Implementation Modality of Hygiene Model for the Urban Poor. Capacity building, Coaching and Monitoring of UPPR Front Line Staff and Core Trainer Groups on Hygiene Behavioral Change Project Practical Action Bangladesh H-12/B, R-4, Dhanmondi, Dhaka-1205 Ph. +880 2 8650439, 9675236, Fax.+880 2 9674340 Email: bangladesh@practicalaction.org.bd Web: www.practicalaction.org
1. Background: The Urban Partnership for Poverty Reduction (UPPR) Programme aims to improve the living conditions and livelihoods of 3 million urban poor and extreme poor in 6 City Corporations and 23 municipalities. It is implemented by the Local Government Engineering Department. The major activities include mobilization of communities, formation of community development committees (CDCs), community action planning, water and sanitation infra-structure, solid waste management and livelihoods and skills development, partnership formation and policy influencing. Hygiene behavioral change is time intensive and a long term process. Despite tremendous social mobilization and hardware supports (water point, sanitary latrine, drain etc.) to the UPPR community; change in hygiene behavior of the poor people was remaining the major challenge. Considering the availability of infrastructures, the findings shows that 45% of latrines are in hygienic and 55% are unhygienic condition. The knowledge level on hand washing before eating, after defecation and after child s bottom cleansing are 49, 56 and 49 percent of households respectively. At the same time, 50 percent of households are aware about necessity of hygienic latrine and 75 percent households know the necessity of cleaning latrine after use and 70 percent of households have knowledge on necessity of safe water source and 79 percent of households on necessity of using safe water for drinking and all purposes. On the other hand, the study also shows that the practice of hand washing before eating, after defecation and after child s bottom cleansing are maintaining only 27, 35 and 28 percent of households respectively. Beside this, only 32 percent households where all the members are using sanitary and clean latrine and 43 percent households are cleaning the latrine properly after using. At the same time, 65 percent of households are maintaining safe water source and 77 percent of households are using safe water for drinking and other purposes. From the findings of hygiene baseline surey, analysing the Training Need aassessment (TNA) and field observation of UPRR, Practical Action has developed a hygiene model considering urban context of UPPR`s poor communities. The model will be implemented at 23 UPPR towns where 1200 UPPR and Municipal staffs will be skill and knowledgeable on hygiene behavioral changes by ToT on hygiene promotion training. And the trained staffs will roll out their knowledge and skill to 2200 CDCs and 24,387 primary groups (PG). The hygien model is concentrating 3 vital hygiene issues including 10 messages which were recommended by the UPPR town`s and central team`s member in the inception workshop of the project. The model (3 hygiene issues) will be implemented effectively updating hygiene community action plan (CAP); designating roles and responsibilites of UPPR, Municiaplity and CDC`s (communities). The PG leaders, mothers, children, adolescent girls and CDCs will work as channels for implementation of the model and cumminity mobilization and ignition, hygiene
sessions, vedio show and game methods will demonstrated and conducted for encreasing knowledge and safe hygiene practices of 23 UPPR town`s communities. 2. Objectives: To increase the knowledge and skill of 1200 UPPR and municipal staffs on hygiene issues which will reflect in the 2200 Community Developemnt Committees (CDCs) and 200 schools for promoting the hygiene knowledge and practice at 23 towns. 23 UPPR towns and Municipality/City will incorporate hygiene issues with their ownprogrammes as sustainable hygiene behavioral change model. 3. Duration: In consideration the range of issue based messages, the hygiene model takes 12 months for effective implementation and capacity building of the implementing staffs and vulanteers sequentially according to the experience of hgiene model implementation in urban poor communities. 4. Output: Improved hygiene practices and reduced incidence of common diseases in 23 UPPR`s urban poor communities (3 million poor people) through sustainable hygiene behaviour changes. 5. Capacity building: A large number of skill and competent staffs (CO and SEA) are engaged in the towns for field implementation and facilitating to Community Facilitators (CF) to strengthen the capacity of community leaders. According to TNA findings, the COs and SEAs are competent enough and some knowledge on hygiene. The CFs also got training on water and sanitation; but they have not enough knowledge and competency on hygiene behavioural changes activities. Practical Action, Bangladesh will provide training to develop a master trainer groups UPPR municipality for implementation of hygiene model an d the master trainers group will roll out the training among 2200 Community Development Committees (CDCs) through different sessions and community mobilization events in the Primary Groups (PG) as well as 400 hundreds teachers, SMC members and education officers from 200 primary schools will be trained up for hygiene behavior changes and will form student`s brigades in these schools. 6. Hygiene Model: The hygiene model has been developed incorporating/focusing 3 hygiene issues (Hand Washing, Sanitation and Safe Water) as requisite of UPPR`s urban poor communities at 23 towns. The modality of hygiene model will be as follows:
7. Roll out the training: In consiration of the project duration, the hygiene behavioral changes project will take total 12 months to implement and capacity building of the implementing staffs and vullennteer sequentially. Every issue means one wave (4 months) will be rolled out in the community for establishing the practice of each hygiene issue. After getting the training, the UPPR staffs will be rolling out the training in 2200 CDCs. Roll out flow diagram of hygiene model Town team Hygiene model 3 issues with 10 messages TM, SEE, SEA, CO Municipal staffs Meeting, discussion and training SEA Training, meeting and Facilitation Community Organizers (COs) Training and on the job training and coaching Community Facilitators (CFs) Training/orientation, on the job coaching and demonstration CDC Leaders Fort nightly meeting Primary groups/ Communities CDC/PG leaders/community mobilization/court yard session
8. Hygiene Issues: 8.1 1 st issue-hand washing (4 month period): Hand washing as 1 st issue of the model, carries out 3 critical messages for mother and child; i) mother wash hand before feeding children and herself eating, ii) mother wash hand after cleaning child s bottom iii) mother herself wash hand after using toilet. Channels: Mother and children will be the prime target group to put critical messages on hand washing into practice. They will educate hand washing to all HHs members during critical time. Tools and materials: Paut and vulu-pushi will be the main tools for hand washing message delivery. Paut is a pictorial tool which carries messages and educates the community. Vulupushi is a game, played by children for community mobilization and ignition and delivers the messages and pragmatic demonstration how to wash hand. Pledge board, another tool will be put in the community for establishing hand washing by pledging as means of social norms and believes. Methodology: the 1 st issue will take 4 months. 1 st round, in the 1 st month, the 3 messages will be delivered demonstrating paut and playing vulu-pushi game in the community through mass gathering. In this round the mother and father groups will pledge signing in the pledge board for hand washing during 3 critical times. From the 2 nd month, CF and PG leaders will give the messages through hygiene session and visit the HHs to observe behavioral changes of hand washing practice level. Responsibilities: Community Facilitators (CF) and Primary Group Leaders (PG) leaders will take over the responsibility to deliver messages of Hand Washing for behavior change. CF, after capturing the knowledge and skill from Tot on hygiene promotion training, will deliver the issue and continue HHs visit and at the mean time h/she will orient the PG leaders on hand washing and each PG leader will follow up the targeted group of hand washing during HHs monitoring. Output: Increased knowledge and practices on hand washing as social norms and believes. 8.2 2 nd Issue Sanitation (1 month period): Sanitation as 2 nd issue of the model carries out 2 messages for mother and father. Mainly they will carry the messages; i) use sanitary latrine ii) clean latrine after using. Channels: Mother and father will be the message carrier of sanitation issue and the mothers and fathers will also be the prime target groups to put 2 messages on sanitation into practice at the HHs level. They will educate rules of hygienic latrine use to all HHs members during latrine use. Tools and materials: Paut and vulu-pushi will be the main tool for sanitation message delivery. Paut is a pictorial tool which carries messages and educates the community. Vulu-pushi is a game, played by children for community mobilization and ignition and delivers the messages
and educates the HHs members especially the children on how to use sanitary latrine. Pledge board, another tool will be put in the community for establishing sanitary latrine use by pledging as means of social norms and believes.. Methodology: the 2 nd issue will take 4 months. In the 1 st month, the 2 messages will be delivered demonstrating paut and playing vulu-pushi game in the community through mass gathering. In this round the mother and father groups will pledge signing in the pledge board for sanitary latrine use and cleaning. From the 2 nd month CF and PG leaders will give messages through hygiene session and visit the HHs to observe behavioral changes of hygienic latrine using practice level and mentoring on sanitary latrine use as per rules (available water, soap and sandal inside of latrine). Responsibilities: Community Facilitators (CF) and Primary Group (PG) leaders will take over the responsibility to deliver the massages of sanitation for behavior change. CF, after capturing the knowledge and skill from Tot on hygiene education training, will deliver the issue and continue HHs visit and at the mean time h/she will orient the PG leaders on sanitation and each PG leader will follow up the targeted group of sanitation during HHs monitoring. Output: increased knowledge and practice level of HHs members on sanitary latrine use. 8.3 3 rd Issue Safe water (2 month period): Safe Water as 3 rd issue of the model carries out 5 messages (steps to have safe water) in aspect of water safety plan (WSP) for Mother and ADGs. Mainly the mothers will carry the messages; i) drink safe water, ii) safe Water source, iii) clean water pot before water collection, iv) cover water pot during carrying and v) preserve safely. Channels: The mothers will be the prime target groups to put the 5 messages on sanitation into practice at the HHs level. She will educate the rules of drinking safe water to all HHs members. Tools and materials: Paut will be the main tool for safe water message delivery. Paut is a pictorial tool which carries messages and educates the community. Pledge board, another tool will be put in the community for establishing safe water use by pledging. The mentioned tools and materials (Paut and pledge board) for education on safe water use will be applied at CDC captured areas of 23 municipalities/city Corporations. The front line staffs of UPPR will facilitate/demonstrate the tools in community for improving knowledge relating to safe water. Methodology: the 3 rd issue will take 2 months. In the 1 st month, the 5 messages will be delivered demonstrating paut in the community through mass gathering in this round the mother groups will pledge signing in the pledge board for safe water use and drinking. From the 2 nd month, CF and PG leaders will visit the HHs to observe practice level of safe water drinking and using in household purpose and mentoring on safe water use as per rules (steps from source to drinking).
Responsibilities: Community Facilitators (CF) and Primary Group (PG) leaders will take over the responsibility to deliver messages on safe water for safe water use and drinking. CF, after capturing the knowledge and skill from ToT on hygiene education training, will deliver the issue and continue HHs visit and at the mean time h/she will orient the PG leaders on the steps on safe water and each PG leader will monitor the targeted group for safe water drinking and using in households purposes. Output: increased knowledge of safe water drinking and using in all household purposes. 9. WASH in School: WASH in School will carry out 6 messages of 3 issues i) hand washing ii) sanitation and iii) Safe water. In addition, 3 more messages on food and personal hygiene will deliver to the school for unhygienic food and personal hygiene education. After completion of ToT on WASH in school programme will help to increase the knowledge and skills of other teachers and school management committee members of 200 primary level schools. The trained teachers will form student s brigades and disseminate selected hygiene messages to school children and monitor the changes in practice level with the help of student brigades. They will develop an action plan depends on selected issue based hygiene messages for hygiene behavior changes of the schools teachers and students. The selected schools will also implement the hygiene model as required in terms of improvement knowledge and practice level before and after the project can be measured against the baseline. Tools and materials: CHAST tool kits (color pencil with pencil box) is main tool of WASH in school for improving hygiene behavioral practices in the school`s teachers and students. Methodology: Lessons learning session will be conducted on CHAST tool kit with the students of class-iii, class-iv and class-v. During the session the students will read lessons on hygiene issues and write the answer according to the questions and also draw the picture same as the picture of CHAST tool kits. Student s brigades will carry the messages to their family and friends learning from CHAST lessons. Project Officer of Practical Action in connection with Socioeconomic assistant will assist the teachers to facilitate/ demonstrate the session to form student s brigade and introduce the process using of CHAST tools kit. Output: Increased the hygiene knowledge and practice level of primary level school teachers and students. 10. Participatory Planning by the CDCs and CAP update: After completion of Tot on hygiene promotion training, the trained UPPR staffs (CF & CO) will facilitate to establish hygiene baseline through CAP update during roll out the training in community. Mainly the concern trained CF will facilitate CDCs to prepare Community Action Plan (CAP) for hygiene model implementation. In Action plan of the hygiene CAP, the 3 issues will be addressed periodically (every issue needs 4 month) and roles of the actors will have indication for implementation. Hygiene map will show hygiene baseline and periodical progress
of the issues as per problem prioritization. The hygiene CAP will guide CDC to implement the hygiene model for hygiene behavioral changes of UPPR urban poor communities. The trained CF along with CDC leaders will deliver issue in the 1 st month through a hygiene session/ mass gathering. After delivering the Hygiene issue, the CDC will update the CAP in 4 month frequency according to hygiene issue duration. The below diagram shows the CAP updating process: Hygine CAP update process: CDC & PG leaders, CF & CO PG leader Issue (4 month) CF/CDC Message delivery in the 1 st month Next 3 month 2 nd month monitoring 3 rd month monitoring 4 th month monitoring Data of 3 month monito ring Sharing the 3 month monitoring information in the CDC meeting and CAP update Primary Group (PG) CAP update in 4 month frequency 11. Capacity building of the community institutions: UPPR is institutionalizing the poor people`s organizations at 23 towns for promoting governance system in the slum dwellers and low income settlements. UPPR is working in demand driven approach and also providing need based supports including water supply, sanitation and drainage as per contacting system by the CDC and cluster CDC. But due to deficiency of planning the hygiene education aspect is very feeble in targeted community. To improve the hygiene behavior and to operate the water and sanitation facilities hygienically, capacity building of CDC and PG leaders on hygiene issues is very important in aspect of hygiene CAP operation and monitoring activities. UPPR front line staffs will facilitate to build the capacity of CDC and cluster leaders on hygiene education through orientation and coaching in CDC meeting so that they can continue the hygiene behavioral changes approach. Only community led approach as means CDCs can ensure the sustainable changes of hygiene behavior of the slum dwellers, being capacited and educated on hygiene behavioral changes issues.
12. Participatory Monitoring and Evaluation (PME): UPPR frontline staffs will facilitate the participatory monitoring and evaluation system in community particularly for the CDC and PG leaders. The participatory monitoring and evaluation system has been developed and will be trained up the UPPR front line staffs in the 2 days long Participatory Monitoring training. The trained staffs will roll out the participatory monitoring system in the PG leaders and facilitate them to be educated with this monitoring process for continuation. The PG leaders will collect the progress information from CAP located households on hygiene issue based messages by using participatory monitoring format Periodically (monthly) and share the monitoring progress findings at CDCs meeting in the presence of CO and this progress will also be shared in town level meeting by SEA for progress review. The below diagram indicates information flow from community to UPPR town team. Capacity building on PME by Practical Action Primary Groups CDC and CF CO SEA UPPR Town Team Sharing with UPPR team review and planning Source of data 13. Roles/Responsibly of concern project stakeholders: Practical Action-Bangladesh has developed a hygiene model and its implementation modality for the urban poor of 23 UPPR towns in light of SHEWA-B experience from 18 Pourashava. It will also facilitate UPPR to implement the model. So, to implement the model, the main role of the stakeholders will be as follows: Urban Partnership and Poverty Reduction (UPPR) Programme: UPPR will coordinate with UNICEF, LGED, Pourashavas, City Corporations and Practical Action to execute hygiene behaviour change interventions with the primary group beneficiaries and targeted schools as per the hygiene promotion modality. Provide office space for one Practical Action`s Project Officer in each town Participate in training/capacity development sessions and provide feedback on the quality of the support provided by Practical Action Socio-Economic Assistant (SEA) will work as focal person of UPPR town and assist the frontline staff (CO & CF) to implement the hygiene model including preparing hygiene CAP (Hygiene map, Problem identification & prioritization and Action plan).
Community Organizer (CO) will facilitate and assist Community Facilitators (CF) and CDCs to roll out the hygiene issues in improving knowledge and practices for hygiene behavioral changes. Community Facilitators (CF) will facilitate the PG leaders to monitor progress of hygiene issues based messages and compile the HHs informations/findings as well. In absence of Project Officer of Practical Action, Socio-economic assistant will assist the teachers to facilitate/ demonstrate the session to form student s brigade and introduce the process using of CHAST tools kit Pourashava and City Corporations: Pourashava and City Corporations will coordinate with UNICEF, UPPR project, Practical Action, LGED and other agencies for smooth implementation of the project activities, Pourashava and City Corporation staffs will participate in the training on hygiene behavior change, organized by Practical Action, Mayors and councilors will disseminate the messages of hand washing and sanitation as social norms and believes for establishing hygiene practices, Provide support in organizing hygiene promotion sessions and community mobilization events at the field level and mainstream the learning from the project particularly on hygiene education into their own programs. Practical Action Bangladesh: Responsible for quality and timely implementation of capacity development support to UPPR and pourashava/city Corporation staff (1200), and 400 school teachers and SMC members of 200 schools on hygiene behavioural change, Develop a hygiene model from the learning and experience of SHEWAB project and findings from TNA and baseline conducted in community and UPPR and municipality/city Corporation staffs. Provide training manuals, guidelines and materials on hygiene promotion to implement the hygiene model in UPPR urban communities. Facilitate the UPPR staffs to be skilled on implementation modality of hygiene model through ToT on hygiene promotion training for implementation in the 2200 Community Development Committees (CDCs). Facilitate to demonstrate Community Action Plan (CAP) focusing hygiene issues and roll out the training in the community, Project Officer of Practical Action in connection with Socio-economic assistant will assist the teachers to facilitate/ demonstrate the session to form student s brigade and introduce the process using of CHAST tools kit. Maintain liaison with UNICEF, UPPR and concerned Pourashavas/City Corporations and keep UNICEF and UPPR informed of field progress on a regular basis. Responsible for routine monitoring, documentation, submission of progress reports to UNICEF in time and facilitating organization of tripartite review meetings.
Community Development Committee (CDC): Community Development Committees (CDCs) will ensure their participation in planning of hygiene CAP preparation. Assist Community Facilitators (CF) and Community Organizers (CO) and involve in organizing the awareness events of community mobilization and ignition on hygiene behavior changes. CDC will provide the budget against the demand of hand washing devices and necessities as well as community mobilization events in community contacting as per community action plan (CAP) for hygiene behavioral changes. Involve in monitoring and follow up activities for finding sharing on hygiene promotion and documentation through CAP update. 14. Sustainability: Hygiene behavioural change is time intensive and a long term process. The hygiene behavioural change activities implemented by this project will supplement UPPR s already strong community empowerment and livelihood components. UPPR has already established structured functional primary groups, community development committees (CDCs), clusters of CDCs etc. These groups are supported further for the construction of WASH infrastructure through the community contracting system and are the main vehicle for sustaining changes in improving the health and environment of slum dwellers. Sustainability of results from the project are expected at three levels: Around 1200 UPPR and Pourashava staff who are trained by the project will be equipped with increased knowledge, skills and facilitation skills on hygiene behavior change to work with the 8800 Community Development Committee leaders and members of 24,387 primary groups (women, children and adolescent girls) on promotion of key hygiene behaviours. These trained UPPR staff are expected to continue to support hygiene behaviour change after the project period. Provision of hygiene behaviour change materials together with continued coaching, supervision, monitoring and on-the-job training by the Hygiene Promoters will contribute to local capacity building for dissemination and monitoring of hygiene messages among the primary group members. As the trained Community Organizers, Community Facilitators and CDC leaders will remain in the community, they are expected to continue follow-up, monitor, observe hygiene behavior practice and provide support where necessary under the guidance of UPPR staff. This is expected to contribute to sustainable changes in hygiene practices. Support to the WASH in school programme will help increase the knowledge and skills of teachers and school management committee members of approximately 200 schools to disseminate selected hygiene messages to school children and monitor the changes in practice level with the help of student brigades. The hygiene behaviour changes both in terms of improvement in knowledge and practice level before and after the project can be measured against the baseline. During the process Practical Action itself will develop its expertise and experience in working with UPPR staff and communities and their resource can be tapped by UPPR if needed.
15. Phase out plan: A project phase out plan will be developed by Practical Action with support of UPPR town and central team. It will be developed for the sustainability of project encompassing CDCs and UPPR town and municipality/city corporation level action plan. It will also be focused on hygiene issues delivery mechanism and sustainability aspects. The plan will be contained with: i) The plan will indicate the hygiene modality operational mechanism by the UPPR town team and community in absence of Practical Action. ii) Documents hand-over to the community (updated CAP, map, baseline and progress information) through UPPR town team. iii) Participatory monitoring manual, Hygiene promotion manual, WASH in school manual and baseline information, Hygiene tools & materials will be provided to UPPR towns town as a project document. iv) Progress documents hand over to UPPR town team and municipalities/city corporations organizing a formal meeting at town level. 16. Overall Hygiene Matrix Issues & Messages Channel Methods Tools & duration materials Hand Washing (4 months duration) Sanitation (4 month duration) Safe water (4 months duration) WASH School in (7 month durations) i) mother wash hand before feeding children and herself eating ii) mother wash hand after cleaning child s bottom iii) Mother herself washes hand after using toilet. i) use sanitary latrine ii) clean latrine after using i) drink safe water, ii) safe Water source, iii) clean water pot before water collection, iv) cover water pot during carrying and v) Preserve safely. i) Hand washing hand before eating ii) Mother herself washes hand after using toilet. iii) use sanitary latrine iv) drink safe water v) Avoid uncovered and terrible food vi) Personal hygiene Mother, father and child Mother and father Mother and ADGs Teachers and students Session and Mass gathering Session and Mass gathering Session and Mass gathering CHAST and student brigades Paut and Vulu-pushi Paut, Vulupushi and pledge board Paut and pledge board CHAST Tool kids Target group Mother Mother and father Mother Students output Increased knowledge and practices on hand washing as social norms and believes increased knowledge and practice level of HHs members on sanitary latrine use increased knowledge of safe water drinking and using in all household purposes Increased the hygiene knowledge and practice level of primary level school teachers and students.