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Change does not depend only on the will of the individual or community; it needs trial and tested methods to find the best solution. Just like owning a lot of books is not enough to improve the intellect. A curious mind, time and leisure to read, a will to put in the effort towards reading or even a book club with whom reading is more enjoyable are just as important as access to books. A medley of influences makes a habitual reader. Similarly, the infrastructure of a toilet is not enough to encourage people to develop sanitary practices. Yet specific coaching on these practices and uptake by the most influential members of a group, can set change into motion.

This area of work is called Water, Sanitation and Hygiene (WASH). A holistic approach to water and sanitation that goes hand in hand with improvements in the personal and community hygiene of a region. It involves not only investing in the infrastructure like piping, toilets and taps and in improving maintenance of the infrastructure but also comprises bringing about behavioral change in the people to voluntarily adopt better hygienic practices that will improve their collective health.

For a long time, it was believed that hand pumps were not being repaired because the technology was too complicated for the villagers. Yet, they operate motorcycles that are much more complicated than pumps. It was also thought that people were too poor to pay for water services. Yet in the villages almost every household has a telephone, and no one was trained for their use or received financing for them. And the money spent on communications far exceeds what would be needed to maintain a hand pump. The problem may simply be the quality of service. When people have the tap at home, they are ready to pay for keeping up the service!

Community-led total sanitation (CLTS) is one of the brilliant 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.

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 and the content reflects his experience and knowledge on the subject. The CLTS method, he 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.

"The JIKURA project is different from those we’ve seen before. Their only condition is that decisions are taken in a participatory and consensual way. Representatives from all the villages are present in the municipal meetings to discuss the issues and how to overcome them" Kelessabali Doumbia, Mayor of Faradièlé

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.

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. We might resolve to read more but eventually fall back to visual media for entertainment and information. Just knowing that focused attention while reading is much better and having multiple books to choose from, is not enough. 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 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.

"Once the blocking factor is identified, we choose different interventions that will specifically address this factor. For example, we directed plays that were enacted by the people to show respect and appreciation for people who did wash their hands." Fatoumata Kone, JIKURA advisor

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.