During 2021 and throughout the COVID pandemic, the Oxfam Handwashing Station (OHS) has been tested at scale with 2010 kits supported by the Humanitarian Innovation Fund (HIF) deployed in refugee camps, host communities, schools, health facilities and other public locations in Bangladesh, DRC and Ethiopia. The purpose of this scaling project was to determine the acceptability and feasibility of the new station design in promoting handwashing practice across the three countries.
Working with the London School of Hygiene and Tropical Medicine (LSHTM) and research institutes in each country (icddr,b, ISDR and the Gambella Regional Health Bureau) we have collected data on the use, maintenance and satisfaction with the OHS. Data has been collected at three points; baseline, midline and end-line to allow for a comparison of results over the 6 months from the OHS installation to the end of September 2021.
Users were consulted throughout to ensure that communities’ needs and preferences were incorporated into the project. Decisions on the locations of each OHS, height adjustment for children and people with physical disabilities, as well as installation at specific sites (markets, schools, and health centres) and decisions over care and maintenance for the facilities were led by users themselves. We believe that this approach contributed to a high level of satisfaction and sense of ownership at the end-line of the project, with 96% of users reporting they were satisfied with the OHS, and between 95% (Ethiopia) to 100% (Bangladesh) of those surveyed saying it was easy to use. The design of the OHS itself aims to drive uptake among all users through design features such as the bright colors, flexibility to adjust heights for different groups including children, mirrors, and the twin compartments for soapy water and water.
This consultation process also contributed key learning in each context. For instance, in Ethiopia, most households preferred to bring the OHS in their houses at night to protect from vandalization, prompting the WASH team to build protective shelters for those OHS that were sited next to family latrines (see picture). In DRC, users preferred local padlocks with keys to close the water tanks, rather than the numeric code padlocks that are supplied with the kits, due to lower literacy levels.
The project also used Mum’s Magic Hands as a promotional approach for handwashing behaviour. Mum’s Magic Hands uses small group discussions, storytelling and emotional motivators which enabled open discussions on barriers to handwashing among users. Activities were conducted using culturally appropriate materials and information in the appropriate local language, which enabled people’s understanding about the importance of handwashing. Caregivers, mothers and other groups especially resonated to the story and the activities which triggered action on handwashing in their households and community. One of these activities included placing stickers in prominent places as reminders of key moments for handwashing, and we were pleased to see many of these had been added to the OHSs (see picture).
At the end of the project, the combination of increasing access to handwashing facilities through the large-scale distribution of the OHS and the promotion of positive handwashing behaviour through the Mum’s Magic Hands approach, resulted in increases of observed handwashing with soap of 47% in Bangladesh, 58% in DRC and 14% in Ethiopia. The results of the large scale pilot were overwhelmingly positive, and show that the OHS can make a substantial impact in increasing handwashing rates in emergency contexts.