Behavior Change in Madagascar

OVERVIEW The RANO WASH program aims to promote the adoption, practice and sustained use of WASH
products and services to decrease incidence and prevalence of childhood diarhhea, exposure to environment en-
terothopy and under five mortality rates. RANO WASH’s behavior change strategy is grounded in determinants
of behavior identified with the Behavior Centered Design framework (BCD)* to inform tools and methods for a
community-centered BC package. The strategy builds on successes of consortium members and previous USAID-
funded projects.

Targeted Key Behaviors

In collaboration with the London School of Hygiene and Tropical Medicine, RANO WASH conducted formative
research to identify target behaviors and practices that the intervention will promote:

The household member in charge of food

All household members, including mem-
cleans uncooked fruits and vegetables with safe
bers with disabilities, use improved latrine (pit
water and ensures that the food is properly and
latrines that are flyproof, washable and venti-
well-cooked prior to consumption; and a cov-
lated) with an available handwashing system
ered recepticle is used for proper food storage
with soap
between consumption

Household members are regularly washing Girls and women that are menstruating change
their hands with soap in three key moments: (i) their sanitary napkins and wash themselves at least
before food preparation, (ii) before eating, (iii) twice a day with clean water
after going to the toilet

Household members use safe water from Men and women make decisions together on
the water supply system funded by RANO matters and issues related to access and use of
WASH or boil water before consumption, and WASH services and products
store it in a clean and covered container

A Community-Centered Approach

Community-based motivators RANO-WASH’s strategy focus-

es on community and household-level drivers and motivators for
the 6 targeted key behaviors. The approach promotes communities
as the most influential unit at which to (catalyzing factor to) change
norms and practices related to WASH behaviors, as many social
norms are reinforced at the community level.
Enabling environment in the community To facilitate access
to and adoption of WASH behaviors, practices, and products, the
program: 1) increases access to WASH products and services
through the private sector, and strengthens institutional WASH in
schools and health facilities; 2) facilitates household access to finan-
cial and loan products; and 3) strengthens governance of WASH
services to ensure durability and quality.

* Aunger, R. and Curtis, V. (2016) Behaviour Centred Design: towards an applied science of BC, Journal of Health Psychology Review
 Multi-level Behavior Change Intervention

The RANO-WASH BC strategy is delivered at three levels: household touchpoints, community touchpoints, and mass touch-
points that influence cognitive, emotional, reactive and habitual drivers of the 6 key behaviors. Activities are delivered in an
interactive and participatory manner that seeks to move away from one-sided delivery of messages. Key activities include:

Level Key Activities

Local Radio Campaigns
Mass Service and product ads on mass media
Messaging using mobile-based platforms
Community Led Total Sanitation and Follow up Mandona

Participatory community theatre

Contests and rewards focused on incremental progress for Village Savings and Loans groups and
Community
households
Community marketing campaigns for targeted WASH products

Community mobilization events

Household visits to accompany households through the BC process and provide follow up
Household
Interactive Group dialogues to generate discussion

Delivery Activities and household monthly follow up are conducted by Community Health Volunteers
(CHVs) and Local Promoters that receive training on gender approaches to ensure representation and participa-
tion of different groups in the community, especially women, girls, and other vulnerable populations. The use of Local
Promoters aims to reduce the workload on CHVs and explore the possibility of using Local Promoters and natural
leaders as community sales agents for WASH products and services.

An iterative process As part of the BCD process, the team will evaluate BC tools and methods every 6 months.
This process will also identify the need for any additional research on behavioral determinants and inform the develop-
ment of specific research questions to explore within the context of the RANO-WASH behaviour change approach.

CONCEPT CASE STUDY

Grow Up: A Leading Household

To tap into positive motivators of pride, status and self-
esteem among women and households, the program de-
veloped the reward concept of a “Leading Household.”
Households earn a sticker when they practice and sustain
one of RANO-WASH’s six key behaviors. Local promoters
and CHVs verify behavior practice over 06 household visits.
Households seek to earn all 6 stickers and complete the
Leading Household “flower,” which is displayed outside
their home.

RANO WASH is a USAID-funded project implemented by CARE in consortium with Catholic Relief Services, WaterAid
and two private sector partners, Bushproof and Sandandrano in 250 rural communes in Vatovavy Fitovinany,
Antsinanana, Amoron’i Mania, Haute Matsiatra, Vakinakaratra, and Alotro Mangoro regions in Madagascar