Written by Axel Vande veegaete, Scientific Coordinator, Humanitarian Services at Belgian Red Cross-Flanders
WASH (Water, sanitation and hygiene)
Meet Charlotte, recently appointed to work with WASH for the Belgian Red Cross. With her knowledge of geology and specialisation in groundwater she is able to provide advice and support to the delegates in the field for the water and sanitation projects in Africa and Asia. These projects, implemented by the local Red Cross and financed by the Belgian Red Cross, have an important hygiene promotion component. One of Charlotte’s first tasks is to get acquainted with the different WASH projects and to deepen her knowledge of sanitation and hygiene promotion.
Photo: Belgian Red Cross
A myriad of methodologies, theories, models and tools
Starting by studying the project documents (the health, WASH and nutrition situation, baseline and KAP surveys; the consultants’ analyses and recommendations; the project plans with logframe, indicators, assumptions, etc.), Charlotte gathers all the WASH documents she can find and starts to read the overwhelming amount of information on sanitation and hygiene promotion. Almost immediately, she is completely lost, confused by the different methodologies, theories, models and tools, including PHAST, CHAST, CLTS, UTLS, SLTS, PHASE, FOAM, CATS, MBM, ABCDE, SARAR, CHC, CtC, CAP, PRA, BCD, RANAS, SPLASH, IBM-WASH, Evo-ECO, PPPHWS, Saniya, SSIP, SaniMart, SanMak, TSSM, nudging and incentives. And even though the Red Cross has long ago chosen to use the PHAST methodology, she notices that this is not the case in all projects. In a lot of cases combinations of methodologies are used. How will the local Red Cross project officers know what works in which circumstances, what leads to behavior change and what factors influence the implementation of all these approaches? Charlotte needs help sifting through the information to be able to advise local Red Cross workers.
Helpful new evidence
Luckily, one of her colleagues points out that CEBaP (Centre for Evidence-Based Practice) of the Belgian Red Cross, together with the Centre for Evidence-Based Healthcare of the Stellenbosch University, has recently worked on a Campbell systematic review entitled ‘Approaches to promote handwashing and sanitation behavior change in low- and middle-income countries’. Charlotte reads the executive summary and scrolls through the review. Realizing she will not find a ‘one-size-fits-all’ solution, she finds enough elements and information to be able to understand the main differences between the promotional approaches, and to identify which ones - or combinations of different ones - can be most effective under which circumstances. She can also see which barriers and facilitators can influence implementation.
Theory of change
When she reads the review more in depth, the detailed, but very comprehensive ‘Theory of Change model’ (ToC) guides her throughout the review.
Charlotte especially likes the ToC (Figure 15 in the full review), the table summarizing the findings (Table 51 in the full review), and the figure representing the identified evidence in a visual way (figure from the plain language summary). The ToC, table and figure are complementary; the information is classified in such a way that she can always relate it back to the ToC and put it in the right context.
For example, Charlotte knows that sustainability is a challenge for behavior change; the fact that the ToC makes the distinction between uptake, adherence and long term use and that the table comparing promotional approaches is organised per behavioral change outcome, makes it easy for her to find the relevant studies in a glimpse. The table also shows the certainty of evidence, and from the figure it is clear what this means for practice by use of colour codes.
With this review, Charlotte feels more confident to be able to understand, analyse and comment upon the sanitation component of the programmes she is advisor for.