The Water, Sanitation and Hygiene Futures Conference was held in Brisbane, Australia, in May of this year. The international conference brought together global leaders in WASH programming and research and showcased innovations in the field in an attempt to pave the path to universal and sustainable water, sanitation and hygiene. At this year’s conference, a joint project designed and implemented by CEES assistant professor Robert Dreibelbis, Save the Children and the University of Buffalo was awarded first place with the Civil Society Innovation Award. The award aims to acknowledge the work of civil society organizations and non-governmental organizations that have developed successful and innovative strategies for improving the sustainability and delivery of WASH services.
In an effort to reduce the risk of enteric and respiratory disease and positively impact child morbidity and mortality in rural Bangladesh, the first place project focused on improving handwashing behaviors after toilet use among primary school-aged children. The traditional focus of handwashing interventions has been behavior change communication and hygiene promotion, though these methods are often time and labor intensive and don’t consistently result in measurable improvements. In an attempt to overcome the challenges of handwashing behavior change, principal investigator Dreibelbis and his partners designed the low-cost and easy to implement nudge path intervention. “Nudges”, or environmental cues that spark quick, unconscious decision-making, have gained attention in recent years as a means to trigger behavioral outcomes in high-income countries. Rather than attempting to tap into the reflective and often complex decision-making process of school-aged children, the aim of the nudge path intervention was to alter the physical environment surrounding
handwashing in order to subconsciously promote the behavior in the focus schools. The nudge paths created in this project connect latrines to handwashing stations via paved pathways. Pathways are painted with bright colors, footprints and handprints, intended to trigger handwashing through visual cues, while the pathways themselves subtly guide students to the handwashing location. The feasibility for the nudge path intervention was assessed in a pilot in 2014 of nudges in two schools in rural Bangladesh, showing an overall increase of 64% in handwashing among primary school students after a toileting event. The nudge path concept is currently under further study in a cluster-randomized trial to assess the longer term sustainability of the intervention as well as the behavioral impact of nudges against a traditional education-focused handwashing and hygiene promotion program.
In an effort to improve WASH in primary schools, recent policy changes in Bangladesh are requiring primary schools to adopt new sanitation infrastructure, referred to as WASH Blocks. The WASH Block design incorporates handwashing facilities within the toileting facility structure, with separate toileting and handwashing facilities for boys and girls. In order to further investigate the potential effect of nudges on handwashing in primary schools while addressing relevant policy issues, the first place prize of $10,000 USD from the Civil Society Innovation Award will be used to investigate the applicability of the nudge design in the WASH Block setting.