SHARE report: research in use

SHARE RIU final report The SHARE supported Research in Use (RIU) project of WaterAid Bangladesh has been rolled out aiming to contribute mainly under four heads; they are – A. Dissemination of SHARE results (Roundtable/ Stakeholders’ workshop) B. Research briefs, IEC promotional, publication C. Media Campaign (RDC/TVC/Documentary/Talk show/Creative) D. Training/ Capacity Building The activities undertaken under these line items as well as their output and impact are portrayed herein chronologically.

A. Dissemination of SHARE results (Roundtable/ Stakeholders’ workshop) Under this output a number of activities done that include roundtable with sector actors; dissemination and dialogue; conferences; and mass media communications through popular channels. The details are as follows under six sub-heads: A1. Roundtable on bridging health and WASH Health experts stressed the importance of hygiene to improve health and called for better handwashing campaigns at a meeting co-organised by SHARE in Dhaka, Bangladesh. Leading figures from research institutes, NGOs, the private sector and media met on 1 October at the offices of the Daily Sun - an English-language newspaper in Bangladesh - to discuss how to improve hygiene practices.

They urged all concerned, including the Govt. of Bangladesh and the private sector, to work together to support long-term and sustainable hygiene promotion efforts.

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The roundtable on health and hygiene was co-organised by SHARE, its partners ICDDR,B, LSHTM and WaterAid, and the Daily Sun. It was a timely discussion as Global Handwashing Day takes place on 15 October and the Government of Bangladesh has designated October as the month for sanitation.

During the three-hour session, health experts identified key challenges limiting good handwashing practices in Bangladesh. Poor infrastructure, especially lack of running water and wash basins, including in certain hospitals and schools, was described as a major weakness contributing to the spread of diseases, such as diarrhoea. Inadequate hygiene education at all levels – from villages to medical schools – was also mentioned as a constraint. The lack of robust data and need for more research on how to scale up hygiene initiatives was raised too. Dr Md Khairul Islam, Country Representative for WaterAid Bangladesh, explained that the current situation resembles a “vicious circle.”

As the health impact of hygiene promotion is not measured, it is not considered to be important, leading to a lack of investment, which means its significance will not get measured; this cycle then repeats itself.

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The delegates also shared examples of successful programmes, and the widespread benefits of good hygiene. Children in hundreds of schools across Dhaka are being educated about handwashing with soap due to a partnership between Lifebuoy - a Unilever brand of soap - and Water and Sanitation for the Urban Poor (WSUP). Dr Selina Ahmed, of DFID Bangladesh, explained that good hygiene can also lead to gains in nutrition and avoid eye infection.

The experts made many suggestions to improve handwashing practices, including better education, especially for children, mothers and Bangladesh’s 40,000 frontline health workers. The government was repeatedly urged to play a larger role as without its support improvements cannot be made on a large scale and long-term basis.

Similarly, the private sector was urged to pursue long-term and sustainable projects.

The support of the media to raise awareness about the importance of hygiene was also invoked. Professor Dr Syed Anwar Husain and Shahnoor Wahid, Editor and Joint Editor of the Daily Sun respectively, confirmed their newspaper's interest and commitment to publicising these issues (click here for the Daily Sun's coverage of the roundtable).

Professor Dr Mahmudur Rahman, of the Institute of Epidemiology Disease Control and Research (IEDCR), reflected the consensus at the meeting when he said: “Health and hygiene go hand in hand.” Likewise, Dr Ainun Afroje, of the Bangabandhu Sheikh Mujib Medical University (BSMMU), summed up the views of all when she added: “We all know that prevention is better than cure, but sometimes we forget to prevent.”

A2. Roundtable on bridging WASH and nutrition Dhaka University, WaterAid and New Age organised a roundtable on ‘Bridging WaSH (Water, Sanitation and Hygiene) and Nutrition’ at the Bangladesh Institute of International and Strategic Studies in Dhaka, Bangladesh.

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A two page supplement featuring leading nutrition and WaSH sector actors of Bangladesh has been published in the national daily New Age that sheds light on the possibility of bridging 'WaSH and Nutrition' in Bangladesh.

The speakers told that about six million of the country's 15 million children below five are undersized and intellectually underdeveloped due to severe malnutrition. Nearly 40% of these under-fives are stunted, a physical state that is the worst manifestation of child malnutrition caused by lack of clean water, sanitation and hygiene, said Tahmeed Ahmed, Director of Centre for Nutrition and Food Security at ICDDR,B. Tahmeed, who also teaches public health nutrition at Brac University, said these malnourished children would not only be physically weak but also suffer from poor intellectual growth. He mentioned that they had observed a slum girl for about two and a half years and found that during the period the child caught diarrhoea and fever 45 times due to lack of clean water, sanitation and hygiene. WaSH and child nutrition are hence indispensable, he noted.

According to Tahmeed, poverty, high density of population, food insecurity, poor sanitation and hygiene and environmental pollution someway or other cause malnutrition. He also said during a survey, they had found that due to lack of WaSH 40% of homemade supplementary foods for babies get contaminated with E. coli, a germ found in faeces.

Stunted parents would give birth to stunted children putting an overall impact on the nation, said Zeba Mahmud, Director of Brac Institute of Global Health.

Dr. Md. Khairul Islam, Country Representative of WaterAid Bangladesh, said the WaSH programmes must be coordinated to achieve the nutrition goal and that assessment on WaSH should be included in the mainstream health programmes. He said successes in achieving the Millennium Development Goals (MDGs) are shown with improved sources of drinking water and a number of sanitary latrines, but the actual success would remain far away unless safe water, proper sanitation and hygiene are ensured at all levels.

Shamim Ahmed, a Programme Manager of WaterAid underscored programme implementation, policy reform and drawing the attention of donor community by evidence based research to address the issue of malnutrition.

CSA for SUN spokesperson Rukhsana Haider, said nutrition must be a development indicator. The struggle for a better future must go on although there are many frustrating realities.

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A3. Global Conference on Community Health WaterAid Bangladesh in association with Partners for World Health and Eminence organised a Global Conference on Community Health in Bangladesh from 19-22 March 2014. The purpose of the conference was to share knowledge and contemporary experiences with sector actors to achieve the sustaining changes for better health at community level. The audience in the conference was from both home and abroad.

WaterAid Bangladesh took this opportunity to explore the WASH issues convergence with health agenda as part of policy advocacy process. Considering the importance of sustainable community health initiatives for global development discourse, the key theme of the conference was “Sustaining Change in Community Health”. WaterAid Bangladesh hosted a particular session titled ‘Water, Sanitation and Hygiene’ under the broader theme of ‘Proximal determinants of health’.

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A4. Dissemination and Dialogue on National Hygiene Baseline Survey The first ever baseline survey on hygiene in Bangladesh conducted by Policy Support Unit (PSU) of Local Government Division (LGD) in association with WaterAid and icddr,b found menstrual hygiene management situation ‘alarming’ and handwashing practice with soap and water ‘very poor’.

The study has also found only 40 percent households have the facilities of handwashing with soap and water after toilet, although most of the inhabitants have claimed they are aware about health manners.

The preliminary report of the National Hygiene Baseline Survey can be downloaded from PSU website logging on to http://www.psu-wss.org/bnhbs.html where people can put their comments and suggestions on the findings as well.

Menstrual Hygiene Management situation in Bangladesh is alarming, as 80 per cent girls of the country are habituated with old pieces of cloth during their menstrual period, according to a combined study on national hygiene.

In the preliminary report released on 26 June in city’s Ruposhi Bangla Hotel has found only toilet against 187 students while there is no separate toilet for doctors and nurses in one fourth cases. LGD Secretary K M Mozammel Huq unveiled the report as chief guest while Director Generals of Directorate of Primary Education, Directorate of Health Services and Directorate of Family Planning were present as special guest. Deputy Executive Director of icddr,b Abbas Bhuiya and Country Representative WaterAid Bangladesh Dr Khairul Islam spoke on the occasion.

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The study report has been prepared by measuring the health manners of school students in khana levels. In addition, it has also scaled up the rate of the health manners of doctors, nurses, restaurants and menstruation health of girls in national level. Researchers claimed the survey conducted in Bangladesh is also for the first time among the developing countries.

The report said 40 percent girls do not go to school on an average for three days during their menstrual period and they re-use the old piece of cloth without washing healthy way as well as dry it properly. In the 40 percent household, it has found that intention of washing hand is very poor even after having soap and water. Besides, 35 per cent schools of the households have the facilities of hand wash with soap and water, which has been reflected in the study.

On the other hand, one third restaurants have kept the provision for its workers to wash hand with soap. A poor number of restaurants used to cover up the food while half of the restaurants wash the plate and dish keeping those in the same water repeatedly.

However, in the hospitals, the researchers have found much modern facilities for washing hand. Nearly 90 percent hospitals have the provision of hand wash system.

But, the researchers during their five hours observation in the hospitals witnessed the real hand wash with soap in 2 to 29 percent cases. About toilet, the researchers have found most of those were locked. It witnessed only toilet against 187 students, although there is supposed to one toilet against 50 students in nationally.

The development activists attended in the ceremony suggested using the result of the study in both government and non-government activities. They demanded to include the handwashing with soap as the indicator of skillfulness in health sector. They also urged both the government and donors to invest on behavioural change campaigns at national level.

Print media coverage (English) ----------------------------------------http://www.dhakatribune.com/safety/2014/jun/27/survey-60-hou… http://newagebd.net/25146/1-toilet-for-every-187-students-su… http://www.bssnews.net/newsDetails.php?cat=0&id=419791&date=… http://www.newstoday.com.bd/index.php?option=details&news_id… http://thebangladeshtoday.com/national/2014/06/menstruation-… http://www.newshour.com.bd/2014/06/26/baseline-survey-nation… http://news.org.bd/news/breaking-news/menstruation-health-ma… http://www.bangladeshchronicle.net/index.php/2014/06/menstru…

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http://unbconnect.com/hygiene-survey/#&panel1-1 http://bongodaily.com/menstruation-health-management-in-bd-a… http://www.thefinancialexpress-bd.com/2014/06/27/41765 Print media coverage (Bengali) --------------------------------------http://www.prothom-alo.com/bangladesh/article/252487/ http://www.dailynayadiganta.com/details.php?nayadiganta=NDk1… http://www.banglanews24.com/beta/fullnews/bn/302423.html http://www.natunbarta.com/health/2014/06/26/88079 http://www.sangbad.com.bd/index.php?ref=MjBfMDZfMjdfMTRfMV8x… http://www.risingbd.com/l/detailsnews.php?nssl=a4d0649394c84… http://arthonitiprotidin.com/2014/06/27/%E0%A6%B8%E0%A6%9A%E… http://www.dhakaprotidin.com/?p=46337 http://sylheteralap.com/category/national/5546/ http://www.karatoa.com.bd/details.php?pub_no=1667&menu_id=5&… http://www.jjdin.com/?view=details&archiev=yes&arch_date=27-… http://www.sorejominbarta.com/health/article/35208/%E0%A6%A8… http://www.jugantor.com/second-edition/2014/06/27/116101 http://news.deshiwebportal.com/%E0%A7%A7%E0%A7%AE%E0%A7%AD-%… http://www.theleadnews.com/home/details/2285 http://news.deshiwebportal.com/%E0%A7%A7%E0%A7%AE%E0%A7%AD-%… http://www.hawker.com.bd/news_details.php?news_id=360351&new… http://www.amarhealth.com/bd/archives/24802#.U62NLUDmBkg Electronic media coverage (TV) --------------------------------------Channel I: http://www.youtube.com/watch?v=VYpt-CxbJ7s Ekushey TV: http://www.youtube.com/watch?v=VGChu2uSFac Bangla Vision: http://www.youtube.com/watch?v=sY8CCrJcM6w SA TV: http://www.youtube.com/watch?v=MZVPkEqG0jk

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A5. Roundtable on School Sanitation WaterAid Bangladesh in collaboration with Campaign for Popular Education (CAMPE), the Daily Prothom Alo and SHARE Research Consortium organised a roundtable on School Sanitation.

The discussants shed light on water, sanitation and hygiene (WASH) situation came out from the first ever Bangladesh National Hygiene Baseline Survey 2014 and opined on possible way out. for e-paper version check out this link: http://epaper.prothomalo.com/view/dhaka/201412-22/11 find out more coverage here: http://www.prothomalo.com/bangladesh/article /397051/ http://bd.thedailystar.net/cit y/40pc-schoolgirls-cut-classes‌

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B. Research briefs, IEC promotional, publication B1. Printing of Bangladesh National Bangladesh National Hygiene Baseline Survey (Preliminary Report 2014) The first ever baseline survey on hygiene in Bangladesh conducted by Policy Support Unit (PSU) of Local Government Division (LGD) in association with WaterAid and icddr,b found menstrual hygiene management situation ‘alarming’ and handwashing practice with soap and water ‘very poor’.

The study has also found only 40 percent households have the facilities of handwashing with soap and water after toilet, although most of the inhabitants have claimed they are aware about health manners.

The preliminary report of the National Hygiene Baseline Survey can be downloaded from PSU website logging on to http://www.psu-wss.org/bnhbs.html

The study report has been prepared by measuring the health manners of school students in khana levels. In addition, it has also scaled up the rate of the health manners of doctors, nurses, restaurants and menstruation health of girls in national level. Researchers claimed the survey conducted in Bangladesh is also for the first time among the developing countries.

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B2. Newspaper Ad on Hygiene Awareness focusing handwashing with soap To take forward the hygiene issues WaterAid Bangladesh published newspaper spot ad with hygiene message onto a daily newspaper that are widely circulated amongst the low and income quartile population.

Bangladesh Protodin found to be the top circulated newspapers and with high readership of targeted population that also has a very high on-the-street readership.

Newspaper spot ad as it appeared in Bangladesh Protidin

Newspaper spot ad (translated in English)

This newspaper campaign ran for three months with thrice-a-week appearance that reached over 500,000 readers.

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C. Media Campaign (RDC/TVC/Documentary/Talk show/Creative) C1. Animated story-based television spot To disseminate the holistic perception of the key elements of Sanitation and Hygiene and its possible impact on human life and environment an animated story-based television spot production was done. The production aimed to create a mass hype on sanitation and hygiene practices through radio and television airing targeting preliminarily the school-goers and then the adults.

The production tried to incorporate and contextualise multiple instances of malpractices from our day to day life shown in the reference 2D animation film in www.choosesoap.org. It also focused the long term effects of malpractices to sensitise the target group to disseminate and share their knowledge for the betterment of the community and society.

The audio-visual production attempted to portray the following within a storyboard: - all basic elements of Sanitation and Hygiene practices with special focus on regular Hand Washing practices with soap - effective impacts on health and nutrition especially of the children

The visual can be viewed here: http://youtu.be/x4mTTzMgg6E

The English lyric is as follows: SHARE RIU Final Report | 12

Soap : I’m soap. Use me!

Mother: Have you washed your hands with soap?

Boy : No, I didn’t.

(Rhyme) If we don’t wash our hands with soap germs Will born and always traverse with us.

(Rhyme) After defecation and before eating If we don’t wash our hands with soap, Germs make us feeble.

It’s very hazardous If we don’t wash our hands Properly with soap.

Another mother Another boy

: Have you washed your hands with soap? : I’ll wash later mom

(Song continues) Germs increase due to our mistakes In daily chores and make us feeble.

Make the habit of washing hands with soap And say goodbye to germs and disease.

C2. Newspaper Ad on Hygiene Awareness focusing handwashing with soap WaterAid Bangladesh’s communications unit planned to disseminate main findings of serious researches in simple, communicable and digestible language. Side by side, we decided to put some key messages (doable action points) as a way out of the situations that the research findings indicate. We planned to adopt product/content marketing approach of communications for this where the original report will be mentioned as reference as a download link and QR code. This will publicise the research itself to the wider audience.

Three of the contents we used have been extracted from the “Bangladesh National Hygiene Baseline Survey 2014” and one from “Faecal Contamination of Commuters’ Hands in Public Places in Dhaka City 2014”. Both of the researches have been carried out by icddr,b with inputs from WaterAid. We developed the contents in Bangla with strong visuals in an engaging tone. The key findings were presented in form of infographic expressed in simple language like a product advertisement. The copy was then checked with the research team to make sure that we’re not wrongly communicating the things. This took a number of back and forth to reach a point of agreement. It was worth spending the time as the final product

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came out of this process found to be simple, clearly understandable, engaging yet scientifically correct. All the messages end up with promoting hand washing with soap.

We have chosen a national daily that has both print and online publication. We picked Prothom Alo (www.prothom-alo.com), the highest circulated daily in Bangladesh. Its readership is around three million per day; over half a million buy the print edition. As per Google ranking – its website is accessed from 210 countries and the highest hit Bangla website of the world. We have published messages in the form of ad in the daily Prothom Alo at the bottom part of page 5. The advert was available online the same day and is still accessible online at its archive. A total of four ads have been published in four consecutive days starting from 19 Nov ’14, the world toilet day.

The contents are available in following pages with an English version (translated just to communicate internally, not scientifically copy-edited or checked). Next to creative that has been published there is an online link.

Ad 1: availability of soap and water around toilet Newspaper insertions published on 19 Nov 2014

English translation of the ad

Weblink: http://epaper.prothom-alo.com/view/dhaka/2014-11-19/5 SHARE RIU Final Report | 14

Ad 2: hand hygiene of mothers Newspaper insertions published on 20 Nov 2014

English translation of the ad

Weblink: http://epaper.prothom-alo.com/view/dhaka/2014-11-20/5

Ad 3: hand and cleanliness of children Newspaper insertions published on 21 Nov 2014

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English translation of the ad

Weblink: http://epaper.prothom-alo.com/view/dhaka/2014-11-21/5

Ad 4: hand hygiene of commuters Newspaper insertions published on 22 Nov 2014

English translation of the ad

Weblink: http://epaper.prothom-alo.com/view/dhaka/2014-11-22/5 SHARE RIU Final Report | 16

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As soon as the newspaper advertisement came out we started receiving a number of media and public queries. Also it has successfully drawn attention of the actors within and beyond the sector and we got numerous communications in this regards.

The ads were shared through social media channels as well that has quite a good number of hits. The post insights (engagement) of each post on the day they went live are as follows (drawn from official Facebook page of WaterAid Bangladesh): Post 1: availability of soap and water around toilet

Post 2: hand hygiene of mothers

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Post 3: hand and cleanliness of children

Post 4: hand hygiene of commuters

After the success of this simple and straight infographics WaterAid Bangladesh is considering to share them in other public spheres.

All the infographics in high res are available to download in the following link: https://app.box.com/s/uwjigrzwzieb9xsrrrct

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D. Training/ Capacity Building ToT on weaning food for Govt. Officials from Ministry of Women and Children's Affairs (MoWCA)

WaterAid as a member of the international consortium of SHARE led by the London School of Hygiene and Tropical Medicine and in Bangladesh country platform working with the International Centre for Diarrheal Disease Control, Bangladesh (icddr,b) and WaterAid Bangladesh to generate rigorous and relevant research for use in the field of sanitation and hygiene.

The purpose of SHARE is to join together the energy and resources of the five partners (the International Institute for Environment and Development (IIED); the International Centre for Diarrheal Disease Control, Bangladesh (icddr,b); Slum/Shack Dwellers International (SDI); and WaterAid) in order to make a real difference to the lives of people all over the world who struggle with the realities of poor sanitation and hygiene.

WaterAid Bangladesh is pleased to disseminate the SHARE funded research titled "Hygiene intervention reduces contamination of weaning food in Bangladesh" through organising an intensive training on essential WASH and Hygiene issues in partnership with Sisimpur Outreach Project, Ministry of Women and Children's Affairs (MoWCA), Government of the People's Republic of Bangladesh (GoB).

The training has been organised for GoB's District Child Affairs Officers of 64 districts, 6 Upazilla Shishu Academy Officer and other district level government officers on 19 June 2013 at Gronthagar Bhaban of Shishu Academy (Library of Children's Academy).

Sisimpur Outreach Project headed by honorable Deputy Secretary coordinated all processes for confirming the participation of 64 Districts' Child Affairs government officials, 6 Upazilla level Shishu Academy government officials, Bangladesh Government High level of officials including Honorable Secretary, Joint Secretary and others. WaterAid Bangladesh made available all trainers and specialists for facilitating the training.

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The training programme attained the following objectives: 

To disseminate the awareness message through the following organogram of the 196,590 people can be covered by 1 cycle of ToT

70 GoB Officials

3320 Teachers

193,200 child & parents

196,590 people

64 District officer 6 Upazila officer

64 Dist. =3200 School 6 Upazila= 120 School

64400 parents and 1288000 Children

Total number of beneficiary



To sensitise the high level of policy makers and executives of the GoB on the issue

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