Day 45: Key Takeaway Recommendations for Hagar

When looking at our results, nearly all users are satisfied with the Biosand filter, for it saves time by removing boiling and acquiring firewood as necessary procedures. Interestingly, a large proportion of the users desired more structured hygiene and sanitation teachings from Hagar. The in-depth interview provides an exploratory perspective that should be further tested. Because the pool of interviewee is small, these following recommendations should only be considered following a well-designed survey with a larger sample size.

1. The villagers will benefit from using soap to wash their storage containers at all times. To achieve this, they must receive additional information from Hagar. Currently, families interviewed are concerned about residual soap in their drinking water. A sizable portion of the families do not feel that they have good grasp of cleaning themselves. Hagar should educate these families about the difference soap makes and, how often to clean the storage filters.. In addition, these families can even be introduced to using bleach in cleaning the storage container. While it may be a tall task to change behavior, with visual illustrations, numerical facts, and personal accounts, it is possible to offer these families detailed step-by-step instruction about cleaning the storage in a brochure.

2. Villagers using the Biosand filter will also benefit from using a transparent filter that gives clear indication for algae growth. With an exception to the concern that the container might be more fragile by subject 2, all of families interviewed expressed positive opinion to its adoption.

3. We believe that villagers can benefit from more active participation in the learning program before filter installation. This active participation comes from both villagers and Hagar. Villagers must engage more family members to show up, as they will distribute the work load to their families eventually. On the other hand, Hagar conducts a group activity with its volunteers . Similarly, Hagar may offer such problem-based learning to her users.

4. Villagers will benefit from learning about when and how to clean the spout. Currently, it is unclear to users whether one should use soap for this particular safe practice. While most claim that it is cleaned almost as often as the storage container, it is clear that it is not the case. Thus, we recommend incorporating step-by-step instructions on cleaning the removable spout as well.

5. Villagers will benefit from a more concrete, comprehensive, multimedia instruction of cleaning the storage container and spout. Currently, Hagar’s multimedia education focuses on Hagar’s presence and the advantages the Biosand filter provides. However, all information about cleaning the storage container and spout are provided at the time of installation. Nearly half of the users do not believe that they have a firm grasp on cleaning the filter and the storage container. For example, the fact that the spout is removable remains elusive and this can be clarified so that users can easily clean them.

6. Villagers will lastly benefit from multimedia instructions on hygiene. Currently, the promotional video does not contain such information. Most of the hygiene information is given at the promotional meeting, after the multimedia video by Hagar staff. If safe hygiene practice, such as when to wash their hand, is given by multimedia instead, Hagar can better demonstrate its significance. We suggest 6 and 7 to be done in a second meeting after the filters are installed.

7. It is implausible to not have the task of cleaning the storage container and spout be assigned to another family member different from the one that participated in the promotional meeting. Therefore, we believe that it may be beneficial to assess rather than demonstrate safe cleaning practices and hygiene at follow-up meetings. We recommend researching the applicability of approaches like having Hagar staff observe and correct user practice if necessary and offering information on acquiring soap.

8. Hagar may facilitate its learning program by partnering with organizations that specialize in health education and utilizing volunteers from such sources. It seems from our interviews that World Vision has provided regular hygiene education to selected families. Cooperation with such organization may help result in more effective education material for users.

9. It may be a boon for Hagar to include incentives so that the staff can make sure that users return for an optional second meeting and understand the washing and cleaning the filter completely. A measure could be to charging $1 more upfront and returning that upon successful completion of the program.

10. Lastly, we recommend testing whether an inexpensive water quality intervention can be adopted here. When family subjects use sodium hypochorite in a Zambian study, 69% of water samples had no detectable growth of E. coli. CDC and Pan American Health Organization have developed a simple, inexpensive, and easy-to-disseminate intervention to improve drinking water quality and hygiene in developing countries. These interventions include 1) point of use water disinfection with a sodium hypochlorite solution produced locally using appropriate technology, 2) durable, plastic storage, and 3) community education about diarrhea and proper use of the intervention. While resistance behavioral change is an initial concern, subjects in their field trial showed high compliance (89.2%). A majority interviewees in our study have said they are open to this idea. Less cleaning work and improved education on the above may encourage them to adopt this practice. However, the willingness of the target population to pay for these elements and to change their lifestyle should be assessed further.