2012年-世界发展银行全球_Four-Country_Synthesis_of_the_Enabling_Environment_for_Hand_Washing_with_Soap_Endline_Analysis_38页_1mb

报告摘要

Four-Country Synthesis of the Enabling Environment for Handwashing with Soap Endline Analysis Summary

Core Content

The Global Scaling Up Handwashing Project (HWWS), implemented by the Water and Sanitation Program (WSP) from 2007 to 2011, aimed to improve handwashing with soap (HWWS) behavior among women of reproductive age (15–49) and primary school-age children (5–9) in Peru, Senegal, Tanzania, and Vietnam. The project tested innovative behavior change approaches to promote sustainable HWWS practices and reduce diseases such as diarrheal disease (DD) and acute respiratory infection (ARI).

This report synthesizes the findings from endline enabling environment (EE) assessments conducted in 2010–2011, focusing on the nine dimensions of the EE that are critical for the scaling up and sustainability of HWWS interventions.

Main Findings

1. Policy, Strategy, and Direction

Peru had the strongest policy integration, with HWWS methodology included in multiple national programs and strategies, including those of the Ministry of Health (MoH), Ministry of Education (MoE), and Ministry of Women and Social Development.
Vietnam also made progress, with the Ministry of Health (MoH) and Vietnam Women's Union (VWU) recognizing the importance of HWWS in sanitation and hygiene programs.
Tanzania did not have an approved national sanitation policy that included HWWS, but it was included in the National Growth and Poverty Reduction Strategy.
Senegal saw the Millennium Program for Drinking Water and Sanitation (PEPAM) and the Public Works and Employment Agency (AGETIP) commit to integrating HWWS into their work.

2. Partnerships

Peru developed strong partnerships with government agencies, NGOs, soap companies, and private sector entities.
Vietnam facilitated a public-private partnership (PPPHW), resulting in the development of a model handwashing station.
Tanzania worked with health, water, and education ministries, as well as the Prime Minister's Office of Regional Affairs and Local Government (PMO-RALG), to coordinate efforts.
Senegal partnered with PEPAM and AGETIP to train midwives and nutrition program staff, supporting national capacity building.

3. Institutional Arrangements

Peru shifted from formal arrangements to supporting local coalitions and programs.
Vietnam had well-defined institutional responsibilities, with VWU, MoH, and other key ministries collaborating.
Tanzania focused on institutional coordination between key ministries and stakeholders.
Senegal leveraged MOUs with midwives and nutrition programs to build national institutional capacity.

4. Program Methodology

All four countries made progress in developing and promoting program methodology.
Peru had the most formal adoption, with MoH, MoE, and Ministry of Women integrating the methodology into their programs.
Vietnam requested the development of an integration kit for MoH staff.
Tanzania had not yet agreed on a preferred model for promoting HWWS.
Senegal expressed interest in learning more about the project's training and communication approach.

5. Implementation Capacity

Peru improved regional and district implementation capacity through advocacy, coordination, and training.
Vietnam trained VWU, MoH, and NGOs to promote HWWS.
Tanzania trained local government staff and volunteers and shifted focus to the Ministry of Health and Social Welfare (MoHSW).
Senegal used MOUs to train national and local staff to integrate HWWS into their programs.

6. Availability of Products and Tools

Soap was widely available in all four countries.
Water access was a challenge, especially in Tanzania and Senegal, where access was seasonal or limited.
HWWS projects in all countries promoted water-saving handwashing stations and soap availability in households.

7. Financing

Peru shifted funding for HWWS from donors to national public and private organizations.
Vietnam discussed increased government allocations for hygiene communication.
Tanzania moved sanitation and hygiene funding from the Ministry of Water to the MoHSW.
Senegal shifted focus from securing funding for PPPHW to supporting PEPAM and AGETIP.

8. Cost-Effective Implementation

Peru and Vietnam did not see an immediate need for cost-effectiveness studies.
Tanzania was interested in understanding costs of large-scale interventions.
Senegal had cost data available but it was not a top priority for stakeholders.

9. Monitoring and Evaluation (M&E)

Peru provided some capacity building in M&E but more was needed.
Vietnam integrated a handwashing indicator into its monitoring system.
Tanzania used national surveys and community-based systems to improve M&E.
Senegal developed a robust performance-monitoring system, which was valuable to partners.

Key Recommendations

Strengthen institutional coordination and capacity building at local and national levels.
Develop national policies and strategies that explicitly include HWWS.
Promote public-private partnerships to ensure sustainable funding and implementation.
Integrate HWWS into existing programs (e.g., education, health, nutrition).
Improve access to water and soap in households.
Ensure cost-effectiveness studies are conducted where necessary.
Build monitoring and evaluation systems that track behavior change and health outcomes.

Considerations for Programmers

There is no one-size-fits-all approach to EE components; prioritization varies by country.
EE assessments are essential to identify gaps and opportunities.
Sustainability depends on institutional support, policy integration, and capacity building.
Partnerships with government, private sector, and civil society are crucial for scaling up and maintaining HWWS behavior.

Conclusion

The endline assessments highlight progress and challenges in building an enabling environment for HWWS in the four countries. While Peru and Vietnam made significant strides in policy and institutional integration, Tanzania and Senegal still require more coordination and capacity building. The HWWS project has demonstrated the importance of multi-sector collaboration, behavior change communication, and sustainable funding mechanisms in promoting long-term HWWS practices. The conceptual framework of nine EE dimensions remains a valuable tool for future projects aiming to scale up and sustain handwashing with soap.