The objective of the compilation on good hygiene practices is to strengthen the capacity of organisations to design and deliver effective hygiene promotion programmes leading to the improved health of communities.
Published on: 29/06/2011
The objective of the compilation on good hygiene practices is to strengthen the capacity of organisations to design and deliver effective hygiene promotion programmes leading to the improved health of communities.
This compilation of three keynote papers and 31 case studies searches for answers to the question: What makes hygiene promotion work? The case studies are written by authors from a wide variety of organisations working in South Asia, South East Asia, the Pacific and Africa. They provide lessons and learnings from very diverse experiences which are relevant beyond the specific project location, and for programmes in other regions too. The case studies were first written for workshops and publications organised by IRC and WaterAid between 2007 and 2010. This compilation draws out a synthesis of key lessons and makes the case studies more accessible by providing a snap shot overview and access on an accompanying CD and a dedicated website at www.irc.nl/foams.
The keynote papers and case studies in this publication provide a wide range of information, in some depth, about hygiene promotion. All case studies offer practical lessons and tools so that we can reflect upon these experiences, and also consider applying some of the techniques in our own work.
To assist you in deciding what to read, the snapshot provides a brief description of each case study. The final section highlights some of the key learnings and is presented using an adaptation of the FOAM model (Coombes and Devine, 2009). The accompanying CD and www.irc.nl/foams include the case studies, following the numbering provided in tables.
The FOAM model describes four core elements of hygiene promotion programmes that all need to be addressed in order to achieve behaviour change. An ‘S’ has been added to the model here, in order to draw attention to the importance of sustaining behaviour change.
| The key elements of ‘FOAMS’ are as follows:
F: Focus practices and focus groups; |
The case studies are a rich source of learning. Among the main themes that have emerged, four are highlighted here.
An undercurrent in many of the case studies is the need for good management. This requires sufficient emphasis on hygiene in WASH and broader health programmes, accompanied by skilled and dedicated staff and clear institutional responsibilities. Volunteers, local committees and staff must be trained, consistently supported and supervised. Another requirement is collaboration among people in communities, government, non-governmental and private sector for strong local support. Quality of interventions is a related issue.
For example, are participatory activities really participatory and carried out with sufficient care and skill?
Hygiene promotion programmes should understand and target the motives people naturally have for changing hygiene behaviour. Different user groups (women, men, elderly, youth, farmers or shopkeepers, urban or rural households) have different drivers that will motivate them to move from knowledge to actual practice. Examples given of using these motives - or drivers – specifically for handwashing with soap are:
For other practices, such as having and using a toilet, the drivers differ significantly from those for handwashing. For example, the status that having a toilet gives may motivate men, while the safety and privacy it gives may motivate women. The important point is that studies are needed with each specific target group to determine the most effective drivers. These need not be long and costly, for example focus group discussions with the different target groups split into adopters (for drivers) and non-adopters (for constraints) can quickly provide very useful insights.
The first efforts to improve hygiene were conducted in a traditional way: by telling communities - especially women - what to do to improve health and trusting that change in practice would follow. Largely it didn’t. So hygiene education was changed to hygiene promotion and two main approaches developed.
One is the social marketing campaign which focuses on one or two major practices and uses formative research through focus group discussions and audience (market) surveys to develop messages that suit target audiences and communicates these messages, usually through mass media, in ways that reach and motivate the audiences.
The other approach, which we call community-based, uses many methods with groups in communities, including participatory activities, demonstrations, group meetings, trials, group planning activities, and so on. The community, rather than the programme, should choose or prioritise the behaviours they want to improve.
Most of the community-based programmes work for improvement in several hygiene practices.
Some projects use elements from both approaches. For example, campaigns may also develop interpersonal community-based communication to promote improved practices. A new publication (Peal, Evans and Van der Voorden, 2010) describing these approaches in detail is: Hygiene and Sanitation Software. An overview of approaches, which can be found at www.washdoc.info/docsearch/title/172562 .
An important lesson learned for both approaches is the value of focusing on a single or a few behaviours at a time. Fewer practices are more effectively integrated into people’s lives; too many are confusing.
Do people wash hands before eating? Do mothers dispose the faeces of young children safely? It is difficult to measure such personal hygiene behaviours and difficult to learn about actual practices. But we must try to measure in order to learn to promote hygiene better and to know what programmes are achieving. Anecdotes, that is stories of success in a particular case, show that hygiene practices can change, but not that everyone in the focus audience is changing. Asking people to report on their own behaviour is not helpful. These self-reports give results that are 2 to 3 times higher than shown by actual observations in homes. Probably the best way is to use several tools - for example, through observations, spot checks, discussions and group ranking or voting - and compare the information. This is called triangulation and gives far more accurate results.
Conducting impact studies showing the health benefits from hygiene promotion and sanitation programmes is complicated, expensive and must be done very carefully to show valid results. We know that if people have the materials and carry out certain practices, their health will be protected. The practices and status of facilities is what should be studied.
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