It is evident that hygiene is one of the most cost-effective public health interventions through which health and economic benefits can be maximized, saving millions of lives every year. Hand washing with soap is recognized as one such highly cost-effective public health intervention. A body of research has shown that hand washing with soap at critical times alone can reduce diarrhoea by up to 35%.
Effective hygiene promotion programming at scale is essential in improving behaviours: preventing diseases, maintaining health, and improving the full benefits of water and sanitation programs. Behaviour change is also essential to creating sustainable services and maximizing the public health impact of investments in water and sanitation. Without hygiene behaviour change, toilets might not be used, water could still be contaminated, food will continue to be also contaminated, and dignity will be compromised.
At Dig Deep (Africa) we have been implementing hygiene promotion programs over the last four years and, in our WASH projects, behaviour change plays a central role for we believe that “ Taps and toilets don’t improve health and education, only using them effectively does”‘
Our approach has been through investing in WASH champions who are trained as Trainer of Trainers (ToTs). These include selected teachers from target schools and community health volunteers from the villages where the schools are located. They are then tasked to create awareness and disseminate the hygiene messages to children at their respective schools.
Training of WASH champions
The ToTs are taken through a three day intensive training to build their capacity on the key WASH practices including water hygiene and safety, latrine use and maintenance and hand washing with soap. The training methodology is mainly facilitatory which enables participants analyse their own WASH situations and come up with actionable solutions.
Promotion of hand washing among children
The education program is then rolled out in each of the target schools where the WASH champions train their peers and children on good hygiene practices. On hand washing, pupils are taught not only why hand washing with soap/ash is important but are also shown how to wash hands properly including the critical times to do so. The children do role plays and learn songs on hand washing so that behaviour is normalized. Within the community, children act as change agents, teaching their families about hand washing and other good hygiene practices.
Enabling technologies for hand washing with soap
Demonstrating good hygiene practices as part of daily routines, and sustaining this behavior, requires innovation, creativity and novel approaches. Different schools have devised their own innovative ways to promote hand washing among the children. One of these is installation of leaky tins, made of locally available materials at strategic places within the school including next to latrines, kitchen area and classrooms. These form as a reminder to wash hands and also a convenient and a fun way to wash especially for children hence increasing the rates of hand washing.
Soap is more effective than using water alone because the soap lifts the germs from skin and scrubbing hands more thoroughly when using soap further removes germs. One of the key constraints of hand washing in most rural communities and schools is the affordability of soap. Additionally, theft and wastage are barriers to keeping soap at a hand washing station hindering regular hand washing. To solve these, the schools innovated solutions to counter; these include putting up local soap dispensers.
Reinforcing of messages
When an individual receives a consistent message through multiple channels it reinforces social norms around the behaviour. Similarly on hand washing, messages are reinforced through posters and talking walls within the schools hence improving on the practice.
Adoption of these good hygiene practices including washing hands with soap/ash at critical times will lead to less risk of disease which in turn will result in stepped up school attendance and ultimately country’s economic growth.