Results

Monitoring and evaluating the interventions that made up the Global Scaling Up Handwashing project is a core activity that contributed to the overall learning objectives of the project.

In terms of health impacts of the project, results from the large-scale impact evaluations using randomized controlled trials in Peru and Vietnam are available to view in this module, as well as baseline findings from evaluation efforts of handwashing with soap programs in Tanzania and Senegal. Additional documents will be added as study results become available.

In terms of outputs and outcomes of the project, they are documented in various publications in this module. In addition, various guidance documents for monitoring and evaluation purposes are also included.

 

 
Key Terms

enabling products

FOAM

hardware performance monitoring

software

Publications
  • Making the Hard-to-Reach... Reachable: Experiences on Public Private Partnerships for Hygiene Promotion in Peru (WSP)
    Private Public Partnerships in Peru are becoming efficient mechanisms to accelerate poverty alleviation, reduce malnutrition and increase healthy behaviors, among others. The Handwashing Initiative (HWI) started in Peru in early 2003 as a public private partnership seeking to raise national  awareness on the benefits brought by handwashing with soap behavior particularly on young children’s health. Linked to education and nutrition, the initiative reached 5.9 million caretakers and children by 2010; built local capacities and established strong partnerships at national and local level that led to the continuation of activities long after it ended as a project in 2010.
  • Scaling Up Handwashing Behavior: Findings from the Impact Evaluation Baseline Survey in Senegal(WSP)
    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.
  • Brochure: Multi-Country Impact Evaluation Study(WSP)
    The impact evaluation (IE) study is an integral component of WSP’s Global Scaling Up Handwashing. The cross-country IE, implemented using randomized controlled designs, aims to support thoughtful and analytical learning and to generate robust evidence on the effects of handwashing with soap on relevant health and welfare outcomes. This introduction summarizes the approach and shares best practices that can be adopted to design IEs for future multi-country interventions.
  • Scaling Up Handwashing Behavior: Findings from the Impact Evaluation Baseline Survey in Vietnam (WSP)
    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. The baseline surveys lay the groundwork for the impact evaluation (IE) component of the Global Scaling Up projects, designed to establish the causal impacts of handwashing with soap behavior change and sanitation improvements on specific health and welfare measures, generating robust evidence on a cross-country basis.
  • Scaling Up Handwashing Behavior: Findings from the Impact Evaluation Baseline Survey in Peru(WSP)
    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.
  • Results, Impacts, and Learning from Vietnam(WSP)
    The Vietnam Handwashing Initiative (HWI) began in January 2006 with the goal of reducing morbidity and mortality from diarrheal diseases in children under five years of age. In December 2006, Vietnam became one of four countries1 in the Water and Sanitation Program’s (WSP ) Global Scaling Up Handwashing project. The objective of the project was to learn how to stimulate improved handwashing behaviors at large scale, sustain the activities after the project ended, and measure the impact on behavioral, health, and welfare outcomes.
  • Practical Guidance for Measuring Handwashing Behavior: 2013 Update(WSP)
    The first edition of “Practical Guidance for Measuring Handwashing Behavior” was published by the Water and Sanitation Program in 2010. There has been substantial research relevant to handwashing behavior measurement since the previous publication. Based on the substantial continued interest in measuring handwashing behavior among researchers and practitioners alike, we present here the first update to this document. We have updated the format to address the validity of each measure as compared with other handwashing measures and health outcomes, potential for bias or data collection errors, use in evaluating handwashing programs, as well as the bottom line for researchers and practitioners.
  • Four-Country Synthesis of the Enabling Environment for Handwashing with Soap Endline Analysis(WSP)
    Results from endline assessments of the enabling environment (EE) in four Global Scaling Up Handwashing Project (HWWS) countries (Peru, Senegal, Tanzania, and Vietnam) show that stakeholders in three of the four countries successfully involved government agencies in promoting handwashing with soap, and stakeholders in all countries developed public and private partnerships. Advances in program methodology were also significant, with stakeholders in Peru adopting the HWWS methodology, and stakeholders in Vietnam working with HWWS staff to develop a handwashing with soap integration kit. Although some progress was made in monitoring and evaluation (for example, national surveys and community-based systems were implemented in Tanzania and a robust performance-monitoring system was developed in Senegal) and financing, further work is needed in these two dimensions.
  • Scaling Up Handwashing and Rural Sanitation: Findings from a Baseline Survey in Tanzania(WSP)
    This technical report provides a snapshot of the conditions of the target population prior to the start of WSP’s sanitation and handwashing program in Tanzania, which was phased into 10 rural districts during the second half of 2009. The report presents summary descriptive statistics for key demographic, socioeconomic, hygiene, health, and child development variables based on a survey of approximately 1,500 households in five of the 10 districts (due to unexpected problems with data reliability collection was limited to five districts). The survey revealed limited baseline knowledge of the critical handwashing times among the target households prior to the program, indicating room to improve handwashing behavior. Likewise, the survey indicated limited access to improved water sources, a scarcity of pit latrines with slabs, and a non-negligible percentage of open defecation practice as reported by the studied households, suggesting the need for continued efforts toward improving the sanitation situation in the country.
  • Measuring the Behavioral Determinants of Handwashing with Soap(WSP)
    A six-step methodology used in Peru and Senegal to identify the relationship between behavioral determinants (factors that influence a behavior) and handwashing practices found that of eight determinants measured, only two (access/availability and habit) served as predictors in more than one site; the other six served as predictors in one site but not the other. To be usable, the scales used to measure determinants must be both valid and reliable; however, not all valid scales are reliable. Moreover, predictors can vary depending on the context and the juncture—for example, determinants that predict handwashing with soap after defecation may in fact be different from those predicting handwashing with soap before eating or before feeding a child. Qualitative formative research may help explore the significance of these different junctures for target populations.
  • Developing a Decentralized Performance Monitoring System in Senegal
    WSP Senegal developed and used a decentralized monitoring information system (MIS) tomonitor 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.
  • Improving Measures of Handwashing Behavior(WSP)
    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.
  • Promoting Handwashing Behavior in Peru The Effect of Large-Scale Mass-Media and Community Level Interventions(WSP)
    This World Bank Policy Research Working Paper from WSP evaluates a large-scale intervention (The Handwashing Initiative), implemented in Peru over a three-year period (2007 – 2010) that included a mass media provincial campaign and a district-level community component. Evaluation results show that a behavior change campaign consisting of radio, print and public events alone was not successfully recalled by target audiences and did not prove to stimulate any behavior change. However, when this strategy was coupled with more intensive activities in community and school settings, the program positively affected the handwashing practices of caretakers of young children, although not to an extent that showed improved child health. Key points are summarized in an 8-page Research Brief.
  • Promoting Handwashing Behavior: The Effect of Mass Media and Community Level Interventions in Peru(WSP)
    This World Bank Policy Research Working Paper from WSP evaluates a large-scale intervention (The Handwashing Initiative), implemented in Peru over a three-year period (2007 – 2010) that included a mass media provincial campaign and a district-level community component. Evaluation results show that a behavior change campaign consisting of radio, print and public events alone was not successfully recalled by target audiences and did not prove to stimulate any behavior change. However, when this strategy was coupled with more intensive activities in community and school settings, the program positively affected the handwashing practices of caretakers of young children, although not to an extent that showed improved child health. Key points are summarized in an 8-page Research Brief.
  • Research Brief: Handwashing Behavior Change at Scale: Evidence from a Randomized Evaluation in Vietnam(WSP)
    The Water and Sanitation Program (WSP) supported implementation of a large-scale handwashing campaign in three provinces of Vietnam over a four-year period (2006-2010). This World Bank Policy Research Working Paper from WSP and the Development Economics Group describes key findings from an impact evaluation of the campaign, known as the Vietnam Handwashing Initiative. Focused on caregivers of children under five years of age, the campaign achieved four key objectives, which are captured in a Learning Note. Key points from the Working Paper are summarized in a 4-page Research Brief.
  • Policy Research Working Paper: Handwashing Behavior Change at Scale Evidence from a Randomized Evaluation in Vietnam(WSP)
    The Water and Sanitation Program (WSP) supported implementation of a large-scale handwashing campaign in three provinces of Vietnam over a four-year period (2006-2010). This World Bank Policy Research Working Paper from WSP and the Development Economics Group describes key findings from an impact evaluation of the campaign, known as the Vietnam Handwashing Initiative. Focused on caregivers of children under five years of age, the campaign achieved four key objectives, which are captured in a Learning Note. Key points from the Working Paper are summarized in a 4-page Research Brief.