Delivering transformative WASH at scale is challenging, in part because delivering behavior-change interventions at the necessary frequency, fidelity, and coverage levels is difficult. Further complicating the issue, behaviors may be individual, influenced by social norms, or require collective action. The Nurturing Care Group (NCG) approach is a model where 10-12 women chosen by groups of 10-15 neighboring households each meet with health promoters, and then relay messages back to their neighbors every two weeks. World Vision conducted a controlled before-and-after trial in two districts of Ghana from June 2019 to December 2020. The NCG program promoted a variety of key WASH behaviors, including household water treatment and storage, toilet construction and use, hand hygiene, menstrual hygiene management (MHM) knowledge and stigma, and animal feces management.
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