Strengthening Hygiene Promotion And

UNICEF EAST ASIA AND PACIFIC REGIONAL OFFICE

STRENGTHENING HYGIENE PROMOTION AND HANDWASHING WITH SOAP DURING EPIDEMICS AND BEYOND Why the Note: This note provides a few Building on hygiene promotion tips for WASH practitioners in addressing to improve handwashing with hygiene promotion during epidemics and sustaining this habit after any disease soap outbreaks. In recent decades, a number of factors have led to a rise in the rate of emerging infections with the potential to cause INTRODUCTION internationally significant epidemics. The spread of COVID-19 is perhaps the For many years, WASH sector global pandemic that has had professionals have been working hard to unprecedented socio-economic impact promote hygiene and particularly globally. handwashing with soap as handwashing with soap and water is found to be the Hygiene promotion and particularly, most cost-effective intervention to break handwashing with soap to prevent or the spread of disease. However, it many mitigate water, sanitation, and hygiene- related diseases, is a cornerstone of people tend to ignore this simple but humanitarian response during infectious effective habit that can easily save lives disease outbreaks. of millions of people. Although ignoring the use of antibiotics and other Despite this, we know little about how substances to reduce infection have humanitarian organizations design, received much attention over the years, deliver or monitor hygiene programmes, ignorance of handwashing with soap has or about what works to change hygiene become a forgotten story and maybe behaviors in outbreak settings. Epidemics become so again once the public health usually create fear that can quickly pandemic issue stabilizes. change existing norms, but those changing norms are not necessarily

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Figure 1. COVID-19 Transmission Route and Barriers

sustainable over years. Here are a few Vision: All children and families are tips suggested to sustain hygiene healthy in any epidemic situation. behavior during and after outbreaks using the epidemic situation. Outcome: All children and families effectively practice handwashing with For COVID-19 prevention, handwashing soap and reduce the risk of COVID-19 with soap is considered to be the most transmission epidemics. effective barrier. This is graphically represented blow. As such, UNICEF aims Approach: A three-phased approach for to promote a nationwide handwashing a hygiene promotion and handwashing campaign to reduce the transmission of programme is recommended for WASH this disease in a phased manner as practitioners as illustrated in Table 1. described in Figure 1.

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Table 1. Three-Phased Approach for a Sustained Hygiene Promotion and Handwashing Programme

Messaging: Phase 1: Central Message (2-3 Phase 2: Central Message (3-6 Phase 3: Central Message (6 Hygiene messages are standardized months till zero case observed): months): months to years and slowly across the country and, if possible, changing the disease name): contextualized to different COVID-19 kills and hand washing COVID-19 is real, handwashing with experiences with soap saves lives. soap can prevent it. COVID-19 will never come back, within the country. handwashing will keep it away.

Education ✓ Map existing national ✓ Create new messages to ✓ Create new messages to channels, campaigns and reflect the change in dynamic reflect the change in promotion activities for hygiene (e.g. WASH in schools, MHM dynamic related to the (e.g. WASH in schools, MHM in schools, WASH in HCFs, messages (e.g. WASH in in schools, WASH in HCFs, nutrition/education promotion, schools, MHM in schools, nutrition/education promotion, etc.). WASH in HCFs, etc.). Explore opportunities to nutrition/education mobilize social media ✓ Use the most popular channel promotion, etc.). influencers and platforms to for the promotion (Long term disseminate key hygiene agreement with ✓ Engage different channel in messages. telecommunication and other the messaging diffusion. messaging entities, radio and ✓ Identify existing government or television on spots using most ✓ Conduct handwashing drills cluster coordination entertaining spots – Sketch, frequently with specific tests. mechanisms related to hygiene hand washing series, etc.). promotion in public health ✓ Develop a plan to reach the emergencies and potential ✓ Promote champions for marginalized communities. gaps, both at national, sub- national handwashing national, regional and local campaign (head state, levels. influencers demonstration how the battle was won) and acknowledge publication those champions for the cause.

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C4D and PME ✓ Review internal C4D and ✓ Develop a business case for ✓ Private sector to continue WASH (hygiene) capacity and hygiene promotion at all levels promoting hand washing in provide technical inputs in the and plan resources for them. their relevant sectors planning and implementation of hygiene promotion and HWWS ✓ Continue private sector ✓ Enforcement of hand activities. engagement on the cause washing in schools and [engaging at scale] with the health care facilities and ✓ Review existing country- developed viability gap communities specific data (e.g. MICS, DHS, analysis for handwashing. KAP) on relevant hygiene ✓ National- practices and behavioural ✓ Scale up implementation of /district0/community-level drivers of these practices. hygiene promotion activities handwashing building on existing community championships ✓ Collect existing hygiene engagement activities (e.g. promotion materials and tools hygiene, health, education, ✓ Document challenges, tailored to specific country nutrition promotion) at scale. lessons learned and context (culturally appropriate, innovations for behaviour in local language, etc.) and ✓ Scale up handwashing with change in handwashing align these materials with soap stations in schools and practices COVID-19 needs. public places and ensure that at those places, the WASH ✓ Review the capacity of washing pre-requisites of water implementing partners and and soap are available. private sector in delivering hygiene supplies and ✓ Support/strengthen hygiene behaviour change promotion offices and communication. Identify their incentivize community health reach and target groups and works in the promotion. determine whether any significant gaps exist in their reach.

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✓ Implement hygiene promotion activities building on existing community engagement activities (e.g. hygiene, health, education, nutrition promotion) and in coordination with C4D.

✓ Build/update handwashing with soap stations in school and public places and ensure that at those places, the WASH washing pre-requisites of water and soap are available.

Behaviour change ✓ Collect baseline information on ✓ Promote social norms change ✓ Create new norms around hygiene promotion and hand around handwashing handwashing with soap as a washing with soap or draw behaviour. lifelong habit. data from the latest JMP reports.

Evaluation ✓ Review lessons learnt from ✓ Review lessons learnt from ✓ Review lessons learnt from past hygiene promotion and past hygiene promotion and past hygiene promotion and hand washing activities hand washing activities hand washing activities including in emergency including in emergency including in emergency context. context. context.

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This note should be used as complement for the existing materials available (Click on each title to access the respective document).

• Joint WHO-UNICEF WASH Technical Brief

• WHO technical guidance pages on IPC

• COVID-19: UNICEF hygiene programming

• Behaviour change communication in emergencies: A toolkit

• Handwashing promotion monitoring and evaluation module (pages 81-110)

• WHO guidance on hand hygiene

• Lessons learnt from hygiene promotion activities during 2013-2014 Ebola outbreak

UNICEF East Asia and Pacific Regional Office UNICEF EAPRO Water, Sanitation and Hygiene (WASH)6 19 Phra Atit Road, Bangkok, 10200, Thailand eapro@unicef.org / www.unicef.org/eapro