Eagle-eye readers may have noticed that we recently amended our Theory of Change. For those who didn’t (most folks!), we are focusing more on well-being and sustainability. Important changes are noted in orange below:

We put a really high value on measuring our impact because we want to know what’s working and what’s not. And if something isn’t working, we want to find out why, and problem-solve how to fix it. Our approach to and process for monitoring, evaluation, and learning is explained here.

Digging in to two recent studies of Splash’s programs, we’re looking for evidence that our programs lead to the outputs, outcomes, and/or impacts listed in our Theory of Change.

Study #1: Facilitators and Barriers for Hand Hygiene in Ethiopia

We wanted to understand which elements of the Splash program activities and infrastructure have the most significant impact on student handwashing behavior. We also set out to identify feasible approaches in reaching students and the school community, with consideration of both cost and programmatic outcomes.

Study Design
A qualitative survey of students and teachers was designed in collaboration with the University of Washington, and students and teachers participated in semi-structured interviews.

Themes in respondents’ answers were identified and coded into different motivations:

Findings
The study found that students and teachers had increased knowledge of handwashing behaviors after Splash’s implementation, and this translated to an actual increase in handwashing with soap. Limitations to be addressed included water availability and soap quality.

Study #2: Menstrual Health Pulse Survey

The objective of the pulse survey was to gain deeper insights into the Menstrual Health and Hygiene program in general – it is more of a “spot check” to assess whether the desired outcomes are achieved or if our previous design assumptions need to be reevaluated.

Study Design
This was a qualitative survey conducted at sites that Splash addressed in the MH social ecosystem program.

Findings

• Most of the schools are conducting peer mentoring and the boy's puberty workshop as Splash standard.
• The focal teachers are getting the necessary support from Splash and the allocated time for the training is sufficient.
• Peer Mentoring Program has impacted the younger female students and mentors are good sources to discuss puberty and menstruation.
• The Boys Puberty Workshop impacted the male students, and the information was new for male students.
• The topics are appropriate for the peer mentoring and boy's workshop, the design and the learning method is child friendly and not boring for children.
• Most school sanitation facilities are not safe and private, not regularly cleaned, not functional.
• Most schools under do not have sanitation facility components and no separate designated MH room.
• Students have enough time to use the sanitation facilities during the breaks between classes at lunch.

In general, Splash's process for implementing the MH ecosystem program is appropriate for the students and the program is implemented according to the intended plan. However, external factors such as sanitation facilities and the school's commitment to resolving related issues are essential for providing a better MH service at school.

Impact

• The program has changed students understanding towards their physical change and menstruation.
• Female students learned how to prepare/plan for their period and learned how to manage their menstrual hygiene at school.
• Female students' confidence increased to share their menstrual experience.
• School absenteeism decreased.
• After Splash engagement student participation in sport and other social activities become increased.
• Boy’s perception towards their female peers and menstruation changed.
• Teasing decreased significantly, and boys also understood the wrong myths about girls and menstruation.
• The program helped improve boys knowledge related to puberty, myths, and facts about menstruation, and how to be an ally for their female peers.
• Mentees expressed their desire to become mentors, reflecting a commitment to raising awareness about menstrual knowledge & positively influencing others.
• The mentors also expressed their desire to continue mentoring for the next year because they are changing students' attitudes, building confidence, and want to reach more students.

The overall outcome shows that the Splash MH program has successfully changed students' attitudes, created a supportive environment among teachers, boys, and girls, built students' confidence, and normalized menstruation as a natural biological process.

So how do these studies relate to measuring well-being?

According to the WHO, “safe drinking water, sanitation and hygiene are crucial to human health and well-being.” Well-being can be understood as how people feel and how they function both on a personal and social level, and how they evaluate their lives as a whole. Quality of life can be defined as the perceived discrepancy between the reality of what a person has and the concept of what the person wants, needs, or expects. WASH-related quality of life is a subset of overall QOL that is directly affected by WASH practices or services.

Many tools to measure well-being already exist! Examples include WELL-BY and SanQol-5.

The following indicators—objective and subjective— are all components of how leading researchers suggest WASH programs, like Project WISE, could better measure well-being:

As we continue to carry out programs and implement them in new cities, Splash will begin using quality of life measures in our regular monitoring and evaluation processes, as well as incorporate well-being measures into future impact evaluations:

We hope you’ll stay tuned to see how we adjust and pivot if indicators fall short and ensure our programs reach sustainability and well-being goals. Ultimately, we’re trying to bring improved and lasting WASH conditions to schools so that kids can thrive, and we believe emphasizing sustainability and well-being will help us do just that!

You can give kids the opportunity to thrive by supporting Splash's work.