What’sInside1 About Global Handwashing Day p. 52 Handwashing with Soap: p. 10 The Basics3 Critical Five: Five Facts Everyone p. 17 Should Know about Handwashing with Soap4 Innovative Ideas in Handwashing p. 205 Global Handwashing Day: p. 27 Get Involved6 Frequently Asked Questions p. 407 Press Release Template p. 438 References and Suggested p. 45 Resources
1 6About GlobalHandwashing DayThe practice of handwashing with soap The challenge is to transformtops the international hygiene agenda on handwashing with soap from anOctober 15, with the celebration of Globalabstract good idea into an automaticHandwashing Day. Since its inception behavior performed in homes, schools,in 2008 – which was designated as the and communities worldwide. TurningInternational Year of Sanitation by the UNhandwashing with soap before eatingGeneral Assembly – Global Handwashing and after using the toilet into an ingrainedDay has been echoing and reinforcing habit could save more lives than anythe call for improved hygiene practices single vaccine or medical intervention,worldwide. cutting deaths from diarrhea by almost half2 and deaths from acute respiratoryThe guiding vision of Global Handwashing infections by one-quarter.3 MoreDay is a local and global culture of handwashing with soap would make ahandwashing with soap. Although people significant contribution to meeting thearound the world wash their hands with Millennium Development Goal of reducingwater, very few wash their hands with deaths among children under the age ofsoap at critical moments (for example, five by two-thirds by 2015.after using the toilet, while cleaning achild, and before handling food). Global Handwashing Day will be the centerpiece of a week of activities thatHandwashing with soap is among will mobilize millions of people across fivethe most effective and inexpensive continents to wash their hands with soap.ways to prevent diarrheal diseasesand pneumonia, which together areresponsible for the majority of childdeaths. Every year, more than 3.5 millionchildren1 do not live to celebrate theirfifth birthday because of diarrhea andpneumonia. Yet, despite its lifesavingpotential, handwashing with soap isseldom practiced and not always easyto promote.
Launched by thePublic-PrivatePartnership forHandwashing withSoap (PPPHW), theannual celebration ofGlobal HandwashingDay 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 8In the long term,Global HandwashingDay can become apowerful platformfor advocacy aimedat policy makers andkey stakeholdersand an occasionfor concrete publiccommitment toactions that will spurbehavior change.
Global Handwashing Day revolvesaround schools and children. Childrensuffer disproportionately from diarrheal During Globaland respiratory diseases and deaths.But research shows that children – the Handwashing Day –andsegment of society so often the mostenergetic, enthusiastic, and open tonew ideas – can also be part of the surrounding week –the solution. Ideally situated at theintersection of the home, school, and playgrounds, classrooms,community, children can be powerfulagents of behavioral change. community centers andThe Public-Private Partnership forHandwashing with Soap (PPPHW) is a the public spaces ofcoalition of international handwashingstakeholders. Established in 2001, thepartnership includes the Water and towns and cities will beSanitation Program, UNICEF, USAID, theWorld Bank, the Academy for Educational awash with educationalDevelopment, the Centers for DiseaseControl and Prevention, the LondonSchool of Hygiene Tropical Medicine, and awareness-raisingJohns Hopkins University School ofPublic Health, the International Centre for activity as countries uniteDiarrhoeal Disease Research, Colgate-Palmolive, Procter Gamble, Unilever,the USAID/Hygiene Improvement Project, to change handwashingand the Water Supply and SanitationCollaborative Council. behavior on a scale neverThe goals of the PPPHW are to:Reduce the incidence of diarrhea and seen before.pneumonia in poor communities throughpublic-private partnerships promotinghandwashing with soap.Support its partners’ large-scale, nationalhandwashing interventions and promotereplication of successful approaches.Share scientific evidence showinghandwashing with soap to be anexceptionally efficacious and cost-effective health intervention.
Handwashingwith soap is a Handwashing withlife-saving soap is seldom done.intervention People all over the world wash their hands with water. The belief that washingwithin the with water alone to remove visible dirt is sufficient to make hands clean is commonplace in most countries. Buttechnological washing hands with water alone is significantly less effective than washing hands with soap in terms of removingand financial germs, and handwashing with soap is seldom practiced. Around the world, the observed rates of handwashing withreach of all soap at critical moments range from zero percent to 34 percent. Using soap adds to the time spent washing, breaks downcountries and the grease and dirt that carry most germs by facilitating the rubbing and friction that dislodge them and leaves hands smellingcommunities. pleasant (which creates an incentive for soap’s use). With proper use, all soaps are equally effective at rinsing away the germsBut promoting that cause disease.it requiresappeals not Tippy Taps are cans or plastic bottles that release a small amount of water— just enough for a clean hand wash—necessarily to each time they are tipped.health, but toother thingsthat people Using soap at criticalvalue, such as moments is the key to handwashing’scomfort, social benefits.status, nurture The critical moments for handwashingand a wish to with soap are after using the toilet or cleaning a child’s bottom and before handling food.avoid disgust.4
Handwashing with soapworks by interruptingthe transmission ofdisease. Hands oftenact as vectors thatcarry disease-causingpathogens from personto person, either throughdirect contact orindirectly via surfaces.When not washedwith soap, hands thathave been in contactwith human or animalfeces, bodily fluids likenasal excretions, andcontaminated foodsor water can transportbacteria, viruses andparasites to unwittinghosts,5 as shown in theF-Diagram of diseasetransmission andcontrol, below.Source: Wagnerand Lanoix. Primary Secondary Barriers Fingers Barriers Fluids Feces Food New Host Flies Fields/Floors Disease transmission Route Barriers to transmission2 12
2 13Handwashing withsoap 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 deathsanitary services were principal drivers of in children under five. A review of more than 30 studies found thatthe sharp drop in deaths from infectious handwashing with soap cuts the incidence of diarrhea by nearlydisease 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, assafe disposal of feces and the provision the pathogens come from fecal matter. These pathogens makeof adequate amounts of clean water, people ill when they enter the mouth via hands that have been inhandwashing with soap is one of the contact with feces, contaminated drinking water, unwashed rawmost effective ways to prevent diarrheal food, unwashed utensils or smears on clothes. Handwashing withdiseases; it is also the cheapest way. In soap breaks the cycle. The figure on the following page showsaddition, handwashing with soap can limit the effectiveness of handwashing with soap for reducing diarrheathe transmission of respiratory disease, morbidity in comparison to other interventions.the largest killer of children under five.And handwashing with soap is also aformidable 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 respiratoryskin 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 diarrhealmorbidity [%] per invention type0% 10% 20% 30% 40%Hand Washing with Soap 44Point-of-use 39Water TreatmentSanitation 32Hygiene Education 28Water Supply 25SourceWater 11Treatment Source: Fewtrell et al. 2005
Handwashing with 2 15soap is cost-effective.Handwashing with soap is the single-most cost-effective health intervention. Disability-adjusted life years (DALYs) are used tomeasure the burden of disease and the effectiveness of health interventions by combining information on years of life lost andyears lived with a disability. Remarkably, handwashing with soap has been shown to be the most effective way to avert DALYsassociated 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 immunizationis not essential; it is simply to point out the tremendously inexpensive life-saving opportunities being missed by the widespreadfailure to invest in handwashing promotion. Soap is already available in most households in the world; cost is not the chief barrierto 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 postAs table 1 (cost-effectiveness ratio) tothe right shows, every US$3.35 investedin handwashing programs yields one Water sector regulation 47DALY; gaining that same year through and advocacylatrine promotion would cost US$11.00;through household water connection, Latrine promotion 11.15more than US$200.00. Source: Jamisonet al. 2006. Hygiene promotion 3.35 (including hand washing)
2 16Effective promotion Public-privaterequires understanding partnerships helpbehaviors and take behavior changemotivations for change. efforts to scale.There is ample evidence that health Partnerships among national and localconsiderations 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 soappromote handwashing – top-down, manufacturers can be extremely effectivehealth-focused campaigns that raise in promoting handwashing with soap.the specter of disease and death – have They combine the health objectives ofhad little success in changing people’s the public sector, the marketing expertisebehavior, research shows. Formative of the private sector and often theresearch – a thorough study of the Different communities value and are community knowledge of NGOs to createfactors that may influence different motivated by different things; there is a more far-reaching and beneficialpeople within a community to wash their no “one size fits all” handwashing impact than any of the three couldhands (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, suggestsby knowing what people do now, that people want clean hands forwhat they value and which benefits of reasons of comfort, to remove smells,handwashing with soap appeal to them to demonstrate love for children and tocan 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.
3CriticalFive:Five Facts Everyone Should Know aboutHandwashing with Soap
1Washing hands with water alone is not enough!Washing hands with water alone, a common practice around theworld, 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 carrymost germs, facilitating the rubbing and friction that dislodge themand leaving hands smelling pleasant. The clean smell and feeling thatsoap creates are incentives for its use. With proper use, all soaps areequally effective at rinsing away disease-causing germs.2Handwashing with soap can prevent diseases that kill millionsof children every year.Handwashing with soap is among the most effective ways to preventdiarrheal diseases and pneumonia, which together are responsible forthe majority of child deaths. Every year, more than 3.5 million childrendo not live to celebrate their fifth birthday because of diarrhea andpneumonia. Handwashing can also prevent skin infections, eyeinfections, intestinal worms, SARS and Avian Flu, and benefits thehealth of people living with HIV/AIDS. Handwashing is effective inpreventing the spread of disease even in overcrowded, highlycontaminated slum environments, research shows.3The critical moments for handwashing with soap are afterusing the toilet or cleaning a child and before handling food.Hands should be washed with soap after using the toilet, aftercleaning a child’s bottom (or any other contact with human excreta,including that of babies and children) and before any contact withfood. Hands are the principal carriers of disease-causing germs.It is important to ensure that people have a way to wash theirhands at these critical moments. Simple, low-cost solutions likeTippy Taps are within the financial and technological reach of eventhe poorest communities.
4Handwashing with soap is the single most cost-effectivehealth intervention.Handwashing promotion is cost-effective when compared withother frequently funded health interventions. A $3.35 investment inhandwashing brings the same health benefits as an $11.00 investmentin latrine construction, a $200.00 investment in household watersupply, and an investment of thousands of dollars in immunization.Investments in the promotion of handwashing with soap can alsomaximize the health benefits of investments in water supply andsanitation infrastructure and reduce health risks when families do nothave access to basic sanitation and water supply services. Cost is nottypically a barrier to handwashing promotion; almost all households inthe world already have soap – though it is commonly used for laundry,dishwashing, and bathing rather than for handwashing.5Children can be agents of changeWhen it comes down to sharing good hygiene practices, children – thesegment of society so often the most energetic, enthusiastic and opento new ideas – can act as agents of change by taking the “handwashinglessons” learned at school back into their homes and communities.The active participation and involvement of children – ideally situatedat the intersection of the home, school, and community – can ensuresustained behavioral change when combined with culturally sensitivecommunity-based interventions. Global Handwashing Day aimsat motivating children to embrace and share proper handwashingpractices, and place them as “handwashing ambassadors” at the heartof each country’s national and local initiatives.
4 21Public-private partnership topromote handwashing in GhanaWhat was new about Background mass media, direct consumer contact and In Ghana, diarrhea accounts for 25 a district-level program through schools,the program? percent of all deaths in children under health centers and communities. TheThe Ghana handwashing program made five and is among the top three reported communication strategy also included acontamination visible to the ordinary causes of morbidity. Children under five public relations and advocacy componentGhanaian for the first time, effectively typically have three to five episodes that targeted policy makers and opinioncommunicating a hygiene message using of diarrhea and a similar number of leaders and promoted the provision ofcommercial marketing techniques. 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 PR campaign: A public relations program LessonsStrategy Achievements targeted at opinion leaders and strategic A major lesson from the GhanaMass media: The program employed targets delivered continued press and program was that when partners fromstate-of-the-art marketing strategies. The media coverage in support of the aims different backgrounds and sectors areguiding concept for this phase of work of the handwashing program. A number not accustomed to working together,was “your hands are only truly clean of radio and television discussion establishing common grounds and trustif washed with soap.” Two radio and programs and interviews were held takes time and effort.two TV advertisements suggested that throughout the country on national mediathere was “something on your hands,” and district-specific FM radio stations. Another important take-home lesson wassuggesting an unknown menace, an An advocacy brochure that outlined that the public and private sector canunseen contamination that only soap the strategy for the initiative was also work together for the public good. Whencould remove. Three advertisements produced and distributed to strategic there is transparency, the strengths of(two on radio and one on TV) targeted targets and partners. each are recognized and each member ismothers and caregivers, while anotheradvertisement on TV targeted children. treated as an equal in the partnership. Evaluation results: An evaluation reportedThe radio and television commercials that handwashing with soap rates forwere supported by posters and mothers after six months of the campaignbillboards sited in all 110 district and were over 80 percent.10 regional capitals of the country, andthe distribution of promotional items like Exposure: Exposure to all campaignbadges, T-shirts, branded poly bags, and materials was also high, with almostsoap. The radio and TV advertisements everyone aware of and able to sing theran for six months, with particularly campaign theme song, and with moreintense activity in the first three months of than 80 percent of children and adultsthe campaign. reporting more handwashing with soap since the campaign.Direct to consumer contact: Underthe Direct Consumer Contact (DCC) The Ghana handwashing program forProgramme, an event management firm the first time made contamination visiblevisited two districts per region in six to the ordinary Ghanaian and was ableregions and conducted 128 high-impact to communicate a hygiene message inevents in schools to reach 103,313 an innovative manner along the lines ofschool children, 2,930 teachers, 926 commercial marketing.food vendors and 132 events in healthcenters and communities for 11,500mothers. DCC is used as an interpersonalcommunication strategy that providesinformation on handwashing with soapin an innovative and interactive, face-to-face manner. This direct contact allowsconsumers to ask questions and converseabout handwashing with soap, whichfacilitates behavior change.
Lifebuoy Swasthya Chetna 4 23What was new about the Backgroundprogram? The Lifebuoy Swasthya Chetna (“HealthThe program used a powerful yet simple Awakening”) program began in 2002demonstration tool – the glow germ demo as a rural health and hygiene educationkit – to make visible the germs on hands initiative in India. The project wasthat look clean, but were not washed designed to spread awareness about thewith 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 knowpresence of germs and the importance Diwas – Health Dayof using soap to remove them.Key project activities: Communicating the Key factors to success ofLifebuoy 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 ishandwashing 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 bothmessage of the campaign is: and into their communities. Children are awareness of hygiene moments and also excellent communicators if they find effective behavior changes. ImprovementsVisibly 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 inThe communication Swasthya Chetna message are adapted achieving its goals.tasks were to: according to the specific audience, andEstablish the presence of germs schools have proven excellent entry Cost-effectiveness of the program – costeven on clean-looking hands, using a points into communities. The element of per village is approximately £50 for thesimple but extremely powerful, low-cost Swasthya Chetna that involves children three exposures, including implementationdemonstration 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, songsfor 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 whatare only truly clean if washed with soap. the brand does in India, and the operating company (Hindustan Unilever Limited) hasEstablish the consequences of these invested more than US$5 million.hidden germs on hands.
4 24Children as agents of change:lessons from UNICEFWhat is new about the BackgroundUNICEF approach? Children have historically had few if anyUNICEF recognizes the potential of roles in school decision making, let alonechildren as agents of handwashing in community-based programming inbehavior change by coupling water hygiene and sanitation. UNICEF worksand sanitation improvements in toward making schools healthier andschools with hygiene education. more attractive to children, especiallyThe use of environmental health girls, through school-based water,clubs, drama groups and student sanitation and hygiene programs. Guidingfocus groups creates the conditions this approach is the knowledge thatfor children themselves to be agents healthier children are more effectiveof change in their schools, families learners, and girls who spend less timeand 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 lessonThe following UNICEF country programs or eating and after using the toilet. The UNICEF’s experience in promotingillustrate the impact children are having students’ work of improving the health handwashing with soap in schools as parton improving handwashing with of their community goes beyond their of a larger water, sanitation and hygienesoap 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 participantsNigeria. Efforts in Nigeria to change (Clean Friday), a national movement, with real project responsibilities ratherthe classroom environment are child- begun in 1994, that encourages hygiene than as passive targets of healthcentered, including forming children’s promotion, particularly handwashing messages. Combining handwashing withhygiene and child rights clubs, training with soap, during meetings on Islam’s soap promotion with hands-on schoolteachers in life skills education, involving holy day. The little doctors are becoming improvements also creates in the childrenparents and encouraging village leaders, learning to communicate a sense of ownership that makes newartisans to participate in hygiene and clearly and effectively, solve problems, behaviors more likely to stick.sanitation projects. One school initiated negotiate and analyze. “People lovean Environmental Health Club, where drama, and parents especially love tostudents promote handwashing with see their children perform,” said one ofsoap in both the school and the the supervising teachers. “It is far morecommunity and advocate for secure effective than telling people directly tohousehold water supplies to continue change the way they do things.”hygienic behavior at home. With thehelp of a teacher, the 12 girls and 18 Malawi. An approach in Malawi honorsboys who make up the club operate and the right of children to participate in amaintain the facilities and keep track of process of developing and institutingthe borehole’s usage. The club funds its national standards for sanitationactivities by selling plastic buckets and facilities and hygiene promotion inclay pots fitted with taps. Two years after primary schools. National review teamsthe project’s inception, handwashing interviewed children on what they likedamong children increased by 95 percent. and disliked about their sanitation facilitiesTeachers reported that students came and hygiene education programs. Theto school clean and had fewer cases of children spoke candidly and perceptivelyringworm and other skin diseases. In of the changes needed, and their insightsaddition, school attendance grew are being used to modify the technicalsteadily each year, from 320 pupils when designs and approach to health behaviorthe program was initiated to 538 in 2001. change. The children proved keen advocates for better sanitation andIndonesia. A primary school project child-friendly health education. Comiccalled “Dokter kecil,” or little doctors, books based on their feedback havedevelops school clubs, consisting of 30 already been designed for grades fivestudents from grades four to six, that to eight. This approach and the insightspromote hygiene through community derived are being seen more activelytheater and other lively, interactive as having potential applications foractivities. The children put on school programming improvements in nutrition,plays for their parents and other education, health and other areas.community members that conveylessons on the importance of washing
Safeguard Pakistan 4 26School EducationProgram empoweringchildren with hygieneeducation:What’s new about The Safeguard schoolthis program? program hasThe Safeguard School Program two components:connects with kids in a language that 1. Execution: The objective of thethey understand. This program execution component is to spread and Partnership with Public Sector Healthleverages the animated character reinforce health and hygiene messages Organizations to make a differenceCommander Safeguard as the among children across Pakistan in a Health and hygiene programs arecommunication vehicle to make the memorable and engaging manner. A carried out in collaboration with theoverall hygiene message relevant, typical school program day consists of PMA, the largest body of doctors acrossmemorable and engaging for school Safeguard’s team of qualified doctors Pakistan, and the IDSP, which is workingchildren. Commander Safeguard visiting schools, where they conduct to create awareness about infectiouscommunicates with children in a way hygiene tutorial sessions. In these disease prevention in Pakistan. Thesethat is novel and exciting. tutorials, children are taught about credentialing partners help Safeguard 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 a handwashing demo. This hygiene Achievements 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. covered more than 10,000 schools in 100Background cities of Pakistan.The Safeguard School Program promotes 2. Reseeding component: The objectiveshandwashing awareness and brings of the reseeding component are toabout habit change at the grassroots Key lesson ensure that health and hygiene learninglevel in Pakistan by becoming an ally in Using a memorable, engaging and continues long after the Safeguard teamempowering children with health and child-friendly vehicle – Commander has completed its health tutorial and tohygiene education. The program has Safeguard – to spread and reinforce help schools institutionalize this learningits roots in the Karachi Soap Health health and hygiene messages is far more through activities like “Health Days.” AStudy (2002) led by the Centers for effective with children than standard Health Day is the celebration of health andDisease Control, HOPE, and Procter health lessons. hygiene organized and led by the schoolsGamble. The study showed that regular Private Sector companies like Procter themselves. Schools have celebratedhandwashing with soap can reduce the Gamble bring unique consumer Health Days in various ways, amongincidence 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 communitymessage of handwashing becomes a innovative ways to influence hand wash cleanliness drives – all organized aroundmessage for survival. behavior change. the theme of health and hygiene.
The drivingtheme for GlobalHandwashing Dayis handwashing inschools.Therefore, a keytarget audienceis children,positioned as the Global Handwashing Day planners’ chiefagents of change. task is to introduce the concept and establish credibility at the global and lo- cal levels. A solid, scaleable frameworkYou can join Global needs to be created that can be built on in future years. Other recognition days have been established for decades; high-profileHandwashing recognition cannot (and will not) come overnight. In order to differentiate Global Handwashing Day from other big-budgetDay celebrations recognition days, Global Handwashing 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 Globalby organizing Handwashing Day activities. In addition, attached as Annex 1 is a briefactivities guide to advocacy in general, which was prepared for the International Year of Sanitation. It provides guidance on theto motivate general principles of issue-based advocacy.children to washhands with soap.
5 29Institutional The Goal for Globalarrangements Handwashing Dayand the globalcontext for GlobalHandwashing DayThe 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 framedEach participating country can have one as a joint global effort to get as manyor more “lead” agencies, chosen based To obtain additional materials and keep schools and schoolchildren to washon convening capacity, which will take up-to-date on Global Handwashing Day their hands with soap on October 15 asnational responsibility for driving the activities, planners are encouraged to visit possible. This will drive headlines andGlobal Handwashing Day on the ground the official Global Handwashing Day web coverage and provide journalists an entryand leading the coalition of organizations site at: www.globalhandwashingday.org point to talk about Global Handwashinginvolved. 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 publicizeshould 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 thedays and national holidays should be globally, how many countries/schools/ target is a realistic stretch – a numberencouraged. Depending upon its human students were involved; quotes from key sufficiently large to attract attention, butand 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 theGlobal Handwashing Day activities and an even bigger and better day in the year facts about the specific handwashingcarrying out local PR and communications to come. situation in that country.aligned with the global strategy and visualidentity guidelines. Lead institutions are At the global level, the goal is to have,also responsible for capturing learnings, year by year, an increasing numberusing a template evaluation scorecard of countries participating in Globalprovided by and collated centrally, to Handwashing Day. The higher the numbermeasure the success of the day. The of participating countries, the better thesuccess of the day should be measured chances of having more children washing their hands with soap.
5 30Compiling data Thus, welland developing in advancekey 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 andthe world as a whole. But journalists, compile stories – stories of how poorly morbidity fromdecision makers and regular people are equipped schools are for handwashing,most interested in knowing about the for instance, but also hopeful stories diarrhea and pneumoniaspecifics 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 handwashingGlobal Handwashing Day is to compile doesn’t motivate people to action – they behavior studies that haverelevant national and, to the degree need to see something concrete that ispossible, state, municipal and local data. already working to inspire them. been doneThe kind of data that will help you Findings of any studies ofmake your case includes mortality and handwashing and sanitationmorbidity statistics for children underfive from diarrhea and pneumonia. If any facilities in schoolsstudies have been done on handwashingbehaviors in your country, the key findings Real-life stories of goodabout the prevalence of handwashing practices in your countrywith soap are useful. Also helpful willbe any data on handwashing or otherhygiene programs, infrastructure or Photographs of good andhabits in schools. It is important to draw bad practices in schoolsa distinction between handwashing and elsewherewith water alone – which is commonlypracticed – and handwashing with soap,which is, in general, comparatively Pre-taped radio interviewsinfrequent. Even a brief observational and quotesstudy showing how many people arewashing their hands with soap after usingthe toilet will make the topic come to life; Charts and other infographicsit is effective to highlight the handwashing that newspapers can justbehaviors of people from all strata of drop into their stories onsociety, 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 Journalistskey messages. For instance, you may Handwashing Day will increasingly be are the way to get your Globalfind that 60 percent of people wash their members of the general public. However, Handwashing Day story andhands with water – and think that doing given that the task is to introduce messages out. Providing ready-madeso is sufficient – but only 10 percent wash and reinforce the very idea of Global information they can use will increasetheir hands with soap. Thus, your key Handwashing Day, journalists, decision the likelihood that they will writemessage may center around the idea that makers, and other opinion leaders are about Global Handwashing Day andwater alone is not enough – you need to important targets. stress the messages that you think arewash with soap for truly clean hands – most important.possibly evoking disgust at all the germsthat are found on the hands. You may Political decision makersfind that in a specific school, parents built are key to bringing handwashing behaviorhandwashing 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 andtheir children healthy. Again, positive “we governments, as well as ministers andcan do it” sorts of messages are more officials with responsibility for education,motivating than a recap of the death- infrastructure, health, finance, socialand-disease statistics (though these are affairs and foreign affairs, all need toimportant 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 32Secondary targets(over time, some of thesegroups may become the focusof Global Handwashing Day):The general public Academicsmust become more aware of the who research topics relevant tobenefits of handwashing with soap in handwashing with soap, including waterorder to foster behavior change at the supply and sanitation topics, shouldnecessary scale. be encouraged to publish research findings in popular media, as wellCommunity and as opinion pieces supporting Global Handwashing Day.women’s groupsare essential allies in seeking tochange hygiene practices. Close to the Celebritiespeople, they can be a good partner for Global Handwashing Day plannersunderstanding current handwashing should consider recruiting popularbehaviors and rolling out campaigns. culture celebrities from music, sports, film and television to help carry Global Handwashing Day messages. To getBusiness people them to agree to do this, these starsshould be encouraged to understand must be convinced that handwashingthe potential commercial benefits of with soap is an issue worthy of theira nation of people using soap instead of time and attention.just water to wash their hands.They should also be encouraged tolend their marketing expertise to thispublic health goal.Religious leadersgreatly influence public opinion in manycommunities and should be encouragedto help inform their congregations of thebenefits of handwashing with soap.
Tailoring your message to the listener:Not everyone is persuaded by the same lineof reasoning. An important guidepost canbe to search for the “what’s in it for me?”for different groups. Handwashing with soapmay appeal to the public health communitybecause it cuts down on diarrheal disease; Politiciansit may appeal to mothers because it is a way Treating diarrhea and pneumonia consumes a large proportion of theto show that they care about their families; it health budget; handwashing can cut themay 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 mayappeal to the Minister of Finance because Handwashing promotion is cost-effective when compared with other frequentlyit is an extremely cost-effective health funded health interventions. A US$3.35intervention. Making the health argument to investment in handwashing brings the same health benefits as a US$11school children or the nurturing argument to investment in latrine construction, athe Minister of Finance might not be terribly US$200 investment in household water supply and an investment of thousandseffective in changing behaviors or prioritizing of dollars in immunization.investment in hygiene promotion. The Investments in health, education andfollowing gives examples of arguments that improved water supply are imperiled bymight be effective with different audiences. the lack of handwashing with soap.
5 34Journalists Health community Businesses Many people do not realize that Handwashing with soap is among Marketing soap for handwashinghandwashing with water alone is the most effective ways to prevent (and generating demand) cannot sufficient to make them clean. diarrheal diseases and pneumonia, increase your business.The information on handwashing which together are responsible for thebenefits and prevalence is an majority of child deaths. Every year, Doing research into the motivationsunderreported 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 canKey newsmakers (sports stars, infections, eye infections, intestinal improve your corporate image.business leaders, top politicians or worms, SARS and Avian Flu, andfirst ladies, for example) are getting benefits the health of people living withbehind Global Handwashing Day. HIV/AIDS. Handwashing is effective in Teachers 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’tIt is cool and fun to wash your hands To nurture your child properly, you mustwith soap! wash your hands at critical moments. currently use soap to wash their hands Yucky germs from poop are everywhere, To raise your child properly, you must People are motivated by differentbut they are too small to see. Washing teach him or her to handwash with soap messages. Health appeals are lesshands with soap makes the germs at critical moments. effective, in general, than appeals togo away! disgust, to the wish to be attractive, The feces of babies and children are to the desire to nurture one’s familyYou can be like a teacher in your family full of disease-causing germs; it is not and the wish to be like others whoabout handwashing with soap. benign, as many parents think. wash their hands. Diarrhea is not a normal condition; it isNGOs an illness that is making your child lessUnderstanding motivations for and able to grow, learn and thrive.barriers to handwashing with soapis the first step toward promotingbehavior change; you are well Community orplaced to understand what motivatesyour constituencies. traditional leaders You can make a difference in your community by organizing handwashingDiarrheal epidemics can jeopardize programs for all members and leadingprojects and undo years of work; the charge to set up handwashinghealthy 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 36Suggestions for National ActivitiesThere are many waysto celebrate GlobalHandwashing Day.The following providessome suggestions andglobal examples ofGlobal Handwashing Launch event School behavior- A half-day kickoff to either the day itself orDay activities. the week of activities, with public figures, change competitions 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 acoordination group media contest soliciting print, electronic, and debates on handwashing and hygieneRevitalization of an existing group or are a great way to get the handwashing and broadcast media submissions onforming a new coordination group message out. Involve school children water supply, sanitation, and hygieneresponsible for Global Handwashing Day and teachers! issues from journalists in developingactivities. This might include a group of countries. The initiative aims to encouragerepresentatives from different stakeholdergroups (government, NGO, industry, broader media coverage of those issues. Photo contest Locally, such a contest might delve further A national photo contest of images ofcommunity) who might gather to plan into issues of importance in your country people handwashing with soap is anotheractivities for Global Handwashing Day. as well as engage the public more on the good awareness-raising technique. FocusLink in, if possible to WASH campaigns issue of handwashing.. on schools and children.– national alliances of governments,parliamentarians, NGOs, media,religious leaders, community groups, Soap wrapper prize Corporate sponsorship schools, private sector actors, and other Leveraging resources by approaching Having a local soap company insertstakeholders that are active in many local soap companies as well as hotels, winning tickets that can be redeemedcountries. WASH campaigns aim to restaurants, and other firms to sponsor for a prize on Global Handwashingraise the commitment of political and Global Handwashing Day activities. Day. Build anticipation toward Globalsocial leaders to achieving hygiene Handwashing Day with handwashingand 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 specialvarious information and communication hygiene hardware for schools. national Global Handwashing Daychannels, using traditional and mass postage stamp.media, hygiene promotion in schools,training and building local capacity Stickers Example: The Nepal Post Office and Hand-shaped, water-drop-shaped, Nepal Philatelic Society developedin communications, and improving or soap-bar-shaped stickers could stamps and commemorative covers withnetworking and research. be provided to school children, who handwashing with soap promotional could then place them near toilets and messages. For 15 days, the postal office stamped all the incoming andHandwashing station handwashing stations, but also other places where people congregate, like bus outgoing national and international lettersdesign competition stops, reminding people to wash hands with a promotional message of GlobalCompetitions to design and construct with soap. Handwashing Day.affordable, useable handwashing stationscould be held. There could be separatecategories – for technical high school Text Messages students, for engineers and engineering Using text messages/sms as a way offirms, for art and design students, for conveying health messages can be anteachers, 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 theInternational Yearof Sanitationadvocacy kit) What is Key steps and elements for 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 change or influence policies issues: What do we 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.
5 393. Setting objectives: 5. Identifying allies: sound bites, slogans or short claims are best: “Clean hands save lives” isWhat are our specific Whom can we work a good example. Turn dry facts andadvocacy 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 toobjectives, advocacy objectives start. Remember to reach out to less evaluation: Howshould be SMART: conventional groups. Approach a wide can we measure range of partners with an outline ofSpecific (What exactly do we want activities and events to discuss and the impact of ourto happen?) agree upon their involvement and activities? support. Discuss their participation by Monitoring and evaluating advocacyMeasurable (Will we know when we’ve focusing on their self-interest – as well work requires clear yardsticks withachieved it?) as supporting a good cause, many which to measure success. It is almost activities can increase their visibility in impossible to monitor or evaluateAchievable (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 proxyRelevant (Is it relevant to all stakeholders Corporate Social Responsibility Strategy. indicators) for all objectives during theand the real problem?) planning phase and incorporate themTime-bound (By when do we want it 6. Developing the in your advocacy plan. Indicators 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 availabletargets: Whom do we How can we best to measure the impact, record whateverwant to influence? reach our targets? evidence – such as clippings – is available as systematically as possible.Whom are we addressing: community No end of tools can be used for good Presenting a reasoned argument for theresidents, municipal authorities, NGOs, advocacy work: press kits, newsletters, likely or plausible impact, based on whatlocal or national politicians, the corporate TV, radio and the press, drama and has been achieved to date, is often allsector, 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 haveadvocacy issue will have shown its You will usually combine several tools, had to plan for follow-up action: Whatspecific local characteristics and the but you need first to look at a large elements contributed to your successpower relationships around that issue, variety of options to find the tools with or failure? How many people did youhelping 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 andto take place. The better you know and your partners can lay ground fordefine 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 messagesadvocacy tools and approaches to that your targets can relate to. Here,reach and influence them.