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Word of mouth or peer education is still the most reliable way to get information. Making sure that information is correct or accurate is another story.

One of Another Option’s role under USAID/Nepal’s Early Grade Reading Program managed by RTI International is to create awareness among parents of children in grades one through three about the benefits of reading, and for children to read outside of schools at home, reading corners, and libraries.

With the Ministry of Education, we developed a peer education guide to encourage parents to talk to other parents. Our research showed that parents talked to other parents about maneuvering their way through the school culture and to assure parents received good advice on what to do for their children to succeed.

Approved by the Ministry of Education and USAID/Nepal, the guide is in English and Nepali with plans to translate into three other languages. The training kit consists of three components: trainer guide, participant guide, and wall hanging with recommended behaviors and activities for parents.

An electronic version will be posted for any to use. Please give credit to USAID/Nepal. Drawings and illustrations by Keshar Joshi.

We are pleased to announce our affiliations with Ljubica Latinovic and Gisele McAuliffe!

Ljubica Latinovic, Founding Partner and Managing Director of LYAHealth

Ljubica Latinovic, Founding Partner and Managing Director of LYAHealth

Dr. Ljubica Latinovic (@LYAHealth) is a Founding Partner of LYAHealth, a woman-owned business that specializes in communication strategies and solutions to health issues. LYAHealth also provides crisis and emergency communication management in public health, digital media, message development, and media relations.

Gisele McAuliffe, President of Advocacy Communications International, Inc. and Bigger Impact

Gisele McAuliffe, President of Advocacy Communications International, Inc. and Bigger Impact

Gisele McAuliffe (@curiousadvocate) is an international communications and advocacy consultant who presides over Advocacy Communications International, Inc. and Bigger Impact. With more than 20 years of communications experience, McAuliffe collaborates with diverse teams to plan, implement and evaluate strategic outreach efforts.

We are excited for our future work with Ljubica and Gisele!

Story by Adheep Pokhrel, Communications Director, Early Grade Reading Program. Another Option is a subcontractor specializing in social and behavior change communication (SBCC) under USAID/Nepal’s Early Grade Reading Program (EGRP) managed by RTI International. EGRP operates in 16 districts in Nepal’s terai (plains) and far west regions. Targeted to parents of students in Grades 1 – 3 from minority ethnic populations and their teachers. Another Option and its research partner, GTA, conducted qualitative research among these target audiences. The qualitative research findings were used to develop messages and the SBCC strategy.
 
A Message Development Meeting called by the Department of Education was held on February 8, 2016.

What do you say to parents to encourage them to support their children in early grade reading, or to be engaged in their children’s early grade reading program?

Turning correct information into memorable and effective communication messages is not as easy as it might first appear. The Department of Education and USAID’s Early Grade Reading Program (EGRP) organized a Stakeholder’s Message Development Meeting held on February 8th to develop key messages that will be used in radio advertisements, social mobilization and a communication campaign targeted to parents, teachers and key stakeholders.

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Representatives from the Central Line Agencies (CLA) and the EGRP communication team worked together to develop messages that combined parents’ and teachers’ personal goals with desired behaviors.  The participants actively engaged in the message development session and produced a series of creative messages that reinforced positive behaviors and came in many forms, including songs, poems and rhyming verse and even a promise of a peaceful and happy life.

The meeting was led by Mr. Bishnu Adhikari, Deputy Director, Department of Education. In his remarks he emphasized the role of the media and education journalists in mobilizing communities to promote early grade reading, and the need for correct messages.

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Mr. Madhav Prasad Dahal, Deputy Director, Distance and Open Learning Unit, NCED, said in his formal remarks, “My office welcomes collaboration with EGRP to develop radio Public Service Announcements for early grade reading that will be aired on national radio. My staff is available to work with EGRP.”

Through community and media mobilization, EGRP will focus on building understanding of the importance of children reading in their first language among parents and communities, as well as engaging parents and community-based organizations in evidence-based practices to support young readers.

The meeting was held at the National Center for Education Development (NCED) in Bhaktapur. Participants included government officials from the Central Line Agencies (CLAs) and the EGRP communication team.

These graphics are taken from The Washington Post’s article, The invisible threat: Rising temperatures mean insects can carry viruses such as West Nile to wider areas, that ran on November 28, 2015 (story by Joby Warrick; photos by Jeremy Lock). One Health is not just a slogan but it is a movement that sees the interconnection between animal health, human health and the environment.


 

As the world warms, the zones of cool temperatures keeping certain mosquitoes in check will move north. Rising temperatures will usher in tropical diseases, such as dengue fever, or “break-bone disease,” which is transmitted primarily by Aedes aegypti mosquitoes infected with the virus. Sources: Nature, Centers for Disease Control and Prevention, World Health Organization

As the world warms, the zones of cool temperatures keeping certain mosquitoes in check will move north. Rising temperatures will usher in tropical diseases, such as dengue fever, or “break-bone disease,” which is transmitted primarily by Aedes aegypti mosquitoes infected with the virus.
Sources: Nature, Centers for Disease Control and Prevention, World Health Organization

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The black-legged tick, or deer tick, transmits Lyme disease, babesiosis, Powassan virus, and Borrelia anaplasmosis.
Sources: EcoHealth, Centers for Disease Control and Prevention

 

Article originally written by Tom Fowler for Medgadget – November 20, 2015.


 

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Anna Young, co-founder of MakerNurse, is bringing rapid prototyping tools into hospital units to enable nurses, other providers, and even patients to problem-solve with innovative do-it-yourself labs within hospitals, with the end goal of ultimately improving patient care. Anna and her team at MIT’s Little Devices Lab bring rapid prototyping tools into hospital units creating “Maker Health Spaces”. They recently spunoff Pop Up Labs, a privately held company to take these tools to scale across clinical environments. Supported by the Robert Wood Johnson Foundation, MakerNurse aims to empower nurses and bring nurse “making” to helm of changing the face of health care. I had the opportunity to meet with Anna at this year’s TEDMED conference in Palm Springs, CA, to talk about her work.

MakerNurse co-founder Anna Young

MakerNurse co-founder Anna Young

Tom Fowler, Medgadget: So Anna, have you always been a tinkerer?

Anna Young: I walked into MIT as a trained economist 6-years ago and it was there that I learned how to teardown medical devices, learn how they work and modify them through design and prototyping. If I could do it, I knew anybody could do it. That became my main interesting: how do you develop democratizing tools for medical device design and prototyping.

Medgadget: What type of traction do “Medical Maker Spaces” see in hospitals? What percentage of nurses will take the leap of faith into becoming device developers?

Anna Young: Across the board, 1 in 5 nurses is what Eric von Hippel will call, a “lead user”, they are faster than a device firm to identify a gap in a product and to spot an opportunity for problem solving. Hospitals are loving the notion that they get to transform themselves from problem spotters in need of design and engineering partnerships to developers of their own solutions.  And it’s not just traditional research hospitals. Our biggest opportunities are in regional and community hospitals with large volumes of patients.

Medgadget: Provide an example of one awesome, and one terrible product that has come from a Maker Health Space.

Anna Young: Best example, wearable google to control hydration in eyes for burn patients.  Worst example, an anatomical wound model that burned through 5lbs of 3D printer filament only to create a very awkward looking mold. To be fair, we love both of them. We think everyone deserves the chance to experiment and prototype. I’d rather see 20 failed prototypes than 1000 post-it notes of ideas for products that never get created.

Medgadget: Does this model have legal dilemmas running into the FDA?

Anna Young: We shepherd the prototyping process to make sure our medical makers meet every regulatory guideline at different levels. Whether it’s an internal IRB study or a 510k submission. Our Maker Health Spaces come wrapped with an ethical and legal advisory board that makes sure the prototypes meet regulatory guidelines. That means that you can prototype a device, take through an internal research study to learn how well it performs and be faster at designing its pathway into patient care.  At the end of the day though, safety is always #1.

Medgadget: If I donated $1 billion to you for any project, what would you do?

Anna Young: Build a network of lending libraries of Maker Health prototyping kits around the country so that prototyping tools become more accessible and we remove the digital device in health technology.


Tom Fowler worked as a programmer in the healthcare IT industry before settling back in school to learn how to become a doctor. He likes to dabble with biotech startups, write postcards to his relatives, and play his ukulele. He was a TEDMED ’13 scholar, has published research in biomedical informatics, and continues to advocate for international maternal and child health. Currently in the SELECT MD leadership program at USF Health Morsani College of Medicine.


Another Option is proud to be a part of TEDMED 2015.

 

 

Congressman Raul Ruiz and TEDMED Chief Operating Officer Shirley Bergin.
Photo credit: Jarod Harris

The Honorable Congressman Raul Ruiz, representative of California’s 36th district, visited the 2015 TEDMED conference on Friday, November 20th. The Congressman is a medical doctor whose background includes working abroad in Mexico, El Salvador, and Serbia, and serving as an emergency physician at a nonprofit hospital in his district’s Coachella Valley. Congressman Ruiz is dedicated to improving health care and addressing health disparities, topics that are closely tied to TEDMED 2015 host city Palm Springs. Palm Springs is an exemplar of a city with a strong, functional health care system: it is a highly diverse community with high quality, accessible health care providers.

TEDMED has announced that their 2016 conference will be held in Palm Springs again next year.


Another Option is proud to be a part of TEDMED 2015.

Content originally written by Andrea Kissick for KQED – November 18, 2015.


I am addicted to TED talks. They breath new life into what was once the boring lecture.

Some of the smartest people have now become some of the most inspirational, thanks to the TED format and delivery.  TED is now its own global industry which includes smaller, more affordable, TED X talks,  a TED video channel and NPR’s TED Radio Hour.

TEDMED, which is kind of the sci-fi edge of medicine, is one of the biggest gatherings in the TED culture.

The TEDMED stage.

This year’s conference, which begins today in Palm Springs, is a who’s who in medical innovation. The list includes several people we  interviewed for KQED stories, including consumer genetics guru, Anne Wojcicki, scientists from UCSF’s genome editing project Crispr, and physicians specializing in mobile health.

There are also a number of speakers that are new to me.  Here are five topics that caught my eye.

MakerNurse co-founder Anna Young

Inventive nurses have been doing workarounds for decades, cobbling together broken medical devices or adapting a dressing for a tiny patient’s wound.   Think about it, who really knows more about how to improve patient care then the person who is at their bedside every day?  I initially heard about Maker Nurse at a conference last year, so I am looking forward to meeting Anna Young and her team from MIT’s Little Device’s Lab.  They are using the ideas behind the Maker Movement to help bring rapid prototyping of tools to patient care.

UCSD sensor innovator Todd Coleman

Todd Coleman is a UC San Diego Bioengineering Professor who develops tattoos for health monitoring in order to make medicine less invasive.  He is also a staunch public health advocate who is looking for ways to deliver sustainable innovations to under-served groups.  Click here for our recent story on KQED’s Future of You about the use of ‘smart tattoos’ to revolutionize diabetes treatment.

Bioengineer Sangeeta Bhatia

Sangeeta is both a trained engineer and physician — a rare combination. In her lab at MIT she works with technologies from the computer industry, like semiconductors, to figure out how to make livers for off-the-shelf transplants that don’t depend on a dying patient’s donation. Her team has developed breakthroughs in cancer treatment and Fast Company named her one of the most creative people of 2014.

Electrified Biogeochemist Kenneth Nealson

What is an electrified biogeochemist? Just the title is enough to peak my interest for this session.

Microbiome researcher Chris Mason

Chris Mason is best known for his recent project to map the New York subway’s DNA, which too more than a year to complete.  But Mason’s interests go beyond swabbing subway trains and urban mircrobiology. His research extends to cruise ships,  Chernobyl-struck villages and outer space.  The Cornell professor is currently working with NASA on a long-term survival plan for interplanetary survival.

You can follow the conference at #TedMed and @andreakissack.  All talks will be available on the TEDMED site after the conference.


Another Option is proud to be a part of TEDMED 2015.

Article originally written by Barrett Newkirk for The Desert Sun – November 18, 2015.

Health and wellness reporter Barrett Newkirk can be reached at (760) 778-4767, barrett.newkirk@desertsun.com or on Twitter @barrettnewkirk.


The annual meeting of minds known as TEDMED got underway in La Quinta on Wednesday with hundreds of attendees hearing from a diverse lineup of experts discussing work that often overlaps medicine and technology.

The annual conference, which is the independent and medically focused offshoot of the TEDTALK series, continues through Friday at the La Quinta Resort & Club. As many as 800 were expected to attend, many of them students, medical professional or entrepreneurs.

Chris Bi, a cancer drug researcher with Pfizer in San Diego, took a moment to snap photos of palm trees lit up at night just before the first round of speakers began. Bi said he came to hear from innovators who may help his own research, but also to get exposure to people working in areas far different from his research lab.

“I want to see how things can intersect to help with work in a lot of fields,” he said.

For those who can’t attend in person, live-streaming events are happening around the world. Talks will also be posted on the TEDMED website after they’re completed.

Speakers Wednesday ran between humorous and deadpan serious. They included people working with the latest in human gene technology and a part-time cardiologist/part-time folk singer who is about to have her second child.

Physician Pamela Wible speaks at TEDMED 2015. Photo credit: Jerod Harris/provided photo

Physician Pamela Wible speaks at TEDMED 2015.
Photo credit: Jerod Harris/provided photo

Family physician Pamela Wible began her 15-minute talk in a light mood before calling an alarm on the medical profession.

“I love the three things that people fear the most,” Wible said, “death, disease and public speaking.”

She then discussed the problem of physician suicide, reading suicide notes and showing photos from three cases. She said it’s “medicine’s dark secret, and it’s covered up by our hospitals, clinics and medical schools.”

Conference speakers Karen Stobbe and Mondy Carter stood in the conference’s social lounge after traveling from North Carolina. Their work also crosses unusual boundaries. They use techniques from improvisational theater to help caregivers relate with Alzheimer’s patients.

Stobbe explained that like with improv, caregivers often need to follow someone else’s lead.

“If you’re on stage and someone says ‘I have a duck in my room,’ and you say ‘No you don’t,’ you get into a horrible argument on stage,” she said. “With Alzheimer’s, if someone says ‘I have a duck in my room,’ you go see the duck in their room.”

Stobbe and Carter’s talk is set for Thursday morning as part of a session all about the human mind.


Another Option is proud to be a part of TEDMED 2015.

Article originally written by Barrett Newkirk for The Desert Sun – November 17, 2015.

Health and wellness reporter Barrett Newkirk can be reached at (760) 778-4767, barrett.newkirk@desertsun.com or on Twitter @barrettnewkirk.


Dozens of people touted as innovators in health and medicine will be in the Coachella Valley for TEDMED, the health-conscious offshoot of the TED Talks speaker series.

As many as 800 people are expected to fill the La Quinta Resort & Club for the annual conference, which will be held Nov 18 to 20.

The 50 speakers slated for the conference range from big names in public health like U.S. Surgeon General Vivek Murthy and renowned HIV researcher Tony Fauci to business people like “insect protein marketer” Shobhita Soor and researchers like Laura Schmidt, a sugar policy expert from the University of California San Francisco.

TEDMED 2015 speakers include (clockwise from top left) Roberta Ness, Kevin Tracey, Daria Mochly-Rosen, Laurie Rubin, Elizabeth Iorns, and Tony Fauci. Photo credit: provided photos.

TEDMED 2015 speakers include (clockwise from top left) Roberta Ness, Kevin Tracey, Daria Mochly-Rosen, Laurie Rubin, Elizabeth Iorns, and Tony Fauci.
Photo credit: provided photos.

Chris Elliott of Palm Springs made plans to attend TEDMED 2015, but as of this week it looked increasingly as if his job might keep him in Washington during the conference.

“TEDMED tends to be on the leading edge of things,” Elliott said by phone Wednesday. “It’s really looking into what health care is going to be 10 years or even 20 years from now.”

Elliott was a neuroscience researcher at the University of California San Diego before he founded MyBrainTest, a market research firm for products that evaluate brain health.

He’s attended TEDMED once before and remembered a speaker discussing the future use of smartphones to negate the need for patients to see doctors in person for routine diagnoses such as the flu.

This year, if he is able to attend, Elliott was looking forward to a session on the mysteries of the brain, which relates directly to his work. The session includes Roland Griffiths from John Hopkins University, who’ll speak on the use of psychedelic drugs to create life-changing experiences for patients.

Elliott said he was particularly interested to learn how those drugs might improve end-of-life care or even assisted suicide.

“That’s what TEDMED does, bring up topics that aren’t usually discussed openly,” he said.

With an attendance price of nearly $5,000, TEDMED in unlikely to attract people just curious to hear a few smart people talk science on stage. Livestreaming events are taking place across the country and internationally, but none have been announced in the Coachella Valley.

Talks will also be posted on the TEDMED website after they’re completed.

TEDMED 2015’s valley location is a departure from past years. TEDMED was held in Washington for four years until 2014 when the nation’s capital and San Francisco split hosting duties.

The change to the desert was an intentional effort to get away from big cities, and give attendees a calmer setting where they would have fewer outside distractions and not be scattered between several hotels, said TEDMED COO Shirley Bergin.

“We hadn’t really been under one roof in four years,” she said. “We wanted to feel like a community. We wanted it to feel like a place where people could relax, let their guard down and really start to dig into the issues at hand.”

The La Quinta Resort & Club is also known as the place Frank Capra wrote the Christmas classic “It’s a Wonderful Life.” That history of storytelling appealed to TEDMED organizers, and Bergin said they are already in talks with the resort about returning next year.

Unlike many medical conferences that focus on a particular specialization, TEDMED takes on broad subject matters that Bergin said draws professionals from a variety of disciplines. Doctors and medical researchers can end up sitting down next to designers and tech entrepreneurs.

“Every year is a slightly different year,” Bergin said. “Different delegations repeat year after year. We infuse it with new and old, those that understand TEDMED and know TEDMED and those who have never come before.”


Another Option is proud to be a part of TEDMED 2015.

Insights from personal observations and interactions with two ethnic communities in Sekong province.

September 30, 2015. By Cecile Lantican.

Sekong Province, Lao People’s Democratic Republic – Early in the morning, our team traveled to Sekong province. With less than 100,000 residents, Sekong is the second smallest province in Lao. It is also one of the poorest. Sekong province is located in one of the most remote areas in Lao: most of the province’s 42 villages are inaccessible by road because the infrastructure has been poorly developed.

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Sekong province, Lao PDR

Our mission was to pre-test communication campaign concepts, materials, and messages for the Lao government’s sanitation program among representative audiences in two rural communities. The district coordinator of the Center of Information and Education for Health (CIEH) arranged for our group to meet villagers of Toungkeo in the Lamam district. Lamam, which means “lowland plain,” is one of the four districts in the province.

The ferry we took en route to Ban Tok Ong Keo.

The ferry we took en route to Ban Tok Ong Keo.

From the ferry station, we drove through rugged terrain and winding mountain slopes. We passed by three small streams that indicated the richness of the water reservoir further up in the hills. It was almost midday when we finally reached Ban Tok Ong Keo. Four staff of the village health center greeted us and joined us for a quick packed lunch.

One of the streams we passed.

One of the streams we passed.

Nestled in between the undulating mountain slopes, the village was covered by lush vegetation following the recent rains. The air was hot and humid. We noted electrical posts in the village, but none of the houses were connected to the main lines. There was no mobile signal and our phones did not work. Considering the distance we traveled, I could imagine how tedious and expensive it would be for latrine sales agents or businessmen to travel here with their latrine products and supplies.  Sales agent never reached this village.

Sekong province is very remote.

Sekong province is very remote.

Almost all of the houses followed a similar construction design: they were made of wood and standing on stilts. Under the houses, we noticed piles of firewood and free-range animals like pigs, goats and cows. Villagers also use the space under these houses as work and rest areas.

A typical house in Ban Tok Ong Keo.

A typical house in Ban Tok Ong Keo.

We proceeded to the house where we would meet our pre-test participants, who had been waiting for us since that morning.

Ethnicity and Language

Sekong province is ethnically diverse. There are 14 ethnic minority groups, and only three percent of the population is Lao Loum. While the government verbally recognizes the use of ethnic languages, it officially encourages people to read and write only in ethnic Lao Loum.

Village women and children.

Village women and children.

 These villagers belong to the Alak ethnic minority, which reportedly constitutes 21 percent of the province’s population. The government categorically includes them among the “Lao Theung” ethnic group, the “mid-slope Lao.” The Alak women are known for weaving unique and high quality Lao “sin” (skirts).

A group of 12 women was assembled to meet us in one of the houses.  The field coordinators explained that people are shy about talking to foreigners, so we did not ask for their names out of respect for cultural sensitivity. Instead, we noted their ages and education levels. We asked the most senior woman her age.  She said,  “I [am] maybe between 50 to 60 years old.” She could not remember her birthday. This is common among Laotians; people do not always know their birthdays and in practice, a majority do not celebrate birthdays. When asked about the names of her 19 children, she could not remember them all.  But she claimed that all 19 children and her grandchildren from her three married daughters are living with her in one house.

Women participants in Ban Tok Ong Keo.

Women participants in Ban Tok Ong Keo.

Most of the women pre-test participants spoke limited Lao language. Only three women could read Lao characters. These women reported that they had reached fourth grade in the primary school before leaving school. The rest of the women had reached only the second grade.

The government built their houses. This could explain why the majority of the houses had similar architecture. One elderly male neighbor said,  “A few years ago, the government resettled us to our present location. We used to stay in a much lower ground along the river. But every time it rained, the river overflowed. We experienced flooding.” As a result, the government built their houses in higher plains and provided gravity-fed water to a cluster of households.

The government also built a latrine for every family. But as the number of families grew over the years, others did not build more toilets. Older villagers in particular reverted to open defecation.

A government-built latrine.

A government-built latrine.

In the neighboring village of Ban Nava Kang, we met eight Alak women. None of them had attended school. They could speak very limited Lao, but could not read Lao characters. Two of the older women were asked of their age. Like the older woman in Ban Tok Ong Keo, they could not also tell us their real ages and birthdays.

Households in this village do not have latrines. We were informed that everyone goes to the open field to defecate. This observation was validated by our pre-test materials.

 Rethinking our BCC Materials and Messages for Sanitation

Among the four communities where we tested the proposed campaign concepts, messages and materials, the responses of villagers from Ban Tok Ong Keo and Ban Nava Kang led us to believe that open defecation is strongly related to factors specific to the culture of groups that practice it. The Alak villagers we met have particular ways of thinking about latrines, and they reacted to situations or events as they understood them.

Men participating in our pre-test.

Men studying our initial communication materials.

The Alak villagers of Ban Tok Ong Keo did not maximally use the pour-flush latrines built by the government. The men respondents suggested the following reasons for this disuse:

  • It is a hassle to collect water before defecating.
  • The water source is too far from their houses.
  • They would need to carry a lot of water because they have to clean the latrine after using it. If they do not clean it, it will smell bad because it is near their house.
  • They prefer to defecate in the open because they can do so easily. Feces will dry up quickly outside in the heat, rather than in a confined and unpleasant-smelling toilet.
  • They worry that neighbors will notice them walking to use the toilet.
  • They prefer the privacy offered by defecating in the bush instead of at home.

The Alak men agreed that latrines would help ensure their daughters’ safety, but the current structure of their toilets does not offer privacy. The Alak women of Ban Nava Kang told us that our visual showing the girl who feels the need to relieve herself was a woman who feels the pain of giving birth. After further probing, one of the women associated the girl’s stomach ache with “diarrhea” from eating unclean food.

Pre-testing our communications materials.

Pre-testing our communications materials.

These two Alak communities showed us that having a latrine was not among competing priorities of their daily needs. The open field where they defecated was seen as more convenient than a latrine. The open field was big, unlike the very small, closed, and hot latrines.

Open defecation has been part of their culture. It is a behavior that they have acquired over time. Hence, these communities could be resistant to changing their sanitation practices. They may choose to stop open defection, but it may take time.

The environmental conditions surrounding these villages further shaped their attitudes in favor of open defecation. In Ban Tok Ong Keo, the geophysical conditions of the village make latrine construction difficult. The soil can be too hard, and the ground water is sometimes too low. Thus, villagers were not motivated to construct new latrines.

This pre-test experience taught us valuable lessons about our communication approach to change sanitation practices among ethno-linguistic populations. It led us to strengthen the effectiveness of our approach by making it adaptive to specific local contexts.

Initially, our team agreed that a communication campaign to improve the sanitation practices of Lao communities like the Alak would require:

  • Determining the socio-cultural beliefs and ecological/environmental context of target communities,
  • Identifying the relevant communication networks, decision-making processes, and social leadership that could be utilized by the community to facilitate change, and
  • Identifying and building the capacity for trusted sources of information in the community.
CAPTION

We left Sekong province with valuable insights.


The National Centre for Environmental Health and Water Supply together with the World Bank’s Water and Sanitation Program and other development organizations have partnered with Another Option, LLC to create a series of communication products that will help to inspire the use of improved sanitation facilities in rural areas.