*) In my experiences:
In 2006, the Ministry of Health of the Republic of Indonesia issued the National Strategy for Community-based Total Sanitation (STBM) “to accelerate community access goals toward sanitation and behavioral hygiene improvement” (STBM, 2008, p: 3). The main goal of STBM is to decrease diarrhea disease and other environmental-related diseases.
STBM identifies five key behaviors, or pillars:
1) Open Defecation Free (ODF) community,
2) Safe food and drinking water handling,
3) Hand washing facility for proper hand washing with soap,
4) Proper wastewater management, and;
5) Proper waste management.
These five key behaviors, with the exception of #4, have been central to Health & Hygiene (H&H) strategy.
The purpose of the “Health and Hygiene Best Practices and Lessons Learned” publication is to reflect on the design and implementation of the Health and Hygiene (H&H) Communication Strategy of the USAID-funded and to share “what worked” with the Government of Indonesia and the larger community working on water.
This publication aims to reach local government officials at the district and sub-district levels, villages and sub-villages, managers of water and sanitation initiatives, grassroots organizations such as NGOs, POSYANDU (integrated health service post) cadres, health and education officials, and those interested in hygiene improvement programs. This document is also intended for the donor community and cooperating agencies that can refer to this body of accumulated knowledge when designing programs that aim to achieve sustainable hygiene improvement with increased potential for scaling-up.
The 22 Best Practices and Lessons Learned presented in this publication are the result of a collective process involving reflection, analysis, and understanding of the H&H Communication Strategy and its effectiveness during field implementation. This document presents the results of a collaborative effort among Local Government authorities, health and education officers, schoolteachers, community leaders, and NGO’s program staff, all of whom were instrumental to program success.
A series of meetings, revisions of communication materials and project documents, and interviews with field partners, have all contributed to the identification of key Best Practices and Lessons Learned.
The Health and Hygiene (H&H) strategy developed from initial conceptualizations among project health specialists to embrace a dynamic process involving a wide variety of community resources, connected through ongoing local initiatives for hygiene and environmental improvement. The resulting H&H strategy cannot be regarded as traditional “hygiene promotion”. Rather, it best considered a community mobilization and participatory effort. It incorporates conventional concepts of hygiene, including hand washing with soap and the use of latrines, as well as concepts less commonly associated with hygiene, such as waste management, re-greening, composting and beautification/cleaner neighborhood as prioritized by the community. These Models for Health and Hygiene Promotion utilizes two fundamental approaches: the “Clean, Green and Hygiene (CGH) Kampung” and the “Clean, Green and Hygiene (CGH) School. As illustrated by this publication, these two approaches promote a more competent network of organizations, solid partnerships, and stronger formal and informal leadership necessary for an effective and sustainable H&H strategy.
Clean, Green and Hygiene (CGH) School
Schools serve as an effective entry point for greater community involvement. Students and teachers spread hygiene messages and behaviors to parents and community members at large. Building hand washing with soap water stations, connecting water pipes, learning about organic and non-organic waste separation, composting, and tree planting would not have been possible without the committed partnership of schools, parents and communities.
Lessons Learned include:
1. Building commitment among a school’s headmaster and teachers by responding to their own goals
2. A well-structured Health and Hygiene curriculum motivates teachers and engages students with innovative and interactive tools and hands-on activities
3. The Clean, Green and Hygiene Agenda leverages support from diverse sectors
4. Expanding Child-to-Child hygiene promotion as an entry point for hygiene behavior change for parents and community members
5. Establishing strong linkages with Local Government, PUSKESMAS and POSYANDU to endorse CGH school activities and leverage support for effective program implementation
6. Involving the media to raise visibility and public commitment of local and school authorities
7. Scaling-up the CGH school approach through demonstration sites (showcases) that allow others to witness the benefit of CGH Schools
Clean, Green and Hygiene (CGH) Kampung
The great diversity and potential for local assets and resources aid in the promotion of Health & Hygiene practices. The representatives of neighborhood wards (Rukun Tetangga, or RT), neighborhood blocks (Rukun Warga, or RW), POSYANDU, PKK networks (Family Welfare Movement) and other informal leaders actively participate in facilitating various hygiene-related activities including: waste management, water treatment at the household level, sanitary disposal of feces, and Hand Washing with Soap (HWWS). This strong network of local leadership helps bring communities together toward a common goal. Lessons Learned include:
8. Leaders provide support to the CGH agenda when they realize that the approach is an opportunity to access technical program-based resources and government funding for their communities
9. The technical expertise provided by the program garnered the commitment of NGOs and CBO’s while increasing their technical capacity to support sustainable activities
10. Promoting HWWS as part of a larger set of hygiene behaviors that resonates closely with community members and encourages routine practice of the behaviors (STBM agenda)
11. Securing access to water and the participation of women increases success of H&H activities
12. The economic impact gained from composting and recycling translated to notably more sustainable practices among those who realized the benefits
Capacity Building among local networks
Capacity building regarded as a comprehensive process by which social networks, stakeholders, and partners do not only gain how-to technical competencies, but also the guiding principles to work toward a shared vision, stimulate commitment, and capitalize from indigenous and local assets. By enhancing those capacities, a positive and enabling environment had created to support the promotion, ownership and sustainability of hygiene behaviors and a cleaner environment. Lessons Learned include:
13. The use of participatory approaches to train local schoolteachers, networks, and community members increases overall commitment for H&H promotion and strengthens interpersonal communication skills, self-confidence, and assertiveness
14. The H&H training curriculum increases networks’ expertise by using local communication vehicles as a platform for H&H promotion
15. The broad range of technical content of the Health and Hygiene training package enhances participants’ skills beyond health promotion; it promotes a sense of confidence and empowers them to undertake new initiatives
Hand Washing with Soap (HWWS) advocacy at local and regional levels
Successful advocacy initiatives show that local governments, leaders, and media influence the creation of an enabling environment, which is necessary for hygiene behavior change and increased access to water and sanitation technologies. Lessons Learned include:
16. Large scale HWWS advocacy events enhance commitment from high level Government officials and private sector partners by generating high visibility through national media, TV and press coverage
17. Encouraging Regional level multi-sector authorities, religious leaders, and school constituencies to take the front stage and lead advocacy efforts at the regional and district levels to enhance visibility and commitment to HWWS
Research, Monitoring and Evaluation
Research and monitoring and evaluation (M&E) are critical to program design, effective hygiene strategies and messages, and learning about the impact achieved. While formative research delivered meaningful results, the M&E has not implemented as originally designed due to other program priorities. The Lessons Learned described in this section had expected to encourage other similar programs to increase efforts to properly fund and prioritize rigorous research and evaluation activities. Lessons Learned include:
18. Investing in innovative formative research, to gain knowledge about people’s perceptions surrounding hygiene, increases the potential for program success
19. A monitoring and evaluation system designed to include the direct participation of stakeholders’ increases understanding and motivation for hygiene promotion.
20. Providing technical support closely supervise data collection by stakeholders in the field to assure data quality and accuracy
21. Tracking school attendance is an easy way to monitor effects of hygiene practices and reduce illness (diarrhea and other hygiene-related illnesses like worms or respiratory infections)
22. Investing in rigorous program evaluation to learn how and why the program worked and build upon components that worked best
This publication has been possible thanks to the contribution of local stakeholders, government officials and Health and Hygiene team members. The publication represents a selection of a larger set of lessons learned accumulated, thanks to the candid and decisive participation of the men and women that reside in H&H locations. Sharing this exercise with a larger community of interested institutions, networks, and individuals in health and hygiene promotion is of prime importance. We expect that the information shared herein will be useful for others confronting unique challenges and opportunities and we welcome feedback from readers to continue to advance the field of Health and Hygiene communication.
..... to be continued*)
In 2006, the Ministry of Health of the Republic of Indonesia issued the National Strategy for Community-based Total Sanitation (STBM) “to accelerate community access goals toward sanitation and behavioral hygiene improvement” (STBM, 2008, p: 3). The main goal of STBM is to decrease diarrhea disease and other environmental-related diseases.
STBM identifies five key behaviors, or pillars:
1) Open Defecation Free (ODF) community,
2) Safe food and drinking water handling,
3) Hand washing facility for proper hand washing with soap,
4) Proper wastewater management, and;
5) Proper waste management.
These five key behaviors, with the exception of #4, have been central to Health & Hygiene (H&H) strategy.
The purpose of the “Health and Hygiene Best Practices and Lessons Learned” publication is to reflect on the design and implementation of the Health and Hygiene (H&H) Communication Strategy of the USAID-funded and to share “what worked” with the Government of Indonesia and the larger community working on water.
This publication aims to reach local government officials at the district and sub-district levels, villages and sub-villages, managers of water and sanitation initiatives, grassroots organizations such as NGOs, POSYANDU (integrated health service post) cadres, health and education officials, and those interested in hygiene improvement programs. This document is also intended for the donor community and cooperating agencies that can refer to this body of accumulated knowledge when designing programs that aim to achieve sustainable hygiene improvement with increased potential for scaling-up.
The 22 Best Practices and Lessons Learned presented in this publication are the result of a collective process involving reflection, analysis, and understanding of the H&H Communication Strategy and its effectiveness during field implementation. This document presents the results of a collaborative effort among Local Government authorities, health and education officers, schoolteachers, community leaders, and NGO’s program staff, all of whom were instrumental to program success.
A series of meetings, revisions of communication materials and project documents, and interviews with field partners, have all contributed to the identification of key Best Practices and Lessons Learned.
The Health and Hygiene (H&H) strategy developed from initial conceptualizations among project health specialists to embrace a dynamic process involving a wide variety of community resources, connected through ongoing local initiatives for hygiene and environmental improvement. The resulting H&H strategy cannot be regarded as traditional “hygiene promotion”. Rather, it best considered a community mobilization and participatory effort. It incorporates conventional concepts of hygiene, including hand washing with soap and the use of latrines, as well as concepts less commonly associated with hygiene, such as waste management, re-greening, composting and beautification/cleaner neighborhood as prioritized by the community. These Models for Health and Hygiene Promotion utilizes two fundamental approaches: the “Clean, Green and Hygiene (CGH) Kampung” and the “Clean, Green and Hygiene (CGH) School. As illustrated by this publication, these two approaches promote a more competent network of organizations, solid partnerships, and stronger formal and informal leadership necessary for an effective and sustainable H&H strategy.
Clean, Green and Hygiene (CGH) School
Schools serve as an effective entry point for greater community involvement. Students and teachers spread hygiene messages and behaviors to parents and community members at large. Building hand washing with soap water stations, connecting water pipes, learning about organic and non-organic waste separation, composting, and tree planting would not have been possible without the committed partnership of schools, parents and communities.
Lessons Learned include:
1. Building commitment among a school’s headmaster and teachers by responding to their own goals
2. A well-structured Health and Hygiene curriculum motivates teachers and engages students with innovative and interactive tools and hands-on activities
3. The Clean, Green and Hygiene Agenda leverages support from diverse sectors
4. Expanding Child-to-Child hygiene promotion as an entry point for hygiene behavior change for parents and community members
5. Establishing strong linkages with Local Government, PUSKESMAS and POSYANDU to endorse CGH school activities and leverage support for effective program implementation
6. Involving the media to raise visibility and public commitment of local and school authorities
7. Scaling-up the CGH school approach through demonstration sites (showcases) that allow others to witness the benefit of CGH Schools
Clean, Green and Hygiene (CGH) Kampung
The great diversity and potential for local assets and resources aid in the promotion of Health & Hygiene practices. The representatives of neighborhood wards (Rukun Tetangga, or RT), neighborhood blocks (Rukun Warga, or RW), POSYANDU, PKK networks (Family Welfare Movement) and other informal leaders actively participate in facilitating various hygiene-related activities including: waste management, water treatment at the household level, sanitary disposal of feces, and Hand Washing with Soap (HWWS). This strong network of local leadership helps bring communities together toward a common goal. Lessons Learned include:
8. Leaders provide support to the CGH agenda when they realize that the approach is an opportunity to access technical program-based resources and government funding for their communities
9. The technical expertise provided by the program garnered the commitment of NGOs and CBO’s while increasing their technical capacity to support sustainable activities
10. Promoting HWWS as part of a larger set of hygiene behaviors that resonates closely with community members and encourages routine practice of the behaviors (STBM agenda)
11. Securing access to water and the participation of women increases success of H&H activities
12. The economic impact gained from composting and recycling translated to notably more sustainable practices among those who realized the benefits
Capacity Building among local networks
Capacity building regarded as a comprehensive process by which social networks, stakeholders, and partners do not only gain how-to technical competencies, but also the guiding principles to work toward a shared vision, stimulate commitment, and capitalize from indigenous and local assets. By enhancing those capacities, a positive and enabling environment had created to support the promotion, ownership and sustainability of hygiene behaviors and a cleaner environment. Lessons Learned include:
13. The use of participatory approaches to train local schoolteachers, networks, and community members increases overall commitment for H&H promotion and strengthens interpersonal communication skills, self-confidence, and assertiveness
14. The H&H training curriculum increases networks’ expertise by using local communication vehicles as a platform for H&H promotion
15. The broad range of technical content of the Health and Hygiene training package enhances participants’ skills beyond health promotion; it promotes a sense of confidence and empowers them to undertake new initiatives
Hand Washing with Soap (HWWS) advocacy at local and regional levels
Successful advocacy initiatives show that local governments, leaders, and media influence the creation of an enabling environment, which is necessary for hygiene behavior change and increased access to water and sanitation technologies. Lessons Learned include:
16. Large scale HWWS advocacy events enhance commitment from high level Government officials and private sector partners by generating high visibility through national media, TV and press coverage
17. Encouraging Regional level multi-sector authorities, religious leaders, and school constituencies to take the front stage and lead advocacy efforts at the regional and district levels to enhance visibility and commitment to HWWS
Research, Monitoring and Evaluation
Research and monitoring and evaluation (M&E) are critical to program design, effective hygiene strategies and messages, and learning about the impact achieved. While formative research delivered meaningful results, the M&E has not implemented as originally designed due to other program priorities. The Lessons Learned described in this section had expected to encourage other similar programs to increase efforts to properly fund and prioritize rigorous research and evaluation activities. Lessons Learned include:
18. Investing in innovative formative research, to gain knowledge about people’s perceptions surrounding hygiene, increases the potential for program success
19. A monitoring and evaluation system designed to include the direct participation of stakeholders’ increases understanding and motivation for hygiene promotion.
20. Providing technical support closely supervise data collection by stakeholders in the field to assure data quality and accuracy
21. Tracking school attendance is an easy way to monitor effects of hygiene practices and reduce illness (diarrhea and other hygiene-related illnesses like worms or respiratory infections)
22. Investing in rigorous program evaluation to learn how and why the program worked and build upon components that worked best
This publication has been possible thanks to the contribution of local stakeholders, government officials and Health and Hygiene team members. The publication represents a selection of a larger set of lessons learned accumulated, thanks to the candid and decisive participation of the men and women that reside in H&H locations. Sharing this exercise with a larger community of interested institutions, networks, and individuals in health and hygiene promotion is of prime importance. We expect that the information shared herein will be useful for others confronting unique challenges and opportunities and we welcome feedback from readers to continue to advance the field of Health and Hygiene communication.
..... to be continued*)
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