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

Hygiene &Sanitation Promotion

WCAR Programme Communication Network Meeting

April 2008

WASH interventions

Water SupplySanitationHygiene promotion

Hand washingSafe disposal of child feces

HWTSWASH in SchoolsWASH in Emergencies

10 million children U5 die each year

Pneumonia 19%

Malaria 8%

Other, 10%

Injuries, 3%

Measles 4%

Diarrhoea 17%

HIV/AIDS 3%

Neonatal 37%

Poor hygiene, lack of access to sanitation and unsafe drinking

water together contribute to about 88% of diarrhoea

deaths

>50% Attributable to Undernutrition

Causes of Mortality among under- five Children

Disease & disability

4 billion cases of diarrhoea each year10% of the developing world suffer from

intestinal worm infections6 million people are blind from

trachoma200 million people in the world are

infected with schistosomiasis

Diarrhoea Risk Reduction

0

10

20

30

40

50

60

70

(a) Sanitation (b) Wateravailability

(c) Waterquality

(d) Hygienepromotion

(e) Handwashing

Red

uct

ion

in

dia

rrh

ea m

orb

idit

y (%

)

Previous reviews Fewtrell et al. (2005)

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.

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

Severe and moderate stunting could be reduced by 39%.

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 ARI’s 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 cost-effectiveness of hand washing at the top of child survival interventions

MBB – economic data, Hand washing $0.39 per person

Cost effectiveness

Interventions against diarrhoeal diseaseCost-effectiveness

ratio (US$ per DALY averted)

Cholera immunizations 1,658 to 8,274

Rotavirus immunizations 1,402 to 8,357

Measles immunization 257 to 4,565

Oral rehydration therapy 132 to 2,570

Breastfeeding promotion programs 527 to 2,001

Latrine construction and promotion ≤270.00

House connection water supply 223

Hand pump or stand post 94

Water sector regulation and advocacy 47

Latrine promotion 11.15

Hygiene promotion (including hand washing) 3.35

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

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

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

Human

Financial

Existing dissemination mechanisms

MoH, MoE, MoWR, NGO’s, FBO’s

Regional Health, Water & Education Bureaus

Private Sector

WASH committees

INPUTS

Recruitment of mass media, press events.Creation, printing of promotional materials,Recruitment, activation & participation of NGO’s, FBOs,CBOs, schools, & community leaders

ACTIVITIES

Mass Media

TV, Radio, print

Interpersonal CommunicationHouse to house promotion with decision makers, caretakers & children

Community Mobilisation Community, religious & educational promotional events

OUTPUTS

Improve knowledge of 4 critical handwashing moments among caretakers and children

OUTCOMES

CLTS/Total Sanitation

Open Defecation Free CommunitiesCommunity based processDemand DrivenTechnology choice secondarySocial change – pride and dignityCommunity managed

CLTS/Total Sanitation

Asia – Cambodia, Bangladesh, IndiaAfrica – Ethiopia, Zambia, Malawi,

Sierra Leone (Kaka free villages)America’s – BoliviaIn total approximately 17 countriesSLTS – 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 makersUnilever, P & G, Colgate, etcExample: UnileverGlobal MoU, Country LoA’sIn Safe HandsProject 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 5’s 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

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.

Getting poorer households across the world to hand wash with soap is more alike as a challenge than it is different.

Program Development

Working in Africa (Uganda) & Asia (TBC)…

1. Scoping

• Clarify Task• Mine info &

knowledge globally

• Develop hypotheses

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

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

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.orgEHP/HIP WebsiteCDCWEDC – information notesWELL

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

WASH in [email protected]

Global Network and forumWorking with Children on key

behavioursEvidence baseEvaluations

WSSCC – It’s the big issuewww.wsscc.org

Water Supply and Sanitation Collaborative Council

AdvocacyWASH CoordinatorsWASH Campaigns/Movements

HygienePromotion

Access toServices

Hygiene Improvement

Enabling Environments

Diarrheal DiseaseReduction

HygieneAwareness

and Promotion

HygieneImprovement

Framework• Behavioural & social

Change & Skills• Family Mobilisation• Social Marketing • Community

Participation in Problem Detection & Solutions (TripleA)

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 ChangeSocial ChangeSocial Marketing