Scaling Up a Water, Sanitation, and Hygiene Program in Rural Bangladesh: The Role of Program Implementation.
Objectives. To evaluate whether the quality of implementation of a water, sanitation, and hygiene program called SHEWA-B and delivered by UNICEF to 20 million people in rural Bangladesh was associated with health behaviors and sanitation infrastructure access. Methods. We surveyed 33 027 households...
| Published in: | American Journal of Public Health Vol. 107; no. 5; pp. 694 - 702 |
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| Main Authors: | , , , , , , , , |
| Format: | Article |
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American Public Health Association
2017
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| Online Access: | View this record in EBSCOhost |
| fields | @attributes: recordID: 1 pdfLink: plink: https://search.ebscohost.com/login.aspx?direct=true&db=ssf&AN=122460829&site=ehost-live header: @attributes: shortDbName: ssf uiTerm: 122460829 longDbName: Social Sciences Full Text (H.W. Wilson) uiTag: AN controlInfo: bkinfo: jinfo: jid: 00900036 APH jtl: American Journal of Public Health issn: 00900036 maglogo: N pubinfo: dt: 2017 vid: 107 iid: 5 pid: 44 pub: American Public Health Association artinfo: ui: 122460829 10.2105/AJPH.2017.303686 ppf: 694 ppct: 8 formats: tig: atl: Scaling Up a Water, Sanitation, and Hygiene Program in Rural Bangladesh: The Role of Program Implementation. aug: au: Benjamin-Chung, Jade Sultana, Sonia Halder, Amal K. Ahsan, Mohammed Ali Arnold, Benjamin F. Hubbard, Alan E. Unicomb, Leanne Luby, Stephen P. Colford Jr, John M. affil: Division of Epidemiology, School of Public Health, University of California, Berkeley Environmental Interventions Unit, Infectious Disease Division, International Centre for Diarrhoeal Disease Research, Bangladesh, Dhaka Division of Biostatistics, School of Public Health, University of California, Berkeley Department of Medicine, Stanford University, Stanford, CA su: Bangladesh UNICEF Water supply Sanitation Hygiene Rural geography Health behavior Infrastructure (Economics) Household surveys Health promotion Evaluation of human services programs Standards sug: subj: Water supply Sanitation Hygiene Rural geography Health behavior Infrastructure (Economics) Household surveys Health promotion Evaluation of human services programs Bangladesh UNICEF Water Supply and Irrigation Systems Standards ab: Objectives. To evaluate whether the quality of implementation of a water, sanitation, and hygiene program called SHEWA-B and delivered by UNICEF to 20 million people in rural Bangladesh was associated with health behaviors and sanitation infrastructure access. Methods. We surveyed 33 027 households targeted by SHEWA-B and 1110 SHEWA-B hygiene promoters in 2011 and 2012. We developed an implementation quality index and compared the probability of health behaviors and sanitation infrastructure access in counterfactual scenarios over the range of implementation quality. Results. Forty-seven percent of households (n = 14 622) had met a SHEWA-B hygiene promoter, and 47% of hygiene promoters (n = 527) could recall all key program messages. The frequency of hygiene promoter visits was not associated with improved outcomes. Higher implementation quality was not associated with better health behaviors or infrastructure access. Outcomes differed by only 1% to 3% in scenarios in which all clusters received low versus high implementation quality. Conclusions. SHEWA-B did not meet UNICEF's ideal implementation quality in any area. Improved implementation quality would have resulted in marginal changes in health behaviors or infrastructure access. This suggests that SHEWA-B's design was suboptimal for improving these outcomes. pubtype: Academic Journal doctype: Article src: R language: English refInfo: copyright: @attributes: flag: N holdings: @attributes: islocal: N |
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