Andilaye "Togetherness"

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 executed the Andilaye Trial which was 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 – addressed 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 operated 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, included 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).

Publications:

1. Quantifying Factors Associated with Personal Hygiene as Measured by the qPHAT Methodology: Andilaye Trial, Ethiopia (2023)

2. The impact of a demand-side sanitation and hygiene promotion intervention on sustained behavior change and health in Amhara, Ethiopia: A cluster-randomized trial (2022)

3. Development and reliability of a quantitative personal hygiene assessment tool (2020)

4. How Do Rural Ethiopians Rate the Severity of Water Insecurity Scale Items? Implications for Water Insecurity Measurement and Interventions (2020)

5. 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)

6. Collective Efficacy: Development and Validation of a Measurement Scale for Use in Public Health and Development Programmes (2018)

7. Quantifying user preferences for sanitation construction and use: Application of discrete choice experiments in Amhara, Ethiopia (2018)

8. Maintaining behaviour change: innovations in demand-side sanitation and hygiene interventions (2018)

Materials:

• Andilaye Intervention Manual

Briefs, reports, case studies:

• Project summary

• Behavioral theme problem and solution trees

• Report: Exploring the barriers and facilitators to improved WASH behaviors in Amhara, Ethiopia

• Report: Andilaye Project Intervention Design Workshop

• One year follow-up: Summary of findings and recommendations

• Report: 2018 Policy Influence Plan Update

• Report: Endline grantee report

In the press: 

• Emory University: Emory Global Health Connection - Building bridges for better health

• World Bank: Ethiopia: The Impact of Enhanced, Demand-Side Sanitation and Hygiene Promotion on Sustained Behavior Change and Health in Ethiopia

timeline

2017-2019

Study Location

West Gojjam and South Gondar Zones of Amhara, Ethiopia

Target Population

Rural and peri-urban households

Principal Investigators

Matthew Freeman (Principal), Abebe Gebremariam Gobezayehu (Local Co-PI)

IMPLEMENTING partners

Amhara Regional Health Bureau

Funders

World Bank, The Children's Investment Fund Foundation (CIFF), International Initiative for Impact Evaluation (3ie)

Project Staff

Mulusew Belew, Maryann Delea, Siraj Mohammed, Gloria D. Sclar, Jedidiah Snyder, Mulat Woreta, Kassahun Zewudie

Co-Investigators

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

Enumerators

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

Artist

Laughing Gas Design: Yemi Yetneberk