Sustainability

The Global Scaling Up Handwashing project emphasizes the need to incorporate sustainability from the very start of intervention activities to ensure the changes achieved continue past the completion of the project.  The factors influencing the likelihood of handwashing programs achieving sustainability vary from country to country, but typically include the need to build institutional ownership and bolstering implementation capacities. Performance monitoring is essential as it can provide evidence to refine programming to improve impact and sustainability. This sustainability module includes a presentation detailing these concepts, as well as reports that address sustainability as a key component of handwashing programs.

 
Key TermsKeep in Mind

behavior change programming

capacity

dedicated funding

evidence-based program design

indicator

memorandum of understanding (MOU)

performance monitoring

political ownership

sustainability

  • Consider sustainability from the start.
    For handwashing with soap to become a habit, people must be continuously reminded about its benefits. Such on-going behavior-change programming also helps new community members understand these benefits and adopt handwashing with soap behaviors.
     
  • Sustainability strategies can (and at times should) change.
    Fieldwork and implementation experiences can uncover new information to refine sustainability strategies, which might also require adjustment as challenges and unforeseen events arise.
     
  • Evaluate the context.
    Sustainability exists in a context; people and programs must be analyzed to determine their strengths and weaknesses—and how those factors will impact sustainability over time.
     
Reports
  • Improving Measures of Handwashing Behavior
    As handwashing promotion is scaled up and adopted by more organizations, the need for field-friendly, affordable, and readily adaptable monitoring and evaluation techniques has increased. A WSP study in Bangladesh set out to determine the most effective methods for measuring handwashing behaviors, with particular interest in the utility of sensor soap. Included are study findings and recommendations for researchers and public health professionals tasked with measuring handwashing behavior.
  • Assessing the Enabling Environment Conditions for Large Scale, Effective and Sustainable Handwashing Projects
    What factors and elements need to be in place to facilitate the success of a sustainable handwashing program? What are the necessary frameworks and methodologies to assess handwashing initiatives at scale? Based on preparatory work for WSP’s Global Scaling Up Handwashing Project, this paper provides guidance to programmatic staff in the water supply and sanitation (WSS), health, and other sectors charged with assessing the enabling environments of handwashing programs.
  • Global Learning Strategy
    Findings on what works, and what doesn’t, in scaling up and sustaining handwashing programs can be short lived unless a structured process for generating, sharing, capturing, and disseminating knowledge is established. Included are recommendations based on a learning strategy developed by WSP’s Global Scaling Up Handwashing Project.
  • Endline Assessment of the Enabling Environment in Peru
    WSP’s Global Scaling Up Handwashing Project in Tanzania aims to inculcate handwashing habits at critical times in 1.3 million mothers and children. An enabling environment assessment was conducted to determine the existing conditions for the scalability and sustainability of the project. Nine dimensions of scalability and sustainability in Tanzania were examined through research, document reviews, and interviews with main stakeholders. Recommendations include: agreeing on a shared vision with project partners, allocating funding for handwashing facilities at schools, creating district-level project management teams, and ensuring that all partners can access monitoring and evaluation systems.
  • Enabling Environment Assessment: Senegal
    WSP’s Global Scaling Up Handwashing Project in Senegal aims to inculcate handwashing habits at critical times in 490,000 mothers and children. An enabling environment assessment was conducted to determine the existing conditions for the scalability and sustainability of the project. Nine dimensions of scalability and sustainability in Senegal were examined through individual and group in-depth interviews, surveys, and document reviews. Recommendations focus on the development of a government-endorsed national hygiene policy; establishment of technical committees on handwashing; and agreements with the Government of Senegal concerning institutional leadership and decentralized implementation.
  • Enabling Environment Assessment: Peru
    In Peru, WSP’s Global Scaling Up Handwashing aims to inculcate handwashing habits at critical times in 1.3 million mothers and children. An enabling environment assessment was completed to determine the existing conditions for the scalability and sustainability of the project. Nine dimensions of scalability and sustainability in Peru were examined through individual and group in-depth interviews, surveys, and document reviews. Included are recommendations that focus on regional, provincial and district partnerships; planning and implementing dynamic advocacy and communication strategies; and developing an appropriate exit strategy.
  • Enabling Environment Assessment: Tanzania
    WSP’s Global Scaling Up Handwashing Project in Tanzania aims to inculcate handwashing habits at critical times in 1.3 million mothers and children. An enabling environment assessment was conducted to determine the existing conditions for the scalability and sustainability of the project. Nine dimensions of scalability and sustainability in Tanzania were examined through research, document reviews, and interviews with main stakeholders. Recommendations include: agreeing on a shared vision with project partners, allocating funding for handwashing facilities at schools, creating district-level project management teams, and ensuring that all partners can access monitoring and evaluation systems.
  • Enabling Environment Assessment: Vietnam
    WSP’s Global Scaling Up Handwashing Project in Vietnam aims to inculcate handwashing habits at critical times in 2.3 million mothers and children. An enabling environment assessment was carried out to determine the existing conditions for the scalability and sustainability of the project. Nine dimensions of scalability and sustainability in Vietnam were examined through surveys and individual and group in-depth interviews. The authors conclude that the project’s success in creating an enabling environment in Vietnam could serve as a model for other programs in the region.
  • Scaling Up Handwashing Behavior: Findings from the Impact Evaluation Baseline Survey in Vietnam
    A baseline survey was conducted in 3,150 households in the Global Scaling Up Handwashing Project area. The research shows that 47% of caregivers report washing hands with soap after using the toilet and less than one-third wash their hands with soap at other critical times, such as before preparing food. However, the survey also reveals the prevalence of diarrhea is significantly lower than the most recent national statistics, findings that shifted the IE focus in Vietnam from tracking disease to measuring behavior change.
  • Scaling Up Handwashing Behavior: Findings from the Impact Evaluation Baseline Survey in Senegal
    In Senegal, less than one- third of households had  a designated place for handwashing with soap and water, according to rapid observations conducted in 1,600 households and 110 clusters. The observations  were part of the impact evaluation survey conducted in 2008 to collect baseline data for WSP’s Global Scaling Up Handwashing Project in Senegal. The baseline data will be used to track changes in handwashing with soap behavior in Senegal and to evaluate the project’s impact on child health and caretaker productivity. The evaluation study seeks to measure and learn about the impact of the intervention on handwashing behavior change with the hope that these lessons will be used to guide future projects and policy in Senegal and globally.
  • Scaling Up Handwashing Behavior: Findings from the Impact Evaluation Baseline Survey in Peru
    WSP’s Global Scaling Up Handwashing Project is testing approaches to learn what works to create and sustain handwashing with soap behavior change. To establish the causal effect of project interventions on specific health and welfare measures, the project is conducting impact evaluation studies using a randomized-controlled experimental design.  This report shares baseline results from research conducted in 3,526 households in the project area in Peru.
  • Emergent Learning a+E4bout Learning
    A challenge for projects implemented at scale and in multiple countries is to capture and disseminate learning in a way that is systematic, timely, and of benefit to country teams, clients, partners, and programmers. Another challenge is to continuously test key assumptions underlying the program design and activities. WSP’s Global Scaling Up Handwashing Project has implemented a culture of learning to help meet these challenges and achieve the project’s learning goals.  
  • Developing a Decentralized Performance Monitoring System in Senegal
    WSP Senegal developed and used a decentralized monitoring information system (MIS) to monitor performance. The system, which is capable of managing a large volume of data, is influencing ongoing projects by multiple agencies. This database has been recognized as a model by other public sector organizations, such as AGETIP for implementation of the Global Sanitation Fund in Senegal and the Municipality of Dakar.

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  • Guidelines for Assessing the Enabling Environment Conditions for Large Scale, Effective and Sustainable Handwashing with Soap Projects
    This purpose of these Guidelines is to provide guidance to programmatic staff in the water supply and sanitation (WSS), health, and other sectors on how to carry out an assessment of the enabling environment for large-scale, effective, and sustainable handwashing programming. In early 2007, the Water and Sanitation Program (WSP) started preparations to implement the Bill and Melinda Gates Foundation funded Scaling up Handwashing Behavior Change Project. The project tests whether innovative promotional approaches can generate large-scale, effective, and sustained increases in handwashing with soap at critical times among the poor and vulnerable in Peru, Senegal, Tanzania, and Vietnam. As part of the preparatory work, the project carried out assessments of the enabling environment for large scale handwashing programming in each of the project countries. The assessments piloted a conceptual framework and methodology developed for this purpose by the Scaling up Handwashing Behavior Change Project. These Guidelines present the background to the study, conceptual framework, methodology, and tools used to carry out the assessments.