DEDICATED TO MAKING A DIFFERENCE World Business Council for Sustainable Development Case study - PDF

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DEDICATED TO MAKING A DIFFERENCE World Business Council for Sustainable Development Case study - PDF Powered By Docstoc

World Business Council for
Sustainable Development                                                 Case study

Fighting disease clean-handed
Diarrhea causes over three million deaths a year worldwide, mostly among children. At a
rate of one child every ten seconds, mortality from diarrheal diseases represents one-
third of all deaths of children under the age of five in developing countries. Yet a World
Bank study estimates that handwashing with soap and water can reduce diarrheal
diseases by up to 48%, preventing over one and a half million children from dying each

Over 70% of India’s one billion population live in rural areas not reached by television,
radio or newspapers. Illiteracy is widespread and there are deep-rooted beliefs about
cleanliness that have to be addressed, such as the widely held belief that if hands look
clean, they are clean.

Unilever, a major soap manufacturer, believes that one of the best and most sustainable
ways it can help to address global social and environmental concerns is through the very
business of doing business in a socially aware and responsible manner.

While Unilever has supported hygiene education programs in India for many years, in
2002 the Lifebuoy brand team devised a way to have a real impact on reducing
diarrhoeal disease. Lifebuoy, produced locally by Hindustan Lever, is Unilever’s biggest
brand in India and the country’s most popular soap.

Changing behaviors

The program’s objective is to educate 200 million Indians – 20%of the population - to
wash their hands with soap after defecating and to achieve this goal within five years.
The program establishes the existence of "invisible germs" and the associated risk of
infection. The campaign, called Swasthya Chetna, or health awakening, is the largest
rural health and hygiene education program ever undertaken in India. The vision of this
on-going project is to make a billion Indians feel safe and secure by focusing on their
health and hygiene needs.

To ensure this initiative has a sustainable impact, the Lifebuoy team worked with advisers
to develop a multistage program, designed to involve and educate whole rural
communities. After seeking permission from village elders, the Swasthya Chetna teams,
consisting of a health development officer and an assistant, visit village schools to teach
children about germs and the importance of handwashing with soap.

The program aims to bring about a change in the underlying behaviors and attitudes of
the villagers through multiple visits and sustained communication in order to reinforce the
health message. By the end of these interactions, the villages will have understood and
internalized the importance of handwashing among other hygiene practices. Since health
awareness is an ongoing process, the initiatives of the village residents will make the
program evolveand keep Swasthya Chetna alive.
                                                                                 WBCSD page 2

The program

The program starts with a Health Development Facilitator (HDF) and an assistant
initiating contact and interacting with schoolchildren and influencers of the community,
like village community representatives, medical practitioners, school teachers, etc. A
number of tools like a pictorial story in a flip chart format, a "Glowgerm demonstration",
and a quiz with attractive prizes are used to reinforce the message. At the “Glowgerm”
demonstration, children apply a white powder to the palms of hands, then wash them with
water only. Hands are then held under an ultra-violet light and the powder glows where
dirt remains, showing that handwashing without soap is not enough. The children then
repeat the process, this time using soap, and discover the UV light shows no trace of the
powder – a simple but highly effective demonstration.

Later, the school puts on a Swasthya Diwas (“Day”) show for parents, village elders and
the community, acting out sketches and songs that extol the virtues of handwashing with

In the third phase, the Swasthya Chetna team visits every house in the village, inviting
mothers of young children to attend a health education session at which the handwashing
message is reinforced and local health workers give children a height and weight check-

The next phase involves recruiting schoolchildren, parents and other villagers as
volunteers to start up health clubs that, in turn, organize events such as community
bathing at the pond villagers use for washing.

The whole process, from initial contact to self-managed health club, takes two to three
years. While this represents a significant time investment, it is essential to ensure the
handwashing habit becomes part of everyday life.

To help people on low incomes afford to buy soap,          “Swasthya Chetna is not
an 18-gram bar of Lifebuoy soap has been                   about philanthropy. It’s a
introduced, enough for one person to wash their            marketing program with
hands once a day for 10 weeks. This sells for two          social benefits. We
rupees, equivalent to the price of four cups of tea or     recognize that the health
enough wheat for a meal for one person.                    of our business is totally
                                                           interconnected with the
Outcomes                                                   health of the communities
                                                           we serve and if we are to
The Swasthya Chetna program started in 2002 in             grow sales of our brand,
the eight Indian states (Uttar Pradesh, Bihar,             we have to increase the
Jharkhand, West Bengal, Orissa, Madhya Pradesh,            number of people who use
Chattisgarh and Maharashtra) where deaths from             soap.” -- Harpreet- Singh
diarrheal diseases are highest and soap sales are          Tibb, Hindustan Lever
lowest. In its first year 9,000 vi llages were visited by  Lifebuoy Brand Manager
150 teams of outreach workers speaking seven
dialects and with leaflets and posters printed in four languages. In 2003, another 9,000
villages were added, and in 2004 the emphasis was on introducing new phases to these
18,000 villages. By the end of 2004 the campaign had reached 70 million people,
including 20 million children at a cost to Hindustan Lever of 22.25 million rupees (US$ 2.7

Hindustan Lever has committed to funding Swasthya Chetna for five years at a cost of
24.5 million rupees (US$ 5.4 million), and the company has already started to see a
return on its investment. In 2003-4 sales of Lifebuoy grew by 20%, with particularly strong
sales in the eight states where the program operates.
                                                                               WBCSD page 3

Lessons learned

Unilever has learned the following lessons from its
                                                           Not always smooth sailing
experiences in India:
• Soap needs to be divided into smaller portions
                                                           Before the start of the Lifebouy
    in order to make it affordable for local               program in 2002, Unilever
                                                           worked on an experimental
• Take into account cultural differences and make          partnership called “The Global
    them work for you --> washing with soap has            Handwashing Partnership” with
    become a kind of ritual, i.e., it has been             The World Bank, Bank-
    accepted;                                              Netherlands Water Partnership
• Use multi-stakeholder relationships as a tool to         and Water & Sanitation Program
    ensure that the social and educational aspects         of the Bank, Procter & Gamble
    of the project are clear to the public;                and Colgate-Palmolive. The
• Be transparent about the company’s role to               partnership aimed to market
    show that the company is not just doing this to        soap by targeting consumers in
    make money;                                            general, not just the urban or
• Engage local actors to help in the process, they         rural poor, helping them change
    have the influence.                                    their behavior and attitudes
                                                           towards handwashing.
Moving forward
                                                           Unilever opted to work in the
Discussions are taking place with the Indian               Indian state of Kerala in 2001 in
government at the national level about extending the       partnership with the Indian Soap
program to other states and beyond Lifebuoy’s initial      & Toiletries Manufacturers'
five-year commitment.                                      Association (ISTMA), along with
                                                           UNICEF, the London School of
Swasthya Chetna has also generated interest in             Hygiene & Tropical Medicine and
other parts of Unilever. Unilever Bangladesh has           a number of NGOs. However,
adopted the Indian model for the past two years and        the program stalled and was
in 2004 close to 3,100 villages had been visited.          abandoned in August 2003
Additionally, the program has been or is currently         because it was unclear what
being rolled out in Indonesia, Pakistan, Sri Lanka,        Unilever’s role was – there to
South Africa, Uganda and Vietnam.                          make money, or there to help the
                                                           people. Kerala already had high
Other efforts in India: Hindustan Lever’s                  health indices, and as such was
Indian health camps                                        probably not the state in India
                                                           most in need of behavioral
Hindustan Lever's soap factory at Orai in Uttar            change.
Pradesh, northern India, is also working on
promoting health and hygiene for more than 7,000           The partnership in general and
people in five local villages. The factory is located in   Unilever in particular received
an agricultural area with high levels of poverty,          criticism including:
where less than half the local population can read         (a) the choice of Kerala for the
and awareness of good hygiene, nutrition and family        program in view of its already
planning is poor.                                          high human development
                                                           indicators; (b) unclear linkage
Health camps are organized to promote healthier            between handwashing and
living. These offer medical check-ups; basic               health improvement; (c) the
treatments such as deworming for children; and             potential adverse effect on the
straightforward advice on treating common diseases         indigenous and local soap
and on improving hygiene, through the regular              industry by increasing the market
cleaning and chlorination of wells for example. So         share of multinational soap
far nearly half the population of the five villages has    companies; and (d) the
attended a health camp and there have been no              suggestion that the state
outbreaks of disease since 1998.                           government was capitulating to
                                                           World Bank pressure.
                                                                                 WBCSD page 4

As well as family planning workshops, programs for mothers and children have been set
up. Maternity care includes monitoring and immunization, resulting in a zero deaths
among pregnant women, compared to a district average of 2.5 deaths per 1,000 live
births. Mothers are also taught about nutrition and hygiene so that infant mortality has
been dramatically reduced to 13 per 1,000 live births compared to an average of 96 per

Regular monitoring and measurement shows the initiative has made significant progress
in improving the lives of local people.

In Bangladesh, Lever Brothers has embarked on a cause-related marketing campaign
with the Friendship Association of Bangladesh, a humanitarian organization. The aim of
cause-related marketing is to link a brand with a cause in order to bring mutual benefits to
the brand, the partner organization and communities.

The aim of this campaign is to improve the health of people living in rural Bangladesh.
This improvement is being delivered via a boat — the Lifebuoy Friendship Hospital. This
unconventional but much needed facility was launched in spring 2002 on the Shitolakkha
river near Dhaka.

Lifebuoy in Bangladesh and Indonesia
Over one-third of Bangladesh's 130 million people live below the poverty line, the vast
majority in rural areas where healthcare is inadequate. The ratio of doctors to people is
20 to 100,000 and it is common for people in the countryside to travel over 40 kilometers
to reach the nearest health center. However, Bangladesh is criss-crossed with rivers and
canals. They can be used as routes for the Lifebuoy Friendship Hospital to reach people
in deprived areas.

Lever Brothers provided an initial $135,000 to the Friendship Association to convert what
was an old oil tanker into a hospital, and also helps with running costs. Every year the
hospital intends to serve at least 30,000 patients with free treatment and medicine. It
provides basic healthcare and hygiene education; offers immunization to children and
mothers; education on pre- and antenatal care and childcare; and also provides minor
eye surgery and dentistry. The medical team on board comprises two doctors, four
nurses, a pathology / X-ray technician and a medical clerk. The team is also being
supplemented by visiting doctors who volunteer their services.

The hospital, branded with the Lifebuoy name, is painted in Lifebuoy's brand colors of red
and white. Leaflets offering advice on basic health and hygiene are given out along with
free samples of soap, ensuring that the health message is spread. It also supports
national health campaigns: in summer 2002, the hospital took part in National
Immunization Days, immunizing around 1,000 children with polio vaccine and
administering vitamin A. In its first few months of operation, half the hospital's cases
concerned children and around a third addressed reproductive health. In June 2002 the
first baby was born on board and named Bhashomani — which means floating — in
honor of the hospital.

In Indonesia, Lifebuoy has been linked with a different but equally important healthcare
campaign. During the country's economic crisis in the late 1990s, a substantial part of the
public healthcare infrastructure was affected due to lack of funding. As a result, some
20,000 health centers closed down.

UNICEF, supported by sponsorship of $200,000 from Unilever Indonesia, reopened 900
health centers in a pilot project. During 2000, the company provided Lifebuoy branded
healthcare leaflets, public service advertisements and free samples of soap.
In areas where healthcare is poor, it is often children who suffer most as their health is
vulnerable until their bodies develop effective immune systems. The Lifebuoy leaflets
                                                                                    WBCSD page 5

carry messages about the importance of cleanliness. Washing hands with Lifebuoy can
reduce the incidence of diarrhea significantly, one of the main causes of mortality in
Indonesian children under five.

The Lifebuoy projects in Bangladesh and Indonesia have given more people the
opportunity to benefit from health care and learn about basic hygiene. At the same time,
Unilever has been able to increase awareness and sales of its brand.

About the WBCSD
The World Business Council for Sustainable Development (WBCSD) is a coalition of leading
international companies that share a commitment to the principles of sustainable development via
the three pillars of economic growth, ecological balance and social progress. All regions of the
world and most major industry sectors are represented in our membership. The WBCSD also
benefits from a global network of national and regional business councils and partner organizations
representing a large and diversified group of business leaders.

Our mission is to:
•   Provide business leadership as a catalyst for change towards sustainable development;
•   Support the business license to operate, innovate a nd grow in a world increasingly shaped by
    sustainable development issues.

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  CH – 1231 Conches-Geneva         Fax: +41 (22) 839 31 31    Web:

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