Baby WASH: increasing communities’ awareness through health extension workers
Sekota Woreda, Northern Amhara region
Nigist lives 20km north of Sekota town in mountainous and remote northern Ethiopia. Together with her husband and two children she lives in a one-room rock-built house in the centre of the village. The village is surrounded by rocky crop fields, where the men plough with the help of two oxen. In early August during the rainy season everything looks not lush but pleasantly green. As Nigist takes a seat on a dusty plastic chair, the neighboring children come closer sitting and standing on the gravely dirt curious to hear and see what she is about to tell.
With the youngest child safely on her back, Nigist starts talking how she cares for him. She explains how she washes the baby’s hands and face three times per day often with soap. “I would always like to wash my baby with soap, but we sometimes find it difficult to afford soap, then I wash him with water only”, she says. “I also wash his body every other day, for my older child it is less frequent”. Nigist’s understanding of the consequences of not properly washing her children’s hands and face with soap seems limited and leads her not to prioritize buying soap rather than other items.
UNICEF in collaboration with BBC Media Action is currently piloting an EU-funded Baby WASH project in Zequalla and Sekota Woredas, Wag Himra Zone, northern Ethiopia. The aim of the Baby WASH project is to reduce the microbial burden encountered by young children in their play and feeding environments.
In August 2018, health extension workers were trained to work with the communities to change hygiene practices improving early childhood development. The focus lies on safe disposal of child feces, handwashing with soap, face hygiene, shoe wearing, protective play areas and food hygiene. During the training, health extension workers learnt about Baby WASH activities and how to work with the communities to effectively change behavior. Listening groups and group discussions at community level using radio recordings are part of the methods the health extension workers use to raise Baby WASH issues in their own community. Additionally, during public discussion led by the local health office, key expectations were raised and discussed.
The market outlet to sell these products needs further investigation - it is planned to use existing woreda sanitation marketing groups to facilitate access to health products as needed.
Debessa is one of two health extension workers in the kebele where Nigist lives. Debessa says:
“I know about safe sanitation and hygiene practices, but these interventions focusing on babies and young children are new for me. It is very interesting and I am learning a lot during the training.”
Debessa is happy about attending the training together with other colleagues from Sekota Woreda. She and her colleague working in the same kebele agree: “We are very motivated to go back home and work with the mothers on the Baby WASH, it is exciting.
To do the handwashing specifically focusing on babies and young children, we can connect to previous handwashing promotion activities. To encourage families to properly dispose child feces, we expect that it will need some time for the change to be effective because this is a new concept for many in the community. And potties are expensive, it isn’t a priority for the families to spend money on potties particularly at this time of the year where families invest most of their money in farming”. The key actions promoted during the training are summarized in form of pictures with both Amharic and Hemtegna language so training material can be used at community level.
Piloting the EU-funded Baby WASH project in collaboration with the government is a promising way forward to start triggering behavior change with a focus on pregnant women, babies and children under 3. Shifting from a “have to” approach to a stronger focus of “how to”, Baby WASH requires close integration with existing interventions on maternal, new born and child health, early childhood development and nutrition. A paper published by UNICEF and John Hopkins University in the Journal of Tropical Medicine and International Health highlighted the need to target interventions to reduce unsafe practices of disposal of baby and child faeces. The Baby WASH project aims to reduce microbial burden, trachoma and other disease exposure of children and therefore help reducing child stunting.
UNICEF Ethiopia WASH has included Baby WASH into its strategy for the new country program to contribute to the improvement of early childhood development.