Annual Progress Report 2009

The purpose of this progress report is to tell the story of the Global Scaling Up Handwashing Project over the last year, with a particular focus on developments since we last reported for the period July 1-December 31, 2008. Download the Executive Summary (PDF) or the complete Annual Report (PDF)—or browse selections of the Executive Summary below.

Since project inception, the numbers of women of reproductive age and primary school aged children exposed globally to behavior change communication programs are compelling:
  • 28.6 million exposed to HWWS mass media campaigns (74 percent of the global end of project target);
  • Over 1.9 million engaged in Interpersonal Communication Programs, or IPC (61 percent  of the global end of project);
  • 49,000 exposed through Direct Consumer Contact, or DCC events (8 percent  of the global end of project target);
  • More than 14,000 people representing a diversity of sectors and segments of society, including teachers, heath professionals, local NGOs, university students and teachers, community volunteers, local governments, and private sector firms trained to facilitate behavior change in HWWS (47 percent  of the global end of project target).
Based on experiences from other behavior change programs (primarily HIV/AIDS), the current literature, our collective expertise, and our personal accounts from trips to the field, we are confident that the communication programs are changing behavior and people are washing their hands with soap when and where they did not before. While the total numbers will not be known until the Impact Evaluation (IE) endline surveys are conducted, emerging results from doer-non doer studies in Vietnam and monitoring surveys demonstrate behavioral determinants are improving, communication messages are resonating with our audiences, and people are now washing their hands with soap. We are, at present, confident that the project is on track to change the behavior of more than 5 million women and children to wash their hands with soap at critical times.
The programming Component is on track to achieve and, in some cases, surpass expected results. During the last six months:
  • There has been a significant increase in the number of women and children reached by mass media, IPC, and DCC programs over the previous reporting period (5,779 percent , 140 percent  and 181  percent increase respectively).
  • The significant increase in mass media reach is the result of the launching of the “Hands to be Proud of” radio campaign in Tanzania, exposing 8.4 million women and children to at least one HWWS program in only four months.
  • The increase in IPC and DCC is due to the rapid scaling up of IPC in Vietnam (1 million women and children reached through 540,000 IPC activities delivered in this reporting period alone) and the number of people reached through DCC events in Peru (25,000 women and children).
Work in the Enabling Environment Component continues to build on past gains and progress has been made in the majority of the nine dimensions. Globally, the project has integrated HWWS in the public sectors of education, health, and water – securing public funding for HWWS programs (Peru and Tanzania), developing HWWS training for teachers and integrating programs into primary school curriculum (Vietnam, Peru, Senegal), and securing the designation as “incubators” to garner financial support, national attention, and local support (Tanzania).
The project has also brokered innovative partnerships between public and private sector entities:
  • Private sector firms are developing and purchasing easy-to-use and affordable soap dispensers (Peru);
  • Soap companies are branding their products with the project logo and are interested in leveraging the project as a distribution channel for their products (Tanzania);
  • Companies and local governments are co-financing large-scale HWWS programs which are integrated into other health-related programs (malnutrition in Peru).
The Global Scaling Up Handwashing Project is designed to learn about implementation and achieving results at scale with a focus on sustainability and replicability. Rich learning is taking place both at the country level and globally and though only 33  percent of expected knowledge products have been completed, we are on track to deliver expected results. Through ongoing research and field experience, we are finding out more about the contributing factors to washing hands with soap:
  • Easy access to soap and water when and where needed has emerged as a significant behavioral determinant for HWWS in Peru and Senegal, underscoring the potential role of enabling products and technologies in HWWS.
  • Knowledge of the best way to wash hands has found to be statistically correlated with the behavior, which was previously assumed not to be a factor.
  • Remaining misconceptions in beliefs and attitudes around soap and water (e.g., if you wash your hands really well with water you do not need soap, washing your hands with soap before feeding a child is important only if you use your hands to feed them, etc.) are significantly correlated with HWWS behavior.
  • All of these findings reinforce the FOAM framework (Focus on Opportunity, Ability and Motivation) developed by WSP as part of the HWWS project and shed more light on some of the necessary conditions for creating sustainable behavior change. 
Further, project teams are engaging other programmers outside of their respective countries to share experiences, build capacities, and lay the foundations for replicating experiences and outcomes achieved by the project:
  •  In Peru, the project was selected by UNICEF to present at the International Symposium: Water, Sanitation, and Hygiene in Schools on experiences integrating handwashing with soap into the education system in 800 schools throughout Peru.
  • The team is also providing an intensive development program for Bank Task Team Leaders and program coordinators from other countries to come to Peru to learn from the team and the experiences of the project. To date, the project conducted two of these programs for representatives from Colombia and Central America. 
The Global Scaling Up Handwashing Project is now well positioned to effectively monitor the implementation of the breadth of activities being implemented throughout the four countries:
  •  Reporting systems have been developed to ensure country teams are receiving regular information from their contractors against key performance targets.
  • Country Management Information Systems, either already operating or currently being finalized, will capture this data and will provide a powerful management tool for project teams to manage for results.
  • The Global Management Information System, which was rolled out during this reporting period and used for this reporting process, will capture data on the key global indicators and provide the headquarters team with performance information on a regular basis.
Overall, the impact evaluation is on track to meet the intended objectives within the extended 5-year time frame. At the time of the writing of this report, all of the baseline surveys have either been completed (Peru) or launched (Vietnam, Senegal, Tanzania). Findings from the Peru baseline have been compiled in a draft report (available upon request) and the results will be shared with a wider group of government partners and stakeholders in October, 2009. Draft reports and stakeholder engagement workshops will be held for the remaining countries in the Winter of 2009/2010.
The overall project management capacity of the HWWS project has continued to strengthen over the reporting period.
  • Short-term resources have been added to country teams to support in the areas of monitoring and Management Information System (MIS) design and knowledge management.
  • The HQ team has provided direct assistance in budgeting and overall technical assistance through numerous missions.
  • Continue work in the programming component to expand the reach and exposure rates of women and children to the HWWS behavior change programs (IPC, DCC, and mass media).
  • Expand on the gains made in the enabling environment to solidify the foundations for sustainability and replication.
  • Prepare and implement activities associated with Global Handwashing Day (October 2009).
  • Analyze emerging data from monitoring, doer-non doer, and tracking surveys to monitor changes in determinants and adapt programming and messages as needed.
  • Use implementation data emerging from country and global Management Information Systems (MISs) to track implementation of activities across all four countries and identify opportunities for improvement.
  • Expand our ability to better translate learning into knowledge products and to share these with other WSP countries, development partners, client governments, other Bill and Melinda Gates Foundation WSS grantees, etc.
  • Begin planning for the end of project transition. Plan will aim to secure commitments from national governments and other partners to sustain HWWS programs and continue to change HWWS behaviors. WSP will very likely remain engaged in HWWS in the four countries, but, depending on funding levels, at a lower level of engagement.