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Thursday, 9th July 2020

Studying handwashing in far-flung places – how and why?

By Alice Witt

Handwashing has been having its moment in the global spotlight over the last couple of months, perhaps more so than SEED expected when at the beginning of March we began a project in partnership with UNICEF Madagascar to promote hygiene – as well as clean water and sanitation – across the Anosy region.

If recent times have taught us anything, it is the lifesaving power of the simple combination of water and soap. And while handwashing requires little thought or effort for some, in many places around the world it is not always so easy.

Research published by UNICEF in 2018 brought to light the appalling reality of water, sanitation, and hygiene (WASH) conditions in Madagascar. In Anosy, identified as having the fifth worst WASH provision of the country’s 22 regions, it was found that only 3.0% of people have access to basic sanitation facilities, 13.0% practice basic hygiene, and 26.0% drink water of a basic cleanliness standard. In fact, more than half of the population of Anosy practices open defecation – and without the infrastructure for or education about safely washing hands or disposing of human waste, this dramatically increases people’s risk of becoming ill.

KAP survey in progress, Anosy Region, MadagascarWith this in mind, SEED wanted to take a closer look at how, at the level of individual villages, people meet their WASH needs, what causes lapses in behaviours, and what can be done to address WASH-related issues. In April 2020, SEED began extensive knowledge, attitudes, and practices (KAP) surveying in over 1,200 villages across the region to investigate when and how handwashing occurs, as well as how water is acquired and stored and what kinds of sanitation infrastructure is available to each household.

To ensure that results accurately reflect WASH conditions in Anosy, at least two households were surveyed in the majority of these target villages. So what tools do we use to carry out over 3,000 surveys in disparate, remote villages with a team of just 32 investigators?

One of the keys to SEED’s successful research in isolated areas with limited electricity, phone signal, and internet connection is ODK (Open Data Kit) technology. ODK permits offline data collection, so that with the app downloaded onto tablet computers with a four-day battery life, our WASH team are able to collect large quantities of data over extended periods of time and at significant distances from SEED’s district offices. The technology then stores the information until team members return to their district office and upload the completed surveys to the online server, where they can be received and analysed by the project team anywhere in the world.

Also crucial to effective surveying is ensuring that the team is well-trained for this type of research. This is particularly true in the field of WASH, where the personal and sensitive nature of questions must be delicately managed to ensure that interviewees feel comfortable, safe, and respected. To achieve this, the WASH team attended two weeks of training at the beginning of the project, some of which was run by our partner organisation, SAF-FJKM, covering topics ranging from participant consent and proper interview conduct to tablet technology and activity planning. In addition, each WASH promoter is assigned to and stationed in one geographical commune, where they both live and conduct their surveys, thereby ensuring a sense of consistency and trust.

WASH survey in MadagascarIn the midst of the coronavirus crisis, the team were also given additional training on minimising potential disease transmission thorough handwashing and social distancing by two metres during each interview. Moreover, in parallel with the survey, the WASH team have used their time with individual households to spread key hygiene messages and to provide training on constructing handwashing stations, both of which have been a vital way of sharing information about minimising disease transmission to isolated communities.

The initial results of the research are now being disseminated to project teams who, equipped with information specific to each village and village cluster, will share key learnings with community leaders. So far, findings starkly represent the severe WASH challenges that the Anosy region faces: just one out of over 3,000 surveyed households meets open defecation free standards, and only 5.4% properly transport, store, and treat water. Yet, with nearly half of households (49.3%) using some form of latrine, these results also highlight the existing motivation of target households to improve their sanitation and WASH behaviours – and therefore how important it is for SEED’s Rural WASH project to enable communities to do just that.

Information about these gaps and opportunities, combined with knowledge generated through participatory research activities and focus group discussions, will help SEED to tailor the focus of project activities to the specific WASH needs of the Anosy region. In giving us access to the bigger picture, this research enables us to best fulfil our fundamental mission of sustainably supporting communities to meet their needs and maintain good health and hygiene, hopefully far beyond today’s global crisis.