Studies

Handwashing Station: A Rapid Process Evaluation and Community Perception

BRAC’s Water, Sanitation, and Hygiene (WASH) program, in collaboration with the Hygiene and Behaviour Change Collation (HBCC), installed community handwashing stations (HWSs) to facilitate handwashing, with the aim of encouraging better hygiene practices and helping people adapt handwashing habit during COVID-19. BIGD conducted a qualitative study to explore the existing handwashing practices of the community and their perceptions about the HWSs, and understand the community level relevance of HWSs. Although the HWSs helped diffuse good habits and was appreciated especially by poor and working-class communities, many users could not understand the sticker instructions for using the HWSs, while others faced difficulties in using the stations due to the height and hardness of the paddles. It was also observed that women made fewer visits to the HWSs, which is to an extent related to social norms and religious stigma around seeing women perform the ‘intimate’ act of handwashing in public. 

Researchers: Dr Shahaduz Zaman; Tanvir Shatil

Partners: BRAC, Behavioural Insights Team

Timeline: 2020

Status: Completed

Contact: Tanvir Shatil
tanvir.shatil@bracu.ac.bd

Context

Handwashing stands out to be one of the strongest preventive measures against many illnesses, including COVID-19. However, it is a matter of behavioural change, which is often hard to achieve. Moreover, in developing countries like Bangladesh, many do not have proper handwashing facilities. Research shows that over one billion people, almost half of whom are children, lack basic access to water and soap at home.

BRAC’s Water, Sanitation, and Hygiene (WASH) program aims to ensure that everyone, everywhere has safe drinking water, a hygienic toilet, and practices good hygiene.  During the pandemic, in collaboration with the Hygiene and Behaviour Change Collation (HBCC), WASH has taken an initiative to install community handwashing stations (HWSs) to facilitate handwashing. Could installing handwashing stations encourage better hygiene practices and help people adapt handwashing habit?

Objectives

In this qualitative study, we explored the existing handwashing practices of the community and their perceptions about the HWSs. We also conducted a rapid formative process evaluation of the functional aspects of the HWS models. The study tried to understand the community-level relevance of HWS by capturing a comprehensive scenario of the programmatic function of HWS at the community-level through process documentation; exploring the contextual relevance of this programmatic intervention as well as identify the usefulness of these HWSs in the local community; identifying barriers and constraints related to the use of HWSs from both the perspective of community and programmatic function, and drawing realistic recommendations for the enhancement of project activities.

Methodology

Data were collected in two phases—one prior to the intervention, followed by another during the intervention. We used Key informant interviews (13), in-depth interviews (25), focus group discussions (8), peer researchers’ observations (8 peer researchers), and visual observations for data collection. Two villages were selected, one from Khulna and the other from Satkhira district. Data analysis was done through daily online debriefing sessions of key findings and thematic analysis. The findings from different sources were triangulated for internal validity.

Findings and Recommendations

Most people appreciated and accepted the paddle-operated “new model” of hand-washing stations during the pandemic since this ensured access for people at community hotspots outside their house, especially for the poor and working-class communities. It created a positive vibe in the community during the pandemic and helped diffuse good habits. However, illiterate community members could not understand the sticker sign instructions on the HWS. Moreover, while children, adolescents, and youth of the communities were excited about this style of handwashing, which helped change hygiene behaviour, children and physically weaker people faced difficulties in using the stations due to the height and hardness of the paddles.

Peer researchers observed that women made fewer visits to the HWSs, which is to an extent related to social norms and religious stigma around seeing women perform the ‘intimate’ act of handwashing in public. Many men did not allow their female household members to use the HWSs, while many women also felt shy about using them. However, working women near the HWSs used them regularly.

Overall, a sense of community ownership of the HWSs was absent, and many thought of it as a government initiative. Many were unaware of the purpose of the HWS due to lack of publicity and were found to use it as a source of drinking water. Lack of maintenance was also found to be a structural issue.

There is scope to think about some structural modification of the HWSs for example, creating separated handwashing facility to encourage women’s participation, developing more user-friendly paddles, and providing low-cost shades over the water tanks. There is a need to take more initiatives to increase the visibility of the HWSs in the community, e.g., through poster announcements.  The program may also think about a mechanism of peer learning for new users to inform them about the use of HWSs. More frequent orientation sessions would also be helpful. Finally, creating community ownership of HWSs would be important for long-term sustainability.

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