WATER SANITATION AND HYGINE
______
Social Analysis and Action (SAA)
Facilitators Guide
Addressing the Social Factors that Influence Gender Transformation and Water Sanitation and Hygiene inRural Communities
Prepared by
WaTER+ Unit,CARE Ethiopia
July, 2015
Written and Compiled by Sintayehu Mesele (MSc)
TABLE OF CONTENTS
1. Introduction
2. What is Social Analysis and Action?
3. Transform Staff Capacity
4. Purpose of the Manual
5. Processes of the WASH SAA manual development
6. STEPS IN SAA GROUP FORMATION
4.1. Steps of WASH advisory group establishment and its Roles
6.1.1. Role of WASH Advisory Group
6.1. 2. Sensitization workshop to advisory group members
6.1.3. Assess the overall kebele situation and SAA group formation
6.1.4. Sensitization meeting with wider community and selection of SAA facilitators
6.1.5. Training of community based SAA facilitators
4.1.6. Identification of members for SAA groups
6.1.7. Convergence of interested parties (getting consensus)
7. SOCIAL BARRIERS
TOPIC 7. 1. Division of Labor in WASH
7.1.1: Roles of women and men at household and community levels
7.1.2: Water collection and management
Topic 7.2: Social Determinants of Personal Hygiene and Environmental Sanitation
7.2.1. Menstruation and Community Perceptions
7.2.2. Drinking Water
7.2.3. Open defecation and use of latrine
7.2.4. Personal hygiene
Topic 7.3: Governance of WASH services
7.3.1: Women in a leadership position of WASHCO
8. TECHNICAL WASH SESSIONS
8.1. HYGIENE PRACTICE
8.2. DIARRHEA TREATMENT
Introduction
Access to safe water is a fundamental human need and therefore, a basic human right. Contaminated water jeopardizes both the physical and social health of people. It is an affront to human dignity”. (Kofi Annan, UN Secretary General).
More than one billion people in developing countries lack access to safe water and nearly two billion do not have adequate sanitation. Where clean water is available, it is often located at quite a distance from the household; the poor, usually women and girls, spend long hours collecting it¾time that might have been spent more productively. Water and sanitation-related diseases lead to higher health costs, lost wages, and lower productivity.
Access to safe water and sanitation in Ethiopia is among the lowest in the world. Currently, just over 54 per cent of households have access to an improved source of drinking water, with a higher proportion among urban households (75%) and among rural households (49%) nationally. Access to water supply fell from an estimate of 79% in 2012 based on internal routine monitoring reports of the MoWE, to 52% in 2013 (based on inventory data collected in 2010/11).
According to Joint Monitoring Program (JMP) 2012 update, the proportion of the population having access to improved and unimproved sanitation facilities stands at 54 % (21% improved and 33 % unimproved). Nearly 39 million Ethiopians – most of them in rural areas don’t have access to safe water. Nearly 48 million Ethiopians lack access to basic sanitation. Open defecation is the norm for 46%of Ethiopia’s population. ().
Very recently, the National water sanitation and hygiene inventory (NWI) has resulted in substantial downward revisions of water and sanitation access figures for Ethiopia. Access to sanitation stood at 63% according to results of the NWI (based on the NWI household survey).
CARE Ethiopian has been implementing WASHinterventions for more than ten years in ten woreda of south Gondar zone in Amhara region whereby more than 600,000 beneficiaries were able to access safe water and sanitation services. However, the results achieved are did not go up to the ladder when compared to the amonut of resources (human, financial, time and material) spent in WASH interventions mainly due to the linkage that exists between social norms and WASH practices in the region. Socialnorms and attitudes are determinants that either allow or prohibit communities in to having healthy water, sanitation and hygiene practices. Hence, throughrecurrent dialogue and analysis within communities,barriers that prohibit communities for healthy WASH outcomes needs to be identify and tackled.
All work related to WASH in the household is considered to be women’s role; provision and fetching water. Women and children spend several hours every day fetching water from the water point, often in physically demanding locations, exposing themselves to dangers early in the morning and in the evenings. The time and effort used for water collection could be used to care for children in the home, to rest, or to engage in income generating activities. For girls, the task of carrying water combined with lack of sanitary facilities in schools, contributes to absenteeism and eventually their drop out of school. Women are culturally not encouraged to take part in governance of WASH services due to fear of their husband and pressure ofthe community.
Menstruation is considered as a taboo. There is a case in one of our operational woreda that a woman under menstruation stays away from all things including getting in side her house until her menstruation period passes. Menstruation is considered a curseif it comes before the age of 10 and sexual intercourse (የወርአበባመርገምነዉ).
There is a community misconception about safe water; there is a saying that “no bad water and mother (የእናትእናየዉሃክፉየለዉም), water can purify everything (ዉሃሁሉንንፁህ ያደርጋል) and water is holly (ዉሃቅዱስነዉ).” There is a practice of smoking water containers so as to give the water good taste. However, technically smoking results in health hazard due to production of mono-gas inhalation. There are also believes that “there is no bad mother and water” where by local communities tend to use open water sources. Moreover, low awareness of rural communities accompanied by fragmentary hygiene and sanitation promotional approaches has resulted in open defecation in most part of the country.
Discrimination against women/ girls is identified about day time defecation– no day time defecation is accepted; communities believe that a woman must not visit latrine during day time. The misconception is that if women visit latrine during the day she is considered as miss-behaving (ሴትቀንአትፀዳዳም).
There are mistaken beliefs about personal hygiene. Frequently body washing is considered as a sign of laziness. There is also discrimination about tidiness over women; a woman who is tidy is regarded as possessing another man over her husband. Hence, women prefer to wear dirty clothing all the time in fear of being discriminated by their husband and community. In some areas, there is also a belief that washing hand before completing harvest will end up take away the blessingof getting good harvest(እህልከጎተራእስኪገባእጅመታጠብበረከትያሳጣል). To this end, communities prefer to abstain from washing hand throughout a day.
Social analysis and action (SAA) is essential to facilitate behavioural change and ensure gender transformation in the WASH service provision in CARE’s operational areas and beyond. It will also create a plat form for local communities to discuss how they can create more accountability, transparency and participation for both men and women in their community.Hence, SAA will be used as a tool to create wider community dialogue so that local community will identify and rectify bottle necks and act up on it with minimum outsider intervention.
This manual has two purposes to serve. First, through recurrent dialogue SAA will enable the community to identify and address taboos and misconceptions that impact women and girls in particular and genderinequalities in general in the area of WASH.Second, SAA will help communities to identify and tackle barriers as well as address gaps in knowledge regarding use of safe water, sanitation and hygiene practices.
What is Social Analysis and Action?
CARE has developed an approach called “social analysis and action” (SAA) to address socialand cultural determinants that influence sexual and reproductive health outcomes. This approach was adapted to SRH interventions, and then to food security programs of CARE Ethiopia. WASH SAA is an attempt to adapt the approach to CARE Ethiopia’s WASH intervention areas by taking in to consideration the changes seen thought SAA implementation in SRH and food security programs. SAA (Social Analysis and Action)for WASHis an approach to catalyze a process of exploration and reflection and to facilitate individual and community actions that support behavioral change towards utilization of safe water, creating open defecation free environment, norms about menstrual hygiene management.
SAA seeks to address the social, economic and cultural factors/determinants that influence WASH outcomes. It is an approach for working with communities through regularly recurring dialogue to address how their social conditions perpetuate their WASH challenges.SAA seeks to enable communities to identify linkages between social factors and WASH and then determine how to address them.
The above cyclical diagram has arrows, which indicate that SAA is an ongoing process; however, it is important that we do not get stuck in one area.Each component is meant to build on the others, in a continuous motion that fosters repeated in-depth reflection. This cycle is an expansion of the basic community action cycle (assess – action plan implementation evaluation), but is unique in that it:
- Starts with ourselves (transform staff capacity)
- Fosters recurring critical reflection and dialogue
- Requires a unique set of facilitation skills
Starts with ourselves: Through the SAA process, we undertake critical reflection and dialogue to recognize how our values and beliefs influence our work:
•Are we the same as the community?
•Do we have the same problems?
•Do we have the same beliefs and attitudes?
•Are we that different from the people we serve in terms of ethnicity, religion, tribe, economic status or education?
Critical reflection and dialogue: the community disusses issues around gender and social norms and their connection to inequity and poor WASH outcomes.
Advanced facilitation skill:important to deepen staffs’ and communities’ understanding of how social norms, attitudes and values may inhibit healthy WASH practices by:
•First to surface, explore and reflect on individual and community attitudes / norms
•Then to support specific action for more equitable norms and cohesive society
As development workers, we know that safe water, hygiene and sanitation are a necessary condition for helping people rise from poverty. Poverty and social disadvantages usually associated with it, profoundly influence people’s ability to access safe water and health environment. For those of us whose careers have been spent working in communities around the world, the relationship between poverty, power and unsafe water and sanitation are painfully clear. But have we done enough to address that relationship in our water programming? Much of our development work has sought to improve the availability of high quality infrastructure and services for poor women, men and young and elderly people. The thinking behind this approach was that WASH infrastructure can easily provide accessible services and enable people to get safe water and live a healthy life.
Social behaviour towards hygiene, sanitation and use of safe water has not been changed very quickly and require a new way of engaging local community along with the promotional tools weare implementing these days where by SAA tool could fill in this gap. To this end, SAA will help transform gender in the areas of WASH. Hence the goal of WASHSAA will be to assist local communities to understand their potential to change particularly girls and women in CARE’s operational area to have reliable access to clean water in such a way that their dignity, rights, culture and natural environment are not negatively impacted.
Transform Staff Capacity
Why we need transforming staff’s capacity and what makes itdifferent from conventionalparticipatory approach?
This foundational step is perhaps the most crucial component of successful SAA approaches, because it prepares staff to involve communities in sensitive and sometimes difficult discussions about how social factors fuel their poor health. Communities might have never had these conversations before, and CARE staff might have never facilitated them. Thus, the stakes will likely be high for everyone involved.
Those engaged in participatory approaches with communities might already understand much of the foundational step: how our actions, as CARE staff, influence reactions from the community; how we need to be facilitators of community-driven processes and often need to take a supportive backseat to community discussion and action.
SAA can often present more extreme challenges than CARE staff have traditionally faced. When engaging in issues that challenge social norms, our own staffs need to be comfortable talking about sensitive and controversial issues. Part of becoming comfortable involves challenging ourselves about our assumptions, beliefs and attitudes, and being conscious of social norms that guide us as well as the larger society. We must also learn how to manage confrontation and how to dialogue across differences.
Facilitators need particularly strong communication, facilitation and challenging skills, as well as good conceptual skills to grasp the connections between issues. They need to be creative, on-their-feet thinkers who are prepared to go on a journey with the community, not limited by their knowledge or comfort.
Purpose of the Manual
The purpose of this guide is to explain how social barriers affect WASH. The field guide can assist practitioners’ to create mass community mobilization to act against misconceptions related to women’s participation in a leadership position, discrimination against women during menstruation, women tidiness vs misbehaving perceptions. The field guide provides general background on how to improve women active participation on water scheme governance, sustainability, hygiene and sanitation as well as division of labor. This manual therefore aids gender transformation taking water as an entry point in CARE’s operational areas and beyond.
Processes of the WASH SAA manual development
This manual is developed after thorough analysis and discussion on the social norms and barriers around WASH transformation with particular emphasis over gender transformation. The manual preparation took four major steps of document review, pre-workshop discussion, rapid assessment of social barriers, and manual preparation workshop. In the document review stage, it was found out that SAA is globally experimented within the health sector. During the pre-workshop stage,lessons and challenges of SAA implementation were identified from CARE Ethiopian’s SRH “Tesfa” program. Accordingly, the basic area of focus identified was staff transformation. Staff’s need to be transformed before any SAA intervention takes place. In the rapid assessment phase, social barrier were identified. Finally, a workshop was conducted in Bahirdar in February 2015 to analyzeand categorize the social barriers. The workshop participants were a mix of government partners, community representatives and CARE’s staffs.
Content of the manual
The social issues incorporated in this manual are identifiedby the community. The issues are tailered to fit in to the local context of the Amhara region, and will enable the communtity to address the social norms and barriers that hinder healthy water, sanitation and hygien practices. The manual is prepared to enable the community to iron out the problems and generate solutions by itself rather than seeking solutions from outsiders.As a result, the community will enjoy flexibility in discussing the social issues in or outside of this manual depending on the priority they see fit their current situation.
STEPS IN SAA GROUPS FORMATION
WASH SAA will be implemented in close collaboration with woreda and kebele government stakeholders and CAREEthiopia WASH projct staffs. The commencement of the implementation has to follow major steps to enable government stakeholders, the community and CARE staffs get a sense of ownership to the process as well as to the outcome. Hence, CARE’s community facilitators has to conduct anintroductory meeting with woreda abd kebele leaders on the overall WASH projects, purposes of establishing advisory groups andthe role they are expected to play to make positiveWASH outcomes possible through the imlementation of SAA.
The following are the mojor steps that should be followed to start SAA implementation:
STEP I: SAA ADVISORY GROUP ESTABLISHMENTSTEP II: SENSITIZATION WORKSHOP TO ADVISORY GROUPS
STEP III: ASSESS THE OVERALL KEBELE SITUATION
STEP IV: SENSITIZATION MEETING WITH COMMUNITY SAA FACILITATORS SELECTION
STEP V: ESTABLISHMENT OF COMMUNITY SAA GROUPS
STEP VI: TRAINING OF COMMUNITY BASED SAA FACILITATORS
STEP VII: CONVERGENCE OF INTERESTED PARTIES (GETTING CONSENSUS)
I.SAAadvisory group establishment and its role
WASH advisory groups will be formed at woreda and kebele levels. The woreda advisory groups are composed of health extension office, agricultural office, environmental protection & land use office, education office, WCYA office, water management office and Woreda administration. The role of woreda advisory group is:
•Reflect monthly on the social norms and identified barriers
•Provide technical and leadership supportfor kebele advisory group and SAA facilitators
•Provide frequent supervision with kebele SAA advisory group
•Be the primary contact group at woreda level
•Conduct quarterly review meeting with SAA facilitators & kebele SAA advisory group
WASH kebeleadvisory group will be formed by Kebele administration chair person,Kebele women affair, health extension workers, development Agents, school director, religious leaders, influential persons, and elders. WASHadvisory group play key role in leading community based activities of WASH projects. Moreover, we may look in to possibilities of aligning the WASHadvisory group with existing government system rather than establishing independent one. Roles of kebele advisory group specific to WASH project are:
- Play advisory role to community SAA Groups and SAA facilitators
- The first group of people to reflect on the social norms and challenge others
- Responsible for community mobilization throughout SAA implementation phases
- Systematically select SAA facilitators
- Facilitate and participate in Community SAA group establishment
- Meet monthly with SAA facilitators
- Responsible to ensure sustainability of the SAA approach
- Primary contact group at kebele level
- 2 SAA facilitators will be elected and trained on SAA facilitation
- Documentation and sharing of good practices through joint supervision, with the project staff and community SAA facilitators
II. Sensitization workshop to advisory groups
Since advisory group members are the primary change agents in the community, a workshop will be organized to members at Woreda and kebele/district levels. The workshops emphasizes on the overall social analysis and action process and on its importance in bringing changes in WASH and gender transformation. Besides purpose and process of WASH SAA group’s formation will highly be discussed with these advisory groups. Woreda/Kebele chairperson, woreda/Kebele manager, religious leader and woreda/kebele women affair, elders, health extension workers, women development army representatives (Atbia members) will primarily attend this workshop. These WASHadvisory group members are also expected to go back and sensitize the remaining WASHadvisory group members in their respective woreda and kebele. At this stage, all advisory group members will be ready to support and lead the community level SAA process including formation of WASH SAA groups.