TOR for Conduct of Formative Research for Hygiene Promotion
1. Background
While investment in the pipes, pumps and treatment systems of wastewater collection systems are often necessary for health improvement, they are insufficient on their own. It has long been recognized that the everyday acts of the individual and the household in managing water and waste can have a profound impact upon health outcomes. These everyday habits are referred to as “hygiene behaviour” which includes such activities as handwashing, the management and disposal of infant stools, household practices of water storage and use, management, disposal/reuse of household solid waste, etc. Efforts to promote (by whatever means) hygiene behaviors that improve health are referred to as hygiene promotion.
Hygiene promotion is recognized as an essential activity to maximize the health benefits resulting from the major infrastructure investment of the Integrated Sewerage and Sanitation Infrastructure Project(ISSIP). The World Bank has accordingly financed a Hygiene Promotion Scoping Study, which has reviewed the overall conditions of Environmental Health in the project area, and identified a range of approaches to the effective implementation of hygiene promotion by project stakeholders.
2. Scope of work
2.a Objectives and summary of the consultancy:
The consultant will be asked to conduct detailed formative research as a basis for ISSIP-related Hygiene Promotion. The data gathered during the formative research should serve as the basis for detailed Hygiene Promotion Program Design, to be closely co-ordinated with the community mobilization efforts of the overall ISSIP program.
The objectives of the formative research are to:
- Identify and prioritizehigh-risk hygiene practices in the project area. This research should take into full account whatever is already known about hygiene behavior in the region, and is intended only to “fill the gaps” of knowledge. In particular, the consultant should start with a review of the work prepared as part of the Scoping Study.
- Identify the most promising motivators for change in behavior: i.e. those aspirations and desires most likely to be effective in promoting change in behavior. (e.g. religious motivation, self-respect, desire for cleanliness, respect for community, peer pressure, etc.)
- Identifythe most appropriate channels and agents of communication to promote hygiene (e.g. house to house visits, mass media, community events, etc.) and by whom (e.g. Cultural Health promoters, Water Users’ Associations, mass media, Health outreach workers, local govt.)
The formative research performed by the consultant will contribute to the subsequent detailed design of hygiene promotion, which will include the following stages:
- Development of a limited number of key messages to address the most significant high-risk behaviors using the most effective motivators for change identified during the formative research.
- Determination of training and other support needs to provide support for implementation and identify any other required support materials and tools
- Design of a detailed implementation plan for hygiene promotion. The detailed design will specify the approaches, methodologies and activities needed to achieve therequired changesin hygiene among the target groups identified in the formative research.
- Development of the detailed program, indicating clearly the scope, frequency and location of activities, the institutional arrangements and responsibilities (who will do what), and their costs. This would be done in tight coordination with the overall community mobilization campaign.
2.b Suggested Methodology of the assigned tasks and Modalities of Investigation
The work may be thought of consisting of three phases:
Identification phase
This step will achieve the following:
- Identify the range of high risk practices Determine which common household or individual practices are most likely to cause health problems: Which risk practices are most widespread? Which risk practices can be altered? This will help in deciding which practices to target by HP activities.
- Identify alternative “target” practices: selection of alternative hygiene practices to replace the risk practices, (e.g. prompt disposal of child feces in a toilet, rather than their dispersion in the environment; handwashing with soap after use of the toilet, before preparing food, after cleaning infants’ bottoms, etc.0
- Define the target groups: Identify the groups that should be contacted and influenced in order to bring about behaviour change across the community: Primary target groups:are those who carry out risk practices (e.g. mothers, children). Secondary target group are theimmediate society of the primary group who influence them (e.g. fathers,school children, mothers-in-law). The third target group which isvery important: opinion leaders such as religious, political, traditionalleaders and elders. They can have a major influence on the success ofthe project, as can partner and collaborating agencies.Thus it is important to determine Who and how many employ the risk practices? Who influence these primary groups?
- Identify communication channels: identify what channels are currently used for communication? Which channels are most trusted or credible in disseminating hygiene messages? Do these channels differ among different target groups? Which ones work best for which groups?
The consultant should consider the appropriate use of the following three methods during the identification phase:
1- Focus group discussions. It is anticipated that sixteen group discussions are going to be held (two in eachdistrict for each governorate).
2- Structured Observation It is anticipated thatthe consultant will observe the developed list of behaviors as well as determine the awareness of caregivers in 210 households and 30 schools (70 households and ten schools /targeted villages /governorate).
3- Household and School surveys would also be conducted among the same community members covered under 2 above.
Analysis
Analyze results of the previousstep(from both focus groups and surveys) which identify risk practices and alternatives, target groups, and communication channels. First, the gathered data are summarized in tables, and a preliminary analysis performed by the consultant. The objectives, methods used, results and their interpretation are then presented to health workers and study participants to “triangulate” on the validity of conclusions drawn.
Development of promotional approaches
At this stage in the formative research, the key question is “how can we motivate the adoption of safer hygiene behavior”? One useful way to look at this is to consider, from the “user’s” point of view“what arethe advantages of the target practices?” To address this it is essential to find a number of child carers (or other target group members) who already use the safe practices (thestructured observation should have identified some).The consultant (through his/her team) then needs to find out what made people adopt the safe practices, and thebenefits that they feel they get from them. Health is just one, and often not themost important, motivation for hygiene, so it is necessary to probe the other benefits whichchild carers feel that they get from their adoption of target practices
In addition to identifying the motivational factors of greatest impact, the research should also investigate the media of communication most likely to transmit these motivational factors credibly and effectively to the various target groups.
It is anticipated that six focus group discussions will be held, i.e. two/governorate.
3. Timeframe and level of effort
This consultancy work is expected to require 68 days to be completed within 16 weeks of launching the assignment. Ayat can you live with this schedule??
Activity / Duration/ working days
- Preparation
- Design observation check list, Structured Observation of School Facilities and Children’s Behavior, Focus Discussion Guide for Students, Focus Discussion Guide for Local Authorities, Structured Interview: Principal, social specialist, Health Workers, and sample preparation and villages selection/ printing.
- Complete logistic arrangements and communication with resource persons
- Field work for focus group discussion, structured observation, household and school survey, interviews with doers of safe practices; including alsotraining for the health promoters, or other survey assistants, tabulation of the results
- Kafr El Sheikh governorate (15 days)
- Garbeya governorate(10 days)
- Beheira governorate (10 days)
- Development of Promotional Approaches
- Conducting Feedback Workshop
- Final Report writing and submission
Proposed Budget Breakdown for conducting HP Design Study
The following is the estimated budget breakdown in which amounts are expressed in Egyptian pounds with total amount of L.E 114,120
Activity (items) / Cost in Egyptian pounds- consultant fees (as principal investigator)
- field supervisors fees (As Co- principal investigators)
- Travel (to and from targeted governorate and internal transportation within villages and districts)
- Perdiem and DSA during field visits
- Training of health promoters and tabulation of data
- Internal transportation
- Coffee break
10 persons x L.E. 5/day x 4 day x 3 governorates = L.E 600
- Coffee break during focus group discussion
- Interviewers (health promoters internal transportation (10 persons /day)
- stationery (papers, pencils, pens, notes, files, transparencies., for the health promoters & for the workshop's members), Printing questionnaire, form printing, pictures and processing, report writing and printing
Total / Approx L.E 120 000 ~ US $21 000
4. Deliverables
1-Field reports after the end of each governorate visit (three field reports) on the results of the formative research
2-A single integrated analysis report on the development of approaches.
3-A half-day workshop to present the findings of the draft report to stakeholders.
4-A final report for the accomplishment of the aforementioned taskswithin two weeks of receiving the comments on the draft report.
5. Coordination
The consultant shall report to Ayat Soliman, Task Team Leader for the Integrated Sewerage and Sanitation Infrastructure Project, and to Alaa Mahmoud Hamed, Senior Health Specialist at the World Bank in Cairo. In addition, copies of reports shall be sent to Pete Kolsky, (.) for review and comment.