Disease & disability 4 billion cases of diarrhoea each year 10% of the developing world suffer from intestinal worm infections 6 million people are blind from trachoma 200 million people in the world are infected with schistosomiasis
Diarrhoea Risk Reduction Previous reviews: a – dEsrey SA et al. (1991) Bull WHO 69 (5): 609-621 eCurtis 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 ARIs 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 $0.39 per person
Cost effectiveness Interventions against diarrhoeal disease Cost-effectiveness ratio (US$ per DALY averted) Cholera immunizations1,658 to 8,274 Rotavirus immunizations1,402 to 8,357 Measles immunization257 to 4,565 Oral rehydration therapy132 to 2,570 Breastfeeding promotion programs527 to 2,001 Latrine construction and promotion270.00 House connection water supply223 Hand pump or stand post94 Water sector regulation and advocacy47 Latrine promotion11.15 Hygiene promotion (including hand washing)3.35 Source: Disease Control Priorities in Developing Countries, 2 nd edition 2006 (www.dcp2.org) – Chapter 41www.dcp2.org
Its all about Partnership.... National and local Government structures NGOs, CBOs, FBOs 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, NGOs, FBOs 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 NGOs, FBOs,CBOs, schools, & community leaders ACTIVITIES Mass Media TV, Radio, print Interpersonal Communication House 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 Communities Community based process Demand Driven Technology choice secondary Social change – pride and dignity Community managed
CLTS/Total Sanitation Asia – Cambodia, Bangladesh, India Africa – Ethiopia, Zambia, Malawi, Sierra Leone (Kaka free villages) Americas – Bolivia In total approximately 17 countries SLTS – School Led Total Sanitation in Pakistan
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PPPHW (www.globalhandwashing.org) Concept Note availablewww.globalhandwashing.org 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 makers Unilever, P & G, Colgate, etc Example: Unilever Global MoU, Country LoAs In Safe Hands Project 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 5s 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…
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.org EHP/HIP Website CDC WEDC – information notes WELL
HWTSS www.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 Schools firstname.lastname@example.org Global Network and forum Working with Children on key behaviours Evidence base Evaluations
WSSCC – Its the big issue www.wsscc.org Water Supply and Sanitation Collaborative Council Advocacy WASH Coordinators WASH Campaigns/Movements
Hygiene Awareness and Promotion Hygiene Improvement 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 Change Social Change Social Marketing