Assessing Hygiene Improvement

Published by the Environmental Health Project (EHP), these guidelines are part of a series of publications intended to strengthen the planning, implementation and evaluation of hygiene improvement interventions. They are intended for use both in programmes with a broad child health agenda and in programmes with a principal focus on water and sanitation.

From About These Guidelines
"[The purpose of these guidelines] is to help program planners and managers design, implement and evaluate water supply, sanitation, and hygiene interventions. Primary users would include managers, program personnel, and consultants. Public institutions, local government organizations, nongovernmental organizations, and community organizations also will find these guidelines equally informative. The material may be useful to students of environmental health and social and behavioral sciences as well.

The Assessing Hygiene Improvement Guidelines provide easy access to up-to-date information about appropriate indicators and data collection instruments that are necessary to evaluate water supply, sanitation, and hygiene interventions. The guidelines describe 66 indicators and propose approximately 360 model survey questions for measuring hygiene improvement comprehensively at the household and community levels and at institutions such as schools and health facilities. The indicators and survey questions are based on the best available knowledge from numerous surveys, including the Demographic and Health Surveys and instruments focusing on water supply, sanitation, and hygiene used by the Environmental Health Project (EHP) and the London School of Hygiene and Tropical Medicine. The selection of indicators and assessment questions is just one step in a longer process (e.g., use of a household survey), which is explained later in this document (see Section A).

These guidelines will help users in planning and conducting the following evaluation tasks:

• Perform a situation analysis and needs assessment to inform an overall strategy and programming options;
• Develop a performance monitoring plan with indicators and data collection instruments;
• Establish a baseline for current hygiene practices and develop a behavior change and communications strategy;
• Assess the current handling of water and plan interventions to improve the quality of drinking water in the home and at institutions;
• Assess community capacity to sustain hygiene improvement interventions;
• Develop tools for self-assessment and supervision of hygiene improvement interventions;
• Assess the mid-term progress of hygiene improvement interventions;
• Measure disparities in access and hygiene behaviors between population groups of different social, economic, or cultural characteristics (e.g., urban slums, ethnic origin, single parent or female-headed households);
• Evaluate the impact of hygiene improvement at the end of a program cycle.

Users should be aware that these guidelines and instruments are not intended as blueprints, but rather as a menu to choose from and adapt according to the field context and user's needs. Indicators that best fit programmatic needs may already be defined here, and others can be added BY USING additional survey questions shown in this document. See "Using These Guidelines for a Situation Analysis and Needs Assessment" for examples.

Not all components of the Hygiene Improvement Framework are equally covered in these guidelines. For example, the guidelines do not address public policies and regulations, nor do they include a full range of measurements associated with water supply, sanitation, and hygiene at the community level, especially related to the operation and maintenance of water and sanitation services and other technical issues. Certain model questions are more applicable in a rural context, while corresponding questions for an urban environment still need to be developed and tested. The model questions address only very basic information about water quality.

While these guidelines are for quantitative data collection, program managers can choose other methods to collect their data as well. Regardless of the mix of data collection methods used, the most important outcome will be that programs use the information to set priorities, design interventions, develop plans of action, and evaluate progress."

The Guidelines are available in three formats: hard copy, CD-ROM and in electronic PDF format. For a hard copy, or an interactive, hyperlinked, Microsoft Word format on a CD-ROM, email: info@ehproject.org