Long Read

WASH and Eliminate – How evidence-based improved hygiene combats neglected tropical diseases

On November 23, Simavi’s WASH programme officer, Selma Hilgersom, will be attending The International Society for Neglected Tropical Diseases conference (ISNTD Water 2017) in London. She is there on behalf of Sightsavers and Simavi to give a joint presentation focusing on innovative approaches to preventing neglected tropical diseases (NTDs), specifically trachoma. Selma gives a sneak preview of her presentation.

“More than one billion people are affected by neglected tropical diseases (NTDs),” Selma says. “These are a diverse group of water-related communicable diseases that prevail in tropical and subtropical conditions[1]. A large number of problems are related to NTDs varying from anaemia to blindness. The good news? We can do something about it!”
In her presentation Selma will focus on how Simavi approaches this in theory and on the ground.

Trachoma in Tanzania

In addition to mass drug administration and providing treatment, NTDs can be controlled and eliminated by improving sustainable WASH infrastructure and promoting good hygiene practices. The latter course of action is the focus of Trachoma in Tanzania, a programme that Simavi has developed and implemented in close cooperation with Sightsavers.

Trachoma is an NTD prevalent in 41 countries. It spreads from person to person in lots of ways, like physical contact, clothing and through flies. Together with local partners Ileje Environmental Conservation Association, Peoples’ Development Forum and Community Aid and Small Enterprises Consultancy, Simavi implements the Trachoma F&E Programme to prevent the further spread of trachoma by changing behaviour towards good personal hygiene and environmental sanitation practices within the project areas.

F&E refers to two components of the Trachoma SAFE (Surgery, Antibiotic, Face Washing and Environmental Sanitation) strategy, developed by the World Health Organisation. Within our programme, we focus specifically on the Face Washing and Environmental sanitation components.

The programme’s aim is to develop and test four key interventions that contribute to improved hygienic practices at school

  •  WASH in schools;
  •  Integrating Trachoma in the school curriculum;
  •  School-Led Total Sanitation;
  •  Social Marketing

All activities are implemented in close cooperation with Helen Keller International in Tanzania, which focuses on increasing the uptake of face washing and general hygiene practices in communities within the F&E programme coordinated by Sightsavers. Testing the interventions leads us to the second key point of Selma’s presentation: evidence programming.

Evidence Programming

Simavi has been implementing WASH interventions for more than 90 years, a body of work that has provided a solid base of knowledge and experience. However, in a rapidly changing world where context-specific factors play an important role, it is vital to also have a good understanding in what works, and why. This feeds into designing effective programmes and thereby creating lasting change.

Simavi has recently started working with various Research, Development & Innovation organisations to measure our impact more scientifically. An example of this are the randomized control trials (RCT) on Simavi programmes that are conducted in cooperation with the Impact Centre Erasmus. The lessons learned from the RCTs are used to create prototype interventions that have shown to be successful in the past.

However there is no ‘one-size-fits-all’ approach for implementing successful programmes. Co-designing the interventions together with the ‘end-users’ is essential to ensure that all stakeholders are involved and that the programme design is tailored to the needs of each community. That’s why evidence programming also requires healthy criticism and flexibility. If, for example, the early engagement with communities indicates that a non-evidence approach is the best option, then this could be an opportunity to gain insight into new successful approaches.

Essentially, this means that we, and everybody involved in combating NTDs, need to question, explore and gather evidence to test if what we’re doing is correct. As Selma says, “If you always do what you have always done, you might never find what works better.”



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