Beyond traditional KAP surveys-need for addressing other determinants of behavioral change for more effective hygiene promotion

This paper is based on an internal assessment of a donor-funded project, implemented over many years by a local NGO. The objective was to identify the factors limiting the effectiveness of behavioral changes aspects of WASH programming. The project under scrutiny was aimed not only to provide water and sanitation facilities in schools in five union councils (UC) but also to improve hygiene practices to bring about behavioral change amongst children and the broader community. The approach used for hygiene education was the Child-to-Child communication (CtC)3 approach. An internal review of the project reveals that project implementers failed to recognize determinants other than knowledge-attitude-reported-practice (KAP) in the design of a hygiene communication plan. It was learnt that for hygiene promotion and behavioral change, it is imperative to also determine pre-disposing and enabling factors for different geographical locations and to tailor the hygiene promotion strategy accordingly. It was realized that low scoring unions had markedly different characteristics compared to higher scoring unions such as technology preferences, channels of information, variation in types and effectiveness of a particular types of local opinion leaders, and homogeneity of community. Rigid use of planning tools such as KAP surveys without an understanding of broader project environment including in depth assessment of predisposing and enabling factors can seriously hamper project outcomes over time. If this lesson is not learned, then continuing stereotyping and over- simplification in planning runs the risk of causing huge losses to societies in terms of high child mortality and morbidity rates thus jeopardizing the gains made under Millennium Development Goals.

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