hygiene & sanitation promotion wcar programme communication network meeting april 2008
TRANSCRIPT
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