access and behavioral outcome indicators for water, sanitation, and hygiene

March 2, 2010

Welcome to HIP’s Webinar on

Access and Behavioral Outcome Indicators for Water, Sanitation,

and Hygiene Presenter: Orlando Hernandez, HIP monitoring and evaluation specialist

If you have any technical issues during this presentation, contact ccurtis@aed.org, tel. 202-884-8358

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Organization of presentation

• Who is the manual for?

• How was the manual developed?

• What does the manual include?

• Limitations of the manual.

• How can I use the manual?

• How can I get the manual?

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Who is it for?

• Program planners, managers and evaluators designing, implementing or evaluating water, sanitation and hygiene (WASH) interventions

• Donor agencies, USAID staff, different levels of government in developing countries, international organizations, NGOs, community organizations

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How was the manual developed?

• Manual is evidence-based and related to reliable and valid measurement of hygiene practices to prevent diarrheal disease in children under 5

• Concerns about what to measure and how to measure access and hygiene practices

• Key players in WASH field: academia, donor and implementation agencies

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How was the manual developed?

• Abt Associates

• AED

• ARD

• Centers for Disease Control

• Water Supply and Sanitation Collaborative Council

• IFC Macro

• IRC International Water and Sanitation Centre

• London School of Hygiene and Tropical Medicine

• The Manoff Group

• Massachusetts Institute of Technology

• Public Private Partnership for Handwashing, WSP

• Population Services International

• UNICEF

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What does the manual include?

• Access to water and sanitation

• Behavioral outcomes associated with hygiene practices:– Household water treatment and safe storage– Handwashing with soap at critical moments– Use and maintenance of facilities to dispose

of human excreta

• Essential vs. expanded indicators

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What does the manual include?

Hygiene Content Area Indicator

Access to Water Supply and Use of Household Water Treatment Technologies and Safe Storage

WA1. % of households that use an improved drinking water source (urban and rural)

WA8. % of households practicing correct use of recommended household water treatment technologies

WA10. % of households storing treated water in safe storage containers

Hand Washing with Soapat Critical Moments

HW2. % of households with soap and water at a hand washing station commonly used by family members

HW3. % of households with soap and water at a hand washing station inside or within 10 paces of latrines

Access to and Use of Sanitary Facilities for the Disposal of Human Excreta

SAN 1. % of households with access to an improved sanitation facility (urban and rural)

SAN 5. % of households using the available (improved) sanitation facility

SAN8. # of communities achieving open defecation free status

Table 1: List of Access and Behavioral Outcome Indicators(Essential Indicators)

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What does the manual include?Hygiene Content Area Indicator

Access to Water Supply and Use of Household Water Treatment Technologies and Safe Storage

WA1. % of households that use an improved drinking water source (urban and rural)WA2. % of households with access to improved drinking water sources from a recommended providerWA3. % of households spending up to 30 minutes to collect drinking water from an improved sourceWA4. % of respondents who agree that their drinking water needs to be treated at homeWA5. % of respondents who believe others treat drinking water at home WA6. % of respondents that feel confident they can improve the quality of their drinking water WA7. % of respondents who know at least one location where they can obtain recommended household water treatment product(s) WA8. % of households practicing correct use of recommended household water treatment technologies WA9. % of households practicing sustained use of recommended household water treatment technologies WA10. % of households storing treated water in safe storage containers WA11. % of households with negative test for E. coli in drinking water at the point of use WA12. % of households with positive chlorine residual in drinking water treated with a chlorine product

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What does the manual include?

Hygiene Content Area Indicator

Hand Washing with Soap at Critical Moments

HW1. % of respondents who know all critical moments for hand washingHW2. % of households with soap and water at a hand washing station commonly used by family membersHW3. % of households with soap and water at a hand washing station inside or within 10 paces of latrines HW4. % of households with soap or locally available cleansing agent for hand washing anywhere in the household

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What does the manual include?

Hygiene Content Area Indicator

Access to and Use of Sanitary Facilities for the Disposal of Human Excreta

SAN1. % of households with access to an improved sanitation facility (urban and rural)SAN2. % of households with reliable access to sanitary facilitiesSAN3. % of households spending less than 10 minutes to travel to public or shared facilitiesSAN4. % of children <36 (or 60) months whose feces were disposed of safelySAN5. % of households using the available (improved) sanitation facilitySAN6. % of households with sanitary facilities that practice adequate cleanliness to encourage useSAN7. % of households with sanitary facilities that practice adequate maintenance to keep them operationalSAN8. # of communities achieving open defecation free statusSAN9. % of communities that are maintaining their open defecation free status

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How is the manual organized?

• Water, hand washing with soap and disposal of human excreta

• Each indicator includes:– Rationale/critical assumptions– Data source– Data analysis– Issues/limitations– Target setting– Questions added to surveys– Procedure to calculate the indicator

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CONTENT : ACCESS TO WATER SUPPLY USE OF HOUSEHOLD WATER TREATMENT TECHNOLOGIES STORAGEIndicator WA3: % of households spending up to 30 minutes to collect water from an improved source

Rationale/Critical Assumptions for Indicator: The amount of time spent fetching water will have implications for the amount of water that a household makes available to its members. The longer the time invested in fetching water, the less chance a family has to acquire enough water to satisfy household water per capita needs. UNICEF and WHO (2008) suggest that when the time invested in going to the source, collecting water, and returning to the household is between three and 30 minutes, the amount of water collected may vary between 15 and 25 liters per person per day. This range is considered suitable for a person to meet basic needs. The international community assumes that if the time invested in fetching water is longer the less time families take to fetch water, the better.

Data Source: Household survey

Data Analysis: Analysis may be done by geographic area (urban and rural) or by administrative unit of interest (region, district, and municipality).

Issues/Limitations: The sense of time may vary from culture to culture and the concept of minutes may not be commonly used among informants.

Example of Target Setting:

Results Data Baseline Year 1 Year 2 Year 3 Year 4

Planned45%

Actual 50% 55%65%

Questions that may be used to measure the indicator include the following:

WAQ6. How much times does it take on average to go to the drinking water source, get water and come back? 30 minutes or less………131 to 60 minutes………..261 to 180 minutes………3More than 3 hours……...4Does not know………….5

Indicator Calculation:Numerator: # of households providing an Answer 1 to Question WAQ6Denominator: # of households with answers 1 through 3, 7 to 10, 12 and 16 to Q WAQ1

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How can I use this manual?

• Which indicators are useful for my program?

• What targets can we set for each year?

• How do I modify my intervention if my targets are not reached?

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How can I use this manual?

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Access to sanitation, Madagascar

Percent

How can I use this manual?

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Handwashing supplies at commonly used station/device, Madagascar

Percent

Limitations of the manual

• Settled populations, adjustments for nomadic or displaced

• No guidance specific methodological issues: sampling or instrument design, pretesting and implementation

• No guidance on training enumerators or supervisors

• No sanitation marketing indicators16

How can I get the manual?

• Download it from HIP’s website at:http://www.hip.watsan.net/page/4148

• Send comments and questions to Orlando Hernandez

ohernandez@aed.org

+1 202 884 8619

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Question 1

Are the Madagascar data national, or for a smaller project area?

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Question 2

How would you pick indicators to apply to your program?

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Question 3

The calculations are a bit complicated. Is there a simple data entry or calculator tool plan?

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Question 4

On p. 59 of the indicators manual, safe disposal doesn’t mention ecosan toilets, nor are there any indicators for this. Is there any reason why?

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Question 5

In reference to sanitation marketing, program indicators, could you comment a bit more on challenges with including these indicators in the manual, and what areas still need research?

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Question 6

Does HIP have any plans to develop a guiding document on measuring hygiene improvement with displaced populations?

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Question 7

Why not mention hand washing with ash as an appropriate technique?

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Question 8

Could you share with us the best systematic monitoring methods for behavior change, other than formative research? Is it feasible to establish baseline data using proposed indicators for behaviors?

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Question 9

Do you think the indicators on water supply are too heavily focused on point of use? There are three indicators for water supply, nothing on community management, tariffs, or technical support, and nine indicators for point of use (POU).

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Question 10

Are there other indicators that relate to the management of water supply for water committees?

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Question 11

What is the connection between this publication and the guidelines for household and community levels produced by the EHP project?

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Question 12

I understand the indicator for hand washing supplies plus station device has been tested for inclusion in the manual. What did the testing say about the relation between the proxy trends as presented on the slide, and actual hand washing at critical times?

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Question 13

Are there any national monitoring systems, such as health or education management information systems, which reflect the hygiene practices?

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Question 14

Regarding sanitation marketing -- did you mention that you were looking into a WSP program in Peru to establish indicators?

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Question 15

Regarding p. 48 of the manual – You included all cleansing agents to be counted for indicator HW3, but the indicator statement is actually only applied for soap. Why not change the language to “cleansing agent”?

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Question 16

Regarding essential indicators – Besides the hygiene behavior mentioned in essential indicators, what other hygiene behaviors might a WASH program want to measure?

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Question 17

Are you aware of a similar manual or document with behavioral outcome indicators for WASH in schools, specifically?

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Question 18

Has the Community-led Total Sanitation (CLTS) approach been officially adopted by USAID/HIP?

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Question 19

What other aspects of hygiene behaviors can you measure?

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Question 20

Will the presentation be available online?

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Question 21

Will this manual be adopted to emergency situations, such as Haiti?

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Thank You!

For additional information on the Hygiene Improvement Project, please see our website, at http://www.hip.watsan.net .

If you have specific questions about the Indicators Manual, please contact Orlando Hernandez at ohernandez@aed.org.

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