Promoting Household Water Treatment through Multiple Delivery and Communications Channels: Evaluating Programs in Zimbabwe and Benin

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1 Promoting Household Water Treatment through Multiple Delivery and Communications Channels: Evaluating Programs in Zimbabwe and Benin Cecilia Kwak Population Service International

2

3 Household Water Treatment in Benin 8.7 million people Over 66% of the population lives in rural areas 43% of the population does not have access to improved water sources.* 9% of kids under 5 had diarrhea in the last two weeks* *According to 2006 DHS

4 Introduction of HWT What questions did we ask? Who is our target audience? What is the best intervention package? What channels can we use to reach this target audience?

5 Primary Target Audience Woman of 25 years, married with 2 kids, primary school education, who lives in a small town. She doesn t have enough money for all of her family s needs. She has to walk to fetch her water She knows that unsafe water can hurt her kids, she just hopes it doesn t.

6 What is the best intervention package? Product: Aquatabs Price: Cost recovery price of $0.25 to treat 200L. Promoted POU, safe storage, hand washing at key times, and use of the latrines.

7 Improving access and use of POU through multiple delivery channels Emergency Relief Public Sector: CAME Community based Distribution Private Sector- Pharmaceutical and FMCG Vendors

8 Promotion Radio Over 90 local language spots a day on community & national radio Television Branded Advertisement encouraged sales with vendors Billboards & Posters Awareness at point of sale Education Brand recognition Community 13 NGO trained in outreach 200 MOH officials trained 100 Women s groups 179 community based sales agents

9 What Resulted from the Program in Benin? 1. Improved access to POU 2. Improved use of POU 3. Improved knowledge on use of POU

10 Increased use of Aquatabs Social Norms 6.3 Ever treated H20 Current Use Aquatabs Self Efficacy

11 Access: Urban and rural individuals purchase their Aquatabs through different channels Urban Households 12% 11% 8% 36% 25% Rural Households 0% 0% 8% 44% 36% Private Pharmacies Health Centers Markets Kiosks Community Based distribution

12 Social connections are influential Vendors Pharmacies Relatives / Friends / Neighbors 4.70% 9.40% With whom did women discuss water treatment? 51.60% Health workers 30.30% Community animators 20% 0% 10% 20% 30% 40% 50% 60%

13 Benin: Launch Achieved? YES! By leveraging multiple channels 35% national coverage in just over one year 6% current use across the country Expect this to grow with time and increased focus on key determinants

14 Zimbabwe: Introducing POU in the midst of cholera PSI Zimbabwe s Safe Water program was launched in 2008 before the cholera outbreak. First cholera outbreak in August 2008 Spread to 56 of 62 districts >91,000 cumulative cases Program focus in cholera-reported areas; currently national scale Communications to promote hand washing, water treatment and IPC through many partners

15 What drives water treatment behaviors in Zimbabwe? Perceived Availability of water purification products Demonstrate that water purification tablets are always easy to find and available within walking distance from their home Social support Encourage assistance on use of water purification tablets as provided by partners, family members and friends Confidence in Ability to treat water Increase beliefs that water purification tablets kill all the germs in water and treating water makes the water safe to drink.

16 Cholera outbreaks generate momentum around water treatment

17 Social Norms: promoting water treatment through diverse and extensive partnerships Technical Advisory Group to Govt. of Zimbabwe s National Cholera Social Mobilization Program Water Sanitation and Hygiene (WASH) National Cholera Crisis Taskforce 15 NGO Partnerships to ensure wide coverage of door-todoor hygiene campaigns and distribution activities Oxfam Great Britain CARE International Catholic Relief Services

18 In rural areas where there is no source of treated water and where water from the wells, protected dug wells, or protected springs is consumed, it must be made safe by boiling or adding a chlorine-releasing chemical such as aquatabs. Incorporation of POU into national guidelines demonstrates sustained support

19 Behavior Change Communications Radio spots: local channels, VOA (~3.1M people reached daily) Mai Chisamba TV talk shows Hygiene promotion road shows IPC reached >10,000 households

20 Social Support: My family, my neighbors treat their drinking water

21 Social Support: My family, my neighbors treat their drinking water

22 A woman at an informal settlement goes through the water treatment process using PUR while reading an instruction leaflet. A PSI/ Z IEC officer and other colleagues monitor the process.

23 5 PSI Messages Addressed Key Determinants and Led to Increased Use of Water Treatment Mean Scores (Out of 5) 3.5 Exposed 3 Not Exposed 2009 Non- 2.5 Exposed Exposure to 2008 Program Baseline Communications led to a Exposed greater adoption of POU water treatment Baseline Availability*** Social Norms*** Self Efficacy to treat water*** Social Support*** Note: ***p<.001

24 Current Use of Water Treatment among Households with children under five from 2008 to % 26.2% 25.0% 20.0% 15.0% Program Achieved 26.2% Use of Household Water Treatment among HHs with Children Under % 5.0% 0.0% 0.3% 2008 National Survey 2009 National Survey

25 Summary Use of multiple channels increases access and availability Exposure to messages based on determinants of behavior increase use. Need to contextualize behavioral determinants Engagement around POU due to emergency response is an important entry point Getting to Scale

26 Thank You!

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