This document provides an update on a climate change and community health project in Kiribati. It summarizes the project's context, objectives, strategies, and status. The project aims to reduce child mortality rates in Kiribati, which are among the highest in the Pacific, by promoting evidence-based behaviors around handwashing, water treatment, and sanitation. Key strategies include community events, demonstrations, interpersonal communication activities, and the promotion of solar water disinfection (SODIS) and tippy taps for handwashing. The project is being implemented in the Kawan Bairiki community and led by health organizations

1. CLIMATE CHANGE AND
COMMUNITY HEALTH
PROJECT UPDATE
02 JULY, 2014

2. Nicol Cave – nicolc@spc.int
CONTEXT
 OFF – TRACK, MDG 4
 respiratory diseases;
 diarrhoeal diseases
 late health care seeking behaviour.
 CLIMATE CHANGE RISKS REVERSING /
SLOWING GAINS AGAINST MDG 4 (and
others)

3. Nicol Cave – nicolc@spc.int
CHILD MORTALITY RATES
(2012)
COUNTRY CHILD
MORTALITY
RATE Per 1000
COUNTRY CHILD
MORTALITY
RATE Per 1000
PNG 63/1000 FIJI 22
KIRIBATI 60 / 1000 SAMOA 18
FSM 39 VANUATU 18
MARSHAL
ISLANDS
39 TONGA 13
NAURU 37 COOK ISLANDS 11
SOLOMON
ISLANDS
31 NEW ZEALAND 6
TUVALU 30 AUSTRALIA 5
NIUE 25source: UNICEF Progress Report ,2013

4. Nicol Cave – nicolc@spc.int
HEALTH COMMUNICATION
COMPONENT
PHASE TIMEFRAM
E
KEY ACTIVITIES & OUTPUTS STATUS
CAMPAIGN
PLANNING
Mar ’14 training; issue selection; draft plan. COMPLET
E
AUDIENCE
RESEARCH
Apr ‘14 Audience Research (FGDs & KAP
Survey)
Baseline & M & E indicators
COMPLET
E
MESSAGE
DESIGN
May ’14 Communication tools dev. & pre-testing
Stakeholder & Expert Review
COMPLET
E
ON
TRACK
DEVELOPME
NT
Jun - July ‘14 Design, production, re-testing IEC,
social marketing & IPC tools
ON
TRACK
CAMPAIGN
ROLL OUT
Aug ‘14 –
Jun ‘15
Campaign launch and roll out ON
TRACK
M & E Jul ‘15 – Aug
‘15
Tracking & KAP Survey

5. Nicol Cave – nicolc@spc.int
PROJECT PARTNERS
Led by MHMS Environmental Health Services with,
Kawan Bairiki community MHMS Health Promotion Unit
MHMS Laboratory Services MHMS Health Information Unit
Ministry of Education, CDRC Office of the President
Kiribati Adaptation Program III Ministry of Public Works & Utilities
MELAD Conservation Unit Red Cross
Kiribati Music Federation GCCA/USP, Live & Learn
 SPC Climate Change, Public Health & SOPAC Divisions
 Collaboration with EU, GCCA and GIZ

6. Nicol Cave – nicolc@spc.intNicol Cave – nicolc@spc.int
CAMPAIGN TARGET
AUDIENCES
PRIMARY TARGET AUDIENCE –mothers
of children under 5 years living in
Kawan Bairiki
SECONDARY AUDIENCE: father of
children under 5 years living in
Kawan Bairiki

7. Nicol Cave – nicolc@spc.int
PROJECT LOCATION
PROJECT SITE SELECTION CRITERIA
 Diarrhoeal disease burden
 Hardship (water source challenges)
 Relative poverty & unemployment
 Convenience (project costs)
 Established relationships (EHS)
 Other role-players focussing on sanitation, few
specifically on HWWS & HWTS.
 Need field testing before replication & scale up

8. Nicol Cave – nicolc@spc.int
KAWAN BAIRIKI COMMUNITY
MAP

9. Nicol Cave – nicolc@spc.int
ABOUT KAWAN BAIRIKI
COMMUNITY
 Population – 1000 - 1100
 Households – 150 - 200
 Water supply
 Rainwater - 54
 Reticulated water - 127
 Well water - 25
 Sanitation/Toilet types
 Pit latrine – 2
 Septic tank – 58
 Others - 62

10. Nicol Cave – nicolc@spc.int
BEHAVIOURAL OBJECTIVES
1. Mothers, wash your hands! (toilet; nappy; food preparation)
2. Mothers, wash your children’s hands (toilet, eating; playing)
3. Mothers, dispose of nappies properly.
4. Mothers, don’t let your children play near human or animal feces/toilets.
5. Use bleach to wipe surfaces and cooking utensils.
6. … always treat (boil, bleach, solar) water for drinking, cooking and washing dishes.
7. Clean water containers properly.
8. Always put bleach into water used for washing dishes.
9. Be careful when you wash children so that water does not go in their mouths/nose.
10. Build covers for open wells.
11. Always keep water wells covered.
12. Clean gutters/rain water harvesting/catchment system every day?
13. Do not let your young children drink straight from the well/tank/water contained.
14. Do not let your children play in flood water.
15. Do not let your children play in the lagoon.
16. Bury waste water/dispose in a “soak pit”.
17. Keep animals away from household water sources (wells).
18. Take your child to the clinic if she/he has had diarrhea or vomiting for more than 2 days.
19. Don’t rely on traditional medicine/traditional healers.
20. Use traditional medicine and clinic medicine.
21. Mothers, know and practice the 5 Fs.

11. Nicol Cave – nicolc@spc.int
• Household Water
Treatment, Storage &
Handling
• Hand-washing with soap &
running water
• Safe disposal of child and
adult faces
EVIDENCE-BASED
behaviours to reduce under 5 diarrhoea
43%
36%
17%

12. Nicol Cave – nicolc@spc.int
BEHAVIOURAL OBJECTIVES
1. Wash your hands with soap & running water
– after toilet, before preparing food, feeding baby, eating.
– Less focus on after cleaning baby – practice already at high level
2. Disinfect all water used for children under 5 years
– try SOLAR DISINFECTION (SODIS)
• Immediately seek treatment for diarrhoea
• Share water & child health responsibilities

13. Nicol Cave – nicolc@spc.int
SMART BEHAVIOURAL OBJECTIVES
1. By June 2015, 35% of households in Kawan Bairiki have
a fixed hand-washing station or tippy tap with soap in
the home (kitchen) or immediate outside/yard area.
 Baseline in May 2014 = 20%
 Data collection method – pre & post intervention KAP Survey
2. By June 2015, 40% of households in Kawan Bairiki
report ever using SODIS water disinfection method.
 Baseline in May 2014 = 10%.
 Data collection method – pre & post intervention KAP Survey

14. Nicol Cave – nicolc@spc.int
BASELINE: Hand-washing with soap (HWWS)
25%
76
20%
81
YES NO
HAND WASHING PROXY INDICATORS AT BASELINE
Fixed washing station in home soap present at washing station
SOURCE: Rapid KAP Survey, May 2014

15. Nicol Cave – nicolc@spc.int
BASELINE: ever used SODIS method
SOURCE: Rapid KAP Survey, May 2014
yes
10%
no
81%
don't
know
9%
ever used solar disinfection

16. Nicol Cave – nicolc@spc.int
KEY CAMPAIGN STRATEGIES
1. Enabling products & skills workshops
• SODIS bottles & tippy tap materials
2. Community meetings & events
• With inter-personal communication activities
3. Community research & demonstration sites
• Showing SODIS and tippy taps
4. Home-to-home promotion (word of mouth)
• Community-based promoters
5. DVD & simple fact-sheet

17. Nicol Cave – nicolc@spc.int
KAP SURVEY RESULTS
5%
4%
4%
10%
24%
29%
24%
PREFERRED COMMUNICATION CHANNELS
brochure
DVD
events/contests
church
community meetings
HW village visit
HW home visit
SOURCE: Rapid KAP Survey, May 2014

18. Nicol Cave – nicolc@spc.int
STRATEGIES: INCREASE HAND WASHING
1. Wash your hands with soap & running water
– after toilet, before preparing food, feeding baby, eating.
2. Construct a household tippy tap:
– With materials you have sourced yourself OR
– With materials supplied by the project after you have
attended SODIS and tippy tap skills workshop
ACTION: Source and cost tippy tap construction materials
ACTION: Check against budget available/cost feasibility
ACTION: Engage private sector to supply materials for trial

19. Nicol Cave – nicolc@spc.int
TIPPY TAP
LOCAL MATERIALS

20. Nicol Cave – nicolc@spc.int
TIPPY TAP
HARDWARE STORE
BOUGHT MATERIALS

21. Nicol Cave – nicolc@spc.int
BEHAVIOUR # 2
TREAT ALL WATER USED FOR UNDER 5’s,
• Try Solar Disinfection (SODIS) method
• Used by +10 million people daily in +50 countries
in Asia, Latin America and Africa
• Practiced for more than 30 years
• First used in 1981 & approved by WHO in 2000
• Currently promoted by WHO, UNICEF, World
Bank, Asia Development Bank, Oxfam, Red Cross
& others.

22. Nicol Cave – nicolc@spc.int
We will promote global
standard – expose bottles to
sun FOR 6 HOURS on sunny
days and over two days if it is
cloudy

23. Nicol Cave – nicolc@spc.int
STRATEGIES: SODIS FIELD TRIAL
• How to enhance SODIS for KI context
• which bottles? which surface? how long in sun?
• affordability, acceptability
• sustainability
• OUTCOMES
• Kiribati-specific SODIS
– Guidelines
– Educational materials
– Products

24. Nicol Cave – nicolc@spc.int
VERY IMPORTANT!!
we already know for certain that SODIS works
we will promote SODIS uptake & do research
at the same time
• The research will
– Involve target audience (skills transfer)
– Communicate findings through demonstration sites
– Test different containers and reflector materials
– Establish Kiribati-specific exposure time
– Establish SODIS enhancements best for KI.
– Establish whether SODIS is acceptable, affordable, sustainable in
Kiribati?

25. Nicol Cave – nicolc@spc.int
Possible barriers to SODIS uptake
• Some people are afraid of taking up new things.
• SODIS so simple, people may lack confidence that it really works.
• The project needs to show that “sun boiling” is well-research,
globally practiced, widely accepted, effective, and endorsed by
major agencies.
• If done properly, SODIS is guaranteed to eliminate 99% of
pathogens harmful to humans.
• Campaign needs to do some pre campaign launch “lobbying” to
respond to possible obstacles to SODIS before they arise. This
includes meeting with and persuading the following stakeholders:
– Clinic in Kawan Bairiki
– Health Promotion Unit leadership
– Kawan Bairiki community elders & community structures

26. Nicol Cave – nicolc@spc.int
Global lessons shows
that “word of mouth”
works best to promote
SODIS uptake
1-2-1 inter-personal
communication (IPC)
STRATEGIES:
COMMUNITY
PROMOTERS
SODIS PROMOTER

27. Nicol Cave – nicolc@spc.int
DEMONSTRATION SITES
– early adopters

28. Nicol Cave – nicolc@spc.int
DEMONSTRATION SITES
– SODIS promoters

29. Nicol Cave – nicolc@spc.int
SODIS MASTER TRAINERS
SODIS PROMOTERS
• Early adopters - Demonstration Sites
• Visit & advise other households
SODIS USERS
STRATEGIES: COMMUNITY (SODIS)
PROMOTERS

30. Nicol Cave – nicolc@spc.int
PROPOSED
DEMONSTRATION SITES
KAWAN BAIRIKI

31. Nicol Cave – nicolc@spc.int
STRATEGIES: Inter-personal
communication (IPC)
• Fun learning games facilitated in small groups
of target audience. Games include:
1. Water lens protection BINGO;
2. Good for health, bad for health & in-between 3-
pile sorting game;
3. 5 F’s of disease transmission game;
4. Gender roles & responsibilities sorting game
5. Hand washing with soap “science” experiments
(using flour, pepper & white cloth)

32. Nicol Cave – nicolc@spc.int
KAP II –
WATER LENS
GAME

33. Nicol Cave – nicolc@spc.int
KAP II WATER LENS PROTECTION GAME

34. Nicol Cave – nicolc@spc.int
IPC - SORTING GAME

35. Nicol Cave – nicolc@spc.int
PRE-TESTING “5 Fs”
TRANSMISSION ROUTES
GAME IN KAWAN BAIRIKI

36. Nicol Cave – nicolc@spc.int
STRATEGIES: COMMUNITY EVENTS
• Events will
– Be held in Kawan Bairiki
– Attract up to 2000 people
– Include a range of stalls, demonstration sites &
activities including
• Mother & child beauty context
• Song & dance competition
• Tippy tap, hand-washing demonstrations
• Quizzes & prizes
• FUN, FUN, FUN!!!!

37. Nicol Cave – nicolc@spc.int
STRATEGIES: DVD & FACTSHEETS
• Develop 10-min local language DVD on SODIS
– What it is?
– Where it is used?
– How and why it works?
– How to do it?
– What evidence is there that it is safe?
• Develop simple picture code on SODIS steps

38. Nicol Cave – nicolc@spc.int
CONTACT
Nicol Cave
Team Leader: Strategic Health Communication
Public Health Division
Secretariate of the Pacific Community (SPC)
nicolc@spc.int