Sustaining Behavior Change through Participatory Approaches

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Project Cycle Management

Rizwana Kousar

Asia Regional Sanitation And Hygiene Practitioners Workshop, Dhaka 2012

Background and Justification • Rapid urbanization and congestion in cities are constant characteristics of Pakistan

demography ever since partition.

• Pakistan's estimated population in 2011 is over 187 million[ making it the world's sixth most-populous country. Pakistan's urban population expanded over sevenfold.

• During 1990–2003, Pakistan sustained its historical lead as the second most urbanized nation in South Asia with city dwellers making up 36% of its population. [4] Furthermore, 50% of Pakistanis now reside in town

• A large scale rural to urban migration due to which Katchi abides population is desensitize

• 48 million Pakistani citizens’ defecate in the open; for them Under the MDG, Pakistan had committed to supply 93 per cent of the population with safe water and 64 per cent of the population with adequate sanitation by 2015. Yet, only 45 per cent people use improved sanitation facilities in Pakistan

Continue… • The water target will be missed by seven years (2022), and the sanitation target will

be met 13 years (2028) too late

• Poor sanitation and hygiene causes many health problems and according World Health Organization (WHO), estimated 97,900 people die every year due to poor water and sanitation in Pakistan.

• World Health Organization and Unicef estimated that every year, 54,000 children under age five in Pakistan die from diarrhea caused by poor water and sanitation

• Due to expansion of population urban sanitation and water issues are becoming more complex in term of land issues lack of space. In urban planning water and sanitation provision to informal settlement is not at priority . Because of poverty and space issues the hygiene condition is becoming worst.

• The Capital Development Authority (CDA) is responsible for the provision of water to the residents of Islamabad, however as the squatter settlements were not in the original master plan, they are seldom provided with water and the community has to obtain water on their own

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• Worst Water, sanitation, and hygiene conditions as Faisal colony is situated on bank of a perennial and polluted stream.

• Community members in Faisal colony had laid their own sewerage systems and water supply lines, but over the years these have rusted and deteriorated to the extent that sewage water is mixing with drinking water.

• Due to this reason water borne diseases like cholera, diarrhoea and skin allergies are very common in this Faisal colony

• In a situation analysis exercise, Early Childhood Care & Development (ECCD) caregiver told that every day 50% of children in her centre miss their class due to

diarrhoea alone”. • Need for WATSAN project was highlighted when an outbreak of cholera occurred in

summer 2009 due to mixing of sewage water with drinking water. Total 125 individuals were affected including a woman who died

Picture Gallery-Before Project

Picture Gallery-Before Project

Why HySter is Needed

• Gives Priority to Hygiene –Sanitation – Water

• Reflect on WASH and provides room to Watsan development work

• Enshrines the National Slogan for focusing on family through multiple channels in Behavior Change

• Four main pillars of the project water, sanitation, hygiene and RBA (right based approach) with gender mainstreaming as a cross cutting theme focusing women and girl child in all phases of the projec

• Creates ‘Whim’ for change WASH as felt need as basic human right

Introduction to HySter

HySter calls for Hysteria (whims, fever) to be created through intense communications

BCC approach related to Water, Sanitation and Hygiene promotion targets a family unit. Our approach is in line with the National BCC strategy 'Hamara Pakistan-Sahtmand aur ba-waqar Khandan‘HySter stands for interventions with different emphasis on priority

HySter emphasis more on Positive Hygienic Behaviors to prevent water borne diseases at first place, followed by safe human excreta disposal, boil water and litter free environment (as part of Sanitation) at second Place and Safe drinking water at third place. This is so as the communities' priorities are always in reverse order i.e. WASH and our response should help them set their priorities Right through HySter.

Principle

Apart from other basic human needs and rights, access to basic sanitation facilities and services is one of the fundamental human right to protect and save lives of the affected population.

Ensuring gender mainstreaming and protecting the extremely vulnerable and people with special needs in the Hyster .

Comprehensive BCC support is essential for responding to gender, different age group, local culture, needs and other special needs, while promoting l positive behavior.

HySter interventions ensuring to safeguard the human health and environment.

Hyster Component

Provision of integrated water and sanitation facilities basis interfacing with other Clusters’ Early Recovery and development

A comprehensive BCC support through multiple channels for diverse audience (all age group, gender, culture, socio-economic group) with the aim to ensure that the water and sanitation facilities are being utilized.

Technical sessions complementing the hard components i.e. water purification method, ORS preparation.

HySter emphasis more on Positive Hygienic Behaviors to prevent water borne diseases at first place, followed by safe human excreta disposal, Boil water and litter free environment (as part of Sanitation) at second Place and Safe drinking water at third place. This is so as the communities' priorities are always in reverse order i.e. WASH and our response should help them set their priorities Right through HySter.

Themes of Communication in Project Cycle Stages

Themes of BCC communication Project Cycle stages

Demand creation Before planning during PRA

Technical Education Before and start of the project for informed choice ( installment of hardware intervention)

Health and hygiene nutrition promotion

Implementation

Liking positive behavior ( proper Exit strategy

Before evaluation, at end of the project.

Medium of Communication

• Print media • Electronic media • Interpersonal communication

Demand Creation Phase

• An orientation meeting was conducted with CBO and 15 member committee were formed executive position to women.

• Demand creation activities ( poster competition, religious celebration in church, problem tree and mobility chart were drown by women, focus group discussion with) were organized and PRA were conducted. the impact of demand creation activity was that need of water sanitation were at top priority by the members of the community

• The women took lead and baseline was carried out on women decide to draw street wise map for installment of bore pump while males were supporting roles.

• Due to intensive communication in demand creation phse community also met with the Director Sanitation-CDA to regularize the system of waste disposal from the Faisal Colony. Capital development Authority (CDA) is now disposing off solid waste regularly

Demand Creation Phase

Technical phase • Before installing bore pump and sewerage session was delivered to project

committee. (Informed choice)

• The impact was observed when vendor dig the bore whole at 70 feet and women observed and stop digging and showed the material that it should be at 140 Rft.

• They observed closely sewerage line and connection of household line to trunk line.

• The vendor dig the bore whole again . The household maintained their rutted latrines and connected to main sewerage line. Project committee motivated community for safe sanitation.

Technical Phase

Promotional Phase

• About 22 community member were trained on solid waste,26 on kitchen gardening 26 on O &

M of WES system management

• 28 on right base approach, 27 on CLTS training and 28 on water bore diseases

• Awareness on water bore diseases, filtrations plant water treatment methods etc

• 28 community members have training on community awareness who very enthusiastically

delivered the hygiene promotion sessions and monitors the hygiene door to door

•

Promotional Phase

Sustaining Behavior Change

• In this phase campaign were organized on CLTS

• Cleanliness campaign were organized and people were motivated for basic hygiene of water & sanitation

• Community were observed dumping waste properly

• Water storage tank cleaned after years in housed

• Community emplace hand washing facilities with and out of washrooms .theater group play were arranged

Sustaining Behaviour

Outcomes of the Approach

• Completion of 17 hand pump . Laying of sewerage lines 720 Rft in 2.5 streets and 15,832 Square feet (5 streets) have been paved

• Community has good understanding about their needs and proper solutions. The waste bins design, its fixing and proper utilization were in the benefit of the community. To make it more successful, they contacted CDA and approved sanitary workers for the colony

• Women participation has improved in the project activities and they took some major decision and are part of O & M.

• Series of sessions on hygiene were conducted and behaviour session are being leading by communty member

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• Solid waste dumping points were placed.

• Children women and men are closely observing the hygiene even door to door

• The impact was observed when neighboring community demanded same material for churches and want to have some session on hygiene promotion

• In the current epidemic 11 death case were reported in 2011 in informal settlement having some the characteristics but not a single case was reported from faisal colony. The main reason was they are continuously sending their water for laboratory test

Conclusion • Behaviour change is viable when the community members are supported to practice in an

enabling environment continued communication through multiple mediums, availability of water, improved drainage

• Behavior change is viable if community internalize the given information and practice it in their routine.

• Intensive communication at entry point of helped to realize access to water and sanitation as felt need as basic human right

• Participatory decision making and involvement gives the sense of ownership • • Hyster themes through intensive communication using different participatory tools help to realize

as felt need, having informed choice and realizing the importance and its maintenance. Community own it and sustained it.

• Hyster help to understand that each member of the family is important for focusing hygiene promotion because behaviors are nourish and learnt at house hold level. So that for behaviour change family unit would be through multiple channels and multiple activities