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Behaviour change determinants, the key to successful WASH strategies
Dany Egreteau

The A.B.C.D. approach (Approach focused on Behaviour Change Determinants) is an anthropology-based approach developed by SOLIDARITES INTERNATIONAL. It is used to develop WASH operational strategies aiming at an optimal and sustainable impact on the reduction of water-borne diseases. It involves studying WASH behaviours along with the socio-cultural and economic determinants of these behaviours. As an example, we present the results of a study carried out in June 2014 in a peri-urban neighbourhood of Kinshasa in the Democratic Republic of Congo to illustrate how the A.B.C.D. approach helped shape the operational strategy of a project.


Many organisations who are active in the WASH sector in humanitarian and development contexts are currently questioning the effectiveness of the assistance provided, with respect to the objective of reducing water-borne diseases [1]. WASH operations are often designed and evaluated in quantitative terms (e.g. number of water points and latrines installed). These results mask a very different reality in the field where many installations are seldom used or used improperly and are often not sustainable. The impact of WASH operations on the reduction of water-borne diseases is not very well known and there are probably many examples of operations which have worsened pre-existing situations [2].

Installing or repairing infrastructure may not have the expected effects if the geographic, cultural and social realities of the targeted communities are not correctly taken into account [3]. Indeed, though the installation of infrastructure should make the environment more conducive to appropriate WASH behaviours, it does not guarantee changes in behaviour in itself [4]. This is where raising awareness about hygiene comes in, which is now recognized as a major part of WASH operations [5]. However, awareness-raising activities are rarely integrated into operational strategies which focus primarily on technical choices and the installation of infrastructure. In addition, one-size-fits-all methodologies are repeated without taking the trouble to contextualize them. What is more, the great majority of awareness-raising activities are based on health messages focused on the dangers of “bad” behaviours rather than on the expected benefits of appropriate behaviours [6]; it is assumed that once the population has been warned of the risk of contamination and the danger of water-borne diseases, they will adopt the thousand and one practices that are encouraged during these awareness-raising sessions. Here again, field realities are very different. The “good” practices which are promoted are restrictive and sometimes imply a major change in family habits. What is more, family habits are subject to a whole range of constraints and influences which are specific to their environment. This can sometimes facilitate changes in behaviour, but more often acts as a barrier to change.

The A.B.C.D. approach was developed in the light of the limits mentioned above. It is based on the work of the London School of Hygiene and Tropical Medicine [7] and the Swiss Federal Institute of Aquatic Science and Technology [8] as well as the socio-anthropological aspects of different WASH project methodologies (e.g. FOAM, CLTS, participatory approaches and social marketing [9]). A.B.C.D. attempts to bring these different sources together in an operational and pragmatic perspective. Its aim is to help develop operational strategies for WASH projects and to reinforce the coherence between infrastructure building, awareness-raising and community mobilization activities. These strategies are based on the analysis of both WASH-related behaviours in the targeted community, and the determinants behind these behaviours. To date, the approach has been tested in four different contexts: two semi-permanent IDP camps in the Central African Republic, peri-urban communities in the Democratic Republic of Congo and rural communities in Bangladesh and Myanmar.

In this article, we will first discuss the main principles of the A.B.C.D. approach, and then to illustrate the approach, we will present some of the results of the study carried out by SOLIDARITES INTERNATIONAL in a peri-urban neighbourhood of Kinshasa.

[1] Hunter P. Waterborne diseases and water safety. in CRASH/Fondation - Médecins Sans Frontières. Is humanitarian water safe to drink? October 2011.

[2] Analysis: Sanitizing the Truth - When WASH Fails. IRIN Africa English Service. Al Bawaba (Middle East) Ltd. 2013. HighBeam Research. 30 Jun. 2014 <http://www.highbeam.com>

[3] Mara D, Lane J, Scott B, Trouba D. Sanitation and health. PLoS Med. 2010

[4] Cairncross S, Shordt K. It does last! Some findings from a multi-country study of hygiene sustainability. Waterlines. 2004

[5] Peal et al, Hygiene and Sanitation Software, An Overview of Approaches. Water Supply & Sanitation Collaborative Council, Geneva, Switzerland, 2010

[6] Peal et al, Hygiene and Sanitation Software, An Overview of Approaches. Water Supply & Sanitation Collaborative Council, Geneva, Switzerland, 2010
Dreibelbis Robert et al., « The Integrated Behavioural Model for Water, Sanitation, and Hygiene: a systematic review of behavioural models and a framework for designing and evaluating behaviour change interventions in infrastructure-restricted settings », BMC Public Health, 13 (1), Dec 2013, pp. 1 13.

[7] Aunger R, Curtis V. The Evo - Eco Approach to Behaviour Change. Applied Evolutionary Anthropology. Springer Verlag. In press

[8] Mosler HJ. A systematic approach to behavior change, interventions for the water and sanitation sector in developing countries: a conceptual model, a review, and a guideline, International Journal of Environmental Health Research, 2012

[9] Peal et al, Hygiene and Sanitation Software, An Overview of Approaches. Water Supply & Sanitation Collaborative Council, Geneva, Switzerland, 2010