Describe a context where you have you implemented Wash'Em. If you have never used Wash'Em, describe a context where you wish you could have used Wash'Em.
How did it help your program design or how might Wash'Em have helped your design?
Describe a context where you have you implemented Wash'Em. If you have never used Wash'Em, describe a context where you wish you could have used Wash'Em.
How did it help your program design or how might Wash'Em have helped your design?
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25 of 38 replies
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.
For me, seeing firsthand the practical challenges people face explained a lot about why behaviour change programs often fail. I would love to hear your experiences in using Wash'Em recommendations as part of your programming.
Interesting. At what stage of the COVID-19 pandemic response do you use it ? What are the benefits you gained compared to traditional approaches ? I would be happy to learn more about it.
I would be very happy to hear your experiences in using Wash’Em. Could you share more information and tips for using it? It’s nice to read that the handashing demonstration tool helped you. I’m really looking forward to using it and see the information we get.
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.
Excellent point Nicole. It's really important to consider what has changed for the displaced community, how these changes affect their handwashing behaviour, and how we can create handwashing campaigns that address their current circumstances.
I am glad you shared this. Context, learning why people do what they do, motives, perceptions are definitely what I saw was missing in handwashing programmes. The KAP survey does not necessarily capture this. We tend to rush especially during an emergency. I have designed programmes based on information gather in areas or other past emergencies in the same area. I love the tools as we can collect data for a more human centered design.
I agree with you. The approach should be context-based and we can only have a good approach by recommendations made after undertaking Wash'Em
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.
Very interesting to hear about your experience, Maria. Seems like it very much negates the common notion that the lack of resources in most humanitarian emergencies plays a primary role to reduce the impact of programs. Not saying it isn't a challenge, but your recount underscores the nuances that exist with implementing behaviour change activities. I'm interested to hear more about how the coordination between WASH and Health actors played out, you mentioned in one of our break-out sessions that the affected population were not aware of any risks - yet the impact of a general lack of hygiene was evident from the incidence of certain diseases related to poor hygiene. From my experience, the health actors do not share epidemiological data - even if anonymised. This raise the a question on the leverage that Health actors has compared to WASH actors, to not only identify hot spots in densely populated camps or camp-like settings but also working in coordination with WASH to design the campaigns. On a more general note, it would be interesting to see if any RCTs are ongoing in areas that have high prevalence diarrhoea - and where WASH'em is implemented on what the outcomes are.
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.
Thanks for sharing this Walid, I believe it's a narrative that repeats itself in different contexts where handwashing facilities are constructed without the community's participation and neglected afterward. I also believe the human-centered approach of WASH'Em could help on this.
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.
@Sian White Thanks so much for sharing your insights regarding Wash’Em in schools and health care settings – super helpful! Although we have yet to complete our Wash’Em training, I had been thinking about Wash’Em application in these settings and was curious if there was a body of knowledge on this. And, of course, thank you for ALL of your efforts in making Wash’Em a reality! 🙏
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've heard similar experiences with other organizations. Some say they don't have time to train their staff in Wash'Em in the early onset of an emergency. The uptake for training seems better if people are trained before the emergency, or when the initial phase of a crisis has passed.
I think this also reflects emergency response in general. In the process of designing Wash'Em we did lots of interviews with humanitarians about their standard processes of hygiene programme design (this was because we wanted to design a process that would fit within the existing humanitarian system and constraints). One key thing we learned is that hygiene programmes are often phased. There is often some kind of standard and relatively generic package that gets rolled out in the acute phase of an emergency (e.g. hygiene education, handwashing facilities and hygiene kit distribution). Some organisations left it at this, but others were able to do additional rounds of data collection a little down the track this allowed them to modify and contextualise their work. So I think if Wash'Em is deemed inappropriate by staff in some acute settings it could still be suggested down the track as a way of modifying and strengthing programmes.
Thanks for posting this. I asked earlier at which stage of the programming, has NGO been using WASH'EM . During the first weeks, it could be difficult for NGO with limited human resources to train staff and implement it. The way, I am seeing it is at the earlier stage of the emergency, we focus more on the hygiene promotion, critical hygiene supplies... But at a later stage, we can gather data for a more human centered approach. However, I am afraid that it shouldn't be delayed too much as the earlier the programme is contextualized, the better.
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.
So interesting that you should mention this Blanca. Just yesterday I spoke with a woman from Catholic Relief Services in Honduras. She and her team used Wash'Em to respond to the same crisis in the same area. They had 30 staff that collected data using the rapid research tools in about a 1 week period. They then designed a campaign using posters and radio (primarily). They distributed through the touchpoints that they identified through the tools. It might be interesting for you to chat directly to learn about her experience - or to talk to the person who coordinated the response. She said that the handwashing demonstration tool provided their team with a lot of insight in terms of the design and location of handwashing stations. They combined Wash'Em with other work they were doing on trying to get safe water to the community.
What a coincidence! Thanks for the information, Lisa. Do you know when they used Wash’Em? Was it just after the two hurricanes of was it sometime after? Indeed, it would be very interesting for me to chat directly with her or the person who coordinated the response, do you think it would be possible? I am so curious to know more about their experience.
@Blanca Sancho Moreno , I believe it was just after the two Hurricanes. I will reach out and see if the person I spoke with is able to connect. I'll also see if I can connect you with the person that coordinated the response.
@Lisa Mitchell That would be great. Thanks Lisa!
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
Hi Frank, did you receive a response to your request?
Best,
Ryan
Hi Ryan,
Not yet, unfortunately. We have gone ahead with a software translation into Arabic (through a professional agency). But what we could really do with now is a representative of an NGO who has implemented Wash'Em in the Middle East (esp. Yemen), and who would be up for an interview as part of our workshop agenda on the 31st August. Do you have any ideas, Ryan? Thanks very much for replying,
Frank
Hi Frank,
I have posted on our internal WASH'Em thread and will keep you posted.
Best,
Ryan
Great - thanks Ryan! This is greatly appreciated,
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.
I´ve not yet used WashEm tools. However, in Mozambique we have been experiencing various displacements due to Al-Shaabab attacks in Cabo Delgado Province, civl war and of recent, we had natural disasters such as Idai Cyclone. Another one of late is the COVID-19. For COVID-19, we have partly used traditional tools such as hygiene kit distributions, community mobilization to teach people how to wash their hands properly . In other cases, we also funded handwashing facilities in market places. We also used Most significant change stories and motives.
Thanks Francisco, your context sounds very challenging. Can you explain a little about most significant change stories?
Its great learning what others are doing and how they are doing it.
I have never implemented Wash’Em before but looking at it’s flow and the solution providing nature, I look forward to using this approach.
Several years ago, I worked in an IDP camp with an outbreak of Hepatitis E virus, a fecal orally transmitted disease. Hygiene promotion programming was a bit challenging because we implemented ideas that were not developed basing on the communities’ context but rather blanket ideas being rolled out across IDP camps. Right now with the knowledge I have got through the Wash’Em, things would get easier and more practical, as I would ensure that activities are designed basing on context considering barriers, motivators, perceived risk, knowledge, use of key channels, putting into consideration needs of vulnerable community members. This way I believe my programs would yield more results.
Hi Fiona, thanks for sharing about your experience with the outbreak of Hep E. Do you think the Wash'Em approach would have been feasible had you known about it at the time? For example, would your organization have been able to devote a little extra time and resources to doing Wash'Em if you had known about it then?
In a situation like that, and basing on resource availability am quite sure my organization would have been receptive to this new idea. I would aggressively market this approach, to better hygiene promotion.
in the organization Wash'Em help us to understand what the IDPs need to wash their hands, yes we did the assessment but we didn't implement Wash'em website ideas. their is some level I didn't understand or didn't implement them correctly in field so I hope to know from the training.
Hi Rasha, yes it's true that Wash'Em can be useful even we partially use the tools, but it will be much more useful if all the tools are used together and the recommendations are implemented!
I have not used Wash'em yet a context where I work - which is Ethiopia, Somalia Regional State, Jigjiga refugee camps. But the context wher i work with refugee population come to my mind,I wish to implement with the onset humanitarian response,understanding behaviors and adapting our WASH projects including the handwashing, I believe its key to have Wash'em tools.
Currently, we have a project we are piloting Wash'Em. In the first scenario, our focal staff was trained. Later on, she trained field teams. Assessment has been carried out and based on the recommendations of analysis, we were able to procure hand washing facilities.
We have not managed to distribute to our beneficiaries as the area is flooded and many families relocated to higher ground.
I believe if we could have used Wash'Em earlier in the IDP camp, we could be seeing positive changes especially on the use of hand washing facilities.
Thanks for sharing, Stephen! Sorry to hear hear of the flooding--I'll be interested to hear if you do end up seeing some positive changes after the waters subside.
Je trouve que Wash'Em est très intéressante car elle est pratique et mieux adapté pour les Situations d'urgence.
All these three videos just melt my heart!!
I didn't see in these videos that behavior change might be even option for them as all of them are looking for surviving , food and shelters.
In such situation organizations should act quite gently to avoid 2nd disaster following their first one ( displacement , disaster or outbreak ) to not experience.
Wash'em provides with good practical recommendations for behavior change to help these population not only to look for food and shelter but to prevent anther disaster of outbreaks.
Hi Taya,
In most cases we use The Most Significant Change Stories in place of Personal Histories. We use this as a monitoring tool, to track positive changes in program, effectiveness and sustainability. The process is the same as we have learned here in Personal Histories. However, to be precise, the person needs first to introduce oneself, tell people who you are and why do you want to write this history, where will that be used, and at the end, a consent form is also signed. This history is based on one to one interview, where a person tells his/her own story about his/er experience. As this happens, you will realize the lowest points of the history, where people tell how life looked like at the begining, then now how is life like, needs to identify the highest points of life, then what changes were noticed up to now. As you write, you can also record for accuracy sake, and make sure you don't put your own words on the history.
I am new in the concept of Wash'em.It is interesting to learn a lot and i appreciate the knowledge. We have been implementing the Hand washing demonstrations in schools where we procure and distribute the hand washing facilities to selected school for practice. We have limited knowledge on how to implement the project thanks to our nutrition manager who helps in some knowledge she learnt in running public health programing.
I will say with this skills, i am able to use the tool to decide what specific intervention to run in assorted consents. It is so engaging and will reduce the headache of planning and designing the Handwashing project especially in emergency context.
Even though I have yet not used the approach, I would like to see in the context where peoples displaced due to internal conflict.
The great thing, I understood that it is possible to quickly identify the hygiene risks with the recommendations.