Engaging Community Members to Adopt Effective WASH Practices for Nutrition

"The first 1,000 days, the period from pregnancy to two years of age, are critical for early childhood development. During this time, children are especially vulnerable to stunting, an irreversible condition that can result in lifelong cognitive and physical deficits."

This brief shares the experience and successes of the Strengthening Partnerships, Results, and Innovations in Nutrition Globally (SPRING) project’s “WASH 1,000” strategy, which is designed to promote focused, evidence-based WASH behaviours to ensure good health and nutrition in the first two years of life, and ultimately to prevent stunting. As explained in the brief, “[M]ounting evidence indicates that poor water, sanitation, and hygiene (WASH) practices contribute significantly to stunting. Improving WASH practices reduces diarrheal disease, environmental enteric dysfunction, and soil-transmitted helminth (parasitic worm) infections. Combined, these reductions contribute to decreases in stunting.” The “WASH 1,000” strategy takes an integrated, multi-sectoral approach, simultaneously delivering products, services, and information to households with pregnant and lactating women and those with children under two (i.e., 1,000-day households).

The project supports the implementation of the Government of Ghana’s community-led total sanitation (CLTS) programme to accelerate the population’s access to and use of basic sanitation facilities. While SPRING/Ghana’s WASH 1,000 strategy implements CLTS to contribute to national Open Defecation Free (ODF) targets, integrating the project’s WASH 1,000 behaviours into the CLTS approach is intended to accelerate improvement of nutrition outcomes in children under two.

SPRING/Ghana’s WASH 1,000 strategy seeks to promote the adoption of four evidence-based household behaviours that allow communities to achieve a “clean household status.” The behaviours include:

• Washing hands with soap at the appropriate times for all caregivers (mother, siblings, others). At a minimum, hands should be washed prior to food preparation and feeding the child, and after defaecation or handling of infant/child faeces.
• Safely disposing of adult and child faeces in a latrine.
• Creating clean play spaces that separate children from environmental contaminants (soil, animal faeces, human faeces), especially for children under two years of age.
• Disinfecting drinking water (most commonly through boiling) for children between the ages of six months (when water is first introduced after exclusive breastfeeding) and two years.

The brief explains how SPRING/Ghana's WASH 1,000 efforts begin with sensitisation and demand-creation in the community using the CLTS approach, which involves the following three phases:

• Pre-triggering - to identify and establish a relationship with the community before working through the CLTS approach.
• Triggering - in this phase, the change process is initiated with community members. In collaboration with district staff, SPRING facilitate a process through which the community analyses its sanitation status by taking stock of its existing sanitation practices, with the aim of achieving awareness that open defaecation is harmful to the community. Action plans are then developed for the school and community to ensure that each household makes improvements in practicing the four key WASH behaviours.
• Post-triggering - activities in the community action plan are implemented.

In an effort to sustain household motivation to practice the four WASH 1,000 behaviours, SPRING works to deliver key WASH messages through mass media, community groups, and direct contact with households and communities. The brief explains the different groups and platforms used to reinforce WASH 1,000 interventions, the purpose of these groups or platforms, and how they fitted into the overall strategy, as well as in what way SPRING worked to support these platforms. The groups and platforms included:

• Community mass media via cinema shows by the Information Service Department using video dramas created by SPRING
• Radio stations
• Natural leaders, water sanitation management teams (WSMTs)
• Mother-to-mother support groups (MTMSGs) and farmer field schools
• SPRING School health clubs and school health teachers
• Community health workers
• Community social/political structure and government agencies
• Environmental Health Officers (EHOs) and Community Development Units

For example, one of the purposes of the natural leaders and water sanitation management teams (WSMTs) was to sensitise community members about the importance of recommended practices and to act as agents of behaviour change in their communities. SPRING worked with these group to build their capacity to serve as WASH champions, create action plans, and lead communities in their implementation.

The brief also discusses some of the key results achieved by the project. Overall, it states that “SPRING/Ghana’s WASH 1,000 approach has largely been successful, as communities have embraced the WASH 1,000 key behaviors as the best way to improve and maintain the nutritional status of children for better growth.” To cite just two results: The airing of SPRING’s WASH 1,000 video dramas in communities reached 63,390 people to motivate, encourage, and reinforce the uptake of key behaviours. In addition, in each community, the project trained and put in place a natural leaders group and a water and sanitation management team, comprising 2,168 and 3,072 members respectively.

Finally, the brief also looks at how the approach contributed to the overall National CLTS strategy. For example, the project promoted handwashing stations within the household to make handwashing more convenient and frequent (whereas government CLTS emphasised hand washing points near latrines and not necessarily near the home). The project also promoted the boiling of drinking water in all households after research conducted by SPRING showed that water treatment technologies to improve water quality, which were being promoted by government, were not always easily available. The brief ends with some personal success stories demonstrating how the project impacted the lives of some community members.

Click here to read this brief online.