Viet Nam: research-based campaign messaging is critical for sustaining handwashing behaviour change

Using data from formative research to focus messaging on mothers’ aspirations for their children and fine-tuning activities based on feedback from the field and household survey data have been key to developing and implementing a handwashing with soap behavior change program in Vietnam.

A new Learning Note, Vietnam: A Handwashing Behavior Change Journey for the Caretakers’ Program published by the Water and Sanitation Program (WSP), describes the steps that were taken to design, implement, and monitor the program to aid program managers in developing other handwashing and hygiene promotion efforts.

Working closely with the Woman’s Union, the program’s activities in Vietnam reached 540 communes in 10 provinces. The project also trained more than 15,000 community motivators who reached more than 1.76 million women through interpersonal communications activities. As the Learning Note reports, these activities evolved over time based on information from the monitoring systems.

“As the target audiences move beyond knowledge to intention to handwash with soap, behavior change messages must also be modified,” the report found, adding that as the project progressed, opportunities arose to “fine-tune the interpersonal communications activities based on feedback from the field and from the household monitoring data.”

Bangladesh: children smash handwashing world record

Washing hands may not seem worthy of a certificate, but for thousands of children in Bangladesh the simple practice has got them into the Guinness Book of World Records.

On Global Handwashing Day last October [2009], Plan Bangladesh and its partners organised an event where 52,970 school children gathered at multiple locations across the country to wash their hands with soap and water. The campaign was set up to motivate people to change their attitude towards current hygiene practices and save lives.

Global Handwashing Day: handwashing demonstration in Sylhet, Bangladesh. Photo: MaMoni

Approximately 110,000 Bangladeshi children aged under 5 die due to diarrhoea every year. Hand washing with soap is the most effective and inexpensive way to prevent the disease.

New world record

The gathering smashed the 2008 record which was set by Bangladesh and stood at 1,213 . Now Plan Bangladesh has received a certificate from the Guinness World Records which seals their place in history. [The official Guinness site still lists the record set on 19 October 2009 by the Edenglen primary school in Johannesburg, South Africa with 1,802 handwashing students, while India also claimed it had broken the record when about 15,000 students from 23 schools converged in a sports stadium n Chennai].

Zillur Rahman, Plan Bangladesh’s water and environmental sanitation specialist who coordinated the event, said: “We are very happy we broke the world record in this. Plan got involved in this campaign to highlight the bad hygiene practices in the country and we believe the campaign has raised this issue amongst people especially in the life of children.”

Spreading the word

On the day, 25,000 children gathered in a school playground in Dhaka to take part. After the event, one of the children said: “Now we know the importance of washing hands with soap and water and we will definitely tell our family and community about its benefit.” Thousands more school children washed their hands with soap and water simultaneously all over the country.

In Bangladesh, hygiene practices are generally poor. The national figure of washing hands with soap and water after defecation is 58.8% while this figure drops to 50.4% in rural areas.

Related web sites:

• Plan International – water and sanitation
• Global Handwashing Day
• Guinness World Records

Source: Plan Bangladesh, 01 Jul 2010

Viet Nam: designing evidence-based communications programmes for handwashing with soap

Since 2006, the Viet Nam Ministry of Health and the Viet Nam Women’s Union, with support from the World Bank’s Water and Sanitation Program (WSP), have been carrying out an evidence-based, comprehensive behaviour change communications programme to promote handwashing with soap (HWWS) among women aged 15-49 and schoolchildren aged 6-10 throughout Viet Nam. The ultimate objective is to reduce the incidence of diarrhoeal diseases in children under the age of five.

The programme has reached more than 1.8 million people in the first phase, with a target of 30 million in phase II. Viet Nam is one of four countries (along with Tanzania, Senegal and Peru) involved in a large global Scaling Up HWWS Behaviour Change project by WSP. This tests whether innovative behaviour change approaches can generate widespread and sustained changes in handwashing with soap habits in target populations. To date, the programme has developed two communications campaigns, one aimed at caretakers of children under the age of five and the other targeting rural and semi-urban schoolchildren in Viet Nam.

Read more: Source Bulletin, May 2010

Pakistan: Safeguard and Save the Children join hands for school sanitation

Procter & Gamble’s Safeguard brand and Save the Children announced their new partnership to reach 100 primary schools in Pakistan through a school health and hygiene project. The project will benefit 40,000 school age children in Quetta, Karachi and Lahore with improved sanitation facilities and health and hygiene education.

Through this partnership, Safeguard and Save the Children aim to address the incidence of common illnesses arising from poor sanitation facilities in school children, and empower Pakistani children to adopt healthy habits through health education and improved access to handwashing, toilet and water supply facilities. The overall aim is to enable children and their families to adopt better health and hygiene habits in the long-term.

Safeguard appeals to Pakistani mothers to help improve the lives of less affluent children. Every bar of Safeguard bought from October 2009 to March 2010 will contribute towards building handwashing, toilet and water supply facilities in Pakistani schools where children do not have access today.

Speaking at the launch press conference, Chief Guest, Minister of Health, Sindh, Dr. Sagheer Ahmed stated, “Today, we are very proud that the private sector has stepped up and extended their full support to the critical issue of sanitation and hygiene, which will greatly help the cause of improving the health of Pakistan. According to estimates, water, sanitation and hygiene related diseases cost Pakistan’s economy about Rs 112 billion per year and over Rs 300 million a day in terms of health cost and lost earnings. Through this partnership, Safeguard and Save the Children have marked the critical importance of adopting healthy and hygienic habits through enabling access to improved sanitation facilities. We would like to thank the Safeguard and Save the Children teams for leading this initiative that has the potential to save millions of Pakistani lives.”

[...] Mubashara Khalid, the Brand Manager for Safeguard in Pakistan, also stated at the event: “Every day, 670,000 children miss school due to illnesses. According to the Karachi Soap Health Study (2002) led by the Center for Disease Control (USA), HOPE and P&G, regular handwashing with soap can reduce the incidence of diarrhea and common illnesses by up to 50 percent. [...] We will be building these facilities this year, and are committed to provide sustainable maintenance to these facilities for the years to come.”

Safeguard has empowered over 6 million children in more than 17,000 Pakistani schools through Sehat-o-Safai, the largest school health and hygiene awareness campaign in the country. To reinforce its commitment to health and hygiene, Safeguard is making this sustainable long term investment to improve the lives of Pakistani children and to instill the message of the importance of handwashing with soap. The Safeguard team will be educating 40,000 children through this partnership, and about 1.5 million children overall through the Sehat-o-Safai program this year.

Source: PR Log / 03 Nov 2009

Afghanistan, Kabul: toilet tribulations

For Kabul’s estimated population of 4-5 million there are only 35 public toilets, according to the municipal authorities.

“We need at least 65 extra public latrines in Kabul immediately,” Nesar Ahmad Habibi, head of Kabul’s waste management authority, told IRIN, adding that the lack of government action and limited resources had prevented the construction of sufficient public toilets in the city.

“We have even sent proposals to the president’s office but to no avail,” he said.

Many people are forced to defecate and urinate in the open: “It’s not that we don’t want to use a latrine, it’s because there is no latrine,” said Arifullah, a local man.

“If you have a pain in your stomach and there is no toilet how long can you wait?” asked another man.

Only five of the 35 public toilets have facilities for the disabled – well below what is needed given the large number of disabled people resulting from three decades of turmoil.

People who use the latrines have to pay a small fee to cover maintenance and cleaning – 5-10 Afghanis [10-20 US cents], a sum that the large number of extremely poor people in the city would prefer to avoid paying.

A rapidly growing population, lack of modern sewage systems, significant waste management problems and the lack of public toilets in Kabul are causing environmental and health risks, according to experts.

No soap

“I don’t use the latrines because they are extremely dirty,” said Abdul Jamil, a young man. “There is also no soap to wash your hands.”

None of Kabul’s public toilets provide soap or hand-drying facilities.

Whilst hand-washing is crucial for disease prevention, soap is also not available in toilets in most Kabul schools, officials in the Ministry of Education said.

“Inappropriate latrines, open defecation and poor waste management cause serious diseases and damage the environment,” Hassan al-Sayed, country director of the French NGO Solidarités, told IRIN.

Waste management

In September 2008 Kabul Municipality said that up to 90 percent of the 3,000 tons of solid waste produced in the capital every day was managed and dealt with.

However, officials say waste management capacities have deteriorated sharply in the past year: “Now we collect only about 50 percent of the solid waste produced in Kabul on a daily basis,” said Habibi, citing dwindling resources, staff reductions and broken-down trucks as major problems.

“For waste management in Kabul we need 17,500 staff but we have only 3,000; and we need 2,500 trucks but we only have 119.”

Rapid population growth and unregulated housing developments have created serious social and environmental challenges in Kabul, according to government officials.

Al-Sayed, whose organization has been helping households in Kabul to build hygienic latrines, emphasized the importance of public awareness about sanitation and hygiene.

“What if there are hundreds of safe latrines but people don’t use them,” he said, adding that people should know the risks of open defecation and unsafe latrines.

Only 12 percent of Afghans have access to improved sanitation and less than 25 percent have access to safe drinking water, according to the UN Children’s Fund (UNICEF).

Most Afghans use the traditional dry vault toilet systems which were ranked the worst toilets in the world by WaterAid’s State of the World’s Toilets 2007 report.

Source: IRIN, 16 Nov 2009

Nepal: Sanitation finally a priority

The diarrhoea that spread earlier in 2009 in 18 districts across Nepal killed nearly 300 people; nearly six months after the initial outbreak, four ministries have finally made a joint commitment to launch a massive water and sanitation campaign to meet the state’s target of providing complete sanitation to all by 2017.

“We were not able to launch all components of water and sanitation in a comprehensive manner earlier, which is why we had diarrhea-related deaths every year,” said Dr. Babu Ram Marasini, chief of health sector reform unit at the Ministry of Health.

The programme was launched on Global Handwashing Day on 15 October 2009 as a comprehensive and combined effort by the Ministries of Health, Education, Physical Planning and Works, and Local Development. The programme will see extension of the construction of latrines in all 75 districts, awareness programmes, establishment of a national sanitation fund among others, according to Kamal Adhikari, an official at the Department of Water Supply and Sewerage. Adhikari also said that the ministries have planned to review the existing policies to provide complete sanitation to all by 2017.

According to a report by WaterAid, about 14.2 million people do not have access to sanitation and 7.1 million lack access to safe drinking water and sanitation in the country; similarly, according to the Ministry of Health, 54 percent of the country does not have access to latrines. Likewise, only 37 percent wash their hands, and only 12 percent use soap. Also, 45 percent of deaths caused by avoidable diseases is because of unsafe drinking water and lack of sanitation. “Earlier, we used to implement programmes related to water and sanitation separately but we are now planning to go ahead in a joint and comprehensive manner,” said Adhikari.

Source: The Kathmandu Post; The Rising Nepal; Gorkhapatra; Naya Patrika; Annapurna Post; Kantipur; Nepal Samacharpatra / NGO Forum, 15 Oct 2009

Afghanistan: bringing proper sanitation to rural areas

The second Global Handwashing Day was celebrated on 15 October 2009 in Kabul and 34 provinces of Afghanistan.

“At home, I wash my hands every morning and noon and evening, and also when I come from the toilet,” said 11-year-old Abdullah Farzad.

Afghanistan’s mortality rates are among the highest in the world. One out of four children dies before her or his fifth birthday. High diarrhoea prevalence resulting from poor hygiene practices, lack of access to sanitation facilities and clean water impact heavily on children’s survival and development. According to a joint UNICEF/WHO report released this week, more than 80,000 children under five died as a result of diarrhoea in Afghanistan in 2007.

“When I started to go to school one year ago, one of the first things our teacher explained to us was the importance of washing the hands before eating,” said Abdullah. “Since then, I have explained this to my mother. In the beginning she was skeptical, but when I told her about the examples that we heard at school – from babies who get sick and die – she started to change.”

Promoting a life-saving intervention

The village of Sohol, Afghanistan is enclaved within mountains. Its residents have no running water and access to safe water and sanitation supplies has been difficult for many.

Despite its life-saving potential, hand-washing with soap is seldom practiced in Afghanistan and not always easy to promote. About 22 per cent of households have access to safe water and less than one out of 10 families has access to latrine facilities.

“We have a water-point in Sohol, our village. Usually it is my sister who goes to fetch the water in the morning and the evening, but sometimes I have to help her. It takes about ten minutes from our house to the water-point,” said Abdullah.

Although people may be aware that water alone is not enough, many families still do not want to invest in buying soap.

“In the past many parents said that it is too expensive to buy soap. Last year, community animators came and made clear to them how much this little investment can do, to ensure the health of their families.” said teacher Mohammad Abdullah.

“It was not easy to make them change their mind, because in a remote place like Sohol it is not always simple to have water and soap at hand when you should have it.”

The ‘Healthy School Initiative’

As a follow-up to the 2008 International Year of Sanitation, UNICEF has initiated clean village projects promoting sustainable behaviour changes on key hygiene practices among families.

The ‘healthy schools’ initiative – which includes the construction of separate toilets for girls and boys, safe drinking water systems and the training of teachers on effective hygiene promotion – is also being implemented.

To date, 1,000 schools with a total of about 320,000 students benefit directly from this intervention.

Abdullah’s school is also one out of 126 schools chosen across 11 provinces for a pilot project of the World Food Programme (WFP) and UNICEF, where water and sanitation facilities are combined with a hot meal.

Water-points, toilets and hygiene education are taken care of by UNICEF, while WFP is providing food commodities and kitchen equipment.

It is estimated that more than 70,000 school children participated in this year’s Global Handwashing Day in Afghanistan. In spite of continued conflict, they celebrated together with millions of other children across five continents.

Source: Cornelia Walther, UNICEF, 16 Oct 2009

Afghanistan: Thousands of schools lack drinking water, sanitation

About two million state school students do not have access to safe drinking water and about 75 percent of these schools in Afghanistan do not have safe sanitation facilities, according to UNICEF. “Only 60 percent of schools have water [on site],” Zahida Stanikzai, UNICEF’s water and sanitation expert, told IRIN in Kabul.

Drinking water and sanitation facilities are also insufficient in many other schools. IRIN visited Char Qala Wazir Abad secondary school in Kabul where about 9,000 students have only one hand-operated water pump. “When it gets hot hundreds of students rush to the pump all at once,” said Sharifa, a teacher at the school.

[...] MoE officials acknowledge the lack of drinking water and sanitation facilities at schools but say such problems are limited to only 12 percent of state schools. “This year we will dig 5,000 wells at schools which lack water points,” Asif Nang, MoE’s spokesman, told IRIN.

“[School] toilets are not clean and well maintained. The current design and location of toilets are not acceptable for children, particularly girls… There are no facilities for grown-up girls,” Stanikzai said. “One of the reasons that the girls do not attend school is because there are no sanitation facilities,” said UNICEF’s Jalalabad head of office Prakash Tuladhar. “It is very important that water and sanitation [systems] are built as components of the school programme. If there are no latrines, then it is almost certain that girls will not be attending school.”

Washing hands with soap, particularly after visiting the toilet and before eating, can reduce child morbidity rates caused by diarrhoeal diseases by almost 50 percent, according to UNICEF. However, the practice is poorly understood and is rarely practiced by families, especially in rural communities. “In most of the schools hand washing facilities are not placed in a proper place. There is a lack of resources to provide soap for hand washing,” said UNICEF’s Stanikzai.

[...] Diarrhoea-related diseases account for 20 percent of deaths among children under five in Afghanistan, according to the UN Assistance Mission in Afghanistan. Despite these staggering figures, there is no nationwide data about school absences due to diseases. UNICEF said it had been helping MoE to provide “safe drinking water and sustainable child friendly sanitation facilities and hygiene promotion” in 500 schools over the past few years.

Source: IRIN, 12 May 2009

China, Yunnan: impact of income on sanitation and hygiene behaviour

Cangjiang, Y. … [et al]. (2009). Effect of village income and household income on sanitation facilities, hygiene behaviours and child undernutrition during rapid economic growth in a rural cross border area, Yunnan, China. Journal of epidemiology and community health ; published online: 02 Feb 2009. doi:10.1136/jech.2008.078246

BACKGROUND: The study aimed to examine the effects of village income and household income on child nutrition status through basic sanitation and hygiene behaviours.

METHODS: A survey was conducted in a rural cross border area of Yunnan, China. Data on village income in 2002-2006 and household income in 2002-2007 were obtained from an official report and a household survey, respectively. Anthropometric measurement of the children aged 6 months to 5 years (n=1,801) was used to determine their nutrition status. Child caretakers were interviewed about household sanitation facilities and their hygiene behaviors using a structured questionnaire.

RESULTS: Households with incomes below the national poverty line decreased from 22% in 2002 to less than 8% in 2007. The coverage of safe drinking water and water-sealed latrines gradually increased but was still inadequate. The prevalence of stunting and underweight of children were 37% and 17.5%, respectively. Village income had a greater positive effect than household income on exclusive breast feeding, drinking boiled water, handwashing with soap, as well as, reducing in prevalence of stunting. Village income at one lag year had the greatest effect on availability of basic sanitation than other lag years, while household income had small but significant effect through all lag years.

CONCLUSIONS: Rapid economic growth is not always followed by improved child nutrition status. Village income has greater effect than household income on sanitation facilities, hygiene behaviors of caretakers, and child nutrition status.

Contact: Yang Cangjiang, Yunnan Provincial Center for Disease Control and Prevention, China, ycj99 [at] hotmail.com

Pakistan: MoE confident to achieve IYS 2008 targets

The Ministry of Environment is making concerted efforts to achieve the targets set for International Year of Sanitation-2008 [...] in collaboration its partners like UNICEF, RSPN, PPAF, Water Aid, WSP-SA, USAID.

The Ministry has prime focus on four targets set for IYS-2008.

The targets one and two include; Finalization and approval of Provincial Sanitation Strategies/Action Plans by the respective Cabinets, and dissemination of hygiene messages [with support of UNICEF, USAID, RSPN and others] focusing on hand washing with soap, construction and use of latrines and use of safe water amongst at least 20% population (33 million).

Targets, three and four, include provision of improved sanitation facilities to at least 6% of the country’s population (700,000 HHs) over and above the existing [by scaling up the concept of Community Led Total Sanitation (CLTS)], and finalization and approval of National Drinking Water Policy by the Federal Cabinet and development of action plan for implementation.

[...] “The Balochistan Provincial Cabinet has already approved the provincial sanitation policy and strategy while in other provinces, the strategies are in the process of approval,” said Director General Environment, Javed Ali Khan. “Strategies for AJK and FANA have also been prepared.”

A Sanitation and hygiene week was observed in collaboration with Ministry of Health and UNICEF [in Punjab from from October 27 to November 1, 2008 - The News, 24 Oct 2008].

Source: APP,  18 Oct 2008

[Speaking at a briefing on Global Handwashing Day, Environment Secretary Khushnood Akhtar Lashari revealed] that unsafe drinking water, inadequate sanitation and poor hygiene practices [...] cost Rs 112 billion per annum in Pakistan. [...] He further said that poor sanitation and hygiene practices were also proving to be one of the route causes of the spread of polio, as, he informed, studies conducted during the year 2008 revealed that most of the Polio cases in Pakistan during the year came from families having no toilets.

[...] In Pakistan, [Lashari] said, diarrhea killed 11% of the total children [who] died before their fifth birthday, while overall cost due to the disease in the country was Rs 55 billion per year.

Source: Khalid Aziz, The Nation, 15 Oct 2008