Behaviour Change Communication in Bhutan

Sustainable sanitation and hygiene for all does not merely mean access to improved facilities, but also sustained behaviour change if the anticipated health benefits are to be realised in the sector.  Innovations around universal drivers of behaviour change are emerging, however these need to be able to be mainstreamed if they are to be scalable and sustainable. The role of local governments is central to this.

In Bhutan, SNV has been working on introducing innovative behaviour change communication (BCC) with the Ministry of Health (MoH) as part of the national Rural Sanitation and Hygiene Programme (RSAHP). This initial work has been successful in building capacities, but change in practice is slow and further innovation and evidence of effectiveness is needed for scaling up.  In response, in partnership with the London School of Hygiene and Tropical Medicine (LSHTM) and MoH, SNV will test an innovative approach to change handwashing behaviour in Samste District in Bhutan, which capitalizes on the groundwork, existing formative research, strategies and goodwill to date. The team will base their approach on an adaptation of SuperAmma, an intervention based on universal human emotional drivers of nurture, disgust and social affiliation that produced positive outcomes when implemented on a small scale in India. The aim of the SuperAmma project was to demonstrate a concept that could be adapted elsewhere. In this project SNV is seeking to take up the challenge of adapting it, testing it and applying it district-wide within a mainstream government programme.

SNV will seek to test the hypothesis that SuperAmma can be adapted for feasible implementation through existing government channels in Bhutan and can be effective in bringing about change in psychological and environmental indicators that are associated with improved handwashing practice. The design will use a randomised, controlled intervention trial to evaluate the impact of the intervention in a subset of communities. In addition, the reach, fidelity, feasibility and acceptability will be assessed in the context of district-wide implementation using a combination of implementation records, household survey and semi-structured interviews with implementers and target beneficiaries.