Global Development Alliance: Handwashing with Soap for Newborn Survival

•A True Partnership

•Commitment to behavior change

•Research from Indonesia and Bangladesh

•What’s next?

Partnership Objectives

• Increased knowledge and practice of handwashing with soap.

• Create and implement a low-cost, scalable strategy to reduce newborn mortality through improved handwashing.

• Establish and utilize a monitoring and evaluation system to determine the effectiveness of the intervention.

Preventable Deaths

Global distribution of neonatal deaths* (percent, n=3.6 million)

* Neonatal = infants in the first 28 days of life

Source: UNICEF 2008; Lawn et al 2005

Low-Cost Interventions

Handwashing with soap is

believed to reduce the risk of

• diarrhea by up to 50%

• respiratory infections by up to 23%, and

• pneumonia by up to 50%.

Source: Darmstadt et al 2005; Pittet 2005; Luby et al 2005; Rhee et al 2008

Handwashing with soap is especially

important for infants and young

children, who are most susceptible

to communicable diseases.

Accelerating Behavior Change

Mothers• New mothers are usually amenable to changing

their behavior

• Studies have found that newborns whose birth attendants washed their hands with soap had significantly lower mortality rates than those newborns whose birth attendants did not wash hands with soap

Birth attendants

About Unilever

• Over 163,000 employees in nearly 100 countries

• Products sold in over 170 countries

• $60 billion in global turnover

• 400 brands spanning the Foods and Home & Personal Care categories

• Unilever products touch the lives of over 2 billion people every day

U.S. Personal Wash Brands

Sustainable Living Plan

3 BIG TARGETS BY 2020

1. HALVE the environmental footprint of our products

2. Help ONE BILLION people improve their health and well-being

3. Source 100% of agricultural raw materials sustainably

By 2015, Lifebuoy has committed to change the handwashing behaviour of one billion people by promoting the use of soap at key

occasions

What does Lifebuoy bring to the Partnership?

• Experience with Hygiene

• Expertise in social marketing and communicating behavior change

• Knowledge of bottom-of-pyramid consumers

• Accessible, affordable and high performing soap

About Lifebuoy

Lifebuoy’s Social Mission: Areas of Intervention

1. Handwashing behavior change programs

2. Capacity building and partnerships

3. Advocacy

Mass-Scale Handwashing Behavior Change

Mass-scale behavior change in schools

THE SCHOOL OF 5:A 21-day behavior change school program for kids.

SUPPLIES

• Comic Books: Fun, colorful, and educational adventures

• Pledge & 21-Day Poster: Recaps the program and serves as daily reminder of commitment

• Puzzle Poster: 4 separate pieces hung weekly in each classroom. At the end of the program, the poster is completed as a reward for the kids’ efforts

• Catch Phrase & Jingle: “Don’t Be A Dope, Always Use Soap!” and a jingle help kids remember

• Red Band: Each child receives a red band with the imprint “School of 5”

• Interactive quizzes, games and learning activities

Pledging

TV quiz shows

Employee engagement

activities throughout

UnileverWorking with

WHO to encourage

scaling up in advocacy (India)

Meeting with Ministers of Health to promote

handwashing at scale

Guinness World Records Global drawing competition

Community events with partners

Celebrity engagement

Schools rallies

Washing hands ceremonies

SNAPSHOT OF ACTIVITIES

Global Handwashing Day

Real-Life Clinical Trial

• In 2009, Lifebuoy re-launched the Lifebuoy Way after a year-long study

– Children using soap at five key skin cleansing occasions experienced:

25% reduction in the number of incidences of diarrhea

15% reduction in the number of incidences of ARIs

46% reduction in eye infections

Today, Lifebuoy is available in more than 34 countries globally

Lifebuoy global presence

• USAID Bureau for Global Health’s flagship maternal, newborn and child health program

•Working in nearly 40 countries worldwide

•MCHIP supports programming and opportunities for integration in

- Maternal, Newborn and Child Health- Immunization, Family Planning, Malaria, HIV/AIDS- Wat/San, Urban Health, Health Systems

Strengthening

MCHIP

Partnership Progress: Where Are We Now?

• Signed formal MOU

• Agreed on key stakeholders

• Identified pilot countries:

– Indonesia

– Bangladesh

– Kenya

• Formative research in Indonesia completed and Bangladesh underway

– Informal interviews in Kenya (formative research to follow)

Formative Research

• Indonesia: to learn how to increase HWWS among women giving birth to first child as well as birth attendants and caregivers of newborns

• Bangladesh: to identify motivators and barriers to HWWS among mothers and caregivers of neonates and infants

– Explore health and hygiene practices of community

– ICDDRB research complete and additional GDA research underway

• Results will be presented at handwashing GDA workshop June 20-21, 2011

Importance of Handwashing with Soap

Source: LHSTM (Indonesia) 2011; ICDDRB (Bangladesh) 2011; Curtis et al 2009; Scott et al 2007

• On average, only 17% of mothers or caregivers of children under 5 wash hands with soap after using the toilet

• Many believe that children’s feces are harmless

• “Frequent handwashing is not a practice in rural areas like [it is for] urban people”

• “No, [lack of handwashing] won’t make the baby sick. If I am sick, the baby could get sick through my breast milk.”

Obstacles to HWWS

Structural issues• Affordability of soap • Lack of water• Distant water source

Types of constraints

Lack of enabling environment

• Limited time with newborn• Location of soap sometimes different than water source

(e.g., pond versus latrine)• Frequency of infants’ defecation makes it difficult

Behavior / Cultural beliefs

• Forgetfulness / laziness• Belief that infants’ faeces are not dirty and thus HWWS is

not necessary after touching them• Belief that touching too much water may cause the baby to

catch a cold

Education• In Indonesia, link between hand-washing and illness only

made by educated urban women• Lack of understanding of proper times to wash hands

Source: LHSTM (Indonesia) 2011; ICDDRB (Bangladesh) 2011

Birth Attendant Attitudes Towards HWWS

– Amount of time before the woman goes into labour

– Availability of soap

– General forgetfulness

– Belief by some that babies are born dirty

Source: LHSTM 2011; Falle et al 2009; Hill 2010

Studies show that handwashing behavior of traditional birth attendants is determinedby several factors:

Next Steps

1. Global Strategy Workshop

2. Lead Country Roll Out inBangladesh, Indonesia, and Kenya

3. Scale Up: measure and collect lessons learned

4. Global Handwashing Day

QUESTIONS?