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Sustaining Behavior Change through Participatory
                   Approaches
                        in
           Project Cycle Management

                         Rizwana Kousar

                                  Asia Regional Sanitation And Hygiene
                                    Practitioners Workshop, Dhaka 2012
Background and Justification
•   Rapid urbanization and congestion in cities are constant characteristics of Pakistan
    demography ever since partition.

•   Pakistan's estimated population in 2011 is over 187 million[ making it the world's sixth
    most-populous country. Pakistan's urban population expanded over sevenfold.

•   During 1990–2003, Pakistan sustained its historical lead as the second most
    urbanized nation in South Asia with city dwellers making up 36% of its population.[4]
    Furthermore, 50% of Pakistanis now reside in town

•   A large scale rural to urban migration due to which Katchi abides population is
    desensitize

•   48 million Pakistani citizens’ defecate in the open; for them Under the MDG, Pakistan
    had committed to supply 93 per cent of the population with safe water and 64 per
    cent of the population with adequate sanitation by 2015. Yet, only 45 per cent people
    use improved sanitation facilities in Pakistan
Continue…
•   The water target will be missed by seven years (2022), and the sanitation target will
    be met 13 years (2028) too late

•   Poor sanitation and hygiene causes many health problems and according World
    Health Organization (WHO), estimated 97,900 people die every year due to poor
    water and sanitation in Pakistan.

•   World Health Organization and Unicef estimated that every year, 54,000 children
    under age five in Pakistan die from diarrhea caused by poor water and sanitation

•   Due to expansion of population urban sanitation and water issues are becoming more
    complex in term of land issues lack of space. In urban planning water and sanitation
    provision to informal settlement is not at priority . Because of poverty and space
    issues the hygiene condition is becoming worst.

•   The Capital Development Authority (CDA) is responsible for the provision of water to
    the residents of Islamabad, however as the squatter settlements were not in the
    original master plan, they are seldom provided with water and the community has to
    obtain water on their own
Continue…..

•   Worst Water, sanitation, and hygiene conditions as Faisal colony is situated on bank
    of a perennial and polluted stream.

•   Community members in Faisal colony had laid their own sewerage systems and
    water supply lines, but over the years these have rusted and deteriorated to the
    extent that sewage water is mixing with drinking water.

•   Due to this reason water borne diseases like cholera, diarrhoea and skin allergies are
    very common in this Faisal colony


•   In a situation analysis exercise, Early Childhood Care & Development (ECCD)
    caregiver told that every day 50% of children in her centre miss their class due to
    diarrhoea alone   ”.
•   Need for WATSAN project was highlighted when an outbreak of cholera occurred in
    summer 2009 due to mixing of sewage water with drinking water. Total 125
    individuals were affected including a woman who died
Picture Gallery-Before Project
Picture Gallery-Before Project
Why HySter is Needed
•   Gives Priority to Hygiene –Sanitation – Water


•   Reflect on WASH and provides room to Watsan development work


•   Enshrines the National Slogan for focusing on family through multiple
    channels in Behavior Change


•   Four main pillars of the project water, sanitation, hygiene and RBA (right
    based approach) with gender mainstreaming as a cross cutting theme
    focusing women and girl child in all phases of the projec


•   Creates ‘Whim’ for change WASH as felt need as basic human right
Introduction to HySter

 HySter calls for Hysteria (whims, fever) to be created through intense
  communications

    BCC approach related to Water, Sanitation and Hygiene promotion targets a family
    unit. Our approach is in line with the National BCC strategy 'Hamara Pakistan-
    Sahtmand aur ba-waqar Khandan‘HySter stands for interventions with different
    emphasis on priority

     HySter emphasis more on Positive Hygienic Behaviors to prevent water borne
    diseases at first place, followed by safe human excreta disposal, boil water and litter
    free environment (as part of Sanitation) at second Place and Safe drinking water at
    third place. This is so as the communities' priorities are always in reverse order i.e.
    WASH and our response should help them set their priorities Right through HySter.
Principle

 Apart from other basic human needs and rights, access to basic sanitation
  facilities and services is one of the fundamental human right to protect and
  save lives of the affected population.

 Ensuring gender mainstreaming and protecting the extremely vulnerable
  and people with special needs in the Hyster .

 Comprehensive BCC support is essential for responding to gender, different
  age group, local culture, needs and other special needs, while promoting l
  positive behavior.

 HySter interventions ensuring to safeguard the human health and
  environment.
Hyster Component
 Provision of integrated water and sanitation facilities basis interfacing with other
  Clusters’ Early Recovery and development

 A comprehensive BCC support through multiple channels for diverse audience (all
  age group, gender, culture, socio-economic group) with the aim to ensure that the
  water and sanitation facilities are being utilized.

    Technical sessions complementing the hard components i.e. water purification
    method, ORS preparation.

     HySter emphasis more on Positive Hygienic Behaviors to prevent water borne
    diseases at first place, followed by safe human excreta disposal, Boil water and litter
    free environment (as part of Sanitation) at second Place and Safe drinking water at
    third place. This is so as the communities' priorities are always in reverse order i.e.
    WASH and our response should help them set their priorities Right through HySter.
Themes of Communication
                 in Project Cycle Stages
Themes of BCC communication              Project Cycle stages



Demand creation                          Before planning during PRA


Technical Education                      Before and start of the project for
                                         informed choice ( installment of
                                         hardware intervention)

Health and hygiene nutrition             Implementation
promotion

Liking positive behavior ( proper Exit   Before evaluation, at end of the
strategy                                 project.
Medium of Communication

• Print media
• Electronic media
• Interpersonal communication
Demand Creation Phase
•   An orientation meeting was conducted with CBO and 15 member committee were
    formed executive position to women.

•     Demand creation activities ( poster competition, religious celebration in church,
    problem tree and mobility chart were drown by women, focus group discussion with)
    were organized and PRA were conducted. the impact of demand creation activity was
    that need of water sanitation were at top priority by the members of the community

•   The women took lead and baseline was carried out on women decide to draw street
    wise map for installment of bore pump while males were supporting roles.

•   Due to intensive communication in demand creation phse community also met with
    the Director Sanitation-CDA to regularize the system of waste disposal from the
    Faisal Colony. Capital development Authority (CDA) is now disposing off solid waste
    regularly
Demand Creation Phase
Technical phase
•   Before installing bore pump and sewerage session was delivered to project
    committee. (Informed choice)

•   The impact was observed when vendor dig the bore whole at 70 feet and women
    observed and stop digging and showed the material that it should be at 140 Rft.

•   They observed closely sewerage line and connection of household line to trunk line.

•   The vendor dig the bore whole again . The household maintained their rutted latrines
    and connected to main sewerage line. Project committee motivated community for
    safe sanitation.
Technical Phase
Promotional Phase
•   About 22 community member were trained on solid waste,26 on kitchen gardening 26
    on O & M of WES system management
•   28 on right base approach, 27 on CLTS training and 28 on water bore diseases



•   Awareness on water bore diseases, filtrations plant water treatment methods etc



•   28 community members have training on community awareness                 who very
    enthusiastically delivered the hygiene promotion sessions and monitors the hygiene
    door to door




•
Promotional Phase
Sustaining Behavior Change

•   In this phase campaign were organized on CLTS

•   Cleanliness campaign were organized and people were motivated for basic
    hygiene of water & sanitation

•   Community were observed dumping waste properly
•   Water storage tank cleaned after years in housed

•   Community emplace hand washing facilities with and out of washrooms
    .theater group play were arranged
Sustaining Behaviour
Outcomes of the Approach

•   Completion of 17 hand pump . Laying of sewerage lines 720 Rft in 2.5 streets and
    15,832 Square feet (5 streets) have been paved

•   Community has good understanding about their needs and proper solutions. The
    waste bins design, its fixing and proper utilization were in the benefit of the
    community. To make it more successful, they contacted CDA and approved sanitary
    workers for the colony

•   Women participation has improved in the project activities and they took some major
    decision and are part of O & M.

•   Series of sessions on hygiene were conducted and behaviour session are being
    leading by communty member
Continue..

•   Solid waste dumping points were placed.

•   Children women and men are closely observing the hygiene even door to door

•   The impact was observed when neighboring community demanded same material for
    churches and want to have some session on hygiene promotion

•   In the current epidemic 11 death case were reported in 2011 in informal settlement
    having some the characteristics but not a single case was reported from faisal
    colony. The main reason was they are continuously sending their water for laboratory
    test
Conclusion
•   Behaviour change is viable when the community members are supported to practice
    in an enabling environment continued communication through multiple mediums,
    availability of water, improved drainage

•   Behavior change is viable if community internalize the given information and practice
    it in their routine.

•   Intensive communication at entry point of helped to realize access to water and
    sanitation as felt need as basic human right

•   Participatory decision making and involvement gives the sense of ownership
•
•   Hyster themes through intensive communication using different participatory tools
    help to realize as felt need, having informed choice and realizing the importance and
    its maintenance. Community own it and sustained it.

•   Hyster help to understand that each member of the family is important for focusing
    hygiene promotion because behaviors are nourish and learnt at house hold level. So
    that for behaviour change family unit would be through multiple channels and multiple
    activities

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Sustaining behavior change through participatory approaches in project cycle

  • 1. Sustaining Behavior Change through Participatory Approaches in Project Cycle Management Rizwana Kousar Asia Regional Sanitation And Hygiene Practitioners Workshop, Dhaka 2012
  • 2. Background and Justification • Rapid urbanization and congestion in cities are constant characteristics of Pakistan demography ever since partition. • Pakistan's estimated population in 2011 is over 187 million[ making it the world's sixth most-populous country. Pakistan's urban population expanded over sevenfold. • During 1990–2003, Pakistan sustained its historical lead as the second most urbanized nation in South Asia with city dwellers making up 36% of its population.[4] Furthermore, 50% of Pakistanis now reside in town • A large scale rural to urban migration due to which Katchi abides population is desensitize • 48 million Pakistani citizens’ defecate in the open; for them Under the MDG, Pakistan had committed to supply 93 per cent of the population with safe water and 64 per cent of the population with adequate sanitation by 2015. Yet, only 45 per cent people use improved sanitation facilities in Pakistan
  • 3. Continue… • The water target will be missed by seven years (2022), and the sanitation target will be met 13 years (2028) too late • Poor sanitation and hygiene causes many health problems and according World Health Organization (WHO), estimated 97,900 people die every year due to poor water and sanitation in Pakistan. • World Health Organization and Unicef estimated that every year, 54,000 children under age five in Pakistan die from diarrhea caused by poor water and sanitation • Due to expansion of population urban sanitation and water issues are becoming more complex in term of land issues lack of space. In urban planning water and sanitation provision to informal settlement is not at priority . Because of poverty and space issues the hygiene condition is becoming worst. • The Capital Development Authority (CDA) is responsible for the provision of water to the residents of Islamabad, however as the squatter settlements were not in the original master plan, they are seldom provided with water and the community has to obtain water on their own
  • 4. Continue….. • Worst Water, sanitation, and hygiene conditions as Faisal colony is situated on bank of a perennial and polluted stream. • Community members in Faisal colony had laid their own sewerage systems and water supply lines, but over the years these have rusted and deteriorated to the extent that sewage water is mixing with drinking water. • Due to this reason water borne diseases like cholera, diarrhoea and skin allergies are very common in this Faisal colony • In a situation analysis exercise, Early Childhood Care & Development (ECCD) caregiver told that every day 50% of children in her centre miss their class due to diarrhoea alone ”. • Need for WATSAN project was highlighted when an outbreak of cholera occurred in summer 2009 due to mixing of sewage water with drinking water. Total 125 individuals were affected including a woman who died
  • 7. Why HySter is Needed • Gives Priority to Hygiene –Sanitation – Water • Reflect on WASH and provides room to Watsan development work • Enshrines the National Slogan for focusing on family through multiple channels in Behavior Change • Four main pillars of the project water, sanitation, hygiene and RBA (right based approach) with gender mainstreaming as a cross cutting theme focusing women and girl child in all phases of the projec • Creates ‘Whim’ for change WASH as felt need as basic human right
  • 8. Introduction to HySter  HySter calls for Hysteria (whims, fever) to be created through intense communications  BCC approach related to Water, Sanitation and Hygiene promotion targets a family unit. Our approach is in line with the National BCC strategy 'Hamara Pakistan- Sahtmand aur ba-waqar Khandan‘HySter stands for interventions with different emphasis on priority  HySter emphasis more on Positive Hygienic Behaviors to prevent water borne diseases at first place, followed by safe human excreta disposal, boil water and litter free environment (as part of Sanitation) at second Place and Safe drinking water at third place. This is so as the communities' priorities are always in reverse order i.e. WASH and our response should help them set their priorities Right through HySter.
  • 9. Principle  Apart from other basic human needs and rights, access to basic sanitation facilities and services is one of the fundamental human right to protect and save lives of the affected population.  Ensuring gender mainstreaming and protecting the extremely vulnerable and people with special needs in the Hyster .  Comprehensive BCC support is essential for responding to gender, different age group, local culture, needs and other special needs, while promoting l positive behavior.  HySter interventions ensuring to safeguard the human health and environment.
  • 10. Hyster Component  Provision of integrated water and sanitation facilities basis interfacing with other Clusters’ Early Recovery and development  A comprehensive BCC support through multiple channels for diverse audience (all age group, gender, culture, socio-economic group) with the aim to ensure that the water and sanitation facilities are being utilized.  Technical sessions complementing the hard components i.e. water purification method, ORS preparation.  HySter emphasis more on Positive Hygienic Behaviors to prevent water borne diseases at first place, followed by safe human excreta disposal, Boil water and litter free environment (as part of Sanitation) at second Place and Safe drinking water at third place. This is so as the communities' priorities are always in reverse order i.e. WASH and our response should help them set their priorities Right through HySter.
  • 11. Themes of Communication in Project Cycle Stages Themes of BCC communication Project Cycle stages Demand creation Before planning during PRA Technical Education Before and start of the project for informed choice ( installment of hardware intervention) Health and hygiene nutrition Implementation promotion Liking positive behavior ( proper Exit Before evaluation, at end of the strategy project.
  • 12. Medium of Communication • Print media • Electronic media • Interpersonal communication
  • 13. Demand Creation Phase • An orientation meeting was conducted with CBO and 15 member committee were formed executive position to women. • Demand creation activities ( poster competition, religious celebration in church, problem tree and mobility chart were drown by women, focus group discussion with) were organized and PRA were conducted. the impact of demand creation activity was that need of water sanitation were at top priority by the members of the community • The women took lead and baseline was carried out on women decide to draw street wise map for installment of bore pump while males were supporting roles. • Due to intensive communication in demand creation phse community also met with the Director Sanitation-CDA to regularize the system of waste disposal from the Faisal Colony. Capital development Authority (CDA) is now disposing off solid waste regularly
  • 15. Technical phase • Before installing bore pump and sewerage session was delivered to project committee. (Informed choice) • The impact was observed when vendor dig the bore whole at 70 feet and women observed and stop digging and showed the material that it should be at 140 Rft. • They observed closely sewerage line and connection of household line to trunk line. • The vendor dig the bore whole again . The household maintained their rutted latrines and connected to main sewerage line. Project committee motivated community for safe sanitation.
  • 17. Promotional Phase • About 22 community member were trained on solid waste,26 on kitchen gardening 26 on O & M of WES system management • 28 on right base approach, 27 on CLTS training and 28 on water bore diseases • Awareness on water bore diseases, filtrations plant water treatment methods etc • 28 community members have training on community awareness who very enthusiastically delivered the hygiene promotion sessions and monitors the hygiene door to door •
  • 19. Sustaining Behavior Change • In this phase campaign were organized on CLTS • Cleanliness campaign were organized and people were motivated for basic hygiene of water & sanitation • Community were observed dumping waste properly • Water storage tank cleaned after years in housed • Community emplace hand washing facilities with and out of washrooms .theater group play were arranged
  • 21. Outcomes of the Approach • Completion of 17 hand pump . Laying of sewerage lines 720 Rft in 2.5 streets and 15,832 Square feet (5 streets) have been paved • Community has good understanding about their needs and proper solutions. The waste bins design, its fixing and proper utilization were in the benefit of the community. To make it more successful, they contacted CDA and approved sanitary workers for the colony • Women participation has improved in the project activities and they took some major decision and are part of O & M. • Series of sessions on hygiene were conducted and behaviour session are being leading by communty member
  • 22. Continue.. • Solid waste dumping points were placed. • Children women and men are closely observing the hygiene even door to door • The impact was observed when neighboring community demanded same material for churches and want to have some session on hygiene promotion • In the current epidemic 11 death case were reported in 2011 in informal settlement having some the characteristics but not a single case was reported from faisal colony. The main reason was they are continuously sending their water for laboratory test
  • 23. Conclusion • Behaviour change is viable when the community members are supported to practice in an enabling environment continued communication through multiple mediums, availability of water, improved drainage • Behavior change is viable if community internalize the given information and practice it in their routine. • Intensive communication at entry point of helped to realize access to water and sanitation as felt need as basic human right • Participatory decision making and involvement gives the sense of ownership • • Hyster themes through intensive communication using different participatory tools help to realize as felt need, having informed choice and realizing the importance and its maintenance. Community own it and sustained it. • Hyster help to understand that each member of the family is important for focusing hygiene promotion because behaviors are nourish and learnt at house hold level. So that for behaviour change family unit would be through multiple channels and multiple activities