Outcome evaluation of WASH intervention in rural households at Jawi district, Northwest Ethiopia: Mixed method design, goal based evaluation

Abstract

BackgroundThe government of Ethiopia revealed that GTP II and SDG were achieved through one Water Sanitation and Hygiene (WASH) program. According to the 2016 Ethiopian Demographic and Health survey, the rural population was more affected by poor sanitation and hygiene. To address this Ethiopian government ratified Rural WASH sanitation and hygiene promotion through a community-centered approach, and to improve WASH service evidence on the effectiveness of an intervention at the household level is needed in developing countries. However, in our country one WASH in rural areas called community centered approach intervention was planned and delivered for 3 years (2018–2020) Nevertheless, as to our review and researchers knowledge, the outcome of this intervention is not evaluated yet in our country as well as in this evaluation study area. MethodThe evaluation was conducted in rural households of Jawi district by a Quasi-experimental design supplemented with a qualitative in-depth interview, from 01/14/2021–3/28/2021 and 4/22/2021–5/25/2021 for quanitative and qualitative study, respectively. Intervention groups were households that took WASH intervention while the controls did not. The evaluation approach was summative and counterfactual plus participatory and focuses on program outcome. A total of 1280 households were selected using two stage sampling with lottery method simple random sampling. We collected quantitative data through survey and structured observational checklist, while qualitative data through key informant interviews using a semi-structured questionnaire. We assessed program effectiveness and also the analytical study was conducted through propensity score matching to assess program effect through Stata 14.1. Qualitative data were transcribed and translated to English and thematic analysis was done using Atlas.ti.9. ResultThe overall program effectiveness was very good but the effectiveness in handwashing before eating using soap and water was poor. Also, this intervention increased water treatment utilization in 41.7% point (ATT=0.417, 95% CI= 0.356, 0.478), 24.3% point (ATT =0.243, 95%CI=0.180, 0.300) in exclusive latrine utilization, 41.9% point (ATT=0.419, 95%CI = 0.376, 0.470) in handwashing using water and soap before eating, 50.2% point(ATT=0.502, 95%CI=0.450, 0.550) in handwashing after defecation by using water and soap in intervention households. Our qualitative finding revealed that unable to afford soap and their working place far away from their home were the most frequent reason reported by the respondent for not using soap for hand washing and latrine utilization respectively ConclusionsThis intervention should be scale-up and pay greater attention and deliver innovative strategies to the improvement of handwashing practice and exclusive latrine utilization. Availability of data and materialsThe data sets used and/or analyzed during the current study are available from the corresponding author on reasonable request.