Wash'Em Contexts

as organization, we used the WASH'em approach an internally displaced context in Somalia. The WASH'em tools allowed our WASH teams in the field to better understand what beneficiaries do, what they think and how they see during covid-19 crisis when it comes to handwashing and they are all excited about it. The most interesting thing is that when you ask people how they do handwashing rather than telling the people how they do handwashing. The approach also helped our teams to observe the practical challenges that people face in the home. 

due to the experience gained from implementing the WASH'Em approach, our field teams advocated that our hygiene promotion activities in our future programs are designed using the approach. 

I haven't implemented the WASH'em approach yet, but one or two different contexts come to mind, in which I wish I would have used a tool as specific and targeted in the past. Those contexts have in common that they are dealing with displacement and refugees or migrants in settings which are similar to their place of origin, but just different enough to not assume that the host country values apply to the displaced population. We often make the mistake that if a displaced population comes from "closeby" or speaks the same language or comes from a similar ethnic background than the host community that we can use materials, approaches and messages that were developed for the host country, without considering the subtle differences of the host vs the displaced community, potentially leading to messages not targeting core beliefs or barriers, etc. 

I have not used WASH'Em yet, still, some contexts with displaced populations and refugees come to my mind where I wish I had such tools. With the onset of the humanitarian response, understanding behaviors and adapting our WASH response, including handwashing, was not established as a priority due to a lack of capacities and resources. In more advanced phases of the emergency, it was decided to prioritize hygiene promotion and a more in-depth analysis of behavior, but the methodologies used were time-consuming and costly, which meant that this process was never completed. I believe it is key to have tools that can be implemented quickly and that respond to the needs of both the populations and the agencies working on the ground during an emergency.

I haven't used Wash'em yet; I hope I can do it anytime soon and see its impact, especially in the short run. One specific context comes to my mind when thinking about using Wash'em; last year, I was in a refugee camp in Greece. The fact that we were in a European context could have made us think that responding to the emergency would be somehow easy. All resources were available for a successful wash intervention, hardware and software resources, and know-how in place. It seemed like a dream mission. Despite having "all wash needs covered," successfully approaching the affected community, engaging them, working together toward behavior change was highly challenging. The incidence and prevalence rates of illnesses within the camp were always on the rise. 

In my opinion, the fact that the affected population was not included as a critical part of all processes from the beginning led to a lack of engagement and ownership feeling that made it highly difficult for humanitarians to intervene in behavior change at some point. Having different cultures, nationalities, languages, and religions was also a challenge. I'm so curious about Washem when in contexts of displacement, we have to respond to affected communities coming from a great variety of countries, cultures, customs, behaviors, practices, etc. 

I have never used WASH'em before. I am currently taking a course on WASH'em so I can use it to implement Handwashing interventions in Sahrawi Refugee Camps where I am currently in service. As a response to the COVID-19 pandemic in the camps, our organization received good funding to support the response to the pandemic by installing handwashing stations. Before the WASH team was gathered, other team members from a different program tried to design this intervention. They developed very good and sturdy handwashing stations that supported the very harsh climate conditions but completely neglected the soft components and did no promotion whatsoever to incite the community to improve their handwashing habits. I think WASH'em would have really helped the team (not so experience in PHP) to design a better intervention and design a handwashing program that would have been adapted to the needs of the community. We are currently planning a handwashing program for schools in the camps and we will be using WASH'em to support that.

We have been responding to different emergency situation in Ethiopia. There are mass displacements currently in the country due to conflict. We have been applying the common hygiene promotion practices that many partners used to implement for such mass displacements such as training the community representatives, religious leaders so that they would be able to cascade the knowledge they get from the training to the larger affected populations. However, the progress towards improved hygiene practice is so slow and limited. Currently, I am attending the Wash"EM training session which opened my eye to think the other round. After finishing this training, I will be discussing with my supervisor and work colleagues to test this new approach ( to design and apply Wash"EM) for the IDP camps we have been intervening, especially for behavior change towards hand washing. I will be working with health extension workers for better internalization of the design and start working with the larger community for its effectiveness. 

@Walid Moulahoum  Interesting to hear that you are planning on using Wash'Em in Schools. Historically we have often cautioned against using Wash’Em in schools or health care settings. This is because Wash'Em has been designed to explore handwashing practices at the community level. In schools and health centres there are often different determinants driving handwashing behaviour. For example, students are quite influenced by the actions of teachers and the routines of the school day - things that Wash'Em is not really great at capturing. The other factor is that the Wash'Em rapid assessment tools have been developed with adults in mind. Learning from children can often be much more challenging as children are normally shy to share their opinions with those they don't know. 

Having said all this we do have lots of people interested in using Wash'Em in schools as certain actors tend to specifically focus on these settings. My recommendations if you decide to proceed would be that you leave out the personal history method entirely since this would not be appropriate to do with children. I would recommend trying the other methods with older children initially (e.g. children 12-18) as I think children at this age should be able to comprehend the questions and give useful answers. For the handwashing demonstrations tool, this is something that you could involve younger children in and this would help to ensure that handwashing facilities are accessible to children of different ages. Lastly do consider how you will go about seeking consent for doing Wash'Em with children. Generally, for people under the age of 18 a parent or guardian would need to give permission and the participating child would need to provide their assent too.  If you do decide to proceed I would really like to hear your feedback on whether it was useful or recommendations you have to further adjust the tools for these settings in crises. 

In terms of other sources of support for handwashing behaviour change in Schools, you may want to connect with the WASH in Schools Network and have a look at this guide about the use of nudges in schools. 

Although I have yet to implement Wash’Em myself, I had previously learned enough about it to recommend it for some of CRS’ emergency responses requiring handwashing stations/hygiene promotion (including flooding response in Timor Leste, earthquake response in Nepal, and others). 

Our team of Global WASH Technical Advisors are currently in the process of training WASH staff on Wash’Em in our country program offices (esp. in countries that have recurring emergencies), however, when disasters hit, circumstances typically do not allow enough time to “build Wash’Em capacity” (esp. w/ travel limited by COVID), and so when Wash’Em is recommended, the result is often: “We don’t have the time to build capacity on Wash’Em now, but let’s schedule a training for after we’ve responded to this emergency”. On the other hand, for the country programs that we have already trained in the Wash’Em approach, I am hearing encouraging results.

I have not used or implemented WASH’EM yet. But, based on what I have learned so far on the approach, I am thinking about Cholera in Haiti where it could have been used to design a more robust handwashing programme which is more human centered. I am thinking about the motives tools to get insight about drivers for positive handwashing behaviours. So, a good way to inform humanitarian interventions but also the regular programme. Although interventions are different, but it could inform both programming. Also, the disease perception tool could help assess the community’s perception on Cholera and how they picture the risk associated to the disease. During the Outbreak and beyond, Handwashing programmes were traditional approaches mainly about provision of handwashing supplies, devices, hygiene promotion focusing on handwashing with soap, household water treatment and storage. They were not necessarily the most cost-effective programming or evidence-based. 

I wish I would have known about the Wash’Em approach before the last deployment of the Mass Sanitation Emergency Response Unit (ERU). The Mass Sanitation ERU was deployed after hurricane Eta hit Honduras last November. While the ERU was on its way to Honduras, another hurricane, Iota, also reached this country, causing more damage on the previous affected areas and worsening the situation. More than 3 million people were affected, 200.000 people were displaced and 75.000 lived in temporary or communal shelters. Approximately 30.000 homes were damaged. More than 400.000 people had no access to safe water. The ERU was deployed to the Sula Valley, one of the most affected areas. I think it could have been a good opportunity to implement Wash’Em, first in the shelters and later, when the water level dropped and the people were able to go back to their homes, in the communities. I think it would have guided the team in getting to know, in a quick way, the actual determinants of behaviour on which they had to focus to achieve the desired behaviour change in such a changing context, and deliver a more effective response. 

I wish I could have used WASHEm during a  cholera outbreak in a Refugee emergency. The limited access to safe water coupled with availability to surface water meant that refugees who had been used to the  Eastern Congo region where surface water sources were abundant, preferred to use the surface water to clean their utensils including handwashing . This meant the handwashing stations installed at the various points did not come across as a point for actual handwashing practice and as such the cycle of transmission was not easy to break without learning the history of where they were coming from and the practices they were used to. Hygiene meant a different thing from our supply-side intervention and what they would deem appropriate. If these barriers would have been anticipated through a tool such as WASHEm, better program design would have been achieved.

I have never used WashEm but would have loved to have the tool when we had several cholera outbreaks in my area

I have never used the WASH EM approach yet as the context is different, most of the context is not emergency because even when people flee from one area to another, there are no camps or shelters although it's has been there some shelters but for a short time only, and then they go to areas where they rent houses or live with their relatives in other areas. 

I believe that adapting WASH EM to urban or semi-urban contexts would be more applicable in Syria. however, I'd be glad to use what I can from this approach in our next interventions and check if this approach is applicable in the local context as I think that this approach will save a lot of time and get the evidence-based recommendations needed to intervene under handwashing activities.

Hi Folks, 

This is Frank Greaves, WASH Lead at Tearfund.  My colleague Rachel Stevens and I are training partner staff in the Middle East Region (including Yemen, Jordan, and Syria) on the Wash'Em Tool, in a 2-day training programme.  The second day is on Tuesday 31st August, and we wonder if a member of any orgnaisation that has already implemented Wash'Em would be willing to speak on this training day for 10 minutes on their experience of using Wash'Em in the MENA context.  That would be a tremendous encouragement to the participants.

If you can help, please contact me at Frank.greaves@tearfund.org

Many thanks,

Frank

I would say that the Wash'em approach would have been very useful in the current context in which I work. In fact, I'm thinking of using it very soon in focus groups that will be organised. Indeed, the population we are working with here had a standard of living almost similar to the most developed countries before the crisis they are still going through. As a result, the beneficiaries of the project are extremely knowledgeable about the hygiene measures needed to be healthy. However, they no longer have access to hygiene products, which makes them very vulnerable. In previous projects, activities were oriented according to the results of the KAP surveys, which does not really reflect the reality, since again, the beneficiaries knew the "right" answers to give for handwashing for example; whereas in reality, they cannot apply it. The Wash'Em approach could allow this context to be taken into account globally.

I've also not used WASH'Em yet, but it has been really interesting reading through everyone's plans on how they intend to implement the approach in the future. For me, I'd like to explore implementing WASH'Em in a range of different contexts, not only to see the differences across different countries and types of emergencies, but also the different ways that staff interact with the approach. One place in particular I would like to work with the team to implement WASH'Em is in the South Sudanese refugee camps in Gambella, Ethiopia. I visited the team there earlier this year, and they had tried a lot of different approaches to encourage hand-washing, and were becoming frustrated that nothing seemed to be motivating people to wash their hands. I think WASH'Em could be a really good tool for them to use to explore the topic in a slightly different way. I also think it would be great to get them to repeat the process when they feel that hand-washing behaviours are dropping off again (because we are all creatures of habit that sometimes lose interest/get bored with a new approach/innovation!) to see if over time the motivations/drivers for handwashing are changing and therefore the approach needs to change. I think this is going to be important particularly in more chronic contexts.