Effect of a Pilot Group Hand-washing Program on Handwashing Behaviors Among Elementary School Children in Assam
Condition: Handwashing Behaviors
Study type: Observational

Summary: 
      The United Nation's International Children's Emergency Fund (UNICEF) is supporting Saba
      Shikha Abihyan (SSA) (Education-for-All Mission) of the Government of Assam (GoA) under their
      Water-Sanitation-Hygiene in School (WinS) program to improve WASH facilities, practices and
      institutionalize WASH in school settings. Under the WinS program, UNICEF piloted a group hand
      washing program in 100 elementary schools. Multiple past studies have shown that handwashing
      is an effective intervention to reduce diarrheal diseases and respiratory tract infections,
      but the evidence on the interventions or programs that can achieve this behavior change is
      mixed and limited in case of school setting. The main objective of Daily Handwashing for an
      Ailment-free Life (DHaAL) program was to institutionalize handwashing with soap before
      consuming mid-day meals and after using toilets among elementary school students. DHaAL is
      implemented on the Mid-day Meal platform where free meals are given to all students attending
      government schools.

      In addition to the standard DHaAL intervention, several pilot phase schools also received an
      additional program for a holistic and participatory development of school systems for health,
      nutrition, learning outcomes and wellbeing of children called Child Friendly School System
      (CFSS). Although CFSS is not a WASH intervention it can develop systems and processes and
      offer longer support from and implementing agencies which help DHaAL Intervention also.

      This evaluation study seeks to answer whether DHaAL improved handwashing practice before the
      mid-day meals in rural lower primary schools as a primary research question. The intermediate
      outputs and secondary outcomes evaluated in this study include functionality of handwashing
      infrastructure at school, handwashing practice after toilet use, and availability of and use
      of handwashing facilities at homes (indirect effect). The evaluation study has other
      supplemental operations research objectives to help improve the program in future.
    


Intervention name(s): DHaAL Intervention; DHaAL + CFSS Intervention
Intervention type(s): Behavioral; Behavioral
Intervention description(s): This group handwashing program is for rural elementary schools to institutionalize the practice of handwashing before mid-day meal consumption and after use of toilets by harnessing the theory of social peer pressure.
DHaAL intervention consists of: (1) capacity building of school teachers to implement group handwashing; (2) installing group handwashing station; (3) generating demand among students to wash hands in group; and (4) establishing systems to sustain handwashing infrastructure and behaviors.; In addition to support under DHaAL, several intervention schools receive a more holistic and participatory support that focuses on health, safety, nutrition status, and psychological wellbeing of the children, and thus can also influence handwashing practices (and other WASH facilities). CFSS provides capacity building support and establishes systems to improve school environment, learning outcome, teachers capacity, and physical education for children.
Observational model: Cohort
Time perspective: Cross-Sectional
Sampling method: Probability Sample
Study population: 
        Elementary schools (Class 1-5) from five education blocks in Kamrup district. The
        respondents/participants include school teachers (Interview/observations), Class 1-5
        students (distant observation), Class 3-5 students (personal Interviews/observations) and
        their parents/other household members (personal Interview/observations).