Achieving behavioral change

While sales are the key to our ongoing ability to provide WASH products and services to rural Ghana, Sama Sama's ultimate goal is to increase the use of WASH products and reduce open defecation and other poor WASH practices. Our focus on human-centered design, combined with a problem-led approach to product sales, has already resulted in quantifiable changes in key WASH behaviors that are critical for improving health outcomes in our target communities.

Real change

Beyond increasing sanitation coverage, the team is excited about our ability to influence WASH behavior and norms. For instance, when asked about hand washing behavior, over 84% of Sama Sama customers report washing their hands always or most of the time. Reported usage of improved toilets among children is also high, with 86% of boys and 88% of girls reporting that they use their toilet all or most of the time. This represents a potentially significant change among children, for whom consistent toilet usage is traditionally low. To date, usage among adults 18-59 is also high, with around 95% of both women and men reporting always or almost always using their toilet.

Interestingly, most households—55.3% of the customers we surveyed—reported that they practiced open defecation before purchasing their Sama Sama toilet. This suggests a sanitation ladder “leapfrog” effect, whereby many of our customers go directly from open defecating to using a high-quality, durable improved latrine. This has resulted in significant time savings, as more than half of our customers reported previously spending 10-30+ minutes finding a safe and available place to relieve themselves, and are now saving that time by using their Sama Sama toilet.

We have also started to see new toilet usage and hygiene behaviors extending beyond our customers' households to become social norms in the broader community. Staff living in our communities of operation have reported that it is no longer seen as acceptable to defecate outside. Although we don't have any data yet to correlate this with our efforts, Sama Sama staff have reported receiving numerous inquiries from community members about how to buy a Sama Sama toilet.

Influencing behaviors at a critical time

At the onset of COVID-19 in Ghana, with the support of Global Affairs Canada, Sama Sama launched a public handwashing initiative to ensure community members could practice key hand hygiene behaviors in heavily trafficked markets and bus stations. Initially, Sama Sama mobilized to roll out seven free public handwashing stations in high traffic areas of Tamale and Savelugu in late March 2020; as of December 2020, Sama Sama had installed 65 handwashing stations across 19 districts. These stations are staffed to ensure safe usage and to educate users on proper COVID-19-related hygiene practices such as handwashing and physical distancing. We also began running educational radio ads to further spread awareness of proper hygiene practices, and to combat the significant and rampant misinformation prevalent in our communities of operation. We are now seeing some tricycle drivers require their passengers to wash their hands at our public handwashing stations before they can get into their vehicles.

As of January 2021, our handwashing stations have facilitated 261,547 hand washings and 52 of Sama Sama sales agents have given 166,649 presentations about the importance of proper hygiene. The gender breakdown for those handwashings is below:

Some districts have begun replicating our public handwashing stations. We are in touch with these districts to ensure we communicate our best practices around operating the stations, including ensuring they are staffed, that soap is always present, and that physical distancing is encouraged.

During the normal training cycle for our new toilet business owners (TBOs), we added COVID-19 modules and distributed PPE, including hand sanitizer, a box of gloves, and reusable masks. We then extended this training for our existing TBOs, and we hope this further catalyzes behavior change in Sama Sama TBOs and other small business operators in the community.