Hand washing with soap (HWWS) is promoted as a primary target behaviour or secondary behaviour of larger sanitation and hygiene programming. In this article, we share campaigns informed by a behaviour change hub approach, a collaboration between Upward Spiral and SNV in Lao PDR, Mozambique, Bhutan, and Indonesia.
HWWS as primary WASH behaviour
Engaging with the hub, the SNV in Lao PDR team selected HWWS (hand washing with soap) as the target behaviour to promote. During the design process and as part of peer learning, the team drew upon learnings from SNV in Bhutan that had previously worked on HWWS; as well as the SuperAmma intervention in India, which used the Behaviour Centred Design framework developed by London School of Hygiene and Tropical Medicine. The framework uses emotional motives (disgust, nurture, affiliation) to change behaviours rather than improving people’s knowledge of germ transmission.
- Evoking disgust for the invisible dirt: The intervention used a combination of storytelling and a demonstration, to make the invisible dirt visible, and thereby evoke disgust.
- Engaging parents for the nurture motive: The research in Lao PDR validated that parents understand how teaching good habits to children leads to progress in life, and hand washing with soap could be included as one of these important habits. To evoke the nurture motive, the team adapted the illustrated Bhutan story into a film. Below, a cartoon developed in 2018 by SNV's Bhutan team.
- Setting up hand washing stations: During the formative research, we observed that households did not have a proper hand washing station. We promoted the importance of a hand washing station through a game and a behaviour trial film. The film showcases how access to a proper hand washing station prompts and facilitates hand washing with soap behaviour.
The intervention is being rolled out in 45 villages (15 villages/district) in Atsaphone, Phalanxay, and Champhone districts of the Savannakhet Province, and is supported by the Australian government’s Water for Women Fund.
HWWS as secondary WASH or COVID prevention behaviour
SNV in Mozambique, Bhutan, and Indonesia took the opportunity to promote hand washing with soap behaviour as part of larger sanitation programmes in latrine construction, safe child faeces management, and COVID-19 interventions, respectively.
Mozambique’s concept of a 5-star latrine: As part of Mozambique’s Namiruku campaign, the concept of a 5-star latrine was introduced. Each star represented an important feature of a 5-star improved latrine, with one star dedicated to the presence of a hand washing station. Communication about hand washing stations were integrated in the communication materials, such as latrine catalogue and films.
The campaign is supported by UK aid from the UK government and is being rolled out in two districts of Mozambique’s Zambezia province.
A 5-star toilet illustration by Mozambique's Namiruku campaign
Bhutan’s safe child faeces management advocacy: Hand washing with soap is a common hygiene denominator for the safe management of child faeces, irrespective of the material or facility used, e.g., cloth nappies, disposable diapers, potties, etc. Because contact with faeces cannot be avoided, hand washing with soap is critical to keep children healthy and safe for the Beyond the Finish Line-SSH4A in Bhutan project supported by the Australian government’s Water for Women Fund.
Management of cloth nappies, Bhutan
The intervention is being delivered through a hybrid of interpersonal and digital touchpoints. It starts with an interpersonal session at the primary healthcare centre where motive story, routine leaflets and interaction cards are presented. During this session the health assistant forms a group chat of caregivers in WeChat, Facebook Messenger, or Telegram. In the group chat, the health assistant shares videos and digital slides on safe child faeces management, including HWWS. Caregivers are encouraged to ask questions and share photographs of their practices.
The intervention is being rolled out in Bhutan’s Dagana district, together with Ministry of Health.
Indonesia and Mozambique’s COVID-19 hygiene promotion: As part of the HBCC programme supported by Unilever and UK aid of the UK government, hand washing with soap was promoted as one of three core behaviours to prevent COVID transmission in public markets, schools and healthcare centres.
Hand washing with soap promotion as a key COVID preventative measure
In the public markets, a 5-star safety rating concept was introduced, with each star signifying the presence of infrastructure/tools (e.g., hand wash station at the entrance) and performance of the behaviour (e.g., customers washing hands with soap before entering). Markets were supported in achieving 5-stars and better performers were recognised and rewarded. Monitoring data showed improved ratings in hand washing infrastructure and behaviours, in both countries.
Apart from the HBCC campaign, all other initiatives are in implementation, pending a Behaviour Change Hub evaluation in 2023. Learnings from the evaluation will be used to strengthen and adjust, as needed, Upward Spiral’s Behaviour Change Hub methods, ensuring that the hub’s clients evolve as partners in its continued development.
Authors: Upward Spiral and SNV