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The Global Handwashing Partnership

Event Summary: From Research to Advocacy–Using evidence to drive change

November 7, 2017

Formative research can help practitioners understand determinants of handwashing behavior, improve program design, and develop achievable—and even scalable—outcomes for policy and programs. Using evidence can also enhance advocacy to influence decision-makers, stakeholders, and donors to adopt, integrate, and invest in hygiene interventions. To explore the role of evidence in advocacy, the Global Handwashing Partnership (GHP) convened a session on October 18th at the 2017 UNC Water & Health Conference. With speakers from FHI 360, WaterAid, and WSSCC, the GHP explored how evidence can be used to drive change and how formative research has been used to encourage hygiene advocacy to impact program design and policy.

Carolyn Moore, Secretariat Director of the GHP, started the session by describing the Partnership’s twin objectives of advocacy and knowledge management. For this reason, the GHP sought to engage WASH colleagues and research experts to better recognize how these two topics fit together, how they can inform each other, and where they may have conflict. When explaining advocacy, the GHP uses the following UNICEF definition:

Advocacy is the deliberate process, based on demonstrated evidence, to directly and indirectly influence decision makers, stakeholders and relevant audiences to support and implement actions that contribute to the fulfilment of children’s and women’s rights.

Strengthening enabling environments to foster progress for handwashing can include advocating for hygiene targets and indicators within policy frameworks and accountability mechanisms. Advocacy often serves as a platform for a wide range of sectors to come together, for example to call for inclusion of hygiene into national WASH/health action plans. At the global level, evidence can be used to drive advocacy directed towards international agencies, global policy makers, and multilateral institutions. One example is the formal process of developing research briefs, social media campaigns, expert-led consultations, and other advocacy actions which resulted in the inclusion of hygiene in the Sustainable Development Goals, marking a fundamental shift in the recognition of hygiene for achieving universal WASH access.

Julia Rosenbaum, Senior Behavior Change Specialist at FHI 360 and Deputy Director for the WASHpals project, discussed how research can be used to make the case for evidence to drive action. By incorporating evidence into strategy, advocates can play an important role in influencing policy. This occurred when the government of Ethiopia adopted a sixth ANC action by integrating handwashing into antenatal programming. The use of evidence-based advocacy targeting policy change at the national level not only led to the adoption of handwashing promotion amongst caretakers of newborns, but helped achieve additional government support that introduced programmatic adjustments to professional training, including soap into clean birthing kits, and promoting tippy taps in outreach strategies and materials. As a result, this outcome demonstrated that:

By distilling findings, evidence works as fuel for advocacy, both on global and country levels, that can drive change and strategically promote integration.

Dr. Om Prasad Gautam, Senior WASH Manager for Hygiene at WaterAid UK, highlighted the use of evidence-based advocacy to drive change in policy as part of WaterAid’s work in hygiene. In 2012, WaterAid conducted a scoping study that researched the impact of integrating hygiene interventions into a rotavirus immunization trial in Nepal. Researchers found that this approach could help to avoid miscommunication about the rotavirus vaccine being a “diarrhea vaccine”, indicating that immunization can act as an entry point for hygiene promotion and should reflect one element of comprehensive strategy to take place in several settings rather than being employed as an individual approach (Velleman et al, 2013). These outcomes were then used to define the course of action for introducing a hygiene promotion intervention in the country; based on the pilot’s findings, WaterAid developed a successful advocacy strategy, which included government awareness raising and consultations. This set in motion a ground-breaking approach for hygiene promotion, in which the government of Nepal agreed to support and scale WASH service delivery into nationwide immunization campaigns, helping to contribute to a reduction in diarrheal disease burden in Nepal. Explaining the larger context around how global and national advocacy can fit together, Dr. Prasad Gautam concluded:

A success of evidence-based advocacy to drive change at the global levels, well-known to many in the WASH sector, is the inclusion of hygiene as a co-indicator in the new Global Goals, which was neglected during the MDG era. However, without effective, successful advocacy around handwashing directed at donors, governments, private sector, and alongside the water & sanitation sectors in countries and across regions, to adopt and integrate hygiene into WASH and health strategies, there will be no success in achieving the 2030 Agenda.

Carolien van der Voorden, Senior Programme Officer for Learning and Documentation at the Water Supply & Sanitation Collaborative Council (WSSCC), explored how evidence helped build the case for adopting hygiene into CLTS protocols. For example, this outcome has occurred in several countries that receive support from the Global Sanitation Fund. As a result, CLTS action plans in Nepal, Tanzania, and Nigeria include an indicator on the presence of handwashing stations in schools, healthcare facilities, public spaces, etc., a requirement for countries in order to qualify for open defecation-free status.

While some progress has been made, Carolien emphasized that more needs to be done to address the importance of inserting hygiene strategies into policy and programming. Continued government and stakeholder buy-in, coupled with understanding the importance of hygiene integration and the role it plays in achieving health and development goals, will help spur continued investment and resource mobilization. To avoid falling short of progress needed to achieve greater support of hygiene, more research is needed to create evidence that can ensure policy translates into practice. At the same time, advocacy strategies must be designed with outcome impact in mind so that progress does not fall short.

After the presentations, the GHP and audience members engaged the panel to continue the discussion on how evidence can be used to drive change. The following are some of examples of discussion’s main takeaways, as well as recommended reading:

  • Research can help advocates know which outcomes to push for, as well as understand motivations, barriers, and leverage points for their audiences to convince them to implement recommendations that emerge from studies. Participants recommended that advocates make advocacy messages more personal by employing evidence that exposes decision-makers to the stark reality of poor hygiene and evoke a sense of urgency for them to act.
  • Addressing research and evaluation at the beginning of the design process can allow for mechanisms to evaluate impact and determine clarity on what needs to be done, what benchmarks need to be measured, and thus determine what elements do or do not work.
  • Consulting with research experts during the design process can allow practitioners to improve interventions, which can result in effective behavior change and additional evidence that can then be incorporated into advocacy. Learn more about research for handwashing behavior change here.
  • Conducting research trials can take time, but it’s not always necessary to wait until evidence is generated before to attempting to stimulate public support. Creating demand for hygiene can help establish a foundation and fast-track the formal advocacy process to leverage greater impact, and rendering an audience to be more likely or willing to be engage.
  • Writing opinion pieces and blog posts, engaging traditional media and organizing social media campaigns and consultations are great ways to make noise around your cause. Read this advocacy toolkit, published by Plan International, to learn more about strategies that use both traditional and social media.
  • Bringing together multiple actors from within the WASH, health, and private sectors in a collaborative spirit can help push advocacy forward and make a bigger splash. Read about how collaborative approaches can translate into greater resources, knowledge, and expertise in this brief Sanitation & Water for All overview.

In addition to the recommendations presented during the session and in suggested resources above, learn more about incorporating evidence into advocacy strategies in this UNICEF advocacy toolkit. Visit the GHP website, for the latest on hygiene advocacy, as well as evidence and research around handwashing with soap. You can view a copy of the session slide deck here.

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