BRAC’s water, sanitation, and hygiene (WASH) program achieved applaudable success in reducing waterborne diseases in Bangladesh by helping people gain access to safe drinking water and practising hygiene behaviours. But many people, especially farming households, are still frequently affected by waterborne diseases. Conducting a randomized control trial (RCT) on BRAC’s WASH and a specially designed WASH-Agriculture intervention, we examined the linkage between WASH and agriculture and the impact of these interventions in promoting hygiene. Findings show that compared to BRAC’s WASH treatment, the WASH-Agriculture treatment was especially effective in improving at-home and on-farm WASH behaviour and practice. However, in some other indicators related to hygiene behaviour and developmental productivity, the existing BRAC WASH treatment performs better.
Researchers: Mohammad Abdul Malek; Tahsina Naz Khan; Nicolas Gerber; Ratnajit Saha; Ikhtiar Mohammad
Partners: Bill and Melinda Gates Foundation (BMGF); Center for Development Research (ZEF)
Timeline: 2014-2015
Status: Completed
Contact: Dr Mohammad Abdul Malek
malekr25@gmail.com
Publications
Working paper: Can a Specially Designed Information Intervention Around the WASH-Agriculture Linkages Make Any Difference? Experimental Evidence of Behavioral Changes and Health Impacts
Context
Lack of safe drinking water and sanitation has a profound effect on human health; the effects are more acute for children and poor households. They are the root causes of waterborne or diarrheal diseases. In response to this perplexing scenario, BRAC’s water, sanitation, and hygiene (WASH) program initially aimed to provide access to safe drinking water and basic sanitation across the country, breaking the cycle of contamination caused by unhygienic latrines, contaminated water, and unsafe hygiene practices. Though the program achieved substantial success in achieving its aim, people are still suffering from waterborne diseases caused by water contamination at the point of use and unhygienic behaviours.
Evidence suggests that farming households have a higher diarrhoea risk than non-farming ones. One of the reasons could be that the hygiene practices that should be maintained at firms are different from those maintained at home. To ensure hygiene at both homes and farms, it is, therefore, necessary to design an intervention by taking the linkage between WASH and agricultural into account and study the impact of that intervention.
Intervention
The specially designed WASH-Agriculture treatment consisted of three interventions:
Research Hypothesis
Our hypothesis was that relative to the individuals and households under BRAC’s WASH treatment, participants of the WASH-Agriculture treatment will:
Methodology
For this study, we conducted a randomized control trial (RCT) in six Upazilas across Bangladesh characterized by comparatively poor WASH indicators. The six upazilas are Atrai, Kalihati, Mirzapur, Bauphal, Bakshigonj, and Melandaha. For this study, we selected a total of 648 students’ households. Among them 330 students’ households were under treatment group 1 (WASH-Agriculture treatment group), 192 students’ households were under treatment group 2 (BRAC’s WASH treatment group), and the rest of the 126 students’ households were assigned as the control group. Structured questionnaires were used to conduct the survey.
Findings and Recommendations
The direct or short-term impact of WASH-Agriculture program encompasses changes in household WASH behaviour, WASH hygiene index, willingness to use or pay for water purification methods, WASH expenditure, and drinking water quality in terms of the presence of Fecal Coliform (FC) bacteria. Indirect impacts include changes in diarrhoea prevalence, anthropometric measures in children, developmental productivity, and school absenteeism.
Compared to BRAC’s WASH treatment, the WASH-Agriculture treatment was especially effective in improving at-home and on-farm WASH behaviour and practices, willingness to use or pay for three of the nine water purification methods (chlorine tablets, filters made of sandstone, and non-electric filters), WASH expenditure and point-of-use (POU) drinking water quality. However, the existing BRAC WASH treatment performed better than the WASH-Agriculture treatment in some other indicators related to hygiene behaviour and developmental productivity. The WASH-Agriculture treatment had no significant incremental impact over the BRAC WASH treatment in terms of diarrhoea prevalence, anthropometric measures in under-five children, and school absenteeism. However, the two treatments did not have any negative impact on household WASH outcomes.
Although the WASH-Agriculture treatment was implemented through SB members, the impact could also be attributed to the efforts of their household members and the community. This shows that our study contributed to building the capacity of the treatment households and communities in monitoring their own WASH environment through water quality testing. Also, involving students in the BRAC WASH program as agents of change and as a channel of conveying hygiene, messages could be an effective strategy for motivating households and communities to improve their WASH behaviours and practices, especially at home and on farms.
