The Ghana Public-Private Partnership for Handwashing

1. The Ghana Public-Private Partnership for Handwashing Experiences from a Country Programme

2. Diarrhoea among the top 3 reported causes of morbidity in health facilities 25% of all deaths in children under five years in Ghana attributed to diarrhoea 9 million episodes of diarrhoea and RTI/yr Bottom line… • Handwashing with soap could save 40,000 young lives each year • National benefits of the campaign could amount to over US $4m and pay for costs of programme • For private sector, 2,000 metric tonnes more of soap sales i.e $1.25m of sales per annum from changed hygiene behaviour

3. OBJECTIVE: Increase the practice of handwashing with soap. From 16% to 50% in two years among mothers and care-givers of children under five years especially after cleaning up a child. 2. From 20% to 50% in two years among school children aged 6-15 years especially after using the toilet. What did Ghana seek to achieve? PARTNERS Government of Ghana Unilever PZ Getrade The World Bank/WSP LSHTM UNICEF DANIDACWSA – Implementing Agency Note: Global Initiative

4. Who are the key stakeholders? Advocacy, selling the idea…creating awareness of benefits and win-win opportunities Obtaining buy-in of stakeholders…and creating momentum behind the idea Clarifying roles and responsibilities…also finding the right institutional home Negotiating rules of engagement.. Ghana Process…1/2 From Global to National National PPPHW Steering Committee Regional and District PPPHW Steering Committees

5. Consumer research! Concept development and testing Materials development and testing Launch and roll-out Evaluation Relaunch…phase 2 Ghana Process…2 WHAT DRIVES CHANGE? disgust Results: positive+change

6. High-impact communication strategy Highly professional, using the power of commercial marketing Target audiences mothers and care givers of children under five years children in basic school aged 6-15 years across the whole country. Public Relations and Advocacy targeting policy makers and opinion leaders Communication Strategy“For truly Clean Hands, always wash with soap”. Mass media DCC District level programme

7. REACH: 71% of women interviewed had heard of campaign. Of this: 69% from TV 13% billboard 58% radio 64% at clinics 14% posters (clinics) 27% from events Campaign Goals.. Create awareness on the benefits of handwashing with soap among 50% of mothers and care-givers of children under five years and 50% of school children aged 6-15 years in the first year and raising it to 80% in the third year. 80% 50% YR 1 YR 3

8. Mobilized: $1.0m funded through CWSP2/1 Financing… Phase 2 Phase 1 • Mobilized: $0.45m $0.3m funded through STWSSP • $0.15m DANIDA

9. Long term sustained financing is crucial… Campaign momentum Loss of momentum PHASE 1 PHASE 2

10. Results…behaviour did change! Before Campaign Reported HWWS (Baseline) 1. After defecation: 76% 2. Before eating: 14% After Campaign Reported HWWS 1. After defecation: 89% …+13% 2. Before eating: 55% …+41%

11. Results…behaviour did change!

12. Professionally crafted high-impact communication strategy using state-of-the-art expertise of the private sector. Innovative, award-winning. Exploiting the power of the media and implementing a highly professional communications programme, using the power of commercial marketing. Pioneering full scale hygiene programme quickly overcome initial sceptism through harnessing the support of diverse stakeholders in an effective advocacy drive Credible partners gave high credence to the programme. Distinctive Features….

13. Overcoming initial resistance and sceptism to the idea of a PPP for Handwashing Getting the advocacy right… PPP – a marriage of convenience or mutual long term goals? Equitable relationship? Key challenges…. • Getting to understand how both sectors work…often frustrating process • National state-of-the-art campaign is an expensive venture. • How to mobilize sustainable long-term commitment and financing

14. Keeping track and improving the message How to deal with the barriers eg. no water supply, no facilities in schools, smell or chemicals in soap Branding Relative cost-effectiveness of channels Key challenges….

15. Invest sufficient time and resources in developing viable partnerships that can sustain the programme..patience will pay higher dividends Programmes should not be dependent on short-term financing eg. Projects. Sustained implementation requires robust long-term financing sources eg. Annual budgetary allocations. Some key lessons…1 • Invest in advocacy…target policy-makers in a sustained way to ensure buy-in at the highest level. Drive this locally. • Be more creative in mobilizing financing eg. Building partnership with the media • Mainstream implementation in appropriate institutional home and develop capacity within public sector to manage large scale programmes

16. Understanding motivation is central to Health Promotion Keep the focus on consumers Adopt a pragmatic approach Marketing mix: optimisation Role of the marketer is key - skills Some key lessons… THANK YOU