Hygiene and Sanitation: How Communities Take Charge and Change Behaviors

The infrastructure of a toilet is not enough to encourage people to develop sanitary practices. It can be challenging to achieve long-term behavioral change in the appropriate use of latrines. We need innovative approaches to achieve lasting results. One of such approaches is RANAS, which addresses a set of psychological factors influencing human behavior.

Our Regional Technical Advisor for West Africa, Jacques Louvat, has over 35 years of experience in Water, Sanitation and Hygiene in the region. He works specifically in Mali, Niger and Burkina Faso. This article is based on a conversation with him about the Community-Led Total Sanitation (CLTS) and the Risks, Attitudes, Norms, Abilities, and Self-regulation (RANAS) approach.

How communities lead the way in hygiene and sanitation

Community-led total sanitation (CLTS) is one of the impactful methods that mobilizes every member of the community to take charge of their hygiene. This method aims at behavioral change and mobilizes the community into action. Each community identifies their own solutions in building toilets and maintaining them, and as a result millions of people across Asia, Africa and Latin America have shifted from open defecation to using toilets. Villages have been transformed into open defecation free environments.

The CLTS method, Jacques Louvat says, has been adapted in these regions to not only promote toilets and to move to open defecation free environments but to sustain a change in improving personal and community hygiene.

One of the projects he helped design in Mali is the JIKURA program, which in Bambara means ‘clean water’. With the support of Helvetas, the local municipalities set improved sanitation as their priority and took the responsibility in their own hands. The problems and the possible solutions are presented at municipal meetings and the community chooses its own route of action.

In periodic meetings, the costs, planned actions, progress and difficulties encountered in the program are reported and discussed. This is driven by the development organization and the municipality along with the representatives from the community. The focus is on addressing the root causes of a lack of WASH services, rather than coming up with quick band-aid solutions.

Changing the behaviors with the RANAS approach

Helvetas provides support only for a period of time, after which eventually the municipalities and the community sustain the change by themselves. In this short time, advisors help train the local leaders to propel the change they want to see in their community. But we all know from personal experience how difficult it is to change behaviors. What should change is the behavior with which we approach the activity.

Behavior can be better understood using the RANAS or Risks, Attitudes, Norms, Abilities, and Self-regulation approach. Imagine if schools provided a clean space for girls and boys and a hand-washing tap located outside to wash their hands before eating lunch. This would encourage students to eat with clean hands. Given that more students practice this, it further invites the reluctant few to join the practice, following the norm of desired social behavior.

It is not enough to provide the infrastructure, if people are not invited to use it: this is where a more personal strategy to modify the behavior comes into play.

With the RANAS approach, project teams can identify the principal factors that underlie hygiene behavior and use this to think of communication messages and strategies towards a change of behavior. For example, knowing that soap will help kill germs in the hand is not enough to actually use one before you eat. The question that should be asked is why an individual or a community is not able to follow through on the habit to use soap to wash their hands. Using surveys, the inhabitants of the community are asked questions regarding five different factors. Responses provide information on what motivates people's behavior. The five categories of questions involve:

1. Risk factor – Do you think you’ll get sick if you do not wash your hands with soap? What is the worst possible scenario if you do not?
2. Attitude factor – Do you like washing your hands with soap? If not, why?
3. Norm factor – How much do people around you approve of your practice to wash your hands with soap?
4. Ability factor – Do you have soap and clean water to wash your hands?
5. Self-regulation factor – Do you have a plan to wash your hands if you do not have soap tomorrow?

The answers provided by the community are entered into a computer program (e.g. Excel), analyzed, distinguishing between those who implement the handwashing and those who don’t. Then, for each factor, the results are compared between doers and non-doers. If there is no difference, that means that all have the same perception of the factor. But if there is a difference, that factor is key for a change in behavior.

An inhabitant of Faradièlé explains that they simply hung a picture of the village chief washing hands in front of their house. Just looking every day at the picture of a respected and important person prompted everyone to do the same. The women are proud that their children are now washing their hands and vow to ensure that soap and water will always be available to do so.

Investment in just constructing toilets or enforcing a plan of action does not provide sustainable results. Instead, providing a helping hand to the ones that take control of their destiny and work towards securing the future of their children, goes a long way in improving communities for the better.

Learn more

• Behavior Change Manual - It aims at providing hands on guidance to field-based staff of development organizations that are working on Behavior Change.
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