Baseline Assessment

Transcripción

Baseline Assessment

Report
Enabling Environment Assessment and
Baseline for Scaling Up Handwashing Programs:
Peru
Michael Favin and Doris Alfaro
Global Scaling Up Handwashing Project
April 2008
This report is one in a series of products of the Water and Sanitation Program’s Scaling Up Handwashing
Project funded by the Bill and Melinda Gates Foundation. The aim of the project is to test whether
innovative promotional approaches can generate widespread and sustained increases in handwashing with
soap at critical times among the poor and vulnerable.
This series of reports documents the findings of work in progress about handwashing with soap in order
to encourage the exchange of ideas and information and to promote learning. Please send your feedback
to: [email protected] .
The Water and Sanitation Program (WSP) is a multi-donor partnership of the World Bank. For more than
30 years, WSP has helped the poor gain sustained access to improved water supply and sanitation services
(WSS). WSP works with governments at the local and national level in 25 countries. For more
information, please visit: www.wsp.org .
Credits
Editorial Support: Hope Steele
Production: Paula Carazo
This report was reviewed by Rocio Florez, Lene Jensen, and Eduardo Perez.
ABOUT THE AUTHORS
Michael Favin
Michael Favin has over 30 years of experience in international public health in more than 25 countries in
Africa, Asia, and Latin America, and has worked periodically in environmental health since his time as a
community organizer and health educator for the Peace Corps in Brazil in the early 1970s. Since joining
the Manoff Group in 1987, he has served as a senior technical adviser or a consultant to numerous health
and nutrition projects. For these projects and others, Mr. Favin facilitated behavior change and
communication strategy design, planning, implementation, and evaluation. He has worked in many
critical public health areas, including child health and nutrition, school health and nutrition, maternal and
neonatal health, and environmental health and has supported innovative tool development in areas such as
routine immunization, growth promotion, care-seeking, and community surveillance. Mr. Favin has
written or contributed to more than 60 books, manuals and articles.
Doris Alfaro
Doris Alfaro is a communications specialist with 15 years of experience participating in and managing
projects in the fields of hygiene promotion, behavioral change, social mobilization, and advocacy for
local development as well as partnership building at the community level. She has coordinated, designed,
and implemented communication plans for health and nutrition programs nationwide. She has been a
communications consultant for the health sector in Peru, Latin America, and the Caribbean for projects in
environmental and public health. She has worked with CEPIS-PAHO/WHO, PAHO, municipalities, and
Ministries of Health as well as for NGOs such as CARE and PRISMA.
The findings, interpretations, and conclusions expressed in this report are entirely those of the author.
They do not necessarily represent the views of the International Bank for Reconstruction and
Development/World Bank and its affiliated organizations or those of the Executive Directors of the World
Bank or the governments they represent. The World Bank does not guarantee the accuracy of the data
included in this publication and accepts no responsibility whatsoever for any consequence of their use.
The boundaries, colors, denominations and other information shown on any map in the document do not
imply any judgment on the part of the World Bank concerning the legal status of any territory or the
endorsement or acceptance of such boundaries.
ii
TABLE OF CONTENTS
LIST OF ACRONYMS AND ABBREVIATIONS ………………………………………………………V
SUMMARY........................................................................................................................................1
1. BACKGROUND..............................................................................................................................3
The Global Scaling Up Handwashing Project……………………………………………………..3
The Peru Handwashing Promotion Project………………………………………………………...4
Rationale for Enabling Environment Assessment …………………………………………………5
2. ASSESSMENT METHODOLOGY....................................................................................................6
Dimension Descriptions …………………………………………………………………………...6
The Assessment Process…………………………………………………………………………...7
Feedback on the Assessment Methodology………………………………………………………11
3. MAJOR FINDINGS BY DIMENSION.............................................................................................13
Policy, Strategy, and Direction…………………………………………………………………...13
Partnerships……………………………………………………………………………………….14
Institutional Arrangements………………………………………………………………………..18
Program Methodology……………………………………………………………………………19
Implementation Capacity…………………………………………………………………………20
Availability of Products and Tools……………………………………………………………….21
Financing………………………………………………………………………………………….21
Cost-Effective Implementation…………………………………………………………………...23
Monitoring and Evaluation……………………………………………………………………….23
4. RECOMMENDATIONS BY DIMENSION........................................................................................24
Policy, Strategy, and Direction…………………………………………………………………...24
Partnerships……………………………………………………………………………………….25
Institutional Arrangements………………………………………………………………………..27
Program Methodology……………………………………………………………………………29
Implementation Capacity…………………………………………………………………………29
Availability of Products and Tools……………………………………………………………….30
Financing………………………………………………………………………………………….31
Cost-Effective Implementation…………………………………………………………………...31
Monitoring and Evaluation……………………………………………………………………….32
5. NEXT STEPS...............................................................................................................................33
APPENDIX A: SELECTED DOCUMENTS.........................................................................................34
APPENDIX B: LISTA DE ENTREVISTADOS......................................................................................36
APPENDIX C: RESUMEN DE PUNTOS IMPORTANTES DE LAS ENTREVISTAS..................................42
APPENDIX D: ENCUESTA SOBRE LAS CONDICIONES PARA LA EXPANSIÓN DEL LAVADO DE
MANOS CON JABÓN: 10 RESPUESTAS.............................................................................................61
APPENDIX E: LAS CONDICIONES PARA LA EXPANSIÓN DEL LAVADO DE MANOS CON JABÓN.
GUÍA DE ENTREVISTA ....................................................................................................................69
APPENDIX F: ESTUDIO DE CONDICIONES PARA LA EXPANSIÓN DEL LAVADO DE MANOS CON
JABÓN (GUÍA DE ENTREVISTA PARA SOCIOS POTENCIALES) ........................................................75
iii
APPENDIX G: INFORME DE VIAJE A PIURA...................................................................................83
APPENDIX H: CONDICIONES PARA LA PROMOCIÓN DE LAVADO DE MANOS ................................88
APPENDIX I: SUMMARY OF MAJOR FINDINGS AND RECOMMENDATIONS BY DIMENSION.........93
APPENDIX J: MENÚ DE ACTIVIDADES PARA ALUMNOS (IDEAS PRELIMINARES)..........................97
APPENDIX K: MENÚ DE ACTIVIDADES PARA PROMOTORES DE SALUD (IDEAS PRELIMINARES).99
APPENDIX L: ACTION PLAN TO IMPROVE THE ENVIRONMENT FOR AN EXPANDED
HANDWASHING PROJECT IN PERU..............................................................................................101
LIST OF FIGURES
Figure 1. Partner Contributions to Interpersonal Communications……………………………...16
Figure 2. Partner Contributions to Mass Media………………………………………………….17
LIST OF TABLES
Table 1. Handwashing Targets by Country……………………………………………………….4
Table 2. The Public-Private Partnership for Handwashing in Peru……………………………….4
Table 3. Dimension Addressed by Stakeholder Type …………………………………………….8
Table 4. Persons Interviewed by Organization Type…………………………………………….10
Table 5. Self-Reporting Questionnaire Responses by Organization Type………………………10
Table 6. Calendar of Assessment Team Activities, May–June, 2007…………………………...11
Table 7. Committee Participants…………………………………………………………………27
iv
List of Acronyms and Abbreviations
CBO
COSUDE
DIRESA
DREA
FBO
HWWS
M&E
MIMDES
MOE
MOH
MOU
NGO
PAC/SEDAPAL
PPPHW
PRONASAR
UGEL
USAID
WSP
Community-based organization
Swiss aid organization
Regional health directorate
Regional education directorate
Faith-based organization
Handwashing with soap
Monitoring and evaluation
Ministry of Women and Social Development
Ministry of Education
Ministry of Health
Memorandum of understanding
Nongovernmental organization
Program in Lima to install/improve small water systems
Public-Private Partnership for Handwashing
National program to install/improve small water systems (Ministry of
Housing)
Local educational management unit
U.S. Agency for International Development
Water and Sanitation Program
v
SUMMARY
To follow up country work supported by the Public-Private Partnership for Handwashing, the World
Bank Water and Sanitation Program (WSP) received funding from the Bill & Melinda Gates Foundation
to support projects to scale up the promotion of handwashing with soap (HWWS) in Peru, Senegal,
Tanzania, and Vietnam. The major project objectives of the Handwashing Initiative are:
•
•
•
inculcate the HWWS habit among millions of mothers and children in these countries,
use a strong monitoring and evaluation (M&E) component to enhance the conceptualizing and
management of such programs,
establish sustainable programs that will continue and expand after this four-year grant ends.
Enabling environment assessments were carried out in all four countries to assess current conditions for
scalability and sustainability and to make recommendations for improving conditions that are not
supportive. This report summarizes the study in Peru, which was carried out by an international and a
national consultant during three and a half weeks in May 2007. All four county studies are following a
similar methodology, developed by WSP, to examine nine dimensions of scalability/sustainability
through individual and group in-depth interviews, an electronic survey in which respondents are asked to
score various statements, and a review of documents (Appendix A).
A partnership of many public and private organizations has supported handwashing promotion in Peru
since 2002, achieving impressive results in advocacy, partnership development, tool development, and
many other areas. The Initiative supported partnership formation, mass media, and capacity building for
on-the-ground promotion in 14 of Peru’s 24 regions.
Evaluation of actual impact on knowledge, attitudes, and practice regarding HWWS shows some positive
and some inconclusive findings. However, the study team feels that much excellent groundwork for the
expanded program in Peru has been solidly laid by efforts to date and that, in combination with strong
1
political will from the national government and a certain level of guaranteed funding, the outlook for
effective expansion is very good.
Nonetheless, the team has a number of suggestions, many of which expand ideas suggested by persons
interviewed. Some of the key recommendations are the following:
•
•
•
•
•
•
Plan and implement a dynamic advocacy strategy that begins immediately and that continues
throughout implementation.
Plan and implement a strong project communication strategy directed primarily to partners but
also to decision makers at various levels and to the public. Materials, formats, and activities
should be directly related to reaching one of the strategy’s objectives (for example, partner
motivation, sharing good ideas) and audiences, which should be clearly defined.
Develop and implement an exit strategy that includes steps for dissemination and sustainability of
program activities and achievements.
Continue to negotiate and sign more formal agreements on partners’ roles and responsibilities and
develop systematic mechanisms to monitor the implementation of the agreements.
Have the key national-level partners, including the implementing organizations (which will be
contracted to manage local implementation), dedicate themselves to establishing the conditions
and providing the tools and support for successful local implementation. In this decentralized
vision, the team expects that key factors for program success will be strong and dedicated
partnerships at local levels, with effective tools, methodologies, and support from the national
level.
Greater attention should be given to carrying out thorough regional, provincial, and district
assessments of organizations, potential champions, resources, programs, and conditions and to
establishing and encouraging strong local partnerships.
The assessment methodology, findings, and recommendations are documented in this report and its many
appendixes (a number of which are in Spanish).
2
1. BACKGROUND
Funded by the Bill & Melinda Gates Foundation, the WSP Global Scaling Up Handwashing
Project will follow the basic approach of the Public-Private Partnership for Handwashing
(PPPHW), a global initiative established in 2001 to promote handwashing with soap at scale to
reduce diarrheal and respiratory infections. 1 This approach draws extensively on lessons learned
from two large-scale handwashing promotion programs. Programma Saniya, implemented in
Bobo-Dioulasso, Burkina Faso, showed the importance of undertaking careful consumer research
at the outset of a handwashing promotion program. The Central American Handwashing for
Diarrheal Disease Prevention Program showed that an effective approach to changing hygiene
behaviors at large scale was to work with a broad partnership of public and private sector
stakeholders that have a mutual interest in increasing handwashing with soap, to focus on the one
behavior with largest potential health impact (handwashing with soap), and to promote it with
cost-effective, consumer-centered marketing.
The Scaling Up Handwashing Project
In hopes of facilitating effective replication and scaling-up of future handwashing-with-soap
behavior change programs, the new project will carry out a structured learning and dissemination
process to develop and share evidence, practical knowledge, and tools.
Specific project objectives are to:
1. design and support the implementation of innovative, large-scale, sustainable
handwashing programs in four diverse countries (Peru, Senegal, Tanzania, and Vietnam);
2. document and learn about the impact and sustainability of innovative, large-scale
handwashing programs;
3. learn about the most effective and sustainable approaches to triggering, scaling-up, and
sustaining handwashing behaviors;
4. promote and enable the adoption of effective handwashing programs in other countries
and position handwashing as a global public health priority through the translation of
results and lessons learned into effective advocacy and applied knowledge and
communication products.
The project is designed to achieve key targets in each country at the end of two years of
implementation. The specific handwashing targets for each country are in Table 1. The target
audience is defined as poor women of childbearing age (15–49) and poor children ages 5–9.
1 Global PPPHW partners include the Water and Sanitation Program, USAID, World Bank, UNICEF, London
School of Hygiene and Tropical Medicine, Centers for Disease Control, Academy for Educational Development,
Water Supply and Sanitation Collaborative Council, Colgate-Palmolive, Procter & Gamble, and Unilever.
3
Table 1. Handwashing Targets by Country
Country
(population)
Target
population
(millions)
Estimate target population
adopting HWWS at critical
times
Peru (28 million)
5.10
1.30
Senegal (11 million)
1.97
0.49
Tanzania (37 million)
5.20
1.30
Vietnam (84 million)
9.20
2.30
Source: World Bank (Water and Sanitation Program). 2007. “Terms of Reference. Enabling Environment
Assessment and Baseline to Scale up, Sustain and Replicate Handwashing with Soap Behavior Change
Programs.” March 9.
The Peru Handwashing Promotion Project
As in many countries, diarrhea and respiratory diseases are the leading causes of childhood
illness and death in Peru, and malnutrition is a major underlying cause of child mortality.
Handwashing with soap can significantly reduce all of these major causes of misery. Attention to
hygiene and handwashing got a significant boost in Peru in the 1990s because of the cholera
epidemic, but as shown by the Handwashing Initiative’s 2004 baseline, practice levels were still
woefully low: 11 percent of mothers and 6 percent of children washed hands with soap before
eating, and 17.6 percent of mothers and 12 percent of children after going to the bathroom.2
The public-private partnership for handwashing developed in Peru over several years, as
summarized in Table 2.
Table 2. The Public-Private Partnership for Handwashing in Peru
Year
Activity
2003
Advocacy, handwashing practices study, development of a business plan
2004
Efforts to secure funding, funding commitments from the Japanese Fund, USAID, WSP (the
Water and Sanitation Program), and COSUDE (Swiss aid)
2005
Selection of communication agencies, design of project strategy and work plan, first campaign
and training workshops, monitoring activities, commitment of private sector funds
2006
Training workshops and promotional activities, monitoring, financial management, international
advocacy, launching of second campaign, effort to establish local alliances, process evaluation,
design of impact evaluation
2007
Financing from the Bill & Melinda Gates Foundation secured, local alliances strengthened,
school program, mass media campaign, monitoring and evaluation
Source: Flórez P., Rocío. “Iniciativa de Lavado de Manos en el Perú.” 17 de Octubre, 2006 (PPT).
2
AB PRISMA. Estudio de comportamiento de lavador de manos con jabón en zonas periféricas del Perú. Preparado
como línea de base para la Iniciativa de Lavado de Manos en el Perú, liderado por PAS-Banco Mundial. Junio 2004.
4
The Peruvian program implemented activities at the national level and developed partnerships
and activities in 14 of Peru’s 24 regions. Preliminary monitoring and evaluation showed mixed
but promising improvements in knowledge, attitudes, and practices, particularly in handwashing
before eating and preparing food.
Fostering partnerships at the national, regional, and local levels has been a key project strategy.
Although this has been difficult and demanding at times, it has also been a major reason for
progress. Both interpersonal communication (in schools and communities) and mass media
(mostly print and radio) made important contributions to changing knowledge, attitudes, and
practices. M&E studies (these and other references are listed in Appendix A) indicate that all of
the communication channels used (mass media broadcasts, print materials, training teachers and
students, and training health staff and volunteers) contributed to reaching the target families, and
that no one channel predominated.
Rationale for Enabling Environment Assessment
In each participating country, an Enabling Environment Assessment is being carried out to (1)
assess the extent to which the programmatic conditions for scale up and sustainability are in
place at the beginning of the project; and (2) on the basis of the assessment findings, recommend
what should be done to address the gaps during project implementation. Toward the end of the
project period—in about 3.5 years—a final assessment will be carried out to determine whether
there is an enabling environment in place in each country that can continue after 2010 without
the Gates Foundation/World Bank project assistance.
The overall handwashing project is four years in duration with three distinct phases:
•
•
•
Phase I is the 1.5-year start-up period for detailed planning at the global and country level.
Several assessments, including a handwashing measures study and the baseline for the
impact evaluation, will be carried out during this period. The baseline assessment of
enabling elements will be carried out during Phase I.
Phase II is the 2-year implementation period.
Phase III is the 6-month wrap-up phase that will include the final evaluation and
dissemination of lessons learned. The final enabling environment assessment will take
place during Phase III.
5
2. ASSESSMENT METHODOLOGY
In other to ensure consistency in the assessment findings, WSP constructed a conceptual
framework for assessing scalability and sustainability. This framework was developed based on a
review of relevant literature and discussions with key individuals.
Dimension Descriptions
The framework comprises nine dimensions that are considered essential to scaling up a
handwashing-with-soap behavior change program.
Policy, Strategy, and Direction: Establishing a shared vision and strategy and ensuring the
political will to implement them is the starting point for scale up. Without political will and a
shared vision and strategy among stakeholders at all levels, scale up will remain an elusive goal.
Developing this shared vision and strategy in a collaborative manner is also the foundation for
coordination and for creating motivation all levels.
Partnerships: This handwashing-with-soap program model is based on a establishing a publicprivate partnership. A partnership is a relationship where two or more parties, having compatible
goals, form an agreement to share the work, share the risk, share the power, and share the results
or proceeds. Partnerships need to be built at all levels among public, private, and NGO sectors
and between communities and local governments.
Institutional Arrangements: Institutions at all levels must clearly understand their roles,
responsibilities, and authority. They must also have the resources to carry out their roles. In
addition to clear roles and responsibilities, institutional arrangements must include the
mechanisms for actors at all levels to coordinate their activities.
Program Methodology: Handwashing-with-soap programs have a seven-step program
methodology. This methodology, adapted to each country context, should be clear and agreed
upon by all key stakeholders.
Implementation Capacity: In addition to clearly defined institutional roles and responsibilities,
institutions at all levels must have the capacity to carry out their roles and responsibilities.
Institutional capacity includes adequate human resources with the full range of skills required to
carry out their functions; an “organizational home” within the institution that has the assigned
responsibility; mastery of the agreed-upon program methodology, systems, and procedures
required for implementation; and the ability to monitor program effectiveness and make
adjustments.
Availability of Products and Tools: A handwashing-with-soap behavior-change program is
predicated on the existence of the soap that responds to consumer preferences and their
willingness and ability to pay for them. In addition, handwashing station supplies—that is,
plastic basins, towels, and so on—need to be easily available.
Financing: This dimension is aimed at assessing the adequacy of arrangements for financing the
programmatic costs. These costs include training, staff salaries, transportation, office equipment
and supplies, and the development of communication and educational materials as well as
programmatic line items in budgets for handwashing-promotion activities.
Cost-Effective Implementation: The potentially high costs of promoting handwashing-withsoap behavior at scale make cost-effective implementation a key element. It is essential to
understand how the unit costs change as activities are scaled up. Although it will not be possible
to assess the cost-effectiveness of the approach and how best to achieve economies of scale until
6
the end of the project, data must still be collected during implementation to make this
determination at the end of the project. Therefore, this assessment will try to ensure that
information will be collected from the outset and that the capacity to collect the information is in
place.
Monitoring and Evaluation: A large-scale handwashing-with-soap behavior-change program
requires regular monitoring and, perhaps more importantly, the willingness and ability to use the
monitoring process to make adjustments in the program. Effective monitoring will identify
strengths and weaknesses in the program methodology, implementation arrangements, and cost
efficiencies. Overall monitoring responsibility must be at the highest level of the program, but
must be based on information collected at the local government or district level.
The Assessment Process
The primary data sources comprised the main stakeholders/present partners for the in-country
program work, including government agencies, international agencies, international NGOs, local
NGOs, private sector organizations, and community-based organizations (CBOs) at national,
regional, district, and local levels. In Peru, all members of the National Committee were sought
for interviews, as well as other partners at the national level and local partners in two of the
country’s 24 regions. Piura was visited as an “old” region that had participated in the
Handwashing Initiative, and Arequipa as a new region that will be included in the expanded
program. In the expanded program, the number of participating regions will increase to
approximately 20, depending on the requirements of the M&E plan.
Secondary data sources comprised documents and additional potential implementers, such as
media and ministries with no direct involvement to date. Appendix A lists the main documents
consulted.
Table 3 indicates the type of stakeholders interviewed on various dimensions.
7
Table 3. Dimension Addressed by Stakeholder Type
Stakeholder Type
Media
X
L
X
–
–
X
X
Partnerships
X
X
X
X
X
L
X
X
X
Institutional Arrangements
X
X
X
X
–
L
X
X
X
Program Methodology
X
X
X
X
X
L
–
X
–
Implementation Capacity
N,D
–
X
X
X
L
–
–
–
Availability of Products & Tools
–
–
X
X
X
L
–
–
–
Financing
X
–
X
–
–
L
–
–
–
Cost-Effective Implementation
N,D
–
X
–
–
–
–
–
–
Monitoring
N,D,
L
–
X
–
X
L
–
–
–
Bilateral
projects
CBOs
X
Advocacy
groups
International
NGOs &
FBOs
X
Private
Sector
International
agencies
Policy, Strategy, Direction
Local NGOs
& FBOs
Government
agencies
Dimension
Note: Unless otherwise noted, an X means that it is appropriate to discuss this dimension at all levels: national,
regional, district, and local; — indicates that this stakeholder type was not questioned on this dimension; N =
national, R = regional, D = district, L = local.
In addition to reviewing documents on the program, both interviews and self-reporting were used
to solicit individuals’ knowledge and opinions. Self-reporting consisted of responding to a
grading-scale questionnaire that was e-mailed to approximately 35 potential respondents, some
of whom were identified at the end of the interviews with the primary informants. Self-reports
allowed the triangulation of information as well as some quantitative analysis that can be easily
compared to findings of the repeat of the assessment planned to take place near the end of the
implementation phase.
Sampling was purposive for all primary data sources. The team strived to interview persons who
had participated in the handwashing program for at least six months. They also sought a good
representation of decision makers, implementers, and midline supervisors/managers from
different levels of organizations involved in the program—that is, national, regional, district, and
local (as indicated needed on the interview matrix of Table 3).
Targets for the minimum sample size were:
•
•
•
one interview and/or self-report (electronic questionnaire) with each current partnering
stakeholder at any level
three interviews in each dimension
two self-reports in each dimension
8
•
•
•
•
•
two interview sets with two different present partnering agencies, within each of these
two organizations, one of each work type
one self-report set with two different present partnering agencies, within each of these
two organizations, one of each work type
two interview sets with two different present partnering agencies with one representative
for each level at three levels minimum—that is, national, district, local
one self-report set with two different present partnering agencies with one representative
for each level at three levels minimum—that is, national, district, local
three interviews with three potential partnering organizations (if appropriate).
The team conducted 35 interviews in different organizations (Appendix B). The persons
interviewed were from the organizations listed in Table 4.
9
Table 4. Persons Interviewed by Organization Type
Types of organizations
Persons interviewed
Government agency
9
Bilateral project
3
Media company
3
Local NGO
4
Private sector
3
International agency
8
International NGO
5
TOTAL
35
Self-reporting questionnaires were sent to representatives of different institutions linked to the
Handwashing Initiative, including some from the same institutions where the team interviewed.
Table 5 shows the types of organizations that provided the 10 completed questionnaires.
Table 5. Self-Reporting Questionnaire Responses by Organization Type
Types of organizations
Persons responding
Government agency
2
Bilateral project
3
Media company
0
Local NGO
1
Private sector
2
International agency
1
International NGO
0
Consultant
1
TOTAL
10
The team carried out a qualitative analysis of the interviews, first by summarizing all
respondents’ positive and negative comments by type of organization and dimension and also
listing the respondents’ corresponding recommendations. Appendix C documents this step in the
process. The team used many, but not all, of the respondents’ recommendations to develop its
own recommendations. The major recommendations were then placed in an Action Plan, as
required by the team’s terms of reference. The team also did a quantitative analysis of the 10
self-reports received (see Appendix D) but did not attempt a further breakdown by stakeholder
type because of the relatively small number of responses.
10
The assessment team was comprised of one international consultant and one local consultant
who worked together during the final 3.5 weeks of May 2007. Table 6 summarizes their
activities in Peru.
Table 6. Calendar of Assessment Team Activities, May–June, 2007
Date
Peru In-Country Activities
May 8–11
Met with country team manager (CTM) to plan the activity
Reviewed the stakeholder list and developed the interview list
Scheduled interviews
Organized logistics
Modified and translated instruments
Sent out self-report questionnaires by e-mail
Began interviews
May 14–
June 1
Conducted interviews (in Lima, Piura, Arequipa)
Summarized responses
Received and tabulated self-reported questionnaires
Drafted findings, recommendations, action plan
June 4–30
Prepared and gave debriefing to global WSP team and Peru program coordinator
Read additional documents
Debriefed for global WSP and drafted this assessment report
Feedback on the Assessment Methodology
The team had to make some adjustments to the general assessment methodology proposed for all
four countries, starting with translating all instruments into Spanish. In addition, they found that
the standard interview questionnaire contained many single questions that contained multiple
issues, so they separated these out. The first few interviews showed that there were too many
questions to ask knowledgeable respondents and that there was some redundancy in questions
under the different dimensions. The team therefore prepared a shortened version of the interview
guide to try to address these concerns. Also, the team was unsure about the degree to which it
should seek information from regions that had already participated in the program compared
with areas where the program would expand. In the end they visited one region of each type, but
they had to prepare another version of the question guide for the new region. (Appendixes D and
E contains these question guides in Spanish. Appendixes F and G contain summaries of the visits
to Piura and Arequipa.)
The persons interviewed varied tremendously by level and nature of their involvement in the
program. Although the methodology anticipated some of this challenge, the interviewers still had
to make on-the-spot decisions on which questions were relevant to the particular respondent and
11
whether the respondent should focus on the past or the future of handwashing promotion
activities.
Many of the respondents of the self-reported questionnaires participated in the Initiative as locallevel implementers or supervisors, so they were really not in a good position to comment on
some of the broader program questions. Nonetheless, there was a fairly strong congruence in
scores for the different questions, which gives some confidence regarding general opinions.
Since it is planned that this assessment will be repeated near the end of the expansion phase, the
team would recommend that different versions of the question guides be prepared for
representatives of key national partners, key regional partners, local implementers, and national
organizations that implemented promotional activities within their own organizations.
12
3. MAJOR FINDINGS BY DIMENSION
Based on documents, interviews and questionnaires, the team prepared a summary of findings
and recommendations in table format (see Appendix I). This section presents a narrative of key
findings.
Policy, Strategy, and Direction
•
•
•
•
•
•
•
The National Committee served as a key venue for manifesting high-level national
commitment to promotion of HWWS.
Government and other organization officials have a strong, positive political will toward
handwashing promotion and child health, although some government officials find it hard
to give these areas special attention because of so many other priorities.
The current national administration has embraced the Initiative and seems well disposed
to collaborate.
Key partners feel that they understand the approach used in the first phase and feel
ownership, but they do not yet have a good understanding of the expanded project (which
is still being designed).
There are several politically prominent national initiatives (regarding malnutrition,
healthy schools, and water and sanitation) that offer natural links with handwashing.
Although the Ministry of Health (MOH) signed a ministerial decree in 2004 in support of
the Handwashing Initiative, its enthusiasm has waxed and waned with frequent changes
of officials; current officials appear to be quite supportive.
At the beginning of the Initiative, national Ministry of Education (MOE) involvement
was minimal, but now the MOE is actively engaged.
There appears to be a strong and positive attitude toward the promotion of handwashing and an
appreciation of its link to child health, in part due to the country’s experience with handwashing
as an effective way to control cholera. This common perception of handwashing promotion as a
key action for improving child health is a major factor favoring program expansion. The current
national government has made a public commitment to improving health and education, and in
turn to supporting several specific programs to which HWWS can directly contribute.
The handwashing program has been successful in promoting the concept that the Initiative is a
true partnership of many organizations and not a program of, for example, the World Bank or the
MOH alone. There has been a shared vision of the partnership that transcends any particular
member, which was no doubt fostered by the National Committee (in particular), as well as the
consultative committee and communication committee. At the same time, the interviews strongly
indicated the need to strengthen dissemination of results and to maintain clarity regarding roles
in the partnership and to nurture partners’ sense of active participation.
Important steps have been taken toward institutionalization, but much work remains to be done.
The Initiative first focused on identifying and engaging with partners to form a public-private
alliance, conducting a study on handwashing practices, and designing a business plan. The MOH
issued Ministerial Resolution No. 062-2004 in support of the Handwashing Initiative, and in
2005 the ministry assumed a stronger leadership role with the initiation of the communication
activities, providing some resources and a resolution in support of a national program of
information dissemination. The MOH also established a sectoral committee comprised of key
ministry offices, but its function was limited to receiving information, and it did not evolve into
making proposals to strengthen the institutionalization of the Initiative.
13
In some of the regions, there has been progress in institutionalizing handwashing activities into
public and private institutions’ work plans (for example, Lambayeque and Ica) and into training
curricula (in Cusco, for teachers). Continuing to encourage such steps is a key to sustainability of
the Initiative.
Although before 2006, the MOE was not linked to the Initiative, MOE offices in various regions,
provinces, and districts were active partners, taking advantage of the Initiative’s communication
tools and using the training modules with children in their classrooms. Today the MOE is
actively engaged in planning for the expanded phase, and it will include handwashing in schools
as part of its national Social Mobilization Program. For this purpose, it has assessed and
pretested the Initiative’s school materials. The current national MOE support should facilitate
strong involvement of local MOE offices.
There is good political will at the regional level also, but not as strong or cohesive as the political
will at the central level. The regional and provincial levels are in a transition to decentralization,
in which authorities are uncertain about their functions, roles, and resources. Local decision
making and regional organizations working together on a common objective are new ways of
working, and local governmental units are in the process of trying to establish their regional
priorities from among a plethora of needs. The regional governments are working on their
development plans and documents on regional health priorities. The Initiative and its partners
should work to make improving child health and reducing diarrheal diseases prominent in these
plans.
At all levels, there are additional avenues for the expansion and sustainability of the project by
linking it with current national political initiatives such as Reduction of Infant Malnutrition,
Healthy Schools, and Water for Everyone, which do or could incorporate handwashing
promotion.
Despite this positive situation, converting political will into program actions remains a challenge
because, as various persons interviewed noted, it is difficult to give special attention to one
particular theme such as handwashing because there are so many other public sector priorities.
Decrees published by government agencies at national, regional, and local levels are very
important since they represent the main door leading to public funding of activities. They also
define a period of time in which the strategy and activities will be implemented. So, as several
respondents pointed out, although a decree does not guarantee further action (rules, regulations,
and activities in work plans and in the field), without them there is no public spending.
Following the MOH decree in 2004, the ministry financed a one-month handwashing campaign
and direct consumer contact (local promotional events) in 24 regions in 2006.
Partnerships
•
•
•
In general this has been a successful and innovative aspect of the program, in particular
with private sector partners.
Public and private organizations have generally worked well together, but not without
some minor friction. Private partners sometimes become impatient because the public
sector tends to be more formal and bureaucratic and to have more changes in personnel.
Some local public officials consider private organizations to be too interested in receiving
individual credit.
Keeping key government ministries (particularly health, education, and housing)
involved is essential, even though this can be difficult at times because of political
changes and overburdened officials who are too busy to participate in meetings.
14
•
Different partners have played very different roles, from being fully engaged as a
member of the national coordinating committee to providing short-term messages on
handwashing and co-financing and/or managing local activities. This is fine as long as
expectations are clear.
The Initiative engaged with diverse organizations and persons, including regional and municipal
governments, communication media, and health and education offices and organizations. Many
partner organizations were able to insert handwashing promotion into existing strong and
efficient networks. In general, the organizational partners were of three types: (1) WSP, donor
organizations, and governmental organizations that managed the program (through the national
committee); (2) national-level implementation partners—from various types of organizations
(public and private), most of which collaborated on the basis of informal agreements and some
on the basis of memoranda of understanding or contracts; and (3) regional and local
implementing partners, also both public and private, and some with financial or material support
from the Initiative.
The different roles of partners at the national level that the team identified include:
•
•
•
•
•
•
providing funding (for example, the Japan Social Development Fund)
providing funding and participating in planning and management of the Initiative (for
example, COSUDE, USAID)
providing funding and participating in planning, management, and national
implementation (for example, the MOH and the MOE, more recently)
implementing communication activities directed to their personnel and customers (for
example, Belcorp, CARE)
carrying out M&E activities and playing a major role in preparing training and trainers
(as, for example, PRISMA, which worked under contract)
supporting a specific activity, such as dissemination or printing, based on its resources
(for example, Banco de Crédito, Transportes Ormeño).
At the regional level, the Initiative established strong relationships with various types of
organizations, usually via the Regional Health Directorates (DIRESA), that made various
contributions. Some examples are:
•
•
•
•
providing funds and participating in the planning and management of the Initiative (for
example, the Regional Government of Lambayeque)
providing funds and participating in local planning, management, and implementation
(for example, the DIRESA, Regional Education Directorate [DREA], or MOE’s Local
Educational Management Unit [UGEL])
implementing communication activities directed to their staff and beneficiaries (for
example, local NGO offices)
getting involved in a specific activity (for example, dissemination or printing) appropriate
to its resources (for example, Radio PROMUDEH in San Martín).
Figures 1 and 2 show organizations that have done person-to-person promotion and mass media
promotion.
15
Figure 1. Partner Contributions to Interpersonal Communications
PUERTA A PUERTA
Socios
Actividad / Impacto
MINSA
Promoción de la Salud
PAC SEDAPAL Ampliación de cobertura
AGAP
Asociación de Agricultores
Programa Mi
Barrio
CARE
Desarrollo público local
Belcorp
Programa Promoción de la
Salud
Venta de cosméticos
Peace Corps
Voluntarios
Prisma
ONG Talleres
Talleres
itinerantes
Talleres y réplicas
Scouts
Actividades de Scouts
+
+
+
+
+
+
+
+
Source: Flórez P., Rocío. “Iniciativa de Lavado de Manos en el Perú.” 17 de Octubre, 2006 [PPT]
16
Figure 2. Partner Contributions to Mass Media
MEDIOS MASIVOS
Socios
RPP
Actividad / Impacto
Serie Radial, avisos
Banco de
Crédito
Circuitos interno de TV220
agencias
Luz del Sur
Aviso en recibo de
electricidad
Avisos en periódicos de
circulación nacional
Expreso Extra
Ormeño
Circuito de TV en buses
Interbank
Circuito interno de TV, 40
agencias
Terra
Avisos en página Web
Radios y TV
Local
25 regiones
SEDAPAL
Aviso en recibo de agua
Source: Flórez P., Rocío. “Iniciativa de Lavado de Manos en el Perú.” 17 de Octubre, 2006 [PPT].
The process of participating in such a public-private partnership has allowed government and
company staff to learn about other ways of working together for public health, in a participatory
way, with support that they could offer with their own resources. The public institutions, the
companies, and the NGOs interviewed indicated their interest in continuing their involvement. In
the case of NGOs, officials are pleased to collaborate to the extent that their goals and funding
address reducing diarrhea and respiratory disease among children.
At the central level, the Initiative worked to achieve financing from the Ministry of Women and
Social Development (MIMDES) for disseminating broadcast materials in the Clean Hands,
Healthy Kids campaign, 15 times a day, mostly in the preferred early morning hours. This
dissemination included four regions where the project was active: Ayacucho, Cusco,
Lambayeque, and San Martín.
In Ayacucho, the Regional Health Council stimulated the formation of a regional Handwashing
Initiative by establishing an implementation committee in which the MOH and DIRESA joined
the regional government to prepare guidelines for health programs and projects. The objective of
the committee is to safeguard the logic and consistency in the implementation of all health
programs in the region. The local partners achieved the collaboration of the army for the
temporary storage of training materials.
In Cusco, the provincial municipality of Canchis participated in inter-institutional agreements
with the UGELs of the Ministry of Education of Cusco and Canchis to train local trainers and
health promoters.
17
In Lambayeque, the regional government took the initiative to engage other partners, including
the DIRESA.
In San Martín, a partnership between communications media and the water company was
established to support health communication.
Many respondents praised the Initiative’s innovative and generally successful partnership of
public and private organizations, particularly in regard to support from the private sector.
Although all types of partners generally worked well together, some respondents did note that
the public sector tended to be more formal and bureaucratic and to have frequent changes of
personnel, which delayed approvals of actions and materials. In general, private sector partners
are more flexible, comfortable with informal arrangements, and able to act more rapidly. Most
private sector companies have had a more focused participation in specific promotional activities
and have not been involved in overall planning or management. Private voluntary organizations,
particularly at the local level, generally integrated handwashing promotion and/or activities and
materials into their existing programs.
Most private companies that collaborated in the first phase do not appear to have been motivated
by a desire to expand their sales of soap (there was only one company that was a major soap
vendor) or other handwashing products. Most collaborating companies have established units for
supporting socially beneficial programs—no doubt motivated by both altruism and a desire to
maintain a public image of social responsibility.
•
•
Many respondents felt that arrangements have been informal yet have worked well based
on the basis of personal relations, particularly for NGOs and private organizations.
Arrangements with governmental organizations were more formal: the MOH issued a
ministerial decree in 2004, and some regional governments approved ordinances.
Beginning in 2006, the Initiative made an effort to sign MOUs with national and local
partners.
The public sector has a strong need to formalize its relationships and commitments. The MOH
did this by issuing a formal ministerial regulation that promoted the Initiative within the MOH
and another decree that established an internal sectorial committee charged with coordinating
implementation responsibility among the various offices and programs of the MOH. However,
interviewees made two common points: (1) that with decentralization, national agreements
would not necessarily translate to the regional level and below; and (2) that although formal
agreements with government organizations were definitely desirable, they were also insufficient
to ensure that the commitments would yield actions and funding in the field. The issuance of
ministerial resolutions and directives contribute to the sustainability of handwashing-promotion
activities by helping to orient work to a theme, but these resolutions and directives still need to
be reflected in work plans, budgets, institutional directives, and actual activities.
Initially, informal relations seemed to work quite well for private sector partners and some
NGOs, but since 2006 the Initiative has negotiated and signed more formal agreements with
public and private partners, a trend that most respondents feel is desirable. For example, there are
letter agreements with such groups as Ecoclubes Perú, Asociación de Gremios Agroexportadores
del Perú (AGAP), the regional government of Ica, Caritas Piura y Tumbes, Municipality of
Surco, and Asociación Civil Pro Ica. More formal agreements are likely to facilitate the
sustainability of organizational commitment, so it seems wise for the Initiative to try to make
informal agreements more formal over time, appropriate to various organizations’ roles.
18
At the regional level, governmental units, including municipal governments, require a formalized
participation. Although NGOs and private organizations are willing to be flexible, a move
toward more formality and the generation of agreements to govern joint work does facilitate
program implementation as well as sustainability.
Program Methodology
•
•
•
In general, opinions were positive; people felt that combining diverse partners’ strengths
produced an effective approach.
Some respondents mentioned the need to focus more on interpersonal communication,
while media representatives felt that mass media could play a larger role.
Many of the persons interviewed pointed out that it has been easier to generate
enthusiasm and behavior change among children than among mothers, particularly in
rural areas.
The Peruvian program has followed the general PPPHW methodology. Findings from formative
research formed the basis of a work plan for promoting behavior change. The Peruvian program
relies strongly on a participatory training methodology that uses games and activities to build the
capacity of change agents (teachers, health staff, and volunteers) and gives them motivations,
resources, and information to influence mothers. Interpersonal communication is supported by
print materials and complemented by mass media communication. The project managed the
design, production, pretesting, and dissemination of all these communication materials.
Opinions on the project methodology are quite positive. Most people appreciate the need for
diverse communication channels to effectively carry information and motivations. A few
interviewees believe that the Initiative has been implemented too much like a short-term
campaign and had insufficient supervision and follow-up. The team’s impression is that this was
certainly not the general situation, although it did happen in specific locations. Short campaigns,
centered on brief public events, are indeed popular in Peru. The strength of supervision and
follow-up seemed to depend very much on the normal working methods and resources of the
local partner. In some cases this happened; in others it did not.
Regarding work at the regional and district levels, various respondents emphasized the need for
strong interpersonal communication in order to achieve behavior change. They view mass media
as an important but supportive channel for sensitizing people and reinforcing information given
person to person. Many respondents recommended that in the expanded program, the field staff
of local partner organizations include interpersonal promotion of handwashing in the programs
and plans; that is, that institutionalization goes beyond formal acknowledgment in program
norms and general guidelines. This refers to the MOH at all levels, to the MOE, to the networks
of women’s organizations, NGOs, and others.
Some international public health specialists question the feasibility of interpersonal
communication on a large scale, but in the opinion of the interviewees and the team, this
component can be affordable and feasible as long as the Initiative:
•
•
•
stimulates the formation of strong local partnerships (of popularly respected
organizations that manage cadres of change agents),
provides strong training guidance and tools as well as job aids,
contracts with implementing agencies for training teachers and health personnel and for
post-training follow-up, and
19
•
encourages the MOH and the MOE to award certificates to change agents who
satisfactorily complete training on handwashing promotion and who carry out actual
counseling on HWWS in their communities and schools.
Respondents judge the behavior-change methodology used to have been more effective with
schoolchildren than with mothers. It would be interesting in the second phase to see if this
impression is valid and, if so, why. (According to the monitoring study, 90 percent of school
children talked with their families about handwashing after having sessions in school.) The
November 2006 evaluation study found the impact of project activities on actual handwashing
behavior to be inconsistent and fairly modest, so it would seem advisable for the Initiative to
monitor behavior change periodically during the second phase to see if slow change is occurring
or if the methodology needs strengthening in some respects in order to achieve the desired
impact on practices.
To effectively apply the methodology at the national and regional levels in the expansion phase,
implementing agencies must master the methodology and have essential materials. Processes and
products need to be standardized, but they also need to be adaptable. Possibly the Initiative can
provide standard resources with instructions for adaptation when needed because of such local
factors as climate, availability of water, ways of warming water in very cold zones, and cultural
factors.
For institutionalization of the at-scale program, it will be important that the methodology can
serve as a resource that public sector institutions can use at the national and local levels, adopted
formally in institutional strategies. The Initiative should meet with the persons responsible for
related programs in the MOH, the MOE, and other partners to promote the use of each other’s
communication materials where appropriate and possible.
The global PPPHW methodology recommends that messages focus exclusively on HWWS. The
team feels that such a focused approach could be quite effective in the short run, but it is not
likely to be sustainable, because there are so many competing priorities, even within child health.
On the other hand, the Initiative should work with the implementing partners to try to ensure that
HWWS information is not given at the same time as messages on many other topics, because this
is not likely to result in people being sufficiently informed and motivated to change their
practices.
The best strategy for sustainability is to integrate HWWS into many existing programs (advocate
for ministerial decrees, regulations, budget allocations) but at the same time work with these
programs to make handwashing promotion more effective and receive more attention.
In general, there is NO guarantee of sustainability. However, the more that partners at all levels
work well together and the more the public supports these activities, the better the chance of
sustainability. Over a period of several years, HWWS at key times could become a social norm
in Peru, passed on within families and communities with little or no need for programs to
promote it. In the United States, this has begun to happen with such practices as using seat belts,
using designated drivers, and smoking in public only in designated areas, but some promotion of
the desired practices is still needed.
•
While the skills and systems needed to implement the program well certainly exist at the
national level, a few of the persons interviewed at the national level expressed concern
about capacity at the local level.
20
A large-scale program requires that central planners in the public sector know enough about
implementation conditions to be able to make good compromises between what they would like
to do and what is feasible in the field.
From the interviews and the team’s analysis, it appears that the national level has capabilities for
program design, planning, preparation of norms and supervision of activities, but not perhaps for
making needed adaptations at the local level because of varying local conditions.
Availability of Products and Tools
•
•
Most of the training and communication materials can be used with little or no change in
the expanded program.
There is little concern with the availability of soap, although access to water is difficult in
some communities.
The Initiative generated a variety of tools to support partner organizations in promoting
handwashing among poor families. These included a methodology to motivate and teach
handwashing through games and activities, modules to build capabilities of teachers and
health/development personnel, and communication materials (posters; reminders; a radio soap
opera, spots, and mentions; and television spots). These tools were developed on the basis of the
baseline behavioral study, and then pretested with their target audiences. Unfortunately an
administrative delay during the creative design process left little time for the complete
intervention, with all of the communication channels working together.
Disseminating all of these tools was a challenge that seems to have been met. Some of the tools
were managed and used directly by the Initiative, while others were offered to partner
organizations that intended to use them through their own channels. The program monitored the
distribution of materials as well as the use of interpersonal materials used in educational sessions.
The monitoring study provided useful feedback on the manuals and educational materials. In
general these were considered well done and effective, although people did express the need to
adapt materials to the zones of the country (coast, mountains, jungle). Problems in the
availability of complementary materials were also noted, and the poster picture may need to be
changed to focus more on hands.
Persons interviewed expressed minimal concern about soap availability in the homes, since the
baseline study (covering all regions of the country) found soap that could be used for
handwashing available in 98 percent of homes (and usually in several places in the home). A few
people in Arequipa, however, did mention that families in isolated mountain communities may
have poor access to soap.
Respondents considered the provision of plastic washing bowls and pitchers to have been useful
in the first phase, and the team observed these being well used in schools.
Financing
•
•
•
Many partners made financial and in-kind contributions during the first phase.
The general opinion is that there is potentially sufficient funding in Peru for this activity,
but that the partners need to work hard to obtain the funding to support HWWS.
The team believes that some external funding is likely to be needed after 2009, mainly for
covering the cost of implementing agencies to support new districts and, at a lower level,
to support continued advocacy. However, partner contributions should increase during
this phase, so the percentage of funding provided by external sources should decline.
21
As a result of awareness-raising and advocacy activities, various donors agencies such as USAID
and COSUDE decided to provide funding to support the Handwashing Initiative. Also, the MOH
showed its commitment by making funds available annually for local communication and mass
media.
In addition, the Initiative received many in-kind contributions from public, private, and civilsociety organizations, which facilitated the incorporation of handwashing messages in activities
of their networks to reach the public. Some made financial contributions for message
dissemination and/or implementation of extra workshops, in addition to those funded by the
Japanese Development Fund, thus allowing the expansion of some handwashing promotion to 14
regions. These organizations included:
Public Sector
•
•
•
•
regional governments of Lambayeque and Ica
municipalities: Santiago de Surco (Lima); Pucallpa (Ucayali); Piura, Castilla, and
Catacaos (Piura); Trujillo (La Libertad); Santiago (Ica), among others
MOH: Direcciones Regionales de Salud (Nivel Nacional); CLAS (Local Health
Administration Committee)
MOE: Dirección Nacional de Educación Comunitaria y Ambiental; Dirección Regional
de Educación (Lima)
Private Sector
•
•
•
•
agricultural companies: Asociación de Gremios Agroexportadores del Perú (AGAP),
Fundación ProIca; Gremio Pro-Citrus (Huaral), Sunshine Export (Piura)
banks: Banco de Crédito, Interbank, Banco del Trabajo
utilities: Sedapal, Luz del Sur
cosmetics companies: Belcorp
NGOs
•
•
•
•
Healthy Cities (Ucayali, Ica, Piura)
Caritas (Piura, Tumbes)
CARE (Piura, Ayacucho, Huancavelica, Huánuco)
Ecoclubes (Piura, Tacna)
In general, there exists potential funding in-country, particularly with the decentralization
process, since the regions are gaining autonomy in preparing and budgeting for their
development plans. For the expanded handwashing program, it will be essential to identify
regional priorities and then lobby (with regional presidents and others) to include handwashing
in local plans and programs.
In addition, each year the municipal governments allocate funds through a participatory
budgeting process that includes discussions with organized citizen groups and local institutions.
For sustainability, it would be highly desirable for the Initiative’s implementing agencies to
participate in these deliberations, since they could lobby not only for activities to promote
HWWS but also for the conditions that would support the sustainability of this and other
desirable objectives.
The team believes that if the handwashing promotion initiative is to continue to expand to new
districts after this second phase, external funding is still likely to be needed after 2009, mainly to
cover the cost of implementing agencies that will probably be needed to support new districts
22
and also to support continued advocacy. However, the percentage of program costs contributed
by national partners should continue to increase.
•
•
In the first phase, WSP and its partners collected extensive cost information and some
impact information, but there was no attempt to calculate the cost-effectiveness of
various activities or strategies.
The capability for collection and analysis does exist in Peru, but technical support and
training will be needed for particular partners and local areas.
Analysis of cost-effectiveness probably cannot be done until the final year of the expansion
phase, but clearly the methodology and data collection systems and procedures need to be
designed sooner than that.
The partners took full advantage of the materials that were developed. For example, the episodes
of the radio soap opera comprise a series, but each can also be used independently to generate
discussions in group education sessions. To maximize their use, the print materials were
distributed to local radio stations, to some municipal radio stations, and to informal
communication channels. Another cost-effective action was drawing on the regional training
facilitators themselves to develop training materials for use with the local facilitators.
Some local NGOs have the ability to collect and analyze information on cost and impact, but it is
still necessary to strengthen existing capabilities and to monitor activities.
Monitoring and Evaluation
•
•
•
The persons interviewed generally consider M&E to be very important for project
success.
Many of the persons interviewed were not very aware of the Initiative’s monitoring
activities or results.
On the electronic survey, respondents scored monitoring lower than any other dimension.
With funding from the Japan Social Development Fund, the NGO PRISMA assumed M&E
responsibilities. There were formal studies and routine monitoring, and the Initiative did
disseminate the findings in annual reports and other summary documents. In the electronic
survey, however, M&E scored lower than other dimensions, which seems to indicate that the
M&E results were not widely or well disseminated; or it may simply be that most respondents to
this survey collaborated at the local level and therefore were less likely to have been exposed to
M&E findings.
The persons interviewed indicated that M&E should be a key component in the expanded
program and that the opportunity to show how well different interventions work in this type of
project should not be lost.
The team feels that it is going to be a challenge to allow the local implementation flexibility that
many respondents recommend while at the same time keeping sufficient uniformity in the
program districts to be able to generalize about them in relation to the control districts. In
addition, the monitoring team will have to control carefully for the effects of the many existing
programs and projects in both intervention and control districts.
23
4. RECOMMENDATIONS BY DIMENSION
The team has a number of suggestions, many of which expand ideas suggested by persons
interviewed. (In some cases, the team further developed some general suggestions from the
interviewees). This section presents key recommendations by dimension. These are also
described in table format in Appendix I.
Policy, Strategy, and Direction
Although the attitudes of public and private officials toward handwashing are generally very
positive, many still lack knowledge of the multiple benefits of HWWS. Moreover, government
officials in particular must try to address many different priorities simultaneously. Therefore, the
Initiative should develop an advocacy strategy—with arguments and materials for different
levels and types of decision makers—that describes the importance of HWWS for reducing
diarrhea, respiratory disease, and infant mortality; for preventing malnutrition; and for improving
school performance, mothers’ confidence and self-esteem, and the nation’s human capital.
Advocacy activities should begin as soon as possible and continue throughout the project period.
At the time of this assessment, even key partners lacked information and had differing
expectations regarding the expanded handwashing program, although clearly steps were already
planned to remedy this situation. Before the selection of implementation districts, the Initiative
should hold individual and group meetings with the key partners to clarify their expectations and
the project’s intentions and constraints (such meetings have already begun). The Initiative should
prepare and disseminate a brief description of the new project that summarizes the proposed
strategy and plans, making clear which features are required under the new project. Initial
discussions of each partner’s role and responsibilities should also occur during these meetings,
leading eventually to MOUs or other types of agreements. A similar process, managed by the
implementing agencies, should be repeated at the regional, provincial, and district levels, once
the intervention districts have been selected.
The National Committee has played a key role in institutionalizing HWWS by making the major
programmatic decisions and being viewed by others as the face of the Initiative. It is important in
the expansion phase that it continues to play this role and that its decisions are well disseminated
to give orientation to regional activities.
The first phase of the Handwashing Initiative in Peru has achieved various degrees of integration
with such programs as PRONASAR; PAC/SEDAPAL; the MOH’s Healthy Schools program;
and, recently, the MOE’s Clean, Safe, and Healthy Schools program. The team (and many of the
people interviewed) strongly support efforts to integrate with and strengthen promotion of
HWWS in existing programs rather than implementing the handwashing promotion as a vertical
program. This makes sense for several reasons:
Many national and local programs, some with strong political support, already include hygiene
improvement and/or handwashing, so they should be quite open to making this component more
effective. For example, there is a strong link between handwashing and infant nutrition, which is
a priority of the president, along with other programs such as Together and Water for Everyone
that are being implemented by public and private organizations.
This strategy of incorporating handwashing promotion into ongoing activities gives the best
chance of institutionalization. In addition to existing programs, there is the potential of synergy
of handwashing promotion with the rollout of rotavirus vaccine (since both interventions reduce
diarrhea) and with planned sanitation marketing programs.
24
Taking a more vertical, campaign-type approach can generate jealousy among other programs
that eventually leads to the demise of the vertical program.
In general, the team recommends a decentralized structure for this expansion phase. The national
level should create supportive policies, standard tools and methods—including strong advocacy,
program communication, and M&E activities—and work through the implementing agencies to
establish strong coordination and clear responsibility at local levels.
The national-level public sector institutions are in the process of taking on a normative role.
More and more decisions on priorities and program activities will be taken at the regional level,
which will also control the resources to implement them. Given the reality of decentralization, it
is important that advocacy activities designed to build and maintain support for HWWS be
directed to decision makers at the regional, provincial, and district levels as well as at the
national level.
In response to the past problem of frequent changes in public sector officials, it is important to
promote the inclusion of HWWS in the annual work plans, guidelines, and budgets of the MOE
and the MOH. Also, it is recommended to link with the National Health Council, a consultative
group of the MOH that is charged with arriving at decisions via consensus and with coordinating
the national Coordinated and Decentralized Health Systems. There are similar institutions at the
regional level, with active civil society participation. These organizations work on health
guidelines but also on implementing regulations and national plans.
Partnerships
The main recommendations at the national level are to proceed with making the MOE a full
national and local partner (already in progress) and also to consider adding to the coordinating
committee the Ministry of Housing, as well as at least one private sector partner such as
CONFIEF, which represents an array of private companies. The Initiative should engage other
old and new partners with national reach through the National (consultative) Committee. It
should also assess the interest of potential new partners in joining the Initiative (for example,
UNICEF, PAHO, Save the Children). The existence of a certain level of guaranteed funding
(from the Gates Foundation), along with concrete products (training and communication
materials, handwashing kits) should help build the confidence of old and potential partners.
Although selling more soap has not been a strong motivator of private sector participation, the
Initiative should meet with companies that produce soap, towels, and plastic containers to see if
they would be willing to incorporate HWWS information in their advertising or packaging in the
hope of expanding their markets. It can be argued that the Initiative is doing free market
expansion, which they should be happy to encourage.
To achieve impact and sustainability, the Initiative should focus on establishing and
strengthening partnerships at the regional, provincial, and districts levels, where the
implementing agencies need to identify existing public and private coordinating groups to take
on explicitly the coordination of handwashing-promotion activities. The first choice for a
coordinating group should be an existing structure such as the mesa de concertación or regional
multisectoral committee. It is also important, at the local level, to identify one or more HWWS
champion organization or person that can identify the groups best positioned to engage other
partners.
Partners at the district level should include the strongest programs and institutions in each district.
A strong partner organization is one that has a good reach into communities, has built confidence
among the population, and is committed to ongoing follow-up and supervision of promotion
25
activities. Each partner should be asked to commit itself to strengthen or expand attention to
handwashing in its objectives and work plans. Organizations to consider include those helping
install or improve water and sanitation systems, Vaso de Leche, comedores populares, and NGOs
with long histories and good reputations in an area.
The WSP, the National Committee, and the implementing agencies should focus on providing
guidelines, tools, and strategic technical assistance to local partnerships. To keep local partners
motivated and informed, the team also recommends a strong project communication program
with a newsletter, Web site, media coverage, and meetings and exchange visits that facilitate the
dissemination of achievements and sharing of lessons learned (see Appendix L).
As part of the process of consolidating the public-private alliance to promote HWWS, it is
recommended that WSP and/or the National Committee lay out clear organizational
responsibilities, including a checklist of requirements for implementing person-to-person
promotional activities, assigning roles and functions to different actors at the regional level.
At the national level, each partner should be invited to join one of the committees listed in Table
7, depending on each organization’s agreed-upon roles.
26
Table 7. Committee Participants
Type of
Committee
Participants
National
Committee
One representative each
from the MOH, the
MOE, from each major
donor organization,
private-sector partners,
and civil-society
partners.
•
Those providing funding and
participating in planning and
management of the initiative (for
example, COSUDE, USAID).
•
Those providing funding and
participating in planning,
management, and national
implementation (for example, the
MOE and the MOH)
Collaborating
organizations that have
less overall involvement
(in limited geographical
or functional areas)
•
Those implementing
communication activities directed
to their personnel and customers
(for example, Belcorp, CARE)
•
Those involved in a specific
activity, such as dissemination or
printing, based on their resources
(for example, Banco de Crédito,
Transportes Ormeño)
Committee of
Institutional
Partners
Type of Institutions
Frequency
Monthly meetings
Meetings every three
months to receive
information and
exchange experiences,
plus information
exchange via other
communication channels
In the first phase, there does not appear to have been a strong connection between the National
Committee and the regional and local partnerships. The Initiative needs to clearly define and
follow through on its relationship with the regional coordination committees. The project
communication program (newsletter, Web site, and so on) should facilitate two-way
communication.
Although MOUs and other formal agreements are no guarantee of follow-up, they are essential
for working with government agencies since they are needed for budget allocations to occur, and
they may limit disruptions caused by changes in personnel. Formal agreements are particularly
important with the MOH, which maintains substantial control over its local offices. The Initiative
should continue to pursue such formal agreements at the national level and instruct its
implementing agencies to do so at local levels.
Although it is fine initially to have less formal agreements with private and civil society partners,
it the long run negotiating and signing more formal agreements is desirable because such
agreements would clarify roles and expectations and support sustainability. All agreements
should define roles, responsibilities, and expected contributions. Moreover, the fulfillment of all
formal and informal agreements should be reviewed and documented every six months. The
WSP and the MOH should be responsible for this monitoring at the national level, and the
implementing agencies should have responsibility at other levels.
More formal arrangements are also needed at the regional level, not only regarding
implementation guidelines but also written commitments on responsibilities and in-kind and
monetary contributions. The types of organizational involvement described in the section on
major findings on partnerships provide a menu of possible relations with the Initiative.
27
Program Methodology
The study team feels that the expanded project can follow a very similar methodology that
combines forming partnerships at every level, advocacy and institutionalization activities, and
strategic communication activities that combine mass media and several channels for
interpersonal communication. It should be possible to scale up interpersonal communication
training and activities, since this will be done by implementing agencies, each of which will be
responsible for three to five regions and selected districts within each region. A key to success
will be the supervision and follow-up of the training by the local partners themselves. The team
has made small suggestions for improving the methodology (for example, by suggesting
handwashing-promotion activities that students and promoters can do in homes and communities,
and preparing modified materials for each of the three zones in the country—see Appendixes J
and K) but has not suggested major changes.
Three general suggestions from various respondents were to: (1) focus on supporting the local
levels, (2) allow local partners flexibility in implementing the general strategy, and (3) urge local
partners to avoid a focus on short campaigns with no clear follow-up. Such campaigns seem to
be very popular in Peru, but their impact is questionable.
In the start-up period, the Initiative should develop a standard methodology and instruments for
assessment visits at the provincial and district levels to identify existing activities in which
handwashing promotion could be added or strengthened, and to identify the strongest partner
organizations and potential HWWS champions.
Most respondents recommended that implementation emphasize interpersonal communication,
but all saw a continued role for mass media. The team favors a focus on local radio in local
languages and interactive formats (call-in shows, radio listening groups, and so on). It is
important to ensure better coordination between mass media promotion and on-the-ground
activities, so they are mutually reinforcing.
The team recommends encouraging and facilitating local partners to create opportunities for
individual and group dialogue between change agents (teachers, students, health staff, health
volunteers) and mothers, to give ample opportunity to explain and discuss the desired behavior
changes and to jointly problem solve if there are barriers to action. Mass media should continue
to support interpersonal communication by generating interest in and reminders of handwashing
with soap.
What is ideal, but only possible in one-on-one or group communication, is for the change agents
to ask a few assessment questions to learn what the mother or group is currently doing regarding
HWWS. So, for example, if the mother is already washing her hands at key times but not using
soap, the focus of the conversation would be on the importance of using soap and how this can
be done by this particular mother. If the mother is washing with soap but only before preparing
food, then the importance of washing of other key times would be the focus.
If feasible, it would be desirable to develop separate communication materials for the coast,
mountains, and jungle areas of Peru. If this is not possible, the Initiative should encourage
regions to modify materials to incorporate more appropriate images, language, and local
conditions, such as limited water or cold temperatures, and counsel families on how to overcome
them.
For both effectiveness and sustainability, the Initiative should encourage strengthening of
handwashing promotion within existing programs such as health promotion by the MOH,
Escuelas Saludables, Viviendas Saludables, Municipios Saludables, PRONASAR (new water
28
and sanitation systems), PRONOEI (preschool program), initiatives directed at malnutrition,
JAAS (water and sanitation boards), NGOs doing health promotion, and so on. Although moving
away from a single focus on handwashing contradicts the general PPPHW strategy, the team
feels that this is the most appropriate approach for Peru as well as the one mostly likely to be
sustainable. On the other hand, any particular educational opportunity should have a specific
focus (on handwashing or some other topic) and be as interactive as possible, so as not to
overwhelm people with too many messages and too much information all at once.
To try to build and maintain a positive program image, to motivate partners and supporters, and
to share useful technical and strategic information, the Initiative needs a strong project
communication program directed at both collaborating organizations and the outside world
(political leaders, donors, the public). At a minimum there should be an electronic newsletter, a
section on the WSP/Peru and MOH Web sites (with links to partners’ sites), and specific efforts
to obtain radio and press coverage of accomplishments and activities. These communication
spaces should include basic information on the program, descriptions of particularly
effective/innovative strategies or activities; updates on achievements and impact; and exchanges
on lessons learned. (This recommendation combines respondent and team ideas.)
The “implementing organizations” that the Initiative intends to contract to manage the program
in several regions should collaborate in preparing an operational guide for the district level. The
guide should propose implementation steps in a way that encourages each district to select those
that are likely to be most feasible and effective.
The program should take advantage of children’s enthusiasm by suggesting activities for students
to promote HWWS at home and in their communities. The Initiative should work with students,
health promoters, and local organizations (soliciting and testing their ideas) to develop new
activities and materials. In addition, the workshop methodology and supplementary materials
should add coverage of how change agents can work with individual mothers on solving
problems, such as (perceptions of) limited water, soap, or time.
Lack of compensation for transportation and food costs are said to be barriers to promoters
making more home visits. Where other partners are willing to share the cost, the Initiative should
contribute to the costs of such compensation at the local level.
Finally, the key partners should develop an exit strategy that addresses both sustainability and
expansion issues. This might include steps to institutionalize support (funding and commitment)
for HWWS in government and partner organizations, plans to expand the program into some
control districts as soon as the final measurements have been completed, intensified efforts to get
handwashing benefits and promotion in curricula and pre-service training, and local and national
presentations on the project’s lessons learned and impact on health and malnutrition.
Considering implementation capabilities of national public sector organizations, and looking at
the institutionalization of the process and human capabilities, the team recommends that the
Initiative link not only with the directorate level of each ministry but also with higher levels such
as ministers and vice ministers, who can instruct the ministry’s various directorates and programs
to be involved. The Initiative is already working on such contacts.
All needed capacities exist in Peru, so the challenge in the expanded program is to build capacity
at decentralized levels. Although regional and district levels have resources of institutions such
as NGOs and some public sector units, it is evident that the large-scale program, mainly through
the implementing agencies, must work intensively to strengthen local capabilities both before
29
and during implementation. Although training is the main approach, provision of materials
(manuals, a district implementation guide, a newsletter, and so on), technical assistance by
implementing agencies, mentoring, and exchange visits are also important. More intense support
should be given to regions, provinces, districts, and municipalities where the local assessments
show particular weaknesses.
WSP and other National Committee members should train key staff in the implementing
agencies, who in turn should train and support persons and organizations in the regions. Training
should be participatory and capacity-based and should include as much practice of skills and
exercises to draw out attitudes as possible. WSP should ensure that the MOH, the MOE, and
implementing organizations receive information on the most outstanding people who were
trained in the first phase, since they are an excellent resource to support implementation in the
regions.
The local partners should be responsible for monitoring the implementation of training skills a
few months after training and then every six months after that. They should also monitor if
significant numbers trained teachers or promoters have left their positions, so additional training
sessions may be planned and implemented.
After their assessment of each region, province, and district where this phase will be active, the
implementing agencies need to identify key leaders or “champions” who can serve as
spokespersons, as well as persons who are already trained and informed about the Initiative and
who can support expansion. For example, these could include the group of regional facilitators
who trained many others to give training in the first phase. Most of them are regional health or
education staff who have leadership capabilities.
The Initiative should encourage and facilitate the existing trend for regional partner organizations
to integrate HWWS into preservice training curricula and, in addition, explore at the national
level adding or strengthening coverage of the benefits of HWWS and promotion of handwashing
in professional training institutions.
Availability of Products and Tools
It is important that the products and tools are appropriate to the local reality at the regional and
district levels—for example, illustrations should reflect coast, mountains, or jungle. If it is not
possible to prepare completely different sets of materials for each geographical zone, the
Initiative should support regional efforts to devise their own appropriate activities and local
materials.
Except in isolated rural communities, soap availability is not a problem, but change agents in
those particular communities should be trained to offer alternatives to soap, such as ash, sand, or
quinoa oil (their acceptability and feasibility should be investigated first; as well as the efficacy
of quinoa oil).
Difficult access to water is a problem in some communities, schools, and homes. Three potential
solutions are to: (1) link handwashing promotion to existing initiatives that install or improve
water systems; (2) train change agents to promote water-saving technologies such as Tippy Taps,
and (3) delay working in schools and communities with poor access to water. Some persons
interviewed suggested that the Initiative support encourage municipal governments to support
infrastructure such as construction of water faucets near kitchens and latrines and simple systems
for disposal of used water. This seems like a logical idea, as many interviewees’ suggested that
handwashing stations near the kitchen and bathroom would facilitate consistent handwashing at
key times.
30
Materials to support training and communication on HWWS (for the hygiene corners in schools
and the training modules) should be given out in the training workshops for local facilitators and
promoters, as was done in most workshops in Phase I, so that they can have the needed tools to
effectively carry out their tasks related to HWWS. Although the team favors the continued
provision of plastic bowls and pitchers, with an eye to sustainability, this should be made a
district responsibility rather than a national one. District partners could devise a plan to have
these materials donated to schools and to some or all families.
The Initiative can continue to use the existing behavior-change materials, which were prepared
and approved with great effort. However, as mentioned, the team has recommended a few
supplementary materials, and the widespread call for more locally appropriate versions needs to
be addressed. The Initiative or its local partners should consider producing reminder materials
that families can place at handwashing stations.
It is important to identify and measure the storage capacity in each intervention area because of
the considerable volume of materials. Because of the ongoing changes related to decentralization,
this issue needs to be followed carefully.
Financing
Aiming toward sustainability, the Initiative should continue to focus during this phase on getting
national and local partners to finance increasing portions of handwashing-promotion costs. To
the extent possible, commitments should be included in signed MOUs whose implementation
should be monitored. In order to expand into new districts at the end of this phase, it is likely that
some funding from external donors will still be needed—mainly to support advocacy, program
communication, implementing partners, and M&E—but the percentage of external funds should
be significantly less than for the current phase. The team recommends preparation and
implementation of an exit strategy so that ideally there can be a smooth transition to the
following phase of handwashing promotion in Peru.
Other, specific ideas include:
•
•
•
•
Continue to explore a co-financing agreement by the Fund of the Americas (FONDAM),
which has expressed interest in supporting HWWS in Peru.
Obtain information on USAID’s small grants program and then decide if it wants to share
this with local partners.
Lobby at all levels of government for budgetary funds directed toward handwashing or
hygiene education.
Continue to seek donated air time and publicly acknowledge the donation of free air time
by private media companies.
In the first phase in Peru, the Initiative collected extensive cost information. This should continue.
The second phase will focus on M&E, so the Initiative should be able to combine findings on
costs and on effectiveness to help formulate recommendations on adding, dropping, or changing
certain program inputs. Although calculating the cost-effectiveness of certain inputs or strategies
requires both art and science, making programmatic decisions on the basis of cost-effectiveness
should also factor in sustainability and non-monetary costs, such as WSP time to coordinate.
In the interest of holding down costs, the use of national radio and television should be modest
and directed more toward decision makers (advocacy). Local radio should be used to reinforce
interpersonal activities at the local level. As much as possible, the local partners should try to
31
negotiate the inclusion of information, discussions, or contests on HWWS in existing programs,
at little or no cost to the Initiative.
The Initiative’s materials appear to have been used effectively and efficiently. For example,
chapters of the radio soap opera could be used independently and as a stimulus to discussions in
group educational sessions. Other audiovisual materials were given to local radio stations, some
municipal radios, and informal communication channels. For sustainability and replicability, the
Initiative should continue to look for and utilize such opportunities to maximize human and
material resources.
Monitoring and Evaluation
A key to maintaining partner and public motivation is the timely dissemination of achievements
and results. There was quite thorough project monitoring, but it came at the end of the first
implementation phase and the findings apparently were not well disseminated—many of the
persons interviewed felt that monitoring was one of the weaker aspects of the program. For the
expanded program, interviewees suggested better communication of achievements, a suggestion
that the team expanded into a recommendation for a strong communication program that updates
partners at regular intervals on major activities, resources, innovations, and achievements, as
well as on the dimensions of scalability and sustainability that this study has used.
There will be a thorough M&E program in this phase, standardized across the four countries. The
team recommends that M&E be managed by a person or group connected to but separate from
those managing implementation, and that findings be used to modify to program. No information
should be collected unless it potentially can be used to modify the program in an important way.
In general the focus should be on changes in practice and their determinants, not on changes in
knowledge. Findings from M&E should be appropriately packaged and well disseminated to
partners, decision makers, and the public.
32
5. NEXT STEPS
Steps recommended by the study team to support program expansion and sustainability are found
in Appendix L. In some cases additional detail may be found in Appendix I. Among the
principal recommendations are:
•
•
•
•
•
•
Plan and implement a dynamic advocacy strategy that begins immediately and that continues
throughout implementation.
Plan and implement a strong project communication strategy directed primarily to partners
but also to decision makers at various levels and to the public. Materials, formats, and
activities should be directly related to reaching one of the strategy’s objectives (for example,
partner motivation, sharing good ideas) and audiences, which should be clearly defined.
Develop and implement an exit strategy that includes steps for dissemination and
sustainability of program activities and achievements.
Continue to negotiate and sign more formal agreements on partners’ roles and responsibilities
and develop systematic mechanisms to monitor the implementation of the agreements.
Have the key national-level partners, including the implementing organizations; dedicate
themselves to establishing the conditions and providing the tools and support for successful
local implementation. In this decentralized vision, the team expects that key factors for
program success will be strong and dedicated partnerships at local levels, with effective tools
and methodologies and support from the national level.
Great attention should be given to carrying out thorough regional, provincial, and district
assessments of organizations, potential champions, resources, programs, and conditions and
to establishing and supporting strong local partnerships.
Although Appendix L contains some elements of a work plan, these ideas should be considered
to be no more than recommendations to the Peru country coordinator, for her to consider in
consultation with in-country partners and WSP staff in Peru and Washington.
33
APPENDIX A: SELECTED DOCUMENTS
AB PRISMA. 2004. Estudio de comportamiento de lavador de manos con jabón en zonas
periféricas del Perú. Preparado como línea de base para la Iniciativa de Lavado de Manos en el
Perú, liderado por PAS-Banco Mundial. June,
Cogswell, Lynne. 2007. “Revised PROTOCOL. Enabling Environment Assessment of HW and
TSSM Programs.” World Bank (Water and Sanitation Program). April 19.
COSUDE. Brochure institucional.
Cuerpo de Paz. Brochure institucional.
Flórez P., Rocío. 2007. Informe de Implementación 2006-2007. May.
Flórez P., Rocío. 2006. “Iniciativa de Lavado de Manos en el Perú.” October 17 (PPT).
Flórez P., Rocío. 2006. “Sistematización. Período 2003-2005.” February.
Iniciativa de Lavado de Manos. 2006. Proyecto de fortalecimiento de capacidades para el cambio
de comportamiento: reducción de diarrea en niños de escasos. Informe de monitoreo. November.
Iniciativa de Lavado de Manos. 2006. Proyecto de Fortalecimiento de capacidades para el
cambio de comportamiento: reducción de diarrea en niños de escasos. Informe de Evaluación de
Efecto. November.
Iniciativa de Lavado de Manos. No date. Módulo para facilitadotes – promotores de salud y
desarrollo.
Iniciativa de Lavado de Manos. No date. Módulo para docentes del nivel inicial y primaria.
Jensen, Lene. 2007. “Quick Backgrounder on the PPPHW Approach to Handwashing
Promotion.” Water and Sanitation Program/Handwashing Secretariat. April 12.
Ministerio de Vivienda, Construcción y Saneamiento, PRONASAR. 2006. Proyecto Piloto de
Agua y Saneamiento en Pequeñas Ciudades. “Cuidar el Agua: La escuela en acción.” July.
Ministerio de Educación, Viceministerio de Gestión Pedagógica, Programa de Educación
Ambiental. Brochure Educación Ambiental.
Ministerio de Educación, Viceministerio de Gestión Pedagógica, Programa de Educación
Ambiental. “Guía instructiva de la Campaña nacional Escuelas Limpias y Saludables 2005 al
2014.”
Programa Nacional de Agua y Saneamiento Rural (PRONASAR). 2007. “Documento de
Sistematización del Proyecto Piloto de Agua y Saneamiento en Pequeñas Ciudades.” January.
SEDAPAL. 2005. “Guía metodológica para la intervención técnico social en la elaboración y
ejecución de proyectos condominiales de agua potable y alcantarillado.” November.
34
Sub Región de Salud Luciano Castillo Colona, Sullana. 2007. Informe de Lavado de Manos.
World Bank (Water and Sanitation Program). 2006. Grant Proposal: Scaling Up Handwashing
Behavior Change. September 25.
World Bank (Water and Sanitation Program). 2007. “Terms of Reference. Enabling Environment
Assessment and Baseline to Scale up, Sustain and Replicate Handwashing with Soap Behavior
Change Programs.” March 9.
World Bank, BNWP, WSP Water and Sanitation Program. 2005. The Handwashing Handbook:
A guide for developing a hygiene promotion program to increase handwashing with soap.
35
APPENDIX B: LISTA DE ENTREVISTADOS
LISTA DE ENTREVISTADOS
NACIONAL
INSTITUCION
PERSONA
CARGO
Ministerio de
Salud
Beatriz Ugás
Coordinadora
Comisión Nac
Armando
Barrantes
Director
Nacional
Dirección
Nacional de
Educación
Sanitaria y
Ambiental
Jorge
Chumpitaz
Ministerio de
Educación
Ministerio de
Educación
Ministerio de
Vivienda/PRON
ASAR
Ministerio de
Vivienda/PRON
ASAR
Rosa Meza
TELEFONO
FECHA
HORA
3156600
Jueves 31
3 p.m.
Van de Velde
160, San
Borja
Pabellón A,
Tercer Piso,
Of. 305
2155800
2155830
(1139)
Martes 22
9 a.m.
Consultor
Dirección
Nacional
Educaciòn
Sanitaria y
Ambiental
Van de Velde
160, San
Borja
Pabellón A,
Tercer Piso,
Of. 305
2155800
2155830
(1139)
Jueves 24
11 a.m.
Especialista
técnico UGP
Paseo de la
República
3361, San
Isidro
4226608
99271760
Jueves 31
9:30 a.m.
Paseo de la
República
3361, San
Isidro
4226608
4226585
Viernes 01
9:30 a.m.
Gabriela
Flores
DIRECCION
36
REGIONAL
INSTITUCION
PERSONA
CARGO
DIRECCION
TELEFONO
FECHA
HORA
Municipalidad
Piura
Giovanna
Bisso
Gerente
Educación,
Cultura
Biblioteca
Municipal de
Piura
073-302525
9687691
Jueves 17
8 a.m.
Omar
Palacios
Jefe de Oficina
de Población,
Salud e Higiene
Municipalidad
de Piura
073-307775
/ 0739961239
Viernes 18
11 a.m.
Municipalidad
Catacaos
Deisy Chero
Presidente de la
Comision de
Salud,
Salubridad y
Saneamiento
Municipalidad
de Catacaos
073-370239
Viernes 18
3 p.m.
DIRESA Piura
Dr. Carlos
Bayona
Sub director
DIRESA Piura
073-342424
341563
Jueves 17
12 m.
Red de salud
Sullana
Jenny
Portocarrero
Relaciones
Públicas
Red de Salud
Sullana
Viernes 18
9 a.m.
Germán
Robles
Especialista
Gestión
Educativa y
Ambiental
Ronda Recoleta
s/n
054-270975
054-252391
Lunes 28
9 a.m.
Sonia
Sánchez
Gerente Gestión
Social
Calle Alvarez
Tomas 304,
Altos (Altos
Biblioteca
Municipal
Arequipa)
054-229240
9862105
Lunes 28
8 a.m.
Gobierno
Regional
Arequipa
Dr. Aníbal
Díaz
Autoridad
Regional de
Medio
Ambiente
Calle Unión
100, Urb. Cèsar
Vallejo, Dist.
Paucarpata
054-463165
054461319
Martes 29
8 a.m.
DIRESA
Arequipa
Haydé Rodas
/ Mariela
Díaz
Promoción de la
Salud
Av. Alcides
Carrión - Hospital
General Honorio
Delgado
235155
Martes 29
11 a.m.
Dirección
Regional
Educación
Arequipa
Municipalidad
de Arequipa
37
Bilateral Projects
INSTITUCION
USAID/Comuni
dades
Saludables
PAC
SEDAPAL
PERSONA
CARGO
DIRECCION
TELEFONO
FECHA
HORA
Edgar Medina
Director MSH
Gonzales
Prada 350
Miraflores
(frente teatro
Marsano)
2429800
Miércoles 16
3 p.m.
Eliana López
Comunicación
MSH
Miércoles 16
4 p.m.
Miércoles 23
10 a.m.
Javier Acosta
Sotomayor
Especialista
social
Av. Nicolás
Ayllón 2309,
Piso 4, Ate.
(Por la
Clínica San
Juan de
Dios).
3261182
99176790
Media
INSTITUCION
RPP
PERUTV
PERSONA
CARGO
DIRECCION
TELEFONO
FECHA
HORA
Directora
Paseo de la
República
3866, San
Isidro (altura
Paseo de la
República y
Aramburú)
215-0200
Martes 22
11:45 a.m.
Oswaldo
Vizcarra
Director de
Prensa
Centro
Comercial
Cayma Of.
R2
054-252525
Martes 29
2:00 p.m.
César Portillo
Gerente de
Producción
Frida
Delgado
38
INSTITUCION
PRISMA
Ciudad
Saludable
ONG Labor
Local
NGOs
CARGO
DIRECCION
TELEFONO
FECHA
HORA
Delia
Haustein
Directora
Ejecutiva
Carlos
Gonzales
251, San
Miguel
6165500
Viernes 11
11 a.m.
Ruth Pérez
Especialista en
comunicación
Viernes 11
12 m
Lunes 28
3:30 p.m.
5 p.m.
PERSONA
Albina Ruiz
Directora
Av. Jorge
Basadre 255
Of. 401 S.I.
Jorge Béjar
Coordinador
Arequipa
Calle Paz
Soldán 307,
Yanahuara
421-5163
92759213
054-272883
256740
992 2496
997 8788
ONG DESCO Arequipa
Oscar Toro
Coordinador
Calle Málaga
Grenet 678,
Umacollo
054-257043
Lunes 28
Private Sector
INSTITUCION
Belcorp
PERSONA
CARGO
DIRECCION
TELEFONO
FECHA
HORA
Daniela
Barbieri
Gerente
corporativo
responsabilidad
social
Av. Canaval
y Moreyra
480 San
Isidro
2113300
(1466)
Martes
15
11 a.m.
Gerente
Av. Camino
Real 456,
Torre Real
Piso 11
98382401
Lunes 21
11:30 a.m.
Gerente
Calle
Quezada 104,
Yanahuara
054-253920
254188
Lunes 28
8 a.m.
PROICA
María Sonia
Arenas
Cámara de
Comercio e
Industria de
Arequipa
Martín
Cotrina
39
International
Agencies
INSTITUCION
PERSONA
CARGO
DIRECCION
TELEFONO
FECHA
HORA
COSUDE
Cesarina
Quintana
OFICIAL DE
PROGRAMA
Av. Salaverry
3242, S.I.
2645001
Miércole
s 23
3 p.m.
Directora de
Programas
Calle Vía
Láctea 132,
Urb. Los
Granados,
Surco.
617-2200 /
617-2210
Martes
15 PAS
9 a.m.
Voluntaria
Plaza de
Armas de
Catacaos
(073) 9628939
Jueves
17
10 a.m.
Oficina de
Salud
Av. La
Encalada
cdra. 17
Monterrico
Viernes
11
9 a.m.
Mabe Arce
Especialista en
comunicaciones
Av. La
Encalada
cdra. 17
Monterrico
6181225
6181350
Lunes 14
4:30 p.m.
PAS
Rocío Flórez
Coordinadora
Iniciativa LM
Alvarez
Calderón 185,
Piso 9
615-0685
Lunes 14
mayo
10 a.m.
WSP/PPL
Iris
Marmanillo
Coordinadora
Perú PAS/BM
Alvarez
Calderón 185,
Piso 9
615-0685
Martes
15 mayo
4 p.m.
Mercedes
Zevallos
Especialista
comunicación
PPL
Alvarez
Calderón 185,
Piso 9
615-0685
Lunes 14
mayo
3 p.m.
Cuerpo de Paz
Cuerpos de Paz
(Catacaos)
USAID
Emilia
Villanueva
Ana Turves
Jaime Chang
40
International
NGOs
PERSONA
CARGO
DIRECCION
TELEFONO
FECHA
HORA
CARE Perú
Lourdes
Mindreau
ESPECIALIST
A EN
CAPACITACI
ÒN
Gral Santa
Cruz 659
Jesús María
4317430
Lunes 21
4 p.m.
CARE Piura
Carolina
Aguilar
CAPACITADO
RA
Urb. 4 de
Enero Mz E
Lote 3
073-304675
Jueves
17
5:00 p.m.
ASESOR
Av. Javier
Prado Este
5318 La
Molina (alt.
cruce Los
Frutales)
4372727
Martes
22
3 p.m.
INSTITUCION
FONDAM
Cáritas Piura
Cáritas
Arequipa
Alvaro de la
Romaña
Juan Manuel
Cendra
Pablo
Manrique
Secretario
General
Calle Cusco
179 Piura
073-311203
Viernes
18
9:00 a.m.
Secretario
General
Federico
Barreto 146,
Frente
mercado
Palomar
054-608800
Martes
29
9 a.m.
41
►(USAID) Se ha tomado la
decisión de apoyar anualmente con
►Existe una marcada voluntad
política de la agencia. La iniciativa
tiene una buena identidad que se
traduce en la existencia de un logo.
Se identifica que la Iniciativa no es
percibida como exclusivamente de
una organización, sino de socios
igualitarios.
►Es interesante ver cómo las
empresas privadas han estado
participando en temas de salud.
►La nueva gestión del MINSA
tiene un marcado interés en seguir
participando en la Iniciativa.
►Existe voluntad política de
trabajar lavado de manos desde
Ministerio de Vivienda
(PRONASAR).
Agencia
internacional
►Desde la Dirección Nacional de
Educación Comunitaria y
Ambiental (DINECA) existe una
voluntad política de participar y de
vincularse a otras iniciativas.
Gobierno
►Las ordenanzas que se emitieron
desde el nivel central generó un
interés de salud en el nivel local.
Fortalezas
Tipo de
institución
Política, estrategia y dirección
42
►La voluntad política ha sido variable
dentro del MINSA porque todavía no se
►Falta presentar lo que se está
avanzando. Es posible que la actuación
del MINSA no esté tan bien descrita.
►Faltó involucrar mayor participación
de otras instituciones como UNICEF,
OPS, las que podrían constituir alianza
de soporte y no nuclear.
Debilidades
►Se debe hacer más diseminación de los avances y actividades
►Esta segunda etapa no debiera constituirse en un modelo de
intervención rígido. Se requiere uniformidad, pero debe ser
flexible como para permitir seguir involucrando otros socios y
otros aportes.
►El nivel central tiene que cumplir su labor de facilitador con
herramientas o guías específicas para una ejecución más
eficiente.
►La Iniciativa coincide con la priorización de los cuatro temas
de esta nueva gestión MINSA: descentralización, seguridad
ciudadana, nutrición y maternidad saludable.
►El MINSA considera necesario trabajar un proceso muy
participativo en el diseño de la segunda fase.
►Considerar las zonas que se están identificando para el
concurso del próximo año en PRONASAR, componente 1
(rural con 2,000 habitantes a menos) y 2 (pequeñas ciudades
2,001 a 30,000 habitantes).
►Chequear disponibilidad de agua primero para que el tema
tenga más impacto. (Gerencia medio ambiente, Arequipa).
►Revisar la decisión política en los Planes Regionales
Concertados de Salud (DIRESA Piura).
►Para la sostenibilidad de la intervención, sería necesario que
se haga una sensibilización inicial a las autoridades que harían
seguimiento al programa (Municipalidad Piura).
►Promover la voluntad desde las Regiones vinculando a la
Dirección Regional de Educación, Área gestión pedagógica.
Recomendaciones
APPENDIX C: RESUMEN DE PUNTOS IMPORTANTES DE LAS ENTREVISTAS
►La visión ha sido desarrollado en
una manera muy participativa.
►Los alcaldes han mostrado
mucho interés por la relación de
lavado de manos con desnutrición y
la falta de capacidad humana.
►Se identificó una fuerte voluntad
política en Lambayeque.
►La estrategia funcionó muy bien
con el sector privado.
►Se ha logrado una visión
compartida, de tal manera que se
privilegia la Iniciativa más allá de
la presencia institucional.
►Forma parte de un componente
de los programas con la comunidad,
que ellos financian.
Existe un marcado de interés de
verlos como procesos: como
mecanismo de Iniciativa y como
alianza público privada.
43
►Las responsabilidades del nivel
central y regional están en un claro
proceso de descentralización, lo que crea
confusión.
►Para revisar la visión y estrategia los líderes gubernamentales
tienen poco tiempo para participar, pero las agencias
cooperadoras pueden ayudar desarrollar estrategias y métodos a
usar en todos niveles.
►Sería muy importante ganar el apoyo del Presidente de la
República, relacionándolo con la contribución a alcanzar los
objetivos del Milenio.
►Es muy importante afinar los roles y involucrar otros socios
que trabajan con agua y saneamiento y/o salud infantil. Se
podría hacer un matriz con todos los roles y responsabilidades
de salud, educación y vivienda a cada nivel.
►Asegurar el vínculo con programas como Agua para Todos
(programa paraguas de PRONASAR).
►A nivel nacional falta una estrategia
intersectorial que pone LM dentro de
muchos programas e iniciativas grandes
del gobierno (salud, educación,
vivienda).
►El LM ha sido una excelente actividad inicial para ayudar a
nuevos Voluntarios del Cuerpo de Paz integrarse en sus
comunidades y ganar la confianza del pueblo.
►Muchas áreas del MINSA
participaron en las discusiones de
estrategia.
►Su ejecución ha sido muy importante para el auto-estima de
mujeres rurales. Se puede usar estas resultados positivos para
motivar a otros a unirse al programa.
►Teniendo en cuenta el momento político, la Iniciativa debiera
unirse a la Alianza contra la desnutrición crónica. El gobierno
está muy comprometido a reducir en un 5% la desnutrición
antes de 2011.
►La estrategia no funcionó tan bien con
el sector público – es más difícil por los
cambios frecuentes en personal y la
abundancia de prioridades para ellos.
►Muchos políticos han cambiado con
las elecciones recientes, lo que genera
una necesidad de orientación sobre LM.
►La Iniciativa debiera estar integrada a programas de agua y
saneamiento para que pueda asegurar su sostenibilidad.
►Es muy importante institucionalizar lavado de manos en el
MINSA, debido a que lo tiene más explícito en el plan
sectorial. También es muy importante tener una relación más
formal entre MINSA y MINED.
►Se requeriría trabajar un plan de abogacía para involucrar
otros actores.
►Un obstáculo es que el personal de
MINSA tiene demasiadas prioridades y
en ese sentido tienen que estar bien
convencidos sobre el valor de LM antes
hacer algo.
►La voluntad política ha variado
mucho con los cambios de líderes en el
MINSA. ►La Iniciativa podría ser más
fuerte con el sector público.
►Se debiera tender a que los instrumentos se conviertan en
parte de las propias instituciones.
de reconocimiento sociales al sector público y privado.
ha consolidado una institucionalización
de LM. Esto depende completamente de
los líderes actuales y su opinión.
fondos exclusivamente para lavado
de manos.
►Ha tenido un estilo de trabajo
informal y abierto a las
instituciones.
Recomendaciones
Debilidades
Fortalezas
Tipo de
institución
►Existe voluntad política e interés
por parte de CARE, sobre todo si se
vincula al actual proyecto que
maneja con PRONASAR.
ONG
►En PAC SEDAPAL existe la
voluntad política de trabajar el
Proyecto
►Fuertes compromisos de líderes
en Ica. Una muestra es que el
nuevo presidente regional envió
una carta a la Iniciativa
confirmando su compromiso.
►La video conferencia en que
participó algunos actores del sector
privado ayudó a explicar la visión y
estrategia común.
44
►La falta de lavado de manos es un problema de desarrollo y
►Prestar atención a los planes políticos, aunque la
implementación sea lo prioritario.
►Tener reuniones para asegurar que los socios principales
entiendan y apoyen la misma visión.
►El apoyo del Presidente Regional es esencial, pues tiene
redes para llegar a los líderes comunitarios.
►Se evidencia una voluntad
política muy fuerte dentro de la
compañía. Hay el sentido que
mucha gente está unida en la
Iniciativa.
Sector privado
(incluye
medios)
►Consolidar la voluntad política en instrumentos operativos,
como mejora en la currícula escolar local.
►Teniendo en cuenta que las municipalidades muchas veces
no cuentan con personal capacitado, se debiera realizar sesiones
de capacitación, por ejemplo al responsable de la Comisión de
Salud, a los equipos que trabajan saneamiento y al equipo de
promoción comunitaria.
►Se requiere mantener informadas a las autoridades locales
para mantener la voluntad política.
►Es bueno aprovechar el contexto que es totalmente
favorable: hay inversión de infraestructura, hay indicadores en
lavado de manos en proyectos como PRONASAR, vinculado a
un cambio de comportamiento.
►Sería bueno que el programa de lavado de manos se
desarrolle junto con otro como es ahorro de agua para asegurar
su buen uso.
►Sería útil revisar los planes de transferencia de los programas
a nivel regional y local.
Recomendaciones
►En el nivel operativo se ha visto
que el compromiso y la voluntad
son muy importantes (PRISMA).
►Falta un soporte comunicacional que
permita que la Iniciativa sea identificada
por todos.
►Se siente el impacto de la Iniciativa
Lavado de Manos en el nivel central,
aunque todavía no es suficientemente
fuerte (CARE).
Debilidades
ONG local
internacional
Fortalezas
Tipo de
institución
tema, que se traduce en la
existencia de este tema en la línea
de base.
bilateral
►Existía alguna confusión en las
relaciones de agencias públicas y
privadas. El sector público está
►La generación de alianzas se ha
dado de manera intuitiva,
lográndose el involucramiento de
actores.
Agencia
internacional
►El programa Escuelas
Saludables se plantea contar con
12,000 escuelas en 2007, por lo
que se identifica muchas
posibilidades de colaboración.
Gobierno
►La participación de las
empresas privadas ha sido muy
importante, porque están
asumiendo un nuevo rol en la
salud de la población.
Fortalezas
Tipo de
institución
Alianzas
Fortalezas
Tipo de
institución
45
►Los frecuentes cambios de personal en el
sector público generan retrasos en la
marcha del proceso o hace que sea más
lenta.
►Todavía se depende demasiado del
equipo nacional.
Debilidades
Debilidades
►Desarrollar guías con los pasos para trabajar la iniciativa a
►La Iniciativa debe identificar un actor comprometido que
asuma la formación de la iniciativa regional, o en todo caso una
institución local que lo asuma. Alguien debe apoyar, teniendo en
cuenta que usualmente las personas ya están trabajando a tiempo
completo.
►Para fortalecer las alianzas se debiera presentar lo que se ha
venido trabajando, como experiencia previa y las lecciones
aprendidas para tener una retroalimentación de los socios.
►Promover alianzas estratégicas con especialistas de
PRONASAR para incluir metodología lavado de manos como
condición a sus operadores.
►Es importante trabajar con “champions” al nivel técnico
porque el nivel político siempre cambia.
►Generar el compromiso de MINSA es esencial para aspectos
técnicos y normativos.
►Colaborar con el programa de Vivienda Saludable, un ataque
integral a agua e higiene, incluyendo cocinas mejoradas.
Recomendaciones
►Usar las Juntas Vecinales Comunales, ahora formalizadas en
la ley de descentralización, como la unidad de implementación
local.
►Se debe trabajar mirando a las Regiones, pero enfocando en
los distritos y comunidades.
►La Iniciativa puede tener más éxito y sostenibilidad si está
implementada como un programa de desarrollo local,
enfocando en un estilo de vida saludable; no como un programa
sectorial de salud.
debe ser atacado desde ese enfoque.
Recomendaciones
►En el MINSA se identificó
mucho entusiasmo; ha tomado
algún liderazgo pero aún no es
suficiente.
►La iniciativa es ”un éxito” que
muestra un esfuerzo unificado
para el desarrollo.
►Es una excelente modelo, muy
flexible.
acostumbrado a tomar dirección,
pero son los otros socios que
tienen los fondos.
46
►La Iniciativa no ha involucrado los
ministerios de Educación y Vivienda
suficientemente.
►La comunicación con algunos socios ha
sido difícil. As veces la Iniciativa tenía
que continuar llamando a MINSA para
recibir una respuesta.
►El MINSA no se siente cómodo con las
relaciones informales.
►Es importante notar qua hay varios tipos
de socios que juegan varios roles. Algunos
solamente hacen su contribución puntual
en coordinación con la Alianza.
►El problema era que muchas de las
contribuciones han sido muy puntuales,
solamente para una campaña corta, y
muchas organizaciones no mantuvieron su
participación activa.
►Es necesario vincular el tema con salud, nutrición, capital
►Usar una figura famosa como portavoz en radio y televisión.
►Es importante vincularlo con programas que mejoran acceso a
agua.
►Para mantener las alianzas hay que monitorear y evaluar
mejor. También los socios tienen que entender que el cambio de
comportamiento lleva tiempo y tiene que ser mantenido.
►Los líderes al nivel nacional y regional estarían interesados en
saber como lavado de manos contribuye a las metas de
Desarrollo del Milenio.
►Las Juntas Administradoras de Agua y Saneamiento (JAAS)
seria una buena estructura a involucrar.
►Se debería involucrar a los líderes comunitarios, quienes
tienen “total credibilidad.”
►Trabajar con Escuelas Saludables.
►Teniendo en cuenta el marco de la descentralización, es muy
importante involucrar los gobiernos regionales – promover LM
en sus planes de desarrollo, de salud, de educación. Así se puede
ganar más aporte de los medios.
►Existe más potencial en socios del sector privado que les
interesan en contribuciones sociales, por ejemplo compañías
mineras.
►Muchísimas organizaciones puede compartir la meta de niños
sanos y hacer varios tipos de contribuciones.
►El paso mas importante es demostrar el impacto de la
Iniciativa en diarrea y desnutrición; los socios necesitan esto para
mantenerse motivados.
►Para la segunda fase la exploración de los actores para la
alianza podría ser algo planificada.
►Se debe ordenar el uso de herramientas para formar alianzas
de este tipo.
►Para el nuevo programa se debiera pensar en alianzas como en
federaciones en que la nacional involucra a las regionales, pero
éstas también son autónomas.
nivel regional, como alianza público privada.
►Ha sido una experiencia muy
►PROICA ya es una alianza de 4
empresas y trabaja en alianza con
varios gobiernos locales.
►Las alianzas son difíciles pero
son importantes para la
sostenibilidad.
►El rol y responsabilidad de los
miembros de la Iniciativa es muy
clara.
Sector
privado
ONG local
internacional
ONG
47
►La alianza en ICA no incluye a ONGs,
pero PROICA misma se convierte en
ONG. Quieren hacer alianzas con medios
masivos locales.
►Se puso de relieve el asocio, pero
todavía es muy nuevo para las Regiones.
►No se identificó al Ministerio de la
Mujer y el Desarrollo Social (MIMDES),
con el Programa Juntos, que tiene una
intervención en 210 distritos, cuyo objetivo
es disminuir la desnutrición crónica, siendo
lavado de manos un componente.
►Hacer más alianzas con compañías privadas y ONGs.
►Hacer contacto con las muchas organizaciones que ya tienen
programas dirigidos a niños, diarrea, desnutrición.
►Identificar una estrategia que oriente la decisión de trabajar en
alianzas hacia algo más corporativo que de personas.
►Sería importante trabajar con el MIMDES [otras personas
dicen que no, porque ha sido demasiado politizado].
►La Mesa de Concertación de Lucha contra la Pobreza puede
ser en algunos lugares una plataforma para la construcción de la
Iniciativa de Lavado de Manos.
►La búsqueda de alianzas debiera ser un poco más sistemática.
►Todas las organizaciones tienen que sentir que la Iniciativa es
de ellas.
►Los ministerios tienen que tener voluntad de compartir el
crédito.
►Colaborar estrechamente con Agua Para Todos, que ya tiene
buenos indicadores, incluyendo la práctica de LM, que la
Iniciativa puede compartir.
►Además de tener un impacto en diarrea e infecciones
respiratorias, considerar que tiene un impacto en desnutrición
crónica. Eso puede implicar mirar otros aliados.
►La Iniciativa tiene que comunicarse mejor con sus miembros,
tanto como con el público, por ejemplo una página Web
interactiva, estado de ejecución, indicadores de progreso,
historias de éxito, lecciones aprendidas, entre otras.
►Es necesario identificar socios regionales y locales que ya
tengan sus programas que llegan directamente al público.
►La Iniciativa debe dejar que espacio para que cada región
desarrolle sus propios métodos.
►Al nivel regional, es esencial identificar “champions”, pues
crear propiedad es crítico para firmar compromisos; planear
juntos y capacitar.
humano, infecciones respiratorias.
►La Dirección Nacional de
Educación Comunitaria y
Ambiental está abierta a realizar
una directiva que describe su
colaboración con la Iniciativa.
►Se ha manejado bien. No ha
sido tan formal y ha permitido que
Gobierno
Agencia
internacional
Fortalezas
Tipo de
institución
Acuerdos institucionales
Proyecto
bilateral
►PERUTV ha estado
acostumbrado a apoyar y
participar en alianzas con otras
instituciones.
interesante pues ha permitido la
participación del sector público y
privado desde su propio aporte,
sin condicionar la participación.
48
►Con excepción del sector público, los
socios trajeron sus propios recursos.
►No se ha informado a las instituciones de
lo logrado, para lograr reiterar los
acuerdos.
►A partir de los lineamientos de
Promoción de Salud se utilizan las láminas
de salud e higiene, que responde también a
la incidencia de la Iniciativa, pero lo
utilizan sin criterio de uso (lo usan también
en escuelas que no cuentan con servicio de
agua y desagüe).
Debilidades
►Podría trabajarse un mapa de relaciones más visual que
establezca dónde está ubicado cada actor en el sistema y qué
►En el Comité Nacional también debiera participar el sector
privado.
►El MINSA está pensando en comités descentralizados por
Regiones o Macro Regiones, que tengan autonomía y
legitimidad.
►Evaluar si el Comité Regional Multisectorial podría ser la
instancia de apoyo a la Iniciativa en la Región Arequipa.
►Trabajar acuerdos con municipalidades para que prioricen
agua y saneamiento en escuelas (PROMSA Arequipa).
►Establecer acuerdos formales con Ministerio de Vivienda y los
programas de agua y saneamiento, vinculándolo a la Iniciativa de
Lavado de Manos.
►Los acuerdos locales deben partir del análisis de los Planes
Regionales de Salud o de las prioridades identificadas por el
Consejo Regional de Salud (municipalidad Piura).
Recomendaciones
►La generación de alianzas locales se hace más fuerte cuando
existe una obra de infraestructura y una distribución de roles muy
clara (PAC).
►Así también se podría buscar a la empresa privada agrupada,
con el Grupo Empresarios por la Educación que CONFIEP está
fomentando y mapeando.
►Existe un espacio que la Iniciativa debiera buscar vinculado a
los espacios regionales, como la Coordinadora de Presidentes
Regionales (RPP).
►Ganar el apoyo del MINSA es esencial, aunque las autoridades
cambian frecuentemente.
►Fortalecer los equipos de trabajo en Ica (PROICA y otros
socios) para hacer mejor seguimiento; formar una comisión sobre
Lavado de manos.
ONG Local
internacional
ONG
►El MINSA ha tenido una
participación adecuada.
►Más socios tienen interés en
mejorar la calidad de vida de
familias pobres, algunas
específicamente en reducir la
diarrea.
►La nueva administración
gubernamental ha aceptado la
Iniciativa, y hay un interés mucho
más fuerte del MINEDU.
►Ha sido un enfoque desde el
inicio. Por eso la Iniciativa no es
percibida como programa del BM
sino como una iniciativa del Perú.
►Al nivel local, fueron acuerdos
tácitos y funcionaron bien sin muy
ayuda de fuera.
►Hay capacidad de adaptación a
las necesidades de cada
institución. Si se necesita más
formalidad (DISAS,
municipalidades) se ha trabajado
en ese sentido.
los procesos sean más fluidos.
49
►Los acuerdos institucionales podrían ser
más claros. Por ejemplo cuando las
campañas de comunicación comenzaron,
varias organizaciones se sintieron celosas
que no eran parte.
►Faltaría involucrar educación y vivienda
al nivel nacional.
►En muchos casos la participación activa
de una institución no es tanto por las metas
de la institución, sino por el interés fuerte
de una o dos personas de influencia (factor
clave es mas personalista).
►Aunque muchos gobiernos regionales
tienen fondos, no saben bien como
gastarlos eficientemente (el gobierno ha
gastado 12% de sus asignaciones este año).
►Existió confusión durante el proceso
porque el MINSA insistió en acuerdos más
formales.
►Se recomienda que los acuerdos con las municipalidades sean
independientes, de manera que le dé valoración al acuerdo.
►Tener cuidado con algunas instituciones u ONGs locales que
participen, porque pueden estar en conflicto con el sector
►Para la siguiente fase promover acuerdos con una serie de
instancias como Consejo Nacional de Salud, FOROSALUD,
donde se identifiquen a colectivos que trabajan por salud.
►Aprovechar el potencial que tienen los convenios saludeducación regional.
►Se necesitan procedimientos claros, un paso por paso.
►Los acuerdos nacionales no son importantes si las alianzas no
funcionan al nivel local.
►Construir una plataforma de discusión para compartir
lecciones aprendidas sobre agua y saneamiento, así como
promoción de higiene.
►Hay campo para más involucramiento de empresas privadas en
las regiones y de ONGs.
►Establecer comités regionales que pueden coordinar lavado de
manos en su región y también dirigirse a otras iniciativas a largo
plazo.
►Es importante tener un compromiso institucional escrito,
especialmente para socios donde el personal cambia
frecuentemente.
►Para mantener el entusiasmo hay que medir y divulgar los
resultados, de modo que la gente puedan tener confianza que sus
esfuerzos hacen una diferencia.
►Con el Cuerpo de Paz se llegó a acuerdo y ahora debería
firmarse.
produce cada alianza.
►Las organizaciones no
gubernamentales hacen lo que
prometen.
Proyecto
bilateral
►El MINSA considera que los
productos de la Iniciativa fueron
buenos, pero siempre
considerando el aspecto de
distribución.
Gobierno
Fortalezas
Tipo de
Respond.
Metodología del programa
►En Ica han trabajado bien
informalmente.
Sector
Privado
50
►Se sintió que algunas actividades se
trabajaron en función a la demanda.
Debilidades
►Todavía las autoridades regionales faltan
un buen entendimiento de la importancia
de lavado de manos.
►Las alianzas son necesarias e
importantes pero los socios tienen que
contribuir más que palabras lindas.
►Evaluar la experiencia PRONASAR en el área rural: es más
fácil promover la práctica en la costa que en zonas más arriba de
►Incentivar a la gente con visitas o viajes de intercambio de
experiencias.
►Se debiera contar con un ejército de supervisores que aseguren
que las actividades se realicen para que salud y educación lo
hagan. Es al principio, luego ya se convierte en una práctica.
►No es recomendable promover lavado de manos donde mucha
gente no tiene buen acceso a agua. El impacto será limitado en
estas áreas.
►Sugiere que se realicen diagnósticos participativos locales,
vinculando a desarrollo humano, calidad de vida. Poner en
evidencia que esta Iniciativa contribuye a la nutrición infantil, a la
descentralización y a tener familias saludables.
►Es importante trabajar el nivel regional desde un principio,
desde la sensibilización, para que en las regiones se sientan “parte
de”.
Recomendaciones
►Participar en un gran esfuerzo nacional de mejorar el estilo de
vida de familias.
►Hacer todo lo posible para que los Presidentes Regionales
asuman su responsabilidad hacia lavado de manos y otros
aspectos de una vida saludable.
►Formar alianzas más amplias en el nivel nacional, regional y
distrital. Cada socio nacional puede involucrar sus redes locales.
►Sería útil orientar a los funcionarios claves sobre sus roles y
funciones en relación a lavado de manos.
►En Ica cree importante para sostenibilidad formalizar los
compromisos de varias unidades gubernamentales.
privado.
►Aborda bien los aspectos
básicos y tiene una manera simple
►La metodología ha funcionado
bien.
►En general los comités
funcionaron muy bien; ganaron
varios tipos de pericia y muchos
contactos de valor. Los miembros
aprendieron uno del otro.
►Funcionó bien, aunque un poco
lento.
ONG
Agencia
internacional
51
►Faltó articulación entre la difusión
masiva y el enganche con las acciones
interpersonales.
►Se necesita ajustar las expectativas para áreas con diferencias en
►Las actividades han sido muy puntuales. Se necesita una
revisión estratégica de la Iniciativa para pensar más al largo plazo
y en términos de institucionalización.
►Todos los socios principales tienen que tener la oportunidad de
entender, hacer sugerencias y aceptar la metodología para la nueva
fase.
►Se debiera dar más énfasis en comunicación interpersonal;
diseñar otras actividades para fortalecer actividades
interpersonales.
►Los fondos de Gates deben ir a los operadores las agencias
ejecutoras, incluyendo la encargada de monitoreo y evaluación, no
al MINSA y los socios.
►Se necesita una fase de sensibilización en todas las regiones
nuevas. Hay que sentarse con los directores de salud y mostrar
cifras sobre como pueden reducir la diarrea. Posiblemente
preparar un video o documento con testimonios de líderes de las
regiones ya trabajadas.
►Una estrategia importante es capacitación de líderes locales
como alcaldes porque la población sigue sus consejos. Los niños
también pueden ser agentes de cambio efectivos.
►La comunicación interpersonal debiera estar unida a iniciativas
y herramientas existentes, por ejemplo, Municipios Saludables,
Escuelas Saludables.
►Medios masivos pueden ser más agresivos en ofrecer tiempo en
radio y televisión.
►Se requiere considerar equipos de trabajo descentralizados para
el programa.
►Estandarizar más la metodología con procesos y productos más
estandarizados. Que exista un menú de posibles actividades que
facilite la decisión de los nuevos aliados y su inclusión en una
matriz de monitoreo.
►Sugiere trabajar con los actores locales claves y público
objetivo, más que a los socios.
los 3,500 msnm, debido al clima. Hay que pensar en tecnologías
alternativas que faciliten subir la temperatura del agua.
►Muy buena relaciones
informales.
►El éxito de la Iniciativa es que
ha logrado cosas concretas:
investigaciones, manuales,
actividades en manuales, material
audiovisual.
►Muy participativa y motivadora.
Apropiada para la cultura, pues
fue muy visual y verbal.
de hacer entender los mensajes, lo
que lo hace muy replicable.
Proyecto
bilateral
Sector
privado
ONG Local
internacional
52
►En Ayacucho hubo avances en
conocimiento y actitudes pero poco en
prácticas.
►Los líderes regionales dan apoyo
verbal pero no lo sigue con acción.
►Cada región debe elaborar su propio plan de comunicación y
materiales.
►Trabajar mucho más por comunicación interpersonal,
especialmente el tipo que estimula a la comunidad a reflejar sobre
sus problemas y proponer e implementar soluciones. No depende
en medios masivos.
►Para sensibilización se puede abordar desde programas TV
como espacio “cabildo abierto” que población puede hacer
reclamos y preguntas y el fin de semana va el alcalde a dar
respuesta a inquietudes.
►También se propone trabajar lo masivo con un mensaje simple y
la profundización de contenidos se trabaje desde programas como
consultorios diferentes a diferentes públicos, urbano marginal,
otro rural en que se podría poner a hablar a los promotores.
►Usar RPP para alcanzar todas partes del programa; es un fuente
muy confiable y salud y nutrición son de mucha interés popular.
►Se debe dar más apoyo en monitoreo.
►En las comunidades identificar al líder, que muchas veces es el
médico, para que ejecute la práctica con las mismas personas. La
práctica misma con ellos les genera una sensación de autoestima.
(Labor de Arequipa).
►Los incentivos que podrían apoyar la implementación del
programa son: costo reuniones de sensibilización, certificación
oficial para operadores coordinando con educación y salud, logos
institucionales en los materiales y premiación a los actores que
han logrado mejores resultados.
►En zonas donde no hay facilitad de contar con agua, se puede
trabajar adicionalmente el uso que se puede dar al agua jabonosa
después de lavarse las manos, como echarla al suelo para que no
levante polvo.
►Para obtener apoyo y participación gratuita de otras
instituciones, es necesario identificar sus prioridades y
engancharlas a lavado de manos. Por ejemplo Cáritas Piura lo
enganchó con su eje ahorro del agua.
►Se necesita hacer más visible el tema con espacios en televisión.
altura, temperatura, cultura.
Agencia
internacional
►El Ministerio de Vivienda a
través de sus programas
PRONASAR en zonas rurales y
pequeñas ciudades tiene
asegurado fondos hasta el 2008 y
se está planificando la
convocatoria para el siguiente año.
Gobierno
►Desde el MINSA se identifica
que hubo capacidad de ejecutar las
acciones de la Iniciativa,
lográndose elaborar materiales y
productos comunicacionales,
talleres realizados y personal
capacitado.
Fortalezas
Tipo de
Respond.
Capacidad de ejecución
►Considerar a los operadores de PRONASAR como posibles
aliados en los comités regionales o distritales.
►Hubiera sido necesario más acciones
de supervisión y monitoreo.
►La estrategia es identificar y contratar varias organizaciones que
pueden, cada una, manejar la implementación en 3 a 5 regiones.
►El aspecto clave es mantener el entusiasmo de los socios; con
eso van a proveer los fondos y otros recursos como el tiempo de
►Falta confirmar que todos los actores
estén integrando sus actividades.
►Todavía no se ha logrado que los
gobiernos regionales publiquen las
53
►Es necesario trabajar en el nivel local, pero tiene una tremenda
necesidad de fortalecer sus capacidades y por ellos quizás sea
necesario empezar por ahí.
►El MINSA es muy jerárquico, pues el
personal necesita órdenes de arriba antes
de actuar.
►Es bueno que para esta segunda fase se contemple medición de
impacto, además de resultados.
Recomendaciones
Debilidades
►Trabajar con los niños, que tienen entusiasmo y que son más
abiertos a cambiar. Usar música, drama, y otras tradiciones para
crear interés.
►El público tiene más confianza en las organizaciones que dan
promoción porque ya han ayudado con infraestructura.
►Combinar la promoción de lavado de manos con programas que
mejoran la infraestructura de agua y saneamiento.
►Dar más responsabilidad de planificar e implementar a las
organizaciones y estructuras locales. Trabajar mucho más con los
gobiernos distritales, que tienen mayor contacto con familias.
►Más allá de los convenios, se necesita buena voluntad.
►Existió capacidad de la
institución para diseñar las
estrategias, metodologías y
aplicarlas.
Proyecto
bilateral
Sector
privado
ONG local
internacional
ONG
54
►La vinculación de quienes operan con
las alianzas regionales fue muy básica.
►Las capacidades existen pero la
Iniciativa no ha aprovechado de muchos
oportunidades de involucrar lavado de
manos en los planes de trabajo de varios
programas. No ganara mucha atención en
agencias gubernamentales como una cosa
extra.
ordenanzas sobre lavado de manos. Esto
es un decreto sobre la Iniciativa que se
necesita para tener fondos dirigidos a
lavado manos en el presupuesto regional.
►Si el programa se ejecuta en Lima, se puede trabajar en
colaboración con los consorcios ya formados por PAC Sedapal.
►La vinculación del MINSA debe estar comprometido más allá
de Promoción de la Salud, para lograr como las campañas de
vacunación en que se dedican a eso por uno o dos meses.
►Además de la alianza público privada que orienta este trabajo,
se deberían identificar grupos de soporte o especializados que
apoyen las actividades y le den sostenibilidad (PRISMA).
►Enfatizar el programa en el nivel regional y local, más que en el
nacional. Este último puede estar vinculado o muy cercano al
aspecto político.
►Es interesante evaluar la capacidad de convocatoria que puede
tener una institución, más allá de la firma de un contrato. Algunas,
tal como Cáritas, pueden movilizar líderes catequistas.
►Es posible que tiene que adecuarse al ritmo del sector público
(más lento).
sus profesionales.
Proyecto
bilateral
local
►No debe ser una barrera si la gente usa su creatividad; como
vincular lavado de manos con temas como agua segura y
abastecimiento de agua.
►Se necesita adaptar los materiales para la región (idioma e
imágenes).
►Se necesita agregar nuevas mensajes e información para
mantener el cambio de comportamiento y facilitarlo donde existan
barreras. Por ejemplo, estrategias cuando falta agua.
►Usar más radio y menos material impreso.
►Se requiere elementos de monitoreo que facilite a las
instituciones que apoyan cómo medir las capacitaciones
efectuadas y su calidad (Cáritas Piura).
►Desarrollar estrategias distintas para costa, sierra, selva, así
como manuales sobre lavado de manos para profesionales de
salud.
►Se puede promover que las familias con difícil acceso preparen
y usen Tippy Taps para poder lavar las manos con poca agua.
►Se puede solicitar donaciones de jabón de los hoteles en las
ciudades más grandes para ser donados a las familias más pobres.
Sector
privado
55
►Alrededor de 1/3 de familias no tiene
fácil acceso al agua.
►En proyectos que consideren infraestructura, acercar la zona de
lavado y no sólo el jabón a la letrina y otro a la cocina para
facilitar la adopción de la práctica.
►Promover la participación de promotores de salud con la
entrega de incentivos como chalecos, materiales y gorros.
Recomendaciones
►Para el nuevo programa se debiera asegurar la entrega de
materiales con la ejecución de las actividades de comunicación y
fortalecimiento de capacidades.
►Pfizer ha donado jabón a los
Voluntarios de Cuerpos de Paz.
►Mas de 90% de las familias se
disponen de jabón que puede ser
usado para lavado de manos.
►La disponibilidad de zonas de lavado y
de agua sí puede constituir un problema
para la promoción de la práctica.
►Los promotores muchas veces se
cansan de apoyar porque no reciben
incentivos. (PROMSA Arequipa)
Debilidades
ONG
internacional
ONG
Agencia
internacional
►Se está evaluando la propuesta
técnica de acercar una zona de
lavado a las letrinas que
PRONASAR promovería.
Gobierno
►El jabón no constituye un
problema ni en las zonas rurales,
pues siempre existe.
Fortalezas
Tipo de
Respond.
Disponibilidad de productos y herramientas
►FONDAM tiene 4 tipos de
financiamiento para programas
como lavado de manos:
concursos, co-financiamiento,
proyectos especiales (chicos), y
proyectos de desarrollo
innovadores. Tienen sus
prioridades geográficas y técnicas.
Gobierno
Proyecto
Sector
privado
ONG local
internacional
ONG
Agencia
internacional
Fortalezas
Tipo de
Respond.
Financiamiento
56
►Aún cuando tiene los fondos las
entidades gubernamentales tienen que
pasar por procesos burocráticos pesados
para gastarlos.
Debilidades
►Cuando el proyecto se presente a la Región se debe solicitar que
sea un proyecto especial y que tenga autonomía en el manejo
presupuestal, organizacional e institucional.
►Para que haya decisión de apoyar inclusive financieramente se
requiere entrar por la nueva Gerencia Regional de Educación, que
está muy cercana a orientar la voluntad política del gobierno
regional. (Labor)
►Debe existir suficientes fondos en los gobiernos regionales
donde reciben canon del las empresas mineras. Para las otras
regiones seria bueno hacer abogacía con el Presidente Regional
para disponer de algunos recursos.
►USAID tiene un programa de donaciones pequeñas (small
grants) que puede apoyar proyectos comunitarios con hasta
$2,000.
►Más fondos deben estar disponibles del sector privado y de
agencias internacionales como UNICEF y SAVE que trabajan a
favor de los niños.
►Identificar el financiamiento de proyectos de agua y
saneamiento para poder vincularlos.
►Explorar mayor financiamiento para este programa.
►El MINSA considera que la fuerza está en los gobiernos
regionales, con el proceso de descentralización, pues ahora
disponen de fondos y debieran priorizar este tema.
Recomendaciones
►Escuelas Saludables ha
desarrollado una tabla de
indicadores que está en el proceso
de aprobación final.
Gobierno
Fortalezas
►El proceso ha sido bien
documentado en términos de
costos e impacto; pero no
específicamente en términos de
costo-efectividad de varias
actividades, materiales, etc.
Fortalezas
Tipo de
Respond.
Monitoreo
Proyecto
bilateral
Sector privado
ONG Local
internacional
ONG
Agencia
internacional
Gobierno
Tipo de
Respond.
Costo eficiencia de la ejecución
bilateral
Debilidades
Debilidades
57
►Es importante que esté desarrollada desde el diseño del
proyecto, con instrumentos precisos y presentados a los socios.
Recomendaciones
►Es la responsabilidad del equipo de monitoreo y evaluación.
Recomendaciones
►No se ha realizado monitoreo
de las actividades de Belcorp.
►PRISMA realizo informes
periódicos; los socios monitorean
sus actividades; las instituciones
que replican talleres envían
informes (RPP, CARE, etc.)
►La línea de base y su repetición
fueron bien hechos, lo que
constituye un aspecto
sobresaliente del programa.
Proyecto
bilateral
Sector privado
ONG local
internacional
ONG
Agencia
internacional
58
►Ha sido un poco ausente pero ha
mejorado recientemente.
►Muchas actividades no han sido
evaluadas.
►Los resultados del monitoreo y evaluación deben ser
trabajados y compartidos con todos los socios de la Iniciativa.
►El proceso de revisión de indicadores de monitoreo y
evaluación podría ser elaborado y/o revisado conjuntamente
(RPP).
►Debiera promoverse la participación de la población a través
de un monitoreo participativo muy visual que permita medir las
condiciones generales y las críticas. La escuela debiera ser un
espacio de medición necesario.
►Se necesita mayor monitoreo y medición de resultados.
►Hay que preparar un plan de monitoreo que explique bien su
relación con la evaluación de impacto. Hay que incluir
requerimientos de informes en los contratos con agencias
implementadotes.
►Publicar la evaluación.
►Usar indicadores más sensibles, simplificar los instrumentos,
no recoger tantos datos y hacer más observaciones.
►Promover el monitoreo y la evaluación de las actividades,
capacitando a los socios en este aspecto y dotando de
herramientas simples de monitoreo.
Tener flexibilidad ajustar el programa a las realidades en el campo y no tener que seguir la metodología global cuando no funciona bien aquí; no
59
Hacer buenos asesoramientos regionales para identificar los socios, programas y estructuras mejores.
Identificar 3 a 5 organizaciones que puedan manejar la implementación en las regiones.
Se necesita una buena comunicación entre los muchos socios, con un comité nacional que trabaja bien y puede resolver problemas.
Se necesita un buen diseño para una ejecución realista.
Incluir el mensaje de poner jabón en todos lugares donde se lavan las manos; usar la repetición de mensajes persona a persona.
Realizar un buen esfuerza de crear voluntad política; difusión de resultados; usar muchas canales con los mismos mensajes.
Monitoreo y evaluación es sumamente importante. La Alianza debe apoyar los socios en esto, dando herramientas y ayuda técnica. Por ello se
necesita coordinar mejor la hora de las acciones de muchos socios para que se apoyen mejor una a otra.
Hacer alianzas a partir de iniciativas existentes; uniéndolo con el interés en disminuir la desnutrición.
No se crea hábitos nuevos solamente con campañas—necesita una intervención sostenida.
No tener una intervención aislada—hacer como parte de un paquete de intervenciones para disminuir la diarrea.
Institucionalizar la promoción de lavado de manos.
Planificación participativa en todos niveles.
Mejor definición de una estrategia que coloca lavado de manos dentro de muchas otras iniciativas relacionado con agua y saneamiento y salud
infantil a todos niveles.
AGENCIA INTERNACIONAL
Emitir en horas para el lugar (5/6 a.m. en el campo) con productos adecuados a los padrones culturales de cada región.
Ajustar los productos o servicios para responder; usar radio local, teatro popular, títeres para los niños, no TV.
Antes de implementar, dar la oportunidad para los beneficiaros explicar sus vidas, esperanzas, deseos.
Focalizar; asegurar que las áreas del programa tiene acceso a agua.
PROGRAMA INTER-GUBERNAMENTAL
Tener en evaluación que cuando existe caño facilita más la práctica, que entregando lavatorios y jarras.
Revisar las condiciones de lavado en zonas de altura, mayor a 3,500 msnm
Asegurar que las zonas de lavado como infraestructura existan o se promueva su construcción para facilitar la práctica.
La construcción conjunta de la propuesta facilitaría que los actores nacionales y regionales se apropien de la propuesta, poniendo en evidencia que
son parte del problema y de la respuesta.
GOBIERNO
Factores más importantes para las condiciones de éxito
Source: Summary of the team’s interviews in Peru.
60
Juntar promoción de lavado de manos con programas de infraestructura de agua y saneamiento puede ser muy efectivo porque los mejoramientos
físicos crean confianza de la población a la organización ejecutora.
Tiene que ajustar la promoción dependiendo en el acceso a agua que las familias tienen.
La Iniciativa tiene que hacer muchos esfuerzos a crear compromisos y colaboración al nivel regional y distrital por muchos socios de varios sectores.
PROYECTO BILATERAL
Ayudar a todos con monitoreo.
Hacer una línea de base.
Trabajar más con comunicación alternativa como pasacalle, teatro, títeres.
Proveer evidencia que los cambios de comportamiento están aconteciendo.
SECTOR PRIVADO
Tener un enfoque más amplio hacia desnutrición y pobreza.
Explorar las mesas de concertación como alianzas locales que ya existan.
Trabajar lo más posible al nivel local.
La alianza público/privada es esencial porque el sector público solo no puede tener los resultados.
ONG LOCAL
Buscar la relación con las16 mineras que están orientando sus acciones de responsabilidad social, a través de la creación de Fundaciones.
La Iniciativa tiene que general opinión publica favorable.
Se necesita buenas alianzas, financiamiento, recursos humanos, un símbolo unificador.
Pensar no en una campaña sino en actividades continuas.
Simplicidad; claridad de roles; mecanismos de reconocimiento; retroalimentación oportuna.
ONG INTERNACIONAL
dejar los requerimientos de monitoreo y evaluación condicionen la ejecución.
Fecha
Tiene una meta y objetivos claros y entendibles en todos
La iniciativa de lavado de manos, incluyendo el
programa:
POLÍTICA, ESTRATEGIA, Y DIRECCIÓN
Maque con "X" el numero que mejor refleja su respuesta
a cada pregunta o frase.
Instrucciones:
0
1
1
6
61
2
área
en esta
mejorar
mucho
Excelente
Se necesita
__1_ nacional __3_regional ___3_ provincial __6__ distrital
__4_ local _____1________ otro
A qué nivel se ha vinculado con el programa?
__5_ tomador de decisiones ___3_ejecutor __3__supervisor/gerente
____3_________ otro
1
I.
__2__ entre 1 y 2 años
Cuál es su papel en su organización?
__2__Entre 6 meses y un año
___5__ Más de 1 año
Hace cuánto tiempo está involucrado en este programa?
Nombre de la organización:
APPENDIX D: ENCUESTA SOBRE LAS CONDICIONES PARA LA EXPANSIÓN DEL LAVADO
DE MANOS CON JABÓN: 10 RESPUESTAS
0
0
0
0
0
Tiene un plan completo formulado
Tiene miembros que entienden su estrategia de larzo
plazo
Tiene un plan formulado para guiar sus esfuerzos.
Tiene políticas y procedimientos que hace posible
cambiar la manera cómo se hacían las cosas
Tiene una visión que es comprendida en todos los niveles
Se destacan los esfuerzos exitosos que pueden ayudar a
reforzar la visión
Tiene líneas de autoridad claras
Puede implementar su visión de manera efectiva
Puede llevar su visión a sus miembros y sus comunidades
ALIANZAS
5
6
7
8
9
10
11
12
13
II.
0
Tiene la capacidad de ofrecer el apoyo requerido por sus
miembros para implementar el programa?
62
Insatisfecho
0
0
0
0
Está satisfecho con que el programa, porque …
1
0
Ha trabajado en pro de establecer políticas favorables
4
0
Establece hitos y alianzas que apoyan sus objetivos
3
0
Ha establecido un visión y estrategia compartidas
2
los niveles
1
Algo
insatisfecho
0
0
1
1
0
1
0
1
0
1
1
0
1
Neutral
2
3
1
2
4
2
3
0
3
2
1
3
5
Satisfecho
6
4
6
5
5
4
5
7
5
5
4
7
3
satisfecho
Muy
2
3
2
2
1
3
2
2
2
2
4
0
1
0
0
0
Totalmente
en desacuerdo
0
0
0
Busca activamente conseguir nuevos contactos en el
transcurso del tiempo?
Utiliza sus contactos y relaciones?
Actúa en una manera abierta e inclusiva?
Es eficiente y productivo, enfocado en resultados?
Se asegura que se disponga de suficientes recursos para
que los miembros alcancen sus objetivos?
Brinda suficiente orientación a sus miembros?
En este programa,
La colaboración y el sentido de equipo juegan un papel
important en el desarrollo del programa.
Los miembros están involucrados en encontrar soluciones
a los desafios del programa.
El aprendizaje es parte del trabajo y luego se convierten
en tareas de rutina
7
8
9
10
11
12
13
14
15
En
0
Tiene varios contactos fuertes en el sector
gubernamental?
6
0
63
1
1
Tiene varios contactos fuertes con ONGs, grupos
sociales?
5
1
0
Tiene varios contactos fuertes en la empresa privada?
4
0
0
0
desacuerdo
1
1
1
0
0
1
1
3
2
0
Tiene amplios contactos que puede motivar a ayudar la
iniciativa, p.e. adogados, banqueros, etc.?
3
1
0
Cuenta con la cooperación y apoyo de sus miembros?
2
3
3
1
Neutral
2
1
2
2
3
3
3
1
2
5
1
4
4
4
De acuerdo
5
5
5
5
3
4
2
3
2
0
6
3
3
5
de acuerdo
Fuertemente
2
3
2
2
3
2
4
4
3
3
2
0
Los miembros están involucrados en encontrar soluciones
a los desafios del programa.
Se comparte el crédito del éxito
Los socios se benefican con la colaboración.
ACUERDOS INSTITUCIONALES
17
18
19
III.
0
0
0
0
0
Fomenta que todos los miembros propongan soluciones a
problemas.
tiene disponible información presupuestario actual para
avaluar gastos del proyecto.
Tiene la costumbre de proveer las herramientas/recusos
necesarios para apoyar iniciativas.
Tiene la costumbre de comunicarse con todos los niveles.
tiene una historica de identificar y resolver problemas.
Sigue un proceso claro de toma de decisiones para nuevas
iniciativas.
3
4
5
6
7
8
0
Continuamente busca entender las necesidades de sus
miembros con encuestas y entrevistas.
2
64
0
Incluye la retroalimentación de los clientes en la
generación de nuevas ideas
1
0
desacuerdo
El programa:
Totalmente
en
0
0
0
Se fomenta equipos con representación de varios
sectores.
16
1
1
2
0
1
0
1
1
desacuerdo
En
0
0
0
0
2
4
2
2
4
3
2
2
Neutral
1
2
2
1
6
5
3
5
2
6
5
5
De acuerdo
5
3
5
6
1
0
3
3
3
1
2
2
de acuerdo
Fuertemente
4
5
2
3
0
0
0
mejorar
mucho
El programa:
Usa technología para mejorar la eficiencia de sus
actividades
Cuenta con un conjunto de tecnología informática para
sus necesidades, ej. Base de datos, programas, etc.
Entiende la importancia de la tecnología informática
como una herramiento estrategica y para mejorar el
programa
Capacitación
El programa:
1
2
3
B.
mucho
0
El programa:
Realiza una evaluación de destrezas como parte del
proceso de planificación.
6
mejorar
Destrezas/Capacidades
C.
65
Se necesita
0
Brinda oportunidades a asistir capacitaciones.
5
0
Apoya la capacitación de sus miembros.
4
Se necesita
Mejorar mucho
Tecnología
A.
1
0
0
0
1
1
Se necesita
CAPACIDAD DE IMPLEMENTACIÓN
IV.
0
Tiene las personas apropiadas a cada cargo y tarea.
9
0
5
3
0
4
4
3
3
4
3
6
3
3
4
6
0
área
en esta
Excelente
4
4
área
en esta
Excelente
3
2
2
en esta área
Excelente
1
MONITOREO
V.
Determina lo que cada unidad operativa contribuye al
valor del programa
6
Hace seguimiento de los resultados
5
0
0
3
Tiene actividades que estado conectadas a los esfuerzos
por capturar lecciones.
Tiene un plan y método para recoger lecciones claves y
divulgarlas
2
4
0
Ha desarrollado métodos para recoger y usar
retroalimentación sobre las actividades del programa.
1
0
0
Se esfuerza continuamente a avaluar las necesidades de
los beneficiarios a través de encuestas cortas y
entrevistas.
a sus miembros y otras personas interesadas de manera
continua
mucho
Este programa:
66
2
2
1
1
1
0
1
3
4
3
4
2
2
3
3
3
5
4
6
5
4
1
1
2
1
3
0
1
0
0
área
en esta
0
Provee a los miembros con habilidades y recursos para
que logren sus resultados
10
1
1
5
mejorar
0
Es capaz de desarrollar las destrezas necesarias en sus
miembros actuales.
9
3
2
Ya excelente
0
Puede contratar a pesonas con las destrezas que se
necesitan.
8
2
Se necesita
0
Tiene suficientes recursos dedicados a proveer
oportunidades regulares para desarrollar destrezas.
7
1
0
0
1
2
1
1
1
Utliza las redes de las empresas para informar y divulgar
los resultados logrados
Revista sus metas cada año y espera ver mejoras cada año
Tiene un sistema de información que está alimentado por
los resulados en los beneficiarios
Mide la satisfacción de los beneficiarios al menos
trimestralmente
Adapta los servicios y actividades a la retroalimentación
de los beneficiarios
Ha establecido indicadores para medir la satisfacción de
los beneficiarios
Vincula sus procesos internos al impacto programático
Desarrolla métodos simples de recolección de
información para uso de los beneficiarios
Tiene un plan comprensible de monitoreo y evaluación
7
8
9
10
11
12
13
14
15
1
0
Tiene escritas las medidas e indicadores de desempeño
del programa. Sí No 4
Mide el impacto de sus servicios y actividades en sus
beneficiarios. Sí No 2
16
17
mucho
Para lo siguiente, favor indicar si lo tiene. En caso sea
positivo, evaluarlo.
67
0
0
0
0
5
3
1
0
0
1
0
0
2
1
1
0
0
0
área
en esta
3
5
4
3
5
4
2
4
2
5
mejorar
3
2
3
3
1
3
3
3
3
2
Ya excelente
1
1
1
1
1
1
2
1
2
1
Se necesita
1
1
y lo comunica a los miembros.
0
0
0
0
0
Ha establecido medidas e indicadores de resultados. Sí
No 3
Ha probado y adaptado herramientas para medir
ressultados. Sí No 3
Ha probado y adaptado herramientas para medir el
desempeño del programa. Sí No 4
Ha probado y adaptado herramientas para medir procesos
de implementación. Sí No 3
Ha probado y adaptado herramientas para medir el
impacto del programa. Sí No 5
19
20
21
22
23
0
Ha establecido un medidas e indicadores de procesos. Sí
No 3
18
68
0
0
0
0
0
0
1
1
1
1
1
1
1
2
1
2
2
4
1
1
1
1
2
0
APPENDIX E: LAS CONDICIONES PARA LA EXPANSIÓN DEL
LAVADO DE MANOS CON JABÓN. GUÍA DE ENTREVISTA
Fecha de la entrevista ____________________________________________________
Nombre del entrevistador _________________________________________________
Nombre del entrevistado __________________________________________________
Cargo __________________________________________________________________
Rol del entrevistado (tomador de decisión, ejecutor, supervisor)
________________________________________________________________________
Tipo de organización (sector público, privado, ONG) __________________________
Alcance de la organización (nacional, varias regiones, regional, distrital, comunal)
________________________________________________________________________
Introducción (5 minutos)
Introducción
Agradecimiento por el tiempo otorgado
Propósito de la entrevista
Explicación de la confidencialidad de la entrevista, no se usará el nombre u otro dato de
identificación
Información de la existencia de preguntas.
Apertura (10 minutos)
Solicitar información acerca de la importancia de lavado de manos
Solicitar información acerca de la institución a la que pertenece, lo que hace en relación a lavado
de manos y los planes que tienen respecto a este tema.
69
Nota importante: Aclare si la pregunta se refiere al nivel nacional, regional, o local o a varios
niveles.
Política, estrategia y dirección (Gobierno, Agencia Int., ONG Int., ONG Local, Sec. Privado,
Proj. Bilat.)
►Qué tan sólida ha sido la voluntad política (nacional, regional, local) para promover el lavado
de manos?
► Qué sugerencias tendría para mejorarla en un programa a escala ampliada?
►¿En su opinión cuánto ha dispuesto la Iniciativa de una visión y estrategia compartida que
asegure la voluntad política? Explique.
►¿Tiene Ud. sugerencias sobre cómo este aspecto podría ser fortalecido en el programa
expandido?
►Esta visión y estrategia fue desarrollado de una manera participativa?
►¿Tiene Ud. sugerencias sobre como este aspecto puede ser fortalecido en el programa
expandido?
Alianzas (Gobierno, Agencia Int., ONG Int., ONG Local, Sec. Privado, CBOs, Media, Proj.
Bilat.)
►¿Cuán efectivas han sido las alianzas público privadas al nivel nacional y regional?
►¿Cree Ud. que los miembros de la alianza han tenido metas complementarias y cómo han
funcionado?
►¿Cree Ud. que los miembros han compartido los riesgos, el poder, así como los resultados o
procesos?
70
►¿Las alianzas han sido construidas en todos los niveles entre los sectores público, privado y
ONGs?
►¿Tiene Ud. sugerencias sobre como estas alianzas pueden ser fortalecido en el programa
expandido?
3. Acuerdos institucionales (Gobierno, Agencia Int., ONG Int., ONG Local, CBOs, Media, Proj.
Bilat.)
►¿Cree que las instituciones que participan en la Iniciativa de Lavado de Manos en todos los
niveles claramente entienden sus roles, responsabilidades y autoridad?
►¿Cree que los socios contaron con los recursos para llevar a cabo sus roles?
►Cree que los socios para un programa a escala ampliada podrían contar con los recursos
necesarios?
►¿Tiene Ud. sugerencias sobre cómo se puede disponer de mas recursos para complementar el
financiamiento de Gates en el programa a escala ampliada?
►¿Cuán adecuados han sido los acuerdos institucionales en definir los mecanismos o
procedimientos para los actores coordinar sus actividades?
►¿Tiene Ud. sugerencias sobre cómo este aspecto puede ser fortalecido en el programa a escala
ampliada?
Metodología del programa (Gobierno, Agencia Int., ONG Int., ONG Local, CBOs, Media)
La metodología del programa consiste en las reglas del programa, actividades específicas y su
secuencia y cronograma.
71
► ¿Qué opina sobre la metodología de trabajo de la Iniciativa?
►¿Tiene Ud. sugerencias sobre cómo mejorar la metodología en el programa a escala ampliada?
►¿Cree Ud. que la metodología ha sido clara y acordada por los socios?
►¿Tiene Ud. sugerencias sobre como tener certeza que la metodología es clara y acordada por
los socios en el programa a escala ampliada?
Capacidad de ejecución (Gobierno, ONG Int., ONG Local, Sec. Privado, CBOs)
En la capacidad institucional se considera aspectos como recursos humanos con las capacidades
y habilidades requeridas para ejecutar sus funciones, una estructura organizacional dentro de la
institución, un manejo de la metodología acordada, sistemas y procedimientos requeridos para su
implementación y la habilidad para monitorear el programa y hacer los ajustes oportunos.
►¿Cree Ud. que al nivel nacional los socios de la Iniciativa han tenido la capacidad institucional
para llevar a cabo sus roles y responsabilidades?
►¿Cree Ud. que al nivel regional los socios de la Iniciativa han tenido la capacidad institucional
para llevar a cabo sus roles y responsabilidades?
►¿En el programa a escala ampliada, cree Ud. que hay uno o más aspectos de capacidad
institucional que se necesita fortalecer en cualquier nivel?
►[Si sí] ¿qué sugerencias tendría al respeto?
6.
Disponibilidad de productos y herramientas (ONG Int., ONG Local, Sec. Privado, CBOs)
►¿Cree Ud. que la Iniciativa ha provisto de los productos y herramientas que respondan a las
preferencias del público objetivo y su decisión y habilidad para pagar por ellos?
72
►¿En el programa a escala ampliada, cree Ud. que hay uno o más aspectos de productos
apropiados que se necesitará fortalecer en cualquier nivel?
►[Si sí] ¿qué sugerencias tendría al respeto?
Financiamiento (Gobierno, ONG Int., CBOs)
►¿Han sido suficientes los acuerdos para el financiamiento de los costos del programa?
►¿Tiene Ud. sugerencias sobre como se puede disponer de mas recursos para complementar el
financiamiento de Gates en el programa expandido?
Costo eficiencia de la ejecución (Gobierno, ONG Int.)
►¿Los socios han tenido los sistemas y procedimientos para recoger y analizar la información
requerida para un análisis de costo eficiencia?
►¿Tiene Ud. sugerencias sobre cómo se puede fortalecer esta capacidad en el programa a escala
ampliada?
Monitoreo (Gobierno, ONG Int., Sec. Privado, CBOs)
Un monitoreo eficiente permite identificar las fortalezas y debilidades en la metodología del
programa, su ejecución y costo-eficiencia.
►¿Cómo ha sido el proceso de monitoreo en la Iniciativa?
►¿La responsabilidad ha sido clara?
►¿Tiene Ud. sugerencias sobre cómo se puede fortalecer esta capacidad en el programa a escala
ampliada?
73
►¿Tiene Ud. sugerencias sobre como se puede tener suficiente capacidad de recoger
información recogida en el nivel comunitario o distrital?
Cierre (5 minutos)
¿Cuál sería el factor más importante que permitiría que el proyecto logre sus objetivos?
¿Cuál sería el aspecto clave que debiera realizarse con el fin de generar las condiciones para que
el proyecto tenga éxito y se pueda trabajar a escala ampliada?
¿Hay una o dos otras personas en [la organización] que pudieran responder a unas preguntas
sobre el tema por correo electrónico? Ellos pueden hacerlo en 10 a 15 minutos. Podría darme
sus direcciones de correo electrónico?
Nombre
Cargo
Correo electrónico
Gracias por su tiempo.
74
APPENDIX F: ESTUDIO DE CONDICIONES PARA LA EXPANSIÓN
DEL LAVADO DE MANOS CON JABÓN (GUÍA DE ENTREVISTA
PARA SOCIOS POTENCIALES)
Primera versión en español
Este cuestionario ha sido creado para ser usado por el equipo del estudio de condiciones para la
expansión de lavado de manos con jabón.
Fecha de la entrevista
____________________________________________________
Nombre del entrevistador
_____________________________________________________
Nombre del entrevistado
_____________________________________________________
Cargo
______________________________________________________
Rol del entrevistado (tomador de decisión, ejecutor, supervisor)
______________________________________________________
Tipo de organización (sector público, privado, ONG)
______________________________________________________
Alcance de la organización (nacional, varias regiones, regional, distrital, comunal)
______________________________________________________
Introducción (5 minutos)
Introducción
Agradecimiento por el tiempo otorgado
75
Propósito de la entrevista
Explicación de la confidencialidad de la entrevista, no se usará el nombre u otro dato de
identificación
Información de la existencia de preguntas.
Apertura (10 minutos)
Solicitar información acerca de la importancia de lavado de manos
Solicitar información acerca de la institución a la que pertenece, lo que hace en relación a lavado
de manos y los planes que tienen respecto a este tema.
Dimensiones de la entrevista (50 – 60 minutos)
Usar el cuestionario anexo.
Encuestas (10 -15 minutes)
Usar en la medida de las posibilidades de los actores.
Política, estrategia y dirección (Gobierno, Agencia Int., ONG Int., ONG Local, Sec. Privado,
Proj. Bilat.)
¿Qué tan conscientes están los tomadores de decisión sobre la importancia del lavado de manos
con jabón en reducir la diarrea y las infecciones respiratorias agudas?
¿Sabe qué dicen los resultados de los estudios de lavado de manos con jabón? En caso sea así,
qué recuerda? (Si no sabe, explíqueselo).
¿En qué medida existe una voluntad política para promover el lavado de manos con jabón (en el
nivel apropiado al entrevistado)?
¿Conoce usted algún decreto o política o norma que el gobierno o las organizaciones privadas
hayan efectuado para promover lavado de manos en esta región. Si no es así, piensa que estas
políticas serían posibles de efectuarse?
¿Su organización ha participado en programas de salud infantil en esta Región?
76
¿Su organización ha participado en la promoción de lavado de manos en esta región? Si es así,
por favor descríbalo y explique qué tan exitoso ha sido.
¿Qué tan importante es la promoción de lavado de manos en su organización, comparado con
otras iniciativas de salud?
Si varias organizaciones se reunirían en una iniciativa de promoción de lavado de manos,
¿quiénes serían los decidores y de quién se requeriría apoyo?
Agradeceríamos nos indique qué organizaciones, individuos o agencias podrían actuar como
catalizadores o líderes de la promoción de lavado de manos en la región. Voy a mencionar
varios tipos de organizaciones. Para cada tipo, mencione cuáles piensa podrían ser las más
interesadas y con recursos para contribuir a la promoción de lavado de manos.
Actividades o contribución
financiera actual a lavado de
manos
Sector público
ONGs
Sector privado
77
Tipo de recurso que podría dar en
apoyo a la iniciativa
Actividades o contribución
financiera actual a lavado de
manos
Tipo de recurso que podría dar en
apoyo a la iniciativa
Medios de comunicación
Otros proyectos de agua y salud
Organizaciones de base
Alianzas (Gobierno, Agencia Int., ONG Int., ONG local, Sector privado, medios de
comunicación, proyectos bilaterales).
¿Existen diferentes tipos de organización en la Región que estén interesados y tengan las
capacidades para trabajar como socios en programas que beneficien a las madres y los niños? Dé
ejemplos.
78
¿Cómo describiría la calidad de las alianzas entre los gobiernos locales y las ONGs? ¿Cómo
podría mejorarse?
¿En qué medida los roles, responsabilidades y expectativas están claras y acordadas en estas
alianzas?
¿Cómo describiría las relaciones que se establecen entre las ONGs y las comunidades en que
trabajan? ¿Cómo podrían mejorarse?
¿Qué alianzas en esta Región supo utilizar el potencial de las alianzas estratégicas entre el sector
público, privado, las ONGs y las organizaciones en el nivel local y nacional? Si es así, ¿cómo se
llegó a realizar? ¿Qué necesitaría ser explorado?
Acuerdos institucionales (Gobierno, Agencia internacional, ONG internacional, ONG local,
organizaciones de base, medios de comunicación, proyectos bilaterales)
¿Hay ejemplos de alianzas establecidas con objetivos en salud? Si es así, ¿qué tan bien los
diferentes grupos trabajaron en….
Planificación
Ejecución
Capacitación
Monitoreo y evaluación?
¿En qué medida los acuerdos estuvieron claramente definidos?
¿Tiene mecanismos establecidos para coordinación entre los socios más importantes? Si es así,
¿cómo están trabajando estos mecanismos? ¿Cómo podrían mejorarse?
¿Tiene idea en cómo establecer o mejorar los mecanismos de coordinación entre las diferentes
organizaciones y niveles de ejecución para un programa de lavado de manos a escala ampliada?
79
Capacidad de ejecución (Gobierno, ONG internacional, ONG local, sector privado,
organizaciones de base)
¿Qué habilidades, métodos, herramientas y recursos humanos piensa que podría requerirse para
ejecutar un programa de lavado de manos en esta Región?
¿Qué recursos ya existen localmente, de manera que pueda apoyar la capacidad requerida? Qué
está faltando?
Financiero
Bienes
Humanos
Capacitación
Tecnología
Otro
¿En qué medida existe una adecuada capacidad para planificar y ejecutar promoción de la
higiene el sector público?
¿Y entre las ONGs?
¿Entre otros grupos o socios?
Por favor describa un programa de promoción de higiene o salud en esta Región que considere
exitoso? ¿Qué lo hizo exitoso?
¿Cómo se involucró al sector privado (agencias de publicidad, etc.) en el programa de salud o
higiene?
80
Para usar SOLO en caso que se necesite continuar con la entrevista:
¿Hay capacidad desarrollada en el nivel local para abordar la ejecución del programa y
monitorear los cambios a nivel de los hogares y comunidad? Si es así, describa.
¿En qué medida existe una adecuada capacidad en el sector privado para otorgar bienes y
servicios y responder a las preferencias de los consumidores?
¿Será el sector privado capaz de responder a la demanda creciente en tanto el programa de
lavado de manos se desarrolle en gran escala?
Disponibilidad de productos y herramientas (ONG internacionales, ONG locales, sector privado,
organizaciones de base)
¿En qué medida las siguientes dimensiones de mercadeo de lavado de manos necesitarían ser
fortalecidas?
Producto: ¿Qué productos que lavado de manos con jabón están disponibles, dónde y cómo? Se
consideran productos al jabón, recipientes para almacenar agua, elementos para tener agua
segura. ¿En qué medida siente que esos productos ofrecidos responden a la demanda del
consumidor?
Precio: ¿En qué medida la gente de menores recursos tiene dinero para comprar productos para
lavarse las manos con jabón? ¿El costo de los productos corresponden a la capacidad y deseo de
pago del público?
Ubicación: ¿Qué tan disponibles están los elementos esenciales cerca de las comunidades pobres?
¿Qué cadenas de producción han sido establecidas para responder a la demanda de los hogares?
¿Existen planes en la actualidad que puedan fortalecer las dimensiones de producto, precio y
ubicación?
81
¿En qué medida es común la preparación de jabón en algunas áreas? ¿Existen programas que
promuevan el uso de este tipo de jabón para lavado de manos?
Financiamiento (Gobierno, ONG internacionales, organizaciones de base)
¿Qué organizaciones posiblemente podrían contribuir al financiamiento de los costos
programáticos de implementar un programa de lavado de manos a escala ampliada? (Costos
como salario de personal, capacitación, transporte, etc.)
¿En qué medida las actividades de promoción ya están incluidas en los presupuestos regionales,
provinciales y distritales?
¿Cómo han contribuido los socios del sector privado a las campañas públicas de salud?, ¿con
dinero en efectivo o en servicios?
Monitoreo (Gobierno, ONG internacional, sector privado, organizaciones de base)
¿Existen en la actualidad programas en esta región que tengan un buen proceso de monitoreo
para medir la efectividad de los programas y sus resultados? Si es así, ¿cómo lo hacen?
¿Qué instituciones del sector público, privado y las ONGs están presentes para conducir varios
tipos de estudios (cualitativo, cuantitativo, etc.), y cuál es su capacidad (en términos de
habilidades técnicas que podrían están disponibles para lavado de manos con jabón?
¿Qué mejoras técnicas, administrativas o financieras son necesarias para asegurar que los
actuales sistemas de monitoreo son adecuados para apoyar un programa a gran escala?
¿Cuáles serían los costos de estas mejoras?
¿Qué incentivos se requieren para lograr el enganche y la diseminación de los resultados de las
actividades de monitoreo? ¿Qué podría fortalecer la valoración del monitoreo?
82
APPENDIX G: INFORME DE VIAJE A PIURA
Fecha
17 y 18 de mayo del 2007
Realizado por
Mike Favin
Consultor internacional
Doris Alfaro
Consultora local
Instituciones entrevistadas
Giovanna Bisso
Gerente de Educación y Cultura
Municipalidad de Piura
Teodora Miranda
Coordinadora de PRONOEI
Ana Turves
Participante Cuerpos de Paz en Catacaos
Omar Palacios
Jefe de la Oficina de Población, Salud e Higiene
Municipalidad de Piura
Dr. Carlos Bayona
Sub Director
DIRESA Piura
Carolina Aguilar
Encargada área social
CARE Piura
Juan Manuel Cendra
83
Secretario General
Cáritas Piura
Deysi Cheros
Presidente Comisión salud, salubridad y saneamiento
Municipalidad distrital de Catacaos
Eleuteria Cruz
Jefa Asuntos comunales y sociales
Municipalidad distrital de Catacaos
Jenny Portocarrero
Relaciones Públicas
Sub Región Salud Sullana
Principales hallazgos por tipo de institución
Sector salud
Existe un marcado interés por participar en acciones vinculadas a la Iniciativa de Lavado de
Manos.
No ha sido evidente un involucramiento directo de la DIRESA con la Iniciativa, aunque sí
conoce de la realización de actividades que sí se han realizado en la Región.
Existe un nicho interesante a partir de Escuelas Saludables y dentro de las campañas de
promoción de la salud en las escuelas.
Se puso en evidencia la necesidad de dar incentivos (como capacitación, certificados o movilidad)
a los promotores de salud para asegurar la llegada continua a la población.
No es difícil asegurar la voluntad política para lavado de manos. El Presidente Regional apoya
muchas iniciativas de salud y existen ordenanzas relacionadas a disminuir la desnutrición crónica
o a mejorar la gestión del Vaso de Leche.
Las autoridades recuerdan mucho la importancia del lavado de manos durante la epidemia del
cólera.
84
Sería importante buscar involucramiento con MINED y con el Programa Juntos que trabaja en
regiones de extrema pobreza y está apoyando en solventar un profesional en cada
establecimiento de salud (54 profesionales), con fondos de la Presidencia de Consejo de
Ministros.
La elaboración y aprobación del Plan Regional Concertado de Salud constituye una oportunidad
para que el tema sea asumido por todas las instituciones de la Región. Están empezando a
trabajar este proceso.
Gobierno municipal provincial
Existe una marcada diferencia entre el involucramiento de la Municipalidad de Piura de la
Oficina de Salud, Población y Ambiente, frente a la Gerente de Educación y Cultura.
En el primer caso se realizó una capacitación al personal de la municipalidad, pero no se realizó
seguimiento posterior.
Se señaló que no existiría ningún problema en involucrar al alcalde.
Les pareció muy adecuada la dinámica y el enfoque participativo del taller.
Se sugirió trabajar una coordinación posterior a través del programa de Municipios Saludables.
En el segundo caso, ha sido muy interesante el trabajo en capacitación con los PRONOEI,
llegando a 1,273 niños menores 5 años.
La metodología fue muy aceptada por las promotoras de los PRONOEI y han trabajado las seis
sesiones, aunque señalan que requerirían un refuerzo.
Los salones de los PRONOEI tienen sus rincones de aseo instalados.
Sugieren que al inicio se considere siempre una sensibilización a las personas que serían las
encargadas de realizar el seguimiento.
Sugieren que se trabajen campañas agresivas, en que el mensaje llegue por todos lados y de
manera muy lúdica, como canciones.
Gobierno municipal distrital
Trabajó de manera consensuada con las líderes del Vaso de Leche (cada uno entre 30 – 50
miembros), a quienes se les encargó la capacitación, así como el monitoreo en cada grupo y
comedor popular.
Acostumbran trabajar en alianzas con el sector público y privado en el distrito.
85
Refuerzan la práctica con el lavado de manos antes de comer en los comedores y antes de recibir
los alimentos en las reuniones del Vaso de Leche.
Han trabajado con incentivos como entrega de ropa a madres.
Sugieren que se establezcan fichas y guías para saber cómo hacer un monitoreo más cercano y
eficiente.
Encuentran que puede ser más interesante trabajar con niños, quienes pueden asumir muchos
comportamientos.
Agencia internacional
A partir de una capacitación de pocas horas se abocó a trabajar con las familias de una
comunidad en Catacaos.
Funcionó lavado de manos cuando lo vinculó a un proyecto concreto, como de cocinas
mejoradas. Para recibir la cocina la familia debía saber los momentos críticos de lavado de
manos.
Encontró más entusiasmo y posibilidad de trabajar este tema con los niños y las profesoras.
Sugeriría capacitar a los que trabajan con población qué aspectos o respuestas dar para motivar
más.
ONG Internacional
La supervisión del proyecto que realizan con PRONASAR muestra que alrededor del 30% de las
familias saben los 5 momentos críticos, frente a un 0% inicial, y el 35% aplica la técnica correcta
de lavado de manos, a través de la observación (agua a chorro, lavado con jabón, secado con
toalla).
Se ha podido definir roles y planes de trabajo con los establecimientos de salud y escuelas.
Un aspecto a considerar que han sabido mantener a las municipalidades totalmente informadas
de los avances.
Contar con un equipo de capacitadores pagados por el proyecto facilita la promoción de la
práctica en las familias (1 x 300 familias).
Se consideró necesario incluir el secado con toalla como un tema adicional (por la existencia de
mucho polvo en la zona).
Sugieren que los videos sean más cercanos a la realidad socio cultural de las zonas.
Indican que debiera trabajarse un material que quede en las familias.
86
Recomienda que primero se fortalezcan las capacidades de las personas que trabajarán lavado de
manos con la población.
87
APPENDIX H: CONDICIONES PARA LA PROMOCIÓN DE LAVADO
DE MANOS
Informe de viaje a Arequipa
Fecha
28 y 29 de Mayo del 2007
Realizado por
Mike Favin
Consultor internacional
Doris Alfaro
Consultora local
Instituciones entrevistadas
Germán Robles
Especialista Gestión Educativa y Ambiental
Dirección Regional Educación Arequipa
Sonia Sánchez
Gerente Gestión Social
Municipalidad de Arequipa
Aníbal Díaz
Autoridad Regional de Medio Ambiente
Gobierno Regional de Arequipa
Haydee Rodas
Mariela Díaz
Lourdes Benavides
Zula Carpio
Mary Ann Zeballón
Promoción de la Salud
DIRESA Arequipa
Oswaldo Vizcarra
Director de Prensa
88
César Portillo
Gerente de Producción
Jorge Béjar
Coordinador Arequipa
ONG Labor
Oscar Toro
Coordinador Arequipa
ONG DESCO
Martín Cotrina
Gerente
Cámara de Comercio e Industria de Arequipa
Pablo Manrique
Secretario General
Cáritas Arequipa
Resumen
El viaje se realizó en un momento clave de la reorganización del gobierno regional y por ende de
las instituciones de salud y educación. En el marco de la descentralización, Arequipa es la
primera Región que ha decidido eliminar la gerencia de desarrollo social para convertir la
DIRESA en Gerencia de Salud y la DREA en Gerencia de Educación. La intención es evitar
duplicidades de funciones y áreas y tener más posibilidad de implementar programas, con menos
carga burocrática.
Un aspecto a considerar es que el 80% de la población de la Región se encuentra en Arequipa,
con facilidades de accesibilidad y el 20% restante está en las otras 7 provincias, siendo algunas
muy lejanas. Sin embargo, existen comunidades andinas distantes que requieren con urgencia
programas de desarrollo social y económico.
La recomendación sería que la Iniciativa trabaje en ambos tipos de áreas. En las rurales sería
interesante que se enganche a programas u ONG existentes.
Respecto al interés por participar en la Iniciativa Lavado de Manos, es muy positiva la reacción
de los representantes de las instituciones aunque el conocimiento sobre los beneficios sea todavía
89
muy limitado. Todos creen que la Iniciativa podría ser incluida en actividades existentes como
proceso, sin pensar en campaña, lo cual es alentador.
Ninguno de los entrevistados pudo brindar un ejemplo de un programa efectivo de cambio de
comportamiento en la Región.
Un tema de discusión con varios de los entrevistas fue respecto a la existencia de un grupo de
coordinación interinstitucional que pudiera asumir la coordinación de lavado de manos. El
CIIMSA (Comité inter institucional de mejoramiento de la salud ambiental) es una posibilidad,
aunque el liderazgo y la promoción está a cargo de una ONG. Es posible que sea mejor trabajar
con un comité liderado por el Gobierno Regional, sobre todo vinculado a las gerencias de salud o
educación. Nos indicaron que por norma existen comités multisectoriales regionales,
provinciales y distritales, aunque sus intereses son muy generales.
Los programas de Cáritas y la actitud empresarial de su director regional causaron buena
impresión. En todo caso, se recomienda que la Iniciativa evalúe su participación en esta Región
y posiblemente en otras donde tenga programas fuertes.
La empresa de televisión regional que está llegando a todo el país vía satélite es Perú TV,
quienes señalaron su voluntad de colaborar con un presupuesto razonable. La programación
podría estar dirigida a tomadores de decisión, además de involucrar lavado de manos en sus
programas existentes.
Si bien no se pudo conseguir una entrevista con funcionarios de la minera Cerro Verde, ellos han
establecido un contacto vía correo electrónico y se les ha pedido una cita cuando vengan a Lima.
Principales hallazgos por tipo de institución
Salud
Lavado de manos es uno de los temas que forma parte del programa de salud e higiene en
Escuelas Saludables, trabajando con 322 en Arequipa. Cuentan con un convenio entre DIRESA
y la DREA. Utilizan el juego de láminas que ha elaborado Promoción de Salud desde el nivel
central (10 láminas sobre cada uno de los 6 temas), siendo uno de los temas higiene y ambiente,
entregándose un juego para cada una de las escuelas.
Señalan que el problema es que muchas de las escuelas no cuentan con agua o servicios
higiénicos porque dependen de las municipalidades para dotarlos de servicios (este hecho pone
en evidencia la necesidad de vincularse con socios que faciliten estos servicios).
Cuentan con un Comité Multisectorial Regional (salud, educación, agricultura, vivienda, policía),
en que cada institución señala lo que puede trabajar en función a un tema específico, pero no hay
cultura de trabajo estableciendo sinergias en las mismas actividades. En las provincias y distritos
debieran tener comités similares.
90
En todo Arequipa cuentan con 2,800 promotores, los que necesitan incentivos y materiales para
seguir trabajando y evitar la deserción. Los materiales tendrían que servir para su identificación
como chaleco, sombrero, material educativo.
Sugieren que se trabajen materiales como rotafolio, que se enseñe por televisión y que se
promueva el intercambio de experiencias.
Educación
Abordan las áreas de prevención como violencia, drogas, prácticas de salud incluyendo lavado
de manos. Algunas aulas cuentan con rincón de aseo, pero no son muchas. Su programa tiene
una hora de tutoría semanal en cada aula y cuenta con un documento oficial que define su trabajo,
incluyendo salud corporal y mental.
Las asociaciones de padres de familia (APAFA) funcionan bien en algunas escuelas, pero en
otras han generado conflicto con las administraciones. Las APAFA funcionan mejor en escuelas
privadas.
Colaboran bien con la DIRESA en el marco del Programa Escuelas Saludables.
Gobierno municipal
La Gerencia de Gestión Social se orienta a trabajar con las poblaciones más pobres,
especialmente las de zonas urbano marginales y rurales, en áreas como alimentación,
capacitación, organización de asociaciones culturales y recreativas. Cuentan con un centro de
atención médica en el mercado, pero no desarrolla actividades específicas de promoción de la
salud.
Identifica que los mejores espacios para hacer acciones de lavado de manos podrían ser los 309
comedores populares que benefician a más de 15,400 beneficiarios.
Autoridad Regional de Medio ambiente
Consideran que la falta de servicios de agua puede ser una barrera para lavado de manos en áreas
rurales y es por ello podría ser que el Programa de Escuelas Saludables se circunscriba a la
provincia de Arequipa, donde se ubica al 80% de 1´170,000 personas, de la cual el 50% es
urbano marginal.
Su oficina podría promover lavado de manos en restaurantes y en la industria alimentaria.
Señaló la existencia de un Comité Regional de Salud en que se invitan a instituciones
relacionadas, como educación, municipalidades, instituciones de enseñanza médica, Cruz Roja,
entre otros. Asimismo, existe un comité equivalente para educación.
Sugiere que con el personal de salud se realicen charlas en las salas de espera de los hospitales y
se aproveche la movilización de vacunación en su llegada casa a casa para promover lavado de
manos.
91
Puso de relieve la necesidad de que se cuenten con fondos para contratar un contingente de
supervisores que aseguren que las personas que sean capacitadas cumplan con sus tareas en los
hogares.
ONGs
Las ONG tienen vinculación con los sectores, en función del objetivo del proyecto, aunque no es
siempre fácil por la burocracia existente, perdiendo muchas veces su sentido técnico por el
político.
Se recalcó la necesidad de promover una voluntad política manifiesta desde el gobierno regional,
debido a los índices de diarrea en la Región y los gastos que se generan para su tratamiento.
Sugirieron orientar el programa hacia las escuelas y los clubes de madres, pues algunos de estos
últimos son fuertes.
Estiman importante conversar con las empresas mineras, teniendo en cuenta la tendencia a la
formación de Fundaciones para derivar fondos para desarrollo social.
Medio de comunicación
Buscan ser una propuesta alternativa al enfoque nacional de los medios que se emiten desde
Lima, priorizando un enfoque regional. Trabajan noticieros, programas de análisis político, de
entretenimiento, magazines incluyendo consultorio médicos y de concurso con feedback masivo
a través de cartas o teléfono.
Cuenta con un programa interesante (Cabildo Abierto) que promueve la participación de la
población durante una semana y el fin de semana las autoridades municipales van al programa y
responden a las preguntas planteadas por la población.
92
APPENDIX I: SUMMARY OF MAJOR FINDINGS AND
RECOMMENDATIONS BY DIMENSION
The following table summarizes major findings and recommendations. Readers interested in
more detail should also consult Appendix C, which contains all of the recommendations (in
Spanish) made by persons interviewed. Although the team agrees with the most of those
recommendations, for this document it selected the ones it considered the most important. While
virtually all of the recommendations listed in this document were made by the persons
interviewed, those ideas that the study team developed further are marked with an asterisk.
Dimensions
Major Findings
Major Recommendations
Policy,
Strategy, and
Direction
►There is generally strong, positive political will toward
handwashing promotion and child health among
organizations and government officials, although some
government officials find it hard to give it much attention
because of so many other priorities.
►Although the attitudes of public and private officials towa
very positive, many still lack knowledge of the multiple ben
government officials in particular must try to simultaneousl
priorities. Therefore, the Initiative should develop an advoc
and materials for different levels of decision makers, that de
HWWS for reducing diarrhea, respiratory disease, and infan
malnutrition; and for improving school performance, mothe
and the nation’s human capital. Advocacy activities should
and continue throughout the project period.
►The new national administration has accepted the
Initiative and seems well disposed to collaborate.
►Key partners feel that they understand the approach
used in the first phase and feel ownership, but they do not
yet have a good understanding of the expanded project
(which is still being designed).
►There are several politically prominent national
initiatives (re: malnutrition, healthy schools, water and
sanitation) that offer natural links with handwashing.
►Although the MOH signed a ministerial decree in
support of the Handwashing Initiative, its enthusiasm has
waxed and waned with frequent changes of officials;
current officials appear to be quite supportive.
►At the beginning of the Initiative, national MOE
involvement was minimal, but now the MOE is actively
engaged.
►In addition, it appears that even key partners lack informa
expectations regarding the expanded handwashing program
that, before the selection of districts and implementation, th
group meetings with the key partners to clarify their expecta
intentions and constraints. In preparation for these meetings
and disseminate a brief description on the new project that s
strategy and plans, making clear which features are required
discussions of each partner’s role and responsibilities shoul
meetings, leading eventually to MOUs or similar agreement
►A similar process, managed by the implementing agencie
regional, provincial, and district levels once the intervention
►Many officials remember the role of handwashing
during the cholera epidemic and are therefore well
disposed to support the Initiative.
Partnerships
►In general this has been a successful and innovative
aspect of the program, in particular with private sector
partners.
►The process of public and private organizations
working together has not always gone smoothly. The
public sector tends to be more formal and bureaucratic
and to have more changes in personnel.
►Different partners play very different roles, from being
fully engaged as a member of the coordinating committee
93
►Consideration should be given to inviting the MOE's env
the MOH’s PRONASAR (small water systems) program to
Committee. (The MOE already has been invited.) It would a
private sector partner such as the CONFIEF, an association
►Assess the interest of potential new partners in joining th
UNICEF, PAHO, Save the Children, and so on).
► WSP, the National Committee, and the implementing ag
providing guidelines, tools, and strategic technical assistanc
►To achieve impact and sustainability, work hard to establ
to providing short-term messages on handwashing and
co-financing or managing local activities. This is fine as
long as expectations are clear.
►Keeping key government ministries (particularly
health, education, and housing) involved is essential,
even though this can be difficult at times because of
political changes and overburdened officials who are too
busy to participate in meetings.
district level.
►Partners at the district level should include the strongest p
district. A strong partner organization is one that has good r
built confidence among the population, and is committed to
supervision of promotion activities. Each partner should be
strengthen/expand attention to handwashing in its objective
to consider include those helping install or improve water an
Leche, comedores populares, and NGOs with long histories
area.
►The Initiative and implementing agencies should work at
district levels to have an existing public-private coordinatio
the handwashing activities, such as the mesa de concertació
committee.
Institutional
Arrange-ments
►Many respondents felt that arrangements have been
informal yet have worked well based on personal
relations, particularly for NGOs and private
organizations.
►Arrangements with governmental organizations were
more formal: the MOH issued a ministerial decree in
2004, and some regional governments approved
ordinances. Beginning in 2006, the Initiative made an
effort to sign MOUs with key national and local partners.
►Although MOUs and other formal agreements are no gua
essential for working with government agencies, since they
allocations to occur, and they may limit disruptions caused
Formal agreements are particularly important with the MOH
control over its local offices. The Initiative should continue
agreements at the national level and require its implementin
levels.*
►Although it is fine initially to work less formally with pri
it the long run negotiating and signing more formal agreeme
agreements would clarify roles and expectations and suppor
► WSP and the implementing agencies should periodically
these agreements.*
Program
Methodology
► In general, opinions were positive; people felt that
combining diverse partners’ strengths produced an
effective approach.
►Some mentioned that the Initiative took too much of a
campaign approach, without follow-up in some places,
and with insufficient concern for institutionalization.
►Some respondents mentioned the need to focus more
on interpersonal communication, while media
representatives felt that mass media could play a larger
role.
►Several of the persons interviewed pointed out that it
has been much easier to generate enthusiasm and
behavior change among children than among mothers,
particularly in rural areas.
►Three general suggestions from various respondents were
local levels, (2) to allow local partners flexibility in implem
(3) to urge local partners to avoid a focus on short campaign
campaigns seem to be very popular in Peru, but their impac
►Develop a standard methodology and instruments for ass
and district levels to identify existing activities in which han
added or strengthened and to identify the strongest partner o
HWWS champions.*
►Most respondents recommended that implementation emp
communication. Use mass media when possible, emphasizin
and interactive formats* (call-in shows, radio listening grou
possible to ensure that there is good coordination between m
the-field activities so they are mutually reinforcing.
►If possible, develop separate communication materials fo
jungle areas of Peru. Encourage regions to modify materials
appropriate images, language, and so on. Recognize local b
cold temperatures, and counsel families* on how to overcom
►For both effectiveness and sustainability, the Initiative sh
of handwashing promotion within existing programs such a
MOH, Escuelas Saludables, Viviendas Saludables, Municip
(new water and sanitation systems), PRONOEI (preschool),
malnutrition, JAAS (water and sanitation boards), NGOs do
on. Although moving away from a single focus on handwas
PPPHW strategy, the team feels that this is the most approp
as the one mostly likely to be sustainable. On the other hand
94
opportunity should be as focused and interactive as possible
►To try to build and maintain a positive program image, to
supporters, and to share useful technical and strategic inform
strong project communication program directed at both coll
outside world (political leaders, donors, and the public). At
electronic newsletter, a section on the WSP/Peru and MOH
partners’ sites), and specific efforts to obtain radio and pres
and activities. These communication spaces should include
program, descriptions of particularly effective or innovative
on achievements and impact; and exchanges on lessons lear
combines respondent and team opinions.)
►The Initiative intends to contract several “implementing o
the program in several regions. These organizations should
operational guide for the district level. The guide should pro
way that encourages each district to select those that are like
effective.
►The program should take advantage of children’s enthusi
students to promote HWWS at home and in their communit
develop such materials with suggestions for students and he
partners to invent additional ideas. In addition, the worksho
supplementary materials should put a greater emphasis on h
with individual mothers on solving problems, such as (perce
or time.*
►Lack of compensation for transportation and food costs a
promoters making more home visits. Where other partners a
Initiative should contribute to the costs of such compensatio
►The key partners should develop an exit strategy that add
expansion issues. This might include steps to institutionaliz
commitment) for HWWS in government and partner organi
program into some control districts as soon as the final mea
completed, and local and national presentations on the proje
on health and malnutrition.
Availability of
Products and
Tools
►Although the skills and systems needed to implement
the program well certainly exist at the national level,
there was some concern about capacity at the local level.
►Develop implementation guidelines and tools to support i
and district levels.
►There is little concern with the availability of soap,
although access to water is difficult in some
communities.
►Ideas mentioned were to collect soap bars from hotels in
the poorest communities; promote Tippy Taps and similar w
needed; promote hand-drying on clean cloths or towels in d
would not be recommended); and promote use of ash, sand,
available.
►Respondents considered the provision of plastic
washing bowls and pitchers to have been useful in the
first phase.
►Where the local assessments show particular weaknesses
agency should provide training, mentoring and exchange vi
technical assistance.
►Local change agents should be prepared to counsel famili
and, where needed, local partners should address shortages.
►Partners at the district level should consider purchasing a
and even soap to the poorest families. The national level mi
these items in order to obtain lower prices.*
Financing
►Many partners made financial and in-kind
contributions during the first phase.
95
►Continue to explore a co-financing agreement by the Fun
which has expressed interest in supporting HWWS in Peru.
►The general opinion is that there is potentially
sufficient funding in Peru for this activity but that the
partners need to work hard to actually obtain the funding
to support HWWS.
►The team believes that external funding is likely to still
be needed at the end of this phase, mainly for covering
the cost of implementing agencies supporting new
districts and, at a much lower level, to support continued
advocacy. However, partner contributions should
increase in this phase, so the percentage of funding
provided by external sources should decline.*
Cost-Effective
Implementation
►The first phase collected extensive cost information
and some impact information, but there was no attempt to
calculate the cost-effectiveness of various activities or
strategies.
►Obtain information on USAID’s small grants program an
partners.
►Lobby national and regional government officials for bud
handwashing or hygiene education.
►Continue to seek donated air time and publicly acknowle
by private media companies.
►The Initiative needs to identify its needs and contract indi
meet them.*
►The capability for collection and analysis does exist in
Peru, but technical support and training will be needed
for particular partners and local areas.
Monitoring
and Evaluation
►Persons interviewed generally consider M&E to be
very important; many are not very aware of monitoring
activities or results.
►The M&E functions are very important in this program, b
the responsibility of persons outside of the central managem
interfere with their ability to manage implementation.*
►On the electronic survey, respondents scored
monitoring lower than any other dimension.
►A key to maintaining partner and public motivation is the
achievements and results (see suggestions for project comm
►It is going to be a challenge to allow the local
implementation flexibility that many respondents
recommend while at the same time keeping sufficient
uniformity in the program districts to be able to
generalize about them in relation to the control districts.
The monitoring team will have to carefully control for the
effects of the many existing programs and projects in
both intervention and control districts.*
96
APPENDIX J: MENÚ DE ACTIVIDADES PARA ALUMNOS (IDEAS
PRELIMINARES)
En casa:
1) Aplique una encuesta en casa sobre las condiciones para LM con jabón en momentos críticos:
Hay jabón para lavar?
Hay agua para lavar?
Hay toallas o trapos para secar las manos?
Hay lugares con agua, jabón, toalla o trapo limpio cerca de donde ir al baño y donde prepara la
comida?
Producto: Las preguntas y respuestas.
Note: Si falta buenas condiciones se debe repetir la encuesta una semana después.
2) Dé una clase a su familia sobre como lavar las manos bien (con agua corriente o echado; jabón,
cenizas, o óleo de quinua; frotando los dedos muy bien; secando en una toalla o trapo limpio (o
no aire libre se es una zona de poco polvo). El día después, dar un “examen” a su madre y
hermanos de 5 a 9 años para ver si saben lavar correctamente. Si no, explique como puede
mejorar.
Producto: Un pequeño informe sobre la experiencia.
3) Dé una clase a su madre sobre los momentos críticos para lavar: después de ir al baño,
después de cambiar el pañal o tener cualquier contacto con heces; antes de preparar la comida. El
día después de la “clase” dar un examen a su madre para ver cuantos momentos críticos ella
recuerda. Si ella no sabe todos, explique lo que falta.
Producto: Un pequeño informe sobre la experiencia.
4) Construye un aparato simple que se deja lavar las manos sin gastar mucha agua. Puede usar su
propio diseño o uno de los siguientes diseños (véa los dibujos abajo):
Tome una lata o recipiente de plástico con forma similar a una lata. Hace un hueco pequeño al
fundo del lado de la lata. Ligar una cuerda al parte superior de la lata para poder colgarla en un
lugar apropiado para lavar manos. Para usar el aparato, hay solo que echar un poco de agua en la
lata, y puede usar el agua que sale por el hueco para lavar las manos con jabón.
Un otro diseño usa una calabaza o botella plástico con pico. Ligar una cuerda para poder colgar
la vasija de un árbol o la casa. Llénela con agua, y cuando quiere lavar las manos simplemente
derríbela una vez para lavar y una segunda vez para echar los burbujas y sucio.
97
Producto: El aparto pronto para ligar y usar.
Source: Salubritas 9: 4 (December 1986) (left); M. Ponga for SANRU (middle and right).
En la comunidad:
La próxima vez que haya alguna fiesta o evento publico en su comunidad, 5 a 10 estudiantes
pueden organizar una esquina educativa sobre lavado de manos con jabón. Pueden cantar las
canciones que aprendieron en clase. Pueden demostrar la técnica correcta de lavar. Un estudiante
puede explicar los beneficios para la salud (proteger contra diarrea, infecciones respiratorias, y
desnutrición). Otro puede explicar los momentos críticos. Si quiere, pueden preparar afiches u
otros materiales.
Producto: Un pequeño informe sobre la experiencia, incluyendo el número de personas que
asistieron, lo que los estudiantes hicieron, y la respuesta de la comunidad.
98
APPENDIX K: MENÚ DE ACTIVIDADES PARA PROMOTORES DE
SALUD (IDEAS PRELIMINARES)
Estas ideas son para un promotor en su comunidad o para un grupo de promotores en una
comunidad. Puede combinar varias ideas si quiere, por ejemplo, 2 y 3, o 2, 3, y 4.
1) Aplique una encuesta en las casas sobre las condiciones para LM con jabón en momentos
críticos:
Hay jabón para lavar?
Hay agua para lavar?
Hay toallas o trapos para secar las manos?
Hay lugares con agua, jabón, toalla o trapo limpio cerca de donde ir al baño y donde prepara la
comida?
Primero, haga una pregunta. Entonces, pregunte si puede mirar (el jabón etc.).
Después de hacer las preguntas, explique sobre los beneficios de lavado de manos (proteger
contra diarrea, infecciones respiratorias, y desnutrición).
Al terminar todas las familias, haga un análisis si puede. Cuántas familias hay y cuántas tienen
jabón, etc.
Aplique la encuesta de nuevo un mes o mas después y comparar los resultados.
2) Enseñe a una familia o a un grupo de madres y otros familiares sobre como lavar las manos
correctamente (con agua corriente o echado; jabón, cenizas, o óleo de quinua; frotando los dedos
muy bien; secando en una toalla o trapo limpio (o no aire libre se es una zona de poco polvo).
Después de explicar y demostrar la técnica correcta, pida a cada participante mostrar la técnica
correcta. Después de cada vez, pregunte al grupo para sugerencias sobre como la persona puede
mejor su técnica.
3) Enseñe a una familia o a un grupo de madres y otros familiares sobre los momentos críticos
para lavar: después de ir al baño, después de cambiar el pañal o tener cualquier contacto con
heces; antes de preparar la comida. Pida el grupo que repita los momentos, y después pida cada
individuo.
4) Ayude a las familias que carecen de agua construir un aparato simple que se deja lavar las
manos sin gastar mucha agua. Puede usar su propio diseño o uno de los siguientes diseños (véa
los dibujos abajo):
Tome una lata o recipiente de plástico con forma similar a una lata. Hace un hueco pequeño al
fundo del lado de la lata. Ligar una cuerda al parte superior de la lata para poder colgarla en un
99
lugar apropiado para lavar manos. Para usar el aparato, hay solo que echar un poco de agua en la
lata, y puede usar el agua que sale por el hueco para lavar las manos con jabón.
Un otro diseño usa una calabaza o botella plástico con pico. Ligar una cuerda para poder colgar
la vasija de un árbol o la casa. Llénela con agua, y cuando quiere lavar las manos simplemente
derríbela una vez para lavar y una segunda vez para echar los burbujas y sucio.
Source: Salubritas 9: 4 (December 1986) (left); M. Ponga for SANRU (middle and right).
5) La próxima vez que haya alguna fiesta o evento publico en su comunidad, organice una
esquina educativa sobre lavado de manos con jabón. Puede demostrar la técnica correcta de lavar;
explicar los beneficios para la salud (proteger contra diarrea, infecciones respiratorias, y
desnutrición); y explicar los momentos críticos. Si quiere, pueden preparar afiches u otros
materiales.
100
►including
HWWS
activities in
work plans.
►devoting time
to handwashing
plans and
programs,
►committing to
handwashing
promotion in
official
documents,
►allocating
funds,
Prepare and implement an
advocacy strategy directed
to officials at the national,
regional, provincial, and
district levels. The strategy
should disseminate
arguments and materials for
different levels of decision
makers that show the
importance of HWWS for
reducing diarrhea,
respiratory disease, and
infant mortality; preventing
malnutrition; and improving
school performance,
mothers’ confidence and
self-esteem, and the
nation’s human capital.
Materials and interpersonal
communication should
show how HWWS can
easily fit into existing
objectives and plans. Try to
obtain free donated mass
media coverage. Meet with
Build decision
makers’ support
for HWWS as a
long-term
priority as
shown by their:
Political support
The attitudes of
public and private
officials toward
handwashing are
generally very
positive (many
recall how
important
handwashing was
in the control of
cholera), but
many still lack
knowledge of the
multiple benefits
of HWWS.
Moreover,
government
officials in
particular are
under pressure to
address numerous
priorities. The
current
Strategy
Objective
Current Situation
101
►Less intense implementation
(including keeping alert for
►Intense implementation (including
trying to add HWWS to broader
advocacy events). Give special focus to
regional presidents (early Phase II).
►Monitor to ensure that the national
and regional coordination committees
are giving attention to advocacy
(Phases II and III).
►Draft, pretest, and finalize materials;
make printing, broadcasting,
disseminating arrangements; identify
advocacy champions during regional/
provincial/district assessments (Phase
I/early Phase II).
►Send draft to partners for comments;
meet with national partners to discuss
(Phase I).
►Draft an advocacy strategy (Phase I).
Phase III: 9–12/08
Phase I: 12/06–8/07, Phase II: 9/07–
8/08,
Recommended Steps and Timing
Two main challenges are to
(1) develop and implement a
strategy that appropriately
addresses the diversity of
leaders of different types of
organizations working at
different levels, and (2) to
convince leaders to give
sufficient support to HWWS
at the same time that they
are being pressured to attend
to many other development
priorities.
Expected Implementation
Challenges
►Ability to
develop and
manage a complex,
multilevel
advocacy activity.
►Ability to
periodically insert
fresh ideas,
materials, and
activities over
time; this is an
ongoing activity,
not just a shortterm campaign.
►Ability to
negotiate and
manage mass
media
contributions.
►Ability to
periodically
monitor and make
appropriate
adjustments.
Skills and
Expertise
APPENDIX L: ACTION PLAN TO IMPROVE THE ENVIRONMENT FOR AN EXPANDED
HANDWASHING PROJECT IN PERU
Provide
opportunities for
partners to have
input into the
project strategy
and plans; and
for them to
understand the
methodology,
plans, and their
roles.
Circulate draft documents
and hold meetings to obtain
partner suggestions and
clarify roles and
expectations.
the leading political
candidates during electoral
campaigns to ask them to
make a public commitment
to improving child health
and nutrition and to HWWS
specifically. The
implementing agencies
(contracted by WSP) would
have major implementation
responsibility at the
regional, provincial, and
district levels.
Although many
people praise the
open and
collaborative
management in
the project, it
appears that even
some key partners
lack a good
understanding of
the expanded
project.
Understanding
and expectations
government’s
focus on health
and education is a
positive factor.
102
►Prepare and disseminate a brief
description on the new project that
summarizes the proposed strategy and
plans, making clear which features are
required under the Gates grant (Phase
I)
►Hold individual and group meetings
with the key partners to clarify their
expectations and the project’s
intentions and constraints. Initial
discussions of each partner’s roles and
responsibilities should also occur
during these meetings, leading
eventually to MOUs or similar
agreements (Phase I). (This process has
begun with the MOE.)
►In abbreviated form, repeat this
process at the regional, provincial, and
district levels, once the intervention
districts have been selected (Phase I
and early Phase II).
►Meet to review implementation
progress and results (every 6 months,
Phases II and III).
opportunities to add HWWS to broader
advocacy events) (Phases II and III).
►The main challenge is
simply for WSP staff to find
the time during this busy
period to have adequate
two-way communication
with key partners.
►Another challenge is to be
able to repeat similar
processes at the regional
level and below. This
responsibility may be shared
between WSP and the
implementing agencies that
it contracts.
Decentralization in the
public sector creates the
need for intense work at the
regional level and below.
►A final challenge will be
to negotiate clear roles and
responsibilities at the subnational level with
organizations that already
have active programs and
WSP has the
project
management
experience and
negotiation and
other expertise
required.
►Keep partners
motivated and
engaged
throughout the
project period.
►Recognize
their
organizational
contributions.
►Collect and
share tools and
lessons learned
that can
improve the
effectiveness of
Stronger
alliances are
needed,
particularly with
partners that can
make strategic
contributions.
Develop and maintain a
strong project
communication program
directed at both
collaborating organizations
and the outside world
(political leaders, donors,
the public) in order to
maintain a positive program
image, motivate partners
and supporters, and share
useful technical and
strategic information.
Strengthen alliances at all
levels with partners that
have both the resources and
desire to contribute. Give
particular attention to
district-level partnerships
that include organizations
that enjoy popular
confidence and that are
committed to ongoing
follow-up and supervision
of HWWS promotion
activities.
Some partners
note the lack of
regular
communication
from the Initiative
about its
activities,
progress and
impact.
Partnerships
In general, publicprivate alliances
have been a
successful and
innovative aspect
of the program.
Adding a few new
national partners
might strengthen
the program.
There has been
minor, temporary
tension between
public and private
organizations,
because the public
sector tends to be
more formal.
Strong
partnerships
103
►Invite the MOE (environmental
health division), and the MOH
(PRONASAR), and possibly a
representative of CONFIEP to join the
coordinating committee (Phase I).
►Add HWWS to the agenda of an
existing coordinating group in each
participating region, province, and
district (early Phase II).
►Seek inclusion of the strongest
programs/institutions in each district. A
strong partner organization is one that
has good reach into communities, that
has built confidence among the
population, and that is committed to
ongoing follow-up and supervision of
promotion activities. Particular targets
of opportunity are those organizations
that support water and sanitation
infrastructure improvements in the
project districts (early Phase II).
►Develop, pretest, and finalize
guidelines and tools for local
partnerships (early Phase II)
►Draft a project communication
strategy. At a minimum there should be
an electronic newsletter (featuring a
partner or district of the month or
quarter), a section on WSP &/or MOH
Web sites (with links to partners’ sites),
and radio and press coverage of
accomplishments and activities. These
communication spaces should include
basic information on the program,
descriptions of particularly effective or
innovative strategies or activities;
exchanges (meetings, visits) on lessons
learned, M&E, and cost-effectiveness
►Keep these activities
strategically focused, that is,
directed toward clearly
defined audiences and
objectives.
►Provide information in
appropriate detail and
formats.
►Collect good information
from people in the field who
are too busy with
implementation to sit back
and reflect and document
activities.
►Find channels to reach
many priorities.
Challenges include:
►inviting the right partners
and individuals to play key
roles
►adding HWWS
coordination to already full
agendas of coordinating
groups
►identifying the strongest
partners in each district
►developing guidelines and
tools that are easy to use and
adapt in a variety of settings
and conditions
►getting sufficient
attention and participation
of key government officials,
many of whom are
overwhelmed with
competing priorities.
►Capability to
design and
implement strategic
communication
activities, not
merely activities
that make a lot of
noise but with no
clear purpose.
►Ability to
monitor activities
and impact and to
make needed
adjustments.
►Responsibility
►Excellent
analytical and
communication
skills, as well as a
thorough
understanding of
the Initiative and
its methodology.
►Ability to
identify and
accurately assess
potential partners,
their resources, and
their true interest in
collaborating.
►Achieve
clearer
definition and
commitment to
roles and
responsibilities
of partners at all
levels.
►Facilitate
sustainability of
organizational
commitments to
HWWS.
Although MOUs and other
formal agreements are no
guarantee of follow-up, they
are very important,
particularly for working
with government agencies.
They should also facilitate
longer-term commitments
from NGOs and other
private partners. Therefore,
the Initiative should
actively pursue at least
semi-formal agreements at
all levels.
Most
arrangements
have been
informal, yet they
have worked well
based on personal
relations,
particularly for
NGOs and private
organizations.
Nonetheless,
many partners feel
that more formal
relations would
help with clearer
understandings of
the program and
roles and
responsibilities in
the expanded
Institutional
arrangements
activities.
►Send draft strategy to partners for
comments; solicit their comments and
suggestions (Phase I).
►Share the project communication
strategy with the implementing
agencies and include in their terms of
reference their tasks in implementing
the strategy at the local level in support
of national activities (early Phase II).
►Implement the strategy (Phases II
and III).
►Review implementation progress and
results (every 6 months during Phases
II and III).
►Meet with partners and reach
agreements on their expected roles and
responsibilities at the national level.
For government agencies and other
partners that so desire, prepare and sign
MOUs describing the agreements. For
other partners, the WSP can simply
prepare a letter to the organization
describing expected roles and
responsibilities (Phase I, early Phase
II).
►Engage with partners with informal
agreements to try to move them to
make formal commitments (Phase II).
►At the regional, provincial, and
district levels, the coordinating groups
should prepare a brief document on
HWWS activities that describes the
expected role of major partners. The
members should approve this document
(early Phase II). (This document should
be considered the conceptual
framework for development of the
HWWS work plans at the local levels.)
104
information (Phase I).
should be shared
by WSP, the
national
communication
subcommittee, and
possibly contracted
individuals or
groups.
Negotiation and
interpersonal skills
are needed, as well
as the ability to
craft agreements
that are at the right
level of specificity.
WSP possesses
such skills.
people and organizations at
the local level, in more
isolated districts that lack
access to the Internet.
►Negotiating and getting
MOUs signed is likely to be
more difficult the more
bureaucratic the organization is. There could easily
be setbacks if key personnel
change.
►The periodic reviews of
MOUs could cause ill
feelings unless done in a
spirit of working together to
achieve the most possible in
the existing circumstances.
The general
objective is to
achieve good
impact on the
practice of
HWWS at
critical times in
the short run, by
using an
approach that
can be sustained
and
institutionalized.
The basic strategy is a
decentralized one in which
the national level prepares
useful tools and guidelines
and aims to stimulate strong
local partnerships, and then
provides strategic support
as needed to local levels.
Build strong alliances first,
at all levels, beginning with
the implementation of the
advocacy strategy and of a
thorough assessment
process at regional,
provincial, and district
levels. A major project
objective should be to build
promotion of HWWS into
ongoing, permanent
activities of agencies and
programs, as indicated by
official directives, work
plans, and budget
allocations. Focus on
interpersonal
communication local radio
(interactive formats) and
group activities.
Although
respondents feel
that most aspects
of the pilot
methodology
worked well,
some felt there
was too much
reliance on mass
media and a
campaign
approach with
uncertain followup.
Program
methodology
program.
105
►Coordinating groups should review
MOUs and committee documents every
6 months to assess to degree to which
they are being implemented, barriers to
implementation and how these may be
resolved, and any needed revisions in
roles and responsibilities (Phases II and
III).
►Develop methodology and
instruments for assessment visits at the
provincial and district levels that will
support identification of existing
activities in which handwashing
promotion could be added or
strengthened and the strongest and
most collaborative partner
organizations and HWWS champions
(Phase I).
►At the national level, develop,
pretest, and finalize communication
and training materials for the coast,
mountains, and jungle areas of Peru
(early Phase II).
►Develop an operational guide for the
district level (early Phase II).
►Make a few small additions to the
workshop methodology and
supplementary materials: (1) put
greater emphasis on how persons
promoting HWWS can work with
individual mothers on solving
problems … such as (perceptions of)
limited water, soap, or time; and (2)
incorporate ideas for what students and
health promoters can do in homes and
communities to motivate, teach, and
facilitate HWWS (early Phase II).
►To manage and support
program activities in so
many diverse districts, with
different challenges and
resources, scattered all over
the country. This requires
excellent communication
and a national program
capable of supporting but
not trying to control district
activities.
►In some districts, poverty,
isolation, climatic and
geographical conditions,
lack of access to water and
to mass media, and so on
will make implementation
more difficult.
►Local effectiveness will
be very dependent on the
strength of local partners,
their reputations and
abilities to reach and
influence families in the
communities where they
work.
Designing and
implementing the
program
methodology will
require a range of
communication,
managerial, and
political skills.
Although these
certainly exist
within the WSP
and its partners,
this is a complex
project to manage
since—given the
multiplicity of
partners and
variety of local
settings—it must
be done in a
decentralized
manner. A final
challenge is to
avoid devoting
time and effort to
communication
activities that
remind people
about HWWS
temporarily but
that have no
Improve the implementation
capacity in regions,
provinces, and districts that
have weak capacity.
►Explore possibilities for
national and local financing,
and publicly acknowledge
contributions.
►Lobby for budgetary
commitments beyond this
phase.
Improved local
implementation
capacity.
Secure
additional
financial and inkind resources
at the national
and local levels
for this phase
and beyond.
There are many
potential sources
of funding and inkind
contributions,
although
accessing them
will require effort.
Some government
programs have
limited
implementation
funding.
Financing
While the skills
and systems
needed to
implement the
program well
certainly exist at
the national level,
there is some
concern about
capacity at the
local level.
Implementation
capacity
►Continue to explore a co-financing
agreement by the Fund of the Americas
(FONDAM), which has expressed
interest in supporting HWWS in Peru
(Phase I).
►Obtain information on USAID’s
small grants program and then decide
whether to share this with local
partners (Phase I, early Phase II).
►As part of advocacy activities, lobby
at all levels of government for
budgetary funds directed toward
handwashing or hygiene.
►Monitor the extent to which the
partner organizations have included
funds for the promotion of HWWS or
provision of water in their annual
budgets.
►Give public recognition for free air
time and other contributions from
private companies, on Web page, in
106
►As parts of regional, provincial, and
district assessments, assess local
implementation capacity (early Phase
II).
►Where the local assessments show
particular weaknesses, provide training
and mentoring and exchange visits with
pilot districts with effective programs
(Phase II).
►Develop implementation guidelines
and tools to support implementation at
the provincial and district levels (early
Phase II).
►It is difficult to predict
what challenges may arise,
but in general funding
agencies and programs have
their own unique
requirements, which may or
may not fit well with the
planned activities and time
line of the Handwashing
Initiative.
►In-kind contributions
from the private sector are
relatively easy to obtain;
focus on those that are most
likely to effectively support
HWWS.
►Government agencies
may be reluctant to commit
funds to such a narrow
objective.
►To establish and
implement mechanisms that
will detect and feedback
local needs for capacity
support.
►To provide appropriate
and effective support in a
timely manner. The WSP
and its main partners,
including the implementing
agencies, should share this
responsibility.
The skills needed
are those required
to establish a
monitoring and
feedback system,
as well as a variety
of capacity
building skills,
ranging from
conducting good
needs assessments
to making good
choices on modes
of capacity
building and
implementing those
actions.
The skills needed
are basically
diplomatic and
interpersonal, as
well as the ability
to write appropriate
proposals. WSP
and its partners
possess these skills.
What may be
lacking is sufficient
time.
follow-up.
Defining data collection and
analysis procedures should
be the task of the M&E
group.
Defining data collection and
analysis procedures should
be the task of the M&E
group.
Without overburdening
partners, collect
and use cost and
effective-ness
information to
improve this
and future
projects.
Measure impact
on behavior and,
to the extent
possible, the
strategies and
inputs most
closely
associated with
impact; use this
information to
improve this
and future
projects.
Persons
interviewed
generally consider
monitoring and
evaluation to be
very important
and to have
received
insufficient
attention in the
pilot phase. The
real problem may
have been
insufficient
dissemination.
►The pilot
project collected
extensive cost
information and
some impact
information, but
there was no
attempt to
calculate the costeffectiveness of
various activities
or strategies.
►The capability
for collection and
analysis does exist
in Peru.
M&E
Cost-effective
implementation
107
Steps should be defined by WSP with
the executive committee.
newsletter, and so on (Phases II and
III).
Steps should be defined by the WSP
with the executive committee.
The main challenge is to
collect, analyze, and use
essential information,
without overburdening
persons in the field who
need to focus on
implementation.
The main challenge is to
collect, analyze, and use
essential information,
without overburdening
persons in the field who
need to focus on
implementation.
Skills needed are
the ability to
conceptualize
essential needs and
decide how to
collect needed
information in a
manner that least
burdens field
people; as also
needed are
analytical skills,
and the ability to
share, discuss, and
use the results both
to improve the Peru
program and
similar programs.
Skills needed are
the ability to
conceptualize
essential needs and
decide how to
collect needed
information in a
manner that least
burdens field
people; also needed
are analytical skills
and the ability to
share, discuss, and
use the results both
to improve the Peru
program and
similar programs.
108

Baseline Assessment

Transcripción

Documentos relacionados