Background
To achieve basic sanitation in developing nations, the rate of progress must increase from an estimated 0.7% to 5% per year—a seven-fold increase. One of the key questions in rural sanitation is how effective different promotion methods are at creating significant behavioral change, and how long those new habits actually last.
Successful sanitation and hygiene approaches cannot rely on one-off campaigns. They must combine effective communication, long-term community engagement, durable construction materials for household facilities, strong local demand, and local governance to reinforce these new practices over time.
VHV
Water for Good’s Vision of a Healthy Village (VHV) approach combines the three pillars of WASH—water, sanitation, and hygiene—to improve health and well-being. The VHV is a three-year project cycle that implements WASH activities within specific geographic areas to achieve 85% basic water access and 90% sanitation coverage.
We provide education to transform behaviors across an entire community through Public and In-Home WASH Trainings. Water for Good starts with Community-Led Total Sanitation (CLTS) to spark collective decision-making. This is followed by house-to-house sanitation and hygiene education, as well as a series of village community conversations to bring about practical changes and lasting habits.
A unique feature of the VHV model is its focus on household-level engagement. Every household in a community is targeted with behavior-change activities, establishing clear and attainable goals like Healthy Home certification and community-wide Open Defecation Free status. We equip families with the knowledge and skills needed to construct their own Healthy Home components, including:
- Improved latrines built with dignity
- Handwashing stations
- Drying racks and clean compounds
- Bathing shelters
- Safe drinking water and safe water storage
Once families meet all of these Healthy Home standards, our teams visit to verify their progress and record each certified home in the project area using mWater. Sustaining these improved behaviors depends entirely on the quality of the knowledge, skills, and attitudes gained by the communities. To reach the wider community and reinforce these changes, Water for Good recruits and trains a workforce of local community volunteers called “WASH Facilitators” to model and promote Healthy Homes in their respective sub-villages. We also work with local social groups, including churches, to establish mechanisms for WASH promotion, monitoring, and enforcement that last beyond the project’s lifetime. Our field teams and community facilitators use standard Water for Good manuals and curricula to guide the implementation of these programs.
Impacts of the VHV Approach
At Water for Good, we engage communities over the long term (1.5 to 3 years) rather than running short-term campaigns. We monitor behavioral slippage, not just project outputs and immediate results.
Our team measures key indicators in strict alignment with national and global WASH standards, including the availability and use of improved household sanitation facilities, handwashing at critical times, and safe water storage. These indicators are assessed at baseline, endline, and two years after the project period ends.
Our data from three countries (Cambodia, Ethiopia, and Uganda) reveal that the VHV approach is highly effective, not only in bringing significant sanitation and hygiene improvements, but also in sustaining those changes two years after the projects were closed. Most notably, across all of our endline evaluations since 2016, we have observed a median reduction of 90% in childhood diarrhea cases in areas that have completed VHV.
Observed household improved sanitation in three countries
Median handwashing in three countries
Take-Aways
- Sanitation behavior change is an evolution, not an event. It requires long-term social and institutional transformation.
- Engage communities deeply, widely, and for a sustained duration.
- Focus on changing long-term habits rather than mere project outputs, making improved sanitation and hygiene the norm for the community.
- Use objective data to drive lasting WASH changes.
By Zerihun Hailu
