Hygiene & Sanitation Promotion

1. WCAR Programme Communication Network Meeting April 2008 Hygiene &Sanitation Promotion

2. WASH interventions • Water Supply • Sanitation • Hygiene promotion • Hand washing • Safe disposal of child feces • HWTS • WASH in Schools • WASH in Emergencies

3. 10 million children U5 die each year

4. 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

5. Diarrhoea Risk Reduction Previous reviews: a – d Esrey SA et al. (1991) Bull WHO 69 (5): 609-621 e Curtis V, Cairncross S (2003) Lancet Inf Dis 3: 275-281. Fewtrell L et al. (2005) Lancet Infect Dis 5(1): 42-52.

6. 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

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

8. 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

9. 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 ARI’s by over by 6-44% (Lower risk by 50%)

10. Evidence Base – Quick Wins • Handwashing is cost effective, HW campaigns avert one DALY per US$3.35 spent. Which places the cost-effectiveness of hand washing at the top of child survival interventions • MBB – economic data, Hand washing $0.39 per person

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

12. It’s all about Partnership . . . . • National and local Government structures • NGO’s, CBO’s, FBO’s • Religious & Community leaders • Development Partners & Donors • Media • Private Sector • Voluntary Groups & individuals • One common logo – joint ownership

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

14. 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

15. RESOURCES Human Financial Existing dissemination mechanisms MoH, MoE, MoWR, NGO’s, FBO’s Regional Health, Water & Education Bureaus Private Sector WASH committees Recruitment of mass media, press events. Mass Media TV, Radio, print Interpersonal CommunicationHouse to house promotion with decision makers, caretakers & children Improve knowledge of 4 critical handwashing moments among caretakers and children Creation, printing of promotional materials, Recruitment, activation & participation of NGO’s, FBOs,CBOs, schools, & community leaders Community MobilisationCommunity, religious & educational promotional events INPUTS ACTIVITIES OUTPUTS OUTCOMES

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

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

18. Dare to think differently. . .Meet Captain Bubbles

19. 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.

20. Private Sector • Soap Manafacturers/detergent makers • Unilever, P & G, Colgate, etc • Example: Unilever • Global MoU, Country LoA’s • In Safe Hands • Project Champion

21. CHAMPION

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

23. 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.

24. Program Development • Working in Africa (Uganda) & Asia (TBC)… • Scoping • Clarify Task • Mine info & knowledge globally • Develop hypotheses • 2. Research • 2 countries • Experimental & exploratory • High core team involvement • 3. Insight & Creativity • Insight work • Ideas Roadshow • Selective testing • 4. Programme Design • Involve agencies & experts as necessary The final program must work: at scale; across continents; where kids have little say; predominately through primary schools & primary school children.

25. 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…

26. POP Intervention Make Hands Happy

27. 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

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

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

30. WASH in Schoolswww.schools@watsan.net • Global Network and forum • Working with Children on key behaviours • Evidence base • Evaluations

31. WSSCC – It’s the big issuewww.wsscc.org • Water Supply and Sanitation Collaborative Council • Advocacy • WASH Coordinators • WASH Campaigns/Movements

32. Access to Services Hygiene Promotion Hygiene Improvement Enabling Environments Diarrheal Disease Reduction

33. Hygiene Awareness and Promotion Hygiene Improvement Framework • Behavioural & social Change & Skills • Family Mobilisation • Social Marketing • Community Participation in Problem Detection & Solutions (TripleA)

34. 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

35. Communicating for WASH • Behavioural Change • Social Change • Social Marketing