Clean Hands, Better Health Om Prasad Gautam, PhD, MPH, MA Technical Support Manager Hygiene
Where we work? WA is an international WASH focused development organisation working in 26 countries around the world: Asia, Africa and Pacific region
Our vision is a world where everyone, everywhere has safe water, sanitation and hygiene
Improve hygiene behaviours Hands may not be washed Food continue to be polluted WA understands that unless the benefits of good hygiene is fully realised and ingrained as a social norm Toilets may not be used Dignity will be compromised Water continue to be polluted
Target settings for handwashing Households/communities Schools Policy settings Health care
Target groups My baby has worms. She often has vomiting and diarrhoea. I walk 2 km to this water point. This water is free but it breaks down two to three times a year. Different target groups in different settings
Design Hygiene Intervention Assessment and or Formative Research 6. Financing 1. Hygiene behaviours / practices 5. Hygiene policy / advocacy 2. Presence of Institutional mechanism 4. Technical Sustainability Programme design, implementation & sustainability 3. Environmental Determinants Deliver and monitoring Evaluate (baseline, follow-up, sustainability assessment)
Handwashing intervention focus Motivating people (Knowledge ) Sustaining practices in key moments Creating social norms Handwashing facilities Behavioural products (soap, water )
WaterAid and partners use multiple approaches to promote handwashing behaviours
Child-to-child approaches
Child-to-child: school curriculum development
Group events/mothers group events Social drama
Handwashing facilities
Puppet shows
Cultural events and theatre
Handwashing demonstration
Using social and commercial marketing techniques
Hygiene promotion through routine immunisation Fan Mirror Bib
Number of people WASH new users by year (n=26 CPs) 6,000,000 5,000,000 4,000,000 3,000,000 2,000,000 Each year, ~ 4 million people exposed with hygiene intervention through WA programme 2,144,921 1,911,135 1,673,410 3,014,060 2,799,606 5,136,064 1,873,665 1,918,801 3,067,330 1,000,000-2012-13 2013-14 2014-15 Hygiene Water Sanitation
Bangladesh PIMS 2014: handwashing facilities in use, with soap of any kind (n=2,849 HHs): an example
Global Handwashing Day: breaking records in India, 2014
Behaviour change: an example from food hygiene trial 5. Water treatment 1. Cleanliness of child food serving utensils using ash/soap Sequentially targeted 5 behaviours: 239 HHs with young children 2. Handwashing with soap before feeding child (by mother) and before eating (by child) 4. Thorough re-heating of leftover/stored food (Maintain re-heating temp 0 3. Proper storage of cooked food in container with tight lid
Nurture Disgust Affiliation Status Delivery (D): 6 + 6
Innovation and creativity in behaviour change: changing settings The script in peoples heads The physical infrastructu re and the objects Social norms belonging to that setting
Mothers practicing all key behaviours (%) 70 Outcomes (intervention trial) Intervention (n=120) Control (n=119) 60 50 40 3 months intervention in intervention group 43 % difference = 42% 30 20 10 0 2 2 1 Before (baseline) After (follow-up) Effect size : 42% (difference of differences) (P = 0.020)* % difference = 0% Key food hygiene behaviours before and after intervention, by study group Source: Gautam, O et al, 2014
WA s learning on hygiene promotion We need to move away from knowledge focused approaches to innovative and creative approaches for creating sustained behaviour change, targeting emotional drivers (nurture, disgust, affiliation, status, comfort etc.), social marketing, and behavioural determinants and settings. Behaviours basically linked to social norms and settings Possible to alter multiple hygiene behaviours including HWWS using emotional drivers and changing environment however: Sustaining behaviours is a big challenge Ensuring behavioural products is a challenge
WA s learning on hygiene promotion cont... Being an expert on WASH does not make us experts on designing innovative package therefore: Formative research should inform the design process Using creative process and team is imperative Hygiene promotion package need to be simple, innovative and also feasible to contextualise for scalability! Monitoring behavioural outcomes in large scale programming still needs improvement
Thank you!