|Hygiene Evaluation Procedures - Approaches and Methods for Assessing Water - and Sanitation-Related Hygiene Practices (International Nutrition Foundation for Developing Countries - INFDC, 1997, 124 pages)|
|2. Planning a hygiene evaluation study|
You will need to plan your investigation in as much derail as possible. For example, you can start by asking what do I want to investigate? How much time and other resources do I have? Who is going to be involved? When? Answers to these questions, however sketchy and preliminary, will shape your plan of investigation.
You may start by writing down the question(s) to be addressed. For example:
· What are the existing problems and priorities concerning sanitation and water supply in my project area? This question will require you to make direct contact with the inhabitants of the area to engage them in defining the problems and ranking them according to importance/priority. This is an effective way of involving local people in your planning. If improved water supply and/or sanitation facilities rate high in their list of priorities, then assessing existing water and sanitation-related practices will lead you to identify appropriate ways of meeting these priorities. The outcome of a hygiene evaluation study can be expected to provide baseline data which can form the foundation of a well-designed project.
If you are designing a hygiene evaluation study half-way through the implementation of project activities, the resulting information may enable you to monitor the progress of activities and either to continue with existing plans of action or to modify them as appropriate.
If the assessment of hygiene practices is being carried our at the end of project activities, the results may provide you with some indication of what has been achieved by the project, directly or indirectly. If the improvement of hygiene practices has been a project goal and baseline data had been previously collected. this assessment will enable you to measure change in hygiene practices by comparing your findings with the baseline data.
· Are the sanitation and water supply facilities promoted or provided by my project being used as intended? If not, why not? Answers to these questions will help you find out how much progress has been made or whether a change of direction is needed in your project implementation. These questions can be posed whether or not appropriate use of facilities had been part of your project's original objectives.
· How successful has my project been in promoting improvement or change in hygiene practices? This question can only be addressed successfully by a hygiene evaluation study if your project had collected information on existing hygiene practices before the start of its hygiene pro motion, education, or communication activities. otherwise the outcome of a study using this handbook can only be used to describe the situation at the time of the study. You will not be able to measure behaviour change because you have no baseline data against which to measure change.
All of these questions are of a general nature and will need to be developed further into specific questions that apply to your particular setting.
In order to assess hygiene practices and to understand why they occur in the way they do, you will need to gather diverse types of information. Some of these may already exist in your project files and/or other written documents, while others will need to be collected during your hygiene evaluation study.
The Physical Environment
Climate, soil type, and availability of water may all influence hygiene practices. For example, people are not likely to use water for washing or bathing frequently if there is very little water available near them and if they have to walk long distances to fetch water for everyday use. Similarly, pastoralist communities who live in very arid regions and move periodically from one area to another are not likely to be concerned about building sanitary facilities.
Different sources may be available for you to use to research this information. There may be written records with detailed descriptions of the area, perhaps with historical perspectives. Ministries of Agriculture, Forestry, and/or Natural Resources may have records you can consult: usually, their annual reports provide some maps and photographs.
However, one of the best ways to collect relevant information on the physical environment is to go out and see, smell, touch, and feel the place of interest for yourself. Visits to existing water sources in and outside villages and familiarity with different parts of villages, districts, and regions around you are necessary if you want to learn about the physical conditions and features of your project site. Try to visit the study site when you start planning, so that you can plan your activities with the particular place in mind. You learn more by visiting villages yourself (and preferably staying in them for more than a day at a time), than by learning about them secondhand. Repeat visits at different times of the year are often necessary to appreciate seasonal variations in climate, water availability, accessibility of villages, agricultural workload of the inhabitants, and so on. Repeat visits also give you the chance to build up friendships with the inhabitants, so you can learn more from them as well as from your own observations.
Before meeting people in your study site, try to find out as much as possible about them. You (and your study team) need to ask yourselves the questions in Box 2.
Once you have answered these questions, you will be able to describe the population and the community. Be clear though, to whom you are referring when you use these terms. A few definitions may be useful:
Population. A defined group of people. The population of a country refers to all people in the country; the population of a village refers to all people in the village.
BOX 2: Preparing for the Study
· How much do I know about the people served by my project?
Study Population This refers to all people you include in the study or evaluation. It is up to you to define them. The study population may be a sample of the total population of a given area.
Village. This term may refer to an administrative area and a geographic area (a group of houses close together), or it may be used only to refer to the administrative area including outlying land. When we talk about villages, however, we usually refer to a number of houses positioned closely together, which share some public facilities - a meeting place or common land, a well, a place of worship such as a mosque, temple, church, or schoolhouse.
Community. A community is a group of people with a shared identity and common interests. People may share a common interest because of their residence, or because of ethnic, language, religious, or other ties.
Family. This term is used to indicate that a group of people are related to each other by blood or by marriage. Not all members of a family will constitute a household, and not all householders may be related or part of a family.
Household. A household is conventionally defined as a group of people who share a single cooking pot. It can include nuclear families (husband, wife, and children only), extended families (additional family members, often grandparents as well), households with more than one wife, and households where not all members are related. In general, households include people usually related, who live under one roof, and share certain economic resources.
Note that all of these terms need to be defined. The term community, for example, seldom refers to a homogeneous group of people. A village community is usually made up of subgroups such as elders, leaders, men, women, and children, and poor and wealthy family groups who may belong to different clans or ethnic groups. The village community may be made up of people who belong to the same language or ethnic group but do not necessarily share the same views or beliefs. People from two different ethnic or language groups in the same area, even in the same village, may be regarded as-and much more importantly, they may regard themselves as-belonging to one community sometimes, and two communities on other occasions.
You cannot assume that these groups share the same views or have the same interests. You need to be sensitive to any conflicting interests within your study population. Men and women may represent significantly different interests. There may be differences even within these two gender groups. Some may be traditional while others are modernist. Some may be conformists while others are rebels.
In urban areas, people may consider themselves to be part of one or more interest groups, types of community that do not necessarily share the same ethnic, linguistic, cultural, or religious affiliations, but have similarly felt or expressed needs and concerns. If you use the term community, make sure you understand what it stands for, and define it carefully.
You need to collect and interpret information that is gender-specific. In other words, you should be able to come up with information that is specific to men, information that is specific to women, and information that is common to both men and women. Many hygiene-related activities have gender-specific roles and values associated with them. You need to ask women about their activities. Do not rely on men telling you what women do, or why they do it. Similarly, do not rely on women to de scribe men's activities.
For example, women and young children are often solely responsible for fetching water, and men's accounts of accessibility and use of water may be very different from women's. Women are also the first health and hygiene educators in the home. Sanitation and hygiene-related habits are inculcated at a very early age when toilet training and personal cleanliness are strongly influenced by the mother's teaching and practice.
Gender-specific roles may influence the adoption of sanitation facilities. In many cultures, the construction of pit latrines is seen as a man's job while the task of cleaning them is be a woman's. In rural western Kenya, women-headed households may face difficulties with latrine construction and repair, because it is not acceptable for a woman to dig a pit latrine or to repair a latrine with a leaking roof.
Hygiene Practices and Health
In order to identify practices that pose health hazards, you will need to find out which water and sanitation-related diseases are prevalent in the project site. This can be done by consulting the local dispensary, clinic, or hospital personnel, and their records. There may also be other institutions including your own project, which may have conducted health surveys or compiled records.
More importantly, you will need to find out what local people do about health-related problems. There may be documentary sources of information on existing health practices, including traditional practices, but there may still be more for you to find out. Understanding what the local population perceive to be good practices and bad ones (those that promote health and those that do not) and why, is an important contribution that your evaluation can make towards the design of an effective health or hygiene promotion intervention. You may be able to provide information on which good hygiene practices to encourage and which bad or harmful ones to try to discourage in acceptable ways.
Your study plan should include some detail of whether the different types of information will be qualitative, quantitative, or a combination of both. The units of analysis used and the sampling strategies applied will depend on the type of information gathered in terms of the qualitative-quantitative mix. As mentioned in the introduction, the emphasis of this handbook is on the depth or richness of information on hygiene practices that can be gathered through qualitative methods, and that can help project personnel better understand the cultural and social context in which they work. Whether or not the study is designed to include quantitative data also will depend on the resources available. The two approaches can be adopted side by side to address questions of breadth and depth at the same time. A qualitative study ideally always precedes the quantitative investigation, especially for baseline evaluation purposes. However, qualitative research can also be preceded by a quantitative survey, which might identify certain issues to be followed up, using qualitative methods, for clarification and further detail.
A hygiene evaluation study will involve different people and will concern them in different ways. identify the main stakeholders: those who are going to be involved in and ultimately affected by it - the primary stakeholders and those who are going to have some intermediary role, the secondary stakeholders (see ODA, 1995).
Before you set out to conduct your hygiene evaluation study, you must get the consent of your study participants. This may include written consent, although this may not be possible if the participants are illiterate or if they regard forms and the provision of their names and/or signatures as intrusive or threatening. The following guideline may be helpful to gain informed consent:
· Explain the purpose of your study to official representatives of your study population(s) as well as to community leaders. These may include elders, religious leaders, and other senior men and women who have socially influential roles in the locality.
· Explain the purpose of the study to your informants (study participants) as well. Assure them that you are not going to use the information they provide against them, and keep your promise. Assure them, too, that you will preserve the anonymity of individual study participants when reporting results of your investigation. People rarely wish to be publicly identified with sensitive information obtained during a study. If you do wish to quote someone, or to present information that could lead to a participant being identified, you should gain his or her permission to do so.
· Strive to make the results of your investigation available to local institutions, both formal and informal, such as government departments and village committees, in ways they can use. Giving feedback of your study findings to participants will increase the credibility of the findings, as they will check them for accuracy. It will also enhance your project's relationship with the target populations.
Ownership of Information
Who will own the data? This question is best addressed before data collection and analysis Where collaborative arrangements have been made at the outset of the study, each party must have a clear understanding as to who will need access to the information (or parts of it) and who is to provide that access. The question of who owns the data is often difficult to answer because various stakeholders may want to assume direct or indirect entitlement to be custodians of information. Among the most common stakeholders are:
· the external agency who financed the study;
· the project manager who needs to use the data to monitor progress and account to funding bodies, make decisions about further action, and so on;
· the participants who spent their time and energy cooperating with the study team in providing, analysing, and interpreting the data;
· those who conducted the study, who wish to make parts of their report available to others (e.g., by publishing).
Problems can arise if one of these stakeholders claims exclusive ownership of the data at the end of the study. For this reason, you must agree on a fair and workable arrangement at the outset.
Most projects include staff of varied personal as well as professional skills, and abilities. You will need to include the range of skills available and allocate tasks appropriately. For example, a member of staff with graduate level qualification (diploma or certificate in public health, sanitary engineering, social development or health work) may be the person to take responsibility for documentation of results and report writing. Another member with highly developed communication skills may be allocated tasks of facilitating group discussions, interviewing, or organizing the activities of the team.
List individual skills and capabilities in your project. A good study ream may include people with the following qualities:
· At least one or two persons who belong to the local population or culture and are good communicators. Members of study populations, such as village health workers, traditional birth attendants, water pump attendants, and women's group leaders may be recruited and trained.
· At least two or three persons (project staff who have good writing skills and can commit themselves to the study from start to finish.
· Other project staff who are senior may already have experience working with the project. Such persons are often invaluable when it comes to translating the study findings into an action plan. Ideally, they should be included in the study team in the preplanning stage and also, if possible, in at least some of the investigation and analysis sessions.
Do not include in your study team:
· Persons who are unwilling or unable to assume the role of a learner in relation to the study population. A person who has difficulties in showing respect to local people and engaging with them on an equal footing may be more of a liability than an asset to your team.
· Persons who are unable or unwilling to stay in poorer areas than they normally live in. For example, the work required to carry our your hygiene evaluation study may require you to spend a lot of time in the poorest parts of a town or in rural areas where eating and sleeping arrangements may be very rudimentary.
Each member of the study team will need to be:
· interested in learning about how to assess hygiene practices in their cultural, socioeconomic, and physical context;
· willing and able to learn and to adopt new skills and attitudes (this may involve unlearning old ones) for effective communication with members of the population(s) under study;
· prepared to initiate and maintain a team spirit with other members of the team/colleagues.
If there is conflict in the study population, try to avoid including, in the study team, persons who are affiliated with only one side of the conflict.
Make sure you include only neutral persons such as teachers, health workers, or extension workers who do not belong to any one group, but live in the locality, or include at least one representative of each of the conflicting groups.
It is not usually a good idea to work closely with political leaders, or to have someone with political connections in your study team, as this can affect how people perceive you, and bias your findings. However, you may wish to include people with political connections in your discussions and interviews during the investigation and analyses. Such people may include political leaders as well as members of their families. Conduct a Stakeholder Analysis to enable you to make pragmatic decisions (see Box 3 for guidance on how to do a Stakeholder Analysis).
It is essential to have in your study team, persons who are native speakers of the local language(s). as this improves the quality of information gathered. If necessary, other members of the team who are fluent in English can translate for them when reviewing and documenting their information.
Write down the amount of resources available to you for use in a hygiene evaluation study. Remember that resources include:
BOX 3: How to Do a Stakeholder Analysis (Adapted from ODA, 1995)
There are several steps to doing a Stakeholder Analysis
· Draw up a "stakeholder table." To do this you need to identify and list all potential stakeholder; identify their interests (overt and hidden) in relation to your study aims and objectives; and determine whether the impact of your study on each of these interests is likely to be positive, negative or unknown.
It may be that your project has budgeted some money for an evaluation. Find out how much time can be budgeted and who can be assigned to carry out the evaluation. When considering time and human resources, do not restrict your vision to your collaborators or fellow project staff only. Think about ways to involve the people who are going to supply the information you require for the study. You will need to carry out a preplanning piece of investigation to find out who your study populations are, what activity patterns they follow by season, income level, or social status, when might be a good time for them to be involved in your study, and what they might expect to get out of it. You will need to consider all of these before you decide how you are going to use your resources.
The following are some of the items of expenditure that should be included in your budget:
· Training of the study team. This may require hiring a specially designated venue such as a hotel, conference centre, or residential school where the initial training of the study team can be carried our.
· Transportation (vehicle maintenance and fuel). If your project owns vehicle(s), you will need to make prior arrangements to make sure that the study team can travel freely during the conduct of fieldwork.
· Subsistence in the study site. Food, drink and accommodation for the study ream, including the driver(s), should be included in the budget, to avoid unnecessary discomfort or inconvenience during the study period.
· Remuneration for project staff who are going to put in extra hours of work during the study. Project staff will be required to work overtime and to spend time away from their families while conducting the study. This may incur extra expenses particularly for mothers of young children. In addition, many people in poor countries survive by holding a second job, and if they are working away from home, they will not be able to do this. The study coordinator should agree to reasonable payments in cash or in kind, as appropriate.
· Allocate some space to the study team, if possible a room to use for meetings, preparation of materials, further training and documentation, as well as for data management, analysis, and report writing. Show all members of your team your appreciation at the end of the study by giving them something. This could be in cash or kind, depending on what is appropriate to the particular project and in the local cultural context.
The timing of your study will depend on your answers to the following questions:
· Do your project objectives include improvements in hygiene practices? If not, then the results of your investigation will not be linked to project objectives. but may be used in redirecting your project goals. If your project is about to come to an end, the main reason for conducting a hygiene evaluation study may be to gain a detailed insight into existing hygiene practices for the record, or possibly to consider in future interventions. If your project is a pilot project, then your study may influence future projects.
· Which methods has your project already applied for monitoring its effectiveness? Are there many records you need to gather, review, and digest before you set out on this study? How much time will that require?
· Do you know when the best times are for you and your colleagues to work on the project? Do you have financial deadlines coming up soon? If the end of a project financial year is imminent, there may be funds left over that need to be spent quickly. However, will you and your colleagues have the time to implement a good hygiene evaluation study? Remember that money is only part of what is needed. What about your collaborators, including government ministries, agencies, and/or trainers? Will your timing easily correspond with theirs?
· Do you know whether and when members of your study population are likely to be willing and interested in participating in your investigation? For example, if they live in a rural area, they will be especially busy at harvest time. They may have been involved in several other studies, and he reluctant to participate without considerable consideration and negotiation. You may also need to allow extra time if climatic conditions make travelling difficult at certain times of year or if climatic conditions will affect study results. For example, heavy rain and prolonged drought both have extreme effects on water and sanitation.
BOX 4: Financial Arrangements for the Study Team
In one study project staff were paid weekly cash allowances to cover subsistence (food and drink). Transportation costs (vehicle, maintenance, fuel) were handled separately. The (external) study coordinator provided materials (paper, flip charts, notebooks, pens, etc.). At the end of the study, the ream rook tea, sugar, bread, and biscuits to the villages where they had worked to share with some of the study participants (those present). The village health workers who acted as support members of the study ream were rewarded for their efforts in kind ( items of local clothing were purchased for them). Project staff were treated to an end-of-study celebration meal and given token rewards for their efforts. This reinforced the sense of ream spirit and shared ownership of the study results.
In another study, community members of the study team were given
rewards in kind - project staff shared their food and drink with them. At the
end of the study, the key collaborators (all women) were each given a new
garment in recognition of their contribution to the study. The project staff
were paid allowances in cash to cover their field expenses. Camping gear was
provided by the project (tents, camp beds, blankets, water containers, plastic
plates, cups and cutlery, a solar lantern, kerosene lanterns, and small
torches.) Tents were nor used for security reasons, but the rest of the camping
equipment was used in village owned buildings, such as meeting rooms and school
rooms, where the study ream was allowed to