Case Study: Challenges on Behavioral Change

Raj K Pandey

 I used to work with the JICA/Japan Medical Association in the capacity of an Assistant
Program Officer. JICA/JMA-SCHP implemented UNICEF funded sanitation program in
the 16 VDCs of Kavrepalanchowk. We used to design and implement several grassroots
based activities in the rural backward areas. The major components were school and
community health promotion through sanitation, toilet construction, providing training on
behavioral change, conducting KAP research, flow up, monitoring, evaluation, prepare
lesson learnt and documentation for the JMA and UNICEF Nepal County Office.

 We constructed several toilets for the schools and rural households where people used to
go in the open places. After completion of the toilet, first of all, we used to provide them
sanitation training prior to the handover. After few months, we noticed that community
people and school children were suffering from the worm. Letter on, we realized that
after use of toilet, children cleaned their hands only by water but did not use cleansing
material-soap. As a result, community people suffered from health problems particularly
worm. To overcome such problem, we modified our training manual; provided soap to
schools; distributed medicines and launched de-worming camping. This program not only
changed the community practices but also made them conscious on personal hygiene.

 We constructed well-equipped health and sub-health posts but the communities did not
receive the health services as they used to practice traditional healing method. We
conducted research and found out that 96% community trusted traditional healers as they
were local, easy assess, no need to pay cash, etc. We started providing training to the
Traditional Healers and worked with them as partner so that they used to refer to the
health posts. We also developed local people as a modern health practitioner with closed
cooperation with the DHO. Its impact was found very effective and efficient to deliver
the health services to the rural communities.

 Hence, we have to be very conscious when we deliver any messages and we must design
our programs in accordance with the interest of community for sustainable development.