A Tippy Tap Revolution

A Digital Green case study from Niger on how video-enabled health extension prompts behaviour change

Rakiya Idi is 27 years old and has lived with her husband, Idriss Yahaya, in Malam Daweye village in Niger for more than a decade. Like her parents before her, Rakiya is a farmer. Idriss farms and works as a trained video mediator in Malam Daweye. There were no schools in her village growing up, so Rakiya never had the opportunity to access formal education. However, as Malam Daweye has a primary school, her four living children, ages 2 to 12, have the opportunity to go to school. In 2013, Idriss took a second wife, Lantana, 17, and the couple have a 19-month old daughter named Nusaifa. Rakiya and Lantana are close and share household responsibilities for their families.

Rakiya first encountered Digital Greens video-enabled approach to nutrition and health extension in early 2015. As part of the JSI-led SPRING project, Digital Green and SPRING introduced this approach in Niger following successful piloting in India. Under the guided facilitation of a trained female health extension worker, Rakiya watched videos on the first 1000 days of a healthy child, hand washing, responsive feeding, exclusive breast feeding, complementary feeding, female nutrition, diarrhoea prevention, and harvest planning. Each video, averaging about ten minutes in length, was produced locally and featured fellow Nigeriens demonstrating good practices and behaviours specific to the videos theme.

Rakiya still remembers watching the video on hand washing in March 2015, and the discussion led by the female health extension worker. Before watching it, she and her family washed their hands infrequently and only with water, never soap. As she watched the video, which showcased behaviours like washing hands using a tippy tap device after going to the toilet, before cooking, before eating, and before feeding children, she was able to immediately make connections between her familys lack of hygiene and their frequent bouts with stomach aches and diarrhoea. Rakiyas third-born child, a daughter named Saratou, had died at the age of two over five years ago; her death caused in part by diarrhoea.

After watching the video, Rakiya literally practiced the steps demonstrated in the video in order to master how to properly wash her hands.  Rakiya says, To be honest, I adopted the practices I saw in the hand washing video immediately because I understood the content and was fully convinced that these small changes could create a positive impact in the life of our family and prevent us from experiencing sickness.

Rakiya carried the videos messages and handwashing practices home with her and shared them with Lantana. Lantana was receptive, so Rakiya taught her the steps and invited her to attend the next video dissemination to view the video for herself.

Now both on board, Rakiya and Lantana, with help from Idriss, built a tippy tap hand washing station in their compound, based on the guidance provided in the SPRING-Digital Green video, which emphasized sighting the station outside the washroom and kitchen. In doing so, they became among the first households to construct a hand washing station after watching the video. Idriss regularly provides the family with soap, but when they dont have the means to buy it, they use ashes as demonstrated in the video. Hand washing is now regularly practiced by all members of their family, and Rakiya and Lantana report fewer cases of illness and diarrhoea among their family since they started hand washing with soap.

For her part, Lantana, is grateful that Rakiya brought the message of hand washing into their household. Lantana acknowledges that, I did not know the steps followed in hand washing until I watched the video. I did not use soap, and I used to dry my hands by rubbing them on my clothes instead of a clean, designated cloth.

Meanwhile Idriss too says that even at 35 years old and despite working as a mediator for the SPRING-Digital Green project, he never knew that there were steps in hand washing until he watched the video for the first time. Now, he calls it easy, because it has become a part of our daily life.” In his opinion, the hand washing video has been a great tool to convince people that they can make a small but important change.

Now many people in Malam Daweye see Rakiya and her family as role models because their hand washing station is properly constructed and used by all members of their family. Their compound has become a de facto demonstration site, with people stopping by their house to see how the hand washing station was constructed and is used. In some instances, even people who were not direct beneficiaries of the videos have built hand washing stations and practice hand washing as the videos messages have spread by word of mouth. Idriss has even received invitations to help people construct their own household hand washing stations.

Rakiya proudly reports that hand washing is now common sense to her family members. She says, Before the hand washing video was disseminated, people did not understand and believe hand washing is very important. Now, people are awakened and good change is happening in Malam Daweye. She goes on to say that, SPRING- Digital Green videos are vital to my life and the life of my family because they touch on problems we face every day and offer us clear ways to make easy changes that improve our lives. I learn new things whenever I watch their videos.

Through March 2016, Digital Green has screened ten locally-produced videos 873 times to over 1,644 households in 20 villages of Guidan Roumdji and Aguie communes in Maradi region in Niger, as part of a one-year pilot project operated under the JSI-led Strengthening Partnerships, Results, and Innovations in Nutrition Globally (SPRING) project, supported by USAID. Approximately 55 households out of 100 participating households in Malam Daweye have constructed hand washing stations in their homes to date.