Maintaining behaviour change: innovations in demand-side sanitation and hygiene interventions

This paper explores innovations in demand-side sanitation and hygiene intervention design and implementation. These innovations build on approaches employed by Community-Led Total Sanitation and Hygiene (CLTSH) programming to sustain improved WASH behaviours. Through an iterative process, our team conducted formative activities in Amhara, Ethiopia to: 1) generate information regarding stakeholders’ experiences with the government’s Health Extension Package (HEP) and previous CLTSH programming, and 2) explore options for intervention design and delivery. Our results suggest in some cases, community members were willing to engage in demand-side sanitation and hygiene programming after having negative experiences with ineffectual CLTSH triggering. Health Extension Workers (HEWs) indicated that high demand is placed on them to deliver the 16-component HEP. We conclude that what is needed are demand-side approaches that: 1) engage more community-level change agents, 2) include plans and resources to provide community actors with supportive supervision and on-the-job-training, and 3) focus on behavioural maintenance.