Hygiene & Sanitation Promotion

WCAR Programme Communication Network Meeting

April 2008

WASH interventions
Water Supply Sanitation Hygiene promotion
Hand washing Safe disposal of child feces

HWTS WASH in Schools WASH in Emergencies

10 million children U5 die each year

Poor hygiene, lack of access to sanitation and unsafe drinking water together contribute to about 88% of diarrhoea deaths

Malaria 8% Measles 4% Diarrhoea 17% HIV/AIDS 3%

Pneumonia 19% Injuries, 3%

>50% Attributable to Undernutrition

Other, 10%

Neonatal 37%

Causes of Mortality among under-five Children

Disease & disability

4 billion cases of diarrhoea each year 10% of the developing world suffer from intestinal worm infections 6 million people are blind from trachoma 200 million people in the world are infected with schistosomiasis

70

Diarrhoea Risk Reduction

Previous reviews Fewtrell et al. (2005)

Reduction in diarrhea morbidity (%)

60

50 40 30 20

1 0 0

(a) Sanitation
Previous reviews: ad e

(b) Water availability

(c) Water quality

(d) Hygiene promotion

(e) Hand washing

Esrey SA et al. (1991) Bull WHO 69 (5): 609-621 Curtis V, Cairncross S (2003) Lancet Inf Dis 3: 275-281.

Fewtrell L et al. (2005) Lancet Infect Dis 5(1): 42-52.

Severe and moderate stunting could be reduced by 39%.

Improved hygiene behaviours would decrease the risk of stunting in one in three children who are already vulnerable

Without improved hygiene behaviours four in ten children will not reach their full educational potential

 Maintaining a healthy environment through hygiene improvements is essential to safe guarding the health and quality of life of people living with HIV/AIDS.
AHI hand washing one of the four key messages

Evidence Base Quick Wins

Hand Washing Correct hand washing at critical times can reduce diarrhoea by 42 -47%.Children Under 15 - 53% lower incidence of diarrhoea. New evidence shows that it can also reduce ARIs by over by 6-44% (Lower risk by 50%)

Evidence Base Quick Wins

Handwashing is cost effective, HW campaigns avert one DALY per US$3.35 spent. Which places the costeffectiveness of hand washing at the top of child survival interventions MBB economic data, Hand washing $0.39 per person

Cost effectiveness
Interventions against diarrhoeal disease Cholera immunizations

Cost-effectiveness ratio (US$ per DALY averted)

1,658 to 8,274

Rotavirus immunizations
Measles immunization Oral rehydration therapy Breastfeeding promotion programs

1,402 to 8,357
257 to 4,565 132 to 2,570 527 to 2,001

Latrine construction and promotion

House connection water supply Hand pump or stand post Water sector regulation and advocacy Latrine promotion Hygiene promotion (including hand washing)

270.00
223 94 47 11.15 3.35

Source: Disease Control Priorities in Developing Countries, 2nd edition 2006 (www.dcp2.org) Chapter 41

Its all about Partnership . . . .

National and local Government structures NGOs, CBOs, FBOs Religious & Community leaders Development Partners & Donors Media Private Sector Voluntary Groups & individuals One common logo joint ownership

Advocacy and Promotion . . ..

Advocacy with decision makers, leaders, donors, private sector, leaders and the media. Promotion at community, school, household and individual levels

Common Messages . . . .
Avoid different and sometimes conflicting messages Simple practical messages that everyone can use One theme to maximise impact handwashing, sanitation, water quality, etc. Build on existing knowledge & practices

RESOURCES

Recruitment of mass Human media, press Financial events. Creation, Existing printing of dissemination promotional mechanisms materials, MoH, MoE, MoWR, Recruitment, NGOs, FBOs activation & participation Regional Health, of NGOs, Water & Education FBOs,CBOs, Bureaus schools, & Private Sector community leaders WASH committees

Mass Media
TV, Radio, print

Interpersonal Communication
House to house promotion with decision makers, caretakers & children

Community Mobilisation
Community, religious & educational promotional events

Improve knowledge of 4 critical handwashing moments among caretakers and children

INPUTS

ACTIVITIES

OUTPUTS

OUTCOMES

CLTS/Total Sanitation
Open Defecation Free Communities Community based process Demand Driven Technology choice secondary Social change pride and dignity Community managed

CLTS/Total Sanitation
Asia Cambodia, Bangladesh, India Africa Ethiopia, Zambia, Malawi, Sierra Leone (Kaka free villages) Americas Bolivia In total approximately 17 countries SLTS School Led Total Sanitation in Pakistan

Dare to think differently. . . Meet Captain Bubbles

PPPHW (www.globalhandwashing.org)
Concept Note available

Global level, the initiative seeks to raise the profile of handwashing and created sustained interest in public and private organizations. Country level, the PPPHW advocates for, and assists in the planning and implementing of large-scale country handwashing programs. While programs tend vary with local conditions, all share a common approach: Researching consumer needs to find out about handwashing habits, barriers and drivers of behavior change, and the best ways to communicate to the target audience; Designing appropriate and appealing messages; Implementing a promotion program making use of all suitable channels, whether through outreach workers, citizen networks, special events, soap distributors, schools, or mass media; Measuring and evaluating results.

Private Sector
Soap Manafacturers/detergent makers Unilever, P & G, Colgate, etc Example: Unilever Global MoU, Country LoAs In Safe Hands Project Champion

CHAMPION

Our goal*
To make a contribution to MDG4 by promoting at scale the essential link between hand washing with soap and the health of Under 5s by creating engaging ways for school children to: a)Influence behaviour change among mothers/caregivers and siblings b)Wash their own hands with soap at critical times.
* Taken from the CHARTER document agreed between Unicef & Unilever /Lifebuoy in 2007

Our Beliefs
Getting poorer households across the world to hand wash with soap is more alike as a challenge than it is different.
Creating a program from scratch in each new country (as is currently often done) wastes valuable resource. School children and schools one of the few common, stable and valued channels of influence within poor rural and urban communities in developing countries can significantly influence behaviour at home.

Program Development
Working in Africa (Uganda) & Asia (TBC)
1. Scoping
Clarify Task Mine info & knowledge globally Develop hypotheses

2. Research
2 countries Experimental & exploratory High core team involvement

3. Insight & Creativity

4. Programme Design
Involve agencies & experts as necessary

Insight work Ideas Roadshow Selective testing

The final program must work: at scale; across continents; where kids have little say; predominately through primary schools & primary school children.

Current Areas of Interest...

Social Norms theory Finding a unifying insight (i.e. attendance) Grossology + Disgust Identifying key role kids can play (energy, channel, conscience, reminder, etc) Things that change behaviour And more

POP Intervention

Make Hands Happy

International Year of Sanitation

A once-off opportunity which we should seize!

UN Water Task force on sanitation led by UNICEF

Common messages and materials

Communication strategy for all aspects

Matrix of interventions and activities Increased funding Advocacy Focus on change not facilities

Useful Sites
Hygienecentral.org EHP/HIP Website CDC WEDC information notes WELL

HWTSS
www.who.int Household Water Treatment and safe storage Waterguard Chlorine based soln Pur/Watermakers Sodis Filters Social Marketing/product based PSI, CDC, and network

WASH in Schools
www.schools@watsan.net

Global Network and forum Working with Children on key behaviours Evidence base Evaluations

WSSCC Its the big issue

www.wsscc.org

Water Supply and Sanitation Collaborative Council Advocacy WASH Coordinators WASH Campaigns/Movements

Access to Services

Hygiene Promotion

Hygiene Improvement
Diarrheal Disease Reduction

Enabling Environments

Hygiene Awareness and Promotion

Behavioural & social Change & Skills Family Mobilisation Social Marketing Community Participation in Problem Detection & Solutions (TripleA)

Hygiene Improvement Framework

Evolution of Interventions: from Pumps to Prevention

Hardware focus - engineering approach Sustainability focus - institutions, policies, cost recovery, community participation, private-sector involvement

Health impact focus - Address improving hygiene behaviors as the key to health improvement

Communicating for WASH

Behavioural Change Social Change Social Marketing