In the Amhara Region of Ethiopia, the Learning by Doing
Initiative (LBDI), a joint project between the Government of
Ethiopia, the Amhara Regional Health Bureau, USAID’s Hygiene
Improvement Project (HIP), and the Water and Sanitation Program,
started at large scale and then expanded, growing from an
initial 93,000 households in four districts to include 5.8
million people in 94 districts. LBDI resulted in 2.8 million
more people stopping the practice of open defecation. In
Learning by Doing: Working at Scale in Ethiopia, Kebede Faris
and Julia Rosenbaum summarize key strategies and lessons from
LBDI.Working at the sub-district level, LBDI trained a cadre of
outreach workers, focusing on both community mobilization and
household-level behavior change tools. Strategies including
building capacity at the community level and developing and
testing tools and training manuals. LBDI also emphasized “small
doable actions,” whereby health extension workers negotiated
directly with household members to determine the sa