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EFFECTIVE HYGIENE BEHAVIOUR

CHANGE PROGRAMMING

Messages rom the South Asia Hygiene Practitioners Workshop,February 2010

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EFFECTIVE HYGIENE BEHAVIOUR

CHANGE PROGRAMMING

Messages from South Asia Hygiene Practitioners Workshop,

February 2010

In February 2010 during a workshop organised

by BRAC, WaterAid, IRC and the Water Supply

and Sanitation Collaborative Council 50 hy-giene practitioners and researchers rom South

and South East Asia came to together to share

lessons learned, and discuss progress and chal-

lenges in promoting hygienic behaviours. Eight-een papers were presented and discussed, rep-

resenting a range o experiences. Considerable

progress has been made in research, in improv-

ing knowledge about hygiene, and, partially, inimproving hygienic practices. In ve o the pro-

grammes represented at this workshop, hygiene

promotion is being implemented at scale with

more than one million people.

A substantial challenge and a major theme

o this exciting meeting was how to move

rom knowledge to sustained practice, at scale.

Reaching this goal requires intensive hygienepromotion, ocus on enabling actors, sucient

time, well-tested communication, and fexibility.Hygiene needs sustained attention.

The detailed discussions led to nine recom-

mendations, presented on the ollowing pages.

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RECOMMENDATIONS

On Monitoring:

1. For the practitioners running hygiene pro-motion programmes, the ocus should be on

monitoring outcomes rather than impact.

Measuring the health impact o a particular hy-giene intervention is notoriously dicult. Pro-

grammes should measure whether their ac-

tions result in the intended behaviour change

and not attempt to measure the health impacto these behaviours.

2. Programmes should realise that reported

behaviour oten diers rom observed real be-

haviour. Sel-reporting as a single monitor-

ing tool is thus unreliable. Using triangulation

(that is, collecting desired data through multipletools, such as observation and spot checks, and

checking internal consistencies) is essential.Reliable and aordable monitoring at scale re-mains a major challenge.

See for example papers 4 and8on the CD-Rom.

On Behaviour Change:

3. How do knowers become doers became the

key question o the workshop. What actors stoppeople who say they know what to do rom actu-

ally practising good habits? One ramework ana-

lysing this is FOAM: Focus, Opportunity, Ability

and Motivation. All actors must be in place or

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people to practise the intended good practice(s).

Other experiences pointed to the need or long-

term (decade rather than ve years) behaviour

change campaigns, use o multiple mediums to

reach dierent user categories and the proper

sequencing o messages and mediums.

4. Do we ocus on one or very ew behaviours and

messages, or many? The consensus was that an

overload o messages is not helpul. Equally im-portant, messages should be relevant and ap-

propriate. This requires preparatory investigation,message testing and refection with the intended

target groups, and possibly reiteration and change

over time, based on outcome evaluation.

5. Especially at the community level, the best

starting point is not to start by developing

messages. Instead, programmes begin with

ormative research and/or should assist com-

munities to do sel-assessments o their situa-

tion, identiy good and bad practices and come

up with solutions and action plans to promotethe good and change the bad. This is in line with

the concept o targeted hygiene: identiying

high-risk sites and situations or transmitting

pathogens in homes and communities and pro-

moting easible and appealing practices where

and when they matter most to reduce peoples

contacts with these pathogens.

See or example papers 14 and17.

On Menstrual Hygiene:

6. Menstrual hygiene is a key component o

personal hygiene or women. Worldwide, its

absence rom hygiene programmes is a gravesource o misery, ill-health and loss o dignity or

poor women. Programmes should ocus not only

on education and promotion, but also on produc-

tion o easy and aordable access to sanitary

napkins and related products, and their sae and

dignied disposal ater use. Simple adjustments

to latrine design and construction, such as a

small raised platorm, also help women to man-

age their hygiene better during menstruation.

Practitioners present at the workshop made ajoint promise to break the silence on this impor-

tant topic, and to start addressing it in their pro-

grammes and their own organisations.

See or example papers 7and11.

4

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On Hygiene Promotion for Men:

8. Most hygiene promotion programmes tar-get women. However, men are major decision

makers, e.g. on nancing. Moreover, the key to

good hygiene is that everybodypractises good

hygiene behaviours. For this, men respond to

dierent impulses, use dierent communica-

tion channels, and may have dierent reasons

or practising than women. A programme in Nepal

has started to look into hygiene promotion or

men in more depth, but urther work needs to bedone to identiy the best ways to ensure that all

amily members support, practise and benet

rom good hygiene.

See or example paper12.

On Mental and Spiritual Hygiene:

9. From the Philippines came the concept omental and spiritual hygiene. Especially in

situations o hardship rom cyclones, foods,

earthquakes and other natural and man-madedisasters, clear and clean minds are as impor-tant or people as clean bodies and environ-

ments. This is another new angle to hygiene

and hygiene promotion in addition to menstrualhygiene and hygiene promotion or men.

See or example paper2

.

On School Hygiene:

7. The result o one study rom Pakistan

showed that children tell the truth, teach-

ers dont. Sustaining hygienic behaviour in

schools is largely a management issue. While

children can be taught and may be willing topractise good hygiene, they need an enabling

environment to actually do so. A minimum

requirement is presence o soap and water.

The study showed that nowhere did school

sta take responsibility and ownership or

their management, with blame shiting be-

tween teachers, principals, cleaners and man-agement committees.

See or example paper 16.

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PAPERS

Hereunder is the ull list o papers produced

or the workshop. All papers are included on

the CD-Rom.

1. Md. Iqbal Ahmed & Rozena Begum(WaterAid, Bangladesh): Hand Washing

Practice in ASEHProject Area: A Study

or Impact Monitoring.

2. Lyn Capistrano (PCWS, the Philippines):

A study on Personal and Home Hygiene in

Flood Prone Communities in the Philippines.

3. John Collett (SNV Bhutan): Thirty-fve

years o searching or answers in Rural

Sanitation and Hygiene in Bhutan.4. Lisa Danquah, (University o Southhamp-

ton, United Kingdom): Measuring hand

washing behaviour: methodological and

validity issues.

5. Ranajit Das, Gitasree Ghosh, Dr. Dibalok

Singha (DSK , Bangladesh): Participatory

community hygiene education in Dhaka

slums:DSKexperience.

6. Jacqueline Devine (WSP, USA):

Beyond Tippy-Taps: The Role o Enabling

Products in Scaling Up and Sustaining

Handwashing.

7. Maria Fernandes (WaterAid, India):

Freedom o Mobility: Experiences rom

villages in the states o Madhya Pradesh

and Chhattisgarh India.

8. Gautam, O.; Adhikari, B.; Rajbhandari,

K.; Jones, O. (WaterAid, Nepal): Stages

o hygiene monitoring: An operationalexperience rom Nepal.

9. Dr. Babar Kabir, Milan Kanti Barua, Rezaul

Karim, Md. Bodiuzzaman, MizanurRahman, Mdd. Hasan Ali Mia (BRAC,Bangladesh): Contributions o VillageWASHCommittee in breaking the cycle of

unhygienic behaviours in rural Bangladesh.

10. Dr. Babar Kabir, Sharmin Farhat Ubaid,

Mahjabeen Ahmed, Mahidul Islam,

Mizanur Rahman and Md. Hasan Ali Mia

(BRAC, Bangladesh): The Role o Imams

and dierent Institutions in Hygiene

Promotion o BRAC WASH Programme.

11. Syed Shah Nasir Khisro, Alta Ur Rahman

(IRSP, Pakistan): Assessing and AddressingHygiene Issues o Internally Displaced

Persons o Swat, Buner and Dir.

12. Ingeborg Krukkert, Carmen da Silva Wells

(IRC , The Netherlands), Yubraj Shrestha,

Mangal Dash Duwal (NEWAH, Nepal):

Hygiene promotion or men Challenges

and experiences rom Nepal.

13. Pro. Kumar Jyoti Nath, Barenyo

Chowdhury, Anish Sengupta (India):

Study on Perception and Practice o

Hygiene and Impact on Health in India.

14. Nga Kim Nguyen (WSP, Vietnam):

Designing Evidence-based Communica-

tions Programs to Promote Handwashing

with Soap in Vietnam.

15. Andy Peal (United Kingdom): Hygiene

promotion in South Asia; progress,

challenges and emerging issues.

16. Ayub Qutub, Fauzia Butt, Erum Bashir,Sobia Shabbir (PIEDAR, Pakistan):Who is Responsible or Soap in Pakistani

School Toilets?

17. Mohammad Riaz, Farooq Khan

(Pakistan): Beyond TraditionalKAP

Surveys Need or Addressing Other

Determinants o Behavioural Change or

More Eective Hygiene Promotion.

18.Laboni Shabnam (

DAM, Bangladesh):The practice o handwashing.

19. Kathleen Shordt (IRC , the Netherlands):

Asia Hygiene Practitioners Workshop:

Summary report.

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RESOURCES

More resources on the nine learning areas on hygiene and hygiene promotion can be read and

downloaded rom the web, both as Acrobat documents (with pictures) and Word documents

(without pictures quicker to download):

Forcasestudies,backgroundpapersandtheworkshopsummarypaper,seehttp://www.irc.

nl/page/51605 or http://www.wsscc.org/topics/hygiene Forschoolhygiene:www.schools.watsan.netorwww.wsscc.org

Formenstrualhygiene,seehttp://www.schools.watsan.net/page/889

Forhandwashingandbehaviourchangejourneys,seehttp://www.globalhandwashing.org/

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About BRACBRAC is a Bangladesh-based international NGO working to empower

people and communities in situations o poverty, illiteracy, disease andsocial injustice. BRAC currently runs a large-scale WASH programme in

many rural areas o Bangladesh.

About IRCIRC International Water and Sanitation Centre (IRC) acilitates the shar-ing, promotion and use o knowledge so that governments, proessionals

and organisations can better support poor men, women and children

in developing countries to obtain water and sanitation services they

will use and maintain.

About WaterAidWaterAid transorms lives by improving access to sae water, hygiene

and sanitation in the worlds poorest communities. In 26 countries in

Arica, Asia and the Pacic region, and at the global level, they work

with partners and infuence decision-makers to maximise impact.

About the Water Supply andSanitation Collaborative CouncilThe Water Supply and Sanitation Collaborative Council (WSSCC) is an

international membership organisation that works to achieve sustainable

water supply and sanitation or all people, through enhancing collaboration

among sector agencies and proessionals.