Hygiene Sanitation Promotion by lxq53487


									         Hygiene &
WCAR Programme
Network Meeting
   April 2008
WASH interventions

Water Supply
Hygiene promotion
  Hand washing
  Safe disposal of child feces
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                     Malaria
 contribute to about
 88% of diarrhoea                       8%              Pneumonia
       deaths                                              19%
                         Measles 4%

                                                           Injuries, 3%
                          17%             >50%
                                      Attributable to
                                      Undernutrition      Other, 10%


      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
200 million people in the world are
 infected with schistosomiasis
Reduction in diarrhea morbidity (%)
                                       Diarrhoea Risk Reduction
                                              Previous reviews             Fewtrell et al. (2005)







                                           (a) Sanitation        (b) Water            (c) Water         (d) Hygiene      (e) Hand
                                                                 availability           quality          promotion       washing
                                      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.
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
Without improved
hygiene behaviours
four in ten children
will not reach their
full educational
 Maintaining a
  healthy environment
  through hygiene
  improvements is
  essential to safe
  guarding the health
  and quality of life
  of people living with

 AHI – hand washing
  one of the four key
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
 $0.39 per person
    Cost effectiveness
Interventions against diarrhoeal disease                 ratio (US$ per DALY
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,
Build on existing knowledge & practices
RESOURCES         Recruitment
                  of mass         Mass Media
                  media, press    TV, Radio, print
Financial         events.         Interpersonal
                  Creation,                            Improve
Existing                          Communication
                  printing of                          knowledge
dissemination                     House to house
                  promotional     promotion with       of 4 critical
                  materials,      decision makers,     handwashing
MoH, MoE, MoWR, Recruitment,      caretakers &         moments
NGO’s, FBO’s      activation &    children             among
                  participation   Community            caretakers
Regional Health,
Water & Education of NGO’s,       Mobilisation         and children
Bureaus           FBOs,CBOs,      Community,
                  schools, &      religious &
Private Sector                    educational
                                  promotional events
WASH committees   leaders

  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)
America’s – Bolivia
In total approximately 17 countries
SLTS – School Led Total Sanitation in
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
 Measuring and evaluating results.
Private Sector

Soap Manafacturers/detergent makers
Unilever, P & G, Colgate, etc
Example: Unilever
Global MoU, Country LoA’s
In Safe Hands
Project 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
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          2. Research         3. Insight &       4. Programme
                                        Creativity         Design
•    Clarify Task   •   2 countries
•    Mine info &    •   Experimental    •   Insight work   •   Involve
     knowledge          & exploratory   •   Ideas              agencies &
     globally       •   High core           Roadshow           experts as
•    Develop            team            •   Selective          necessary
     hypotheses         involvement         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
Common messages and materials
Communication strategy – for all aspects
Matrix of interventions and activities
Increased funding
Focus on change not facilities
Useful Sites

EHP/HIP Website
WEDC – information notes

 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

Global Network and forum
Working with Children on key
Evidence base
WSSCC – It’s the big issue

Water Supply and Sanitation
 Collaborative Council
WASH Coordinators
WASH Campaigns/Movements
Access to                            Hygiene
Services                            Promotion

     Hygiene Improvement

             Diarrheal Disease

            Enabling Environments
   Awareness                      Hygiene
   Promotion                 Improvement
• Behavioural & social
  Change & Skills
• Family Mobilisation
• Social Marketing
• Community
  Participation in Problem
  Detection & Solutions
           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

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