WASH for Health Communication Package Brief

Designed with Extension Workers for Extension Workers to Use in Communities to CHANGE BEHAVIOUR

FOR A HEALTHY FAMILY, IT IS GOOD TO KNOW OUR RESPONSIBILITIES:

Build, Use and Maintain an Improved Latrine

Wash Your Hands with Soap Under Running Water Before Eating and After Defecating

Treat, Store, and Fetch Your Drinking Water Safely

MODULE 1: GUIDES AND GAME

For a healthy family, it’s good to know our responsibilities: Build, use and maintain an improved latrine. Wash your hands with soap under running water before eating and after defecating. Treat, store and fetch your drinking water safely.

List of Materials

1. GUIDE: Community Entry ...... 1

2. GUIDE: Discussion ...... 3

3. GUIDE: Group and Community Facilitation ...... 5

4. GUIDE: Role Plays ...... 7

5. GUIDE: Team Building ...... 9

6. GUIDE: Using Radio Spots and Drama ...... 11

7. GUIDE: When and How to Combine WASH Topics ...... 13

8. GUIDE: WASH Game ...... 15

Full permission granted to photocopy For a healthy family, it’s good to know our responsibilities: Build, use and maintain an improved latrine. Wash your hands with soap under running water before eating and after defecating. Treat, store and fetch your drinking water safely.

1. GUIDE: Community Entry

What is Community Entry? Community Entry is a process through which community workers mobilize a community using participatory methods, such as community mapping, to come together to discuss their common interests and issues. It provides community workers with the opportunity to get to know the community before they begin to interact with them in-depth.

Community Entry involves recognizing the local leadership structure of the community and working with their already laid down systems including their traditions and culture. Most communities have their established calendars and rules of engagement, for example, there are meetings days, funeral days, and communal labour days in each month.

What is the purpose of Community Entry? Community Entry sets the stage and lays the foundation for all participatory work to be done in the community.

How do we enter a Community?

Guidelines to the Facilitator

Getting to Know the Community: Extension workers have to know something about the community they intend to work in, even before they go there for their first visit. Some of the places you can get information on a community are:

. District Assembly Documents such as The District Profile, District Water and Sanitation Plan, District Environmental Sanitation Strategy Action Plan (DESSAP) or from the Clients office at the Assembly . Documents from the Community Development Department . Documents from the District Health Management Team . Documents from the Environmental Health Department . District Education Office . Other NGOs or partners within the District

You can also get some information from informal sources, such as conversations with people who know the community.

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The duration for Community Entry will differ from community to community as the process is informed by the culture and practices of the people.

STEPS:

Step Know the Community: You should go into a community well Why be sensitive to the 1 informed. culture of the people? . Read about the community and also speak to people Respect the culture of the who know the community. people, especially their protocols in meeting with their leaders. Respect their Visit the Community: Start early so that you can spend a Step timelines including taboo days reasonable amount of time there. 2 and meeting times. . Once you get to the community, identify a contact person, e.g. Assembly member, Unit Committee member, influential person in the community, etc. Why provide information?

Provide as much information Step Meet the Community Leadership: Clearly explain the as possible of your planned 3 purpose of your visit to the community and how you intend activities. This way the to work with them to achieve the objectives. Observe local community will prepare itself protocols. mentally to work with you. . Seek their permission to work with the community. Say exactly what you are bringing to the table and what

part community members Step Plan to Meet the Community as a whole: Work with your have to play. 4 contact person or any person assigned by community leaders to work with you to plan how to mobilize the community towards your first meeting with them. Who is a Contact Person? . Clearly agree on who will do what and when. A Contact is a person in the . Remember to meet marginalized groups, e.g. women, community who acts as a children, aged, persons with disabilities liaison between the Extension field officer and the Step Conduct your first Community Meeting: Explain why you community at large. The 5 are there and how you intend to work with them. Allow Contact Person introduces the community members to express their views and influence field officer to the community the process if necessary. leadership. . If you planned conducting any participatory exercises keep them interesting. . Keep the meeting focused and just long enough to discuss the issues clearly. . Agree on next steps before you close.

Once you have successfully entered the community, use the additional guides provided in this series, such as Group and Community Facilitation, How and When to Combine WASH Topics, etc., to successfully guide your communities through interactive, participatory activities to encourage positive behaviour change.

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2. GUIDE: Discussion

What is a Discussion?

Discussion is a process by which people express their views and opinions on a topic. Used in the context of community work. Discussion:

 Allows for intensive interaction between a facilitator and a community group.  Provides opportunity for community members to share their perspectives on community issues.  Uses their experiences and understanding of local issues to bear on finding solutions for challenges in the community.

In a Discussion, the facilitator gives control to the group and empowers them to learn for themselves. A facilitator provides the trigger, such as a statement, a question, a picture, a video, a scenario, or other for discussion and the group members determine what they want to discuss based on that trigger and come up with solutions that work for them.

What is the purpose of a Discussion?

A Discussion allows community members to leave with a clear message on how to improve their WASH and Health practices (situation) and what actions to take based on their own experiences and understanding of local issues.

What are the steps to conducting an effective Discussion?

Planning and organizing a Discussion is essential to a successful outcome, that is to say, the community group members will leave with a clear message on how to improve their practices and what actions to take.

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STEPS: Prepare and know the community  Review materials on the subject you will be discussing. Sample Prompting Questions  Prepare a prompting list of open-ended and probing questions to guide the discussion.  Can you detail the situation more?  Prepare lead questions for your triggers.  Why do you think this is the situation in your community?  Learn more about the community in which you will be  To what extent is this common working from colleagues, co-workers and other partner among most members of the organisations. community?  If you are unfamiliar with the community, walk around  How might you change the situation? it before starting your discussion to be able to visualize community issues.

Set up a Discussion-friendly physical setting Prepare the setting so that:  Participants are comfortable and can relax.  They can see each other and the facilitator easily (see above illustration).  The facilitator feels like a part of the group.

Discuss Managing Discussion Participants Start the Discussion  Watch participant body language to  Have participants sit and welcome them. encourage many to speak  Start with informal small talk to relax participants.  Watch your time carefully  Set ground rules together with participants - most  Support all statements and engage importantly: (1) respect for others’ comments and (2) around all views equal right to be heard.  Allow participants to draw their own conclusions and determine their own  Read/show the “trigger” solutions  Pose a lead question, such as “To what extent does  Provide information only when this happen in your community/is this an issue in your absolutely necessary or after the community?” discussion has ended Continue the Discussion  Listen attentively and repeat important information that is made to draw attention to it.  Allow participants to freely react directly and spontaneously to responses, comments or suggestions made by other members.  Use your prompting questions to keep the Discussion moving and in focus. End the Discussion  Detail key actions points that community members can do.  Focusing on these key action points, agree on what community members are going to do, as a community or as individuals and by what time.  Share the relevant commitment as a final word.

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3. GUIDE: Group and Community Facilitation

What is Group and Community Facilitation? Community facilitation includes skills and techniques for ensuring that the community is able to participate as fully as possible in all stages of programme implementation, with all stakeholders involved, aware and active. These skills include community organizing, participatory approaches to implementation, adult education and creating dynamic learning environments to maximize outcomes.

What is the purpose of Group and Community Facilitation? Group and Community Facilitation is geared towards action to address the urgent problems and issues that need to be tackled and solved in the communities.

When might you use Group and Community Facilitation? a. At the start of something new. b. When an issue can no longer be ignored. c. When groups need to be brought together. d. When an existing group is considering its next step or seeking to address an issue of importance to it.

What are the Elements of an Effective Group and Community Facilitation?

 All members of the group have a chance to speak, expressing their own ideas and feelings freely, and to pursue and finish out their thoughts.  All members of the group can hear others’ ideas and feelings stated openly.  Group members can safely test out ideas that are not yet fully formed.  Group members can receive and respond to respectful, but honest and constructive feedback.  A variety of points of view are put forward and discussed.  The discussion is not dominated by any one person.  Arguments, while they may be spirited, are based on the content of ideas and opinions, not on personalities.  Even in disagreement, there’s an understanding that the group is working together to solve a problem, create a plan, make a decision or come to a conclusion.

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How can you use a Group and Community Facilitation?  Create a new situation – form a coalition, start an initiative, etc.  Explore cooperative or collaborative arrangements among groups or organizations.  Discuss and/or analyse an issue.  Create a strategic plan – for an initiative, an intervention, etc.  Discuss policy and policy change  Air concerns and differences among individuals or groups  Hold public hearings on proposed laws or regulations, development, etc.  Decide on an action  Provide mutual support CHECKLIST  Solve a problem  Resolve a conflict How well am I facilitating group or community activities?  Plan the work or an event Check all that you feel are true. If you checked 8 or more, you What is good facilitator are facilitating well. If less than 8, think about how to strengthen those unchecked areas. behaviour? . Model the behaviour and Do I use the three basic principles of facilitation?  I bring out the opinions and ideas of group members attitudes you want group  I focus on how people participate in the process as well as members to employ on what gets achieved . Use encouraging body  I never take sides language and tone of voice, as well as words Do I encourage participation? . Give positive feedback for  I make sure everyone feels comfortable speaking  I create an environment that allows all ideas to be heard joining the discussion  I make members feel good about their contributions . Be aware of people’s reactions  I support what they’ve said, I do not criticize and feelings, and try to respond appropriately Do I understand the tasks of the facilitator? . Ask open-ended questions  I understand the goals of the meeting or activity . Control your own biases  I keep the group and the agenda moving forward  . Encourage disagreement, and I involve everyone in the meeting  I encourage consensus decision making help the group use it creatively . Listen more, allowing participants to speak more than you do.

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4. GUIDE: Role Plays

What is a Role Play?

Role Plays are an exercise that create opportunity for discussion of key issues. Individual from the group are given roles which they will act out using a provided scenario. People act out the role based on their knowledge of the chosen character and appreciation of the issue (s) under discussion.

Role plays can bring out health issues with the objective of facilitating behaviour change and generating a more insightful appreciation of the issues that influence people’s behaviours.

What is the purpose of a Role Play?

A Role Play allows community to act issues around a topic and freely discuss how to deal with this issue based on their community context.

Guidelines to the Facilitator

Each Role play scenario provided comes with discussion points. These discussion points are expected to bring out the key issues related to the focus of the Role play. The guidelines below, are generic instructions for discussing Role plays. The facilitator should integrate the discussion points with the guidelines to fully address all aspects of the topic. At the end of each discussion the facilitator should mention the commitment which is appropriate to the discussion.

 How did you feel playing your individual roles?  What did the audience see? How would you describe the actions of each player?  To what extent does this reflect real life situation? How was it different?  How might the ‘situation’ be improved? Why? Who needs to be involved? How?  What lessons can we learn from the personal experiences of others?  What steps/actions are we going to take when we leave here today? Why?

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What are the steps to conducting an effective Role Play?

Step 1 Introduce the Issue: If at the beginning of a session or Select Roles Carefully: It is interaction, introduce the topic of discussion and the important that those key focus issues. chosen to play a role have • If in the middle of a session or interaction, knowledge of the role introduce the key focus issues in the role play otherwise they will not be scenario. able to bring out the critical issues.

Step 2 Identify Roles: Ask for volunteers. Also, be sensitive when there are persons with • Specify roles - outside of the full group [participants disabilities in the group. should only know the general topic and key focus Their disability should not issues]. be mocked at during the • Give them a few minutes to prepare. enactment. Involve them • Provide them with props. where appropriate.

Step 3 Set Scenario: Give brief introduction on the topic of discussion and/or key focus issues involved.

Always remember that Step 4 Act: Have volunteers act out the role play scenario the Role Play is not a Drama. Role Plays are Step 5 Discuss: Lead a discussion on the role play, using specific short and straight to the discussion points provided. point. Role Players do not • Emphasize key focus issues. have to learn a script. • Share relevant commitment as a final word.

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5. GUIDE: Team Building Audiences: Mothers, Caregivers, Fathers, Grandparents and Children Users: Environmental Health Officers, Community Development Officers, Health Promotion Officers, Community Health Volunteers, Community Health Nurses, Natural Leaders, Teachers, SHEP Coordinators, other WASH and Health Practitioners. Venues for Use: Communities, Homes, Schools, CHPS Compounds

What is Team Building?

Team building refers to various activities that can be undertaken to motivate community members and increase overall performance.

A team can achieve more than an individual when each and every member is focused on and understands his or her responsibilities. A motivating factor is a must. When individuals with a common purpose are motivated to do Successful Team Building their best, the team that is formed by these No matter which activity is selected for team individuals is equally motivated to achieve building, the success of your activity will be the common purpose. influenced in no small part by:

 The similarity between the activity and the Team building can be integrated into daily required outcomes. tasks, like opening a community meeting, etc.

While various activities can be undertaken to address different issues, ensuring an element of fun will increase the effectiveness of the activity.

What is the purpose of Team

Building?  The conditions the facilitator creates.  The enthusiasm shown and created by the Team building brings together a group of facilitator. people around a common problem or task to  Acknowledgement that some people are find a solution acceptable to all. more comfortable than others in “Together Everyone Achieves More undertaking activities.  How the team is organised.  The quality and way the introduction is run.  The post activity follow-up.

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How do you build a Team?

Try using any of these simple exercises at the beginning of a group discussion, community meeting or discussion to work on a particular issue or at any time you feel is appropriate.

Team Building Activities STICK Instructions: Form two lines facing each other. Lay a long, thin stick on each member of the group’s index/pointer finger. Tell each team to lower the stick to the ground together, never grabbing the stick, only using their index finger. Materials Needed: 2 long sticks, long enough so that at least 5 people can hold it with their index/pointer fingers Questions to Ask: What happened? Why was it easy or difficult to move or lower the stick to the ground together? What lesson have been learnt and how does that affect us in our daily life? UNTANGLE Instructions: Put 6-20 people in a circle. Ask them to close their eyes and put their left hand into the middle of their circle and grab a hand. Tell them to keep their eyes closed and put their right hand into the circle and grab a hand. Tell them to keep hold of the hands they have grabbed and now open their eyes. Ask them to untangle their hands and arms WITHOUT LETTING GO OF EACH OTHER’S HANDS. Materials Needed: None required Questions to Ask: What happened? Why was it easy or difficult to untangle your hands and arms without letting go off each other’s hands? What lesson have been learnt and how does that affect us in our daily life? TRUST Instructions: Scatter objects on the ground, with just enough room to move around and through them. Put 10 people into pairs of 2. Ask one person to be blindfolded or close their eyes. Instruct the other to verbally guide his/her blindfolded partner through the objects to the other side. Materials Needed: Objects-rocks, buckets, basins, chairs, stools, other; blindfolds Questions to Ask: What happened? Why was it easy or difficult to guide the person through the obstacles? What lesson have been learnt and how does that affect us in our daily life? SUPPORT Instructions: Invite 5 participants in the middle of the group. Ask them to form a circle. Ask the full group, how many legs they can count (10). Ask these 5 participants to reduce the number of legs to 7, then 5, then 4, with all the 5 participants still in the form of a circle. Materials Needed: None Questions to Ask: What happen? Was it easy or difficult to reduce 10 legs to 7, 5, and 4? What lesson have been learnt and how does that affect us in our daily life?

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6. GUIDE: Using Radio Spots and Drama

What is a Radio Spot or Script?

Radio spots are 30 - 60-seconds story taped by actors and played on the radio. Radio scripts are the text of these same spots that can be read if a taped spot is unavailable. Radio scripts and spots can be read or played during a group session or community activity to encourage discussion around the specific WASH and health behaviours.

How can you use a Radio Spot effectively during a group or community session?

Remember these simple, helpful tips and using a radio spot or script will be effective every time. If the spots are airing in your communities, remember to link the radio spot messages to your sessions and remind community members to always listen to the aired spots.

If playing the Radio Spot:

 Put the group in a circle close to the playing device so Preparation to Use a Radio Spot or that all can hear clearly Radio Script  Play a spot and discuss with the group  Make sure you have your laptop,  Play the spot 2-3 more times and continue to discuss and CD or radio to listen to it when it airs. If using the Radio Scripts:  Ensure you have the batteries or electricity you need.  Prepare to read it out as if it were a radio spot and  If you are going to read it, discuss with the group practice it 2-3 times before your  As with the radio spots, read the script 2-3 more times session. and continue to discuss  If the script calls for more than  Be sure to ALWAYS read the narrator part at the one person, be sure they have beginning and end of the spot enough notice to practice the  Be sure to ask questions for feedback script as well.  Prepare a few discussion questions before the session.

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What is a Drama Script?

A drama script is a longer story in 2-3 Acts that can be performed live. Drama scripts can be performed by a local group at a community event or meeting and used to encourage discussion around the specific WASH and health behaviours.

How can you use a Drama Script effectively during a group or community session?

Remember these simple, helpful tips and using a drama script will be effective every time.

 Find a local troupe or school children or interested people within the community that can perform the drama.  Provide them with copies of the drama at least one week prior to when they will act out the drama. Preparation to Use a Drama Script  Have them do a dress rehearsal so that you can assure they are following the:  Pull together all materials (1) Script - Please note that the script should not be needed for the drama. changed as it will also change the messages. The  Find a suitable location for the scripts were developed based on research, so please drama – that can don’t add or subtract from dialogue. accommodate the audience so (2) Set layout - Have they put the same items in the that they can see what is scene that are mentioned in the script. These items happening and large enough are essential to the dialogue, so please follow them as for the actors to perform. closely as possible.  Prepare your discussions  Ask discussion questions after the drama has been questions to use after the enacted. drama.

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7. GUIDE: When and How to Combine WASH Topics

What WASH topics might you want to combine? You might want to combine any of the following WASH topics: 1. Treat drinking water safely 2. Store drinking water safely 3. Fetch drinking water safely 4. Build a Tippy Tap or handwashing station for proper handwashing 5. Wash hands with soap under running water before eating 6. Wash hands with soap under running water after defecating 7. Use a household latrine properly 8. Maintain a household latrine properly 9. Maintain an institutional latrine properly

When might you want to combine these WASH topics?

Often times, you know that you will only have the group or community members once and then not again for a while, so you want to maximize your time with them. This would be the time to combine appropriate WASH topics so that you can encourage them to consider a couple of cluster behaviours – those behaviours that reinforce each other or make the behaviours easier to perform, such as a handwashing station makes handwashing with soap under running water easier.

Guidelines to the Facilitator when Combining WASH Topics  Use the topics in a logical order:  Treatment before storage of drinking water  Building of a Tippy Tap near the latrine to encourage handwashing with soap under running water after defecating.  Use topics that reinforce each other:  Use and maintenance of a household latrine  Use of a household latrine and handwashing after defecating  Combine no more than three topics at a time  Never combine “constructing an improved household latrine with something else  Only combine WASH topics when you know you have at least one hour with the group

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How might you combine these WASH topics? While you can use any of the topics listed above by themselves in the time you have available to you, you should only combine WASH topics when you know you have enough time with the group.

Time Available Audience Topics to Combine for the Session Mothers . Wash hands properly with soap under running water before eating . Wash hands properly with soap under running water after defecating 1 hour General Community . Wash hands with soap under running water before Members eating . Wash hands with soap under running water after defecating Mothers . Build a Tippy Tap and demonstrate proper hand washing with soap . Wash hands properly with soap under running water before eating . Wash hands properly with soap under running water after defecating Children . Wash hands properly with soap under running water before eating . Wash hands properly with soap under running water after defecating 1 hour 30 Partners . Use a household latrine properly minutes . Maintain a household latrine properly Partners . Wash hands with soap under running water before eating . Wash hands with soap under running water after defecating General Community . Wash hands with soap under running water before Members eating . Wash hands with soap under running water after defecating . Use a household latrine properly

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8. GUIDE: WASH Game

DESCRIPTION “The WASH Game” is a tool which specifically addresses “good” and “bad” behaviours on water, sanitation and hygiene (WASH). It highlights the best practices to avoid diarrhoeal and other water- borne, sanitation, and hygiene-related diseases.

This game is designed to educate, foster discussion, entertain, and promote positive changes in WASH behaviours that lead to a healthy family. It can be played by adults and children during group sessions, school activities, or community events.

The game consists of:

1. Dice 2. Counters (pebbles) 3. Picture Cards depicting good and bad WASH behaviours 4. Game board

HOW TO PLAY

The game is played by 2 to 4 players.

Each player will enter at START on the board and finish on END. You need to throw a SIX (6) on the dice to enter at START. You play again to move forward. At the start of the game, the cards are shuffled and placed Upside Down and will remain in the same position until the Game is finished.

The Footsteps on the Playing Board will lead you the way to go.

Upon landing on BLACK-COLOURED SQUARES on the Game Board, you pick up the top card and the player who picked the card will state whether the picture on the card is a good or a bad practice and why. The rest of the players will indicate whether they agree or not and give reasons. See HOW TO AWARD MOVEMENT to determine whether a player moves forward, backward or stays in place. The card is then placed at the bottom of the pile.

For easy interpretation of the Good and Bad WASH Practices of the pictures Good Practice WHITE background Bad Practice GRAY background

The first player to reach the END is the winner.

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HOW TO AWARD MOVEMENT (STEPS FORWARD OR BACKWARD)

 If a player picks up a “good behaviour” card and can cite at least 3 reasons why it is a good behaviour, the player will move forward 5 steps.  If a player picks up a “good behaviour” card, but cannot cite at least 3 reasons why it is a good behaviour, the player stays where s/he is (does not move forward 5 steps).  If a player picks up a “bad behaviour” card and can cite at least 3 reasons why it is a bad behaviour, the player stays where s/he is (does not have to move back any steps).  If a player picks up a “bad behaviour” card, but cannot cite at least 3 reasons why it is a bad behaviour, the player moves back 5 steps.

FACILITATION OF THE GAME

The pictures on the cards depict scenes of good and bad WASH behaviours. Each picture should be presented to the wider group (both players and observers) and described by the player who picked up the card. During facilitation, possible questions to ask of the players to stimulate discussion could include:

1. What is happening in the picture on the card? (Ensure that the scene is described and understood) 2. What is good and bad about the scene on the card? What happens to people and the wider community when these practices are engaged in? 3. How common is this practice in your community? 4. What could be a better practice?

At the end of the game, the facilitator should ask the wider group what they think were the main messages? What have they learned? What changes will they make in their WASH practices?

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GAME CARDS – BEHAVIOURS AND ID CODES

NO KEY BEHAVIOURS GOOD PRACTICES (WHITE BACKRGOUND) BAD PRACTICES (GRAY BACKGROUND) 1 BUILD LATRINE GC1-1 Build an improved household latrine GC1-3 Open defecation GC1-2 Construct Tippy Tap by household latrine GC1-4 Defecating in plastic bag 2 USE LATRINE GC2-1 Drop anal cleansing material in squat hole GC2-3 Dirty Household latrine GC2-2 Use an improved household latrine GC2-4 Defecating by a stream 3 MAINTAIN LATRINE GC3-1 Drop ash in pit to reduce odour GC3-3 Bushy household latrine surroundings GC3-2 Sweep household latrine daily GC3-4 Rundown household latrine 4 DISPOSE OF GC4-1 Assist young children use HHL GC4-3 Woman emptying faeces in chamber pot into bush CHILDREN’S FAECES GC4-2 Empty chamber pot in HHL GC4-4 Woman cooking by uncovered chamber pot with flies SAFELY 5 WASH HANDS GC5-1 Wash hands properly before eating GC5-3 Hand washing in bowl of water before eating BEFORE EATING GC5-2 Assist young children wash hands before GC5-4 Communal hand washing by children before eating eating 6 WASH HAND AFTER GC6-1 Wash hands properly after defecating GC6-3 Broken down Tippy Tap DEFECATING GC6-2 Wash hands after emptying chamber pot GC6-4 Child eating while defecating 7 BOIL WATER GC7-1 Filter water before boiling GC7-3 Drinking surface water BEFORE DRINKING GC7-2 Boil water before drinking GC7-4 Drinking water from barrel 8 STORE DRINKING GC8-1 Cover drinking water pot GC8-3 Uncovered drinking water pot WATER SAFELY GC8-2 Store drinking water safely GC8-4 Poor water storage practice 9 FETCH DRINKING GC9-1 Fetch drinking water for children GC9-3 Fetching drinking water with cup without handle WATER SAFELY GC9-2 Fetch drinking water safely GC9-4 Fetching and drinking from same utensil

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The WASH for Health Communication Package

The Water, Sanitation, and Hygiene (WASH) for Health (W4H) Program has put together a comprehensive package of materials for you to use in your communication sessions. These materials have been developed to help you change WASH behaviours in your communities.

The following is a list of the types of materials contained in the WASH for Health Communication Package. Materials have been developed for the following three behaviours and responsibilities:

1. Build, use and maintain your household latrine properly 2. Wash your hands with soap under running water before eating and after defecating 3. Treat, store and fetch your drinking water safely

Materials Description Guides Guides are basic overviews and steps for how to conduct discussions, role plays, community entry, group and community facilitation, team building and when and how to combine WASH behaviours. These guides are only intended for you to help strengthen and refresh on your community and group skill sets. Game Game allows group and community members a fun way to learn about WASH and the desired WASH behaviours. Fact Sheets Fact sheets provide specific information so that you can effectively answer questions that might come up on each of the specific WASH behaviours. How to’s How to’s provide illustrations of steps to carry out the practices and behaviours being promoted. They are intended for use during discussions sessions and for distribution to community and group members. Instructions to Instructions provide you with step-by-step details on how to conduct a group Conduct session on the specific WASH behaviours. Sessions Radio Spots Radio scripts and spots can be read or played during a group session or (scripts and community activity to encourage discussion around the specific WASH spots) behaviours. Drama Scripts Drama scripts can be performed by a local group at a community event or meeting and used to encourage discussion around the specific WASH behaviours. Role Plays Role plays provide you with a set of short scenarios that can be acted out by a couple of members of a group and discussed. Each role play provides key focus issues and questions to help you guide the discussion after the role play has been enacted. Stories for Stories for discussion are short stories for you to read to a group that will Discussion stimulate conversations around the specific WASH behaviours. Home Visit Home Visit Checklists give you a short set of questions and observation points Checklists that you can use when you are visiting households to assess where things are working and where you might need to place more emphasis in your group discussions as they are not changing their practices as you would like to see.

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WHEN AND HOW TO USE EACH MATERIAL

Material WHEN HOW Guides When you need to  Review a guide when you need to refresh your refresh your information information on an  Use the list of questions and checklists as appropriate approach before  Practice the skills discussed in each you conduct a  Work to improve those skills where you have session weaknesses and reinforce those skills where you have strengths Game During a group or  Review the game instructions community session  Reconfirm that all cards and game pieces are there  Develop a list of questions you can ask during the game and after the game – reinforcing the three key practices  Play the game  Discuss the game afterwards Fact Sheets When you need to  Use this information to respond to questions as they refresh your are asked information on a  Provide details when appropriate topic before you  Develop questions for the group based on the conduct a session information found in the Fact Sheets [please note that this Communication Package provides several sets of questions like this for you] How to’s When you conduct a  Have many copies available group or community  Distribute them to the primary audience session or event  Use them to guide a discussion on how to carry out the specific behaviour Instructions to Before you conduct  Read them before you start a session Conduct a session  Adapt any section as needed for your group or situation Sessions  Be sure to have the “commitments” clearly in mind so that you can assure everyone leaves with a practice to do when they get home Radio Spots When you conduct a  If you have the spots, have a recorder or laptop (scripts and session or event available to play the spots spots)  Play a spot and have discussion with the group  If you only have the scripts, prepare to read it out as if it were a radio spot [be sure to have a second person available when the script calls for two of you]  Be sure to ALWAYS read the narrator part at the beginning and end of the spot Drama Scripts When you conduct a  Find a local troupe that can perform the drama school or  Provide them with copies of the drama at least one community event week prior to when they will act out the drama  Have them do a dress rehearsal so that you can assure they are (1) following the script and (2) following the set  Develop your list of questions to ask of the participating group after they have seen the drama

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Material WHEN HOW Role Plays During a group or  Review the role play scenarios community session  Make sure you have all materials needed for the role play  When possible, ask a couple of participants to prepare before you start the session  Use the discussion questions to discuss what happened and provide the key focus issues Stories for During a group or  Review the story for discussion Discussion community session  Prepare your list of facilitating questions  Read it out during the session  Allow the group to discuss, while you facilitate the discussion Home Visit During a home visit  Use only one type of checklist per home visit, e.g. only Checklists Handwashing or only Water or only Latrine – not all together  Prepare enough copies to use during your home visits  Complete one checklist per household  Review the results  Based on results, adjust what sessions you carry out, e.g. if you find that mothers are “using soap”, but not “under running water”, target your next session on ensuring they wash hands under running water

WE WISH YOU ALL THE BEST IN YOUR COMMUNICATION WORK AND THE BEST OF CHANGING WASH BEHAVIOURS IN YOUR COMMUNITIES.

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For a healthy family, it’s good to know our responsibilities:

Build, use and maintain an improved

household latrine properly

Wash your hands with soap under

running water before eating and after defecating

Treat, store and fetch your drinking

water safely.

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MODULE 1: GENERAL GUIDES AND GAME Guides General Material Name Audience 1. Community Entry Secondary 2. Discussion Secondary 3. Group and Community Facilitation Secondary 4. Role Play Secondary 5. Team building Secondary 6. Using Radio Spots and Drama Secondary 7. When and How to Combine WASH Topics Secondary WASH General Material Name Audience 8. WASH game Primary

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MODULE 2: BUILD, USE AND MAINTAIN AN IMPROVED LATRINE Build an Improved Latrine Material Name Audience 1. Fact Sheet on Build a Latrine Secondary 2. How to Build an Improved Latrine Primary 3. Instructions to Conduct Session on Building a Latrine Secondary 4. Radio Spot-Build Latrine Primary 5. Drama-good sanitation practices and benefits of latrine ownership Primary 6. Role Play - Build a latrine Primary 7. Role Play - Affordability of household latrine Primary 8. Story for Discussion - Safety and convenience of latrine Primary 9. Discussion - Need for household latrine Primary 10. Home Visit Checklist – Build an Improved Latrine Secondary Use and Maintain an Improved Latrine Material Name Audience 11. Fact Sheet on Use and Maintain Latrine Secondary 12. How to Use and Maintain Latrine Primary 13. Instructions to Conduct Session on Using and Maintaining a Latrine Secondary 14. Fact Sheet on Safely Dispose of Child’s Faeces Secondary 15. How to Safely dispose of child’s faeces Primary 16. Instructions to Conduct Session on Safely disposing of child’s faeces Secondary 17. Radio Spot - Use and maintain latrine Primary 18. Radio Spot - Safely dispose of child’s faeces Primary 19. Drama script - Use and Maintain latrine Primary 20. Role Play - Use latrine properly Primary 21. Role Play - Maintain latrine properly Primary 22. Role Play – Safely dispose of child’s faeces Primary 23. Story for Discussion - Use and clean latrine Primary 24. Story for Discussion - Maintain latrine Primary 25. Story Discussion - Dispose of child’s faeces properly Primary 26. Home Visit Checklist - Latrine Usage, Maintain, managing child’s faeces Secondary

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MODULE 3: WASH YOUR HANDS WITH SOAP UNDER RUNNING WATER BEFORE EATING AND AFTER DEFECATING Material Name Audience 1. Fact Sheet - Handwashing with soap Secondary 2. How to Wash hands with soap under running water Primary 3. Instructions to Conduct Session on Handwashing with soap Secondary 4. How to Build Tippy Tap Primary 5. Instructions to Conduct Session on Tippy Tap constructions Secondary 6. Radio spot – Handwashing with soap Primary 7. Radio spot – Handwashing station Primary 8. Drama – Handwashing with soap Primary 9. Talk Show Guide on Handwashing with soap Secondary 10. Role Play – Handwashing with soap – before eating Primary 11. Role Play – Handwashing with soap – after defecating Primary 12. Story for Discussion - Handwashing with soap women Primary 13. Story for Discussion - Handwashing with soap men Primary 14. Home visit checklist - Handwashing with soap Secondary

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MODULE 4: TREAT, STORE AND FETCH DRINKING WATER SAFELY Material Name Audience 1. Fact Sheet Boil Water Secondary 2. How to Boil Water Primary 3. Instructions to Conduct Session on Boiling water Secondary 4. Fact Sheet Store and Retrieve Water Secondary 5. How to Store and Retrieve Water Safely Primary 6. Instructions to Conduct Session on Storing water Secondary 7. Instructions to Conduct Session on Fetching water Secondary 8. Radio Spot – Boil Primary 9. Radio Spot – Store Primary 10. Radio Spot – Fetch Primary 11. Role Play – Boil – Sister Rose Primary 12. Role Play – Boil – Kwesi Primary 13. Role Play – Store Primary 14. Role Play - Retrieve/fetch Primary 15. Story for Discussion – Boil – Refreshing Primary 16. Story for Discussion – Boil – Boring Primary 17. Story for Discussion – Store – Clean Containers Primary 18. Story for Discussion – Store – Out of Reach of Children Primary 19. Story for Discussion – Store – Separate Containers Primary 20. Story for Discussion – Fetch Primary 21. Home Visit Checklist - Boil, store and Fetch Secondary 22. Home Visit Checklist - What/How/When to Clean Drinking water Secondary containers/utensils LEAFLETS INTENDED FOR DISTRIBUTION TO THE PRIMARY AUDIENCES 1. Key Promise and Key Messages 2. How to Build an Improved Latrine 3. How to Use and Maintain Latrine 4. How to Safely Dispose of Child’s Feces 5. How to Wash hands with Soap under Running Water – School Children 6. How to Wash hands with Soap under Running Water – Mothers, Caregivers, Fathers 7. How to Build Tippy Tap 8. How to Boil Water 9. How to Store and Fetch Water Safely

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Full permission granted to photocopy

MODULE 2: BUILD, USE AND MAINTAIN AN IMPROVED LATRINE

MODULE 3: WASH YOUR HANDS WITH SOAP UNDER RUNNING WATER BEFORE EATING AND AFTER DEFECATING

List of Materials

1. FACT SHEET: Washing your Hands with Soap under Running Water Before Eating and After Defecating 1

2. HOW TO Wash your Hands Properly in 5 SIMPLE STEPS – School Children ...... 2

3. HOW TO Wash your Hands Properly in 5 SIMPLE STEPS – Mothers, Fathers, Caregivers ...... 3

4. INSTRUCTIONS: Proper Handwashing with Soap ...... 4

5. HOW TO Build a Tippy Tap ...... 5

6. INSTRUCTIONS: Constructing a Tippy Tap ...... 6

7. RADIO SPOT: Wash Your Hands with Soap Under Running Water Before Eating and After Defecating ... 7

8. RADIO SPOT: Handwashing Station Close to Your Kitchen and Latrine Makes Handwashing with Soap Under Running Water an Easy Thing ...... 8

9. DRAMA SCRIPT: Handwashing with Soap ...... 9

10. TALK SHOW GUIDE: Handwashing with Soap Under Running Water Before Eating and After Defecating16

11. ROLE-PLAY: Handwashing with Soap Under Running Water Before Eating ...... 18

12. ROLE PLAY: Handwashing with Soap Under Running Water After Defecating ...... 19

13. STORY FOR DISCUSSION: Handwashing with Soap Under Running Water ...... 20

14. STORY FOR DISCUSSION: Handwashing with Soap Under Running Water ...... 21

15. HOME/SCHOOL VISIT CHECKLIST: Wash Hands with Soap Under Running Water Before Eating and After Defecating ...... 22

Full permission granted to photocopy

1. FACT SHEET: Washing your Hands with Soap under Running Water Before Eating and After Defecating

WHAT IS HANDWASHING WITH SOAP UNDER to manage wastewater. Taps, Veronica buckets, RUNNING WATER? and Tippy Taps are all good handwashing Handwashing with soap under running water is facilities. Pouring water from a bowl, ‘buta’, cup the way to clean hands of germs that can cause or other receptacle on to the hand is also a illnesses and diseases. good form of washing hands under running water. Communal handwashing in a common WHY IS IT IMPORTANT TO WASH HANDS WITH bowl is not healthy. SOAP UNDER RUNNING WATER? Frequent handwashing WHEN SHOULD WE WASH OUR HANDS? practice is the most Handwashing is important at all times; important thing you can however, there are two especially critical times do to prevent disease and when we should never forget to wash our reduce the spread of hands. These two times are before eating and infection. It is also after defecating. (1) Before Eating important to wash the hands of young children Handwashing is critical before we put anything under five and infants. They constantly put into our mouth. We should thoroughly wash their hands in their mouths. Washing their our hands before we eat anything. This even hands can reduce diseases and illnesses caused includes things like biscuits, bread, fruits, and by dirty hands such as the cholera and nuts. Mothers and caregivers should also wash diarrhoeal diseases. Handwashing with soap the hands of their infants and young children also refreshes our hands making us feel before they eat and comfortable. before feeding them. (2) After Defecating WHAT DO WE NEED TO WASH OUR HANDS? Anytime we finish using  Soap - Any type of soap can be used for the toilet, we handwashing including bar soap, liquid soap immediately need to and powdered soap. wash our hands. This  Water – Adequate running water is will ensure that any

required. germs that our hands  Handwashing station - Having a pick up, including pieces handwashing station near the latrine and where of faecal matter, can be washed off. Mothers the family eats makes it easier to wash hands. and caregivers should also wash the hands of It encourages handwashing as a habit and an their young children after they use the toilet. everyday action. Good handwashing stations *It is also important for mothers with infants to provide soap, running water and soak away pit wash their hands after cleaning their babies’ bottoms.*

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Full permission granted to photocopy

2. HOW TO Wash your Hands Properly in 5 SIMPLE STEPS – School Children

It is important to wash our hands properly with soap every time before eating and after defecating to kill the disease-causing germs that can make us sick.

1. Wet your hands 3. Wash hands and and apply soap 2. Rub palms together fingers

4. Rinse under running 5. Air dry water

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Full permission granted to photocopy

3. HOW TO Wash your Hands Properly in 5 SIMPLE STEPS – Mothers, Fathers, Caregivers

It is important to wash our hands properly with soap every time before eating and after defecating to kill the disease-causing germs that can make us sick.

1. Wet your hands and 2. Rub palms together 3. Wash hands and apply soap fingers

4. Rinse under running water 5. Air Dry

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Full permission granted to photocopy

4. INSTRUCTIONS: Proper Handwashing with Soap Audiences: Mothers, Caregivers, Fathers, Grandparents and Children Users: Environmental Health Officers, Community Development Officers, Health Promotion Officers, Community Health Volunteers, Community Health Nurses, Natural Leaders, Teachers, SHEP Coordinators, other WASH and Health Practitioners. Venues for Use: Communities, Homes, Schools, CHPS Compounds

What is handwashing?

Handwashing is the act of cleaning one's hands with the use of running water and soap to remove soil, dirt, and/or germs. Handwashing before eating and after defecating must be done always to be effective. It is an easy, quick, and inexpensive habit that a whole family can practice to stay healthy.

How can you use these instructions for a demonstration? Preparation Steps:  Review and refer to  Welcome the group and explain the purpose of the Handwashing with Soap session: the importance of handwashing for themselves Fact Sheet, as needed. and their children under five, the two critical times to  Have a demonstration Kit wash hands, and how to properly wash hands. with all provisions: water,  Ask participants: soap, Veronica bucket, o What do you know about handwashing? and/or Tippy Tap o Why is handwashing important for you and your  If you plan to distribute the children? How-to Wash Hands, carry o When do you wash your hands and that of your needed copies with you. children?

o How do you wash your hands? (Let one or two members demonstrate) o How do you wash the hands of your children? (Ask one or two members to demonstrate)  Demonstrate the proper ways to wash hands building on their own example for (1) their own hands and (2) the hands of their children.  Ask questions to reinforce new knowledge as you demonstrate each.  Ask them if they have any questions and if in your plan, distribute the How-to Wash Hands.  Ask for their commitments to the points below: 1. Wash the hands of their children under five with soap under running water every time before eating and after defecating. 2. Wash their hands with soap under running water every time before eating and after defecating.

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5. HOW TO Build a Tippy Tap A Tippy Tap will help you wash your hands properly and regularly making it a habit. Place a Tippy Tap near your latrine and near where you eat.

2m Forked sticks x2 1m Straight sticks x2

1. Dig two small holes about 2 feet apart 2. Place one forked stick in each 3. Fill each hole with sand and hole. Make sure they are the same stone to pack the sticks tightly so height that they don’t move

Digging tools 6. Make a hole in the soap. Put the string through it String 4. Heat the nail with the fire Soap Nail 5. Make two holes in the container as shown

Gravel 8. Attach the other end of the string to

Water 7. Attach a string to the the foot stick as container shown container Fire

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6. INSTRUCTIONS: Constructing a Tippy Tap

What is a Tippy Tap? A Tippy Tap is a simple device that allows the whole family to easily wash their hands under running water with soap before eating and after defecating.

How can you use these instructions for a demonstration?

Steps:  Welcome the group and explain the purpose of the session: handwashing and building a Tippy Tap.  Ask participants: o When do you wash your hands? o How do you wash your hands? (one or two demonstrate) o Do you have a handwashing station now? If yes, what kind? Where is it placed?  Build a Tippy Tap with the group watching carefully. Preparation  Ask for questions as you  Review and refer to Handwashing with Soap Fact build. Sheet, as needed.  Now ask the group to build  Gather possible handwashing supplies: water, another Tippy Tap, providing gallons, basin, soap, sticks, nails, and twine, source help when and where of heat needed.  Prepare building supplies to build two Tippy Taps  Ask them if they have any (see page 2). questions about building a  If you plan to give out Tippy Tap building supplies to Tippy Tap. each participant, be sure you have collected and put  Distribute one bar of soap to together the number you need. each participant for their  If you plan to distribute the How to Build a Tippy Tippy Tap and Tippy Tap Tap, copy the number needed. building supplies or

How to Build a Tippy Tap.  Ask for their commitment to the points below. 1. Build at least one Tippy Tap near where they eat and near their toilet. 2. Ask their entire family to wash their hands with soap under running water before eating and after defecating.

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7. RADIO SPOT: Wash Your Hands with Soap Under Running Water Before Eating and After Defecating

Time Sound Voice 00.0 – 00.03 Key Promise Music Key Message Voice: For a healthy family, it’s good to know our responsibilities: Wash your hands with soap under running water before eating and after defecating.

00.03 – 00.10 Narrator: Hello, did you know that the simple act of handwashing with soap under running water before eating and after defecating is very effective in cleaning our hands of germs that cause or spread diseases such as cholera and 00.11 diarrhoea?

00.20 – 00.23 Sound of handwashing Narrator: Making handwashing with soap a habit under running water can be easy because handwashing is an everyday thing. Simply station a handwashing facility with soap and water near eating or cooking area and toilet. This makes handwashing easy when it is needed most – before eating and after using the toilet.

00.42 – 00.50 Key Promise Music Key Message Voice: For a healthy family, it’s good to know our responsibilities: Wash your hands with soap under running water before eating and after defecating.

This message is brought to you by Ghana Health Service and USAID.

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8. RADIO SPOT: Handwashing Station Close to Your Kitchen and Latrine Makes Handwashing with Soap Under Running Water an Easy Thing

Time Sound Voice 00.00– 00.03 Key Promise Music Key Message Voice: For a healthy family, it’s good 0.04 – 00.10 to know our responsibilities: Wash your hands with soap under running water before eating and after defecating.

00.11 – 00.13 Sound of digging Akua: eh! Akos, what are you doing? Are you 00.13 expanding your kitchen?

Akos: No! My friend, I’m just fixing a handwashing facility near the kitchen. This way, handwashing with soap under running water will become easy for everybody in my family. I will also fix one near the latrine. We will wash our hands with soap under running water before we cook, serve food or eat and after using the latrine. And it will be easy to wash my hands after cleaning my baby’s bottom.

Akua: how did you think of such a great idea? We also wash our hands but this is a better way.

Akos: I spoke with the community-based volunteer and he taught me how to make this simple handwashing facility. It is so easy to build. Now all I have to do is to teach the children to wash their hands with soap and ensure the whole family uses it and also make sure there is soap and water always.

Akua: I’m also going to learn how to make this handwashing facility and make sure we also practice this better handwashing.

00.50 – 00.55 Key Promise Music Key Message Voice: For a healthy family, it’s good to know our responsibilities: Wash your hands with soap under running water before eating and after defecating.

This message is brought to you by Ghana Health Service and USAID.

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9. DRAMA SCRIPT: Handwashing with Soap

A PLAY IN ONE ACT

CAST OF CHARACTERS

Kofi: A JHS 2 Pupil

Stephen: Kofi’s Friend. Also in JHS 2

Rose: Kofi’s younger Sister

Maa Lucy: Kofi and Rose’s Mother

Hajia: Waakye Seller (Food Vendor)

Kwame: Younger brother of Kofi and Rose

Scene On the school compound, outside. At home, outside. Outside.

Time Present day

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Scene 1

Setting: On the school compound during break time. Hajia the Waakye seller has Stephen’s food dished out and is in the process of serving Kofi while Stephen washes his hands with soap at the Veronica bucket close by.

At Rise: Stephen talks to Kofi as he washes his hands.

Narrator “For a healthy family, it’s good to know our responsibilities: Wash your hands with soap under running water before eating and after defecating”

Stephen It’s so easy to remember to wash one’s hands before eating when there is a handwashing station close by. Kofi (He looks at both hands and rubs them vigorously in his school shorts, picks his food from Hajia and starts eating without washing his hands. There is no time to wash hands as the bell will soon go for break over.)

Rose (Walks onto the stage towards the boys and confronts her brother.)

Rose Eh Kofi! I was observing you. You did not wash your hands before eating.

Kofi Aah! Rose paa, what are you talking about? Must we always wash our hands before eating?

Rose Of course, You will get sick otherwise. Always wash your hands with soap under running water before eating and after defecating. Besides you have no excuse as you have a Veronica bucket right here. Stephen washed his hands, why can’t you?

Kofi Hey Rose, stop spoiling my appetite.

Rose Mummy will definitely hear about this when we get home. If your stomach starts hurting don't blame anybody.

Kofi Mind your own business, you can tell anybody you like, I don't care.

(Rose walks off the stage)

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Stephen You should listen to your sister.

Kofi Hey, my friend, don’t you start. Just let me enjoy my food.

(The bell goes for break over, they both hurriedly finish their food, wash their hands and rush off the stage

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Scene 2

Setting: Both boys use the toilet after school. There is a handwashing station close to the school toilet.

At Rise: Stephen has just come out of the toilet and is washing his hands at the handwashing station. As Stephen comes out of the toilet, Kofi goes in. Shortly Kofi comes out of the toilet and he walks past the handwashing station.

Stephen Kofi, my friend, wash your hands! Why are you ignoring such an easy thing? The station is right here. Do you want to get sick? Did you learn nothing from what your sister said this morning?

Kofi What’s the point, look at my hands, do they look dirty to you? Anyway she said I should wash my hands before I eat. I am not going to eat; we are going to play some football before we go home. I have no time. Come on let’s go play some football.

Stephen You should always wash your hands under running water with soap before you eat AND after you defecate.

Kofi So now I have to wash my hands for two reasons, humph. This is not my habit.

Stephen Your naked eyes cannot see the germs that your hands pick as you use the toilet. Washing your hands this safe way clears your hands of the disease causing germs. You have to change your habit before you fall sick one of these days.

(They both walk of the stage, Stephen is shaking his head, Kofi is looking annoyed)

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Scene 3

Setting: Outside, in front of house, one chair, one mat on ground, one small table with plate of food on it appropriate for a 4-year old, Tippy Tap visible, Maa Lucy sitting on mat, with food next to her.

At Rise: Maa Lucy is sitting and looking through the newspapers. Rose, her daughter walks in and joins her.

Rose Maa, what are you reading?

Maa Lucy The newspaper. It says “Corolla” breaks in Cape Coast.

Rose (looks at her mother with a questioning face) What Maa? Corolla is doing what?

Maa Lucy (speaking very loudly and distinctly) Corolla? I said… Cholera…strikes in Cape Coast again

(Both start laughing at the misunderstanding, as they are laughing, Kwame a young child of 4, Maa Lucy’s youngest child comes in to pick up the plate of food on the table near Maa Lucy. Maa Lucy stops him.)

Maa Lucy Kwame, come we must make sure you wash your hands before you start eating.

(They move to the household Tippy Tap to wash the child’s hands and return to the table while Rose continues talking)

Rose Maa, where is Kofi? I haven’t seen him today.

Maa Lucy Kofi is sick. He has a very bad diarrhoea. He is going to miss school, but I must keep him home for now. He is sleeping just now.

Rose Maa, I think I know the cause. Two days ago, I caught him in school, two times, not washing his hands. He was just starting to eat and he refused to wash his hands. The handwashing bucket was just right there. I told him to wash his hands and he told me to mind my own business. Then later that same day, he used the toilet, came out and walked right past the handwashing station that we put in the school to make it easy to wash hands with soap. He walked right past it!!!!

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Maa Lucy Did you say something again to him, to remind him? He knows he should wash his hands under running water with soap. He learns this at home and at school. We know our commitment to keeping our family healthy.

Rose I tried, but when I warned him, he shouted on me. Serves him right for not listening to me.

Maa Lucy Well, I think he might listen now and all of us mothers would do well to wash our own hands under running water with soap and remind all of our children to do so as well.

(They both exit)

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Scene 4

Setting: Outside.

At Rise: Kofi and Stephen walk onto the stage from different directions. They meet.

Kofi (Exclaiming) Eh! Stephen, is that you? Do you know what happened to me?

Stephen What? I knew something wasn’t good. You haven’t been in school for two days. You missed the maths test!! Kofi Oh, I was so sick. I had such bad diarrhoea. I felt I was going to die oo. The way I have suffered hmmm. My stomach. The way I have gone to toilet paaa hmmm. I will never forget.

Stephen You should have listened to your sister. Or you should have done what I do, wash my hands under running water with soap every time I eat or use the toilet. Especially as it is so easy to wash your hands at a handwashing station. I haven’t been sick all year. I haven’t had diarrhoea all year. And my Mom always reminds me to wash my hands at home.

Kofi My Mother always tells me the same thing, but I never listen. Now I am going to be a handwashing Ambassador, so I don’t get so sick again and so my friends don’t get sick either.

Stephen Me too, I want to be an ambassador with you.

Kofi and Stephen (singing and dancing together) “Wash your hands with soap under running water before eating and after defecating” oh yeah, wash your hands with soap under running water (Kofi only) before eating (Stephen only) after defecating

(They keep singing as they move off stage)

Narrator “For a healthy family, it’s good to know our responsibilities: Wash your hands with soap under running water before eating and after defecating”

THE END

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10. TALK SHOW GUIDE: Handwashing with Soap Under Running Water Before Eating and After Defecating

What is a Talk Show? The Talk Show is a live conversation between a Host and a Resource person (s) with the aim of educating the community on a topic of interest. The discussion is led by the Host, who ask questions from a carefully prepared guide to which the expert(s) provide answers. It is possible for the public to tune in and ask questions or make contributions to clarify issues and also share their experiences concerning the issue being discussed. The Talk Show can be held in the studio of a community radio station or at the Community Information Centre. The important thing is that it is broadcast so that a wider audience can listen in.

What is the purpose of a Talk Show? A talk show allows a wide audience and many community members to listen in to a discussion on a particular topic. The audience can also participate in the discussion by asking questions to stimulate interest and deepen understanding of the topic being discussed.

What you need to provide the Talk Show Host and Resource persons?

 Fact Sheet on Handwashing with Soap  Steps for Handwashing with Soap Under Running Water  Steps to Building a Tippy Tap – a Simple Handwashing Station

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How do you organize and carry out a Talk Show? STEPS:

Step Arrange with the Talk Show Host: Make prior Read the Fact sheet and 1 appointment with the Community Radio Host to review the Steps, so you discuss the purpose of the discussion, who will be are conversant with the involved and when it can be done. issues for discussion. Step Provide the Host Background Information: You may add relevant or 2 Provide Host a copy of the Fact sheet on Handwashing practical examples for and highlight the questions for discussion [see emphasis. samples provided].

Step Meet with the Resource Person(s): Meet with the Discussion Questions: 3 resource person(s) and give him/her a copy of the Factsheet on Handwashing. Discuss the key issues 1. What is handwashing? which have to be highlighted in the show. Also, inform 2. Why is handwashing them of the date and time so that they can prepare important? adequately. 3. When should we wash our hands? Step Alert the audience: Once you have completed all 4 4. What is needed for arrangements for the Talk Show, spread the word handwashing? among community people so that they can listen in. 5. What is the proper

way to wash hands? Step Carry out Talk Show: On the day of the Talk Show,

5 be punctual and make sure resource persons also 6. What happens when arrive early enough. Remind them to keep their we don’t wash our responses short and simple so that the audience can hands? remember. Use the sample Discussion Questions to 7. What should be the lead the session. individual or collective responsibility? Provide information to community on:  Where to get further information in the community  Asking local community-based volunteer If you think it will be questions or advice on handwashing with soap  Benefits of joining a community hygiene useful, bring a sample discussion group Tippy Tap for the Host Remind host to end conversation by emphasizing the and other Resource Key Promise and message: People to see so that they can effectively talk “For a healthy family. It’s good to know our about it. responsibilities: Wash your hands with soap

under running water before eating and after defecating”.

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11. ROLE-PLAY: Handwashing with Soap Under Running Water Before Eating

Scenario: Proper handwashing before eating keeps the whole family healthy Materials Needed: Water, container for fetching water, bowl, soap, and 2 kitchen stools. Scenario Key Focus Issues:  Wash hands properly before eating to keep from getting sick  It must be done with soap under running water to clear hands of all germs  Having a handwashing station close to eating area can make it easy Amina just arrived from the city to visit her sick mother Mma Sadia. After preparing the evening meal for the rest of the family, they sit down to eat. Only Fati, Amina’s younger sister gets up to wash her hands. Amina is angry with the rest of her family. She asks Fati to explain why she is washing her hands hoping that the rest will learn too. Fati explains that she must wash her hands with soap under running water before she eats or else she will be eating all the germs on her hands with the food that will make her fall sick. Amina is happy that her little sister Fati is so smart and cares about her health. Amina doesn’t understand why the handwashing station is so close to where they eat yet the whole family is not making it a habit to wash their hands before eating. Discussion Points:  How common is handwashing before eating? Is it done always with soap? How about under running water?  How easy is it to wash hands with soap under running water before eating?  How easy is it to go through the proper handwashing steps?  What steps will we take to make handwashing with soap under running water before eating a habit for the whole family? How can we maintain the habit?  How can we commit to creating a handwashing station with soap and water close to where you eat?

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12. ROLE PLAY: Handwashing with Soap Under Running Water After Defecating

Scenario: Handwashing is habit forming Materials Needed: 2 chairs, handwashing station or Tippy Tap if possible. Scenario Key Focus Issues:  Always wash hands properly after defecating  It must be done with soap under running water to clear hands of germs  To be effective handwashing must be a habit  Create a handwashing station close to latrine to make it easy to wash hands Auntie Mansa calls her daughter Ewura Ama and enquires what is taking her so long. Ewura Ama responds that she had gone to use the latrine and she sits on the chair next to her mother. “Have you washed your hands after using the toilet” her mother asked her. “Yes Maa”, she responded. “With soap” her mother inquired. “There is no soap by the Tippy Tap so I only washed with water”. Auntie Mansa is angry, “You better go grab one of the leftover soap we keep for handwashing for the Tippy Tap and wash your hands again before I smack your face. How many times do I have to tell you that water alone is not enough to clear your hands of germs? This will ensure that any germs that our hands pick up, including faecal matter that our eyes can’t see are washed off. That is why the Tippy Tap is kept so close to the toilet, to make it easy to wash our hands right after using the toilet. We must make it a habit. We all have to remember to do this always to keep the family healthy” Auntie Mansa added. Discussion Points 1  How easy is it for you to wash your hands after defecating? Is it done always with soap under running water?  Do we have a handwashing facility or station? Do we have one close to the toilet? If yes, is soap and water always available? If not what will it take to create a station close to the toilet?  How easy is it to go through the proper handwashing steps?  How can one make handwashing with soap under running water after defecating a habit for the whole family? How can we sustain the practice? Who should be responsible for ensuring the up-keep of the habit?

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13. STORY FOR DISCUSSION: Handwashing with Soap Under Running Water

Story Trigger: Clean hands for dinner Akua was waiting impatiently for her food. She had done all chores that Saturday morning and even filled the water barrel. She was really hungry and it seemed her mother was intentionally delaying the food. Akua sat restlessly with an angry frown on her face. Dada Kojo, her father walked in and also took his seat. He saw the frown on his daughter’s face and commented, “Somebody here is extremely hungry”, and he teased her. His wife responded from the kitchen, “Hmm, she says she is so hungry she can’t wait”. Akua could not stand all the jokes, all she wanted was her food. Then at long last, her mother brought the food. The bowl of banku and okro soup looked like the best thing on earth at that moment to Akua. She stretched out her hand to take the first bite and suddenly stopped with her hand midway and with disappointment in her voice, she cried out, “Aaah!!!”. Her parents looked towards her direction. Her father quickly asked “Is something wrong?”, and her mother also followed, “Did the soup pour on you?”. Akua responded, “No, I just remembered that I have not washed my hands with soap and water yet”. “That’s my girl, I’m glad you now remember to always wash your hands with soap under running water before eating” Dada Kojo commented. His wife turned and looked at him and said, “You better wash your hands too before I bring your food”. “The whole family should make handwashing before eating a habit to stay healthy” she added. Prompting Questions  Can you detail the situation more?  Why do you think this is the situation in your community?  To what extent is this common among most members of the community?  How might you change the situation?

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14. STORY FOR DISCUSSION: Handwashing with Soap Under Running Water

Story Trigger: African germs don’t kill Mr. Manu and his friend Kweku Atta have just arrived at the ‘Don’t Mind Your Wife’ chop bar. They take a seat and place their order - fufu and goat soup with tuna served in one big earthenware bowl. They also order a tot each of ‘Atinka bitters’. The drinks came first and Mr. Manu quickly drinks down his tot. He then excuses himself. “Kweku, let me go and empty the stomach for the feast ahead”. With that, he left to the provisional washroom behind the bar. He returned about 5 minutes later, took his seat and stretched. As if by design, the waitress brought the big bowl of fufu and placed it in front of them and pointed to the handwashing facility close by for customers. Mr. Manu got up washed his hands with soap, then sat down and took his first bite. Kweku Atta while he was waiting for Mr. Manu noticed a handwashing poster on one of the walls of the bar. As he looked at the poster, he said to himself “Who will have time to wash hands when food is waiting”. He looked at his friend and added “African germs don’t kill” and simply started eating with his unwashed hands. Prompting Questions  Can you detail the situation more?  Why do you think this is the situation in your community?  To what extent is this common among most members of the community?  How might you change the situation?

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15. HOME/SCHOOL VISIT CHECKLIST: Wash Hands with Soap Under Running Water Before Eating and After Defecating

District Area Council Community Family name/size/contact No. ……………………………………../……………/…………..………………………….. Ask the following questions and tick or specify as applicable Tick as applicable Household Activity Always Sometimes Never 1. How often do you wash your hands? (Observe as well) 2. At what times (When) do you wash your hands? a. Before eating b. After defecating c. Specify other: 3. With what do you wash your hands? a. Only water b. Water and soap c. Other material - Specify: 4. Where do you wash your hands? a. At a handwashing station close to the toilet b. At a handwashing station close to the kitchen c. Specify other location: 5. How do you dry your hands after washing them? a. Shakes hands to air dry b. Wipe with personal napkin or piece of cloth c. Wipe with communal towel or napkin d. Wipe in clothes 6. Who washes/supervises children’s handwashing Mother Caregiver Fathers  Other  Specify: 7. Demonstrate how you wash your hands. (Observe and tick all steps followed) Wet hands and apply soap Rub palms together  Wash between: Finger nails Fingers, around thumbs  Wash back of hands Wash around wrists  Rinse hands: under running or poured water  In a bowl with water  Communal bowl 

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List of Materials

1. FACT SHEET: Building an Improved Household Latrine ...... 1

2. HOW TO Build an Improved Latrine ...... 2

3. INSTRUCTIONS: Build an Improved Household Latrine ...... 3

4. RADIO SPOT: Build an Improved Household Latrine ...... 4

5. DRAMA SCRIPT: Improved Household Toilets ...... 5

6. ROLE PLAY: Build an Improved Household Latrine ...... 13

7. ROLE PLAY: Build an Improved Household Latrine ...... 14

8. STORY FOR DISCUSSION: Build an Improved Household Latrine ...... 15

9. STORY FOR DISCUSSION: Build an Improved Household Latrine ...... 16

10. HOME VISIT CHECKLIST: Building a latrine ...... 17

11. FACT SHEET: Properly Using and Maintaining a Latrine ...... 18

12. HOW TO Use and Maintain Your Latrine ...... 19

13. FACT SHEET: Safely Disposing of Children’s Faeces ...... 20

14. HOW TO Safely dispose of your child’s faeces ...... 21

15. INSTRUCTIONS: Safe Disposal of Child’s Faeces ...... 22

16. RADIO SPOT: Use and Maintain Your Household Latrine ...... 23

17. RADIO SPOT: Safely Throw Your Child’s Faeces into the Household Latrine ...... 24

18. DRAMA SCRIPT: Use and Maintain A Latrine ...... 25

19. ROLE PLAY: Use a Latrine Properly ...... 29

20. ROLE PLAY: Maintain Your Latrine Properly ...... 30

21. ROLE PLAY: Safely Dispose of Child’s Faeces in the Latrine ...... 31

22. ROLE PLAY: Safely Dispose of Child’s Faeces in the Latrine ...... 32

23. STORY FOR DISCUSSION: Use an Improved Household Latrine Properly ...... 33

24. STORY FOR DISCUSSION: Maintain an Improved Household Latrine Properly ...... 34

25. STORY FOR DISCUSSION: Safely Dispose of a Child’s Faeces ...... 35

26. HOME VISIT CHECKLIST: Latrine Use, Maintenance and Managing Children’s Faeces ...... 36

Full permission granted to photocopy

1. FACT SHEET: Building an Improved Household Latrine

It must: Slab  Eliminate odour Slabs can be made of local materials or a nuisance. concrete slab. They should be suitable for  Be easy to use children and adults and have a cover for the and maintain. latrine hole, depending on the type.  Keep the interior dark for fly Above Ground Building (Super-structure) control. The above ground building should be solid  Keep out rodent and reptiles. and can be built of local materials such as  Make good use of appropriate, available, mud, bamboo, wood and/or palm fronds. It local building materials. should have a door that can be latched from the inside and is easily accessible to children WHY IS AN IMPROVED HOUSEHOLD LATRINE and elderly. The roof IMPORTANT? should prevent rain and An improved household latrine eliminates keep out light to open defecation reducing the spread of germs discourage flies. that cause diarrhoea. Vent Pipe HOW SHOULD AN IMPROVED HOUSEHOLD Vent pipes should fit LATRINE BE BUILT? and be at least a few inches higher than the An improved household latrine should be roof of the latrine to carry out odour and simple, affordable, acceptable, safe and prevent flies. sustainable. Costs Location Available local building materials can be used Latrines should be sited downstream and built for the construction to keep the costs a minimum distance of 90 feet from the affordable. nearest water source and 18 feet from the house so that it does not contaminate a water Technical Support source and is easy to reach at night and in bad Building an improved household latrine weather. It should face the prevailing wind. requires technical support during siting, lining and construction of the sub-structure. Pit (sub-structure) Environmental Health Officers can provide The pit is the below ground part of the latrine. guidance on technical assistance and It should be lined to prevent pit collapse, financing options available.

Sanitation - P a g e | 1 Full permission granted to photocopy For a healthy family, it’s good to know our responsibilities: Build, use and maintain an improved latrine. Wash your hands with soap under running water before eating and after defecating. Treat, store and fetch your drinking water safely

2. HOW TO Build an Improved Latrine

It is important to have your own household latrine and stop defecating in the open to reduce the spread of diarrhoeal diseases. Ask your local Environmental Health Officer for help.

1. Select an appropriate place and draw out the latrine 2. Dig a pit and line it if needed 3. Cast or buy a slab

6. Add the roof, a door 7. Install a handwashing 4. Place the slab 5. Build the latrine structure and vent pipe facility securely over the pit

Sanitation - P a g e | 2 Full permission granted to photocopy For a healthy family, it’s good to know our responsibilities: Build, use and maintain an improved latrine. Wash your hands with soap under running water before eating and after defecating. Treat, store and fetch your drinking water safely

3. INSTRUCTIONS: Build an Improved Household Latrine

What is an Improved Household Latrine?

An improved household latrine provides a safe and hygienic way to separate human excreta from human contact for a household. An improved household latrine consists of three parts: substructure (pit), slab and superstructure. It should: (1) prevent flies from moving in and out of the latrine; (2) offer the user privacy, convenience and dignity; (3) eliminate odour nuisance; and (4) be easy to use and maintain.

How can you use these instructions for a demonstration?

Steps:  Welcome the group and explain the purpose of the session: the importance of having a household Preparation latrine, the benefits of having a household latrine,  Review and refer to “Build an and the steps to building a latrine. Improved Latrine Fact  Ask participants: Sheet”, as needed. o Why is it important to have a household latrine?  Have a demonstration Kit o What are the benefits of an improved latrine? with all provisions: supplies o What is needed to build a latrine? for building, etc. o What challenges do you see with trying to build  If you plan to distribute “How your own latrine? to Build an Improved o How can these challenges be overcome? Latrine” leaflet, carry needed  Demonstrate or show the improved latrine, talking copies with you. about or pointing out each important feature of it.  If you have sample latrines in  Ask questions to reinforce new knowledge as you go along. the community, consider  Ask them if they have any questions about building conducting the session an improved latrine. nearby so that you can show  If in your plan, distribute the “How to Build an these latrines. Improved Latrine” material.  Ask for their commitment to the points below. 1. Talk to other family members about building a latrine. 2. Plan the resources needed to build a household latrine. 3. Seek technical support from Environmental Health Officers and Community Health Volunteers. 4. Build an improved household latrine for their family.

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4. RADIO SPOT: Build an Improved Household Latrine Time Sound Audio 00.00– 00.03 Key Promise Music Key Message Voice: For a healthy family, it’s 00.03 – 00.10 good to know our responsibilities: Build, Use and Maintain an improved household latrine.

00.11 – 00.13 Sound of gong-gong Woman beating Yes, a toilet in every house means:

. 00.14 – 00.46 Sound to highlight each You will stop open defaecation . 00.16 – 00.32 point. You will reduce diarrhoeal diseases. . You will avoid snake bites and other dangers in the bush . You will avoid embarrassment when visitors ask to use the toilet . You will have security for your wives, daughters, and entire family. . You will guarantee the dignity of your whole family

The easy part, an improved household latrine can be constructed with a variety of local materials such as old drums, bamboo, logs, old lorry tires etc.

Talk to your Environmental Health Officers, Community Health Volunteers and the Natural leaders for help in building your toilet. 00.47 – 00.55 Key Promise Music 00.48 – 00.52 Key Message Voice: For a healthy family, it’s

good to know our responsibilities: Build, Use and Maintain an improved household latrine.

This message is brought to you by Ghana Health Service and USAID.

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5. DRAMA SCRIPT: Improved Household Toilets Audiences: Mothers, Caregivers, Fathers, Grandparents and Children Users: Environmental Health Officers, Community Development Officers, Health Promotion Officers, Community Health Volunteers, Community Health Nurses, Natural Leaders, Teachers, SHEP Coordinators, other WASH and Health Practitioners. Venues for Use: Communities, Homes, Schools, CHPS Compounds

HOUSEHOLD TOILETS A PLAY IN TWO ACTS

CAST OF CHARACTERS

Kwesi: Proud owner of a household toilet

Maame Ama: Kwesi's wife

Egya Kwame: Kwesi's Neighbour

Sister Abena: Egya Kwame's wife

Old Lady: Sister Abena's mother

Scene

Kwesi's house

Time

Present time

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Act 1

Scene 1

Setting Kwesi's house. A simple set up with three chairs.

At Rise Maame Ama is sitting on one of the chairs, repairing a tear in a dress with a thread and needle.

Narrator For a healthy family, it is good to know our responsibilities: Build, use and maintain an improved household latrine properly.

Egya Kwame (Walks on stage) Agoo!! (Walks towards Maame Ama) Maame Ama, where is your husband? I have come to see him.

Maame Ama Welcome Egya Kwame. Please have a seat, (See pulls a seat for him) He will join you in a few minutes. (Egya Kwame sits)

Egya Kwame How are the children doing? It has been a while since I last saw Yaa, your eldest daughter.

Maame Ama They are doing well, Yaa has gone to school in Koforidua. The younger ones are in the room preparing to sleep.

(Kweku walks in shaking the water off his hands)

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Kweku

You are welcome to my humble home. (He sits down) Sorry about the delay, I was in the toilet. You are welcome once again. Have you been given water?

Egya Kwame Ooh, thank you. I'm fine.

(They shake hands) Our elders say 'we know, but we still ask'. What brings you here this evening?

Egya Kwame Hmmm, my friend, I have a big problem on my hands and for now it is only you who can save me from embarrassment. Kweku (Anxious) What is it, how can I help? Egya Kwame (Hesitates a bit. Looks around to see if somebody else is there) My in-law has come to visit us, and we can’t take her to the community toilet this evening. You know the place is dark at this time.

Kweku But how can I help. Do you need to borrow my torchlight?

Egya Kwame Oh no, no, no. It’s not that. Actually (He is almost stammering now) I want to see if my wife can bring her to use your toilet.

Kweku Oh I see. Let me ask my wife. You know she is the one who maintains the toilet.

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Egya Kweku (Anxiously) No, no, no!!1. Please, let this remain between us.

Kweku OK. I will see what I can do. Go and bring her.

Egya Kwesi Thank you, thank you, my friend. (Egya Kwesi exits)

Kweku (Calls out loudly) Ama, Ama Maame Ama Yes, I’m coming oo. (She hurries in)

Kweku Can you imagine what Egya Kwesi wanted?

Maame Ama No, unless you tell me.

Kweku He wants to bring his in-law to use our toilet. Can you imagine that?

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Maame Ama (Sighs) I knew this would happen one day. When you started building the toilet, he was complaining. I remember he said, the wind will carry the smell of toilet to my compound.”

(She says this in a very dramatic manner)

Today look at him.

Kweku Anyway, I told them to come, so prepare for them.

Maame Ama My husband, I hear. It’s not a problem. (They both exit)

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Scene 2

Setting Kwesi’s house. A simple set up with three plastic chairs.

At Rise Maame Ama is sitting on one of the plastic chairs, Sister Abena is at the door.

Sister Abena (Shouting out loudly) Agoo, agoo!!!

Maame Ama Yes, I'm coming. (She walks to meet the visitors)

Sister Abena Good evening my sister.

Maame Ama Good evening Sister Abena, is this your mother? (Looking at the older woman) You look so much like her. (She bows to the older woman) Welcome Maa. (Addressing the older woman)

Older Woman Thank you my daughter.

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Maame Ama Maa please come with me, my husband has already spoken to me. (She leads the older woman out)

Sister Abena (Talking to herself) Hmmm what an embarrassment. Going to beg to use a toilet ah! (She shakes her head in sorrow)

(Maame Ama walks back on stage to Sister Abena)

Sister Abena Eh, my sister, I envy you ooo. Having a toilet in the house is a blessings oo!

Maame Ama We thank God. That is really true. Having a toilet at home is very good. It is safe and convenient. I don't worry about flies and smell, because I keep it neat always. Since the toilet was completed, my last born no longer has the frequent episodes of diarrhoea.

Sister Abena I regret I did not push my husband to also build one when you were building yours.

Maame Ama My sister (Places her hands on Sister Abena’s shoulder) It’s never too late, you and your husband can build one too.

(Older woman walks back on stage shaking the water off her hands).

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Older woman There you are my daughter. Thanks for letting me use your toilet. There is indeed a woman in the house. (Turns to her daughter, with a stern look) Abena, let’s go.

Sister Abena Yes, Maa. (Turns to her friend) I thank you so much. I am going to start talking to my husband about building a toilet immediately. Good night.

(They both walks off the stage)

Maame Ama (Turns to face audience) You see how a simple thing like a toilet in the house can make a difference? If you don't have one yet quickly arrange to build one.

(Kwesi walks on stage and stands beside Maame Ama and holds her hand)

Kwesi (Also speaking to the audience)

The Community Health volunteers, Environmental Health Officers and natural leaders are there to offer us help. Talk to any one of them today and get your household latrine constructed.

Narrator For a healthy family, it is good to know our responsibilities: Build, use and maintain an improved household latrine properly.

THE END

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6. ROLE PLAY: Build an Improved Household Latrine Audiences: Mothers, Caregivers, Fathers, Grandparents and Children Users: Environmental Health Officers, Community Development Officers, Health Promotion Officers, Community Health Volunteers, Community Health Nurses, Natural Leaders, Teachers, SHEP Coordinators, other WASH and Health Practitioners. Venues for Use: Communities, Homes, Schools, CHPS Compounds

Scenario: Proud owner of an improved household latrine Materials Needed: Two chairs Scenario Key Focus Issues:  Having your own latrine increases pride in the household  Building a latrine is affordable  Having your own latrine reduces embarrassment and dangers of defecating in the bush Memuna visits her friend Asana in a nearby village to buy salted fish for the next market day. During the course of their discussions, Memuna asks Asana to show her a bush nearby where she can defecate. Asana tells her friend she now owns and uses an improved household latrine, just behind her house. Upon her return, Memuna ask how much it cost. Asana indicates she did not spend much to complete their household latrine because she used locally available materials. She advised Memuna to see the Natural leaders for information and advice.

Asana tells her friend how safe and proud she is among other women in her village just knowing that she has a toilet at her convenience and privacy. Memuna recounted how the village youth leader nearly ran into her when she was defecating in the bush. She had to hide behind some trees to avoid the embarrassment. Memuna swears she will encourage her husband to immediately start constructing their household latrine when she gets back home.

Discussion Points  How much does it cost to own a household latrine?  How many household toilets are in the community? Why do people not have toilets at home? What can be done about the situation to increase the number of household toilets in the community?  What additional information and help would people need to build their own toilets? Who can provide that information?  How can one commit to build an improved household latrine?

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7. ROLE PLAY: Build an Improved Household Latrine Audiences: Mothers, Caregivers, Fathers, Grandparents and Children Users: Environmental Health Officers, Community Development Officers, Health Promotion Officers, Community Health Volunteers, Community Health Nurses, Natural Leaders, Teachers, SHEP Coordinators, other WASH and Health Practitioners. Venues for Use: Communities, Homes, Schools, CHPS Compounds

Scenario: Improved Household Latrines keeps us safe. Materials Needed: None Scenario Key Focus Issues:  An improved household latrine provides safety from diarrhoeal diseases and other health hazards.  Everyone can own a latrine by using local materials. Bismark finds his friend Musah panting heavily standing by the side of the road. He is barefooted. Bismark inquires why his friend is panting and looking very much like someone who is running away from some trouble. He teases his friend that he is being chased by a jealous boyfriend. Musah recovers his breath and scolds his friend for playing with serious matters. Musah narrates his experience: he had gone into the bush to defecate. As he squats to defecate, some noise in the bush alarmed him about the presence of an animal. He turns just in time to see a huge snake staring him in the face. He takes to his heels without looking back. In the process, he lost his sandals and suffered some cuts and bruises.

Bismark reminds Musah that he did not take the call to build household latrine seriously and remarks that latrine are not only safe but also affordable. Even Maame Lucy, the poor widow in their community owns a latrine now, so Musah has no excuse for not building one.

Discussion Points  Why is it good to have an improved household latrine?  How can each of us own one?  How can we commit to building an improved household latrine?

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8. STORY FOR DISCUSSION: Build an Improved Household Latrine Audiences: Mothers, Caregivers, Fathers, Grandparents and Children Users: Environmental Health Officers, Community Development Officers, Health Promotion Officers, Community Health Volunteers, Community Health Nurses, Natural Leaders, Teachers, SHEP Coordinators, other WASH and Health Practitioners. Venues for Use: Communities, Homes, Schools, CHPS Compounds

Story Trigger: Improved household latrines are affordable It has been a month since the two best friends Mark and Stephen met at the local palm wine base. They as usual shared a few calabashes full of fresh palm wine and Mark asked, “Tell me, what is new?” Stephen said to his friend, “I have constructed a beautiful improved household latrine.” “I guess you won a lottery because there is no way you could do that; you do not have the money.” said Mark. Stephen explained how Yaw Manu, the Community Natural leader assisted him to put one up with available local materials. “The old drums my father used to brew local gin those days, was used for lining the pit since our soil is not stable.” “There is a lot of bamboo in your village and it can be used to construct most parts of your latrine, so you might end up spending less than me.” Stephen added that all the Environmental Health Officers are skilled to give everyone technical support. Mark vowed to immediately contact John, the Environmental Health Officer stationed at the Area Council office in their village for technical support. “I will ensure my improved household latrine is completed before the yam festival in my village in two weeks,” said Mark.

Prompting Questions

 Can you detail the situation more?  Why do you think this is the situation in your community?  To what extent is this common among most members of the community?  How might you change the situation?

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9. STORY FOR DISCUSSION: Build an Improved Household Latrine Audiences: Mothers, Caregivers, Fathers, Grandparents and Children Users: Environmental Health Officers, Community Development Officers, Health Promotion Officers, Community Health Volunteers, Community Health Nurses, Natural Leaders, Teachers, SHEP Coordinators, other WASH and Health Practitioners. Venues for Use: Communities, Homes, Schools, CHPS Compounds

Story Trigger: The chief’s son died practicing open defaecation The entire Galikope community was still in a state of shock days after the burial of the only son of their chief. How he died was still a shock, bitten by a poisonous snake when he was defecating in the bush. He always failed to use the only latrine in the entire community, a communal latrine which always gave any user the most “permanent perfume” and was home to all sort of rodents and insects. There was no Cleaner or Attendant, as nobody was willing to take up that huge task. The chief together with his elders didn’t hesitate to declare the community as a “No place for open defaecation” and gave a directive for the youth to immediately close and pull down the communal latrine. They also issued an ultimatum for all households to construct improved latrines within the next three months. This was received with loud applause by the whole community especially the women as other men will no longer see their nakedness in the bush when they go out to defecate. They were equally excited about the privacy, convenience, safety and dignity that the household latrines will bring. Davi Abla, who stays close to the communal latrine exclaimed, “I can now breathe well and sleep soundly”

Prompting Questions

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10. HOME VISIT CHECKLIST: Building a latrine

District Area Council Community Family name/size/contact No. …………………………../…………/…………………… Stage of latrine Sub structure  Slab  Super-structure  Completed 

Ask the following questions and tick as applicable depending on stage of the latrine

Household Activity

Sub structure (Pit) 1. What shape is the pit? Round  Rectangular  2. Is the pit between 5 feet and 8 feet in depth? Yes  No  3. What is the nature of the soil? Loose  Water logged  Stable  Rocky  Clayey 4. Is the pit lined? Yes  No  If yes with what material?...... Slab 5. Is there an improved squat slab? Yes  No  6. What material is the slab made of? Wood  Wood and mud  Concrete  Concrete and Iron Rods  Other:………………………….. 7. Does the squat hole have a cover? Yes  No  8. Does air freely pass through the cover into the pit? Yes  No  9. Does the slab provide safety? Yes  No  Superstructure 10. What is the super-structure wall made of? Brick and cement  Metal sheets  Palm mat  Mud  Bamboo Thatch  Wood  Others………………. 11. What material is the door made of? Metal sheet  Bamboo  Wood  Others………… 12. Can the door be bolted or locked? (Especially from the inside)? Yes  No  13. What is the roof made of? Wood  Iron Roofing sheet  Thatch  Plastic  Bamboo  Others…………………………… 14. Does the roof provide at least minimal cover from the rain and sun? Yes  No  15. Is there a vent pipe? Yes  No  16. Is the vent pipe covered with a net? Yes  No  17. Does the super-structure provide safety? Yes  No  18. Does the super-structure provide privacy? Yes  No 

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11. FACT SHEET: Proper Use and Maintenance of a Latrine Audiences: Mothers, Caregivers, Fathers, Grandparents and Children Users: Environmental Health Officers, Community Development Officers, Health Promotion Officers, Community Health Volunteers, Community Health Nurses, Natural Leaders, Teachers, SHEP Coordinators, other WASH and Health Practitioners. Venues for Use: Communities, Homes, Schools, CHPS Compounds

WHAT IS PROPER USE AND MAINTENANCE HOW SHOULD THE LATRINE BE OF A LATRINE? MAINTAINED? Proper use and maintenance of a latrine To extend the lifespan of a latrine and keep it means to keep it clean, odourless, free of flies safe for use by the entire household, maintain and to ensure that is always repaired, working the latrine as follows: 1. Keep the area around the latrine free well and safe to use. from weeds and garbage. 2. Make sure the pathway to the latrine is WHY USE AND MAINTAIN THE LATRINE clear to make it safe to use at all times. PROPERLY? 3. Check the latrine regularly to be sure it is A household latrine is one of the best safe to use and works properly: investment any family can make considering  Examine the fly proof netting on top of its convenience, safety, privacy and health the vent pipe and replace it when torn to benefits. If it is properly used and prevent flies that enter the latrine from maintained, it will keep families healthier, coming out. reduce diarrhoeal diseases and last until the  Replace torn pit is full. fly proof netting on top HOW SHOULD THE LATRINE BE USED? of latrine doors To use a latrine effectively, a latrine owner immediately to should: prevent flies

1. Confine all household faeces, including from entering children and babies, to their latrine. the latrine or coming out of it. 2. Position themselves well on the squat  Constantly inspect the latrine building for hole to avoid messing the floor with urine cracks and repair them to keep off and faeces and teach their children and dangerous reptiles and rodents from other family members how to use it. latrine. 3. Throw cleansing material into the squat  Cut grown trees around the latrine, hole. especially the branches on the latrine roof 4. Use a latrine hole cover as appropriate. to improve ventilation. 5. Throw wood ash into the pit from time to  Pour a little water down the vent pipe time to reduce occasionally to remove cobwebs and dirt. odour.  Check for and repair leakages between 6. Sweep it daily. vent pipe, slab and roof. 7. Clean it frequently 4. Dig a new pit when the old one gets full, with soap and move the latrine slab to the new pit and water and any fill the old pit. time it is soiled Community members can seek advice from with urine and/or Environmental Health Officers, Community faeces. Health Volunteers, and other trained persons 8. Place a on how to get the best out of their latrine and handwashing facility near the latrine for maintain it properly. easy handwashing after defecation

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12. HOW TO Use and Maintain Your Latrine

It is important to use and maintain your latrine properly because it reduces the spread of diarrheal diseases and keeps your family healthy.

Clean your latrine with Keep the latrine hole Throw ash into your soap and water regularly Throw all paper and wiping Sweep latrine daily covered as appropriate latrine to reduce odour to remove faeces and material into the pit

urine stains

Keep the area around your Make sure the pathway to the Check your latrine regularly, Dig a new pit when your latrine gets full, latrine free of weeds and latrine is clear and timely fix any needed move the slab to the new pit, and fill in refuse repairs the old pit

Sanitation - P a g e | 19 Full permission granted to photocopy

13. FACT SHEET: Safely Disposing of Children’s Faeces Audiences: Mothers, Caregivers, Fathers, Grandparents and Children Users: Environmental Health Officers, Community Development Officers, Health Promotion Officers, Community Health Volunteers, Community Health Nurses, Natural Leaders, Teachers, SHEP Coordinators, other WASH and Health Practitioners. Venues for Use: Communities, Homes, Schools, CHPS Compounds

WHAT IS “SAFE DISPOSAL” OF A CHILD’S HEALTH IMPACT OF UNSAFE DISPOSAL OF FAECES? CHILDREN’S FAECES To safely dispose of a child’s faeces means to There is widespread belief that the faeces throw it in a latrine or of infants and young children are not bury it immediately. It is harmful, but this is untrue. There is essential that mothers evidence that children’s faeces could be should always wash their even more harmful than adults’ faeces, hands after disposing of the faeces. due to higher amounts of diarrhoea and other germs in children’s faeces than in adults’ faeces. Children’s faeces should be WHY IS IT IMPORTANT TO SAFELY DISPOSE OF treated with the same concern as adults’ A CHILD’S FAECES? faeces Children’s faeces are as harmful as adults’ The unsafe disposal of children’s faeces faeces. If they are safely disposed of, it can can be an important source of disease reduce diarrhoeal diseases and make the family, particularly children under five, healthier. around the household, increasing the risk of illness for infants and children under HOW SHOULD WE SAFELY DISPOSE OF five. CHILDREN’S FAECES? This can include a higher prevalence of The safest way to dispose of a diarrhoeal diseases, intestinal worms, child’s faeces is to help an malnutrition, and death. Further, stunting, older child use a latrine. For very young children, a wasting and worm infestation can reduce chamber pot can be used and children’s intellectual capacity, which then emptied into a latrine affects productivity later in life. immediately or well-covered Diarrhoeal diseases account for 6.8% of all until it can be emptied. When child deaths in Ghana (WHO 2015). a latrine is not available, a child’s faeces can be safely buried. Mothers Diarrhoea can force households to spend should always wash their hands with soap under significant sums on medicine, running water after safely disposing off their transportation, and health facility fees. The child’s faeces. average monthly cost for routine care for illnesses such as diarrhoea is GH cedi 11.09 (World Bank 2015).

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14. HOW TO Safely dispose of your child’s faeces

It is important to quickly and safely dispose of your child’s faeces in the latrine or bury it to reduce the spread of diseases as children’s faeces is as harmful as adults’ faeces.

Cover the chamber pot with a tight lid, if Use a chamber pot Dispose of child’s faeces in you cannot throw it away immediately a latrine immediately

Help younger children learn Dig a hole and bury the child’s faeces, Always wash your hands under to use the latrine if you don’t have a latrine yet running water after disposing of child’s faeces Sanitation - P a g e | 21 Full permission granted to photocopy

15. INSTRUCTIONS: Safe Disposal of Child’s Faeces Audiences: Mothers, Caregivers, Fathers, Grandparents and Children Users: Environmental Health Officers, Community Development Officers, Health Promotion Officers, Community Health Volunteers, Community Health Nurses, Natural Leaders, Teachers, SHEP Coordinators, other WASH and Health Practitioners. Venues for Use: Communities, Homes, Schools, CHPS Compounds

What is safe disposal of a child’s faeces? The safest way to dispose of a child’s faeces is to help the child use a latrine. For very young children help them to use a chamber pot and empty the faeces into a latrine in a timely manner. By definition, “safe disposal” is only possible where there is access to a latrine. However, when a latrine is not available, a child’s faeces can be safely buried. In any case, mothers should always wash their hands with soap under running water after safely disposing of their children’s faeces.

How can you use these instructions for a demonstration? Steps:  Welcome the group and explain the purpose of the session, which are the importance of burying or throwing child’s faeces into the latrine and what to do if you don’t have time to bury or throw a child’s faeces into the latrine immediately.  Ask participants: o Why is it important to safely dispose of a child’s faeces? Preparation o What do you normally do to dispose of your child’s faeces?  Review and refer to “Safely o How should you safely dispose of a child’s faeces? Dispose of your Child’s  Using the Fact Sheet go through each picture and ask them Faeces” Fact Sheet, as what they see and what it means. needed.  Ask questions to reinforce new knowledge as you go along.  Have a demonstration Kit with all materials.  If you plan to distribute  Ask them if they have any questions about disposing off a “How-To Dispose of your child’s faeces. Child’s Feces”, carry needed  If in your plan, distribute the How-To Dispose of your Child’s copies with you. faeces.  If you have sample latrines in  Ask for their commitment to the points below. the community, consider 5. Obtain a chamber pot with cover. conducting the session 6. Throw child’s faeces in the latrine. nearby so that you can show 7. If no latrine, bury child’s faeces. the latrine. 8. Always wash my hands with soap under running water after disposing off child’s faeces.

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16. RADIO SPOT: Use and Maintain Your Household Latrine

Seconds Sounds Voice 00.0 – 00.03 Key Promise Music Key Promise Voice: 00.04 – 00.10 For a healthy family, it is good to know our responsibilities: Build, use and maintain an improved household latrine.

00.11 – 00.12 Sound effect – door opening Mama: Eh! (shock) What is this? 00.13 – 00 Mama: (shouts) Kwesi! Kwame! Boys: Yes, Maa

00.16 – 00.18 Sound effect – running feet Mama: Is this how you kept the toilet these few days I have been away? What a mess!!

Boys: Oh Maa

Mama: Come on, hurry up and go tidy up the place.

00.26 – 00.28 Sound effect – sweeping The toilet is a very important place for the family. It should always be kept clean so that it does not smell, breed flies or bring us diseases like cholera or diarrhoea.

You should sweep the toilet every day. Put all cleansing materials in the squat hole. Regularly clean with soap and water to remove urine and faeces stains and to reduce odour and flies.

00.46 – 00.48 Sound effect – door opening Mama: Ah! (with satisfaction) What a clean toilet. Now I can do my thing happily.

Boys exclaim “Clean toilet smells good”

00.54 – 00.56 Key Promise Music Key Promise Voice: 00.57 For a healthy family, it is good to know our responsibilities: Build, use and maintain an improved household latrine.

This message is brought to you by Ghana Health Service and USAID.

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17. RADIO SPOT: Safely Throw Your Child’s Faeces into the Household Latrine Seconds Sounds Voice 00.00– 00.03 Key Promise Music Key Promise Voice: 00.04 – 00.10 For a healthy family, it is good to know our responsibilities: Build, use and maintain an improved household latrine.

00.11 – 00.13 Sound effect – footsteps Akosua: Yaa, good morning, where are you off to? 00.14 – 00. Yaa: Good morning, my sister. The child went to toilet and I’m throwing it away in the bush behind the house. Akosua: Eii! are you still doing that? I thought we had all stopped open defaecation? Yaa: Aah, but this is only a child’s faeces. Akosua: Faeces are faeces oo. It does not matter whether it is an adult’s or child’s. Both carry germs that the houseflies will carry back to the house to give us cholera or diarrhoea. Yaa: Aah! so what should I do now? I can’t take it back to the house. Akosua: Until you get your latrine, you can dig and bury the faeces. Let’s go do that now.

00.44 – 00.46 Sound effect – footsteps Monologue 00.46 – 00.57 All faeces are dangerous. Both adults’ and children’s faeces carry germs that can give us diarrhoea or cholera. Let us stop throwing children’s faeces whether in a chamber pot or diaper into the bush, in gutters or refuse dumps. The best place to dispose of faeces is in a latrine or to bury it.

00.57 – 00.59 Key Promise Music Narrator: 01.00 – 01.07 For a healthy family, it is good to know our responsibilities: Build, use and maintain an improved household latrine.

This message is brought to you by Ghana Health Service and USAID.

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18. DRAMA SCRIPT: Use and Maintain A Latrine

A PLAY IN ONE ACT

CAST OF CHARACTERS

Adika: Husband of Korkor and father of Afi and Lumo

Korkor: Wife of Adika and mother of Afi and Lumo

Afi: 10-year-old daughter of Adika and Korkor, older sister to Lumo

Lumo: 4-year-old son of Adika and Korkor, younger brother of Afi

Serwa: Neighbour and best friend of Korkor, also member of the Village Health Committee

Scene At Adika and Korkor’s compound.

Time Present day

Materials Needed 3 Chairs, a Mat

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Scene 1

Setting: Outdoors at Adika’s compound with both children, Afi and Lumo sitting on a mat doing school work and playing.

At Rise: Serwa walks in with her scarf drawn over her nose

Narrator

“For a healthy family, it’s good to know our responsibilities: Build, use and maintain an improved household latrine.”

Adika Welcome Serwa! How are you this fine day? I will call Korkor for you, she is in the kitchen preparing dinner. Afi, go get your mother so that she can come and see Serwa.

(Afi gets up and goes behind to get her mother)

Adika Please Serwa, are you sick? You have been holding your scarf over your nose since you entered the compound. If you are, please stay away from me, I have to go to the farm every day and I cannot afford to get sick.

(As Adika finishes speaking, he gets up and walks away, Afi returns with her mother by the hand)

Korkor (As she speaks she is pulling out a chair for Serwa to sit on)

What’s this Serwa? Are you sick? Please come sit down, you should not be standing. What is the matter? Is this why you have come to see me? How can I help?

Serwa (Exclaims angrily) I am not sick, if you would just give me a minute, I could explain, but you haven’t stopped talking since I got here.

Korkor Oh please Serwa, tell me what’s wrong. I can see that you are angry.

Serwa I ‘m not angry, just concerned. I came over here because there is a very bad smell coming from your backyard. I did not know what it was till I got here.

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Korkor (Says nothing but looks around the ground, knowing that Serwa as a member of the Health Committee in the village always visited houses which have health issues.)

Serwa You should call Adika as I am sure what I have to say concerns your husband as well.

(Korkor calls her husband to join them and pulls a chair for him to sit as he enters).

(Adika sits down and orders the kids to go and prepare to go to bed.)

Serwa Adika and Korkor, I think we need to talk. I just passed by your latrine and you need to do something about it. It’s so messy. The fly proof netting on the door is torn. I even looked inside and I saw anal cleansing materials scattered all over the floor, there are urine and faeces stains around the squat hole and the netting on top of the vent pipe is also missing. As for the odour emanating from the toilet, the least said about it the better.

Korkor (Says very quietly as she knows her latrine is not very clean) Yes, I have learned that I need to sweep it daily and clean it at least once a week with soap and water or whenever there are urine and faeces stains.

Serwa To reduce or prevent the odour, all the anal cleansing materials must be dropped in the squat hole. Another way to reduce the smell is to drop some ash in the drop hole from time to time.

Adika I know you are going to get at me now. Don’t worry. I’m going to fix the door and replace the fly proof netting on top of the door and on top of the vent pipe.

Serwa Yes, that way the flies that enter can’t come out with faeces to contaminate our food. And once you are up there drop some water down the vent pipe to clear it of cobwebs. And in case you get too busy to do it yourself Efo Kojo your next door neighbour is a trained Natural Leader and can help you for close to nothing.

Korkor Please, can you also cut the bushy branches of the tree close to the latrine to improve the ventilation? This Saturday I’ll let the kids clear the weeds and refuse around the latrine and clear the path to it as well. It will then be safe and secured and we won’t have to worry about snakes or rats.

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Serwa Papa Adika you might as well repair the cracks in the walls once you set yourself to work on the latrine. I do see one very good thing that I don’t always see in other households, you have put a handwashing station with soap and water right near your latrine, so that even now I can wash my hands (Serwa proceeds to wash her hands) after touching things talking about your latrines.

Korkor I am so glad you came, now we can make things right and be sure we stay healthy and don’t bother our neighbours with the bad smell from our latrine.

Adika I promise you that things will be different by the next time you visit us.

Narrator “For a healthy family, it’s good to know our commitment: Build, use and maintain an improved household latrine.”

THE END

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19. ROLE PLAY: Use a Latrine Properly Audiences: Mothers, Caregivers, Fathers, Grandparents and Children Users: Environmental Health Officers, Community Development Officers, Health Promotion Officers, Community Health Volunteers, Community Health Nurses, Natural Leaders, Teachers, SHEP Coordinators, other WASH and Health Practitioners. Venues for Use: Communities, Homes, Schools, CHPS Compounds

Scenario: Mansa the lazy one Materials Needed: Latrine cleaning materials, set up like a latrine. Scenario Key Focus Issues:  Latrine should be well cleaned regularly.  Sweeping and scrubbing with soap and water will help keep it clean.  Disposing of the wiping materials into the pit will reduce the smell.  Throwing ash into the pit can also reduce the smell and flies. Maame Esi has visited her daughter Mansah. There is a bad smell of faeces (shit) coming from behind the house. Maame Esi is uncomfortable to ask but she does. Mansah accuses her husband of not building a proper latrine for the house. He is lazy and can’t do what other men do. Maame Esi asks if the latrine is full or is damaged. Mansah responds in the negative. Is sweeping and cleaning done regularly? Mansah responds in the negative. Maame Esi is surprised at her daughter and rebukes her for being the lazy one. She goes on to educate her on keeping the latrine safe and user friendly by sweeping it daily, cleaning with soap and water whenever stained with urine and faeces and dispose of anal cleansing materials into the pit. To reduce the odour and flies, she asks her to throw ash into the pit from time to time. Maame Esi is angry and demands that her daughter go out and clean the latrine immediately.

Discussion Points  How do people generally care for their latrines in the community?  What materials do they use in cleaning their latrines and how often do they clean it?  Who normally does the cleaning of the latrine?  What are individual users required to do when they use the toilet? (Use the right anal cleansing material and drop it in the squat hole, immediately clean any mess, pour ash to reduce smell, pour water, etc.)

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20. ROLE PLAY: Maintain Your Latrine Properly Audiences: Mothers, Caregivers, Fathers, Grandparents and Children Users: Environmental Health Officers, Community Development Officers, Health Promotion Officers, Community Health Volunteers, Community Health Nurses, Natural Leaders, Teachers, SHEP Coordinators, other WASH and Health Practitioners. Venues for Use: Communities, Homes, Schools, CHPS Compounds

Scenario: Regular maintenance saves major repairs Materials Needed: Best to perform near a latrine so that the players can use it in the role play. Scenario Key Focus Issues:  Latrines need to be maintained regularly to work properly.  There are local artisans who can help with maintenance.  Poorly maintained latrines can increase the risk of the spread of diseases. Kwame has invited Master Paul the local artisan to do some maintenance works on their household latrine. Kwame mentions the vent pipe which has cracked close to the base. Master Paul, is happy to change the vent pipe but before he does, he comments that it is only Kwame who has ever called on him to fix a fault on his latrine. This is despite the fact the he has observed that some latrines he built for other households have some visible faults. Kwame comments that people generally don’t care much about maintenance. He adds that regular checks for faults on the latrines and fixing them not only saves one the cost of major repairs but also extends the life span and benefits of the latrine. He is also worried that as others do not keep their latrines properly, thereby increasing the threat of diarrhoeal diseases in the whole community. He encouraged Master Paul to enter those houses that have latrines with faults and try to convince them to have them repaired. Master Paul agrees it is worth trying and asks to go and begin his work.

Discussion Points  How can you properly maintain your household latrine?  What are the common maintenance issues? What happens when faults on toilets are not repaired? Are there shops in the community or nearby towns where toilet parts can be bought? What local materials can be used for repairs?  Where do community members get help and information on latrine maintenance? Are there Latrine Artisans or Extension workers to help?

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21. ROLE PLAY: Safely Dispose of Child’s Faeces in the Latrine Audiences: Mothers, Caregivers, Fathers, Grandparents and Children Users: Environmental Health Officers, Community Development Officers, Health Promotion Officers, Community Health Volunteers, Community Health Nurses, Natural Leaders, Teachers, SHEP Coordinators, other WASH and Health Practitioners. Venues for Use: Communities, Homes, Schools, CHPS Compounds

Scenario: Pooping in the compound Materials Needed: Bucket, latrine sample Scenario Key Focus Issues:  Children and babies’ faeces carry the same germs as adult’s faeces.  Children and babies’ faeces should be disposed of in the latrine timely.  Where a latrine is not available, children and babies’ faeces should be buried. Hajia Merri is angry with her eldest daughter who has allowed her little son to defecate on the floor within the compound. She orders the faeces to be collected quickly and poured into the household latrine. When that is done, she talks to her daughter about why it is very wrong to allow the child to defecate on the floor. She mentions that apart from it being messy and an eyesore, defecating on the floor spread diseases such as cholera, typhoid, dysentery and worm infestation. Hajia Merri entreats her daughter to buy a chamber pot with cover the next time she goes to the market. That way she can throw the child’s faeces into the latrine or safely cover it and dispose of later if that can’t be done immediately. Where a toilet is not available, one can dig and bury the faeces to prevent flies and domestic animal from having access to it. Her daughter apologizes and promise never to allow that to happen again.

Discussion Points  Where do little children defecate? Why are some children allowed to defecate on the floor? Are chamber pots used regularly?  If chamber pots are used, do they have fitting covers? How are little children and babies’ faeces kept until they are disposed of?  Where are little children and babies’ faeces disposed of? Where should it be disposed of? How frequently are chamber pots emptied when they are used?

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22. ROLE PLAY: Safely Dispose of Child’s Faeces in the Latrine Audiences: Mothers, Caregivers, Fathers, Grandparents and Children Users: Environmental Health Officers, Community Development Officers, Health Promotion Officers, Community Health Volunteers, Community Health Nurses, Natural Leaders, Teachers, SHEP Coordinators, other WASH and Health Practitioners. Venues for Use: Communities, Homes, Schools, CHPS Compounds

Scenario: Using a chamber pot Materials Needed: Chamber pot, bucket with water. Scenario Key Focus Issues:  If you use a chamber pot, dispose of the faeces in the latrine timely.  If you cannot dispose of faeces in a chamber pot immediately, cover it tightly have time to do so.  Children and babies’ faeces carry the same germs as adult’s faeces. Davi Abla’s baby has just finished defecating in the chamber pot. She has food on the fire and does not think she has the time to go out and pour the baby’s faeces into the latrine and get back without burning her food. She quickly pours some water into the chamber pot and pours the content out through the window. Her husband steps in just at that moment and asks what she just threw out. He is surprised at her when he finds out. He rebukes her and even though she tries to explain, he rejects her excuses and goes on to explain why it is important to throw all, including children’s’ faeces into the latrine promptly or to dig and burry where there is no latrine.

Discussion Points  How many use chambers pots for their babies? Do they have covers? What are the challenges with potty training?  Where are babies and little children’s faeces disposed of? How about faeces in used diapers?  How long are faeces kept in chamber pots before being disposed of? If not immediately why? Are the faeces in the chamber pots covered before emptied in a latrine or buried? Why should the chamber pots be covered?  How does having a latrine influence the safe disposal of children’s faeces?

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23. STORY FOR DISCUSSION: Use an Improved Household Latrine Properly

Story Trigger: Spotless, Just the Way We like It Two friends are walking back from the mark et. Adwoa asks her friend if they can go to her house first, as it is closer, so she can use her latrine. As they get to the house, Adwoa runs to the latrine, she had needed to go since morning and knew she shouldn’t go out in the bush. She returns shortly with a frown on her face. “Muni, I am surprised, your latrine is so dirty! I would have been better waiting until I got home, or worse, going in the bush and you know our community’s taboo of “No open defecation”. But your latrine, ah, so smelly, so dirty. Why do you not keep it clean?”. Muni says nothing as now she is embarrassed. She had been meaning to clean it since last week and hadn’t gotten around to it. Adwoa says, “You know if you throw the wiping papers in the latrine as you use them and sweep and throw ash into the hole daily, it already starts to stay clean. Then if you really clean it with soap and water frequently to remove, the urine and faeces stains, it will be odour free, clean and keep your entire family healthy.” Muni remains silent as she can tell her friend has more to say. Adwoa continues, “also if you cover your latrine hole with the netted cover, it keeps it aired out properly and stops the flies that get in from escaping and carrying germs to your family.” Muni looks at her friend Adwoa, hugs her and says, “Adwoa, you are always looking out for me and my family and have the best advice always. Next time you come and need to use our latrine, I promise, it will be so clean, you will think it was just newly built – it will be spotless, just the way we like it!”

Prompting Questions  Can you detail the situation more?  Why do you think this is the situation in your community?  To what extent is this common among most members of the community?  How might you change the situation?

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24. STORY FOR DISCUSSION: Maintain an Improved Household Latrine Properly

Story Trigger: From run-down to repaired James comes home to find his wife and their neighbour staring at their household latrine. They looked concerned. He had his latrine built six months ago, but the rain and the wind have been gradually damaging the latrine. The rain has made the weeds grow very quickly around the latrine. His wife looks at him, “James, we need to repair our latrine. The netting is ripped, the pipe is cracked and part of the plastering is crumbling. It does us no good to have a latrine if we don’t maintain it, then it doesn’t work properly and keep our family healthy.” James looks a bit angry and replies, “But I work on the farm all day, I don’t have time to repair this latrine.” “Dear James” his wife responds, “We can ask the village mason, you know the one who has been trained to build latrines to come and take a look at it. He is very reasonable. He often helps you do the work, charges less and does the repairs quickly.” She continues as she knows she has his attention now, “We can assign the task of weeding and clearing the pathway to the kids, just like they help me with the latrine cleaning.” James looks thoughtful, “Yes, I can see that this will work-and if we maintained the latrine well, it will serve the whole family for a long time to come. James’ wife smiles, she knows her husband is proud to have a latrine for his family and will do everything to keep it in good working condition. Their latrine will soon go from run-down to repaired.

Prompting Questions

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25. STORY FOR DISCUSSION: Safely Dispose of a Child’s Faeces

Story Trigger: My Compound is unsafe and I’m going to fix it. Rita is so sad these days. Every time she turns around, her family is sick. She doesn’t know why. Her good neighbour, Afi comes over to see her and she can tell that Rita is unhappy. “Rita,” Afi asks softly, “why the sad face? Money problem again?” Rita looks at Afi and sighs, “Well, yes and no! We are having problems paying for our medical bills because the family always seems to have diarrhoea. My husband can’t even work on the farm every day!” Afi looks at her and says, “Well, I know that you have a latrine and you keep it very clean, so it can’t be that….” Rita stops for a minute and looks around the compound. “And I can see that you have proper handwashing stations with soap and water that I have seen your family use often – in fact, handwashing is more of a habit and everyday thing in your household than mine, so it can’t be that too.” Rita sighs again because she is sure she is doing everything right. Then Afi looks around and sees some diapers in the nearby bushes with many flies on them. “Ahaa, now I see the problem,” Afi says shaking her head in disgust. “You are not properly disposing of your daughter’s faeces in the latrine!!!”. Rita looks confused and says, “but infant’s faeces don’t carry germs like adult’s faeces, do they? Besides my daughter is too young to use our latrine” Afi replies, “Yes they do, your young daughter’s faeces are as harmful as adult’s faeces, it contains the same germs and can make you sick. When you throw it in the bushes, the flies get on it and carry the germs to your house, food and family." Rita now looks very surprised, “So what can I do?” Afi explains, “Have your daughter use a chamber pot and empty the content in the latrine. If she poops on the ground, collect and throw it in the latrine immediately. When she gets a little older, you can teach and assist her on how to use the latrine.” Rita sighs again, but this time contentedly and adds, “Now I see why my family is always getting diarrhoea. My compound is unsafe and I am going to fix it.”

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26. HOME VISIT CHECKLIST: Latrine Use, Maintenance and Managing Children’s Faeces

Audiences: Mothers, Caregivers, Fathers, Grandparents and Children Users: Environmental Health Officers, Community Development Officers, Health Promotion Officers, Community Health Volunteers, Community Health Nurses, Natural Leaders, Teachers, SHEP Coordinators, other WASH and Health Practitioners. Venues for Use: Communities, Homes, Schools, CHPS Compounds Only use this checklist if household has an improved latrine Audiences: Households (Mothers/Caregivers, Partners and Children) Users: Environmental Health Officers, Community Development Officers, Health Promotion Officers, Community Health Volunteers, Community Health Nurses, Natural Leaders, Teachers, SHEP Coordinators, and other WASH Practitioners. Venue for Use: Households with improved latrines District Area Council Community Family name, size and ……………………………………./…………………/……………………… contact number Ask the following questions and tick as applicable Household Activity LATRINE USE 1. How often does this household clean its latrine(s)? (tick appropriate response) Daily  Weekly  Any time it is messy  Other: ______2. How does this household dispose of its anal cleansing material? (tick responses) In the latrine hole  In a bin  On the floor  Other: ______3. What does this household use to reduce smell from its latrine? Ash  Dettol Other(s)…………………… 4. Does household have a squat hole cover which allows air to move freely into the pit? Yes  No  5. Does this household use its squat hole cover? Yes  No  LATRINE MAINTENANCE 6. Does household check its latrine regularly to be sure it is in good working condition? 7. If yes to question 6, which of the following actions does the family undertake? (tick all that apply) Examine the fly proof netting at the top of the vent pipe  Change torn fly proof immediately  Pour little water down the vent pipe occasionally to remove cobwebs and dirt  Cut grown tree branches around the latrine  Constantly inspect and mend cracks in the latrine building  Check for leakages between vent pipe, cover slabs, and roof  Keep the area around latrine free from weeds and refuse  Make sure the pathway to the latrine is clear of weeds 

MANAGING CHILDREN’S FECES 8. Where do the young children (under five years) defecate? (tick responses) Chamber pot  Latrine with assistance  Diaper  On the ground and collected  Other: ------9. If children in this household use a chamber pot, diaper or defecate on the ground and collected, where is the faeces disposed of? Thrown into the latrine  Dig and bury  Other: ______

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MODULE 4: TREAT, STORE AND FETCH DRINKING WATER SAFELY

List of Materials

1. FACT SHEET: Boiling Water to Drink ...... 1

2. HOW TO Boil Your Drinking Water ...... 2

3. INSTRUCTIONS: Boiling Drinking Water ...... 3

4. FACT SHEET: Properly Storing and Fetching Safe Drinking Water...... 4

5. HOW TO Safely Store and Fetch Your Drinking Water ...... 5

6. INSTRUCTIONS: Safely Storing Drinking Water ...... 6

7. INSTRUCTIONs: Safely Fetching Stored Drinking Water ...... 7

8. RADIO SPOT: Boil Water Collected Before Drinking ...... 8

9. RADIO SPOT: Storing Drinking Water ...... 9

10. RADIO SPOT: Fetch Drinking Water Safely ...... 10

11. ROLE PLAY: Boil Water Collected before Drinking ...... 11

12. ROLE PLAY: Boil Water Collected before Drinking ...... 12

13. ROLE PLAY: Drinking Water Storage ...... 13

14. ROLE PLAY: Fetch Your Treated Drinking Water Safely ...... 14

15. STORY FOR DISCUSSION: Boil Water Collected before Drinking ...... 15

16. STORY FOR DISCUSSION: Boil Water Collected before Drinking ...... 16

17. STORY FOR DISCUSSION: Store Drinking Water Safely ...... 17

18. STORY FOR DISCUSSION: Store Drinking Water Safely ...... 18

19. STORY FOR DISCUSSION: Store Drinking Water Safely ...... 19

20. STORY FOR DISCUSSION: Retrieve Drinking Water Safely ...... 20

21. HOME VISIT CHECKLIST: Water Treatment, Storage, And Retrieval ...... 21

22. HOME VISIT CHECKLIST: How and When to Clean Drinking Water Containers and Utensils ...... 22

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1. FACT SHEET: Boiling Water to Drink Audiences: Mothers, Caregivers, Fathers, Grandparents and Children Users: Environmental Health Officers, Community Development Officers, Health Promotion Officers, Community Health Volunteers, Community Health Nurses, Natural Leaders, Teachers, SHEP Coordinators, other WASH and Health Practitioners. Venues for Use: Communities, Homes, Schools, CHPS Compounds

WHAT IS BOILING WATER TO DRINK? unsafe sources. Unsafe sources of water Boiling is a way to kill germs and bacteria include surface water, unprotected wells found in most and river water. Water can also be water sources to contaminated by dirty containers, their make it safe to covers and during transportation to the drink. It is an house, so it is good to even boil water easy and very from the borehole to be sure it is safe to cost effective drink. method of getting safe WHEN SHOULD water. If the water is cloudy, it should be WE BOIL filtered to remove the dirt before boiling WATER? it. Drinking water should be boiled WHY IS IT IMPORTANT TO BOIL WATER before it is TO DRINK? consumed and it Drinking contaminated water creates should be many health problems, including diarrheal allowed to cool. diseases. Boiling water kills the germs It is also good to boil drinking found in it that make it unsafe to drink. water when there is an outbreak of Most harmful microorganisms and germs diseases like cholera, even if you think the in water die when it has been boiled source is safe. making it safe to drink. Boiling does not; however, destroy or remove HOW LONG SHOULD WATER BE BOILED? contaminants or chemicals in the water. Water should be boiled until it rolls with large bubbles. The time it takes to achieve WHAT WATER SHOULD BE BOILED FOR this will depend on how hot the fire that is DRINKING? being used to boil the water is and the Water should be boiled if it comes from amount of water being boiled.

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2. HOW TO Boil Your Drinking Water

It is important to boil your drinking water properly so that you kill all the germs and your family will stay healthy.

2. Boil the water until

1. Filter water you see big bubbles

3. Let boiled water cool, then 4. Ensure container is store in a safe container for use covered at all times

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3. INSTRUCTIONS: Boiling Drinking Water Audiences: Mothers, Caregivers, Fathers, Grandparents and Children Users: Environmental Health Officers, Community Development Officers, Health Promotion Officers, Community Health Volunteers, Community Health Nurses, Natural Leaders, Teachers, SHEP Coordinators, other WASH and Health Practitioners. Venues for Use: Communities, Homes, Schools, CHPS Compounds

What is boiling of drinking water?

It is water that has been boiled/treated to make it potable. Boiling kills the disease-causing germs found in water that make it unsafe to drink. Germs die in boiling water, so by the time water boiled vigorously, all germs have been killed, making it safe to drink.

How can you use these instructions for a demonstration?

Steps:  Welcome the group and explain the purpose of the Preparation session: the importance of boiling your drinking water,  Review and refer to Boil how to plan for water boiling, and how to boil drinking Drinking Water Fact water. Sheet, as needed.  Ask participants:  Have a demonstration Kit o Where does your drinking water come from? with all provisions: water o Why is it important to boil your drinking water? containers, lids, jerry can, o How do you boil drinking water? tap, other choices as o How can you plan for your drinking water boiling? appropriate. o How do you water has boiled enough?  If you plan to distribute  Distribute the “Boil Drinking Water How-to” and go Boil Drinking Water How- through each step asking them to describe what they see To, carry needed copies and understand. with you.  Ask questions to reinforce new knowledge as members are discussing.  Ask them if they have any questions about boiling their drinking water.  Ask for their commitment to the points below: 1. Boil drinking water for the family daily. 2. Plan for the boiling of drinking water to make the task easier and less costly. 3. Use locally available fuel to boiling water.

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4. FACT SHEET: Properly Storing and Fetching Safe Drinking Water Audiences: Mothers, Caregivers, Fathers, Grandparents and Children Users: Environmental Health Officers, Community Development Officers, Health Promotion Officers, Community Health Volunteers, Community Health Nurses, Natural Leaders, Teachers, SHEP Coordinators, other WASH and Health Practitioners. Venues for Use: Communities, Homes, Schools, CHPS Compounds

WHAT IS SAFE DRINKING WATER? It is water that has been boiled or treated to WHAT ARE THE ELEMENTS OF A SAFE make it drinkable. FETCHING CUP?  Long-handled cup that can be safely WHAT IS PROPER STORAGE OF SAFE stored on top of DRINKING WATER? the drinking water Safe storage of drinking water is the practice container; or of keeping treated water in a clean separate  A tap to take out container with a clean fitting cover that the drinking water protects it from re-contamination. without opening the container; or WHAT ARE THE ELEMENTS OF A SAFE  Smaller opening STORAGE CONTAINER? where water can It is preferable to store treated water in be poured out into plastic, ceramic, or metal containers with the a cup (still needs to following characteristics, which serve as be large enough to physical barriers to recontamination: clean the container properly every day)  A small opening with a lid or cover that discourages users from placing potentially dirty items, such as hands, into the stored water; or Key Points  If small opening is unavailable, container  Wash drinking water containers with a good lid and a long-handled cup regularly or before refilling with soap that can be safely stored inside and used and clean water. only to take out water; or  Always keep drinking water well-  A tap or small opening to allow easy and covered. safe access to the water without requiring  Only use long-handled cup for fetching. the insertion of hands or objects into the Do not drink from this cup. Always container; and ensure that long-handled cup is clean.  A container that can be easily:  Use separate containers for drinking 1) Cleaned regularly with soap and clean water only. water and  Keep drinking water out of reach of 2) Placed out of reach of small children. small children.  Keep drinking water container in a clean environment. WHAT IS PROPER FETCHING OF DRINKING  Separate drinking water cups from WATER? other utensils when storing. Safe drinking water fetching means taking water out of the drinking water container in a manner that does not contaminate it.

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5. HOW TO Safely Store and Fetch Your Drinking Water

It is important to store and fetch your drinking water safely to keep it clean and safe to drink for your whole family.

3. Cover your drinking water 1. Wash your drinking water containers 2. Pour your boiled water into a container regularly with soap and clean water clean drinking water container

4. Keep your drinking water out 5. Use a long-handled cup 6. Use a separate cup for of reach of your small children to fetch your drinking drinking water Water - P a g e | 5 Full permission granted to photocopy

6. INSTRUCTIONS: Safely Storing Drinking Water

What is safe drinking water? It is water that has been boiled/treated to make it fit to drink, wholesome or potable.

What is safe storage of drinking water? Safe storage of drinking water is the practice of keeping treated water in a clean separate container with a cover that protects the water from re-contamination.

How can you use these instructions for a demonstration?

Steps:  Welcome the group and explain the purpose of the session: the importance of storing your drinking water safely and how to safely store drinking water. Preparation  Ask participants:  Review and refer to Safe o Why is it important to store your drinking water Storage of Drinking Water safely? Fact Sheet, as needed. o How can you safely store your drinking water?  Have a demonstration Kit  Ask a few members of the group to demonstrate how to with all provisions: water safely store drinking water. Use the How-to Store and containers, lids, jerry can, Fetch Drinking Water Safely handout to assist with tap, other choices as picture and illustrations. appropriate.  Ask questions to reinforce new knowledge as members  If you plan to distribute are demonstrating. How-to Store and Fetch  Ask them if they have any questions about storing their Drinking Water Safely, drinking water safely. carry needed copies with  Go over the steps once again as you distribute the How- you. to Store and Fetch Drinking Water Safely handout.  Ask for their commitment to the points below: 1. Have separate containers for drinking water. 2. Clean drinking water container(s) and fetching cup at least once a week. 3. Tightly cover drinking water. 4. Keep drinking water out of reach of children under five-years old.

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7. INSTRUCTIONs: Safely Fetching Stored Drinking Water Audiences: Mothers, Caregivers, Fathers, Grandparents and Children Users: Environmental Health Officers, Community Development Officers, Health Promotion Officers, Community Health Volunteers, Community Health Nurses, Natural Leaders, Teachers, SHEP Coordinators, other WASH and Health Practitioners. Venues for Use: Communities, Homes, Schools, CHPS Compounds

What is safe drinking water? It is water that has been treated to make it fit to drink, wholesome or potable.

What is safe fetching of stored treated drinking water? Safe fetching of drinking water is taking or removing water out of the drinking water container in a manner that does not contaminate it.

How can you use these instructions for a demonstration?

Steps:  Welcome the group and explain the purpose of the Preparation session: the importance of fetching your drinking water

safely and how to safely fetch drinking water.  Review and refer to Safe  Ask participants: o Why is it important to fetch your drinking water Fetching of Drinking Water safely? Fact Sheet, as needed. o How can you safely fetch your drinking water?  Have a demonstration Kit  Ask a few members of the group to demonstrate how with all provisions: water to safely fetch drinking water. (Allow them use containers, lids, long- materials you have brought along or materials they handled fetching cup, and have provided.) cup for drinking.  Ask questions to reinforce new knowledge as members  If you plan to distribute are demonstrating. How-to Fetch Drinking  Ask them if they have any questions and if in your plan, Water Safely, carry needed distribute the How-to Fetch Drinking Water Safely. copies with you.  Ask for their commitment to the points below: 1. Purchase and use a long-handled cup to fetch water from the drinking water container. 2. Drink from a different cup than you use to fetch your drinking water. 3. Keep fetching cup out of reach of small children to keep them clean. 4. Hook fetching cup on the inside of the water container to keep it clean.

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8. RADIO SPOT: Boil Water Collected Before Drinking

Time Sound Audio 0:00 – 0:04 Key Promise Music Key Message Voice: For a healthy family, it’s good to 0:04 – 0:10 know our responsibilities: Boil, store and fetch your drinking water safely.

0:10 – 0:12 Sound effect – Monologue instrumental music Woman: Water is Life. But not all water is safe to drink. Water can easily get contaminated, even just 0:12 carrying it from the borehole or pipe. Water from streams, ponds and rivers also has to be treated before it becomes safe to drink. It is easy to treat your water to make it safe for drinking. After preparing the family meal, don’t put off the fire immediately, use it to boil your water for the next day. 0:28 – 0:29 Sound effect – All you need is a clean pot or saucepan with a lid. saucepan and lid Pour the water into the pot and put it on fire. Let it 0:31 – 0:32 Sound effect – boil until you see large bubbles, then you can take it boiling water off the fire. Let it cool down and pour it into your clean drinking water container with a lid. 0:36 – 0:38 Sound effect – instrumental music You see, it’s simple! Now, you and your family have 0:38 clean water to drink all day.

0:42 – 0:50 Key Promise Music Key Message Voice: For a healthy family, it’s good to know our responsibilities: Boil, store and fetch your drinking water safely.

This message is brought to you by Ghana Health Service and USAID.

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9. RADIO SPOT: Storing Drinking Water

Time Sound Audio 0:00 – 0:03 Key Promise Music Key Message Voice: For a healthy family, it’s good 0:03 – 0:07 to know our responsibilities: Boil, store and fetch your drinking water safely.

0:07 – 0:08 Sound effect – gong Narrator: 0:08 gong beating Agoo! Agoo! Can everyone hear me? Today we are going to talk about something simple but very important. Are you listening? Are you ready?

Do you know water meant for drinking must be stored separately and properly in a clean water 0:24 – 0:25 Sound effect – saucepan storage container with a lid and kept in place out and lid of reach of children?

It is not only that, the container and lid should also be cleaned with soap and clean water regularly to have fresh safe water for the family.

You see, it’s a simple procedure. Now, you and the family can drink that safe water you always deserve.

0:44 – 0:47 Key Promise Music Key Message Voice: For a healthy family, it’s good 0:47 – 0:48 to know our responsibilities: Boil, store and fetch your drinking water safely.

This message is brought to you by Ghana Health Service and USAID.

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10. RADIO SPOT: Fetch Drinking Water Safely

Time Sound Audio 0:00 – 0:03 Key Promise Music Key Message Voice: For a healthy family, it’s good to know 0:03 – 0:09 our responsibilities: Boil, store and fetch your drinking water safely.

0:09 – 0:11 Sound effect – Monologue instrumental music Woman: Water is Life and so it must be well protected till it is consumed. Safely stored water must be fetched with a 0:11 designated clean long-handled cup.

A long-handled cup will keep your hands out of your clean drinking water. Not any container at all should be used to fetch drinking water. It should always be a long-handled cup that is used to fetch the drinking water. The water can then be poured into the drinking cup. This keeps the water clean and safe to drink.

It is inexpensive and easy to find long-handled cups to use to fetch your drinking water. Make sure you use one today!

You see, it’s simple! Now, you and your family can drink that clean water you always deserve.

0:51 – 0:54 Key Promise Music Key Message Voice: For a healthy family, it’s good to know 0:54 – 0:60 our responsibilities: Boil, store and fetch your drinking water safely.

This message is brought to you by Ghana Health Service and USAID.

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11. ROLE PLAY: Boil Water Collected before Drinking Audiences: Mothers, Caregivers, Fathers, Grandparents and Children Users: Environmental Health Officers, Community Development Officers, Health Promotion Officers, Community Health Volunteers, Community Health Nurses, Natural Leaders, Teachers, SHEP Coordinators, other WASH and Health Practitioners. Venues for Use: Communities, Homes, Schools, CHPS Compounds

Scenario: CHAT WITH SISTER ROSE, SISTER ABENA AND AKUA

Materials Needed: Bucket, two chairs

Scenario Key Focus Issues:

 Drinking water is boiled, even from a borehole  Boiled drinking water is stored in a clean, separate container  Boiled drinking water is safest to drink Sister Rose and her friend Sister Abena are engaged in a chat when Akua, Sister Rose’s daughter walks in with a bucket of water just from the borehole. Sister Rose instructs her daughter to quickly prepare the drinking water as they had almost run out of drinking water in the house. Sister Abena is curious and asks her friend about the instruction given to her daughter to prepare drinking water. Sister Rose explains to her friend that drinking water in her house is always boiled and stored separately. She explains that this is to ensure they drink only the safest water. Sister Abena is impressed and commits to adopt the practice.

Discussion Points

 What are the sources of water in the community? Which sources do people use for drinking water?  Is it common practice to treat drinking water? Which water treatment options are common in the community? Are there any benefits in boiling drinking water?  How easy and convenient is it to boil drinking water? How long does it take to boil drinking water?  What can be done to make boiling drinking water a regular practice in the community?  Share relevant responsibility as a final word.

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12. ROLE PLAY: Boil Water Collected before Drinking Audiences: Mothers, Caregivers, Fathers, Grandparents and Children Users: Environmental Health Officers, Community Development Officers, Health Promotion Officers, Community Health Volunteers, Community Health Nurses, Natural Leaders, Teachers, SHEP Coordinators, other WASH and Health Practitioners. Venues for Use: Communities, Homes, Schools, CHPS Compounds

Scenario: KWESI AND MENSAH FROM THE FARM

Materials Needed: Water, cup for drinking

Scenario Key Focus Issues:

 Drinking water should be boiled  Boiling water kills germs and prevents most diseases  Boiled drinking water is kept in clean container  Family is healthier because water is boiled Kwesi and his friend Mensah have just returned from the farm. Mensah requests a cup of water to drink before continuing home. He drinks the water and comments on how refreshing it is. Kwesi attributes it to the fact that they are tired, but Mensah insists and wants to know the secret behind the consistently refreshing water he always drinks in Kwesi’s house. Kwesi’s wife steps in and explains how drinking water is treated in their house. Water from the well is filtered, then boiled and stored in a clean separate drinking water container with a tight-fitting cover. Mensah wonders why all that trouble just for drinking water. Kwesi explains that even water from the borehole if not handled well can easily get contaminated. One way to be sure your water is safe to drink is to boil and store it properly. That is why he is so proud of his wife because she does that every day to keep the whole family healthy.

Discussion Points

 What are the water sources in the community? Which sources do people get drinking water from?  Is water treated in the home? Which treatment methods do people use commonly? When is water treated? How often is water treated?  Is drinking water commonly stored separately? What containers are usually used to store drinking water?  What do you do in your household to treat and store drinking water? Why?  Share relevant responsibility as a final word.

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13. ROLE PLAY: Drinking Water Storage Audiences: Mothers, Caregivers, Fathers, Grandparents and Children Users: Environmental Health Officers, Community Development Officers, Health Promotion Officers, Community Health Volunteers, Community Health Nurses, Natural Leaders, Teachers, SHEP Coordinators, other WASH and Health Practitioners. Venues for Use: Communities, Homes, Schools, CHPS Compounds

Scenario: It is very easy to store our drinking water safely. Materials Needed: water storage container, water, soap and sponge Scenario 1 Key Focus Issues:  Place drinking water out of reach of children  Obtain separate container with clean fitting cover for storing drinking water  Clean drinking water storage containers every day

Mrs Adamu goes to Mrs Abu for salt for the evening meal. When she gets there she realizes her friend is thoroughly washing a container with a lid with soap and sponge. She asks Mrs. Abu what she is doing. Mrs. Abu explains that she is cleaning the water container that she uses solely for storing her family’s drinking water. She cleans it with soap and sponge any time she has to refill it with the treated water for drinking. Mrs. Adamu explains that she cannot use a separate container as her young child will simply put all manner of things in it and make it dirty. So she just leaves all the water in the big drum from which they fetch water to drink. Mrs Abu tells her that she learnt from the Community-based Volunteer at the last meeting that to ensure the family has safe water to drink all the time, they needed to obtain a separate container with cover for storing their drinking water, place it out of reach of the young children, then clean drinking water storage container(s) every day. That is exactly what she is doing. Mrs Abu adds that her husband is so happy because they have clean water and the children are healthy and not falling sick as before. Mrs Adamu thanks her friend and adds,” I can’t wait till the next market day to buy a new container to safely store my family’s drinking water too”.

Discussion Points  How difficult is it to get a water storage container?  Why should we have a designated place for water to avoid contamination?  How frequent should a water storage container be cleaned? What are the materials required in cleaning a water storage container?  How easy is it to water storage containers every day?  Why should we have clean fitting lid/cover for our water storage containers?  Share relevant responsibility as a final word. Water - P a g e | 13 Full permission granted to photocopy

14. ROLE PLAY: Fetch Your Treated Drinking Water Safely

Scenario: We can easily contaminate our drinking water Materials Needed: Water, cup for drinking, long-handled cup for fetching, storage container Scenario 1 Key Focus Issues:  Where to obtain the long-handled cup  How to properly fetch water from the container  The type of container to use in fetching water  Family is healthier because water doesn’t get contaminated during the fetching process Linda is thirsty after spending the day playing with Musah under the mango tree in Musah’s house. She went for the tin tomato container sitting on top of the veranda to fetch some water from the water storage container in the Kitchen. Musah stops her and rather directed her to use the long-handled cup on top of the storage container to fetch the water. Linda wants to know why she has to use the long handled cup and not the used Tin Tomato can. Musah explains that, the only water they drink in their house is water that has been filtered, boiled and stored in that clean storage pot with a cover. To keep the drinking water safe from contamination, only the long-handled cup is used in fetching water from the drinking pot. That cup is placed top of the water container cover at all times and washed with soap, sponge and water daily to keep it clean. Musah reaches out and picks one of the cups from a basket nearby and hands it over to Linda to drink from and adds “Never drink from the long-handled cup as you will end up introducing saliva or other germs from your mouth into the drinking water. Linda drinks her water and sigh “What refreshing water”, my mother will hear of this. She thanks Musah for the health tips. Discussion Points  What is used for fetching drinking water in our homes?  Are you considering buying a long-handled cup for fetching of water?  Where are the fetching utensils kept? How do we ensure they are clean always?  How do we fetch our drinking water from containers?  Are we willing to have discussions on water fetching advice with community based volunteers?  Share relevant responsibility as a final word.

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15. STORY FOR DISCUSSION: Boil Water Collected before Drinking Audiences: Mothers, Caregivers, Fathers, Grandparents and Children Users: Environmental Health Officers, Community Development Officers, Health Promotion Officers, Community Health Volunteers, Community Health Nurses, Natural Leaders, Teachers, SHEP Coordinators, other WASH and Health Practitioners. Venues for Use: Communities, Homes, Schools, CHPS Compounds

Story Trigger: Stream water is so refreshing! The evening meal was finished, everybody had eaten their fill and Adjo had just finished reheating the soup she made. Once the soup was hot, she took it off and brought out a nicely polished saucepan, filled it with water and set in on the fire. Adjo’s mother, who was visiting her daughter and family, sat quietly observing her daughter. Out of curiosity, she asked her daughter, “What are you going to do with the water and why that nice saucepan?”. “Maa”, Adjo replied, “I’m using the rest of the fire to prepare our drinking water.” “Drinking water?” Her mother asked, even more curious now. Adjo pulled a chair and sat next to her mother. “Maa, we get our water from the stream, who knows what happens to it. It might look clean, but since people do all kinds of stuff in the stream these days, I separate the water that we will drink, boil it and when it cools down, I pour it into the clean drinking water containers over there”, she pointed to the containers as she spoke, “It is easy and I don’t need to get more wood to boil it.” Adjo’s mother stared at her for a minute and then said, “But stream water is so refreshing and you grew up drinking raw water from the stream and now look at you, only boiled water is good for your family to drink” Hmmm, but come to think of it, you are right looking at all the things that end up in our streams these days. Only God has been protecting us from falling sick from using polluted water.” Prompting Questions  Can you detail the situation more?  Why do you think this is the situation in your community?  To what extent is this common among most members of the community?  How might you change the situation?

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16. STORY FOR DISCUSSION: Boil Water Collected before Drinking Audiences: Mothers, Caregivers, Fathers, Grandparents and Children Users: Environmental Health Officers, Community Development Officers, Health Promotion Officers, Community Health Volunteers, Community Health Nurses, Natural Leaders, Teachers, SHEP Coordinators, other WASH and Health Practitioners. Venues for Use: Communities, Homes, Schools, CHPS Compounds

Story Trigger: Boiling water is boring! Mansa and her friend Afua had just returned from the borehole, where they had gone to collect water for their individual homes. On the way back, they had been talking about a funeral they would be attending the next day. Afua told Mansa, “let me just pour the water into the barrel and I will come over for us to finish the discussion on the funeral”. “Okay, I will be waiting”, Mansa responded. True to her word, Afua arrived at Mansa’s house 10 minutes later. When she got there, Mansa was busily boiling water on her coal pot. From the look of the pot and that fact that it was after dinner Afua knew her friend was not cooking. “Eh how cold is the evening that you are boiling water to bath?”. “Afua asked her friend. Mansa motioned her friend to sit, “I’m not boiling bathing water, I’m boiling water for drinking”, she responded. Afua was surprised, “Really?”, she said, “Is this not part of the water we collected from the borehole just now?”, “I thought they said the borehole water is very pure, but is it not boring to have to take time to boil it again?”. Mansa replied her friend, “Yes, the borehole water is good water, but remember that from the time we fetched the water and carried it home till now, it could get contaminated. So to be sure, my family and I are drinking the safest water, I boil the water and pour it into a clean container with tight fitting cover that we use only as drinking water.” Afua was surprised for the second time, “Really?” she said. “It looks like a lot of work but I think it is very important. I will try it.” She concluded. Mansa replies “Not that difficult and certainly not boring, if you plan it. See, I only boil the drinking water after cooking the evening meal using the left over fuel wood. By morning it’s all cool, with any particles settled and ready to pour into the drinking water container”. Prompting Questions  Can you detail the situation more?  Why do you think this is the situation in your community?  To what extent is this common among most members of the community?  How might you change the situation? Water - P a g e | 16 Full permission granted to photocopy

17. STORY FOR DISCUSSION: Store Drinking Water Safely

Story Trigger: Clean drinking water containers regularly and properly Kwabena and Abena are cleaning their containers by the stream. Kwabena notices that Abena does not have all of her containers with her. “Abena, did you lose or forgot some of your containers?” he asks her. “What do you mean Kwabena? I am washing the ones I always wash at the stream.” Abena replies. “If you mean the other blue ones I have, those are our drinking water containers and I never wash those at the stream.” Kwabena stops for a minute, not sure how to respond, then says, “Why do you wash your drinking water containers differently and why are they all blue?” Abena smiles and says, “The colour makes it easy to always remember that they are our family’s drinking water containers and we use them for nothing else. It keeps our drinking water always clean and I am always sure to clean them properly.” She stops and Kwabena prompts her, “and why don’t you clean them at the stream?” Abena frowns at Kwabena, “I was just about to finish, always so impatient Kwabena! I wash our drinking water containers with soap and a sponge every day. I rinse them out well with clean water before I pour my fresh and cooled boiled drinking water in them again.” “Doesn’t this waste your drinking water?” Kwabena questions. “Oh no, I only use a little of the boiled water, that way I’m always sure the containers are clean and safe for storing our drinking water,” Abena answers and continues washing out her other containers. Prompting Questions  Can you detail the situation more?  Why do you think this is the situation in your community?  To what extent is this common among most members of the community?  How might you change the situation?

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18. STORY FOR DISCUSSION: Store Drinking Water Safely

Story Trigger: Out of reach of children Auntie Akua comes into the house and sees her young child knocking over the drinking water pot. She exclaims, “Kojo, stop spoiling the drinking water. I have told you countless times to ask me when you need water to drink. Now I will have to boil one whole container again. We have not only wasted water, but we will be wasting firewood or charcoal as well.” Just as she finished this outburst, her neighbour, Maame Ama, comes over to see what she is fuming about. “Akua, what is the matter this time? Why are you yelling at Kojo?” Auntie Akua sighs and says, “Kojo has knocked over the water pot again, now I have to boil another container full. Maame Ama says to her friend, “you should do what I have started doing after I spoke with our Community Health Volunteer. I am now putting our drinking water where my younger children cannot reach it. That way I am sure it stays clean and doesn’t get knocked over,” Maame Abena shares. Auntie Akua is impressed and says “let me go and take a look at where you keep your drinking water and see what changes we can make to prevent Kojo from knocking it over again.” As they go, Maame Ama reminds her friend “but make sure you always save some in a water bottle for the children to drink when no adult is at home”. Auntie Akua looks relieved and follows her neighbour into her kitchen to see what could be done. Prompting Questions  Can you detail the situation more?  Why do you think this is the situation in your community?  To what extent is this common among most members of the community?  How might you change the situation?

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19. STORY FOR DISCUSSION: Store Drinking Water Safely

Story Trigger: Store drinking water in separate containers Asana and Fusena are sitting outside talking after preparing food for the evening meal. Asana notices in Fusena’s kitchen that she has several plastic containers, with three larger blue ones in the corner on a table out of reach of the children. She asks, “What is so special about those three large coloured containers that you have them together and on a table?” Fusena looks around to see what her friend is talking about. “Oh those containers are very important!” she exclaims. “They contain the most important thing in our household – our drinking water!” Asana shakes her head as Fusena always makes everything sound so important. Fusena continues, “I keep all of our drinking water in the blue separate containers so my family always knows where to find their safe water. I want my family to stay healthy, so I try to make it easier for all of us to remember. Also, now, I always know which ones I need to clean properly to keep the containers safe for drinking.” Asana adds, “I like this arrangement, you always seem to know the right thing to do to safe guard your family’s health”. “I’m going to follow your example. I’m tired of visiting the hospital all the time with the episodes of diarrhoea or another sickness”. Prompting Questions  Can you detail the situation more?  Why do you think this is the situation in your community?  To what extent is this common among most members of the community?  How might you change the situation?

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20. STORY FOR DISCUSSION: Retrieve Drinking Water Safely

Story Trigger: Dirty hands in the drinking water As Maureen walks into Akua’s compound, she asks, “Oh I am so glad to be here Akua! I have been walking all day and I am so tired and thirsty. Can I get some water to drink?”. “Of course, Maureen, let me get Kofi to bring you some immediately.” Akua responded and asked her son to bring her friend some water. Her son walks to the separate drinking water container, removes the lid and sticks his hand down into the pot to scoop some water for Maureen to drink. Maureen exclaims, “but I don’t want to drink water that has his dirty hands in”. Why do you let him dip his hand into the clean drinking water, Akua? I know that you boil your drinking water and store it in clean, separate, covered containers, but now your son dirties the entire container of water by dipping his hands with the cup in the water.” Akua looks embarrassed as she has tried to keep her family healthy and be a good role model for her neighbours. Maureen continues, “You should do what we do, we always use a long-handled cup to fetch our drinking water out of the container. “We then pour the water from the long- handled cup into another cup for drinking.” It is easy to find the long-handled cup on the market and they are affordable too. Akua asks, “How do you keep that cup clean.? Do you hang it out of the way, hook it inside the water container or what do you do?” Maureen answers promptly, “We place it on top of the lid of the water container and cover it with a clean napkin. This keeps it clean always and right where we need it.” Akua looks relieved as she now has a solution to her problem of fetching their drinking water safely. Now her whole family can fetch their drinking water safely. Prompting Questions  Can you detail the situation more?  Why do you think this is the situation in your community?  To what extent is this common among most members of the community?  How might you change the situation?

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21. HOME VISIT CHECKLIST: Water Treatment, Storage, And Retrieval Audiences: Mothers, Caregivers, Fathers, Grandparents and Children Users: Environmental Health Officers, Community Development Officers, Health Promotion Officers, Community Health Volunteers, Community Health Nurses, Natural Leaders, Teachers, SHEP Coordinators, other WASH and Health Practitioners. Venues for Use: Communities, Homes, Schools, CHPS Compounds

District Area Council Community Family name/size/contact No. …………………………../…………/……………………

Ask the following questions and tick as applicable Tick Household Activity YES NO 1. Does this household treat its drinking water? [If No, then continue to question 7. If Yes, continue with the remaining questions] 2. If yes, what methods does it use? (check all that apply) Boil  Ceramic Pot Filter  Chlorine  Tablets  Solar Disinfectant (SODIS)  Sand Filter  Cloth Filter  Other… If they said YES to Boil, complete #3-#5; otherwise continue to #6 BOIL WATER COLLECTED FOR DRINKING. Does this household: 3. Boil its water using an existing fire started for other purposes? 4. Sets fire just to boil water? 5. Plan how it boils its drinking water? 6. Use locally available fuel like charcoal or firewood for boiling water? STORE DRINKING WATER SAFELY. Does this household: 7. Store its drinking water in clean container (s)? 8. Store its drinking water in separate container (s)? 9. Cover its drinking water container with a tight-fitting lid? 10. Keep it in a place out of reach of small children? 11. Make drinking water accessible to children when adults are out of the house 12. Clean its drinking water container(s) at least once a week? FETCH DRINKING WATER SAFELY. Does this household: 13. Use a hooked, long-handled cup or ladle to fetch drinking water? 14. Keep fetching cup clean? 15. Keep fetching cup out of reach of small children? 16. Use a tap on its drinking water container(s)? 17. Hook its fetching cup on the inside of its drinking water container(s)? 18. Keep a separate cup for drinking ONLY (not used for fetching)?

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22. HOME VISIT CHECKLIST: How and When to Clean Drinking Water Containers and Utensils

District Community Area Council Family name/size/contact …………………………../…………/…………………… No.

Ask the following questions and tick as applicable

Household Activity

1. How often does this household clean its drinking water container(s)? Daily  Every other day  Weekly  When filling the container(s)  Specify other………………………….

2. What does the household use to clean its drinking water container(s)? With only water  With soap and sponge  Specify other material(s)………………………………

3. Does the household have a long-handled cup for fetching water? Yes  No  4. How often do they clean their long-handled cup (s)? Daily  Every other day  Weekly  When filling the container(s)  Specify other time(s)………………………………………………………………………………. 5. What does the household use to clean its long- handled cup for fetching water? With only water  With soap and sponge  Specify other material(s)………………………………. 6. How often do they clean the lid or cover? Daily  Every other day  Weekly  When filling the container(s)  Specify other time(s)…………………………. 7. What does the household use to clean their lid or cover? With only water  With soap and sponge  Specify other material(s)………………………………

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