Hygiene promotion in South Asia; progress, challenges and emerging issues : paper presented at the South Asia Hygiene Practitioners Workshop, Dhaka, Bangladesh, 1 to 4 February 2010

South Asia (with the exception of Afghanistan) is showing an on-going ‘general improvement’ in terms of both child mortality and adult mortality. In the period since 1990 the regional under-five mortality rate has decreased by 39% (from 124 to 76) and the adult mortality rate has decreased by 24% (from 320 to 244). This is an encouraging sign for the hygiene sector but much improvement is still needed. This background paper focuses on hygiene promotion, the subject of the South Asia Hygiene Practitioners’ Workshop held in Rajendrapur, Bangladesh in February 2010. The paper gives an overview of hygiene and behaviour change approaches and experiences in the sector and describes the hygiene and behaviour change approaches used in South Asia. Hygiene practitioners in South Asia face a plethora of challenges in implementing programmes and projects, the paper describes some of these challenges and describes the appropriate measures and actions that have been taken to meet them and what can be learnt from them. Drawing from the 17 papers submitted by practitioners, the paper presents important emerging issues for discussion at the workshop. These include how to raise the profile of hygiene up the political agenda; how to scale up hygiene approaches, projects and programmes; how to verify and demonstrate that hygiene promotion is cost-effective; how to convert high levels of hygiene-knowledge into practice; the importance of menstrual hygiene management; and the benefits of and opportunities for linkage to other sectors. In conclusion, the paper identifies a shortlist of ‘common elements of success’ of hygiene promotion programmes that can be easily replicated.