Global Handwashing Day 15 October
Planner’s Guide Second Edition This Planner’s Guide is designed to ensure that you have the materials you need to make Global Handwashing Day a success! Clean hands save lives What’s Inside
1 About Global Handwashing Day p. 5
2 Handwashing with Soap: p. 10 The Basics
3 Critical Five: Five Facts Everyone p. 17 Should Know about Handwashing with Soap
4 Innovative Ideas in Handwashing p. 20
5 Global Handwashing Day: p. 27 Get Involved
6 Frequently Asked Questions p. 40
7 Press Release Template p. 43
8 References and Suggested p. 45 Resources 1
About Global Handwashing Day 1 6
About Global Handwashing Day
The practice of handwashing with soap The challenge is to transform tops the international hygiene agenda on handwashing with soap from an October 15, with the celebration of Global abstract good idea into an automatic Handwashing Day. Since its inception behavior performed in homes, schools, in 2008 – which was designated as the and communities worldwide. Turning International Year of Sanitation by the UN handwashing with soap before eating General Assembly – Global Handwashing and after using the toilet into an ingrained Day has been echoing and reinforcing habit could save more lives than any the call for improved hygiene practices single vaccine or medical intervention, worldwide. cutting deaths from diarrhea by almost half2 and deaths from acute respiratory The guiding vision of Global Handwashing infections by one-quarter.3 More Day is a local and global culture of handwashing with soap would make a handwashing with soap. Although people significant contribution to meeting the around the world wash their hands with Millennium Development Goal of reducing water, very few wash their hands with deaths among children under the age of soap at critical moments (for example, five by two-thirds by 2015. after using the toilet, while cleaning a child, and before handling food). Global Handwashing Day will be the centerpiece of a week of activities that Handwashing with soap is among will mobilize millions of people across five the most effective and inexpensive continents to wash their hands with soap. ways to prevent diarrheal diseases and pneumonia, which together are responsible for the majority of child deaths. Every year, more than 3.5 million children1 do not live to celebrate their fifth birthday because of diarrhea and pneumonia. Yet, despite its lifesaving potential, handwashing with soap is seldom practiced and not always easy to promote. Launched by the Public-Private Partnership for Handwashing with Soap (PPPHW), the annual celebration of Global Handwashing Day is designed to:
1
Foster and support a global and local culture of handwashing with soap.
Shine a spotlight Raise awareness on the state of about the benefits 2 3 handwashing in of handwashing each country. with soap. 1 8 In the long term, Global Handwashing Day can become a powerful platform for advocacy aimed at policy makers and key stakeholders and an occasion for concrete public commitment to actions that will spur behavior change. Global Handwashing Day revolves around schools and children. Children During Global suffer disproportionately from diarrheal and respiratory diseases and deaths. But research shows that children – the Handwashing Day – and segment of society so often the most energetic, enthusiastic, and open to the surrounding week – new ideas – can also be part of the solution. Ideally situated at the intersection of the home, school, and playgrounds, classrooms, community, children can be powerful agents of behavioral change. community centers and
The Public-Private Partnership for Handwashing with Soap (PPPHW) is a the public spaces of coalition of international handwashing stakeholders. Established in 2001, the towns and cities will be partnership includes the Water and Sanitation Program, UNICEF, USAID, the World Bank, the Academy for Educational awash with educational Development, the Centers for Disease Control and Prevention, the London and awareness-raising School of Hygiene & Tropical Medicine, Johns Hopkins University School of Public Health, the International Centre for activity as countries unite Diarrhoeal Disease Research, Colgate- Palmolive, Procter & Gamble, Unilever, to change handwashing the USAID/Hygiene Improvement Project, and the Water Supply and Sanitation Collaborative Council. behavior on a scale never
The goals of the PPPHW are to: seen before. Reduce the incidence of diarrhea and pneumonia in poor communities through public-private partnerships promoting handwashing with soap.
Support its partners’ large-scale, national handwashing interventions and promote replication of successful approaches.
Share scientific evidence showing handwashing with soap to be an exceptionally efficacious and cost- effective health intervention. 2
Handwashing with Soap: The Basics Handwashing with soap is a Handwashing with life-saving soap is seldom done.
People all over the world wash their intervention hands with water. The belief that washing with water alone to remove visible dirt is sufficient to make hands clean is within the commonplace in most countries. But washing hands with water alone is significantly less effective than washing technological hands with soap in terms of removing germs, and handwashing with soap is seldom practiced. Around the world, and financial the observed rates of handwashing with soap at critical moments range from zero percent to 34 percent. Using soap adds reach of all to the time spent washing, breaks down the grease and dirt that carry most germs by facilitating the rubbing and friction that countries and dislodge them and leaves hands smelling pleasant (which creates an incentive for soap’s use). With proper use, all soaps are communities. equally effective at rinsing away the germs But promoting that cause disease. it requires Tippy Taps are cans or plastic bottles that release a small amount of water— appeals not just enough for a clean hand wash— necessarily to each time they are tipped. health, but to other things that people Using soap at critical moments is the key value, such as to handwashing’s comfort, social benefits. status, nurture The critical moments for handwashing with soap are after using the toilet or cleaning a child’s bottom and before and a wish to handling food. avoid disgust.4 Handwashing with soap works by interrupting the transmission of disease. Hands often act as vectors that carry disease-causing pathogens from person to person, either through direct contact or indirectly via surfaces. When not washed with soap, hands that have been in contact with human or animal feces, bodily fluids like nasal excretions, and contaminated foods or water can transport bacteria, viruses and parasites to unwitting hosts,5 as shown in the F-Diagram of disease transmission and control, below. Source: Wagner and Lanoix.
Primary Secondary Barriers Barriers Fingers
Fluids
Feces Food New Host
Flies
Fields/Floors Disease transmission Route
Barriers to transmission
2 12 2 13
Handwashing with soap reduces disease.
Handwashing is a cornerstone of public Diarrheal disease: health, and new hygienic behaviors and Diarrheal Infections are the second most common cause of death sanitary services were principal drivers of in children under five. A review of more than 30 studies found that the sharp drop in deaths from infectious handwashing with soap cuts the incidence of diarrhea by nearly disease in affluent countries in the late half.6 Diarrheal diseases are often described as water-related, 19th century. Along with the isolation and but more accurately should be known as excreta-related, as safe disposal of feces and the provision the pathogens come from fecal matter. These pathogens make of adequate amounts of clean water, people ill when they enter the mouth via hands that have been in handwashing with soap is one of the contact with feces, contaminated drinking water, unwashed raw most effective ways to prevent diarrheal food, unwashed utensils or smears on clothes. Handwashing with diseases; it is also the cheapest way. In soap breaks the cycle. The figure on the following page shows addition, handwashing with soap can limit the effectiveness of handwashing with soap for reducing diarrhea the transmission of respiratory disease, morbidity in comparison to other interventions. the largest killer of children under five. And handwashing with soap is also a formidable ally in efforts to combat a Acute respiratory infections: host of other illnesses, such as helminths Acute respiratory infections like pneumonia are the leading (worms), eye infections like trachoma and cause of child deaths. Handwashing reduces the rate of respiratory skin infections like impetigo. infections in two ways: by removing respiratory pathogens that are found on hands and surfaces and by removing other pathogens (in particular, enteric viruses) that have been found to cause not only diarrhea, but also respiratory symptoms. Evidence suggests that better hygiene practices – washing hands with soap after defecation and before eating – could cut the infection rate by about 25 percent.7 And a recent study in Pakistan found that handwashing with soap reduced the number of pneumonia-related infections in children under the age of five by more than 50 percent.8
Intestinal worm and skin and eye infections: Though not as extensive and robust as the research evidence for diarrheal disease and respiratory infections, studies have shown that handwashing with soap reduces the incidence of skin diseases; eye infections like trachoma; and intestinal worms, especially ascariasis and trichuriasis. More evidence is needed, but existing research points to the effectiveness of handwashing in reducing the incidence of these diseases. Reduction in diarrheal morbidity [%] per invention type
0% 10% 20% 30% 40%
Hand Washing with Soap 44
Point-of-use 39 Water Treatment
Sanitation 32
Hygiene Education 28
Water Supply 25
Source Water 11 Treatment
Source: Fewtrell et al. 2005 Handwashing with 2 15 soap is cost-effective.
Handwashing with soap is the single-most cost-effective health intervention. Disability-adjusted life years (DALYs) are used to measure the burden of disease and the effectiveness of health interventions by combining information on years of life lost and years lived with a disability. Remarkably, handwashing with soap has been shown to be the most effective way to avert DALYs associated with diarrheal diseases. Handwashing is also orders of magnitude less expensive than immunization; for instance, one DALY requires investment in measles immunization anywhere from US$250 to US$4,500. This is not to say that immunization is not essential; it is simply to point out the tremendously inexpensive life-saving opportunities being missed by the widespread failure to invest in handwashing promotion. Soap is already available in most households in the world; cost is not the chief barrier to handwashing with soap.
Interventions against diarrheal disease
Cholera 1,658 to 8,274 immunizations
Rotavirus 1,402 to 8,357 immunizations
Measles 257 to 4,565 immunization
Oral rehydration 132 to 2,570 therapy
Breastfeeding 527 to 2,001 promotion programs
Latrine construction <270 and promotion
House connection 223 water supply
Hand pump or 94 stand post As table 1 (cost-effectiveness ratio) to the right shows, every US$3.35 invested in handwashing programs yields one Water sector regulation 47 DALY; gaining that same year through and advocacy latrine promotion would cost US$11.00; through household water connection, Latrine promotion more than US$200.00. Source: Jamison 11.15 et al. 2006. Hygiene promotion 3.35 (including hand washing) 2 16
Effective promotion Public-private requires understanding partnerships help behaviors and take behavior change motivations for change. efforts to scale.
There is ample evidence that health Partnerships among national and local considerations rarely motivate people governments, international organizations, to change their hygiene and sanitation nongovernmental organizations (NGOs), practices. The conventional way to and multinational, as well, as local soap promote handwashing – top-down, manufacturers can be extremely effective health-focused campaigns that raise in promoting handwashing with soap. the specter of disease and death – have They combine the health objectives of had little success in changing people’s the public sector, the marketing expertise behavior, research shows. Formative of the private sector and often the research – a thorough study of the Different communities value and are community knowledge of NGOs to create factors that may influence different motivated by different things; there is a more far-reaching and beneficial people within a community to wash their no “one size fits all” handwashing impact than any of the three could hands (or not) – is a critical first step in campaign. For instance, formative achieve on its own. any hygiene promotion campaign. Only research in Kerala, India, suggests by knowing what people do now, that people want clean hands for what they value and which benefits of reasons of comfort, to remove smells, handwashing with soap appeal to them to demonstrate love for children and to can you design an effective campaign. exercise their social responsibility. In Ghana, a study found the chief motives for handwashing to be to nurture, to avoid disgust and to gain social status. Social marketing campaigns that are based on the hopes and desires of the target population and approach that population as consumers with a range of behavior choices have found far more success than conventional promotion campaigns based on what experts believe a target population should do. 3
Critical Five: Five Facts Everyone Should Know about Handwashing with Soap 1 Washing hands with water alone is not enough! Washing hands with water alone, a common practice around the world, is significantly less effective than washing hands with soap. Proper handwashing requires soap and only a small amount of water. Using soap works by breaking down the grease and dirt that carry most germs, facilitating the rubbing and friction that dislodge them and leaving hands smelling pleasant. The clean smell and feeling that soap creates are incentives for its use. With proper use, all soaps are equally effective at rinsing away disease-causing germs. 2 Handwashing with soap can prevent diseases that kill millions of children every year. Handwashing with soap is among the most effective ways to prevent diarrheal diseases and pneumonia, which together are responsible for the majority of child deaths. Every year, more than 3.5 million children do not live to celebrate their fifth birthday because of diarrhea and pneumonia. Handwashing can also prevent skin infections, eye infections, intestinal worms, SARS and Avian Flu, and benefits the health of people living with HIV/AIDS. Handwashing is effective in preventing the spread of disease even in overcrowded, highly contaminated slum environments, research shows. 3 The critical moments for handwashing with soap are after using the toilet or cleaning a child and before handling food. Hands should be washed with soap after using the toilet, after cleaning a child’s bottom (or any other contact with human excreta, including that of babies and children) and before any contact with food. Hands are the principal carriers of disease-causing germs. It is important to ensure that people have a way to wash their hands at these critical moments. Simple, low-cost solutions like Tippy Taps are within the financial and technological reach of even the poorest communities. 4 Handwashing with soap is the single most cost-effective health intervention. Handwashing promotion is cost-effective when compared with other frequently funded health interventions. A $3.35 investment in handwashing brings the same health benefits as an $11.00 investment in latrine construction, a $200.00 investment in household water supply, and an investment of thousands of dollars in immunization. Investments in the promotion of handwashing with soap can also maximize the health benefits of investments in water supply and sanitation infrastructure and reduce health risks when families do not have access to basic sanitation and water supply services. Cost is not typically a barrier to handwashing promotion; almost all households in the world already have soap – though it is commonly used for laundry, dishwashing, and bathing rather than for handwashing. 5 Children can be agents of change When it comes down to sharing good hygiene practices, children – the segment of society so often the most energetic, enthusiastic and open to new ideas – can act as agents of change by taking the “handwashing lessons” learned at school back into their homes and communities. The active participation and involvement of children – ideally situated at the intersection of the home, school, and community – can ensure sustained behavioral change when combined with culturally sensitive community-based interventions. Global Handwashing Day aims at motivating children to embrace and share proper handwashing practices, and place them as “handwashing ambassadors” at the heart of each country’s national and local initiatives. 4
Innovative Ideas in Handwashing 4 21
Public-private partnership to promote handwashing in Ghana
What was new about Background mass media, direct consumer contact and a district-level program through schools, the program? In Ghana, diarrhea accounts for 25 health centers and communities. The The Ghana handwashing program made percent of all deaths in children under communication strategy also included a contamination visible to the ordinary five and is among the top three reported public relations and advocacy component Ghanaian for the first time, effectively causes of morbidity. Children under five that targeted policy makers and opinion communicating a hygiene message using typically have three to five episodes leaders and promoted the provision of commercial marketing techniques. of diarrhea and a similar number of respiratory infections a year. Nine million handwashing infrastructure in schools and episodes of disease could be prevented public latrines. each year by washing hands with soap.
Ghanaians use soap, and they buy a lot of it. However, the soap is almost all used for cleaning clothes, washing dishes and bathing. In a baseline study, 75 percent of mothers claimed to wash hands with soap after toilet use, but structured observation showed that only 3 percent did so, while 32 percent washed their hands with water only. Mothers who did wash hands with soap generally did so because it felt good to remove dirty matter from hands, it was refreshing, it was a way of caring for children and it could enhance their social status.
The Ghana Public-Private Partnership to Promote Handwashing with soap crafted a high-impact communication strategy with the slogan “For Truly Clean Hands, Always Wash with Soap.” The intensive phase of the program’s communication activities was carried out in the period 2004-06. During this phase, the program used three routes to bring the handwashing with soap message to the target audiences – mothers and caregivers of children under five years and children in basic school, ages 6-15 years, across the whole country. The routes included The Communication Strategy Achievements PR campaign: A public relations program Lessons targeted at opinion leaders and strategic Mass media: The program employed A major lesson from the Ghana targets delivered continued press and state-of-the-art marketing strategies. The program was that when partners from media coverage in support of the aims guiding concept for this phase of work different backgrounds and sectors are of the handwashing program. A number was “your hands are only truly clean not accustomed to working together, of radio and television discussion if washed with soap.” Two radio and establishing common grounds and trust programs and interviews were held two TV advertisements suggested that takes time and effort. throughout the country on national media there was “something on your hands,” and district-specific FM radio stations. suggesting an unknown menace, an Another important take-home lesson was An advocacy brochure that outlined unseen contamination that only soap that the public and private sector can the strategy for the initiative was also could remove. Three advertisements work together for the public good. When produced and distributed to strategic (two on radio and one on TV) targeted there is transparency, the strengths of targets and partners. mothers and caregivers, while another each are recognized and each member is advertisement on TV targeted children. treated as an equal in the partnership. Evaluation results: An evaluation reported The radio and television commercials that handwashing with soap rates for were supported by posters and mothers after six months of the campaign billboards sited in all 110 district and were over 80 percent. 10 regional capitals of the country, and the distribution of promotional items like Exposure: Exposure to all campaign badges, T-shirts, branded poly bags, and materials was also high, with almost soap. The radio and TV advertisements everyone aware of and able to sing the ran for six months, with particularly campaign theme song, and with more intense activity in the first three months of than 80 percent of children and adults the campaign. reporting more handwashing with soap since the campaign. Direct to consumer contact: Under the Direct Consumer Contact (DCC) The Ghana handwashing program for Programme, an event management firm the first time made contamination visible visited two districts per region in six to the ordinary Ghanaian and was able regions and conducted 128 high-impact to communicate a hygiene message in events in schools to reach 103,313 an innovative manner along the lines of school children, 2,930 teachers, 926 commercial marketing. food vendors and 132 events in health centers and communities for 11,500 mothers. DCC is used as an interpersonal communication strategy that provides information on handwashing with soap in an innovative and interactive, face-to- face manner. This direct contact allows consumers to ask questions and converse about handwashing with soap, which facilitates behavior change. Lifebuoy Swasthya Chetna 4 23
What was new about the Background program? The Lifebuoy Swasthya Chetna (“Health The program used a powerful yet simple Awakening”) program began in 2002 demonstration tool – the glow germ demo as a rural health and hygiene education kit – to make visible the germs on hands initiative in India. The project was that look clean, but were not washed designed to spread awareness about the with soap. importance of washing hands with soap and to promote general hygiene in rural villages. The program has reached more than 100 million people, and its teams have reached at least 44,000 villages in rural India. Swasthya Chetna is one of the world’s largest self-sustained and self- funded hygiene promotion projects.
Glow germ demo used to establish the Children performing on Swasthya Rally: to let the whole village know presence of germs and the importance Diwas – Health Day of using soap to remove them.
Key project activities: Communicating the Key factors to success of Lifebuoy Swasthya Chetna is a multi- message to children: the program: phase activity that works toward effecting School children are change initiators Continuous monitoring and evaluation is handwashing behavior change among the and, in this context, the program works at the core of the program – each year, rural communities it touches. The central with them to take the messages home program activities are evaluated on both message of the campaign is: and into their communities. Children are awareness of hygiene moments and also excellent communicators if they find effective behavior changes. Improvements Visibly clean is not really clean. the topic or activity fun and involving. can be made to the subsequent year’s The tools to communicate the central program to make it more effective in The communication Swasthya Chetna message are adapted achieving its goals. tasks were to: according to the specific audience, and Establish the presence of germs schools have proven excellent entry Cost-effectiveness of the program – cost even on clean-looking hands, using a points into communities. The element of per village is approximately £50 for the simple but extremely powerful, low-cost Swasthya Chetna that involves children three exposures, including implementation demonstration tool called the “glow focuses on how to position hygiene as and development of the materials. germ demo kit.” Developed by Unilever fun and uses stories, games, songs for use in Swasthya Chetna, it brings to and quizzes. Commitment of the operating company – the target audience the idea that hands Swasthya Chetna is now central to what are only truly clean if washed with soap. the brand does in India, and the operating company (Hindustan Unilever Limited) has Establish the consequences of these invested more than US$5 million. hidden germs on hands. 4 24
Children as agents of change: lessons from UNICEF
What is new about the Background UNICEF approach? Children have historically had few if any UNICEF recognizes the potential of roles in school decision making, let alone children as agents of handwashing in community-based programming in behavior change by coupling water hygiene and sanitation. UNICEF works and sanitation improvements in toward making schools healthier and schools with hygiene education. more attractive to children, especially The use of environmental health girls, through school-based water, clubs, drama groups and student sanitation and hygiene programs. Guiding focus groups creates the conditions this approach is the knowledge that for children themselves to be agents healthier children are more effective of change in their schools, families learners, and girls who spend less time and communities. fetching water have more time for school. Helping to build separate and decent sanitation facilities in schools can reduce dropout rates, especially among girls. Achievements hands with soap before preparing food Key lesson The following UNICEF country programs or eating and after using the toilet. The UNICEF’s experience in promoting illustrate the impact children are having students’ work of improving the health handwashing with soap in schools as part on improving handwashing with of their community goes beyond their of a larger water, sanitation and hygiene soap behavior: theater productions. They also take effort shows how important it is to involve charge of the village’s Jum’at Bersih children themselves as active participants Nigeria. Efforts in Nigeria to change (Clean Friday), a national movement, with real project responsibilities rather the classroom environment are child- begun in 1994, that encourages hygiene than as passive targets of health centered, including forming children’s promotion, particularly handwashing messages. Combining handwashing with hygiene and child rights clubs, training with soap, during meetings on Islam’s soap promotion with hands-on school teachers in life skills education, involving holy day. The little doctors are becoming improvements also creates in the children parents and encouraging village leaders, learning to communicate a sense of ownership that makes new artisans to participate in hygiene and clearly and effectively, solve problems, behaviors more likely to stick. sanitation projects. One school initiated negotiate and analyze. “People love an Environmental Health Club, where drama, and parents especially love to students promote handwashing with see their children perform,” said one of soap in both the school and the the supervising teachers. “It is far more community and advocate for secure effective than telling people directly to household water supplies to continue change the way they do things.” hygienic behavior at home. With the help of a teacher, the 12 girls and 18 Malawi. An approach in Malawi honors boys who make up the club operate and the right of children to participate in a maintain the facilities and keep track of process of developing and instituting the borehole’s usage. The club funds its national standards for sanitation activities by selling plastic buckets and facilities and hygiene promotion in clay pots fitted with taps. Two years after primary schools. National review teams the project’s inception, handwashing interviewed children on what they liked among children increased by 95 percent. and disliked about their sanitation facilities Teachers reported that students came and hygiene education programs. The to school clean and had fewer cases of children spoke candidly and perceptively ringworm and other skin diseases. In of the changes needed, and their insights addition, school attendance grew are being used to modify the technical steadily each year, from 320 pupils when designs and approach to health behavior the program was initiated to 538 in 2001. change. The children proved keen advocates for better sanitation and Indonesia. A primary school project child-friendly health education. Comic called “Dokter kecil,” or little doctors, books based on their feedback have develops school clubs, consisting of 30 already been designed for grades five students from grades four to six, that to eight. This approach and the insights promote hygiene through community derived are being seen more actively theater and other lively, interactive as having potential applications for activities. The children put on school programming improvements in nutrition, plays for their parents and other education, health and other areas. community members that convey lessons on the importance of washing Safeguard Pakistan 4 26 School Education Program empowering children with hygiene education:
What’s new about The Safeguard school this program? program has The Safeguard School Program two components: connects with kids in a language that 1. Execution: The objective of the they understand. This program Partnership with Public Sector Health execution component is to spread and leverages the animated character Organizations to make a difference reinforce health and hygiene messages Commander Safeguard as the Health and hygiene programs are among children across Pakistan in a communication vehicle to make the carried out in collaboration with the memorable and engaging manner. A overall hygiene message relevant, PMA, the largest body of doctors across typical school program day consists of memorable and engaging for school Pakistan, and the IDSP, which is working Safeguard’s team of qualified doctors children. Commander Safeguard to create awareness about infectious visiting schools, where they conduct communicates with children in a way disease prevention in Pakistan. These hygiene tutorial sessions. In these that is novel and exciting. credentialing partners help Safeguard tutorials, children are taught about in recruiting and training doctors and germs and how they are spread through preparing tutorial material communicated casual contact via a germ visualization in schools. demo. They are also taught how to wash their hands properly through Achievements a handwashing demo. This hygiene message is reinforced through a The Safeguard School Program has Commander Safeguard animated empowered more than 5 million school cartoon. Each student is then given children between the ages of 6 and 11 take-home educational material so that years with hygiene education over the they can continue to learn and monitor last four years. To date, this program has their hygiene habits with their families. Background covered more than 10,000 schools in 100 cities of Pakistan. The Safeguard School Program promotes 2. Reseeding component: The objectives handwashing awareness and brings Key lesson of the reseeding component are to about habit change at the grassroots ensure that health and hygiene learning Using a memorable, engaging and level in Pakistan by becoming an ally in continues long after the Safeguard team child-friendly vehicle – Commander empowering children with health and has completed its health tutorial and to Safeguard – to spread and reinforce hygiene education. The program has help schools institutionalize this learning health and hygiene messages is far more its roots in the Karachi Soap Health through activities like “Health Days.” A effective with children than standard Study (2002) led by the Centers for Health Day is the celebration of health and health lessons. Disease Control, HOPE, and Procter & hygiene organized and led by the schools Gamble. The study showed that regular Private Sector companies like Procter themselves. Schools have celebrated handwashing with soap can reduce the & Gamble bring unique consumer Health Days in various ways, among incidence of diarrhea by up to 50 percent. understanding and marketing expertise them drama competitions, debates, In Pakistan, where every year more than which, if combined with public sector singing competitions, art galleries, 250,000 children die from diarrhea, this health organizations, can lead to new health awareness walks, and community message of handwashing becomes a innovative ways to influence hand wash cleanliness drives – all organized around message for survival. behavior change. the theme of health and hygiene. 5
Global Handwashing Day: Get Involved The driving theme for Global Handwashing Day is handwashing in schools. Therefore, a key target audience is children, positioned as the Global Handwashing Day planners’ chief task is to introduce the concept and agents of change. establish credibility at the global and lo- cal levels. A solid, scaleable framework needs to be created that can be built on in You can join Global future years. Other recognition days have been established for decades; high-profile recognition cannot (and will not) come Handwashing overnight. In order to differentiate Global Handwashing Day from other big-budget recognition days, Global Handwashing Day celebrations Day will have a consistent tone and dis- tinct visual identity. on 15 October This document outlines the main areas to consider when planning your Global by organizing Handwashing Day activities. In addition, attached as Annex 1 is a brief guide to advocacy in general, which was activities prepared for the International Year of Sanitation. It provides guidance on the to motivate general principles of issue-based advocacy. children to wash hands with soap. 5 29
Institutional The Goal for Global arrangements Handwashing Day and the global context for Global Handwashing Day
The Global Handwashing Day call is open by the end of the school week in which To provide a “news hook” for media, to all countries wishing to participate. Global Handwashing Day is celebrated. Global Handwashing Day will be framed Each participating country can have one as a joint global effort to get as many or more “lead” agencies, chosen based To obtain additional materials and keep schools and schoolchildren to wash on convening capacity, which will take up-to-date on Global Handwashing Day their hands with soap on October 15 as national responsibility for driving the activities, planners are encouraged to visit possible. This will drive headlines and Global Handwashing Day on the ground the official Global Handwashing Day web coverage and provide journalists an entry and leading the coalition of organizations site at: www.globalhandwashingday.org point to talk about Global Handwashing involved. Day as well as handwashing with soap A press release will go out at the end more broadly. Where possible, the national coalition of the school week itself to publicize should be built on existing structures and the success of the day. The release At the national level, each lead agency, relevant working groups, such as WASH will include the following information: working with its partners on the ground, coalitions. Tie-ins with other recognition achievements of Global Handwashing Day will set its own goal, ensuring that the days and national holidays should be globally, how many countries/schools/ target is a realistic stretch – a number encouraged. Depending upon its human students were involved; quotes from key sufficiently large to attract attention, but and financial resources, lead institutions opinion leaders; a summary of events that not one that will be impossible to reach. will be responsible for launching the took place; and a prediction or pledge for The target should be grounded in the Global Handwashing Day activities and an even bigger and better day in the year facts about the specific handwashing carrying out local PR and communications to come. situation in that country. aligned with the global strategy and visual identity guidelines. Lead institutions are At the global level, the goal is to have, also responsible for capturing learnings, year by year, an increasing number using a template evaluation scorecard of countries participating in Global provided by and collated centrally, to Handwashing Day. The higher the number measure the success of the day. The of participating countries, the better the success of the day should be measured chances of having more children washing their hands with soap. 5 30
Compiling data Thus, well and developing in advance key messages of the day, the following will be useful:
This kit provides data and messages for In addition to numbers, it is helpful to Hard data on mortality and the world as a whole. But journalists, compile stories – stories of how poorly morbidity from decision makers and regular people are equipped schools are for handwashing, most interested in knowing about the for instance, but also hopeful stories diarrhea and pneumonia specifics in their own country. Thus, an about what is working in your country. important first step in preparing for Doom and gloom news by itself generally Findings of any handwashing Global Handwashing Day is to compile doesn’t motivate people to action – they behavior studies that have relevant national and, to the degree need to see something concrete that is possible, state, municipal and local data. already working to inspire them. been done
The kind of data that will help you Findings of any studies of make your case includes mortality and handwashing and sanitation morbidity statistics for children under five from diarrhea and pneumonia. If any facilities in schools studies have been done on handwashing behaviors in your country, the key findings Real-life stories of good about the prevalence of handwashing practices in your country with soap are useful. Also helpful will be any data on handwashing or other hygiene programs, infrastructure or Photographs of good and habits in schools. It is important to draw bad practices in schools a distinction between handwashing and elsewhere with water alone – which is commonly practiced – and handwashing with soap, which is, in general, comparatively Pre-taped radio interviews infrequent. Even a brief observational and quotes study showing how many people are washing their hands with soap after using the toilet will make the topic come to life; Charts and other infographics it is effective to highlight the handwashing that newspapers can just behaviors of people from all strata of drop into their stories on society, not just poor people. Global Handwashing Day Whom to target Primary targets:
From this data collection will emerge your Over time, the primary targets for Global Journalists key messages. For instance, you may Handwashing Day will increasingly be are the way to get your Global find that 60 percent of people wash their members of the general public. However, Handwashing Day story and hands with water – and think that doing given that the task is to introduce messages out. Providing ready-made so is sufficient – but only 10 percent wash and reinforce the very idea of Global information they can use will increase their hands with soap. Thus, your key Handwashing Day, journalists, decision the likelihood that they will write message may center around the idea that makers, and other opinion leaders are about Global Handwashing Day and water alone is not enough – you need to important targets. stress the messages that you think are wash with soap for truly clean hands – most important. possibly evoking disgust at all the germs that are found on the hands. You may Political decision makers find that in a specific school, parents built are key to bringing handwashing behavior handwashing stations and created a soap change to scale. They should be urged, fund: one of your messages might be that directly and through their constituencies, parents, working together, can keep all to take action. Heads of state and their children healthy. Again, positive “we governments, as well as ministers and can do it” sorts of messages are more officials with responsibility for education, motivating than a recap of the death- infrastructure, health, finance, social and-disease statistics (though these are affairs and foreign affairs, all need to important to provide context, background be engaged. and support for your messages). Education officials and teachers are particularly important targets, as Global Handwashing Day focuses on schools. Creating ready-made handwashing materials and activities that teachers can do with their students is a good approach.
School children are important agents of change; activities on Global Handwashing Day should be ones that children can also do at home. An efficient way to reach out to this audience is by managing information campaigns in primary and secondary schools. 5 32
Secondary targets (over time, some of these groups may become the focus of Global Handwashing Day):
The general public Academics must become more aware of the who research topics relevant to benefits of handwashing with soap in handwashing with soap, including water order to foster behavior change at the supply and sanitation topics, should necessary scale. be encouraged to publish research findings in popular media, as well Community and as opinion pieces supporting Global Handwashing Day. women’s groups are essential allies in seeking to change hygiene practices. Close to the Celebrities people, they can be a good partner for Global Handwashing Day planners understanding current handwashing should consider recruiting popular behaviors and rolling out campaigns. culture celebrities from music, sports, film and television to help carry Global Business people Handwashing Day messages. To get them to agree to do this, these stars should be encouraged to understand must be convinced that handwashing the potential commercial benefits of with soap is an issue worthy of their a nation of people using soap instead of time and attention. just water to wash their hands. They should also be encouraged to lend their marketing expertise to this public health goal.
Religious leaders greatly influence public opinion in many communities and should be encouraged to help inform their congregations of the benefits of handwashing with soap. Tailoring your message to the listener: Not everyone is persuaded by the same line of reasoning. An important guidepost can be to search for the “what’s in it for me?” for different groups. Handwashing with soap may appeal to the public health community because it cuts down on diarrheal disease; Politicians it may appeal to mothers because it is a way Treating diarrhea and pneumonia consumes a large proportion of the to show that they care about their families; it health budget; handwashing can cut the may appeal to children because an admired rates of diarrheal disease by nearly half, pneumonia by one-quarter. sports star has been shown doing so; it may appeal to the Minister of Finance because Handwashing promotion is cost-effective when compared with other frequently it is an extremely cost-effective health funded health interventions. A US$3.35 intervention. Making the health argument to investment in handwashing brings the same health benefits as a US$11 school children or the nurturing argument to investment in latrine construction, a the Minister of Finance might not be terribly US$200 investment in household water supply and an investment of thousands effective in changing behaviors or prioritizing of dollars in immunization. investment in hygiene promotion. The Investments in health, education and following gives examples of arguments that improved water supply are imperiled by might be effective with different audiences. the lack of handwashing with soap. 5 34
Journalists Health community Businesses Many people do not realize that Handwashing with soap is among Marketing soap for handwashing handwashing with water alone is the most effective ways to prevent (and generating demand) can not sufficient to make them clean. diarrheal diseases and pneumonia, increase your business. The information on handwashing which together are responsible for the benefits and prevalence is an majority of child deaths. Every year, Doing research into the motivations underreported story. more than 3.5 million children do not for using soap will allow you to create live to celebrate their fifth birthday the most effective marketing campaigns. Handwashing with soap could save because of diarrhea and pneumonia. 1 million lives per year. Working with governments, NGOs and Handwashing can also prevent skin others to promote handwashing can Key newsmakers (sports stars, infections, eye infections, intestinal improve your corporate image. business leaders, top politicians or worms, SARS and Avian Flu, and first ladies, for example) are getting benefits the health of people living with Teachers behind Global Handwashing Day. HIV/AIDS. Handwashing is effective in Diarrhea is responsible for the loss of preventing the spread of disease even hundreds of millions of school days in overcrowded, highly contaminated every year; handwashing with soap can slum environments, research shows. reduce diarrheal disease by nearly half.
Religious leaders The handwashing habits you teach in Many religious faiths call for washing school will last a lifetime. and cleanliness before prayer or during other religious rituals; only hands that You can easily include handwashing have been washed with soap are with soap in many lessons. truly clean. Making handwashing stations is a good The health of your congregants, activity for school children and can particularly the children among them, influence their families. is imperiled by lack of handwashing with soap.
One million lives could be saved each year through handwashing with soap. Children Parents Others who don’t It is cool and fun to wash your hands To nurture your child properly, you must currently use soap with soap! wash your hands at critical moments. to wash their hands Yucky germs from poop are everywhere, To raise your child properly, you must People are motivated by different but they are too small to see. Washing teach him or her to handwash with soap messages. Health appeals are less hands with soap makes the germs at critical moments. effective, in general, than appeals to go away! disgust, to the wish to be attractive, The feces of babies and children are to the desire to nurture one’s family You can be like a teacher in your family full of disease-causing germs; it is not and the wish to be like others who about handwashing with soap. benign, as many parents think. wash their hands.
Diarrhea is not a normal condition; it is NGOs an illness that is making your child less Understanding motivations for and able to grow, learn and thrive. barriers to handwashing with soap is the first step toward promoting behavior change; you are well Community or placed to understand what motivates traditional leaders your constituencies. You can make a difference in your community by organizing handwashing Diarrheal epidemics can jeopardize programs for all members and leading projects and undo years of work; the charge to set up handwashing healthy people can better capitalize stations in homes and schools. on social and economic interventions.
Your role is critical for the success of Global Handwashing Day and your participation will make a difference.
The benefits of handwashing with soap and other hygiene improvements will only come if the community works together as one – if only a few participate the effect will be small and the community will miss an opportunity to distinguish itself. 5 36
Suggestions for National Activities
There are many ways to celebrate Global Handwashing Day. The following provides some suggestions and global examples of Global Handwashing Launch event School behavior- A half-day kickoff to either the day itself or change competitions Day activities. the week of activities, with public figures, Competitions geared at training an overview of Global Handwashing Day, students in best handwashing and planned activities and discussion with practice, such as: local experts, authorities, school children and teachers, and media. Handwashing song competitions – if you
give children some existing verses to a Handwashing song, then they are more likely to make up new verses; it’s hard for them to start learning event from scratch A half- to one-day seminar on handwashing, with case studies, videos, Playground game competition – create discussion, and a field visit highlighting half a game involving handwashing and some of the best and worst examples of ask children to find ways to finish it action/inaction, best practices, etc., with a Relay races involving handwashing at focus on schools. handwashing stations Example: In the rural village of Saran Posters that illustrate key messages about Maradi, Niger, a primary school elected handwashing a gender-balanced school government Essay contests for older children which included a sanitation and hygiene minister. The “minister” was responsible Rhyme/poetry contests for promoting activities and participation Drama/plays on Global Handwashing Day. The school used “edu-tainment” tools to get the Dress-up parade (Children can dress up public’s attention nationwide. In front of as germs, soaps, hands, etc.) TV crews, several radio channels and popular local newspapers, they made a salesperson-type demonstration of the Celebrities and leaders eight steps for proper handwashing with as handwashing soap. They then sang a song dedicated to clean hands and the benefits of champions handwashing against diseases. Sports stars, singers, actors, former political leaders, corporate leaders, and academics can all act as ambassadors for Media event handwashing behavior change. A picture An event specifically geared toward the of a much-admired sports star washing media to launch Global Handwashing Day, his hands with soap can go a long to with guest speakers, celebrities, officials, motivating children to handwash. or a field visit to a school with good Example: In India, cricket star Sachin practices and infrastructure to support Tendulkar led a handwashing campaign them. Example: In Bhutan, a panel that culminated in millions of children discussion on Handwashing was held on across South Asia simultaneously national television in commemoration of washing their hands. Global Handwashing Day. Global Participation in the Radio campaigns Radio campaigns including soap operas, Handwashing Day WASH Media Awards short PSA spots, and celebrity interviews The WASH Media Awards initiative is a coordination group and debates on handwashing and hygiene media contest soliciting print, electronic, Revitalization of an existing group or are a great way to get the handwashing and broadcast media submissions on forming a new coordination group message out. Involve school children water supply, sanitation, and hygiene responsible for Global Handwashing Day and teachers! issues from journalists in developing activities. This might include a group of countries. The initiative aims to encourage representatives from different stakeholder broader media coverage of those issues. Photo contest groups (government, NGO, industry, Locally, such a contest might delve further A national photo contest of images of community) who might gather to plan into issues of importance in your country people handwashing with soap is another activities for Global Handwashing Day. as well as engage the public more on the good awareness-raising technique. Focus Link in, if possible to WASH campaigns issue of handwashing.. on schools and children. – national alliances of governments, parliamentarians, NGOs, media, Corporate sponsorship religious leaders, community groups, Soap wrapper prize Leveraging resources by approaching schools, private sector actors, and other Having a local soap company insert local soap companies as well as hotels, stakeholders that are active in many winning tickets that can be redeemed restaurants, and other firms to sponsor countries. WASH campaigns aim to for a prize on Global Handwashing Global Handwashing Day activities. raise the commitment of political and Day. Build anticipation toward Global social leaders to achieving hygiene Handwashing Day with handwashing and sanitation goals and effecting the questions and answers on the soap Postage stamp necessary behavioral changes through wrappers. Prizes should be geared to Investigating the possibilities of a special various information and communication hygiene hardware for schools. national Global Handwashing Day channels, using traditional and mass postage stamp. media, hygiene promotion in schools, Example: The Nepal Post Office and training and building local capacity Stickers Nepal Philatelic Society developed in communications, and improving Hand-shaped, water-drop-shaped, stamps and commemorative covers with networking and research. or soap-bar-shaped stickers could be provided to school children, who handwashing with soap promotional could then place them near toilets and messages. For 15 days, the postal Handwashing station handwashing stations, but also other office stamped all the incoming and places where people congregate, like bus outgoing national and international letters design competition stops, reminding people to wash hands with a promotional message of Global Competitions to design and construct with soap. Handwashing Day. affordable, useable handwashing stations could be held. There could be separate categories – for technical high school Text Messages students, for engineers and engineering Using text messages/sms as a way of firms, for art and design students, for conveying health messages can be an teachers, etc. students, for engineers effective way to reach wider audiences. and engineering firms, for art and design Example: The Government of Nepal/ students, for teachers, etc. Nepal Telecom sent a SMS message, “wash hands with soap and be healthy,” to the mobile users of five rural districts of Nepal, on Global Handwashing Day. Annex 1: How to advocate (adapted from the International Year of Sanitation advocacy kit)
Key steps and elements for What is planning advocacy activities advocacy? Effective advocacy work needs good planning. These seven questions can guide The word advocacy has its you in the development of origins in law, but its modern your advocacy plan. meaning is the process of managing information and 1. Identifying the knowledge strategically to issues: What do we change or influence policies and practices that affect the want to change? Many people wash their hands with water, lives of people (particularly but comparatively few wash their hands the disadvantaged). with soap. Our aim is to motivate people to automatically wash their hands with soap at critical moments – after using the toilet, after cleaning up a child who has defecated and before handling food.
2. Analysis: What do we already know and what knowledge can we use? To ensure credibility among your target groups, you ought to be well informed and familiar with more than just the key facts. For country and local activities, you will need specific information on your region and the special problems of people there. Local data will be most persuasive to local media and politicians. 5 39
3. Setting objectives: 5. Identifying allies: sound bites, slogans or short claims are best: “Clean hands save lives” is What are our specific Whom can we work a good example. Turn dry facts and advocacy objectives, with? statistics into easy-to-remember, clear key messages and lively stories. and how can we make Start by gathering information on potential partners. For handwashing, them SMART? existing handwashing partnerships and 7. Monitoring & As for any project or program WASH coalitions are a logical place to objectives, advocacy objectives start. Remember to reach out to less evaluation: How should be SMART: conventional groups. Approach a wide can we measure range of partners with an outline of Specific (What exactly do we want activities and events to discuss and the impact of our to happen?) agree upon their involvement and activities? support. Discuss their participation by Monitoring and evaluating advocacy Measurable (Will we know when we’ve focusing on their self-interest – as well work requires clear yardsticks with achieved it?) as supporting a good cause, many which to measure success. It is almost activities can increase their visibility in impossible to monitor or evaluate Achievable (Is it possible to achieve the community or the general public. progress with vague objectives. given our resources and time?) For example, when approaching actors in the private sector, check out their Define indicators for success (or proxy Relevant (Is it relevant to all stakeholders Corporate Social Responsibility Strategy. indicators) for all objectives during the and the real problem?) planning phase and incorporate them 6. Developing the in your advocacy plan. Indicators Time-bound (By when do we want it should be drawn up for inputs, to happen?) messages, choosing outputs, outcomes and, as much as approaches and possible, impact. 4. Identifying the selecting the tools: If no hard, quantitative data are available targets: Whom do we How can we best to measure the impact, record whatever want to influence? evidence – such as clippings – is reach our targets? available as systematically as possible. Whom are we addressing: community No end of tools can be used for good Presenting a reasoned argument for the residents, municipal authorities, NGOs, advocacy work: press kits, newsletters, likely or plausible impact, based on what local or national politicians, the corporate TV, radio and the press, drama and has been achieved to date, is often all sector, journalists? theater, artists and celebrities, the that can be done.
Internet, lobbying, project visits, Your research and analysis on your petitions, posters, leaflets, and more. Find out what impact your efforts have advocacy issue will have shown its You will usually combine several tools, had to plan for follow-up action: What specific local characteristics and the but you need first to look at a large elements contributed to your success power relationships around that issue, variety of options to find the tools with or failure? How many people did you helping you determine who has the the potentially biggest impact on your reach? Inform your partners about this. power to effect the change you wish target groups. Thanking the planning committee and to take place. The better you know and your partners can lay ground for define your targets, the better you will To develop clear messages, transform future collaboration. be able to select the most appropriate your data and information into messages advocacy tools and approaches to that your targets can relate to. Here, reach and influence them. 6
Frequently Asked Questions 6 41
What are the benefits What is the “correct” barrier to handwashing at schools; however, schools in developing countries of handwashing way to wash hands? often have neither soap nor appropriate with soap? Proper handwashing requires soap and handwashing facilities. Building Tippy only a small amount of water. Running Taps and getting help from parents’ Diarrheal diseases and pneumonia water from a tap is not needed; a small groups to supply soap or create a small together kill almost 4 million children basin of water or “Tippy Tap” is sufficient. fund for soap are good options. In under the age of five in developing (Tippy Taps are cans or plastic bottles schools, toilets and handwashing stations countries each year. Children from the that release a small amount of water – are critical to students’ health and to poorest 20 percent of households are just enough for a clean hand wash – reducing absenteeism. more than 10 times as likely to die as each time they are tipped.) One should children from the richest 20 percent of cover wet hands with soap; scrub all households. Hands are the principal surfaces of hands, including palms, back, carriers of disease-causing germs. Based Can handwashing between the fingers and especially under on scientific research and intensively the fingernails, for at least 20 seconds; monitored trials at both household make a difference rinse well with running water (rather than and school levels, it is estimated that in overcrowded, highly rinsing in still water); and dry either on handwashing with soap could avert 1 a clean cloth or by waving in the air. An million of those deaths.10 Washing hands contaminated slum easy way to gauge 20 seconds is to find with soap after using the toilet or cleaning environments? a familiar song that takes about that long a child and before handling food can Yes. A study in Karachi, Pakistan, found to sing; for instance, it takes about 20 reduce rates of diarrheal disease by nearly that children in communities that received seconds to sing the “Happy Birthday” one-half and rates of respiratory infection intensive handwashing interventions were song twice. Every country has short, by about one-quarter. Handwashing half as likely to get diarrhea or pneumonia popular children’s songs that can be can also prevent skin infections, eye than children in similar communities that used for this purpose. infections, intestinal worms, SARS, and did not receive the intervention. Avian Flu, and benefits the health of people living with HIV/AIDS. Is antibacterial soap Once people better at stopping understand the Why isn’t it enough the spread of disease to wash with water health benefits of than regular soap? handwashing, alone? With proper use, all soaps are equally Washing hands with water alone, a effective at rinsing away the germs won’t they more common practice, is significantly that cause diarrheal disease and automatically do it? less effective than washing hands with respiratory infections. No. Human beings the world over fail soap. Using soap adds to the time spent to do things they should do. If they did, washing, breaks down the grease and dirt everyone would maintain a healthy weight, that carry most germs by facilitating the no one would smoke or drink to excess rubbing and friction that dislodge them What about people and all of us would rise at dawn for an and leaves hands smelling pleasant. The who don’t have hour of cardiovascular exercise. clean smell and feeling that soap creates is an incentive for its use. access to soap? Lack of soap is not a significant barrier to handwashing at home. The vast Is lack of hand- majority of even poor households What are the have soap in their homes. Research washing with soap “critical moments” in periurban and rural areas found, for a problem only in instance, that soap was present in 95 when hands percent of households in Uganda, 97 developing countries? should be washed percent of households in Kenya and 100 percent of households in Peru. The Even in places where handwashing is a with soap? problem is that soap is rarely used for (comparatively) entrenched practice and Hands should be washed with soap handwashing. Laundry, bathing and both soap and water are plentiful, people after using the toilet or cleaning a child’s washing dishes are seen as the priorities often fail to wash their hands with soap. bottom and before handling food. for soap use. Lack of soap can be a A study in England found that people washed their hands only about half customers motivated by a diverse range support its partners’ large-scale, national the time after cleaning a child after of preferences and motivations, yields handwashing interventions and promote defecation, and a recent study of best results. replication of successful approaches doctors’ handwashing practices in the at the global level; and share scientific USA revealed that they failed to wash There is much to be learned from evidence showing handwashing with soap their hands with soap between patient successful interventions in other sectors. to be an exceptionally efficacious and visits with surprising frequency. Medical Reproductive health programs that cost-effective health intervention. The personnel, who fully understand the pay attention to consumer needs and PPPHW harnesses the marketing skills of health benefits of handwashing with preferences work better than those that industry and the capacities of the public soap, often failed to do so because of impose top-down targets, evidence sector in a program that aims to save the lack of time, rough paper towels for shows. Similarly, approaches that create lives of children. drying, inconveniently located sinks, and incentives for positive provider attitudes hands chapped by frequent washing with and behaviors get better results than drying soaps. However, handwashing those that rely on targets and punitive with soap remains very important in the management practices. Successful Whose handwashing industrialized world. A handwashing sanitation programs generate community behaviors are campaign begun in 2005 in New York City demand for toilets and latrines by public hospitals has drastically reduced appealing to people’s desires for status, the handwashing the number of serious infections, such acceptance, community solidarity, promotion programs as blood infections and pneumonia, privacy, convenience, safety and comfort; contracted by hospital patients. appeals to health tend to be significantly aiming to change? less effective in motivating behavioral In many countries, a coalition of public change. The non-health motivations can and private organizations has come be compared to the reasons people try to together to promote handwashing with How can you change lose weight; maintaining a healthy weight soap on a large scale. These partnership is very important to one’s health – but the programs seek to reduce illness and death people’s handwashing reason people go on diets is generally not due to diarrhea and pneumonia among behaviors? to be healthier but rather to look better. children under the age of five. The primary target groups of PPPHW programs are Practitioners in the water supply, mothers and other caregivers of children sanitation and hygiene sector, as well as under the age of five. Another target manufacturers of soap, have learned a group for handwashing programs is great deal about what works – and what What is the Public- school-age children, who themselves are doesn’t – in changing private, personal Private Partnership often caregivers for their younger siblings. behaviors and habits. What doesn’t work School programs can help establish is top-down, technology-led solutions for Handwashing lifelong healthy habits. or campaigns that hinge on health with Soap? education messages. What is more effective is using approaches that build PPPHW is a coalition of international on the lessons of social marketing. This handwashing stakeholders. Established Who else can take new approach emphasizes the role of in 2001, the partnership includes the careful formative research (a thorough Water and Sanitation Program, UNICEF, part in promoting study of the interests, attributes, needs the World Bank, the Academy for handwashing and motivations of different people Educational Development, the Centers within a community). It is also based on for Disease Control and Prevention, the with soap? the recognition that one size does not fit London School of Hygiene and Tropical Everyone can contribute to promoting all and evidence showing that promoting Medicine, Johns Hopkins University handwashing with soap! A good first a single message is more effective School of Public Health, the International step is to find out what individuals than promoting multiple messages. Centre for Diarrhoeal Disease Research, and organizations are already doing The new programs seek to reach and Colgate-Palmolive, Procter & Gamble, and build on that. WASH campaigns influence their target audiences through Unilever, the USAID/Hygiene Improvement – national alliances of governments, multiple mass media and interpersonal Project, and the Water Supply and parliamentarians, NGOs, media, communication channels with specific Sanitation Collaborative Council. Its aims religious leaders, community groups, messages designed to respond to their are to: reduce the incidence of diarrhea schools, private sector actors and expressed needs and preferences. In and pneumonia in poor communities other stakeholders – are active in many short, treating people not as passive through public-private partnerships countries. WASH campaigns aim to project beneficiaries, but rather as active promoting handwashing with soap; advance hygiene and sanitation goals. 7
Press Release Template 7 44
Clean hands save lives: Global Handwashing Day celebrated worldwide
Children suffer disproportionately from diarrheal diseases - with more than 3.5 million children under five dying every year from diarrhea and pneumonia-related diseases. The simple act of washing hands with soap can reduce the incidence of diarrheal rates among children under five by almost 50 per cent, and respiratory infections by nearly 25 percent.
Under the slogan “Clean hands save lives”, the driving theme for Global Handwashing Day is children and schools. Children acting as agents of change, take the good practices of hygiene learned at school back into their homes and communities. The active participation and involvement of children, along with culturally sensitive community-based interventions aim at ensuring sustained behavioral change. 8
References and Suggested Resources 8 46
References and Sample Materials for Citations and Credits: Suggested Resources Use in Schools
Luby, S., M. Agboatwalla, D. Feikin, J. Scrub Club (www.scrubclub.org) Introduction: Painter, W. Billhimer, A. Altaf, and R. M. Cover Art and Global Handwashing Day Hoekstra. 2005. “Effect of Handwashing Healthy Schools, Healthy People (HSHP). logo, Landor Associates on Child Health: A Randomized Controlled It’s a SNAP: A Cross-Curricular, School- Trial.” The Lancet, Vol. 366, July 16, Wide Education Program for Middle Peru Handwashing Girls 1, 2005. http://www.aku.edu/CHS/pdf/ Schools. Available through the HSHP photo by Nga Kim Nguyen/WSP SoapHealth_ARI_Lancet_Man.pdf website at http://www.itsasnap.org/snap/pdfs/ Section 1 Clasen, T. F., I. G. Roberts, T. Rabie, SNAP%20Toolkit%20FINAL%204.pdf. 1 UNICEF, State of the World’s W-P Schmidt, and S. Cairncross. 2006. Children 2008. “Interventions to Improve Water Quality for Preventing Diarrhoea.” Cochrane 2 Lorna Fewtrell, Kaufmann R.B., Kay Database of Systematic Reviews (2006), D., Enanoria W., Haller L., and Colford, Issue 3, Article No. CD004794. http:// J.M.C., Jr. 2005. “Water, sanitation, and www.cochrane.org/reviews/en/ab004794. hygiene interventions to reduce diarrhoea html in less developed countries: A systematic review and meta-analysis.” The Lancet Curtis, V., and S. Cairncross. 2003. Infectious Diseases, Vol. 5, Issue 1: 42- “Effect of Washing Hands With Soap 52. Also, Curtis, V. and Cairncross, S. on Diarrhoea Risk in the Community: A 2003. “Effect of washing hands with soap Systematic Review.” Lancet Infectious on diarrhoea risk in the community: A Diseases, Vol. 3, Issue 5, May 2003, pp. systematic review.” The Lancet Infectious 275-281. http://www.globalhandwashing. Diseases, Vol. 3, May 2003, pp 275-281. org/Publications/Attachments/ CurtisHandwashing.pdf 3 WELL Fact Sheet at http://www.lboro. ac.uk/well/resources/fact-sheets/fact- Ensink, J., with V. Curtis (quality sheets-htm/Handwashing.htm assurance). WELL Fact Sheet: Health Impact of Handwashing With Soap. Section 2 Accessed online at the WELL website 4 WELL Fact Sheet. (managed by the Water, Engineering and Development Centre, Loughborough 5 WELL Fact Sheet. University). http://www.lboro.ac.uk/well/resources/ 6 Lorna Fewtrell et al. fact-sheets/fact-sheets-htm/ Handwashing.htm. 7 WELL Fact Sheet.
Fewtrell, L., R. B. Kaufmann, D. Kay, W. Enanoria, L. Haller, and J. M. Colford, Jr. 2005. “Water, Sanitation, and Hygiene Interventions to Reduce Diarrhoea in Less Developed Countries: A Systematic Review and Meta-Analysis.” Lancet Infectious Diseases, Vol. 5, Issue 1, January 2005, pp. 42-52.
The Handwashing Handbook: A Guide for Developing a Hygiene Promotion Program to Increase Handwashing with Soap http://www.globalhandwashing.org/ Disclaimer:
8 S. Luby, Agboatwalla M., Feikin Little Three Girls Handwashing, The findings, interpretations, and D., Painter J., Billhimer W, Altaf A., photo from Unicef conclusions in this planner’s guide and Hoekstra R. [2004] “The effect are entirely those of the author(s) and of handwashing on child health: A Safeguard logo, should not be attributed in any manner randomised controlled trail.” The Lancet, credit Procter & Gamble to the member organizations of the Vol. 366, Issue 9481: 225-33. Global Public-Private Partnership for Hygiene Lecture photos, Handwashing with Soap (PPPHW). All F-Diagram of disease transmission credit Procter & Gamble reasonable precautions have been taken and control, source: Wagner and Lanoix. by the authors to verify the information Safeguard Reseeding Component photos, contained in this publication. However, Reduction in diarrhea morbidity, credit Procter & Gamble the member organizations of the PPPHW source: Fewtrell et al. 2005. do not guarantee the accuracy of the IDSP logo, credit Infectious Diseases data in this document and accept no Cost-effectiveness ratio chart, Society of Pakistan responsibility for any consequences of source: Jamison et al. 2006. their use. Pakistan Medical Association logo, Mother and Daughter Handwashing In credit Pakistan Medical Association Nepal, photo from Unicef Nepal Section 5 9 The UNICEF IYS Country Support Section 4 Package Ghana PPPHW Poster, credit Ghana Public-Private Partnership Section 7 to Promote Handwashing with soap 10 The Handwashing Handbook at http://esa.un.org/iys/docs/san_lib_docs/ Lifebuoy Swasthya Chetna, Handwashing_Handbook.pdf credit Unilever
Lifebuoy Logo, credit Unilever
Glow Germ demo photos, credit Unilever Little Girl Handwashing, photo from Unicef
Little Boy Handwashing, photo from Unicef www.globalhandwashingday.org June, 2009