In Ethiopia, sanitation and hygiene are receiving recently the attention they deserve. With the introduction of the Health Extension Program—Ethiopia’s primary health care strategy—sanitation and hygiene were identified as essential components of primary health care and were given their own institutional home within the Ministry of Health (MOH). To ensure universal access to sanitation and hygiene by 2012, the National Hygiene and Sanitation Strategy was designed by the Federal Ministry of Health (FMOH).

The Bureau of Health of Amhara Regional State, with the support of the Water and Sanitation Program-Africa (WSP-AF) and USAID’s Hygiene Improvement Project (USAID/HIP), has embarked on a brand new approach to implement the new National Hygiene and Sanitation Strategy and address the appalling hygiene and sanitation situation of over 20 million inhabitants of the Amhara Region. This is called the Program to Support at-Scale Implementation of the National Hygiene & Sanitation Strategy through “Learning by Doing” in the Amhara Region. The approach begins by bringing together the “Whole System in a Room” (WSR) to commit to achieving universal access to hygiene and sanitation for all and develop a common action agenda for reaching our goals. WSR has become shorthand for total sector commitment to change, a battle cry for total behavior change for hygiene and sanitation. Both the WSR and learning by doing underscore the vital importance of increased partnership and coordination among a host of actors to achieve the ambitious goal of Total Sanitation and Hygiene Behavior Change.

This community approach functions on the principles of harmonization, alignment, and integration with the government’s Health Extension Program; within the framework of the Memorandum of Understanding (MOU) signed among the FMOH, Federal Ministry of Water Resources, and Federal Ministry of Education; and at the regional level among the bureaus of Health, Water, and Education as an historic milestone to launch a nationwide water, sanitation, and hygiene (WASH) movement to achieve the relevant targets of the Millennium Development Goals.

The learning by doing approach is a hybrid of innovative and tried and true methods, bringing together the SCALE systems approach (Whole System in the Room), network theory, community-led total sanitation, participatory hygiene and sanitation transformation (PHAST), sanitation marketing, the hygiene improvement framework, and good solid social mobilization and management. But its real uniqueness lies not only in combining best practices in hygiene and sanitation improvement, but in embedding them within the national, regional, and woreda programs and processes. The learning by doing program is gaining a national reputation as one of the best practices in hygiene and sanitation, and in this spirit is offered as a model for scale up in other regions of the country.

It is with this vision and missionary zeal that the Amhara Region undertook the challenge of producing a Resource Book during 2008, the International Year of Sanitation. The book offers the basic tenets of the learning by doing approach, starting with the Whole System in the Room multi-stakeholder meeting, the conduct of Woreda WASH ignition training and conferences, data collection form action, and Ignition for Change! It is intended for use by all who would like to understand and undertake the Whole System in a Room approach to reaching Total Behavior Change in Hygiene and Sanitation in their own communities.

This Training Guide is a supplement to the Resource Book meant to train facilitators who will be engaged in Kebele and Gott ignition and action. With this Training Guide and the Resource Book the Woreda WASH Team can help people change unsafe behaviors and bring about a cultural transformation in basic hygiene and sanitation by putting an end to open defecation, having people wash their hands at critical times, and protecting drinking water from source to mouth. The Training Guide outlines the behavior change approaches, doable and achievable steps, which have been identified and tested on the ground through a learning-by-doing experience. These steps can be customized to fit different circumstances and tailored to community settings with diverse cultures. In so doing we learn, and the learning by doing continues. The application of collective knowledge and wisdom for the good of  mankind makes the planet earth a better and healthier place to live in. The Tree of Knowledge is only to rest in the shades thereof, but the Tree of Life is to eat the fruits there from and live an abundant life. The value of this book is not in the number of people who merely read it, but the number of lives saved as a result of applying the principles, approaches and steps therein. Let us all tend and keep the precious lives of our children and our families and make good hygiene and sanitation behavior an inheritance to the next generation.

For the complete publication, click HERE.

Asrat Genet Amnie, MD

Head, Bureau of Health, Amhara National Regional State

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