By Sylvester Baffoe, M&E Officer, UNICEF Ghana

Pneumonia and diarrhoeal diseases are one of the major causes of death for children under five in Ghana. In 2015 alone, over 10,000 children under five in Ghana died from pneumonia and diarrhoeal diseases.

Handwashing with soap and water (HWWS) is a proven intervention to reduce this rate. However, less than 1 in 8 Ghanaian households practice HWWS.

Handwashing with Ananse is an educational game to teach children why, how and when to wash their hands with water and soap. © Engagement Lab/2016/Kimbrough

UNICEF Ghana has therefore partnered with the Ghana Education ServiceRed Cross/Red Crescent Climate CentreEngagement Lab at Emerson CollegeRight to Play and Ghana Red Cross to develop a set of highly engaging, interactive stories and offline games called Handwashing with Ananse to promote HWWS. “Handwashing with Ananse” is currently being piloted in a few Ghanaian primary schools.

A quasi-experimental evaluation is accompanying the pilot roll-out of “Handwashing with Ananse” to measure the effectiveness of the intervention in creating learning and HWWS behaviour change.

The tippy tap is a hands free way to wash your hands that is especially appropriate for rural areas where there is no running water.

Ten control and intervention schools each have been selected for the evaluation. All 20 schools have been provided with Tippy Taps, and volunteers who ensure that the Tippy Taps have water and soap during school hours throughout the entire evaluation period.

While a survey is being used to assess changes in HWWS knowledge and attitudes among students, a combination of four types of measures are being used to assess changes in behaviour: sensors on the Tippy Tap water containers; video cameras mounted above the Tippy Taps; measurement of the amount of soap and water used each day; and structured observation.

The sensors provide accelerometer data on the angle and duration of the tilt of the water container. When correlated with the amount of water used this data can determine the number of times and length of time the water is used. Video footage will be used to calculate the average number of handwashing events that were conducted over particular time periods.

Students in chosen schools use the Tippy Tap.

An image recognition algorithm will evaluate hand movement within the video frame over the soap dish to detect a HWWS event.  This will validate sensor data and daily soap and water measurement and will be used to derive the number of HWWS events that occurred.

Trained observers are also being used to unobtrusively observe the use and state of the Tippy Tap stations and record in their observation log. This will provide data on quality of handwashing behaviors, such as whether all steps of HWWS were followed and whether soap was used, and barriers to proper handwashing at all schools.

Focus groups with students from intervention schools at the immediate follow-up will also evaluate students’ engagement in the game and learn how game implementation could be improved.

UNICEF’s Sylvester Baffoe talking to some students after playing the game.

This rigorous evaluation which comprises of a baseline, immediate post-intervention and 3-month post-intervention surveys and hardware/technology data collection is expected to be completed by August 2017. The baseline and immediate post-intervention data collection have already happened.

The Engagement Lab at Emerson College is the principal organization leading the evaluation, with operational support from TNS Ghana.

Based on the results of this evaluation, UNICEF Ghana and its partners will determine the suitability of ‘Handwashing with Ananse’ for a wider roll-out, in Ghana and possibly in comparable contexts.

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