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Study Overview

Evaluation of the impact of the HiFive for HySan program on pupil independent hand-washing practices in elementary schools in the Philippines
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Schoolchildren in the Philippines suffer from a high burden of preventable diseases, with hygiene deficiencies identified as a common cause. Hand-washing with soap is a simple yet highly effective strategy to reduce respiratory tract infections and diarrhea. In an effort to promote improved hand-washing behaviors, the International WaterCentre (IWC), in collaboration with UNICEF and the Philippine Department of Education (DepEd), designed the school-based HiFive for Hygiene and Sanitation Program (HiFive). This program trains teachers to conduct a series of fun classroom activities, which include songs, stories, games, and art, that reinforce students’ understanding of hygiene and deliver tailored messages to motivate independent hand-washing with soap. This cluster randomized experiment across 196 primary schools assesses the impact of the HiFive intervention on hand-washing behavior of students. The findings from this evaluation will inform the possible scale-up of the HiFive intervention to other schools in the Philippines.
Water and Sanitation
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Principal Investigator(s)

Name of First PI:
Lilian Lehmann; Clément Bisserbe; Qayam Jetha; Daniel Waldroop
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Intervention Overview

The HiFive for HySan intervention is a behaviour-change approach that was developed through research conducted in Philippine elementary schools, and is designed to help schools achieve three key outcomes: 1) independent hand-washing by pupils before eating and after using the toilet (defined as “critical times”); 2) operation and maintenance of toilet and hand-washing facilities; and 3) improved toilet use by school children. The HiFive for HySan intervention focuses on motivating improved hand-washing behaviors and triggering discussions on how to better maintain clean and functional toilets. Designed to not overload teachers or pupils, HiFive for HySan includes five main steps that are supported by five tools, leading to five key results. The five tools are: (1) HiFive Storyboard - A storyboard to share key messages (2) iWash Song - A song to help remember the key messages (3) Poo-Tag - A game to reinforce understanding of contamination and introduce pupil roles in toilet use (4) Storyboard stencils - Stencils for painting school murals (5) HiFive Star-chart - A Star-chart for helping school implement HySan interventions
Theory of Change:
Multiple Treatment Arms Evaluated?

Implementing Agency

Name of Organization:
the Philippine Department of Education (DepEd)
Type of Organization:
Public Sector, e.g. Government Agency or Ministry

Program Funder

Name of Organization:
Philippine Department of Education and UNICEF Philippines
Type of Organization:
Public Sector, e.g. Government Agency or Ministry

Intervention Timing

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Evaluation Method

Evaluation Method Overview

Primary (or First) Evaluation Method:
Randomized control trial
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Method Details

Details of Evaluation Approach:
In order to evaluate the HiFive for HySan intervention and answer the evaluation questions identified above, IDinsight will conduct a clustered randomized controlled trial in 196 elementary schools in Camarines Norte Province and Puerto Princesa City. These participating schools were randomly assigned into two groups of an equal number of schools in each location. In the treatment group, both the Wash in Schools (WinS) program (a nationwide program to improve water, sanitation, and hygiene in schools) and the HiFive intervention are being implemented; in the control group, only the WinS program is being implemented. The study will evaluate the impact of the HiFive for HySan intervention by comparing the hand-washing behavior of pupils in these two groups of schools. Random assignment was stratified by province and by “WinS implementation quality index score”, a measure of pre-program water, sanitation, and hygiene infrastructure and characteristics of a school (sourced from administrative data). No baseline data collection was conducted due to the rapid roll-out of the HiFive intervention.
Outcomes (Endpoints):
Research Question (RQ) 1 - Does the HiFive intervention increase the prevalence of independent hand-washing with soap (IHWWS) at critical times by pupils at school? Outcomes: (1) Pupil washed hands with soap and water after toilet use (2) Pupil washed hands with water after toilet use (3) Pupil washed hands with soap and water before eating (4) Pupil washed hands with water before eating RQ 2.1 - Does the HiFive for HySan intervention increase the frequency of daily supervised group handwashing activities in schools? Outcomes: (1) Class conducted group hand-washing activity RQ 2.2 - Does the HiFive for HySan intervention affect pupil perception of critical times and motivations to practice iHWWS at critical times? Outcome categories: (1) Perceived critical times to practice IHWWS (2) Motivations to practice IHWWS (3) Beliefs and expectations around hand-washing (4) Barriers to practice IHWWS RQ 2.3 - Does the HiFive for HySan intervention increase sanitation infrastructure? Outcome categories: (1) Availability of hand-washing facilities with water and soap (2) Availability of functional and clean toilet facilities
Unit of Analysis:
School children
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Number of Clusters in Sample:
196; 98 in Treatment and 98 in Control
Number of Individuals in Sample:
Approximately 8,600 students, although this number is dependent on the number of students who use the restroom in a two hour class.
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Supplementary Files

Analysis Plan:
HiFive Analysis Plan.pdf
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Outcomes Data

Two data collection visits will be completed at each of the 196 sample schools. The following data collection tools will be used during each visit: Visit 1 - Pupil classroom observation tool (grades 1-6), Hand-washing facility observation tool, & Toilet facility observation tool Visit 2 - Pupil survey (grades 4-6)
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Treatment Assignment Data

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Data Analysis

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Study Materials

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Registration Category

Registration Category:
Prospective, Category 1: Data for measuring impacts have not been collected

Completion Overview

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Preliminary Report:
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Data Availability

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Study Stopped