Adequate water, sanitation, and hygiene are essential components of providing basic
health services, and access to safe drinking water, use of toilet, and hand
hygiene are the most critical components of WASH services. Correct, consistent,
and continuous practices of WASH serve to prevent infections and spread of
diseases. With the lack of access to an improved water source, proper sanitation,
and availability of soap and handwashing stations, these rural communities are facing
social, economic, and health-related challenges.

The project aims to spread awareness about the importance of safe drinking water,
use of toilet, and the benefits and importance of washing hands thoroughly. A
situation analysis study among the most vulnerable 317 poorest families in
Vaishali, Bihar, revealed that many do wash their hands with water or with water
and soil, but not on a regular basis. It was also observed that they often suffer
from waterborne diseases such as diarrhea and typhoid. Sensitization and awareness-building
sessions thus aimed at improving WASH behavior. In every session, people are
informed that most diseases occur due to not washing of hands before cooking
meals, before eating meals, and after the use of a toilet.

Lack of resources and knowledge are the major barriers for the poor state of handwashing
practices. With the awareness-building sessions, the community understood the
need for hand hygiene, and they started adopting those practices in their daily
lives, however they did not have enough money to build a proper handwashing
station. Understanding this situation, the project team started promoting
tippy-taps, the zero-cost solution for a handwashing station. These simple, low
cost, and locally made systems for washing hands with running water with no
hand touch motivate people to practice handwashing in an appropriate manner.
Case stories of the people living in the study area and practicing the use of
tippy-tap handwashing station:

1.   Ashok Paswan, a resident of village Khoksa Kalyan in district Vaishali, says that to
avoid illness, one has to pay attention to the aspects of handwashing. He says
that they understood how diseases spread, and proper handwashing is very
effective in preventing diseases. So far, ten families in the hamlet made a tippy-tap
handwashing station to wash hands as they learned in the community sessions.
People find it very easy to use and now, due to the availability of soap and
water in it, people like to use it all the time. Children are very happy to see
the new DIY (do it yourself) technology (tippy-tap) and keep washing their
hands at regular intervals. Children have started competing with each other in
making better and innovative tippy-taps. The project motivated these children
by providing soaps to those who installed handwashing stations in their homes.

2.  Usha Devi, a resident of village Lakhanpur,says that before cooking or serving food, before eating food or feeding children,
and after using toilet and changing of clothes, one should wash hands
thoroughly. Earlier, going to the hand pump for washing hands seemed to be a
task, but now having tippy-tap within the home is very convenient, as it is
easy to wash hands.

3.  Shobha Devi, an ASHA worker by professionin village Khoksha Kalyan Ward No. 2, says that washing hands with soap is one
of the most important preventive health tips that can save us from illnesses. Evidence
proves that soap and clean water can remove the dirt in a better way.

4.  Mamta Devi, a resident of village Mohammadpur Lakhanpur and an anganwadi worker by profession, says that all family
members, especially children must wash their hands thoroughly with soap and
water after using toilet and before eating meals to keep themselves healthy.

5.  Radhika Devi, an anganwadi worker in ward number 6 of Lakhanpur Lal village, explains the steps of washing hands as
described below.

• First apply soap on both hands and rub well. Do this for minimum 10 seconds.
• After that, turn the palms and rub the back in the same way.
• Now clean the space between the fingers.
• Clean the back surface of the fingers in a similar manner.
• Now clean the surface of the thumb thoroughly by rubbing.
• Clean the nails by rubbing.
• Finally rinse the hands with water.
• Finally, wipe the hands with a clean, dry towel.

These positive changes when observed in the community demonstrate that with sensitization,
awareness building, and recall, people will adopt correct, consistent, and
continuous WASH behavior in their lives.