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Julia Rosenbaum, WASHplus (FHI 360)Kebede Faris, Water and Sanitation Program/ World Bank-AF
Asrat Genet , BoH/Amhara (WSP)Orlando Hernandez, WASHplus (FHI 360)
Belete Muluneh, WSP/WB (now UNICEF))
Applying a Mix of Community-led and Household-level WASH Innovations to Improve
WASH, Reduce Diarrheal Disease
and Strengthen Health Systems
Making ‘what works’ work: Changing behaviour in sanitation and hygiene, AfricaSan, 20 July
2011
At scale
Hygiene and Sanitation
Improvement in the
Amhara Region of Ethiopia
through “Learning by Doing”
Community-led Total Behaviour Change in Hygiene and
Sanitation
Embedded in a national and regional process• National Hygiene and Sanitation Strategy
Built around Health Extension Programme• Carried out by Health Extension Workers
Supported by “the whole system”• Emphasis on bridging and bonding
Implementing a hybrid of …
• Systems Approach to Change – engaging the multiples• (Community-led) Total Sanitation• Strengthened Home Visits Negotiation of Improved Practices• Robust WASH Friendly Schools component• Investment in building capacity of health and other sector cadres
DisgustShame
Fear
CLTSCLTS
Negotiation of Improved Practices or
Small Doable Actions
Practices: Access to Sanitation Facilities
Baseline-Endline Comparison: All Respondents
**Source: Amhara LBD Evaluation Report, USAID/HIP-WSP/WB-AF, November 2010
ETHIOPIA
Knowledge of When to Wash Hands
2008 Baseline 2010 Endline Survey
Presence of HW Stations at
Latrines
17%
16%
Dimensions Factors p Odds Ratio
InterventionCharacteristics
Community participated in walk of shame .00 2.23
Household visited by health work to improve sanitation
.05 1.75
Intervention -related Perceptions
Having a latrine contributes to the community’s health
.00 2.6
Having a latrine contributes to the community’s development
.00 1.8
ALL of THESE …………………………………………….. >> 8.38
Predictors of Latrine OwnershipEndline
**Source: Amhara LBD Evaluation Report, USAID/HIP-WSP/WB-AF, November 2010
