Hygiene Behaviour Change
in UNICEF WASH
Programmes: Progress and
Challenges
Mark Henderson
Chief, WASH
UNICEF Haiti
19 January 2012
Hygiene Promotion
The planned, systematic attempt to
enable people to take action to
prevent or mitigate water,
sanitation, and hygiene related
diseases, and a practical way to
facilitate community participation
and accountability
Traditionally…….more Hygiene Education than
Hygiene Promotion
• Focused on increasing knowledge, providing
standardized information rather than changing
behavior
• Messages often negative and focused strictly on the
avoidance of illness as a motivator
• Standardized messages: not based on any in-depth
knowledge of the local situation
• Messages “educated” the audience on a very wide
range of health related subjects
• One time education sessions
To improved approaches…
• Target a small number of risk practices
• Target specific audiences (school children and
caregivers)
• Identify the motives for changed behavior – not just
health messages. Positive and fun.
• Highly participatory methods, adaptable to local context
• But still ….difficult for sustained behavior change at
scale
• Need for changing social norms
Main focus of Hygiene Promotion
Hand Washing
with Soap is the
most effective
intervention
Source: Fewtrell et al. 2005 5
Handwashing with soap – the greatest
self administered vaccine?
• Can reduce Diarrhoea rates by
up to 44%
• Can reduce Acute Respiratory
Infections by up to 25%
• When practised by mothers and
birth attendants, can reduce
neonatal mortality rates by 44%
• Daily HWWS in school reduces days
of absence by 27% ( Philippines)
Global Handwashing Day
15 October
• 2008 - the International Year of Sanitation
declared by the UN General Assembly – also first
Global Handwashing Day
• GHD has been echoing and reinforcing the call for
improved hygiene practices worldwide
• GHD is supported by the Public-Private
Partnership for Handwashing with Soap (PPPHW)
7
Global Handwashing Day
15 October
• In 2010: more than 80 countries had GHD activities
• 500 million persons reach by HW messages (media)
• 42 million reached directly through community
hygiene promoters
• From one-day event to long-term HWWS
programmes
• In 2011: 1 million schools
8
GHD impact
on HWWS Programming
Number of countries with behaviour change
programmes which include HWWS
87
83
53
2008 2009 2010
Source: UNICEF annual reports 2010 (out of 138 countries reporting)
National HWWS Programs &
Mainstreaming Efforts
• Sierra Leone – HWWS as part of a
larger sanitation marketing
programme
• Handwashing stations in schools
• Regional SOPO efforts in Africa
(Kenya, Malawi, Zambia)
• HWWS communications as part of
national diarrhoea strategies
• HWWS as a daily ritual/social norm in
schools (India, Philippines)
Major goals of handwashing
promotion programmes
• Advocacy: Influence public policy and resource-
allocation decisions
• Education: Increase knowledge of benefits of using soap
for handwashing and critical times for handwashing
• Behaviour Change: Build up and sustain good
handwashing practice and form handwashing habits
• Health Impact: Improve child health by preventing
diarrhoea and respiratory illness
In Latin America …..
• Inclusion of Hygiene promotion
in WASH in Schools: ESCASAL in
Honduras or IEAS in Nicaragua
• Creation of new partnership to increase
HWWS programming: FOCARD (Central
America and Dominican Republic)
• Involvement of stakeholders in GHD
across the region
12
Hygiene Promotion in Emergencies
Hygiene Promotion in Emergencies:
- a practical way to facilitate community
participation and accountability
- way to ensure appropriate
design, use and maintenance of facilities
In 2009, global tools were finalized
including:
- Hygiene Promotion Orientation Package
- Training materials aimed at Community
Mobilisers and Hygiene Promoters
- A Visual Aids Library
Hygiene Promotion in Haiti
Earthquake response Cholera response
• Coordination of messages •Adapt messages and extend
and activities through HP activities to rural areas
group (camps focus) (national focus)
• Building capacities of •Train 4500 new Hygiene
Hygiene promoters using promoters using religious
global tools leaders, government and
• Focus on HWWS, use and NGO networks
maintenance of latrines, •Focus on HWWS, water
safe water (transport and treatment (chlorine
storage) products) and use of ORS
14
Global Handwashing
Day in Haiti
2010 2011
Organizations participating 77 150
Persons washing their hands 186,000 229,670
during GHD activities
Schools involved 160 978
Rural communities involved 62 417
Health centres 4 68
Source: UNICEF Haiti 2011 15
Challenges and Opportunities
• Supporting country capacity building for
improved HWWS programming, specifically
on monitoring and effective messaging
• Inter-sectoral collaboration and integration of
HWWS into broader health, sanitation and
education programming especially in school
• Working in partnership to leverage strengths,
increase coherence of messages,
effectiveness and reach
• Understanding the role that children can play
as messengers in different contexts
Thank You!
