Combining hygiene behavior change with water and sanitation : a pilot project in Hato Major, Dominican Republic

In a water and sanitation construction program launched by USAID in 1999 to repair the damage wreaked by Hurricane Georges, a project to add hygiene behavior activities was initiated. EHP was requested to provide technical assistance to incorporate the behavior-change approach, the goal being to increase the health impact of the water and sanitation project, in particular for children under five.
The project evolved in two phases : 1) intensive training in behavior techniques to 40 health promoters, 2) a pilot project implementing behavior-change activities in nine communities in the municipality of Hato Mayor. This pilot was rather successful. As a result among others, diarrhoea prevalence under children under five declined from 27 % at baseline to 11 % at mid-term and reported hand washing of caretakers after defecation increased from 54 % at baseline to 66 % at mid-term. Significant increase in the presence of a permanent, designated hand washing location was noted, and use of soap increased significantly.
It became apparent that when water and sanitation infrastructure is in place in target communities it facilitates behavior change, and that a coherent and balanced team of trained technicians can apply the behavior-change methodology effectively. Lessons learned from this two-phase project are likely to be applied because of the follow-on activities and continuity in the team that has provided advisory assistance. For additional assessment and to replicate the approach elsewhere in the Dominican Republic, Nicaragua and Peru additional funding to continue the work was granted through 2003 and 2004.