Sustain and Study

Determine if the behaviour has been adopted and Sustained

• Monitoring and evaluation (M&E) needs to be done much better. There was little data or information in any of the case studies about whether or not behaviours had been sustained over time, more commonly anecdotes from community members were supplied to suggest that change had occurred.
• Hygiene promotion programs should better assess existing conditions and practices at the start, then during, at the end of a hygiene promotion program, and then some time afterwards. It is better to measure only a few indicators over time, than a whole lot only at the start and finish.
• Use good tools to collect information. Asking a person to report on his/her own practice often gives different information from observing real behaviour. Thus in case study 27, the self-reports of handwashing with soap were 2 to 3 times higher than the observations. Data should be collected using several tools—for example, through observations, spot checks, discussions and group ranking or voting—and the results compared. This is called triangulation and gives far more accurate results.
• Do not do health impact studies in a project. They are complicated, expensive and must be very carefully done to show valid results. We know that if people have the materials and carry out certain practices, their health will be protected. This (the practices and status of facilities) is what should be studied.
  Case study 8; Case study 18; Case study 27; Case study 29
• Hygiene promotion needs much better program monitoring to answer questions such as: Is the program being carried out as planned? Who is being left out? The poor? Those in isolated communities? Are the field workers carrying out their work as planned? Are committees active? What problems are the field workers, promoters and committees facing? What have they learned during their work? Keeping an eye on this will improve hygiene promotion and help keep programs flexible.
• We need much better information on the cost of hygiene promotion programs – only one case study included some information on cost. Without better information on cost it will be difficult to advocate for greater priority for hygiene promotion.