Now that you have completed this study session, you can assess how well you have achieved its Learning Outcomes by answering these questions.

Rewrite the paragraph below using terms from the list provided to fill the gaps.

behavioural barriers, community-based action plan, CLTS, health promotion intervention, open defecation, priority behaviours, sustainable.

When planning a ……………… in a community it is important to identify the ……………… that can make a difference to the health of the target population. You also need to be aware of possible ……………… that may present challenges for your plan.

……………… aims to improve hygiene and sanitation behaviour by helping communities to realise the health risks from ……………… so that they all make a commitment to change their behaviour. During the process they prepare a ……………… that describes the activities and schedule for building new latrines. It is important to check for ……………… change by having regular reviews of progress to ensure that the improved practices of latrine use and handwashing continue into the future.

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When planning a health promotion intervention in a community it is important to identify the priority behaviours that can make a difference to the health of the target population. You also need to be aware of possible behavioural barriers that may present challenges for your plan.

CLTS aims to improve hygiene and sanitation behaviour by helping communities to realise the health risks from open defecation so that they all make a commitment to change their behaviour. During the process they prepare a community-based action plan that describes the activities and schedule for building new latrines. It is important to check for sustainable change by having regular reviews of progress to ensure that the improved practices of latrine use and handwashing continue into the future.

The remaining SAQs are based on the following case study. Read the Case Study below about menstrual hygiene and then answer the SAQs which follow.

Case Study 10.2 Menstrual hygiene

Like many parents in low-income countries, Selam does not discuss menstrual hygiene with her daughter, Mana. She is not willing to provide Mana with sanitary towels even though the family has no shortage of money. Selam believes that menstruation is not something that should be discussed openly with her daughter. Because Mana lacks the knowledge and the material to manage her menstruation properly, she misses up to five school days every month. Her school does not have separate latrines for girls and boys because of shortage of budget. During her period, Mana generally tells her teachers that she is sick and stays at home. At home, she tells her mother that there are no classes. This is adversely affecting her performance at school.

Identify two priority behaviours which are important to try to change to improve the chances for girls like Mana to successfully complete her education.

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You may have identified two of the following three priority behaviours:

Mothers should openly discuss menstruation with their daughters, since it is a normal feature of female physiology and nothing to be ashamed of.
School girls should be provided with sanitary towels and be taught about menstrual hygiene management.
Schools should prioritise the building of separate latrines for girls and boys.

What are the personal, cultural and infrastructure barriers which might prevent the change of such behaviours?

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These are among the examples of behavioural barriers you might have thought of:

Personal: Lack of proper knowledge about menstruation, negative attitude towards open discussion, lack of appreciation of the advantages of providing daughters with sanitary towels.
Socio-cultural: A culture of silence about menstruation.
Infrastructure: Unavailability of separate latrines for girls in schools, shortage of budget for providing separate latrines or for providing sanitary towels at affordable prices.

Which type of communication intervention would you recommend in order to improve Mana’s situation and why?

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Behaviour change communication could help to increase awareness about menstruation, encourage mothers to talk to their daughters about menstruation and encourage them to provide their daughters with sanitary towels.
Social change communication, such as community conversation, would help to change attitudes and social norms about menstruation.
Social mobilisation to all stakeholders in support of constructing separate latrines for girls in schools.
Advocacy to convince decision makers to allocate budget for constructing separate latrines for girls in schools and to subsidise the price of sanitary towels.