2010年-世界发展银行全球_Peru___A_Handwashing_Behavior_Change_Journey_8页_1mb

Summary of the Global Scaling Up Handwashing Project in Peru

Core Content

The Global Scaling Up Handwashing Project in Peru, launched in 2003, is a multi-sectorial initiative aimed at increasing handwashing with soap among mothers and children. The project's second phase (2007–2011) focused on expanding the intervention to 24 of Peru’s 25 regions, targeting mothers of children under five and children aged 5–12. The goal is to stimulate and sustain handwashing behavior at critical times, such as before cooking, after using the toilet, and before eating.

The project adopted a behavior change framework called FOAM, which includes determinants like knowledge, access/availability, and attitudes/beliefs. These factors were identified as key drivers of handwashing behavior, based on findings from formative research in 2004 and a follow-up in 2008.

Main Viewpoints

• Behavior Change Approach: The project moved away from traditional hygiene education and instead focused on motivating mothers and engaging children as agents of change. This was supported by interpersonal communication (IPC), mass media, and direct consumer contact (DCC).
• Innovative Tools: A superhero named Super Jaboncín was created to promote handwashing through entertainment-education. This character was used in radio spots, songs, and DCC events to make the message more relatable and engaging.
• Multi-Sectorial Collaboration: The project involved public and private sectors, including local governments, NGOs, schools, and even mining and agriculture companies, to ensure broad reach and standardization of tools and approaches.
• Sustainability through Integration: The project was integrated into existing public programs such as education and nutrition, which helped in sustaining behavior change beyond the project’s lifespan.
• Monitoring and Evaluation: A performance monitoring system was developed to track both outputs (e.g., number of people reached) and outcomes (e.g., handwashing behavior). This included intercept studies, longitudinal surveys, and baseline/endline surveys.

Key Information

Target Populations and Behaviors

• Mothers: Handwashing with soap at four critical times (before cooking, after using the toilet, after changing a baby's diaper, and before eating) and placing soap near the kitchen and toilet.
• Children: Handwashing with soap at two critical times (after using the toilet and before eating).

Communications Strategy

• A multi-channel approach was used, combining IPC, mass media, and DCC.
• Radio was the primary medium for mass media due to its geographic flexibility and targeted reach.
• The Super Jaboncín superhero concept was used to promote handwashing, with three radio spots and a related song to reinforce the message.
• DCC events included games, live theater, and kiosks for demonstrations. A SJ kit was developed to support these events, ensuring standardized messaging.

Handwashing Stations

• A simple handwashing device made from recycled plastic was designed by Duraplast to improve access to soap and water.
• The device holds two 3-liter soda bottles (one for water, one for liquid soap) and can be mounted in health centers, schools, and households.
• In areas where the device is not yet available, front-line workers encourage the use of artisanal techniques to build handwashing stations.

Implementation Arrangements

• The project operates in a highly decentralized environment, with facilitating agencies and regional coordinators overseeing activities.
• Training of master trainers and front-line workers was essential for the implementation and consistency of the program.
• Private sector engagement played a key role in scaling up and standardizing the intervention.

Monitoring and Evaluation

• A Management Information System (MIS) was used to track outputs like the number of front-line workers trained and the target audience reached.
• Field supervision ensured quality control and strategy adaptations based on cultural and geographic diversity.
• Intercept studies and longitudinal surveys were conducted to monitor behavioral outcomes and health impacts.

Challenges and Lessons Learned

Challenges

• Measuring Behavioral Determinants: Developing and translating FOAM questions required significant effort and time.
• Demand for Super Jaboncín: The handwashing device was in high demand, but production and distribution have not yet met the need.
• Monitoring in a Decentralized Environment: Ensuring quality and consistency across 400 districts and 16,000 front-line workers was complex.
• Message Consistency: Translating messages into local languages (e.g., Quechua) posed challenges for uniform communication.
• Sustainability vs. Evidence-Based Practice: Balancing long-term sustainability with research-driven methods required ongoing evaluation and adaptation.

Lessons Learned

• Tangible Products Support Behavior Change: The Super Jaboncín device and handwashing stations were found to be effective in promoting handwashing.
• Multi-Sectorial Approach Enhances Scale: Involving the private sector allowed for broader reach and standardization of tools and strategies.
• Clear Policies and Agreements Facilitate Resource Allocation: Defined roles and responsibilities in policy frameworks helped secure budget and resources.
• Integration into Public Programs Promotes Sustainability: Embedding handwashing promotion within existing programs like education and nutrition ensured long-term impact.

Results (as of June 2010)

• 6.1 million people reached through radio spots.
• 230,000 people reached through DCC events.
• Approximately 217,000 mothers and children reached through 21,400 trained front-line workers.
• The project has surpassed some targets and is on track to achieve its goals.

Conclusion

The Global Scaling Up Handwashing Project in Peru exemplifies a comprehensive, multi-sectorial approach to behavior change. By integrating innovative communication strategies, tangible tools, and policy engagement, the project has made significant progress in improving handwashing practices among mothers and children. The Super Jaboncín concept has proven to be a powerful tool for engagement, and the multi-channel strategy has ensured widespread reach. The project's focus on sustainability through integration and capacity building highlights its long-term vision for behavior change and public health improvement.