WASH (Water, Sanitation and Hygiene) Behavior Change Curriculum for Ethiopian School-Goers

Type: Graduating Industry Thesis
Timeframe: 6 Months (Jan 2021-Jun 2021)
Team: Tanwi Mirajkar, Pranjal Begwani, Eyoel Berhan Mekonen and Kofi Selorm Azasoo, Megan Williams and Samyuktha Sam

My Role: Design Research and Visual Design
Methods: Literature Review, Expert Interviews, Field Interviews, Behavior Prioritization, Prototyping, Testing and Delivery

Poor hand-washing practices and waterborne illnesses are the leading cause of disease and death in children in Ethiopia. How might we use behavior change as a tool to tackle this?

The Challenge

Index

PART 1
How I Simplified Behavioral Science For Myself

The project purpose was to marry the power and simplicity of Human Centered Design (HCD) with the more grounded approach of behavioral science frameworks.

This is a model I built (after looking at a lot of other models) to understand how HCD and BehSc. work together in tandem.

PART 2
Literature Review

The Literature Review is the first step to creating an evidence base for the development of a comprehensive understanding of the existing practices in rural Ethiopia around handwashing, hygiene and menstruation and finally analyse how the existing curriculum feeds the rural landscape.

This literature review focused on the following three core objectives:

  • Summarize existing evidence on WASH practices in rural Ethiopian schools

  • Establish significant motivators and barriers towards receptivity to employing appropriate behaviors towards handwashing, clean water, toilet use and advocacy and menstrual health

  • Identify gaps related to infrastructure, access to infrastructure and access to knowledge to create an environment wherein we may intervene with solutions to foster appropriate behaviors.

PART 3
Field Research Design

The objective of the primary research was to understand perspectives from WASH themes and the different stakeholders in a school setting —

Primary and Secondary Students

  • To understand what knowledge motivates their actions and behaviors about WASH

  • To better understand their social, cultural and educational fabric/context

Hygiene Curriculum

  • To understand their perceptions and knowledge about WASH that the existing curriculum

  • To understand their current behaviors (reactive)

Menstrual Curriculum

  • To understand their perceptions and knowledge about Menstruation

  • To understand their current behaviors (reactive)

Teachers

  • To understand what role they play as an individual, in school and in society

  • To understand their attitudes and behaviors towards WASH

Janitors

  • To understand what role they play as an individual, in school and in society

  • To understand their attitudes and behaviors towards WASH

I created a discussion guide matrix for our partners in field to use during interviews

PART 4
Research Synthesis

Based on our primary research we were able to plot a summarized version of a typical students’ daily routine in terms of WASH behaviors. We centered our idea development around these touch-points since we had to intervene in their natural environment; this was crucial for our understanding.

A “typical” rural Ethiopian school goers Behavior Journey Map

Based on the insights that we got from our initial phase of testing and clustering we realise that a fair amount of knowledge already exists but they failed to act on their existing knowledge which is why we said let’s try this and see exactly where we need to motivate them to act. 

Behavior Prioritization

We plotted our findings on what we called an Action-Knowledge matrix that helped us categorise what they “act on”, what they “don’t act on”, what they “know” and what they “don’t know”.

Personally, this was a clear and beautiful way for us to visualise how all of our findings looked. This not only brought clarity but also immediate direction as to what we needed to work on and do next.

PART 5
Curriculum Development

We looked at the curriculum development in two aspects: “What they should know” and “What they should learn and finally practice’’. We developed this scale to break down the approach.

Students have to understand the learning objective and reach conclusions in order to learn for themselves after facilitation has taken place since behavior s work with reinforcement. But before that, we had to make it easy for both the facilitator to teach and students to learn, so we used the “learning by doing” approach.

We looked at the curriculum development in two aspects: “what they should know” and “what they should learn and finally practice’’. We Picked up 4 specific behavior themes to ensure the curriculum would seek to achieve and defined learning objectives for each of them

HAND HYGIENE

  • Understand how germs spread

  • Understand the importance of washing hands thoroughly

  • Understand washing with soap makes hands cleaner

  • Understands hands need to be washed at crucial times to stay safe and keep others safe

DRINKING SAFE WATER

  • Understand the meaning of safe water

  • Know the importance of drinking safe water

  • Source drinking water that they know is safe

  • Drinking safe water is a part of their daily routine and life

PROPER TOILET USE

  • Understand how to sit on the toilet

  • Pour water/flush after every user

  • Pour water into the toilet if it’s dirty

  • Use a toilet for defecating and urinating

  • Understand that keeping the toilet clean, keeps everyone safe and healthy

MENSTRUAL HYGIENE

  • Understand efficient ways to dispose of single use pads

  • Understand the importance of changing the pad frequently

  • Practice the routine for periods

  • More in tune with their body

Curriculum Activities

The curriculum we finally outlined looks like this- 7 chapters with 13 activities out of which one is an experiment four are demonstration-led and 7 peer-led activities and discussions all throughout.

PART 6
Curriculum Testing

We tested the curriculum in 3 schools in semi-urban and rural regions and iterated basis the feedback everyday. Every activity was pressure tested to see if how receptive the students were and what further gaps we needed to fill.

Findings From The Field

Students had very specific questions about some activities

  • Why wash hands for 20 seconds?

  • What is immunity? How does it work?

  • Does touching someone spread COVID-19? • How can we keep the toilet clean?

Both students and teachers were ‘intrigued’

  • Their understanding of germs was strengthened due to visual aids

  • Difference of water and soap water proved their hypothesis that their hands are actually dirty even if visibly clean.

“Eureka Moments” for the students during testing

  • - By not washing hands properly, their hands can have germs.

  • - They have the power to curb the spread of germs - “it’s my responsibility”

  • - They know where germs are, but aren’t viscerally aware of them at the moment

  • - Peer support/guidance helps them to follow good practice

PART 7
Designing the Curriculum

The curriculum had to be designed in a way such that it was not just a manual to WASH but a broader window reflecting the people using the guide and workbook. The workbook facing the students had to mirror the child-like sensibility wrapped in their fierce sense of responsibility, nurture and care they display. Representation was important here and we decided to make it the central theme.

Huge shout out to Shagnik Chakroborty, a supremely talented friend and classmate, who was the illustrator.

Representation

The illustrations were made to be human and not flat with the characters looking like actual Ethiopian people representing how they look and dress as a cultural entity.

Usability

Making this easy to use, read and handle was of foremost importance. The final curriculum was designed to use the standard A4 paper dimensions, of
210 x 297 mm.

PART 8
The Final Package

1. The Facilitation Guide -Teacher Facing

Every chapter is color coded according to the behavior pillar it addressed and hence the progression from orange, to green, to purple, to yellow to finally blue.

Every chapter has an introductory spread that specifies the goal that the activity addresses along with the duration of the activities involved.

2. The WorkBook Guide- Student Facing

Just like the facilitation guide, every chapter is color coded according to the behavior pillar it addressed and hence the range of colors.

From our testing findings, we knew that writing and reading long paragraphs of text was not something they were used to and hence we went bold with the colors and minimal with the content layout.

The language is conversational with the characters explaining and talking to the reader with a personal, candid tone to it.

Dissemination

The curriculum was slated to be delivered across 10 districts located in 8 regions of Ethiopia and serving 558,075 students within 415 schools.

The direct curriculum implementation was a bit more complicated given the elections in Ethiopia in 2021, COVID-19 and the unrest that the region was seeing due to ethnic violence all along with famines. Direct implementation could be as early as September 2021 or as late as 2022.

Splash, as of June 2021 was planning to start focal teacher training in whatever capacity they can once they get the entire curriculum translated and packaged for print and distribution. 

PART 9
References

    1. https://www.britannica.com/place/Ethiopia

    2. https://www.expogr.com/ethiopia_country_information.php

    3. https://en.wikipedia.org/wiki/Tigray_People%27s_Liberation_Front

    4. https://en.wikipedia.org/wiki/Ethiopia

    5. https://ethiopiaglocal.wordpress.com/tips-for-travelers/climate/

    6. https://en.wikipedia.org/wiki/Ethiopia

    7. https://en.wikipedia.org/wiki/Ethiopia

    8. https://www.britannica.com/place/Ethiopia/Education#ref281780

    9. https://www.britannica.com/place/Ethiopia/Sports-and-recreation

    10. https://www.britannica.com/place/Ethiopia/Education

    11. https://www.britannica.com/place/Ethiopia/Health-and-welfare

  • USAID - HIP (Hygiene Improvement Project 2010)
    Basic Guide For School Directors, Teachers, Students, Parents & Administrators

    Eco Soap Bank
    How To Wash Your Hands- A Guide For Teachers

    UNICEF
    Water, Sanitation And Hygiene For School-Children In Emergencies A Guide Book For Teachers

    UNICEF, 2010
    A Manual For Wash Activities In Elementary School Clubs

    USAID- Zambia (2014)
    WASH-Friendly Schools- A Training Resource For Splash Use

    Water And Sanitation Programe, 2010
    Senegal: A Handwashing Behavior Change Journey

    USAID, 2013
    WASH Plus Bheaviour Change Strategy

    UNICEF, 2008
    Training Manual Good Water, Sanitation & Environmental Hygiene Practices for Primary Schools

    Malteser International, 2017
    Wash Guidelines For Field Practitioners PART 3: Hygiene

    Eawag:Swiss Federal Institute of Aquatic Science and Technology
    Systematic Bheaviour Change In Water Sanitation And Hygiene

    Water Aid
    Approaches to promoting behaviour-change around handwashing-with-soap

    Lifebuoy, 2019
    Way Of Life: Towards Universal Handwashing With Soap- Social Mission Report