From 1988 onwards, the Social Mobilization (SocMob) Programme sought to create hygiene awareness and to eliminate the health hazards emanating from: lack of sanitary latrines, drinking of unsafe water and absence of the practice of hand washing. The programme was implemented by DPHE, with assistance from UNICEF, in three phases. The last phase was implemented between 1997-99. The objectives of the 1997-99 phase of the SocMob Programme may be summed up as follows: obtaining commitments and support of top leadership and policy makers for effective programmatic interventions at the grassroots; and making alliance with different partners and allies like NGOs, school teachers, religious leaders, elected representatives, local elites, local administration, medical professionals and workers etc. to mobilize and motivate people at the grassroots to use sanitary latrines, adopt safe personal hygiene practices and use safe water for all purposes.
At the end of Phase III of the programme in June 1999, UNICEF felt it necessary to evaluate its impacts and achievements. The lessons learnt in the process of evaluation will assist in forming the guidelines of a larger project that UNICEF is going to undertake with the assistance of DFID. The assessment is being conducted:
The above tasks will be examined in the context of:
The methodology includes:
The programme covers 32 out of 64 districts of the country. One district from each of the six divisions has been selected in such a manner that all types of interventions made by the project are covered by the sample districts. In consideration of the above, the final selection of districts was made in consultation with the UNICEF consultants and the Project Coordinator. Two upazilas from each of the six districts were selected at random. Two randomly-selected unions of each thana were covered.
Findings and Conclusions:
PRA/FGD, intensive interviews and household surveys indicate that people at the grassroots level were exposed to this or that motivational activity or activities. Some heard miking, others saw TV programmes, or listened to radios or participated in a WATSAN fair or "Uthan Baithaks" or saw posters, leaflets and the like. Women in the villages were approached by health and family planning workers. Intervention of the Imams before "Khutba" or the Friday prayer is also reported. Thus, an overwhelming majority of the people got exposed to SocMob ideas on sanitation and hygiene through one or more motivational activities. And yet, further strides in these lines will be necessary to attain effective social mobilization.
The household survey yielded information on the ownership of sanitary latrine, hand washing, use of safe water and witnessing of SocMob activities. 48% of the respondents said that children belonging to the 3-5 year age group defecated in open space while only 28% reported using latrines. About two-thirds reported ownership of some kind of latrine. All people having a monthly income of Tk. 5000 had sanitary latrines. Half the people having sanitary latrines reported that they had these in the course of the last 3 years. Only less than one-third of the respondents acknowledged receipt of assistance for installing sanitary latrines. 87 per cent of the respondents heard of the need for hand washing. Here also, half of the 87 per cent respondents heard about it in the last 3 years. Hand washing with soap remains at 35 per cent, below SocMob target of 40 per cent. 75 per cent of respondents reported witnessing SocMob activities.
It is now evident that simple knowledge and awareness are not enough to induce one to install a sanitary latrine or to wash hands with soap after defecation. These are behavioural issues and would require a more sustained effort on the part of the social organization, which desires to bring about changes in behavioural pattern. A critical level of awareness has to be reached. And for this purpose, continuous social mobilization for hygiene awareness is necessary. The ideas of SocMob have to be instilled in the minds of the people. A high-powered salesmanship is necessary. Motivational activities at the grassroots did not reach that level or that peak.
In development scenarios, subsidies have often played a vital role. With almost half the people below the poverty line, the purchase of sanitary latrines may appear difficult. Outright dole of sanitary latrines is advocated by some poorer people. It is sometimes claimed that if prices are halved, 95 per cent of the people will install sanitary latrines. However, the prospect of subsidizing sanitary latrines has not found favour with the policy makers or responsible organizations involved with SocMob. It has also been suggested by some NGOs or stakeholders that the VGD programme of GoB or the loan programme of the NGOs may be tied up with the installation of such latrines. It may be mentioned in this connection that prices are sought to be kept low at a range of Tk. 300.00 through NGO intervention and distribution under this supply-pushed sales programme. There is now a suggestion for even a demand-pulled marketing of sanitary latrines.
The NGOs planned to construct more than 3 lac latrines. The latest report said that NGOs have fulfilled 98 per cent of their target. Overall coverage of sanitary latrines in the rural areas of the 32 districts will be around 40 per cent. The NGOs could not give any such figure in the absence of surveys. FGD in rural areas indicated coverage from 40 per cent to less than 50 per cent. The household survey shows that 49 per cent of the households under survey have sanitary latrines. The survey figures are for January 2000.
Monitoring of SocMob activities needs to be further strengthened. Without a coordinating or overall facilitating agency, monitoring could not pick up. However, NGO-Forum or major NGOs maintained that they have a well-established monitoring apparatus.
An ephemeral, but substantive, obstacle to the implementation of SocMob was due to the unforeseen floods of 1998, when local government officials got entrenched in flood relief and rehabilitation. The work plan and results of advocacy workshops got sidestepped. This, of course, is not a fault of the programme design. The 1997–1999 time span is also considered somewhat limited compared to the tasks/targets, according to many NGOs who worked at the grassroots level.
Some general recommendations are offered below. Recommendations are also offered at District, Union and Village level.
Continuity: Hygiene awareness building should be made a continuous process to motivate non-users of sanitary latrines and non-acceptors of hand washing and other important hygienic practices. The focus of attention should be the union, the rural schools, villages and other grassroots-level people and institutions, including the Imam, Teachers, Ansar/VDP personnel and field level Health and Family Planning workers.
Coordination: There is a need for the co-ordination of SocMob activities at various levels. The DCC and UCC should be doing this co-ordination at the district and upazila levels, respectively. Executive Engineer/DPHE and SAE/DPHE will take the leadership of the SocMob activities and suitably-selected NGOs may be placed with them to render assistance in this respect, in view of their manpower limitations. Cost of NGO services may be included in project cost.
Focus: Motivational activity should now be aimed at house-to-house canvassing for the installation of sanitary latrines at differing costs, reflecting differing options for rings and slabs. The good work of posters, leaflets, folksong and fairs, including radio and television programmes, should continue. However, stress may be placed on courtyard meetings.
Monitoring: Strong monitoring should constitute an integral part of any future programme of social mobilization. DPHE should undertake the monitoring of the SocMob-related activities, extending from the center to the Union Parishad level through the upazilas, and the districts.
Benchmark Survey: In future projects of this nature, it will be advisable to have a benchmark survey on knowledge, attitude and practice so that monitoring and evaluation may be facilitated.
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WES - Hygiene Promotion
Department of Public Health Engineering (DPHE), DFID