2008年-世界发展银行全球_Enabling_Environment_Assessment_and_Baseline_for_Scaling_Up_Handwashing_Programs___Tanzania_74页_907kb

Enabling Environment Assessment and Baseline for Scaling Up Handwashing Programs in Tanzania

Core Content

This report is part of the Global Scaling Up Handwashing Project, funded by the Bill & Melinda Gates Foundation, which aims to promote handwashing with soap (HWWS) at critical times among the poor and vulnerable in four countries, including Tanzania. The project is led by the World Bank Water and Sanitation Program (WSP) and follows a structured approach to learning, dissemination, and replication of effective behavior change programs.

The Enabling Environment Assessment (EEA) was conducted to evaluate the readiness of Tanzania for scaling up and sustaining HWWS programs. It focused on nine key dimensions: Policy, Strategy, and Direction, Partnerships, Institutional Arrangements, Program Methodology, Implementation Capacity, Availability of Products and Tools, Financing, Cost-Effective Implementation, and Monitoring and Evaluation. The assessment aimed to identify gaps and recommend strategies to improve conditions for program success.

Key Findings

• Handwashing rates in Tanzania are low, with only 4% of mothers and 5% of children washing hands with soap after using the toilet.
• Despite high sanitation coverage (over 90%), diarrheal disease (DD) and acute respiratory infection (ARI) rates remain high, particularly among under-five children.
• Water access is a critical factor for HWWS adoption, with 42% of rural households having access to public water points in 2000, increasing to 53.56% in 2005.
• Soap availability is widespread, but usage is limited to non-critical activities such as bathing and laundry.
• Consumer behavior is influenced by cultural norms, including the belief that children's feces are safe and that lack of visible dirt equates to cleanliness.

Main Recommendations

1. Policy, Strategy, and Direction

• Begin advocacy efforts immediately to build political will and stakeholder support.
• Develop a shared vision and strategic roles among all relevant sectors.
• Use real-life success stories to enhance advocacy and public engagement.
• Ensure core messaging is clear and consistent among all project spokespersons.

2. Partnerships

• Establish a broad-based public-private partnership (PPP).
• Engage key stakeholders, including government, NGOs, private sector, and communities.
• Organize summit-type meetings to share experiences and build collaboration.
• Use data from other countries to help the private sector understand potential impacts.

3. Institutional Arrangements

• Focus on district-level coordination and national-level alignment.
• Involve permanent secretaries and district executive directors (DEDs) in institutional planning.
• Create district-level project management teams with government and non-governmental partners.

4. Program Methodology

• Adapt the WSP methodology to the Tanzanian context.
• Incorporate constructive feedback from stakeholders into the program design.
• Use consumer-centered marketing to drive behavior change.

5. Implementation Capacity

• Clarify capacity building needs with partners.
• Target district governments for strengthening to ensure program sustainability.
• Build community and ward capacity to plan and engage with the private sector.

6. Availability of Products and Tools

• Ensure water availability at schools to support HWWS.
• Integrate HWWS into Water Sector Development Program (WSDP) and National Environmental Health, Hygiene and Sanitation Strategy (NEHHASS).
• Include relevant indicators in program monitoring to encourage implementation.

7. Financing

• Help districts effectively use hygiene promotion funds.
• Ensure funding allocation for HWWS facilities in schools.
• Balance efficiency and partner commitment in resource allocation.

8. Cost Effectiveness

• Promote cost tracking and cost-benefit analysis.
• Highlight the cost-effective impact of HWWS on reducing DD and ARI.
• Simplify data collection to make cost analysis more accessible.

9. Monitoring and Evaluation

• Use the minimum number of indicators necessary for project guidance and evaluation.
• Leverage an existing M&E system to ensure consistency and transparency.
• Provide evidence of health outcomes through collaboration with experienced research groups.

Project Overview

• The Tanzania Handwashing Initiative seeks to meet the basic hygiene and sanitation needs of the rural poor.
• It is aligned with MDG 4 (reduce child mortality) and Tanzania's Development Vision 2025.
• The project will test demand creation strategies, improve product supply, and promote HWWS.
• It will assess HWWS alone and in combination with total sanitation and sanitation marketing (TSSM).

Target Population

• Poor women of childbearing age (15–49 years) and poor children (5–9 years) are the primary target groups.
• The project aims to increase HWWS adoption among children under 5 and school children (6–13 years).

Project Timeline

• 1.5 years of planning: Completed in 2006.
• 2 years of implementation: Expected to cover 10 districts.
• 6 months of evaluation: To be conducted at project end.

Conclusion

The Enabling Environment Assessment provides a comprehensive understanding of the current conditions and gaps in Tanzania that need to be addressed for successful scaling and sustainability of HWWS programs. It emphasizes the importance of policy alignment, strong partnerships, and effective implementation to achieve long-term behavioral change and public health impact.