The complexity of behavior change

Today, I went downtown and met an old colleague. We both used to work for NGO in Indonesia. I mainly worked in the health sectors. Juggling over some programs like HIV/AIDS, Watsan, Health In Emergency, Psychological Support and a bit of blood donors. Together we used to be member of health working group.

Now after 5 years leaving NGO, and met again somewhere else, it was really interesting to look back at what happened back then. I guess to look back after having a distance to something that we used to do, to environment we used to live in or to situation we used to engage somehow provide us with the opportunity to assess it in a more balance manner.

What I want to discuss here is about the approach that we took in doing our work. When we came to the community who needs our assistance, we ensure from the beginning that they are involved in identifying their problems, there are various tools that can be used here VCA/PRA/PPP, etc.

Through this process a set of problems are identified. When it come the communities, the problems rarely simple but it rather complex and mostly one things led to the other. So I would call this a systematic problems. For example, from the field survey we get the information that diarrhea is the highest incidence in a village, this information most of the time confirmed by the data from the local Health Care Unit (if the statistic is available). Then another problem is that most of the villagers do not have access to clean water, we probably assumed that their hygiene practice is poor. So this is great! Now we really have a good reasons to assist them with installing the water system.

And moreover, most of our donors earmarked their funding to Water and Sanitation. So let say that our findings matched our funding, or it can be the other way around, we found a legitimate reasons to write a proposal based on this problems.

So we are happily work in the field, do some surveys, check the water sources, put on some budget and calculation and massively conducted hygiene training to the local people. Cover as much people as possible in a quite short or a lengthy of time.

This involves at least three day training, talking a great deal about personal hygiene, F-Diagram, washing hands, etc. Now the question is what is the impact? On the long term, we would like to see sustainability. But it takes sometime to reach that stage.

What strikes me is after this three days training, lot of lectures, interactive learning, role play and etc then when it came to dining time, still most of the training participants still stick to their old habits, one is taking food with hand without washing it. While washing hands practice is one of our biggest goal out of the training, many times we do not see an immediate impact of this training. Which led to some questions, do they get the message? Do they get overwhelmed by the information given to them through the training? or what is actually makes people change their behavior?

Behavior change for sure does not happen over a night and perhaps we should investigate more about what is the most appropriate approach to encourage behavior change.