LEARNING TOPIC : IMPROVING COMMUNITY HAND WASHING BEHAVIOR IN ASAL, NOMADIC AREAS A case study for Marsabit in Kenya ( March 2010-April 2012) Findings of : FH KENYA

MARSABIT

WHAT YOU SHOULD KNOW ABOUT MARSABIT! Marsabit County is located in the upper reaches of Northern Kenya. According to the 2009 census, Marsabit district supports a total population of 187,367 over a land area of 61,590 sq km A population density of just over 3 people per sq km. According to the 2009 census, of 2,306,566 or more than 37 head per sq km herds of sheep, goats, cattle and camels are found here

Have you heard about this? During the 2005/06 drought an estimated % of livestock (shoats, camels and cattle) died. the 2008/2009 and 2011 droughts brought the triple shocks to communities soon before they recovered from the shocks of previous droughts. Global Acute Malnutrition (GAM) rates during 2011 drought was 27.1% against 15% WHO emergency threshold

A must tell…. In Marsabit access to water, both for domestic and livestock uses, is severely limited and is the single most critical issue facing the district’s population. The average amount of water available for household use in is only 46 liters/day which translates to only 7.7 liters/day/person against 15liters/day/person according to SPHERE standards (UNICEF Integrated Nutrition and Health Survey Report, Marsabit District, March 2011)

INTRODUCTION FH Kenya has implemented the Safe Water Systems, low cost sanitation model school and community safe storage and treatment of drinking water, facilities and hygiene promotion and specially promoted for hand washing ( grant period) The project has championed the formation of school health clubs and utilization of community health workers to promote message transfer to other children and communities in 22 communities and 11 schools. FH Kenya has collaborated with Government and other development partners in the implementation of the project.

LEARNING POINTS 1) What are the specific barriers to sustainability of Hand washing in ASAL, 2) What are Hand washing characteristics that are more successful in sustaining, and 3) What are the recommendations for continued improvements of Hand washing to further sustainability from MWA-FH project

What is Hand Washing? Hand washing is a vigorous, brief rubbing together of all surfaces of lathered hands for about 20 seconds followed by rinsing under a stream of water. It is important to dry hands completely after handwashing (WHO).

Threats to poor hygiene Each day about 6,000 people in the developing world die as a result of diseases caused poor hygiene sanitation practices (UNICEF health survey 2011)

Tools for this learning Observations Key Informant Interviews(KII) Focus group discussions(FGD) MWA MEL Framework administration Lessons learnt by other agency working in Marsabit

In order to have sustained hand washing impact The following regular activities were identified Provision of water for hand washing. Daily provision of soap. Provision of safe clean water for drinking in safe storage containers.

For this learning topic 30 communities and 20 schools in Marsabit county where FH has implemented MWA grants. Representing 3,000 HH.

Is Soap important in hand washing? Soap is important Soap contains ingredients that will help to: Loosen dirt on your hands. Soften water, making it easier to lather the soap over your hands. Rinse your hands, leaving no residues to irritate and dry your skin.

In order to provide an enabling environment for hand washing, The following preconditions have been identified: Availability of an accessible water source Hand washing facilities Purchase of soap Teachers, SHC,CHW monitoring and hygiene promoters promoting key activities at school and community level School health club or other mechanism to engage children while CHW, have to engage both men and women at communities and health facilities…....

Sustainability threats that have been identified Lack of water access Lack of financial resources Human and institutional resources and motivation Technological limitations Nomadic nature of the people Cyclic droughts HAS UPTAKE LEVELS IMPROVED OVER PROJECT PERIOD???

Taking the bull by horns?? BarriersWhat has been done to improve sustainability? What is being considered / planned to improve sustainability? What challenges remain? Costs  Repurchase of water treatment products & soap  Purchase of water during the dry season  Repair & replacement of containers / taps  Affordability of containers  SCHOOL WASH members are currently engaging with relevant stakeholders at the school (i.e. SMCs), local (i.e. chiefs), and district (i.e. DDOs) levels to increase allocation of funds to schools for WASH  In School WASH, training of the activities includes training the SMCs on allocating adequate funds for soap and water treatment is helping to improve the situation  Income generation opportunities from liquid soap, containers or treatment products, or rainwater sales to help fund soap  Encouraging schools to apply for CDF funds for WASH improvements and provision of soap  As a result of the Last drought, many people’s purchasing power has decreased while some commodities have increased in price making purchase of hand washing inputs within the community a financial challenge

Taking the bull by horns?? BarriersWhat has been done to improve sustainability? What is being considered / planned to improve sustainability? What challenges remain? Water access  Distance to sources in dry season  Stop treating water when get improved source  Turbid sources of water  Water storage containers  Advocating to government officials for the inclusion of schools in community water projects  Refresher training is currently being conducted Package schools with emphasis on the importance of treatment  Rainwater feasibility assessment has currently Was conducted by FH and this is a partial alternative to turbid water sources  Through involving the SMCs in SWS training, the need for proper budgeting will increase the likelihood of purchasing additional storage containers and soap  Reinforced message on need to treat water from protected source  Need to provide ash as an alternative detergent at home  Ensuring that treatment of water takes place despite how “protected” a source of water may be. Great need for creating awareness / emphasizing on hand washing regardless of the source  Need for greater research on alternatives hand washing detergents to soap or reducing technologies that are affordable

Taking the bull by horns?? BarriersWhat has been done to improve sustainability? What is being considered / planned to improve sustainability? What challenges remain?  schools are now receiving redesigned stands to reduce tap breakage  Division level supply chain to improve access has been established in Marsabit county FH is currently working with local vendors in Marsabit and Moyale Districts to stock handwashing inputs.  Refresher course are currently being provided to by FH and Ministry of public health schools to ensure hand washing practices,water treatment using WaterGuard bottles are taken into account  Pilot different soap options (i.e. powder or netting to secure soap)  Train patrons in tap repair  Explore alternative tap designs  Explore 20 liter container options for community level uptake.  FH will engage with local vendors to encourage them to purchase additional plastic taps in order to ensure schools /communities have local access to repair / replace broken taps  Local vendors may not continue selling of Hand washing and hygiene inputs if uptake is not high  schools are now receiving redesigned stands to reduce tap breakage  Division level supply chain to improve access has been established in Marsabit county FH is currently working with local vendors in Marsabit and Moyale Districts to stock handwashing inputs.  Refresher course are currently being provided to by FH and Ministry of public health schools to ensure hand washing practices,water treatment using WaterGuard bottles are taken into account

Taking the bull by horns?? BarriersWhat has been done to improve sustainability? What is being considered / planned to improve sustainability? What challenges remain? Water access  Distance to sources in dry season  Stop treating water when get improved source  Turbid sources of water  Water storage containers  Advocating to government officials for the inclusion of schools in community water projects  Refresher training is currently being conducted Package schools with emphasis on the importance of treatment  Rainwater feasibility assessment has currently Was conducted by FH and this is a partial alternative to turbid water sources  Through involving the SMCs in SWS training, the need for proper budgeting will increase the likelihood of purchasing additional storage containers and soap  Reinforced message on need to treat water from protected source  Need to provide ash as an alternative detergent at home  Ensuring that treatment of water takes place despite how “protected” a source of water may be. Great need for creating awareness / emphasizing on hand washing regardless of the source  Need for greater research on alternatives hand washing detergents to soap or reducing technologies that are affordable

Taking the bull by horns?? BarriersWhat has been done to improve sustainability? What is being considered / planned to improve sustainability? What challenges remain? Institution and People  Lack of prioritization and motivation  Teacher turnover  School health club stops  Voluntary role of SWS activities in teachers’ job description and daily duties  Lack of defined school systems  Budgeting for soap  Need for greater community engagement  Recommendation to use Child-to-Child methodology to help head teachers select appropriate teachers to be patrons and students for the School Health Clubs. Training can also target the School Management Committees, and government officers (i.e. Area Education Officers, Public Health Officers, etc.) as well  SMCS includes to sensitize the wider community (i.e. during Parent-Teacher Days)  Reward systems for most where by best performers in handwashing insitutuins are recognized and motivated parents to participate  IEC and talking walls, posters with handwashing messages  Work with educational,PHOS officials to develop standards and norms regarding school and community WASH  Governt through Ministry of Public Health and Sanitation has rolled out CLT, and has trained key staff in districts. The curriculum has pre-tested prior to introduction to the MOE.  Incorporate school wash into performance / monitoring assessment of schools by government officers  Encouraging teachers to incorporate WASH into teacher’s science curriculu  Institution and People  Lack of prioritization and motivation  Teacher turnover  School health club stops  Voluntary role of SWS activities in teachers’ job description and daily duties  Lack of defined school systems  Budgeting for soap  Need for greater community engagement

Best practices/success CLTS has worked very well in this project. 200 hh have been able to do successively adopt simple household latrines, and tippy taps in at their own. Hygiene and sanitation linkages to health facilities has further helped further helped increase uptake level,CHW and house to house hygiene promotion has worked well does house to house hygiene promotion

Photo 1:Demonstration of Handwashing

Constructed storage reservoir

SCH HYGIENE PROMOTION CAMPAIG

THANKS