Hygiene Promotion

Hygiene promotion is a planned approach that aims to reduce the incidence of poor hygiene practices and conditions that pose the greatest risk to the health of children, women and men. Several hygiene promotion methodologies have been developed over time to promote hygiene. Experience with these methodologies has shown that effective hygiene promotion is based on several key principles¹:

Target a small number of risk practices. Because changing habits is not easy, an assessment should be made to understand which risk practices are most widespread, and which can be changed. From the point of view of controlling diarrheal disease, the priorities for hygiene behavior change are likely to include hand washing with soap (or a local substitute) after contact with stools, and the safe disposal of adults' and children's stools.
Target specific audiences and identify defining characteristics that affect their approach to hygiene. For example, a specific audience may include students, but students can represent different sexes, cultural groups, and social groups.
Identify the motives for changed behavior. While the argument for washing hands with soap will be mainly health related, the motivation for the use of toilets often may have nothing to do with health. People may be persuaded to use a toilet so that their neighbors or classmates will respect them, or for other motives. By working with the target groups one can discover their views of the benefits of safer hygiene practices and use these as the basis for a motivational strategy.
Keep hygiene messages positive. Both children and adults learn best when they laugh, and will listen more attentively if they are entertained. Hygiene promotion projects that attempt to frighten their audiences will alienate them.
Identify appropriate channels of communication and understand how the target audiences communicate. For example, what proportion of each listens to the radio and attends social or religious functions? Using traditional and existing channels is easier than setting up new ones, but existing channels can only be used effectively if their nature and capacity to reach people are understood.
Decide on a cost-effective mix of communication channels. When several channels send the same messages, the messages are reinforced. Be aware of the trade-off between reach, effectiveness, and cost. Mass media reach many people cheaply, but their messages may be soon forgotten. Face-to-face communication can be highly effective in encouraging behavior change, but tends to be expensive. Therefore, a hygiene promotion program will often use a mix of different channels to get the best of all.
Plan, execute, monitor, and evaluate hygiene promotion carefully. At a minimum, collect information at regular intervals on the outputs and the population coverage achieved. Define and periodically assess indicators of the impact of hygiene promotion on the targeted behaviors and populations.

Examples of Messages

Box 1 provides examples of communication designed to be used with school-aged children. The examples are based on comments in which respondents stated what they liked most about their school toilets.

Box 1. Messages for Promoting Sanitation and Hygiene in Schools

Toilets make school compounds clean. Toilets are easier to access than the bush. You do not have to travel far to use a toilet. The bushes might harbor snakes and things, so using a toilet is safer and less scary!
Good toilets control flies and smells
Toilets decrease diseases like cholera and help students stay healthy
Toilets offer more privacy than the bush
Improved toilets are easier to keep clean than traditional pit toilets
Improved toilets are safer and the risk of collapse is lower, especially when the pits are lined
Good toilets are safe for small children to use

Messages that should be considered once the toilets have been constructed:

Cleaning toilets is everyone's responsibility. It should also show a teacher cleaning a toilet, as well as young and old children. Children clean using mops, rags and water. Boys should be shown fetching water to fill hand washing facility and cleaning
Toilets are safe to use: it should show lined pits and solid construction
Everyone is responsible to keep the toilet in good order and use it properly.
- It could show an older child assisting a younger child to use the toilet and putting his/her feet on the foot rests.
- It could show a child replacing the drop hole cover after use.
- It could show a child putting ash in the toilet to decrease smell.
Taking care of school property is everyone's business. Could show a mischievous child throwing rocks on the tile roof of a toilet and breaking it and other angry children around. This should express unacceptable behavior.

Source: Adapted from UNICEF Malawi 2001

Hygiene Promotion Options

Depending on the characteristics of the target community and the budget available, several options for hygiene promotion activities are available. When aiming to instill hygiene skills in children, the more participatory and more long-term techniques will be necessary. The advantages and disadvantages of the different types of activities are outlined in table 1 below.

Table 1. Hygiene Promotion Options at a Glance
Option 1: Hygiene Education
Provides education opportunities (especially for women in remote areas) It is very easy to monitor knowledge (before and after) One set of lessons or lectures can be used for an entire area	Does not usually lead to improved hygiene behavior (knowing is not necessarily doing) Risks alienating local people because of the "I know more than you do" assumptions of educators/trainers Often does not monitor behavior, so its effectiveness is unknown Requires a lot of materials Usually based on the assumption (which may not be the reality) that desire for good health is the motivator for behavior change
Option 2: Mass Media Campaign
Can reach wide audiences with minimal expenditures (per-capita costs for each person reached are minimal) Can focus on a few key messages; do not provide too much information for people to grasp Short and quick; requires minimal follow-up Can be very timely (for example, information about cholera just before the rainy season) Does not need a high number of personnel	May only reach selected audiences (that is, better-off households that own a television or radio) Not very effective for long-term behavior change Monitoring behavior change is difficult Requires a lot of pre-testing Tends to be centrally produced and therefore may not be appropriate in a country with many ethnic/ linguistic groups Requires a lot of technical knowledge and materials
Option 3a: School Sanitation - Educational Approach
Can reach a large number of families through the children When children tell their families what they've learned at school it isn't as intimidating as when a stranger comes to "educate" the adults Could potentially reach an entire generation of children Monitoring of knowledge is simple Makes good use of existing institutions for a hygiene education forum Teachers often hold a high position of respect	Focus is on increasing knowledge (and therefore does not necessarily lead to improved hygiene behavior) Depends on the teacher: an enthusiastic person will carry it out but not every teacher is enthusiastic. There may be no incentives to do so. Requires monitoring of teachers which may exceed human resource capacities Requires a lot of materials (books, posters, pamphlets, quizzes)
Option 3b: School Sanitation - Promotional Approach
A flexible method which is suited to each specific schools' needs (to better reach the children of that particular school) Focus is on motivating behavior change Monitoring systems are put in place as part of the project - indicators are developed by the students and teachers together Motivation to change focuses on the feelings of the target audience rather than their health Students, teachers, and community all monitor thereby reducing the burden on teachers alone Requires minimum equipment/materials Can create healthy habits in the long term	Success of the project depends on the teacher and support setup Requires time to assess each school's situation and modify the project accordingly Takes time and committed staff to find the real motivating factors for change in teachers', students', and communities' behavior May require considerable communication between community and school; school and private sector; school and different local government departments
Option 4a: Participatory Hygiene Promotion
Based on local beliefs and knowledge Builds on what people see as their own needs and their own priorities for behavior change Success of project is success of local people: high level of community ownership Very relevant to the village situation Can monitor behavior change Usually very effective at leading to specific behavior change Requires minimal equipment/materials Behavior change will be long term	Requires time (many visits) by project staff Usually requires teams of project staff to go to each location regularly, and therefore requires a lot of human resources May not show quick results Reaches only small concentrated audiences (for example, one village at a time) Quality and effectiveness highly sensitive to the quality of facilitators Difficult to scale up quickly
Option 4b: Social Marketing
Uses marketing techniques which have proven effective for the private sector Principles are to create a demand for services or products (such as toilets or hand-washing facilities), and to base the message on what really motivates people Can reach large audiences or small target areas There may be several national examples of successful social marketing to follow in other sectors (private or public) Work (and costs) can be shared with the private sector	Focus-group interviewing techniques require trained facilitators May take time to find out motivational factors from the target populations Advertising campaigns can be expensive Initially, will be most effective with affluent people who can easily afford the product (such as soap) or change in habit

For more details, see Life Skills-based Hygiene Behavior Programs

¹ Adapted from the WELL Fact sheet on Hygiene Promotion at: http://www.lboro.ac.uk/well/resources/fact-sheets/fact-sheets-htm/hp.htm

Resources for this Section


	Examples of Messages
	Hygiene Promotion Options

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