Important gaps in knowledge related to current sanitation and hygiene programming, and effective approaches for intervention delivery exist – in particular, the effectiveness of these types of interventions in fostering progressive and sustained NTD-preventive, WASH-specific behavioral adoption and maintenance at the community level, and the corresponding impacts on mental well-being. With research grants from the World Bank’s Strategic Impact Evaluation Fund (SIEF), the International Initiative for Impact Evaluation (3ie), and the Children’s Investment Fund Foundation (CIFF), Emory University and its consortium partners launched a three-year impact evaluation, designed as an ex-ante parallel cluster-randomized, controlled trial (RCT) with a preliminary formative research phase to generate evidence to fill in these knowledge gaps. The purpose of the three-year Andilaye project is to use formative research findings to inform the integration of NTD components into existing community-based WASH behavior change approaches (CLTSH, and the HEP more generally) in Ethiopia, and to evaluate the effectiveness of such an intervention on sustained behavior change and mental well-being. The study’s intervention arm includes households from targeted villages (i.e., gotts) within randomly selected sub-districts (i.e., kebeles) receiving the Andilaye intervention. This intervention consists of an integrated sanitation and hygiene programming approach that is enhanced through the incorporation of NTD-preventive components as well as community-oriented behavior change and maintenance strategies facilitated through the leveraging of positive motives. The counterfactual arm includes households from targeted villages (i.e., gotts) within randomly selected sub-districts (i.e., kebeles) receiving the GoE’s current standard of care WASH programming (i.e., current CLTSH programming).
The main objectives of this work involve an examination of change along our hypothesized, yet evidence-based Andilaye Theory of Change, and include the following: 1. Determine the impact of Andilaye’s enhanced and integrated WASH-NTD intervention on NTD-preventive sanitation and hygiene-related behavioral antecedents (e.g., internalized risk and capability perceptions, attitudes, and norms), intermediate outcomes along the causal chain; 2. Explore whether the promotion of the Andilaye intervention leads to an increase in the uptake, maintenance, and exclusive use of sanitation facilities and improved personal hygiene behaviors, behavioral outcomes along the causal chain; 3. Investigate whether changes in personal hygiene, sanitation, and water behaviors are sustained; 4. Examine whether the integration of official hygiene and other NTD-preventive promotion and monitoring as a component of demand-side sanitation and hygiene programming results in behavioral benefits for NTD prevention and mental well-being, the impacts of interest the terminal end of the causal chain; and 5. Assess whether collective efficacy and water insecurity modify intervention effectiveness.
As indicated above, the study assesses and tracks changes in sanitation and hygiene-related indicators along the causal chain, including behavioral antecedents (e.g., attitudes, capabilities, collective efficacy, norms), contextual changes in household conditions that may facilitate habituation of improved behaviors (e.g., improvements in conditions of household sanitation and hygiene), and behavioral outcomes. We are also measuring and tracking changes in hypothesized behavioral mediators such as water and sanitation insecurity, and health impacts including respondent-reported diarrhea and mental well-being at multiple time points. We are examining behavioral antecedents and other behavioral mediators to establish causal determinants of behavioral change and maintenance over time and identify mechanisms that lead to behavioral change. There is utility in employing such an approach, as it will help us determine not only if, but how, and why the intervention was successful, and in which contexts. As part of this evaluation, we are developing and validating novel metrics and frameworks to track key outcomes along the causal pathway (e.g., behavioral antecedent indicators; innovative, objective facial and and cleanliness indicators; sanitation insecurity, water insecurity, and collective efficacy scales refined and validated during the course of this study).