Millions of people in Ethiopia are at risk of neglected tropical diseases (NTDs), and the Government of Ethiopia has made control and elimination a priority. Amhara is a region of Ethiopia in which several NTDs are hyperendemic, and behavioral slippage of water, sanitation, and hygiene (WASH) practices (i.e., relapse to unimproved WASH practices) is common.
Emory University and its government partners are executing a three-year assessment of the effectiveness of an enhanced, demand-side sanitation and hygiene intervention called Andilaye on sustained behavior change and health in Amhara, Ethiopia.
The intervention – informed by rigorous, theoretically-driven formative research – addresses issues related to over-extension of Health Extension Workers and over-saturation of Health Extension Package messaging through the engagement of additional community change agents as mechanisms for intervention delivery. The overarching intervention motto, “Together we can be a strong, caring, healthy community”, and related intervention components offer an aspirational message that emphasizes the need for collective action to make positive change in one’s community.
The intervention focuses on three behavioral themes, informed by formative research: (1) sanitation, (2) personal hygiene, and (3) household environmental sanitation. Within these themes are eleven specific behaviors and practices that are targeted by the intervention.
Intervention activities operate at four levels – district, community, group, household – and employ a variety of behavior change catalyzing and maintenance techniques, with intervention components that tap into a wide-range of motives to address behavioral antecedents and determinants at various levels of influence. Key activities, amongst others, include community mobilization and commitment events, community conversations (guided by the Andilaye community conversations facilitator flipbook), and household counseling visits with caregivers (guided by the Andilaye ‘Gobez!’ [good job!] flipbook and household goal card).
Design of a parallel cluster-randomized trial assessing the impact of a demand-side sanitation and hygiene intervention on sustained behavior change and mental well-being in rural and peri-urban Amhara, Ethiopia: Andilaye study protocol (2019)
Briefs, reports, case studies:
In the press:
West Gojjam and South Gondar Zones of Amhara, Ethiopia
Rural and peri-urban households
Matthew Freeman (Principal), Abebe Gebremariam Gobezayehu (Local Co-PI)
Amhara Regional Health Bureau
World Bank, The Children's Investment Fund Foundation (CIFF), International Initiative for Impact Evaluation (3ie)
Mulusew Belew, Maryann Delea, Siraj Mohammed, Gloria D. Sclar, Jedidiah Snyder, Mulat Woreta, Kassahun Zewudie
Emory University: Tom Clasen, Craig Hadley, Bethany Caruso, Deb MacFarland, Hiwote Solomon, Frederick Goddard. Oregon State University: Kenneth Maes, Yihenew Alemu. University of Reno, Nevada: Joshua Garn. Amhara Regional Health Bureau: Tenagnework Antefe
Adanech Admasu, Asayech Bimrew, Ayalnesh Belay, Balemlaye Addisu, Destaw Asnakew, Eleni Nebiyu, Mahider Adamu, Maritu Yibrie, Mulubirhan Shitu, Rahel Tsegaye, Selamawit Abebe, Senait Mulualem, Sintayehu Wasihun, Tibeltalech Mihiret, Tigist Abebe, Tigist Bitew, Tirusew Alayu, Tiruzer Engidaw, Woyneshet Genetu, Yeserash Gashu, Yeworkwuha Abay
Laughing Gas Design: Yemi Yetneberk