangashia

7

Gulishakhali

Pasurbunia Dalachara

7 9

Haridrabaria

7

Total

30

4.11 Formative Study 4.11.1 Baseline Survey At the very outset of the project a baseline survey was conducted through developing questionnaire and orienting staffs. The survey was completed in October 2011. In this connection ten villages were chosen from two Union Parishads. The villages are: Pasurbunia, Baliatali, Ghopkhali, Arpangashia and Tarikata under Arpangashia Union Parishad and Haridrabaria, Gulishakhali, Dalachara, Gozkhali and Angulkata under Gulishakhali Union Parishad. Household data was collected through sampling basis at an interval of 17 households. A database was prepared for future planning and activities.

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A multi prong beneficiaries focused approach to promote increase in hand washing–field trails in rural Bangladesh

4.11.2 Midterm Survey A midterm survey was conducted on sample basis in order to see the impact of the project. This survey was conducted in 550 households of ten villages in the working area. It was done in February 2012 and a draft report has been prepared for this survey.

4.11.3 End line Survey At the end of the project, last week of September 2012, an end line survey was conducted in order to study the impact of the research. In this connection 500 households were targeted with an interval of 17 household as were done in baseline and midterm. A questionnaire was developed in this regard and enumerators were hired from outside and data have been collected and recorded in data base. It has been analyzed to see the trend of changes with base line.

4.11.4 Data Management A data management system was developed to collect data from field and to monitor the field performance, development and changes. The major monitoring is CHV monitoring on hand washing in household levels and hand washing device monitoring. Data have been collected from households on hand washing practice as well as use of hand washing devices through CHV and CM in weekly basis. At the end of each month the data base was updated for analysis.

4.11.5 Data analysis on hand washing practice During the interventions from November 2011 to September 2012 were analyzed with CHV monitoring data and found that a growing trend of hand washing practices in household levels in four clusters have increased significantly. But in cluster 5 where we have no activities rather than colleting data on hand washing, shows very insignificant changes. The following figures show the trend of changes due to this intervention.

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A multi prong beneficiaries focused approach to promote increase in hand washing–field trails in rural Bangladesh

Figure-1: Trend of handwashing after defecation

Figure-2: Trend of handwashing before eating

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A multi prong beneficiaries focused approach to promote increase in hand washing–field trails in rural Bangladesh

Figure-3: Trend of handwashing after cleaning baby’s feces

Figure-4: Trend of handwashing before feeding children

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A multi prong beneficiaries focused approach to promote increase in hand washing–field trails in rural Bangladesh

Figure-5: Trend of handwashing before serving food

Figure-6: Trend of handwashing after handling cattle

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A multi prong beneficiaries focused approach to promote increase in hand washing–field trails in rural Bangladesh

5. Trend of behavioral change hygiene and sanitation 5.1 Defecating A significant change has been seen in case of defecation places due to Courtyard Sessions, C to C Campaign and School Hygiene Sessions. During base line it was found that there were 12 open latrines, 3 shared latrines, 12 hanging latrines and 5 other latrines in targeted survey households. In mid-term survey the situation was found to be decreased and in the end-line survey the situation was found to be increased due to more motivational activities.

Figure-7: Showing defecating situation

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A multi prong beneficiaries focused approach to promote increase in hand washing–field trails in rural Bangladesh

5.2 Latrine Status In the end-line survey, in 500 households, it was found that the numbers of sanitary latrines have been increased significantly. During base line survey it was found that i) Feces properly confined latrines were 86, ii) Well connected latrines were 70, iii) Odor free latrines were 44. In the end-line survey the situation was found to be improved significantly which were 157, 147 and 27 consecutively.

Figure-8: Changes in improving latrines

5.3 Hygienic Latrines Status During baseline survey out of 500 households 30 latrines were found clean, in the midterm survey 24 latrines were found clean and in the end-line survey 32 latrines were found clean. In this case no significant changes were found due to unavailability of pucca sanitary latrines.

Clean latrines

30

32

Base Line Mid Term End Line

24

Figure-9: Latrine cleanliness status ~ 15 ~


A multi prong beneficiaries focused approach to promote increase in hand washing–field trails in rural Bangladesh

Figure-10: Materials available in latrines

Figure-11: Facilities inside or near latrines

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A multi prong beneficiaries focused approach to promote increase in hand washing–field trails in rural Bangladesh

Figure-12: Frequency of handwashing

Figure-13: Handwashing in critical moment

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A multi prong beneficiaries focused approach to promote increase in hand washing–field trails in rural Bangladesh

6. CHANGES While working and implementing the project activities the following changes have been observed       

Children are playing a good role as change agent of hand washing and they are capable to conduct session on hand washing, hygiene and sanitation. Women have taken hand washing as one of the integral part of their life. Madrasa students’ participations have increased in hygiene session and they are more responsive. Children are using hand washing devices with deep concentration and washing their hands carefully. One woman has made WWP by her own initiative. Interests of innovation hand washing device making with low cost materials have been created among children and their mothers. Use of ash as locally available agent has been increased for washing hands after defecation. WWP women groups are members are united to think something different to create self help group through collecting savings from the members. They will help the other in emergency or medical need from this fund.

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A multi prong beneficiaries focused approach to promote increase in hand washing–field trails in rural Bangladesh

7. CONSTRAINTS The major constraints we had to face during implementing the project activities were –   









As the project was research oriented and first time in this area therefore the project duration was not enough to find out the real outcome of the project. Concept was not clear to all staff and they had not enough academic knowledge on the issue. The Community Volunteers (CHVs) were not educated enough to facilitate the program at community level with elegantly. CHVs acceptance in some places was not positive because they were not educated enough for the purpose and their social acceptance was not good. Some cases, it has been observed that a number of community people did not give priority on the matter lack of education and consciousness and traditional behavior. In some places husbands did not allow their wives to attend CHV session. Some houses at Baliatali village NGO workers were not allowed to enter and men blamed that NGOs are misguiding their women from religion and the women will dominate men on being empowered. Up representatives in some cases did not support the program as there were nothing to give their people and they expected to have something to be provided as the other NGOs are doing. The Andy Handy devices were not user friendly because the water flow push pins were hard and it was very uneasy to use.

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A multi prong beneficiaries focused approach to promote increase in hand washing–field trails in rural Bangladesh

8. RECOMMENDATIONS The following recommendations are made based on the study findings:  To achieve further success the program should pay more attention on providing knowledge related to personal and domestic hygiene and follow-up practical changes which might help program to ensure proper hygiene practice in the intervention areas.  Safe water facilities are one of the important prerequisites of ensuring safe hand washing. It would be better if it could be provided with safe water points like tube-well and PSF.  Different motivational activities such as cluster meetings, folk songs, and popular theatre should be strengthened ensuring participation of all target groups to further improve knowledge and awareness.

 Health and nutrition related more initiatives can bring a good change in removing malnutrition at community level especially in coastal areas.

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WASH Innovation Project Report of NSS  
WASH Innovation Project Report of NSS  
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