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Study Overview

Evaluation of Group Handwashing with Soap before Mid-day Meals in Rural Elementary School of Assam
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UNICEF has been supporting Axom Saba Shikha Abihyan(SSA) Mission, Government of Assam (GoA) under their WASH in School (WinS) program to improve WASH facilities, practices and institutionalize WASH in school settings. Under the WinS program, UNICEF piloted a group hand washing program in 100 elementary schools. The main objective of Daily Handwashing for an Ailment-free Life (DHaAL) program was to institutionalize handwashing before consuming mid-day meals and after using toilets among elementary school students. Additionally, bottlenecks to institutionalizing group handwashing are addressed including provision of simple but effective group handwashing facilities. This evaluation study seeks to answer whether DHaAL improved handwashing practice before mid-day meals in rural lower primary schools as a primary research question. The intermediate outputs and secondary outcomes evaluated in this study include functionality of handwashing infrastructure at school, handwashing practice after toilet use, and availability of and use of handwashing facilities at homes (indirect effect). The study has other operations research objectives to help improve the program in future.

Registration Citation:

Patil, S., 2015. Evaluation of Group Handwashing with Soap before Mid-day Meals in Rural Elementary School of Assam. Registry for International Development for Impact Evaluations (RIDIE). Available at: 10.23846/ridie074

Health, Nutrition, and Population
Water and Sanitation
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Principal Investigator(s)

Name of First PI:
Sumeet Patil
Network for Engineering and Economics Research and Management
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Intervention Overview


We evaluate two pilot scale synergistic interventions: (1) Daily Handwashing for an Ailment-free Life (DHaAL); and (2) DHaAL + Child Friendly Schools and Systems (CFSS). Under UNICEF's WASH in School (WinS) program, a local NGO partner piloted DHaAL in 100 elementary schools in Rani and Rampur blocks of Kamrup district, Assam. The main objectives of DHaAL are to generate support at SSA and Department of Education for policy changes to make group handwashing formally a part of mid-day meal platform, provide group handwashing facilities, addressing the bottlenecks such as soap provisions, and provide handholding support to schools to implement group handwashing. 40 out of the 100 DHaAL pilot schools were also included as a part CFSS intervention. CFSS is an intensive process that built school capacities and systems to deliver quality education that goes beyond just academics. DHaAL+CFSS joint program resulted in a longer period of NGO engagement and support to the schools and the outcomes anticipated under DHaAL may have benefited because of the synergies with the processes followed under CFSS although CFSS did not target handwashing with soap as the main objective.

Theory of Change:
Multiple Treatment Arms Evaluated?

Implementing Agency

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NGO (local)/Community Based Organization/Other civil society organization

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Foreign or Multilateral Aid Agency

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Evaluation Method Overview

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Method Details

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Our identification strategy to estimate the group mean difference in the post-intervention outcomes between the matched cohort of intervention and control schools. The parameter of interest for all outcome comparisons is intention to treat. We will match the cohort of treatment and control schools and assess the balances in pre-intervention confounders and covariates using a secondary data source called District Information System for Education (DISE) for year 2012. For matching purposes, we will establish criteria for exclusion of pilot treatment schools and then match DHaAL pilot schools with controls without replacement to select the best matched 15 pairs. We will repeat the process for DHaAL+CFSS schools and find additional 15 pairs of treatment and control schools. The study is not designed or powered for comparison of CFSS+DHaAL versus DHaAL. However, we will be qualitatively comparing the outcomes between these two intervention arms. We will estimate both unadjusted and adjusted for baseline imbalance effects. We will also use covariates highly correlated with the outcome to improve precision of the estimates.

Outcomes (Endpoints):

Primary outcome: Proportion of children washing hands with soap before the mid-day meals in rural lower primary schools. Secondary outcomes: availability of and functionality of handwashing facilities at school (by different types of facilities including those provided under DHaAL), handwashing practice after toilet use in school (if toilet is available), and availability of and use of handwashing facilities and use at homes (indirect effect).

Unit of Analysis:
School children, their home, and schools depending on the indicator.

Primary Hypothesis: H0: Pilot DHaAL (or DHaAL + CFSS) Intervention did not change handwashing practice before the mid-day meals in rural lower primary schools compared to business-as-usual situation in the non-program or control schools.

Unit of Intervention or Assignment:
Lower primary government schools (Class 1 to 5)
Number of Clusters in Sample:
60 clusters total (30 matched pairs)
Number of Individuals in Sample:
900 students (Class 3-5), their households (n=900), 60 teachers (1 form each school), and all present students (class 1-5. Enrollment in 2012: 12-180. Actual N may be different as per attendance)
Size of Treatment, Control, or Comparison Subsamples:
15 DHaAL intervention Schools, 15 DHaAL+CFSS intervention schools, 30 control schools

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Outcomes Data

This is a cross sectional survey being conducted now. Depending upon the respondent and type of information sought, we will use following instruments: (1) Observation checklist - for handwashing (with and without soap) before the mid-day meal. This data will give school level % OR child level binary data (2) Observation check list for handwashing after toilet use in school (3) Child (Class 1-3) questionnaire (4) Household questionnaire (5) School teacher questionnaire
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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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Study Stopped