research demonstrates that reinforcement
of positive behaviors is critical if change is to
be sustained over the long term, particularly for hand-washing behaviors where the
goal is to prevent incidence of diarrhea5.
Still, the program’s emphasis on infrastruc-
ture to support positive behaviors, such
as hand-washing stations and increased
availability of community latrines, increases
the likelihood of sustainability, particularly
for reducing open defecation and the use of
data from the sensors can potentially
have multiple applications. The data can be
analyzed and compared to secondary data
sources such as social surveys, finances, com-
modity prices, rainfall, school and healthcare
facility attendance, or work schedules to bet-
ter understand user behavior. Other compari-
sons can be made between implementation
strategies such as particular educational ma-
terials or the use of community health work-
ers to disseminate the technology. Results
can also be monitored with more frequency
than traditional survey methods, allowing for
more adjustment of program interventions.
With this data, systems and implementation
strategies can be designed more effectively to
accommodate a user’s needs and desires.
Instrumented monitoring systems may be
an effective method to improve data collection and thereby program quality and impact
within global health programs. Mercy Corps,
like other development organizations, invests
significant resources in water and sanitation
infrastructure and behavior change programs.
It also invests in monitoring and evaluation
staff time, though it remains aware that
survey data can be biased towards showing
success and most often relies on self-reported
data. By incorporating instrumentation with
remote data access, programs can monitor results over time, rather than relying on
isolated survey response, and more directly
measure behavior and reduce self-reporting
bias. This can now be done at a significantly
lower per-sample cost given the availability of
Remote sensors can capture usage data, but
they don’t tell the whole story. It is important to
triangulate these findings with other sources of
information, and qualitative data as well, to bet-
ter understand behaviors and attitudes related
to these practices.
But use of remote monitoring sensors
coupled with traditional monitoring and
evaluation methods may work to improve
overall programming in the long run.
Combining both methods throughout the
intervention period and beyond the end of
the program could potentially contribute to
greater understanding of the effectiveness
of the projects and ensure that not only
targeted program indicators are met but that
the end results—abundant clean water, improved hygiene, reduced infectious disease
rates and malnutrition, especially in young
The authors recognize the significant collaborations in this ongoing program, including students and staff at Portland State
university and Stevens Water and Mercy
Corps staff in Portland and Jakarta. •
Breslin, E. (2010). Rethinking hydro-philanthropy: smart
money for transformative impact. From http://aquadoc.
C. C. Gibson, K. A. (2005). The Samaritan’s Dilema: The
Political Economy of Development. Oxford: Oxford
Cho wdhury, Z. E. (2007). An inexpensive light-scatter-ing particle monitor: field validation. Journal of Envior-nmental Monitoring , 9, 1099-1106.
Clasen, T. F. (2012). Making Sanitation Count: Developing and Testing a Device for Assessing Latrine Use in
Low-Income Settings. Environmental Science and
Technology , 46 ( 6), 3295-3303.
Curtis, e. al (1997). Dirt and diarrhea: formative research
in hygiene promotion programmes. Health Policy and
Planning, 12 ( 2), 122-131
Curtis, V., Cairncross, S. and R. Yonli (2000). Domestic
hygiene and diarrhea — pinpointing the problem,
Tropical Medicine and International Health, 5( 1), 22-32.
EHP/USAID. (2009). Joint Publication 8. They Hygiene
Improvement Framework-A Comprehensive Approach
for Preventing Chidhood Diarrhea. Prepared under EHP
Project 26568/CESH. HI. ADVOAC Y. Y3
FAO. (2011). Integrated food-energy systems: generat-
ing climate-smart energy for food security. Retrieved
2011 from http:// www.fao.org/bioenergy/67564/en
GACC. (2011). Global alliance for clean cookstoves quick
facts. From http://cleancookstoves.org/wpcontent/
Jaggi, N. K. (2011). Multi-sensor activation for tempo-
rally correlated event monitoring with renewable en-
ergy sources. International Journal of Sensor Networks,
10 (1/2), 42-58.
Kafetzoglou, S. P. (2011). Energy-efficient framework
for data gathering in wireless sensor net works via the
combination of sleeping MAC and data aggregation
strategies. International Journal of Sensor Net works ,
10 (1/2), 3-13.
Kapur, D and Kumar, P. (2012) Formative Research on
Sanitation and Hygiene Behaviors Current Status,
Knowledge, Attitudes, Barriers and Enablers: Primary
Research Findings, Paper prepared for the Asia Regional Sanitation and Hygiene Practitioners Work Shop,
Dhaka, Bangladesh, 31 January — 2 February 2012, IRC
WASH Library from http:// www.irc.nl/page/68626
L. Olembo, F. K. (2004). Safe water systems: an evaluation of the Zambia CLORIN program. From http://
Marsh, D.R, Schroeder, D. G., Dearden, K. A., Stemin, J.
and Sternin. (2004) The power of positive deviance.
BMJ, 329; 1177-9.
Morreale, P. Q. (2011). a green wireless sensor network for
environmental monitoring and risk identification. International Journal of Sensor Networks, 10 (1/2), 73-82.
P. Hunter, D. Z.-N. (2009). Estimating the impact on
health of poor reliability of drinking water interventions
in developing countries. Science of Total Environment,
Properzi, F. (2010). Rapid assessment of drinking water
quality (RAD WQ) . UNICEF/ WHO.
R. Bailis, V. B. (2007). testing for monitoring improved
biomass stove interventions: experiences of the household energy and health project. Energy for Sustainable
Development, 11 ( 2), 57-70.
Thomson, P. H. (2012). GSM-enabled remote monitoring of rural handpumps: a proof of concept study.
Journal of Hydroinformatics.
United Nations. (2005). UN Department of Economic
and Social Affairds, Population Division, Wolrd Population. United Nations.
V. Berrueta, R. E. (2008). Energy performance of wood-burning cookstoves in Michoacan, Mexico. Rene wable
Energy, 33 ( 5), 859-870.
WHO. (1998) Participatory Hygiene and Sanitation
Transformation Planning Process, PHAS T, http://www.
WHO. (2004). Sanitation and hygiene links to health;
facts and figures. WHO.
WHO/UNICEF. (2010). Progress on drinking water and
sanitation. Geneva: WHO and UNICEF Jount Monitoring
Program on Water Supply and Sanitation.
WSP (No date). Methodology for Participatory Assessments, World Bank Water Sanitation Program (WSP)
and IRC International Water and Sanitation Centre
1 Stanton B F, Clemens J D, 1987 An education intervention for altering water-sanitation behavior to reduce
childhood diarrhea in urban Bangladesh II. A randomised
trial to assess the impact of intervention on hygienic
behaviors and rates of diarrhea. American Journal of
Epidemiology 125( 2): 292-301.
2 Manun’Ebo M , Cousens S , Haggerty P , Kalengaie M ,
Ashworth A, Kirkwood B, 1997. Measuring hygiene
practices: a comparison of questionnaires with direct
observations in rural Zaire. Trop Med Int Health 2: 1015
3 Chowdhury, Z. E. (2007). An inexpensive light-scat-tering particle monitor: field validation. Journal of En-viornmental Monitoring , 9, 1099-1106.
4 Thomson, P. H. (2012). GSM-enabled remote monitoring of rural handpumps: a proof of concept study.
Journal of Hydroinformatics .
5 Clasen, T. F. (2012). Making Sanitation Count: Developing and Testing a Device for Assessing Latrine Use in
Lo w-Income Settings. Environmental Science and Technology, 46 ( 6), 3295-3303.