LSHTM, WaterAid, National Institute of Public Health
In 2019, 17 Triggers teamed up with London School of Hygiene and Tropical Medicine (LSHTM) and WaterAid under the Changing Hygiene Around Maternal Priorities (CHAMP) project to design and test innovative behavior change solutions that could improve handwashing to reduce the neonatal mortality rate in Cambodia. Nudges were developed to be integrated into labor & delivery rooms, as well as postnatal care units to encourage regular handwashing at key moments before, during, and after childbirth. Read more about the detailed interventions that were developed here.
While the 2021 evaluation of CHAMP showed that the interventions successfully effected improvements in hand hygiene, there were still improvements to be made. Thus, in 2022, WaterAid reached out once again to 17 Triggers to collaborate on “CHAMP Plus”. This time, the project focused on healthcare facilities with a higher volume of births in the province of Kampong Cham. The 17 Triggers team engaged health officials and government stakeholders to learn more about the behavioral gaps and shortcomings of the tools previously developed, then headed back into the field to ideate and test adaptations to the intervention.
Testing showed that, while midwives liked the digital training from CHAMP, there was not enough detail in the training sessions and they struggled to recall key information that linked to the nudge stickers in the labor and delivery room. As a solution, we moved to a hybrid approach of longer, in-person training sessions coupled with frequent digital self-study exercises, including quizzes and games, that applied learnings to real life scenarios. During training sessions, germs were made “visible” in a fun demonstration to discourage midwives from double gloving. The midwives also had an opportunity to reflect on their practices in teams and plan for improvements. A simple color ranking peer review system allowed them to continue supporting and encouraging one another long after the training sessions.
Midwives engage in a card-sorting game to discuss and memorize key moments for hand hygiene during labour and delivery.
Short explainer videos and simple instructional posters were added to postnatal care units to explain the “Clean Hand Zone” stations and tools. This took the pressure off of busy midwives who struggled to find time to introduce the “Clean Hand Zone” to moms and visitors and ensured that families were consistently briefed on the importance of hand hygiene.
The intervention went live in November 2022. Evidence generated from CHAMP Plus is being fed into ongoing policy processes in Cambodia to influence Cambodia’s Maternal Newborn Child Health National Strategy in the hope that it will complement and strengthen existing policies and guidelines.