Posted by: Wasrag | April 10, 2013

Rotary Club Handwashing Program in the Dominican Republic

Rotary Handwashing Campaign in the Dominican Republic

Handwashing Station

Handwashing Station

Question:  what’s the most-effective, least-expensive way to reduce disease and save lives in Developing Nations?

In other words, what health intervention can give us the “biggest bang” for Rotary’s “humanitarian buck?”

Almost everyone is surprised to learn that handwashing:

  • Can save 5% more lives than point-of-use water treatment, like water filters, chlorination, and solar pasteurization.
  • Can save 12% more lives than latrines.
  • Can save 33% more lives than treated public water.

In fact, some researchers say that “handwashing with soap could be thought of as a ‘do-it-yourself’ vaccine.”  Others have concluded that handwashing is “the single-most, cost-effective, health intervention” known – bar none.

Pneumonia, a respiratory disease, is the world’s greatest child-killer.  Diarrheal diseases follow right behind.  In fact, these two account for 64% of all childhood deaths, globally.  (And there’s still malnutrition.)

But international studies show that a well implemented handwashing campaign can:

  • Reduce diarrheal diseases by over 40%.
  • Reduce respiratory infections (including pneumonia) by 30%.
  • Reduce substantially the deaths from malnutrition caused by diarrhea and nematod infections.

That’s three strikes against three killer diseases.

But wait.  There are also some bonuses.  Handwashing can also:

  • Reduce death from infections at birth.
  • Reduce skin infections.
  • Reduce eye infections.
  • Reduce co-infections and disease progression of HIV/AIDS victims.

It’s just a fact.  What is on your hands can make you sick!

So what do we do?

We call it “The Big Three.”  Wash your hands:

  • After the toilet and after changing the baby.
  • Before preparing food.
  • Before you eat.

Simple!  No rocket science required.

Well, it’s not quite so simple.  Personal and cultural habits die hard.  Changing public behavior is treacherous and takes time.  So how are we going about it in District 4060 —  Dominican Republic?

Our strategy is to leverage up Rotary’s efforts by using schools to teach students and penetrate communities.  The work and funding that Rotary puts into a handwashing project through the schools puts into motion a process of training and behavioral support that can last for years.  That’s real leverage!

There are 13 countries that have national handwashing campaigns.  Mega millions of dollars are going into those campaigns from The World Bank, UNICEF, national governments, and the like.  These campaigns tend to work from the top down.  Rotary does not have mega millions to spend, but Rotary is very, very good at what it does – working from the bottom up.  Person-by-person, family-by-family, school-by-school, village-by-village.

So with a “little” we can leverage up to get a “lot” of bang for the buck.  How do we do that?

We start with the principals of individual schools.  We convince principals that reducing diarrhea is good for the school and good for the families of the students.  That’s not hard to sell.  Then we enter into a contract with the principals:  “here’s what we will do” and “here’s what you will do.”

Kids Learn Quickly!

Kids Learn Quickly!

Then the principals assign at least two teachers from their schools to be trained and certified to teach hygiene and handwashing to the classes in those schools.  We conduct workshops to train and certify these teachers.  And We provide classroom teaching materials.  And we provide handwashing stations because most schools do not have lavatories and the lavatories in those that do rarely work.

The teachers return to their schools and set up a schedule with their principals to teach all the classes in a school.  We have some schools with 16 students, but some have 3,000 students.  The teachers file certified reports showing us what classes they have taught and how many students were in each class.  This gives us documentation for project evaluation.

Adults Learning Too

Adults Learning Too

But, human nature being what it is, we also find it wise to have a monitor to visit the schools.  First, we want to be sure we provide support and solve any problems they have.  Second, we want to make sure they are in compliance with our contract with their school – that is, that they are, in fact, teaching students as they were trained to do in the workshops.  Third, we want to see if there are qualitative improvements in student health.

This campaign started in November, 2012.  Already we are getting good anecdotal evidence that absences from diarrhea are coming down and that some skin diseases are abating.

Where are we headed with this program?

Our goal is to make this a national campaign.  Rotary literally has the opportunity to change the face of a nation by improving the health of its children – children who deserve to live, today, and who will be the nation’s adults, tomorrow.

The early phases of this Campaign are for building a successful model to launch it nationally.  When we have a tested operational model and a stable campaign of broad scope in the Dominican Republic, then we plan to launch a similar campaign for our neighbor, Haiti.

The Rotary Foundation and District 6310 (N.E. Michigan, USA) have been pioneers with us in starting this Campaign.  But it will take many, many clubs and districts to have a national program.  We Need You!

If this approach to reducing disease and saving lives gets you excited, please let us know.  We will email you a Power Point presentation (in English or Spanish).  Then we can (a) design a program that fits your district’s goals and capacities and (b) work with you to prepare a grant application.

In English, send your questions to:

Charles Adams

In Spanish, send your questions to:

Dra. Alexandra Martinez

To learn what it’s like to work with us, send your questions to:

David Morgan, Chair of the WASH Committee, District 6310:

Peace Through Service – La Paz a Través del Servicio.

Charles Adams

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Responses

  1. Hello, We admire your commitment to reduce these diseases and save lives. We do have some questions. Perhaps you can answer these or refer us to reference sources. <For the handwashing program, what is the source of the water for the student population to use at "The Big Three" times? <what type of soap is used and how is it supplied, and secured for the regular handwashing at the schools? <what is the cost of your handwashing program per school?

    <Could you refer me to the research/method from which you drew the statistics about handwashing efficacy to control disease as compared to provision of drinking water and filters or providing latrines?

    We have worked/volunteered for an NGO for over 10 years in Kenya at schools. We are very interested in other organizations who are providing assistance in water development. Mark and Diane Reimers

  2. Mark & Diane. Very useful questions. I’ll take my best shot at them.
    1. We don’t have much control over water quality for washing hands. Some schools have abundant and reasonably good water from the village aqueduct. Others are lucky to have any water at all. Same for homes. While we train students and families about the dangers of contaminated water and urge people to use the cleanest water available, whether in schools or homes, they use what they can. That said, it’s reasonable to believe generally that hands are cleaner after having been washed with soap, regardless of water quality.
    2. The type of soap appears to be immaterial. The role of soap is not to kill microbes. In fact, it’s reasonably well know that anti-microbial soap is not more effective than regular soap even in First-World countries. The role of soap is to cause the oils on the skin to release the microbes so that they can be washed away. In fact, wood ashes will do the same thing if soap is not available – as several studies will attest. We use about the cheapest soap we can find, typically laundry soap.
    3. The supply of soap, and its security, is always an issue. While some studies show that washing without soap has benefits, the greater benefits clearly occur when washing with soap (or ashes). Once principals and teachers are firmly on board with the program, there is more attention paid to the need for soap. Cheap soap is not very expensive in almost any country. But theft becomes a problem. We put our soap in the small nylon net bags like you buy onions or potatoes in and secure these bags to handwashing stations. This way, a student can wet his hands, handle the soap through the bag, lather, and rinse. If the handwashing location is in a visible, public place in the school, the opportunity to steal the soap is reduced. However, we do not provide a handwashing station unless the school signs an agreement to assign a responsible student, every day, to monitor and maintain the station throughout the day and to report any malfunctions, vandalism, or thefts. The school also agrees to impose sanctions upon any student jeopardizing the health of another student by damaging the handwashing station.
    4. The cost per school of our handwashing program is still a moving target as we continue to build a successful model and refine it for scaling up. The budget line items in grant applications are clearly changing each step of the way. While simple in concept, there are hundreds of moving parts to any significant project like this. We do not believe an effective project of this kind of any significant size can be initiated and supported exclusively by volunteers or in a decentralized way. Accordingly, we use professional trainers that have standing in working with principals and teachers for the original training. We have a paid coordinator who schedules meetings, workshops, does follow up, collects data, etc. We have a program to boost public awareness of handwashing that involves signs, banners, newspapers, radio and TV. All of this takes place under centralized management. In a $25,000 grant, we work with about 100 schools, train and certify about 200 teachers for classroom teaching, provide classroom training materials, and train about 500 families. Increasingly, however, we are having to put more resources and better systems in place to support what we have started and to get accurate data. (By the way, when starting a program in any particular school, we require that school to sign a contract that clearly sets forth what we will do and what the school agrees to do. This helps clarify our respective responsibilities as time goes along.)
    5. A couple of references for the efficacy of handwashing compared to other health interventions:
    a. Lorna Fewtrell, Kaufmann R.B., Kay D., Enanoria W., Haller L., and Colford, J.M.C., Jr. 2005. “Water, sanitation, and hygiene interventions to reduce diarrhoea in less developed countries: A systematic review and meta-analysis.” The Lancet Infectious Diseases, Vol. 5, Issue 1: 42-52. Also, Curtis, V. and Cairncross, S. 2003. “Effect of washing hands with soap on diarrhoea risk in the community: A systematic review.” The Lancet Infectious Diseases, Vol. 3, May 2003, pp 275-281.
    b. Jamison, D.T., Breman, J.G., Measham, A.R., Alleyne, G., Claeson, M., Evans, D.B., Jha, P., Mills, A., & Musgrove, P., eds., 2006. Disease Control Priorities in Developing Countries, 2nd ed., Oxford UP.
    It is not always easy to access the scientific literature directly. Thus the results of the above literature are cited on pages 14 and 15, here:
    http://www.wsscc.org/sites/default/files/publications/ppphw_planners_guide_global_handwashing_day_2008.pdf
    6. By separate email, I’ll send you a Power Point presentation where, in the “Comments” sections below the slides, the scientific literature is cited in support of the various points we make in the article. Anyone may get a copy of this Power Point who requests it.
    7. Our intent is to create a robust operating model for a handwashing campaign on a fairly substantial scale, starting in the Dominican Republic. Our broader goal is to make this model available and to assist humanitarian efforts in other countries so that wheels do not have to be reinvented. In all of this, we are deeply indebted to The Rotary Foundation and the “early-adopter” districts and clubs who have seen the vision clearly.
    I’d be happy to provide any additional information we have that you would find useful.
    Charles Adams
    District 4060
    Dominican Republic

  3. […] Below is from a blog post from the Water & Sanitation Rotarian Action Group: […]

  4. I’d like to help sponsor and promote through my club and through a non profit church organization. I will be there the first week of August and would love to speak to domrkne from 4060 while I’m there who can I contact?

    • Sorry someone

    • Dear Mr. Canchols:
      Many thanks for your interest in WASH activities in the Dominican Republic. Diarrhea is still one of the top killers of children under five in the DR so we can use all the help we can get.
      We’d love to connect with you when visit. My wife, Dr. Alexandra Martinez, is the District Governor, this year. Her district duties will be greatly diminished after July 1 so we will be able to devote even more time to the Handwashing Campaign and the new water filter. We’ll be happy to explore your interests.
      Your schedule may pose something of a problem for us, however. We are scheduled to be in the U.S. late July/early August, although the exact dates are not yet confirmed. Should our schedules not coincide, we’ll be sure to arrange meetings for you with Rotarians here who can discuss our challenges and your interests. In the meantime, we can continue communicating by email to do the same.
      By separate email, I’ll send you additional information on the Handwashing Campaign and on the new water filter we have introduced in the DR.
      Peace Through Service.
      Charles Adams

    • Mr. Canchols…..I’ll need your email address to send the additional materials…..CFA

  5. I am involved in a series of Rotary projects in northern Tanzania including sanitation. Can you recommend materials/curricula for teaching effective hand washing practices for primary and secondary students?
    Thanks,
    Walt Schafer

    • Dear Walt: The Centre for Affordable Water and Sanitation Technologies ( http://www.cawst.org) is one of the premier organizations in training for water and sanitation. Here is a link to a series of their posters, some of which you would find applicable to hygiene and handwashing:

      http://resources.cawst.org/package/water-sanitation-and-hygiene-poster-set-trainer-guide_en

      And you can learn more than you’ll ever need to know from the Public-Private Partnership for Handwashing (PPPHW). Try these links:

      http://globalhandwashing.org/sites/default/files/Handwashing_Handbook.pdf and more briefly

      http://globalhandwashing.org/sites/default/files/Global_Handwashing_Day_2nd_Edition.pdf

      If you need anything more, let me know. I can share bits and pieces from our Rotary Handwashing Campaign in the Dominican Republic. Vive Rotary! Cambia Vidas! Charles

      On Fri, Nov 1, 2013 at 1:28 AM, Wasrag (Water & Sanitation Rotarian Acti

    • Walt:
      I replied earlier about your request for teaching materials for handwashing. However, it occurred to me that your projects may also include water. If so, you may be interested in the new hollow-fiber membrane water filter being introduced in the Dominican Republic, Haiti, and Honduras. We believe it to be superior to other household filters commonly used in Rotary projects.
      If you are interested, let me know and I can send you some materials.
      Charles


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